By Jenna Hughes
As the U.S. population ages, at-home care is emerging as a cornerstone of post-acute recovery, improving outcomes while reducing costs.
The aging population is rapidly transforming the U.S. healthcare system, driving sustained growth in care services that support recovery and long-term care after hospitalization.
As the demand for long-term care continues to increase, new care delivery models have been introduced to support greater quality and efficiency of patient care. In the at-home care sector specifically, value-based care models focus on providing high-quality care to allow patients to manage chronic conditions outside of inpatient healthcare facilities in the comfort of their own home.
Hillary Loeffler, Vice President of Policy and Regulatory Affairs at the National Alliance for Care at Home – an organization of more than 1,500 members representing about 10,000 different locations of home health agencies, hospices, palliative care providers, home and community-based service providers across the nation – said that patients may rely on home-based care for a variety of reasons.
“There are situations where home health and community-based care is needed to prevent somebody from going to the hospital in the first place,” said Loeffler. “There are also times when home health is used for post-acute care following a hospitalization, skilled nursing facility stay, or a surgical procedure to help an individual regain function, support recovery and ultimately transition safely back to the home.” For individuals living with chronic or complex conditions at home, home health can also help maintain stability, support independence and prevent an individual from being hospitalized.
At-home care, versus inpatient post-acute care, has the potential to reduce the overall cost of care while enhancing patient experience. An essential goal of value-based care at home is to ensure that care teams do everything possible to reduce the need for costly rehospitalizations and improve patient health outcomes.
“Value-based care improves patient care by asking: How well is a home health agency doing at keeping somebody out of the hospital, or keeping somebody from having to go to the emergency department? What was the patient’s function before, and how did we help them improve in their function by the time of discharge? These are key measures for someone who’s at-home care is focused on rehabilitation,” said Loeffler.
“There are also patients that have conditions such as dementia and Alzheimer’s that are being taken care of at home, and they have different care needs than somebody that’s coming from, say, a knee replacement,” said Loeffler. “Quality measures are going to differ based on the patient population and the goals of care. We believe that home-based care is well positioned to support value-based care efforts.”
The transition to at-home care
Home health agencies’ relationships with acute care facilities are a key part of patient-focused care – ensuring patient satisfaction and improved outcomes within the at-home care space.
The transition from an institutional setting to the home is a critical point in time when a patient is at an increased risk of relapse. In these instances, a smooth handoff to the home and home health agency is vital.
“Home health agencies must start caring for the patient as soon as possible following acute care stays. Having a great relationship, coordination and interaction with acute care facilities is necessary to make sure that these agencies can get the patient settled, stabilized and starting their course of treatment in a very timely manner,” said Loeffler. “This coordinated care assures that patients feel supported in their recovery and reduces the need for patients to return to the hospital.”
While home care plays a major role in patient transitions from the hospital to home, about half of all home care cases begin in the community, without hospitalization.
“These cases tend to be disease management and often serve patients with declining cognitive ability and mobility,” said Alex Hartzman, Vice President, Research Analytics, National Alliance for Care at Home and Head of Operations, Research Institute for Home Care.
The earlier patients can access skilled care in the home the better the experience for both the patient and our health care system. One example is hospice, where patients and their families benefit from receiving care sooner.
“Current barriers to timely access include individuals and their families accepting a possible transition to hospice care, and also doctors making timely and appropriate referrals,” said Hartzman. “However, we know that when patients are able to take advantage of the hospice benefit, they receive high-quality care, report satisfaction with that care, and are able to remain in their preferred setting – at home.”
Evolving models of care
As the need for post-acute care rises among patients, the U.S. healthcare system must continue adapting its delivery models and strategies to accommodate more individuals with complex care needs.
“As the post-acute care landscape has evolved alongside heightened demand, we see new technologies and payment models emerging. The Home Health Value-Based Purchasing Model, which adjusts Medicare payments based on agency performance on certain quality measures, represents one example as an effort to drive positive outcomes at lower costs, though its design continues to evolve,” said Hartzman.
Other government payment models, through the Centers for Medicare and Medicaid Services (CMS), also aim to improve how post-acute care is delivered. The CMS Innovation Center develops and tests healthcare payment and service delivery models in the acute and post-acute sectors to improve patient care, lower costs, and align payment systems.
“About 10 years ago, the Innovation Center introduced their first mandatory model, which means facilities were mandated to participate,” said Loeffler. “This joint replacement model was aimed at people getting knee and joint surgeries and holding hospitals accountable for the total cost of care, not only for just the surgery, but also a patient’s post-acute care following surgery.”
