In New York, Home Care Workers Are Key to Value-Based Payment

Due largely to the increasingly expensive nature of health care in America, policymakers and industry leaders have long searched for ways to reduce medical costs while improving care quality and population health—referred to in this sector as the “triple aim.” With the mounting health care and economic costs associated with the COVID-19 pandemic, it has become more important than ever to strengthen the quality of our health care system while minimizing costs.

One relatively recent approach to achieve this triple aim has been value-based payment, where health care providers are paid based on the value of their services rather than the volume. Our analysis over the years on New York State has shown that it has led the way in implementing value-based payment in home care – largely by better leveraging the essential role of home care workers in this sector.

Building on the findings of PHI’s 2019 case study, which showed that value-based payment holds the potential for improving home care job quality, in 2020, PHI interviewed seven Medicaid-funded home care agencies and four training experts (known as “Workforce Investment Organizations,” or “WIOs”) in New York City about their progress and ongoing challenges in leveraging home care workers to achieve value-based payment goals. Additionally, the interviews explored the impact that COVID-19 and recent state budget pressures have had on value-based payment in New York.

Interviewees shared progress and opportunities across four areas: training, data, care-related communication, and evolving worker roles—described in detail in our new case study. They also shared that while COVID-19 and budget pressures have stunted value-based payment initiatives, these two factors have not completely halted these initiatives—among many other findings.

Based on these interviews, PHI identified three main considerations for policymakers in New York and other states who are navigating or exploring value-based payment approaches in this sector:

• Home care workers are essential to realizing value-based payment goals. Since they provide the majority of paid, hands-on care to home care clients, home care workers are able to spot changes in condition and identify care needs that help improve quality of care and achieve value-based payment goals.
• Planning time and sustainable funding are necessary to spur progress on the implementation of value-based payment initiatives. Transforming the home care system through value-based payment requires considerable investments of time and long-term funding to enable home care agencies and others to design, implement, and evaluate new strategies for achieving value-based payment goals.
• All types of collaboration are vital for achieving value-based payment goals. Collaboration allows stakeholders to work together to better provide quality care. For example, close partnerships between a home care worker and the rest of the care team help proactively address client care needs. As another example, the partnership among training experts, home care agencies, and managed care plans can lead to more successful training interventions.

Read the full case study.