In this twice-monthly newsletter, you will find policy developments, research, and updates on how health care organizations are striving to shift more health care delivery into the home – meeting patient needs where they are and expanding access to quality health care.
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Moving Health Home Update
Moving Health Home: 2022 Year-in-Review (12/12) - Since its launch in March 2021, Moving Health Home (MHH) has made significant progress in accomplishing our founding goals, including:
Breaking down federal and state legal barriers to care in the home;
Educating policymakers about new clinical models involving the home;
Advocating for new payment models that focus on risk-sharing and incentives for in home care and population health management;
Engaging incumbent fee-for-service providers about ways to maximize their services in patients’ homes; and
Producing and present research and evidence on care in the home.
We appreciate the engagement of our members in helping us drive this meaningful work forward. Read a summary of our top activities and accomplishments in 2022 in support of these goals.
Medicare Payment Advisory Commission (MedPAC): Assessing Payment Adequacy and Updating Payments: Home Health Care Services (12/9) - By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. For the March 2023 Report to the Congress, MedPAC recommended to cut the base payment rates for both home health and hospice agencies in calendar year (CY) 2024. The Commission’s draft recommendation to the Centers for Medicare & Medicaid Services (CMS) would cut the home health base rate by 7 percent and the hospice aggregate by 20 percent. For additional coverage, see McKnights Home Care.
House of Representatives: Introduction to the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (12/6) - On December 5, Reps. Joyce (R-PA), O’Halleran (D-AZ), Panetta (D-CA), and Dunn (R-FL) introduced the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (H.R. 9427), which would permanently extend certain in-home cardiopulmonary rehabilitation flexibilities established in response to COVID-19. The bill would permanently allow patients to continue receiving in home cardiac and pulmonary rehabilitation services via telehealth under Medicare.
McKnights Home Care: Providers Tell Congress to Put the Breaks on PAYGO (12/6) - The National Association of Home Care & Hospice and the National Hospice and Palliative Care Organization recently urged Washington lawmakers to prevent the statutory Pay-As-You-Go sequestration cuts to Medicare from taking effect at the end of this congressional session. In a letter to House and Senate leaders, NAHC, NHPCO and five other provider groups said failure to waive PAYGO would result in $38 billion in cuts to Medicare next year, which would have a devastating and destabilizing impact on health care access. Home health also is contending with a $635 million cut scheduled to take effect in 2023 related to the final Medicare home health rule.
White House: Biden Administration Announces COVID-19 Winter Preparedness Plan (12/15) - The Biden Administration announced a plan to stay ahead of an increase in COVID-19 cases this winter. The Administration’s COVID-19 Winter Preparedness Plan includes expanding easy access to free at-home COVID-19 tests and at-home administration of vaccines and free home delivery of treatments, among others. Additionally, HHS will work with states to launch teams and use partner with their Quality Improvement Organizations (QIOs), home health agencies, and Emergency Medical Technicians to deliver vaccines to residents of long-term care facilities.
Centers for Medicare and Medicaid Services (CMS): Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program Proposed Rule (12/14) - CMS issued a proposed rule that proposes revisions to regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the Elderly (PACE). CMS also proposes requiring MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits.
Rosalynn Carter Institute for Caregivers: National Family Caregiver Strategy Must do Better (12/5) - The Rosalynn Carter Institute for Caregivers urged the Department of Health and Human Services to put more funding and structural support behind its National Strategy to Support Family Caregivers under the RAISE Family Caregiver Act. RCI praised the Biden administration in a letter to HHS Secretary Xavier Becerra for providing “long overdue visibility on federal commitments” to family caregivers. However, RCI also said the Administration for Community Living (ACL), which will administer the program, needs better funding and authority to “fully realize and compel the promise” of the strategy.
Research and Polling
Home Health Care News: Home Health Spending Flat As Health Care Utilization Rebounds (12/14) - Spending on home health care stayed mostly flat in 2021, a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) reveals. The steady spending on home health care last year came despite a sharp dip in government funding tied to the public health emergency (PHE). The decrease in PHE-related funding was generally offset by a rebounding of health care utilization across the board.
National Hospice and Palliative Care Organization (NHPCO) Diversity Advisory Council (DAC): Hospice Hesitancy Persists Among Racial and Gender Groups (12/13) - According to NHPCO study, Black and Latino adults are less likely than whites to be aware that hospice is a benefit under Medicare. Also, many LGTBQ adults doubt hospice would respect their sexuality. NHPCO recommends that Black and Hispanic caregivers should be advised early on of the hospice benefits offered by Medicare, as well as the typical costs of hospice for those with Medicaid or private insurance. Ensure understanding that hospice is an at-home option that is covered by their benefits. Clearly explain how the Medicare hospice benefit works. This can be on the hospice organization’s website and printed collateral. For additional coverage, see McKnights Home Care.
