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I was working in home Health back when it was first introduced back in 2010, as a way for c m s to not only create structured penalties for hospitals with excessive readmissions, but also to reward and incentivize those providers for effective carecoordination and collaboration with post-acute providers across the care continuum.
So, basically, with a stepped care model, the goal is to tailor care delivery to the patient’s needs while at the same time utilizing less clinician resources. How it works is that all patients will have access or encounters with the specialty trained clinician, a psychologist, a socialworker, a palliative care clinician.
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