It is often more costly for patients to go to a skilled nursing facility or inpatient rehabilitation facility following these types of joint and knee surgeries than it is to be cared for at home.
“This introductory model started the process of hospitals engaging more with home-care communities and home health agencies,” said Loeffler.
CMS has also introduced similar care structures, such as the Bundled Payments for Care Improvement (BPCI) Model, which has had several variations, all with the goal of trying to steer people to the most effective setting for their post-acute care.
Currently operating, said Loeffler, is the CMS Team Model – where for certain surgical procedures, patients are encouraged to go to the most appropriate setting of care for their needs, which is often home health. The model also provides greater incentives for people to remain at home and be treated at home for lower overall costs.
“The newest model that touches on our patient population, coming from the innovation center side, is the LEAD (Long-term Enhanced ACO Design) Model, an Accountable Care Organization (ACO) driven model. This entity of the government is responsible for total cost of healthcare,” said Loeffler.
LEAD utilizes improved benchmarking to appeal to a broader mix of health care providers, including those with specialized patient populations.
“This model holds a lot of promise, because one of their goals is for ACOs to partner with preferred entities to make sure homebound individuals, seriously ill and chronically ill individuals, and those at the end-of-life are receiving the right care at the right time, with the goal of better quality care and lower cost overall for the Medicare program,” said Loeffler.
Changing post-acute landscape
With demographic projections showing a tripling of the 85 and older age group by 2060, a radical new approach to post-acute healthcare delivery models is more necessary than ever.
“For all of those who care for people with serious chronic illness or the aging population, a top concern driving change is the question of who will continue to provide the care,” said Hartzman.
The aging population is changing everything in the post-acute care sector – from Medicare and Medicaid financing to emergency room capacity, workforce shortages and more.
“On average, caregivers are spending 26% of their personal income on caregiving,” said Hartzman. “We know continuing to care for the aging population is a major crisis that demands both regulatory and policy changes.”
About half of Medicare beneficiaries currently receive care through the traditional or original Medicare Fee for Service Program. The remaining half of patients are enrolled in private insurance plans known as Medicare Advantage.
“The value-based landscape is a little different based on whether you’re talking about the original Medicare population or those that are enrolled in these private Medicare Advantage plans that manage Medicare Part A and B benefits,” said Loeffler. “We think there’s a lot of promise in keeping people at home, keeping patients where they want to receive care and aging in place, and value-based arrangements or models coming from the government could really help in this space and keep patients where they want to be for their care – at home with their families.”
Going forward, an increasing number of people will be relying on Medicare, and our post-acute care infrastructure is already feeling the strain. According to Loeffler, as the amount of people in the 65 and older population increases and post-acute care facilities begin to reach their capacity, the ability for patients to be cared for at home will become even more important.
“With this in mind, as an industry, we must focus on what we can do now to help people stay in their homes for care as long as possible,” said Loeffler. “We must build stronger momentum to support policies that keep people at home, because the nursing home is absolutely an appropriate place for patients, depending on their situation – but if you can avoid a patient going to the nursing home in the first place, that’s always better.”
Home care itself has expanded most under Medicaid Home- and Community-Based Services (HCBS) programs, according to Hartzman. HCBS has reached new patient populations and helped to reduce the use of institutional settings.
“These programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing. HCBS are often designed to enable people to stay in their homes, rather than moving to a facility for care,” said Hartzman. “These government programs have enabled a large swath of Americans to remain in their homes and have supported countless families navigating complex circumstances.”
“Because of these healthcare delivery models and government programs, the focus on helping people remain in their homes and age in place is growing,” said Loeffler. “Value-based care arrangements are naturally expanding into this space. We’re on the cusp of a shift and are reaching a point in time where providers will really prioritize and promote the home as a care setting and develop more creative ways to make sure people can stay at home for care.”
Key Takeaways
- Aging America, Growing Need: Post-acute care demand is soaring as the 65+ population expands.
- Care at Home Wins: Home-based services reduce costs, prevent rehospitalizations, and support patient independence.
- Smooth Transitions Matter: Coordinated handoffs from hospitals to home health agencies improve recovery and satisfaction.
- Value-Based Models Lead the Way: CMS programs like HHVBP, BPCI, and LEAD reward high-quality, efficient care.
- Aging in Place: Medicaid HCBS programs and innovative delivery models help Americans stay in their homes longer.