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.
Home Health Care News: HHS Renews Public Health Emergency, Keeping Key Home Health Waivers in Place (4/13) - The legislation would also require the CMS to establish uniform health and safety requirements for program participants within a year of its enactment. “We’ve been putting health systems that are actually providing hospital-at-home services through the waiver in front of Hill staff to build that support,” Jeremiah McCoy, director of policy and government relations at Moving Health Home, previously told HHCN. “There’s a lot of education that needs to happen with Hill staff. We are working to make sure they know about the waiver, where the benefits are, the impacts on cost, quality, patient satisfaction and health equity.”
Home Health Care News: Despite Strong Bipartisan Support, Choose Home Facing Roadblocks(4/7) - NAHC, LeadingAge, Allies for Independence and Moving Health Home – the relatively new home care coalition whose founding members include Amazon Care and multiple health systems – are among other organizations behind Choose Home. The National Council on Aging, the Council of State Home Care & Hospice Associations and the Forum of State Associations, a division of NAHC, support the bill as well.
Becker's Hospital Review: How Intermountain, Ascension and Amazon Care coalition is advocating for permanent hospital-at-home care (4/5) - Nathan Starr, DO, medical director for home services at MHH member Intermountain Healthcare in Salt Lake City, spoke to Becker's Hospital Review about how and why the Moving Health Home coalition is advocating for care in the home.
Department of Health and Human Services (HHS): Renewal of Determination That A Public Health Emergency (PHE) Exists (4/12) - On April 12, Secretary Becerra renewed the COVID-19 PHE declaration for another 90 days. The new expiration date for the PHE is July 15, 2022. Renewal of the PHE provides for several CMS waivers to continue, including those enabling care in the home, such as expanded use of telehealth and the Acute Hospital Care at Home program.
Centers for Medicare and Medicaid Services (CMS): Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests (4/4) - CMS expanded access to free over-the-counter COVID-19 testing for people with Medicare Part B, including those enrolled in a Medicare Advantage plan. Medicare beneficiaries with Medicare Part B will now have access to up to eight FDA-approved, authorized or cleared over-the-counter COVID-19 tests per month at no cost.
HHS: Secretary Becerra: 'Everyone Deserves Opportunity to Live at Home' (4/4) - In response to the Notice of Funding Opportunity for Medicaid's Money Follows the Person Demonstration Program, Xavier Becerra, Secretary of Health and Human Services stated: "Everyone deserves the opportunity to live at home, in their communities and with their loved ones. This funding will bring dignity and peace of mind to even more seniors and people with disabilities across the country. We will continue expanding these programs to ensure all Americans have equitable access to the high-quality health care they deserve – no matter where they live.”
Research and Polling
University of Michigan National Poll on Healthy Aging: Older Adults’ Preparedness to Age in Place (April 2022) - Over January and February 2022, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their perspectives on aging in place, their homes, and available social supports. According to the new survey, the majority of adults age 50–80 (88%) felt it is important to remain in their homes for as long as possible (62% very important, 26% somewhat important), and 12% rated it not important. “Aging in place” refers to living independently, safely, and comfortably in one’s home for as long as possible, and it’s an important goal for many older adults and their families.
American Journal of Managed Care (AJMC): Patient Perceptions of In-home Urgent Care via Mobile Integrated Health (4/8) - The objective of this study was to compare patient experiences with in-home urgent care via mobile integrated health (MIH) vs. urgent care provided in emergency departments (EDs). Study participants were members of a managed care plan who were dually eligible for Medicare and Medicaid, 21 years or older, and treated either by MIH or in an ED for nonemergent conditions around Boston, Massachusetts, between February 2017 and June 2018. The study survey assessed patients’ perceptions of their urgent care experiences. The results showed that patients appear satisfied with receiving paramedic-delivered urgent care in their homes rather than EDs, perceiving higher-quality care. This suggests that in-home urgent care via MIH may be acceptable for patients with nonemergent conditions.
AJMC: Shifting Away From Emergency Department and Office-Based Urgent Care: No Place Like Home? (4/8) - In this issue, Dorner and colleagues assess the ability of community paramedicine to help fill this void. The authors evaluate patient perspectives of care delivered in the home by community paramedics for after-hours care for dually eligible (Medicare and Medicaid) patients who require urgent (but not emergent) clinical services. It is not surprising that patients preferred receiving care in the home over a trip to the ED. A more unexpected finding was that the patients perceived the quality of care from community paramedics (87% rated care excellent or very good) more favorably than the care provided by ED clinicians (65% rated care excellent or very good).