Current Health: The State of Care at Home: Trends, Challenges and Opportunities for Evolving Care Models (12/13) - Care-at-home programs present one opportunity to address many of the ongoing challenges health systems are facing, while also improving experiences for patients and providers. In September 2022, Current Health surveyed more than 100 primarily C-suite hospital and health system leaders in the United States, examining the evolving market and use cases for care at home. The survey focused on the opportunities and needs driving care at home, the value leaders see from these programs, and the challenges to scaling care-at-home experiences. For additional coverage, see Forbes, Home Health Care News, Chief Healthcare Executive, and MedCity News.
Home Health Care News: Survey Highlights ‘Frustrating’ Care Navigation Process In US (12/12) - Nearly one in four U.S. adults aged 50 and above said that they or a loved one needed long-term care over the past year, according to a survey commissioned by Nexus Insights. Specifically, the survey highlighted that more than half of these adults said that selecting long-term care options caused anxiety and frustration. The survey also included 69 percent of these older adults saying it was extremely important to them to learn additional information about the cost of care and options to pay for it. A note of importance for home-based care providers was also that 63 percent wanted to know more about the different types of long-term care services available.
Integrated Home Care Services: Are Health Plans Prepared for Home Care’s Rapid Ascent? (12/6) - According to a poll by home care benefits administrator Integrated Home Care Services, 91 percent of executives said demand for home care has increased over the past five years. Medicare Advantage (MA) plans represented the largest number of plans utilizing home care in the poll, with about a fifth of them stating approximately 40 percent of their members use home care benefits. For additional coverage, see McKnights Home Care.
KLAS Research: Home-Based Post–Acute Care 2022 (12/5) - The home care market has surged as health care organizations have sought to maintain quality patient care throughout the pandemic and fulfill requirements for value-based reimbursement. Organizations are looking to expand their home care offerings; however, the pandemic has exacerbated staffing shortages and decreased bandwidth, making operations—let alone growth—difficult. To help organizations understand how peers are approaching the current environment, KLAS interviewed 88 leaders from home-based care organizations regarding the top challenges they face and the technology vendors they use or have considered investing in to address these challenges. For additional coverage, see HIT Consultant.
Skilled Nursing News: Home Health Services Added 6,600 Workers (12/4) - Home health services added 6,600 workers last month, and community care facilities for the elderly added 5,300 workers. “The monthly gain paints an image of a still growing, but slowing, labor market,” Beth Mace, chief economist at the National Investment Center for Seniors Housing & Care (NIC), wrote in a Friday blog post on the latest jobs data from the Bureau of Labor Statistics (BLS). With tight labor markets driving wage growth and fueling inflation, the Federal Reserve might be inclined to continue ratcheting up interest rates.
News and Market Developments
Home Health Care News: SCAN Group Set To Combine With CareOregon To Form ‘HealthRight Group’ (12/14) - The SCAN Group and CareOregon announced that they have entered an agreement to combine under the name HealthRight Group. Together, they will become a mission-driven, nonprofit health care organization. After the deal is closed, HealthRight will also launch a diversified business unit that will be comprised of the assets from both organizations. That will be very focused on home-based care delivery.
Herald-Whig: SIU Center for Family Medicine Recognized for Home-Based Health Care Services (12/14) - SIU Center for Family Medicine has been awarded recognition by the National Committee for Quality Assurance Patient-Centered Medical Home Program. The NCQA Patient-Centered Medical Home program reflects the input of the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and American Osteopathic Association (AOA) and others. It was developed to assess whether clinician practices are functioning as medical homes and recognize them for these efforts. The NCQA Patient-Centered Medical Home standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement.
Fierce Healthcare: Robot Bringing Companionship to Seniors ElliQ (12/14) - ElliQ, a voice-operated care companion for the elderly, is getting an update with 2.0 hardware and software including a companion app for family members and caregivers. The robot, called the first proactive AI care companion and a Time Best Invention of 2022, was developed to address the loneliness epidemic in older adults and has shown the ability to decrease loneliness by 80 percent. With ElliQ’s new companion app, family members, friends, caregivers, case managers or home health aids can connect with loved ones through ElliQ’s tablet. Loved ones can conduct video calls, send texts, images, video messages and set reminders.
