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.
Moving Health Home (MHH) deeply appreciates Senators Carper and Scott, and Representatives Blumenauer and Wenstrup for their leadership in advancing innovative, patient-focused hospital at home models of care. As a result of their efforts, bipartisan, bicameral legislation was enacted into law. The Hospital Inpatient Services Modernization Act (S.3792/H.R.7053) extends the important Acute Hospital Care at Home waiver for two years, allowing patients needing acute-level care, and their caregivers, to continue to have access to these services in the home.
National Journal: Leaders in Congress Warn Not to Ignore Home Health Services (1/12) - While the new Congress may still be settling in, Rep. Debbie Dingell is not waiting to start working on making home-based health services more accessible. Dingell is already reaching across the aisle to find Republicans who will work with her on home- and community-based services, also known as HCBS, an issue that she championed along with Democratic Sen. Bob Casey last Congress. Both Dingell and Casey plan to continue pushing proposals from their Better Care Better Jobs Act. “I haven’t made a final decision but my preference would be do both: Reintroduce the bill in its you might call more-fulsome version, which is what we already introduced in the last Congress, but also to consider breaking up portions of it for those opportunities where you can get bipartisan support on an element of it,” Casey said Monday.
Congressional Budget Office (CBO): CBO Estimate of the Consolidated Appropriations Act, 2023 (1/12) -On January 12, CBO released cost estimates of provisions from the Consolidated Appropriations Act, 2023 (CAA of 2023), recently passed by Congress. Extending the Acute Hospital Care at Home waivers and flexibilities scored at $5 million over a ten-year period. The small cost is a result of additional dollars allocated to the Centers for Medicare and Medicaid Services to operate the program and other provisions in the CAA of 2023. Apart from the allocated dollars, the two-year Acute Hospital Care at Home extension was scored as budget neutral.
Administration for Strategic Preparedness & Response (ASPR): Renewal of the COVID-19 PHE (1/11) - On January 11, the Department of Health and Human Services (HHS) Secretary Becerra renewed the COVID-19 PHE. The COVID-19 PHE is now expected to end on April 11, 2023. As a reminder, Congress included the extension of the Acute Hospital Care at Home waiver in the omnibus funding package and delinked it from the PHE timeline.
Research and Polling
ATI Advisory: In-Home Support Services Analysis (1/18) - The number of Medicare Advantage (MA) plans offering in-home support services as a benefit increased by approximately 32 percent this year. In 2023, 1,375 MA plans are providing in-home supports, such as home care, as a supplemental benefit, compared to 1,035 plans last year. The number of plans offering expanded supplemental benefits grew by more than 40 percent. Nearly half of them are offering more than one benefit. The findings is a reflection of beneficiary interested towards person-centered benefits. For additional coverage, see McKnights Home Care.
McKnights Home Care: Medicare, MA Serving Vulnerable Home Health Populations, Schiller Explains (1/12) - The latest Chartbook report revealed that Medicare and Medicare Advantage home health beneficiaries are older, sicker, poorer and more racially diverse. And in a change from years past, fewer of them are joint replacement recipients; more are complex, higher-acuity patients. Jennifer Schiller, executive director of the Research Institute for Home Care, which published the report, talks about the significance of these findings in a Newsmakers podcast with McKnight’s Home Care. The report also uncovered continued beneficiary access issues with MA plans.
American Journal of Critical Care: From Hospital to Home: Rooming-in Program Provides Peace of Mind for Families and Nurses (1/10) - A novel rooming-in program at Children’s Healthcare of Atlanta provided greater peace of mind for families of infants with critical congenital heart disease (CCHD) and the pediatric nurses preparing the infants for discharge. The transition to home for infants who require complex care can be overwhelming for caregivers, who need to absorb large quantities of unfamiliar material in a short time. The study found that the quality of discharge education and care coordination are important elements for a successful transition to home, and participants pointed to how this program improved both family and nursing outcomes. Participants mentioned better communication and collaboration between nurses, discharge coordinators, other providers and caregivers, paving the way for a smooth transition home. For additional coverage, see Newswire.
Journal of Pediatric Hematology/Oncology Nursing: Ambiguous Expectations of Parent Caregiving for the Child and Adolescent With Cancer at the Hospital and at Home—An Ethnographic Study (1/10) - This study aimed to explore the experiences of children and adolescents with cancer, who had received treatment through a portable infusion pump, and their parents in managing different care tasks. It is the first study and forms the basis of the research project INTACTatHome, that develops and tests interventions of home-based intravenous anti-cancer treatment. This study contributes to a deeper understanding of the varying experiences of children and adolescents and their parents in managing different care tasks for a child or adolescent with cancer. This perspective is crucial when developing and implementing future home-based care services.
