Elevating Home Health and Home Care Workers to Advance Value Based Care

As care delivery continues to shift from institutional settings into the home, the home-based care workforce has become both more essential and more strained. Persistent workforce shortages, high turnover, and a value proposition that remains underrecognized in a largely fee-for-service reimbursement environment continue to challenge the sector. Yet home care workers occupy a vantage point that no other member of the care team can replicate: frequent, sustained in-home contact that enables them to identify subtle changes in a patient's condition before those changes escalate into avoidable emergency department visits, hospitalizations, or other adverse outcomes.

This paper presents findings from a six-month study of home care workers in New York City that tested the use of a modified early-warning tool, Stop and Watch Plus, to help workers identify changes in patient status and communicate those changes to the broader care team. The findings offer an early look at both the promise of integrating home care workers into care coordination and early detection workflows, and the operational challenges that must be addressed to sustain that integration. Strengthening workflow integration, clarifying escalation pathways, increasing employer engagement, and aligning payment incentives will be particularly critical as value-based care models focused on home care continue to evolve.

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