May 3, 2024

Welcome to the Moving Health Home newsletter!

In this 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.

Please send any news or events to rcheung@movinghealthhome.org for future inclusion in this newsletter.

Moving Health Home Updates

Fierce Healthcare: Food and Drug Administration Spends $1.2 Million to Spur Development of At-Home Care Devices (4/25) - The Food and Drug Administration (FDA) launched an initiative to promote at-home medical device development with a focus on health equity in at-home care. Lessons from the Home as a Health Care Hub could inform future regulation in the space and technology used in hospital-at-home programs. Though the FDA's lessons are nearly a decade and a half in the making, Krista Drobac, executive director of Moving Health Home, said the FDA is likely trying to further understand the extent of the use of at-home medical devices and software, which have rapidly evolved in recent years.

Moving Health Home: Hospital at Home Regulatory & Policy Summit (4/16-4/17) - Moving Health Home participated at the Hospital @ Home Regulatory & Policy Summit on April 16-17, 2024. Krista Drobac, Executive Director led a panel discussion with MHH members and a second discussion with members from the Administration on care in the home.

Administration

White House: A Proclamation on Older Americans Month, 2024 (4/30) - The White House released a proclamation on Older Americans Month. Agencies are observing Older Americans Month by highlighting aging trends, promoting resources that help older adults, and sharing facts about older adults' well-being. 

Food and Drug Administration (FDA): FDA Launches Health Care at Home Initiative to Help Advance Health Equity (4/23) - FDA launched its Home as a Health Care Hub initiative, which would reimagine the home environment as an integral part of the health care system, with the goal of advancing health equity for all people in the U.S. While many care options are currently attempting to use the home as a virtual clinical site, very few have considered the structural and critical elements of the home that will be required to absorb this transference of care.Moreover, devices intended for use in the home tend to be designed to operate in isolation rather than as part of an integrated, holistic environment. As a result, patients may have to use several disparate medical devices, some never intended for the home environment, rather than interact with medical-grade, consumer-designed, customizable technologies that seamlessly integrate into an individual person's lifestyle.

Centers for Medicare & Medicaid Services (CMS): Independence at Home Demonstration Year Eight Evaluation Report (2/23) - The Independence at Home (IAH) demonstration posted its year eight evaluation report. IAH is a Congressionally mandated test of whether a payment incentive for providing home-based primary care reduces health care spending and improves the quality of care for high-cost, high-need fee-for-service Medicare beneficiaries. Participating home-based primary care practices can earn incentive payments if their beneficiaries’ Medicare spending is less than a given spending target and if they meet the standards for selected quality measures.

Congress

House of Representatives: Introduction of the Improving Access to Home Dialysis Act (4/18) - Reps. Miller (R-WV), Strickland (D-WA), Miller-Meeks (R-IA), and Blumenauer (D-OR) introduced the Improving Access to Home Dialysis Act (H.R. 8075). The bill would provide for Medicare coverage of staff-assisted home dialysis for certain hemodialysis and peritoneal dialysis patients and to ensure all patients are educated on modality options and receive the resources, information, and support to succeed on the modality of their choice. See the National Kidney Foundation statement here. 

Senate Finance Committee: Bolstering Chronic Care through Medicare Physician Payment Hearing (4/11) - Senate Finance Committee Chair Wyden (D-OR) mentioned support and the need for care in the home: "In my view, the challenge before the Finance Committee is to improve the way Medicare pays for services delivered in the doctor’s office, or at home, so there is a laser focus on managing those chronic conditions that are dominating the health of seniors."

Research and Polling

Health Affairs: The Acute Hospital Care At Home Waiver And The Future Of Hospital At Home In The US (5/3) - Despite this robust evidence base, adoption of HaH in the US was stymied by the lack of payment in fee-for-service Medicare and among commercial payers. This changed with the Acute Hospital Care at Home (AHCaH) waiver promulgated by CMS in November 2020, in response to COVID-19-related hospital capacity issues. The temporary nature of the waiver creates uncertainty and perpetuates these barriers. Fully addressing common agency will require a multiyear waiver extension or permanent payment mechanism for HaH in fee-for-service Medicare and would operate on several levels. It would incentivize other payers to overcome the inertia to enter the HaH market, creating a wide-ranging multipayer environment for HaH. This is critical.