Journal of the American Medical Directors Association: Decline in Veterans' Admissions to Nursing Homes During COVID-19 and Finding Alternative Care Settings (1/5) - The decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic raises questions about how replacing nursing home care in favor of home- and community-based care affects the health outcomes and wellbeing of Veterans and their caregivers.
Journal of Gerontological Nursing: Home-Based Care Provider Perspectives on Care Refusal During the COVID-19 Pandemic (1/1) - In this study, researchers conducted telephone interviews with 27 home-based care providers (HBCPs) from Medicare-certified home health care agencies located in eight U.S. counties to explore older adults' decision making around home-based care service continuation during the coronavirus disease 2019 (COVID-19) pandemic. Four themes emerged, including two related to older adults' decision making around refusal of in-home care and two related to HBCPs' responses to care refusals. Fear of COVID-19 infection motivated older adults to make care-related decisions that were incongruent with their health needs, including refusal of care in the home, despite receiving education from HBCPs. These data highlight a need for tools to help HBCPs better support patients through decision-making processes about care continuation during COVID-19 and future infectious disease pandemics.
News and Market Developments
Home Health Care News: The Benefits Of Strong Quality Assurance and Performance Improvement (QAPI) Programs In Home Health Care (1/18) - Quality Assurance and Performance Improvement (QAPI) programs have been ubiquitous in the home health space for the past few years, but in light of the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP), the process may begin to hold more weight than ever. The goal of QAPI is to ensure that agencies are continuously looking for ways to improve the ways that they operate. With HHVBP, home health stakeholders are really seeing where QAPI can be tied to better outcomes, which is then tied to better reimbursement.
McKnights Home Care: UnitedHealth Group: Home is the New Frontier for Value-Based Care (1/17) - UnitedHealth Group executives called home the “new frontier for value-based care” late last week as the company prepares to close on its purchase of home health giant LHC Group through its Optum Health division. “You will see us both developing the platform for home care increasingly in a comprehensive fashion, as well as integrating home care with our clinic-based care model,” Optum CEO Wyatt Decker, MD, told investors during an earnings call with Wall Street analysts. “It really creates two growth vehicles for us.” UnitedHealth is expected to close on its $5.4 billion deal to buy LHC Group in this quarter, and executives indicated the business will play a key role in the company’s plans to dive deeper into the home. In 2023, Minnetonka, MN-based UnitedHealth plans to expand in-home services including vaccinations, testing and social determinants of health.
VCU Health: VCU Health Launches Home Hospital, The First Hospital-at-Home Program in Central Virginia (1/17) - VCU Health announced a program that will allow patients to receive acute, hospital-level care from within the comfort of their homes. The Home Hospital program is the first of its kind in central Virginia and aims to serve nearly 2,000 patients during its first year. Patients who would normally have needed to be in a hospital for acute care needs, such as sepsis, congestive heart failure or pneumonia, now have the option to receive the same level of care at home.
Home Health Care News: How American Advantage Home Care Grew From 13 Patients To 200 Through Referrals (1/17) - Faced with headwinds such as staffing constraints and cost-of-care increases, home-based care companies have been forced to become more strategic when it comes to referrals and sales. One such company, American Advantage Home Care, is very familiar with this process. In terms of locking down these referrals, American Advantage Home Care partnered with orthopedic surgeons and specialists in the area. It also directly approached discharge planners,local doctors and facilities in the area.
Newswire: DiscoverU Health Creating Greater Access to Health Care for Uninsured and Underinsured Populations (1/16) - Launched in August of 2018, membership-based DiscoverU Health is a NURSE-led health care management firm that provides inclusive Concierge Medicine to Pediatrics and Adults designed to create a seamless, end-to-end experience and eliminates the inefficiencies afflicting today's health care system. In addition, DiscoverU Health specializes in “bringing care to you” by offering convenient virtual and home-based medical services and is working to build an inclusive network offering solutions to unlock health care's potential and improve the experience for members and their families.
Health Leaders: Polychronic Care Provider Raises $375 Million in Growth Funding (1/16) - Monogram Health, a polychronic care provider that specializes in home-based treatment of chronic kidney and end-stage renal disease, has raised $375 million in growth funding. About 90 percent of Monogram Health's patient visits are conducted in the home, with the remainder of visits conducted through telehealth. Monogram Health has a value-based care financial model, and the company works primarily with Medicare Advantage health plans. For additional coverage, see Home Health Care News.
McKnights Home Care: InnovAge CEO: PACE Provides a Natural Fit for MA Plans (1/13) - Medicare Advantage and managed care organizations could be the secret to growing Programs of All-Inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and social services to frail, older adults who qualify for skilled nursing care, but can still live at home. The 30-year-old program provides services both at home and at PACE centers. InnovAge is the largest and only publicly held PACE program.
