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 News
Moving Health Home: This Holiday Season, We're Thankful for Care in the Home (11/22) - In this blog post, Krista Drobac, founder of Moving Health Home, calls on state and federal policymakers to implement permanent flexibilities and programs that build on the lessons learned from the temporary waivers of the Public Health Emergency (PHE).
"I have personally experienced, and heard countless stories of patients and caregivers spending the holidays in the hospital or a long-term care facility. We try to make the most of it – decorating the room or bringing home-cooked meals – but it doesn’t compare, and is rarely preferred to being home."
Krista Drobac, Founder of Moving Health Home
At the federal level, needed changes include:
Passing the bipartisan, bicameral Hospital Inpatient Services Modernization Act (S.3792/H.R.7053) before the end of the year so patients needing acute-level care, and their caregivers, would continue to have access to Hospital at Home.
Passing an extension to the Medicare telehealth flexibilities.
Passing the Choose Home Care Act of 2021 to give nursing home-eligible beneficiaries more options as to how and where to recover post-hospitalization.
Ensuring that the Centers for Medicare and Medicaid Services is reimbursing home-based providers at parity with facility-based providers to allow equal access to care in the home and look at changes to network adequacy standards in private insurance to encourage coverage of home-based care.
Working with stakeholders to ensure home is an option for care in traditional Medicare, which favors facility-based care. Congress could remove barriers in traditional Medicare to improve access to care in the home in areas such as personal care, infusion, labs, dialysis, diagnostics, and primary care all while also addressing workforce issues.
Centers for Medicare and Medicaid Services (CMS): CMS Releases 2021 Global and Professional Direct Contracting (GPDC) Results (11/23) – CMS released the Performance Year (PY) 2021 financial and quality benchmark performance results for the 53 Direct Contracting Entities (DCEs) that participated in the GPDC Model in Calendar Year (CY) 2021. DCEs in PY2021 generated approximately $119 million in gross savings and all 53 DCEs attained quality scores of 100 percent. Participants report using care teams that consist of social workers and nurses to better support high-risk beneficiaries in their homes; they are also connecting beneficiaries to services, such as meal support and transportation, that address health-related social needs, and many are covering Part B cost-sharing as well. For additional coverage, see HC Innovation.
U.S. Government Accountability Office (GAO): Congressional Review Act of the Calendar Year (CY) 2023 Home Health Prospective Payment System Final Rule (11/15) - GAO reported that the Centers for Medicare and Medicaid Services (CMS) Home Health final rule does not fulfill the Congressional Review Act (CRA) timeline. The CRA requires a 60-day delay in the effective date of a major rule from the date of publication in the Federal Register or receipt of the rule by Congress. The rule was published in the Federal Register on November 4, 2022 but has a state effective date of January 1, 2023. Therefore, the rule does not have the required 60-day delay in its effective date. The CRA analysis was requested by leaders of the Senate Finance Committee, the House Energy & Commerce Committee, and the House Committee on Ways & Means.
Senator Cassidy: Cassidy, Scott, Carper, Menendez, Cornyn, and Warner Launch Bipartisan Effort to Improve Care for Patients Jointly Enrolled in Medicare and Medicaid (11/23) - Sen. Cassidy (R-LA) led a bipartisan group of senators in seeking feedback from the health care and patient communities as they develop legislation to improve coverage for individuals jointly enrolled in Medicare and Medicaid, who are also known as dual eligibles. The request for information (RFI) specifically focuses on models for integrating care, the diversity of needs in the dual eligible population, and system implementation. Responses are due January 13, 2023.
Senator Carper: Sens. Carper (D-DE) and Cassidy (R-LA) Introduced the PACE Part D Choice Act (11/16) - Sens. Carper (D-DE) and Cassidy (R-LA) introduced the PACE Part D Choice Act (S. 5106). The bill would ensure Medicare-only PACE program enrollees have a choice of prescription drug plans under Medicare part D. PACE is a Medicare-Medicaid program that provides adult day services, meals and some medical care at PACE centers, in addition to home-based care. For additional coverage, see McKnights Home Care.
"[The National PACE Association] urges Congress to pass this bill quickly so that many more older adults and their families can be served by PACE and receive the care they need in their homes and communities."