Home Health Care News: How Large Health Systems Are Integrating Home-Based Senior Care (12/12) - Hospital systems are now making a greater effort to collaborate with senior care providers – including those in home-based care – to elevate care delivery. Key players in this larger move to work more closely with senior care providers, or to integrate that care directly, are Kaiser Permanente and Trinity Health. While home-based care always played a role in care delivery at Kaiser Permanente — one of the largest health systems and health plans in the U.S. — last year the company leaned in further by building a designated Care at Home arm. Kaiser Permanente’s Care at Home services line includes home health care, home-based palliative care, hospice care, hospital at home, lab at home, a virtual nursing center, DME and medical transportation services.
Healthcare Finance: Blue Shield of California Partnering with DispatchHealth on In-Home Care (12/12) - Blue Shield of California revealed a partnership with DispatchHealth, a company that provides in-home, same-day health care from medical professionals who treat more than 40 health conditions, including respiratory infections, pneumonia and chronic obstructive pulmonary disease (COPD). With the collaboration, members now have access inside their own homes to additional medical care services for a range of illnesses and injuries.
Insider Intelligence: Digital Health Trends to Watch for 2023 (12/12) - Insurers and retailers are now buying home health companies to expand into in-home care. Remote patient monitoring (RPM) and at-home diagnostic tests are helping to boost these efforts. Up to $265 billion in care services for traditional Medicare and Medicare Advantage (MA) beneficiaries could migrate from traditional facilities to the home by 2025, per McKinsey & Company.
McKnights Senior Living: Potential National Provider Directory Draws Support (12/12) - Long-term care provider groups generally support a potential National Directory of Healthcare Providers and Services — with some caveats, according to comments recently provided to Centers for Medicare & Medicaid Services. Nicole Fallon, LeadingAge vice president of health policy and integrated services and director of the association’s Center for Managed Care Solutions and Innovations, said that the need for a national directory is important for providers of long-term care supports and services, home- and community-based services, post-acute care services and home health. The effort would ease efforts related to data reporting and maintenance, streamline processes and reduce the cost of resources to keep up with federal and state data requirements, as well as those from Medicare and Medicaid managed care organizations.
Modern Healthcare: What Policies Three CEOs Say They Want to Drive Health Innovation (12/12) - An increasing number of health systems are seeking to shift care delivery to home and outpatient care. But regulatory and policy changes are necessary to help enable those changes—and to address ongoing challenges facing the industry, including reimbursement and surprise billing. In the second part of a two-part series, Modern Healthcare asked the CEOs of Nashville, Tennessee-based Ardent Health Services; Marlton, New Jersey-based Virtua Health; and Rapid City, South Dakota-based Monument Health to share their policy wish lists and plans for spending on projects beyond brick-and-mortar facilities.
McKnights Home Care: Industry Seeks Delay of Home Health Cut in Funding Bill (12/12) - Home care providers are pushing for an end-of-the-year government funding package to include legislation that would postpone the 2023 home health cut of 3.925 percent for one year and require the Centers for Medicare & Medicaid Services (CMS) to offer transparency in its rate setting going forward. “All eyes at this point are on the funding package to fund the government through the remainder of the fiscal year,” Calvin McDaniel, director of government affairs for the National Association for Home Care & Hospice, said in a NAHC congressional advocacy webinar.
Home Health Care News: Amid Shift To Value, Providers Caution Against Telehealth (12/9) - In order to stay ahead of the needs of consumers and payers, post-acute care leaders — including those in home-based care — are looking to innovate how care and services are delivered to seniors. Michael Bailey, CEO of American Health Partners, believes that the current reimbursement market isn’t designed to incentivize home-based care on a continual basis. With this in mind, he stressed the importance of working with payer partners.
Home Health Care News: How ConnectRN is Assisting Home Health Providers Solve The Staffing Shortage (12/8) - The marketplace for home health providers has become more complex as providers not only have to find and serve patients, but find and convince clinicians to work for them. To do that, staffing companies like connectRN are helping home health providers navigate these new challenges. What started as a platform built to find nurses and other health care professionals work, particularly in skilled nursing facilities (SNFs), has now grown into a much larger platform with a vested interest in home-based care.
Forbes: How Remote Primary Care Can Close the Home Health Care Delivery Gap (12/8) - Virtual care has made strides toward public adoption, accelerated by COVID-19 when remote care suddenly became an attractive, and sometimes the only, option for receiving care in the most convenient, desirable location – the home. But while virtual care technology exists and is widely known, there is a major delivery gap between how virtual health care is being deployed and utilized in the home and how it should be used to help health care organizations meet their goals of reducing the cost of care while delivering the best possible care for patients. Health plans and providers should look for solutions that enable them to facilitate comparable care to in-person care.