The Journal of Post-Acute and Long-Term Care Medicine (JAMDA): Patients Enrolled in Home-Based Primary Care (5/1) - Home based primary care (HBPC) has unique advantages for medically complex patients seeking access to primary care. While increasing patient access to care, it simultaneously decreases unnecessary care utilization. Virginia at Home (VaH), a HBPC program with a strong outpatient referral base, offers the opportunity to examine patients who are referred from the ambulatory setting.

JAMA Health Forum: Preferences for Postacute Care at Home vs Facilities (4/26) - Two in 5 US hospital stays result in rehabilitative postacute care, typically through skilled nursing facilities (SNFs) or home health agencies (HHAs). However, a lack of clear guidelines and understanding of patient and caregiver preferences make it challenging to promote high-value patient-centered care. The results of this survey study underscore a prevailing preference for home-based postacute care. As with all health care, ensuring equitable support and improved quality measure tools are crucial for promoting patient-centric postacute care, with emphasis on addressing the needs of marginalized groups.

American Journal of Medical Quality: Bypassing the Brick-and-Mortar Hospital: Direct Admissions from the Emergency Department to Inpatient Hospital-at-Home (4/24) - Home hospital programs continue to grow across the United States. The article describes how an interdisciplinary team used quality improvement methodology to significantly increase the number of admissions directly from the emergency department to the Advanced Care at Home program.

Mass General Brigham: Remote Care Approach Improved Therapy Adherence and Uptake in Patients with Type 2 Diabetes (4/7) - A Mass General Brigham study found earlier and greater uptake of medication when a remote care team delivered simultaneous education and medication management compared to a period of education before medication management. The platform is part of Mass General Brigham’s larger efforts to transform health care delivery by helping patients access services and monitor health from home, especially at a time when hospitals are regularly operating over capacity. Results were presented at the 2024 American College of Cardiology’s Annual Scientific Session and simultaneously published in Circulation.

Journal of Palliative Medicine: Interventions for Family Caregivers of Patients Receiving Palliative/Hospice Care at Home: A Scoping Review (1/5) - There is a need for understanding the breadth of interventions for caregivers of individuals receiving hospice care at home, given the important role caregivers play in caring and the negative outcomes (e.g., depression) associated with their caregiving. Our review highlighted the current state of interventions for caregivers of patients receiving hospice care at home. Many of the interventions were in the early phases of development, raising the need for future studies to look at efficacy, effectiveness, and the ability to implement interventions in real-world settings.

News and Market Developments

Texas Medical Association: Texas Primary Care Physicians Improve Access for Older Patients (5/1) - Dallas geriatrician Deborah Freeland, MD, values patients’ input in UT Southwestern Medical Center’s home-based primary care practice. Seeing patients at home eases certain access challenges, like transportation, and gives her insight into the nonmedical drivers of health at play. “This allows for better interventions, as the social issues are more easily understood and recognized when seeing a patient in their home,” she told Texas Medicine. 

New York Post: Groundbreaking Program Brings Hospital-Quality Care to Home (4/29) - There’s no place like home — and now hospitals are starting to recognize that as well. Jonathan Kelly, DO, medical director of the Hospital at Home Program at NYU Langone Hospital—Long Island, explains how a groundbreaking concept is changing the way patients recover by taking them away from the brick and mortar of the hospital and allowing them to heal in the comfort of their own home with the support of their family. 

Chief Healthcare Executive: Effectiveness of Managing Conditions with Remote Patient Monitoring (4/28) - Remote patient monitoring has experienced substantial growth in recent years, driven by technological advancements and a growing recognition of its ability to improve outcomes across various health conditions. From managing chronic illnesses like diabetes and hypertension to addressing mental health concerns and post-surgery recovery, RPM has proven effective in empowering patients and enhancing clinical decision-making. RPM's efficacy as a health care delivery model, providing patients with a positive experience and high-quality care within the confines of their homes.