Home Health Care News: Modivcare CEO: Companies Leveraging Size, Community-Based Approaches Are ‘Winning’ (1/13) - Modivcare offers technology-enabled health care services and provides non-emergency medical transportation (NEMT). The company also has its Modivcare Home division, which includes personal care, remote patient monitoring and nutritional meal delivery services. Modivcare believes it’s in a rare position to capitalize on growth opportunities moving forward. One of those reasons is the social determinants of health work that the company is doing.
Hospice News: UnitedHealth Group CEO: Home-Based Care Resonates Strongly with Payers (1/13) - Through acquisitions and contracts with providers, more payers are going all-in on home-based care. The quest for cost reductions, often through risk-based models, is leading a rising number of insurance companies and other payers to make (sometimes) huge investments in the space. Among them is UnitedHealth Care. These investments underscore the rising profile of the home setting within the health care system. For additional coverage, see Becker's Payer Issues and Home Health Care News.
McKnights Home Care: Enhabit Execs Say Medicare Rates Cloud Home Health Outlook (1/12) - Continued uncertainty around Medicare reimbursement rates could keep dogging the home health industry this year. Enhabit Home Health & Hospice executives said that the firm is focusing on hospice deals more than home health deals due in part to the additional -3.925 percent behavioral adjustment to the Patient Driven Groupings Model (PDGM) expected in 2024. The firm predicted that home health valuations could come under pressure this year due to a number of factors, including the labor shortage and rising interest rates.
Forbes: Bringing Modernized Kidney Care To The Home: How Monogram Health Is Transforming Polychronic Care (1/12) - Monogram saw the need for long overdue innovation in kidney care engagement and rose to the challenge. Collectively, the team set out to completely reset the treatment standard for chronic kidney disease (CKD), end stage renal disease (ESRD), and other polychronic conditions by prioritizing comprehensive, patient-centered care delivered at home, optimally driven by a multispecialty team in the rapidly emerging value-based environment. Delivering care in the home, Monogram dismantles a longstanding barrier to care by enabling consistent access to patients and their families, which allows us to develop individualized care plans around patient goals, based in trusted relationships.
Home Health Care News: MedPAC Unanimously Recommends Home Health Payment Rate Cuts (1/12) - The Medicare Payment Advisory Commission (MedPAC) recommended that the Medicare base payment rate for home health care be reduced by seven percent for CY 2024. This recommendation is in line with previous recommendations by the commission over the years. The implications of a seven percent reduction would mean, among other things, a decrease in government spending by $750 million to $2 billion over one year.
Healthcare IT News: Why Direct Primary Care May be the Future, and What Technology is Needed to Support it (1/12) - Many in health care believe patients tend to be happiest and healthiest when they're in the home. This increasing awareness could potentially fuel a trend toward shifting direct primary care into the home. Lynn Carroll, chief operating officer at HSBlox, a vendor of health IT for the administration of value-based care programs, talks about what direct primary care is, how direct primary care has the potential to produce better outcomes, an improved patient experience and lower costs, and how coordinating care, services and reimbursements through a digital infrastructure can potentially improve health equity for vulnerable populations.
Home Health Care News: InTandem Capital Partners Makes Majority Investment In HouseWorks (1/12) - InTandem Capital Partners LLC, a health care services-focused private equity firm, has completed a strategic equity investment in HouseWorks. The Massachusetts-based HouseWorks is a personal care company that also offers home-modification services. Its “BetterCare at Home” approach combines personalized care and technology to deliver services. HouseWorks has the potential to partner with great home care agencies across the region and deliver on a better way of doing business and better way of caring for patients.
McKnights Home Care: Amedisys CEO Bullish on Better Home Health Rates (1/11) - Amedisys Chairman and CEO Paul Kusserow forecast more favorable home health rate increases beyond 2023. Kusserow told investors during a JP Morgan conference that he thinks the Centers for Medicare & Medicaid Services (CMS) and Congress have a better understanding of home health’s value, which potentially could translate into a healthier rate increase than the 0.7 percent the industry received for 2023.
Mobi Health News: Digital Musculoskeletal Care Company Hinge Health Launches In-Person Home Care (1/11) - Digital musculoskeletal care company Hinge Health announced it would expand into in-person care with a physical therapy house call service. The offering will first launch in Chicago followed by a nationwide rollout. Hinge is pitching the home option as a complement to virtual care, arguing in-person evaluations could improve patients' digital experiences.