Shawn Bloom, President and CEO of the National PACE Association
Research and Polling
Reuters: The Caregiver's Lament: How to Handle the Costs of Care (11/30) - You might know P.J. Byrne from the movies, most likely as one of the fast-living brokers alongside Leonardo DiCaprio in "The Wolf of Wall Street." But these days Byrne's most important role is closer to home: that of son and caregiver. His 79-year-old father has suffered from dementia for about 10 years, which currently requires 24/7 home care from not just one but often two health aides. It adds up to about $200,000 a year in costs for the family. Just consider some of these numbers, cited in the Aspen Institute report on "The True Cost of Caregiving." Home health aide: $52,620 annually. Assisted living facility: $48,612. Private room in a nursing home: $102,204. Those numbers are so huge that family members often have to take on those tasks themselves. In fact, the United States has 53 million unpaid caregivers, according to a study by the National Alliance for Caregiving and the AARP.
CNBC: Here's How Those Looking to 'Age in Place' Can Fund Home Health-Care Services (11/28) - Some 70 percent of people want to age at home, yet only 10 percent have long-term care insurance, a HCG Secure/Arctos Foundation study found. Furthermore, about half of respondents had no idea how much in-home care would cost. With the median annual cost of a home health aide nationally estimated at $61,776, how are folks going to fund this? With home health aides costing almost $62,000 a year, how can average people fund their care? Tom Beauregard, founder of insurance company HCG Secure, said there’s “a need for innovation in this space to cover middle-income families to age at home.” Besides insurance coverage, retirees can look into alternate resources and tactics such as nonprofit service providers, cost-sharing with other retirees and tapping veterans benefits.
Kaiser Family Foundation: A Look at Waiting lists for Home and Community-Based Services from 2016 to 2021 (11/28) - Home and community-based services (HCBS) waivers allow states to offer a wide range of benefits and to choose—and limit—how many people receive services. The only HCBS that states are required to cover is home health, but states may choose to cover personal care and other services such as private duty nursing. Those benefits are generally available to all Medicaid enrollees who need them. States may use HCBS waivers to offer expanded personal care benefits or to provide additional services such as adult day care, supported employment, and non-medical transportation. Because waivers may only be offered to specific populations, states often provide specialized benefits through waivers that are specific to the population covered. This data provides new information about waiting lists from KFF’s most recent survey of state Medicaid HCBS programs, highlighting why waiting lists are an incomplete measure of unmet need and why they are not comparable across states or over time.
American Journal of Managed Care: Pandemic Leads to Shifting Care, Increasing Spotlight on At-Home Hospitalization (11/23) - The COVID-19 pandemic brought about new flexibility and adaptations in hospital-at-home (HAH) care for elderly patients, and the resulting model could be a meaningful way to optimize resources and curb health care costs. In a study from Spain, researchers highlighted that HAH may substitute an episode of inpatient care (step-up or inpatient avoidance pathway) or may enable an early supported discharge from the hospital (step-down) to continue medical treatments or rehabilitation.
Health Leaders: Three Challenges Facing the Home-Based Post-Acute Care Market (11/22) - A Home-Based Post-Acute Care 2022 report by KLAS Research found that the increased demand for home care services has been hindered by the staffing shortage. KLAS Research interviewed 88 home-based care leaders, with 66 percent identifying staffing as a challenge. Burnout and difficult work environments were named as contributing factors. Regulatory requirements (38 percent) are another challenge home-based post-acute care is facing. Many interviewees stated that the new and changing regulatory requirements from CMS complicate workflows and stretch already thin budgets to their limit.
Better Medicare Alliance: Analysis: In-Home Support Benefits, Caregiver Support on the Rise in Medicare Advantage (11/17) - A new brief by Better Medicare Alliance demonstrates that more Medicare Advantage (MA) plans will offer supplemental benefits in 2023. The largest increase will be in in-home support services. The number of MA plans providing at least one of the five recently expanded supplemental benefits — in-home support services, home-based palliative care, adult day services, support for caregivers of enrollees and therapeutic massage — jumped by 35 percent (824 to 1,111) from 2022 to 2023. The largest increase is in in-home support services, now offered across 794 plans in 42 states. For additional coverage, see McKnights Home Care, and Health Payer Intelligence.
