Report: Advancing the Home Care Workforce

and home care workers benefit from the training and mentorship, as well as the social status of inherent in integrated models. We believe that all three of these structural issues could be addressed if home care and home health care services became part of an integrated health care system. Ideally, the organization hosting the pilot would form part of an Accountable Care Organization (ACO). ACOs are allowed to keep a portion of cost savings over time and are rewarded for improved health outcomes and include dual eligible who wish to sign up. Given the current funding streams from Medicare and Medicaid, as well as the private market, and given the growing demand for such services, the expansion would be relatively low risk. Health systems would benefit from regular reimbursement streams for these services, in addition to the saved savings and rewards they could generate. Workers would use satellite clinics as a hub to reduce travel time and to decentralized services without reducing integration. Aims: The aim would be to increase home care services in rural areas by using existing satellite clinics as hubs, thereby growing the number of clients and creating economies of scale that allow for workforce development, workforce support services such as transportation, advanced roles, and integration with the clinical teams, and increased wages. 5. Pilot advanced roles with one home care agency in a closed rural setting with one payer. Rationale : The evidence base continues to be weak for the ROI on advanced roles for home care agencies. Studies that do exist are unable to control for contextual factors, and they do not evaluate the effects of component parts of different programs. This makes it difficult to use the evidence to persuade other employers to experiment with advanced roles. Aims: The aimwould be to conduct a pilot in a relatively controlled (closed) rural setting, with one large agency and one large payer, in order to limit confounding factors. Based on the results, a second phase could be developed to disseminate results and provide technical assistance (see the recommendation to create guides below) to other home care agencies that are open to experimenting with advanced roles campaign. 7.3. Products 6. Training Apps Rationale: While experts we interviewed insisted that adult learning is most effective using face-to-face small group sessions, COVID-19 has brought with it new distance, on-demand technologies that may be changing the landscape of learning opportunities. In addition to more traditional online courses, there are also interactive decision support learning apps such as Human Diagnostics, 92 as well as apps that are intended to be motivational such as Walking

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