Journal of the American Geriatrics Society: Health equity in Hospital at Home: Outcomes for economically disadvantaged and non-disadvantaged patients (4/1) - The objective of this study was to determine whether Hospital at Home (HaH) services were received by disadvantaged patients, and if so, whether effectiveness differs for patients depending on socioeconomic status (SES). Researchers found that the duration of acute care was shorter in HaH compared with hospital inpatient controls regardless of SES. The 30-day ED revisits not leading to hospitalization were significantly reduced in patients with Medicaid favoring HaH. As such, this research suggests that HaH is feasible for economically disadvantaged patients and that these patients may even have greater benefit from HaH. The study authors hypothesized that better outcomes for low SES patients may result from the ability of HaH providers to directly observe and provide care to patients in their homes, where they can address social determinants of health.
News and Market Developments
Home Health Care News: Why Home Health Agencies Could See an Unfavorable Medicare Payment Landscape in 2023 (4/21) - The U.S. Centers for Medicare & Medicaid Services (CMS) released its 2023 proposed payment rule for the nursing home industry earlier this month. In it, the agency called for a 3.9% increase to Medicare payments for skilled nursing facilities (SNFs) – with a 4.6% cut to the Patient-Driven Payment Model (PDPM). If CMS does decide to enact a similar cut with PDGM, it could potentially dampen M&A activity, prompting home health operators to spend more conservatively. A less favorable rate environment may also detract from investor interest. At the same time, home health agencies will likewise have to grapple with the nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) Model next year. Timing wise, a PDGM cut and possible HHVBP penalty could create a difficult operating environment for some home health businesses.
Home Health Care News: Where the Director of the Center for Medicare Wants to See Care Go (4/18) - During last month's Home Health Care News’ Capital+Strategy event Dr. Meena Seshamani expressed optimism for the future of home-based care, pointing to more care taking place outside of traditional facilities, innovative care models and the shift to value-based care in general. She highlighted the success of the Home Health Value-Based Purchasing (HHVBP) Model as an example.
BusinessWire: New JAMA Article Highlights the Outcome and Safety Benefits of Remote Patient Monitoring During the Pandemic and Beyond (4/18) - Masimo today announced the findings of a Viewpoint article recently published in the Journal of the American Medical Association (JAMA) which highlighted the benefits of remote home patient monitoring, reporting in part on research that used Masimo SafetyNet®, a remote patient management solution. In the article, “Remote Patient Monitoring During COVID-19: An Unexpected Patient Safety Benefit,” researchers conclude that through recent technological advances in remote monitoring, a patient’s physiological needs can now more often be the primary factor in determining the level of monitoring they receive, rather than their physical location.
Home Health Care News: Proposed Payment Rules for Other Settings Forecast Home Health Trouble (4/17) - Though the home health proposed payment rule has not yet been released, industry stakeholders have already begun to forecast what providers can expect to see in terms of the Medicare payment landscape. Due to workforce investments, more expensive supplies and the overall cost increase of goods and services in the U.S., including the price of gasoline, it has gotten more expensive for home health agencies to stay in business. While CMS does update the home health rates by an inflation index every year, the updates have failed to keep pace with the rising costs for staffing, medical supplies and fuel, Joanne E. Cunningham, executive director of the Partnership for Quality Home Healthcare, told HHCN.
Home Health Care News: Why Best Buy Is a Home-Based Care Player Worth Watching (4/14) - Best Buy's purchase of Current Health established the company's position as a player in the home-based care technology market. According to Diana Gelston, the VP of virtual care sales, marketing and client success at Best Buy, the goal for the company in the future is to connect patients to physicians, health systems and health insurers to provide – or facilitate – better outcomes through care in the home. Best Buy's potential ability to enable hands on, home-based care at a large scale is what could make it a very integral player in the shift to home-based care over the next decade.
Home Health Care News: UnitedHealth Group ‘Moving at Speed’ in Bringing Together Home-Based Care Capabilities (4/14) - UnitedHealth Group is moving toward value-based care at a faster pace than even it originally imagined. And that’s partly because of the success of its home- and community-based care capabilities, according to CEO Andrew Witty. “Our pending combination with LHC Group will reinforce our ability to deliver care and support in the home as well as in other ambulatory locations,” Witty continued. Having a wide variety of home- and community-based care capabilities allows UnitedHealth Group to shift care into the most appropriate – and often lowest-cost – setting. It likewise adds appeal from a patient and member perspective, as most Americans, when possible, prefer to receive treatment in the comfort of their own homes.
Health Payer Intelligence: Top Challenges, Benefits of At-Home Coronavirus Testing Coverage (4/12) - Changes in at-home coronavirus testing coverage have created opportunities and challenges for payers as the pandemic reshapes preventive care services. Providing an avenue for access to over-the-counter coronavirus tests through Medicare could relieve some of the financial pressure on community health plans to fund these tests. However, supply chain issues, price gouging, and increasing consumer demand for convenient preventative care options are all areas which will have to be addressed within the home health industry moving forward.
Digital Health Business and Technology: 3 obstacles University Hospitals overcame in adopting hospital at home (4/11) - University Hospitals in Cleveland advanced hospital-at-home technology and programs in rapid response to the COVID-19 pandemic, and experienced reduced mortality, average length of stay, and readmissions rates in patients associated with the program. However, the three main obstacles that the system faced in its Hospital at Home program were 1) vendor collaboration; 2) fitting remote patient monitoring technology into the organization’s structure and the clinicians' workflows; and 3) payment uncertainty.