Home Health Care News: What Makes Home Health Provider-Payer Relationships Work (12/7) - Amid the ongoing shift toward value-based care — and away from fee-for-service payment models — providers in senior care are still navigating in the dark, especially when it comes to working with payers and other third-party stakeholders. LHC Group, like Amedisys Inc., Enhabit Inc. and other top home health players, are trying to turn these relationships into ones that are worthwhile from a financial perspective. Perhaps no entity has a better perspective on this than Helion, the somewhat new home- and community-based services division of Highmark Health. Highmark is a payer-provider hybrid, and Helion has created a network of home health providers in value-based arrangements with it.
McKnights Home Care: Home Health Rule Could Continue to Negatively Affect Dealmaking (12/6) - Continued uncertainty over Medicare’s final home health rule could tie up deals in the segment for months, according to Enhabit Home Health & Hospice executives. Legislation delaying a $635 million in behavioral health cut in 2023 is now before Congress and garnering wide bipartisan support, Enhabit CEO Barbara Jacobsmeyer told investors during a Bank of America Home Care Conference. Although Enhabit completed the acquisition last week of Southwest Florida Home Care in Ft. Meyers, the executives said they are now primarily focused on hospice, as opposed to home health acquisitions.
Managed Healthcare Executive: As Home-Based Supplemental Benefits Explode, Health Plans Embrace Digital Tools to Improve Access to Services (12/5) - Medicare Advantage (MA) is on track to become a major payer for nonmedical home-based benefits. As care continues to move into the home and community, the trend toward benefits that address social determinants of health (SDOH) will continue. The payer industry is acknowledging what home care providers have long known: It is possible to reduce costs and improve the quality of care by offering wraparound non-medical benefits such as transportation, durable medical equipment, nutrition services and in-home support. As more in-home care benefits are offered, the importance of making sure those services are easily accessible will become a measure of quality — and Star ratings. When done right, investing in the technology to manage and coordinate supplemental services can lead to more healthy days at home, higher member satisfaction and, ultimately, higher rates of retention.
Home Health Care News: As Costs Of Private-Pay Services Rise, 24 Hour Home Care Acquires Medicaid-Based Home Care Provider (12/5) - 24 Hour Home Care has acquired the New Mexico-based home care company Inteli-Care, which will allow the former to broaden the types of patients it can care for. 24 Hour Home Care is a mission-driven organization that wants to serve as many people as possible in the home. Acquiring Inteli-Care – which focuses on the Medicaid population in New Mexico – will allow it to do so. The Los Angeles-based 24 Hour Home Care offers home care and intellectual and developmental disability (IDD) services across California and Arizona. Inteli-Care will allow 24 Hour Home Care to serve patients in yet another state, adding 500 clients to its overall network.
State AARP: Family Caregivers Need Support (12/5) - In Michigan and across the country, AARP is fighting to support family caregivers and the loved ones they care for. Every day, 1.32 million Michiganders help their parents, spouses, siblings, grandparents, neighbors, and other loved ones to live independently at home – where they want to be. At the federal level and here in Michigan, AARP will continue fighting to make providing care easier for family caregivers through better access to resources; training, education and inclusion in care; and more support at home among others.
BizJournals: In-Home Care Startup HelloCare Elevates Caregiver Support (12/5) - HelloCare, an in-home care service, is for those who need extra help or medical care but want to remain in their homes. Clients range from young people experiencing illness to seniors who want to age in place. A key element of HelloCare is taking care of its care givers, including certified nursing assistants and unlicensed workers. HelloCare looks to elevate care giving, which is typically an undervalued role in the economy.Patients can pay directly or through long term care insurance, VA insurance or Providence ElderPlace. Medicare does not pay for in-home care.
American Medical Association (AMA): Providing Hospital Level Care at Home (12/5) - In this AMA Update, Narayana Murali, MD, system chief medical officer of medicine services at Geisinger Health, discusses providing hospital level care in patients' homes. Dr. Murali is also chair of the AMA’s Integrated Physician Practice Section (IPPS).
Practice Advisor: How To Advise Clients on Long-Term Care Options (12/4) - Home is where most people want to be, especially since the pandemic began, but home health care can also cost well over $100,000 per year. Relatively few people may have a plan to protect their savings from the cost of an extended illness or degenerative conditions such as Parkinson’s Disease or dementia. With a plan in place, patients are better able to preserve their assets, standard of living and independence.
Inside Telehealth: Hospital At Home Telehealth Waiver Expected In Year-End Package (12/2) - Acute hospital care at home telehealth flexibilities are likely to make it into the expected year-end bill, according to three telehealth lobbyists, as lawmakers reach the final stretch of negotiations over what health riders to tuck into the massive funding package. The Democratic-led Senate Finance Committee is leading the charge to include the hospital at home telehealth provision, according to lobbyists. There is extra urgency for hospital at home waivers to make it into the year-end bill because the flexibilities were not in the 151-day post-PHE extension of other telehealth waivers.