News and Market Developments
McKnights Home Care: At-Home Therapy Firm Luna to Double Workforce in 2023 (12/2) - As more health care shifts to the home, at-home physical therapy provider Luna is setting an aggressive 2023 goal to double its staff from 2,500 therapists to 5,000 across the 27 states and 50 markets it serves. Therapy at home is not a new concept. Many small mom-and-pop home therapy agencies contract with payers and home health agencies to provide physical, occupational and speech therapy at home. A 2016 study found patients who received physical therapy in their homes recovered just as well as those who were treated in outpatient clinics.
McKnights Home Care: Humana to Scrap its SeniorBridge Home Health Unit (12/2) - Humana said it is closing its SeniorBridge home division at the end of the year to focus on its Medicare Advantage plans. The company made the announcement earlier this week in a brief statement that explained Humana wanted to focus on “organizational efficiencies” that better meet the needs of its evolving business. SeniorBridge operates in nine states, offering personal home care, private duty nursing, infusion services and care management. Louisville, KY-based Humana acquired the company in 2012 to expand its care management capabilities and better meet the needs of chronically ill adults.
McKnights Home Care: Provider Group to Congress - Fix Immigration Now (12/2) - LeadingAge is calling on Congress to address immigration reform in a legislative package by the end of the year to help stabilize the aging services workforce. In a letter to congressional leaders this week, LeadingAge President and CEO Katie Smith Sloan said the long-term care workforce is in a crisis due to a shortage of direct care workers that must be addressed immediately. Home Care Association of America President Vicki Hoak saysit also backs LeadingAge’s call for a special visa category designed for direct care workers.
The Hill: Support Home- and Community-Based Services Before More Veterans, and Caregivers Are Left Feeling Abandoned (11/29) - Increasing numbers of aging and disabled veterans are straining VA’s long-term care services. The rising costs of long-term care, coupled with VA’s spending caps on Home and Community-Based Services (HCBS) and home care worker shortages, are forcing veterans who prefer to receive their care at home, as well as their caregivers to make difficult sacrifices. The reality is some veterans, especially those with catastrophic disabilities, and their caregivers feel abandoned, broken, and unsupported by a system that was designed to meet their unique needs. Currently, the application for each HCBS program is lengthy, time-consuming, and disjointed. Ensuring veterans are simultaneously assessed for these programs assures efficient access to appropriate resources and improves user experience.
McKnights Home Care: Robotic Retrievers: One Possible Answer to the Caregiver Crisis (11/29) - Labrador Retriever, a California technology company, hopes to begin deploying Labrador Retrievers into the homes of seniors by the end of 2023 to help them safely age in place. These caregiver assistants aren’t canines, however, but rather robots developed by Labrador Systems to help home care firms and senior living facilities fill in caregiving gaps. A number of home care firms are using technology in various ways to help address the caregiver shortage. Artificial intelligence, for example, is being deployed to detect falls and help agencies determine the best way to provide care to seniors.
Home Health Care News: What Home-Based Care Agencies Should Know About The Independent Contractor Proposed Rule (11/28) - The independent-contractor pendulum in home-based care could be swinging back in favor of pro-union policies. Providers should take note of potential changes coming down the pike. In October, the U.S. Department of Labor (DOL) issued that proposed rule, which would also apply to potential employers that include registries, virtual marketplaces or consumer-directed agencies. In home care, caregivers are often obligated to follow state-required plans of care, maintain certain certificates or licenses and abide by safety protocols. Under the proposed rule, those requirements could potentially be deemed as “control,” and therefore employment.
Home Health Care News: BrightSpring Health Services No Longer Plans To Go Public (11/28) - BrightSpring Health Services – a large home- and community-based services provider – is not going through with its planned IPO. Backed by the private equity (PE) firm KKR and Walgreens Boots Alliance , the company had initially filed the paperwork for an IPO that was expected to raise close to $800 million in October of 2021. BrightSpring provides care to complex populations. Its offerings include home health, personal care, hospice, neuro rehabilitation, pediatric therapy and behavioral health services, among others. Overall, its network spans across 50 states and over 360,000 clients and patients.