Fierce Healthcare: Value-based senior care startup Vytalize Health grabs $53M (4/11) - Value-based care platform Vytalize Health has landed $53 million in series B funding to power its virtual and in-home primary care offerings for seniors. As an accountable care organization, Vytalize aims to connect physicians and specialists to wrap care around Medicare patients, working to improve preventive health services and reduce avoidable costs like those associated with unnecessary visits to the emergency room. Vytalize’s virtual and in-person clinic options, designed to fill care gaps rather than to replace the care practices are already providing, include services for chronic disease management, remote monitoring, behavioral health, post-discharge planning and coordination, annual wellness exams and house calls.
Healthcare Finance: HHS is giving clear signals of wind down of public health emergency (4/11) - CMS has granted numerous waivers under the PHE that would be terminated either upon the end of the emergency period, 60 days after the waiver or modification was first published, or at the end of the year the PHE expires. Hospitals have used these waivers to spur innovation, with two of the biggest being the use of telehealth and acute hospital care at home. Hospital at home models became imperative for many health systems during COVID-19 surges, to free up needed hospital beds. It also created a financial advantage for hospitals in value-based contracts, such as Medicare Advantage agreements that extended care to 30-day episodes.
Health Leaders: Home Sweet Home: Healthcare Moves Away from the Hospital (4/8) - With hospitals struggling to maintain staffing levels and reduce inpatient traffic, some health systems are using the hospital at home strategy, which combines digital health and in-person services, to replicate the ICU environment at home. These programs and strategies will expand and become more comprehensive as health systems shift to value-based care, changing the concept of the hospital and giving patients more opportunities to receive care at home.
Home Health Care News: Over 4 Million MA Beneficiaries Have At-Home Care Access Through Supplemental Benefits (4/7) - A new report from ATI Advisory shows that in-home support services are one of the most popular non-medical supplemental benefits in Medicare Advantage (MA) plans, with the benefit currently being available for 4 million MA beneficiaries. Roadblocks to further utilization include data limitations, reporting metrics, and inequitable geographic distribution of benefits.
Modern Healthcare: Help at Home acquires two companies, enters New York (4/6) - In-home care provider Help at Home has acquired two New York-based home care companies as part of its strategy to grow in various markets. Edison Home Health Care and Preferred Home Care of New York offer traditional care through licensed home care service agencies and Medicaid's Consumer-Directed Personal Assistance Program. This merger brings an additional 10,500 clients and 12,000 employees to Help at Home across dozens of counties in New York and Pennsylvania.
Home Health Care News: How Walgreens, VillageMD Are Driving Home-Based Care Forward (4/5) - In addition to the over $6 billion invested in VillageMD – and the goal the two companies have set to open 1,000 new clinics within five years – Walgreens Boots Alliance also has a stake in the large home health care provider BrightSpring Health Services. It additionally recently invested $330 million in CareCentrix, a health-at-home solutions company. Walgreens sees itself at the forefront of health care’s transformation in the U.S., and not just a vehicle working alongside that transformation.
STAT: Home care instead of hospital care: Congress should extend a crucial waiver (4/5) - Since launching in August 2021, the UMass Memorial Health home hospital team has cared for nearly 300 patients with acute medical conditions who would otherwise have spent days in the traditional hospital. The home hospital program has demonstrated excellent quality, safety, and patient satisfaction outcomes. By extending the CMS Acute Hospital Care at Home waiver, the bipartisan Hospital Inpatient Services Modernization Act will help ensure that all patients — regardless of race, ethnicity, or socioeconomic status — continue to have access to safe and effective inpatient-level care in their homes.
HIT Consultant: At-Home Digital Health Innovations Transforming Diabetes Care (4/4) - The widespread adoption of at-home digital health solutions could improve quality of care for patients with diabetes. Remote Patient Monitoring (RPM) platforms for diabetes can facilitate personalized dosing adjustments, interventions and ongoing support of people with diabetes. Ideally, these platforms should also:
Enable data collection from whatever diabetes devices a patient wants to use or their insurance company requires;
Offer patient-friendly tools that allow participants to easily upload and share their data remotely or in the clinic;
Allow physicians, health systems and patients to securely view all patient information through a single portal; and
Provide personalized support to enhance patient engagement and improve adherence to treatment protocols.
Daily Caring: Medicare Advantage Programs Support Aging in Place and Increase Access to Care (April 2022) - To support aging in place, Medicare Advantage plans offer access to preventive programs and home- and community-based care that help minimize hospitalizations and promote better health at home. Aetna Medicare explains how they work and 4 community programs that improve access to care. Through benefits like care management programs, telehealth, fall prevention, and in-home care, Medicare Advantage can support and encourage aging in place and increase access to care for older adults who may benefit from this new approach.