McKnights Home Care: Why Health Systems Should Embrace Advanced In-Home Care Models (4/25) - Health systems stand to gain manifold by embracing the paradigm shift to care in the home. By moving more advanced care delivery into peoples’ homes, systems can effectively curb acute healthcare utilization, decreasing hospital-acquired conditions and drastically improving patient and family experience. Embracing these in-home advanced care models opens bed capacity, both through hospital avoidance and length of stay reduction. This capacity can be used to cater to new, potentially more critical or high-acuity patients. Additionally, the quality of inpatient care is improved as patients no longer endure prolonged wait times to be seen or boarding time awaiting an inpatient bed.

HealthData Management: Home is Where the Health Is: Home-Based Solutions Revolutionizing Care (4/24) - The health care industry is experiencing a significant transformation, transitioning from traditional facilities to more personalized, home-based care. This trend positions the home as a primary site for health care services and reflects a broader change in health care delivery. This shift to home-based care is driven by various factors, including the aging population's desire to age in place, the increasing prevalence of chronic illnesses, and the digital transformation in healthcare. Telehealth and remote patient monitoring technologies play a pivotal role in facilitating this shift, offering innovative models of care that prioritize patient comfort and convenience.

MedCity News: Patient Engagement Is Essential for Achieving the Goals of Value-Based Care (4/24) - Meeting patients where they are (virtual, home, clinic) and connecting through their preferred communication channel (patient portal, in-person, digital apps) are critical for facilitating productive and trusted patient–provider relationships. A growing number of private-sector organizations are innovating new approaches:

• Aware Recovery Care brings substance use disorder services, including ambulatory detox, medication assistance, and addiction treatment into the home. This both lowers care costs and improves the quality of life for individuals needing these services.
• Vesta Healthcare connects home care with primary care to better serve individuals with complex health needs using tailored care management plans and 24/7 support. These strategies can include proactive and remote monitoring of blood pressure, oxygen, weight, and other metrics that allow care providers to know when there is a change in health status and to provide timely and effective interventions that can help obviate the need for hospitals and nursing homes and help people stay at home.

Help at Home: Help At Home Responds to CMS Efforts (4/24) - Help at Home, a national provider of home care services, announced that it is encouraged by the Administration's continued recognition of the value of the home care industry and its critical role in support of millions of complex, fragile individuals receiving care in the home. As an industry leader dedicated to Medicaid-funded, home-based care, Help at Home is committed to continuing to improve access and quality of care in the home and looks forward to continued engagement with both federal and state agencies on our shared objective.

Inbound Health: SSM Health Partners with Inbound Health to Offer In-Home, Post-Hospital Care to Patients (4/23) - SSM Health and MHH member Inbound Health, a provider of in-home, announced a partnership to bring personalized, in-home, post-hospital health care services to patients. The first phase of this collaboration begins at SSM Health St. Mary’s Hospital – Madison this week with the launch of a new SSM Health at Home program – Recovery Care at Home. Hospitalized patients who meet certain criteria will have the option to be discharged home to receive services traditionally offered in a skilled nursing facility within their own homes.

Biofourmis: Community Health Network Selects Biofourmis to Help Drive Care-at-Home Outcomes Across the Continuum (4/23) - MHH member Biofourmis announced it was selected by Community Health Network (Community), a six-hospital integrated health system serving central Indiana, to help enhance and scale its care-at-home services for patients across the care continuum. With the Biofourmis solution, Community patients will be closely monitored and cared for remotely by Community clinicians based on their conditions and clinical protocols, with a focus on early interventions to reduce hospital readmissions and emergency department visits. Community aims to expand its services using Biofourmis' care-at-home solution to support seamless transitions for eligible patients from the hospital to the home.

Home Health Care News: BrightStar Care Dives Further Into Hospital-At-Home Care (4/23) - MHH member BrightStar Care announced a collaboration with Medically Home to provide primary in-home clinician and transport services. Where BrightStar Care is working with Medically Home, patients and their care teams will be linked to physicians and nurses, who will, together, monitor their condition and coordinate necessary services.  

Novant Health: Novant Health Launches Hospital at Home Program (4/23) - Novant Health launched a hospital-at-home program. Patients, who are monitored by technology around the clock, have 24/7 access to a remotely located registered nurse, receive at least two visits a day from paramedics, and meet virtually with a physician once daily. The program treats patients with chronic disease flare-ups or other "lower-risk conditions" or who are recovering from surgery. The program received $2.7 million in financial support from the New Hanover Regional Medical Center Foundation to help cover startup operational expenses.