Newswire: DispatchHealth Raises More Than $330 Million to Expand Its Technology-Enabled Ecosystem of High Acuity Care in the Home (11/24) - Moving Health Home board member DispatchHealth announced it has raised more than $330 million in combined equity and debt financing. Optum Ventures leads the equity financing round to further accelerate DispatchHealth's leading in-home, technology-enabled system of care. DispatchHealth's in-home, high acuity care model aligns health plans, health systems, at-risk provider groups and patients with complex care needs by delivering a value-based alternative to high-cost settings such as the emergency room, hospital ward or skilled nursing facility, reducing medical costs while improving clinical outcomes and patient and provider satisfaction. Financing will help DispatchHealth scale its hospital alternative care model, advance innovation of its technology platform, and fund strategic growth initiatives to meet the growing need of in-home high acuity care.
Business Wire: Yes Hearing Announced Expansion of Integrated Home-Based Care Services for Health Plans (11/23) - Yes Hearing, an audiology care provider, announced the expansion of their services to additional home- and community-based care services to health plan beneficiaries. Further supporting the company’s mission of enabling older adults to stay happy, healthy, and safe in their own home as they age, Yes Hearing — through an integrated and person-centered care model — will provide audiology care, fall prevention, and social needs screenings to enhance the lives of members in their preferred care setting — at home.
Stat News: Why Doesn't the U.S. Have At-Home Flu Tests? (11/22) - With so many potential viruses in play, it would be helpful if Americans had a way to distinguish between different ailments at home. And when it comes to the flu in particular, at-home testing could help telehealth doctors decide when it makes sense to prescribe treatments like Tamiflu, which need to be started within two days of onset of symptoms. Home flu testing would ensure that those who do need and receive antiviral medication for influenza are the ones who need it the most. Currently, the only test available for differentiating flu, Covid, and RSV at home is the Labcorp Pixel test, where users swab themselves at home and send the sample in for lab testing. However, this test’s turnaround time of one to two days wouldn’t be able to compete with an at-home test that gave results in 15-30 minutes.
Modern Healthcare: Health Systems Bet on Hospital-at-Home (11/22) - Health systems are increasingly investing in acute hospital-at-home technology to ease overburdened hospitals, reduce costs and improve outcomes. By equipping patients’ homes with biometric devices, along with tablets and other ways to communicate with clinicians, organizations aim to provide inpatient-level services to those who don’t need intensive care. One example includes how Moving Health Home member Current Health has piloted a program dispatching Geek Squad tech support employees to patients’ homes to assist with device setup and troubleshooting.
NVIDIA: What is a Smart Hospital? (11/22) - Smart hospitals, which utilize data and AI insights to facilitate decision-making at each stage of the patient experience, can provide medical professionals with insights that enable better and faster care. For example, video analytics can detect when a patient needs attention, such as detecting the risk of falls in the hospital or at home. Systems can also extend beyond the hospital walls to monitor at-risk patients at home.
McKnights Home Care: Providers Urge Congress to Pass Bill Stopping Home Health Rule (11/22) - Home care providers have asked Congress to include a measure in end-of-the-year omnibus legislation that would suspend implementation of the final home health rule that includes a $635 million cut to home health providers starting in 2023. The rule, which CMS issued last month, includes a four percent market-basket increase alongside a phased-in -7.85 percent behavioral adjustment related to the Patient-Driven Groupings model. The rate cut will be -3.925 percent, or $635 million, for 2023, starting on Jan. 1. Providers, who believe the rate cut is based on flawed methodology, expect the total adjustment will trigger an estimate $18 billion in payment reductions over the next decade.
Penn Today: No Place Like Home (11/21) - Patients can now receive complex care at home for a broad array of treatments that long ago or just recently were only offered in clinical settings. Penn Home Infusion Therapy can treat patients for hemophilia; provide parenteral and enteral nutrition; infuse intravenous gamma globulin to treat autoimmune diseases, and colony stimulating factors for leukemia and bone marrow transplant patients; manage pain; and administer IV fluids, antibiotics, and biologic therapies for diseases from Crohn’s disease to multiple sclerosis. Penn’s Cancer Care at Home has already been shown to cut down on trips patients need to make for clinical services and time spent in the hospital.