Home Health Care News: Enhabit Set To Go Big On De Novos, Medicare Advantage In 2023 (1/11) - Enhabit is a home health and hospice provider that operates across 34 states with over 10,000 employees. Today, home health makes up about 80 percent of Enhabit’s revenue. After acquiring the Fort Myers, Florida, location of Southwest Florida Home Care, Enhabit is a top five home health provider in the majority of the states it operates in. Because of some of the uncertainty around reimbursement rates in home health, Enhabit CFO Crissy Carlisle said most of the M&A focus will be in hospice.
MedCity News: CVS Health Makes Waves (1/11) - CVS Health announced investments in Carbon Health, Monogram Health and Array Behavioral Care: $100 million to Carbon Health, a primary care and urgent care company; a contribution to a $375 million funding round for Monogram Health, a value-based provider of in-home care for those living with polychronic conditions; and $25 million to Array Behavioral Care, a virtual mental health care provider. CVS Health has long made its interest in primary care clear, as well as home care through its plan to acquire Signify Health for nearly $8 billion. CVS Health has three strategic priorities: primary care, home health and physician enablement to value-based care.
Health Leaders: Sharp Memorial and West Health to Develop Best Practices for Senior Care (1/11) - Sharp Memorial Hospital and West Health have entered into a three-year deal to create a "model of excellence for older-adult care," which would bring together best practices for everything from primary care to inpatient services to home-based care. Many seniors are looking to remain in their homes for a longer time, rather than move in with family or into senior care facilities, putting pressure on health care to improve home-based monitoring and care management services. Sharp Memorial and West Health, a collection of non-profits focused on senior care services and successful aging, want to create a platform of care management that eliminates siloed services and gives health care organizations a master plan for treating seniors. It would include care coordination as well as senior-specific programs.
Home Health Care News: Top Home Care Trends for 2023 (1/11) - The home care industry is fighting its own monetary battle: the rising cost of services. Providers are investing in what they believe to be differentiators, whether that’s through Medicare Advantage (MA) business, technology, care coordination or alternative home-based programs. Home Health Care News lists out all home care trends providers should watch out for in 2023.
Chief Healthcare Executive: Dina Aims to Help Hospitals and Health Plans ‘Extend Their Reach into the Home’ (1/10) - Dina, a Chicago-based company, works with hospitals and health plans to improve home-based care. Dina offers an AI-powered care coordination platform and network to help coordinate programs and services for patients in their own homes, such as skilled nursing care, medical equipment and other needs, such as meal delivery. Bayada Home Health Care has selected Dina to help power its digital care transition solutions and services.
Home Health Care News: Primary Care Growth To Accelerate Home Health Utilization (1/10) - Over the next few years, Humana hopes to have more of its members utilizing all three of its health care service arms in order to drive up margins and revenues. That plan includes CenterWell Home Health. Today, Humana has about 700,000 members covered under its value-based home health model, which is about 14 percent of its member population. "We really want to see our [primary care] physicians working with our home health asset." For additional coverage, see McKnights Home Care.
University of Massachusetts Amherst: Massachusetts AI and Technology Center for Connected Care In Aging and Alzheimer's Disease Funds First Seven Pilot Projects (1/9) - The Massachusetts AI and Technology Center for Connected Care in Aging and Alzheimer’s Disease (MassAITC) at the University of Massachusetts (UMass) Amherst announced $1.7 million in funding for seven projects to pioneer approaches for in-home care using artificial intelligence (AI) and other advanced technologies. The MassAITC pilot projects aim to support the goal of aging at home through an interdisciplinary research approach that leverages the perspectives of patients, caregivers, clinicians, behavioral scientists, and others to enhance efforts in wearable and contactless sensing, AI, and machine learning (ML). The awards competition for the pilot projects was guided by a broad mandate to use advanced technologies, like AI and ML, to address challenges related to aging and managing Alzheimer's disease and related dementias (AD/ADRD). For additional coverage, see mHealth Intelligence.
Home Health Care News: Amedisys CEO Paul Kusserow: If Conveners Don’t Change, Their Day Is Coming To An End (1/9) - Home health providers have been directing ire at Medicare Advantage (MA) plans for some time over what they consider unfair rates for their services. However, especially over the last year, there’s a new target – and that’s conveners. Broadly, conveners are the middlemen between home-based care providers and MA plans. MA plans and conveners will need to change their game plan to ensure they are still able to provide access to home health.
Mobi Health News: Why the Digital Health User Experience is Key to Senior Uptake (1/6) - Seniors make up a growing portion of the population in the U.S., and many express a desire to stay in their homes as they get older. Some people aging at home will have to manage multiple chronic conditions. Cutting down on the number of devices and apps they need to keep track of will also enhance their experiences.