Skip to main content

Home health care demands call for process advances

Staff, Appian
November 20, 2014

Business process management tools enable organizations in any industry to keep up with operational changes created through technological innovation. Investing in solutions that drive process improvements is becoming more important than ever in the home health care segment, where a growing number of patients and an increased focus on e-health and even mobile health initiatives call for procedural and technological innovation.

According to a recent InformationWeek report, fraud has become a major problem as home health care providers try to deal with a growing quantity of patients who are either sick or disabled and choosing to receive care in their homes. The Institute of Medicine estimates that approximately $75 billion is lost annually through fraud and abuse in the health care industry. At this point, home health providers are increasingly turning to technology to solve their mounting fraud problems.

Understanding the home health care fraud problem

The news source explained that many of the fraud problems in the home health care sector stem from physicians behaving illegally. A few prominent cases have emerged in recent years in which doctors have received large payments from Medicare and similar entities to support their efforts to care for patients in the home. However, closer scrutiny revealed that some of those patients either didn't need the treatments or home care they were being charged for. In many situations, physicians were not even making home visits, but still claiming payment from insurance companies and similar organizations.

BPM tools can support critical innovation in home health care.

These types of fraud problems pose a major threat in the industry, but can be fought with the right technological investments. Electronic visit verification technologies are emerging as part of the solution to fraud issues, but the solution will not always be enough to get the job done.Marvin Javallana, chief operating officer at Better Care Home Health, told the news source that investing in new technology isn't just about verifying proper operations, it also comes down to needing to operate at peak efficiency as Medicare reimbursements decline and home health providers need to operate more effectively.

BPM, health care and process optimization

One of the best ways to improve operational efficiency among a distributed workforce is to ensure users have access to collaboration, communication and process management tools regardless of where they are working or which device they are using. BPM tools can give users a process hub that lets them perform key operations at home on a computer, in the office or with a mobile device. The result is an operational climate that is easier to manage and helps ensure users work at peak efficiency, something that is increasingly important in health care.