PR Newswire: MUSC Health Selects UpStream Healthcare as its Value-Based Partner for Medicare Patients (11/21) - The Medical University of South Carolina (MUSC Health) and UpStream Healthcare, a value-based health care company, have jointly announced their partnership to advance the health and wellbeing of Medicare patients within their expanding network across the state. The partnership aims to improve quality results for Medicare patients across South Carolina by giving them access to a team committed to improving coordination of care. Pharmacist led teams are embedded into primary care providers' practices along with nurse coordinators who perform home visits to coordinate care and ensure patients' needs are met.
Home Health Care News: Sprinter Health Continues To Capitalize Off Of In-Home, In-Person Capabilities (11/21) - Sprinter Health and Firefly Health, two companies dedicated to improving access to home-based care, are partnering to bring a new hybrid model of telehealth and at-home care to patients in the Boston area. The new partnership will aim to improve access to care by integrating Sprinter Health’s in-home clinical services into Firefly Health’s virtual primary care model. Through the partnership, Firefly patients will be able to get lab draws, vitals checks, electrocardiograms, diabetic eye exams and other services at their home.
Health Leaders: Parkview Health Expands Virtual Care Offering (11/21) - Parkview Health, an Indiana-based network announced a new program which will offer virtual care programs designed to support patient recovery and self-management at home. The program, featuring patient engagement, device-based monitoring, and telehealth tools to manage patients who are at risk of readmission, is being deployed in partnership with Veta Health, a provider of remote patient monitoring services. By leveraging remote monitoring devices and telehealth capabilities to support the care journey, the program will offer connected layers of interaction and support from care teams to optimize recovery and outcomes.
Chief Healthcare Executive: Solving the Blindspots in Transitional Care (11/20) - Starting in January, CMS plans payment cuts so substantial that the National Association for Home Care and Hospice, the leading industry group, says more than half of the country’s home health agencies will operate at a deficit. The combined impact of the proposed payment cuts and a continued shift away from the traditional Medicare fee-for-service (FFS) model is a not-so-subtle nudge for home health agencies to innovate—both clinically and financially— and to do so with urgency. This change represents a generational opportunity for forward-thinking agencies to embrace and effectively implement new models of providing in-home care.
New York Times: What if You Could Go to the Hospital … at Home? (11/19) - In November 2020, Medicare officials announced that, while the federally declared public health emergency continued, hospitals could apply for a waiver of certain reimbursement requirements — notably, for 24/7 on-site nursing care. Hospitals whose applications were approved would receive the same payment for hospital-at-home care as for in-hospital care. Uncertainty over Medicare’s future involvement hinders the approach from being adopted more widely.
“Americans have been trained for 100 years to think that the hospital is the best place to be, the safest place,” said the medical director of the Brigham and Women’s Hospital Home Hospital program, Dr. David M. Levine. “But we have strong evidence that the outcomes are actually better at home.”
Home Health Care News: Home Care Provider Leaders Get Candid About Survival Amid Rising Costs (11/18) - While the tailwinds in the market remain, personal home care provider leaders have a lot more to consider about their futures than they did just five years ago. “As you look across all the providers — whether they’re in a franchise network, independent, whatever the case may be — anyone in the health care space has really gone through a lot of fatigue,” Moving Health Home member Right at Home CEO Margaret Haynes said at Home Health Care News’ Home Care Conference. “We’re just now starting to process that and it’s why maybe when you talk to individuals or family members, they might be a little crispy. It’s really because they’re starting to just come out of what has been a really traumatic experience with the pandemic.”
McKnights Home Care: Repeal of Vaccine Mandate Could be a Setback for Home Health (11/17) - A coalition of 22 states, led by Montana Attorney General Austin Knudsen, formally called on the Biden Administration to withdraw its vaccine mandate for health care workers and all related guidance. However, the National Association for Home Care & Hospice President and CEO William Dombi said that withdrawing the mandate could discourage some patients from letting health care workers into their homes and increase absenteeism among direct care staff who contract the virus.