Healthcare Innovation: Camden Coalition Pilots Home-Based BP Monitoring With Complex Patients (4/23) - The New Jersey-based Camden Coalition is piloting a short-term, home-based intervention with patients living with hypertension in combination with other complex health and social needs. 

American Hospital Association (AHA): AHA Comments on Draft Legislation to Extend Hospital-at-Home Program (4/22) - AHA provided comments on the discussion draft of the Hospital Inpatient Services Modernization Act, which would extend the hospital-at-home program through 2027. AHA thanked the sponsors for their ongoing work to extend this innovative program and voiced support for its continuance.

Fierce Healthcare: Four Key Takeaways from the NAACOS Spring Conference (4/16) - The National Association of ACOs (NAACOS) hosted a spring conference last week, with sessions on post-acute care, fraud, implementation best practices, health equity and legislative priorities. As policymakers and legislators transition health care to value-based care, experts on the panel warned SNFs they must adapt. Reading the Centers for Medicare & Medicaid Services (CMS) tea leaves shows that the feds are funding more and more initiatives pushing patients to home-based care and fewer hospitalizations, said Dana Strauss, senior director of government affairs for CVS Health. “We are on the precipice of a significant shift of care into the home,” she said. “SNFs have to believe first that there is an existential threat to where their referrals are coming from.”

MedStar Health: MedStar Health and DispatchHealth Launch Exclusive Partnership to Provide Acute Care at Home (4/4) - MedStar Health announced a partnership with MHH member DispatchHealth to deliver acute care services in qualifying patients' homes shortly after their discharge from a MedStar Health emergency department (ED) or hospital in Washington, D.C. — typically within 72 hours of the visit. MedStar Health providers connect patients to DispatchHealth based on clinical need and geographic and insurance criteria, primarily before their discharge from inpatient units or EDs at MedStar Georgetown University Hospital and MedStar Washington Hospital Center. The rapid follow-ups also reach patients living in surrounding areas.

Upcoming Events

June 3-4, American Health Care Association/National Center for Assisted Living, "Congressional Briefing." 

June 4, McKnights Long-Term Care News, "Advancing Dementia Care: Insights Into New Care Approaches for Home Care and Beyond." 

June 14, MedPAC, "June 2024 Report, Includes Hospital-at-Home Chapter." 

August 21-23, Home Health Care News, “Future Conference”

October 28-29, Home Care Association of America, "National Home Care Conference." 

Previous Events, Videos, and Podcasts

Healthcare Finance, "HIMSSCast: The Need for Home Care Continues." A nurse by training, Tim Ashe, chief clinical officer at Wellsky, knows the challenges that burnout, staffing shortages and bed capacity have on clinicians and the health system. Making the transition to acute hospital care at home was made possible by remote patient monitoring and technology, including Wellsky's intelligent care platform. The pandemic now officially ended, Ashe sees a continued demand for home-based services.

Home Health Care News, "Signify Health President: ‘We’re Just Scratching The Surface’ On What Can Be Done In The Home". Paymon Farazi, the president of Signify Health, recently joined Home Health Care News’ Disrupt podcast to talk about Signify’s direction about how the company could work with traditional home-based care providers in the future and where Farazi sees Signify – and health care – headed in the near- and long-term future.

HCP Live, "Bruce Leff, MD, MACP: Discussing ‘Hospital at Home’ Program, Important Takeaways". During this segment of his HCPLive interview at the 2024 American College of Physicians (ACP) Internal Medicine Meeting, Bruce Leff, MD, MACP, discussed what he hopes internal medicine physicians viewing ‘Hospital at Home for Older Adults: Outcomes and Implementation’ walk away understanding. 

NPR, "Why the Growing Push for Programs to Help Keep Seniors in their Homes Longer." As the senior population in the U.S. grows, so do efforts to help older Americans stay at home — and out of hospitals and nursing homes. A 2023 University of Iowa report estimated seniors who are part of the program could significantly reduce their use of health care services and save them an average of around $15,000 over a 10-year period.

Please subscribe to this newsletter and send any news or events to rcheung@movinghealthhome.org for inclusion in this newsletter.