In this twice-monthly newsletter, you will find 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.
This newsletter recaps current events and research. Please send any news or events to email@example.com for future inclusion in this newsletter.
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'Choose Home' Introduced in the Senate and Projected to Save Up to $247 Million Annually
The home health industry reached a major legislative milestone with Senators Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.) teaming up to introduce a new bill to support in-home care.
The Choose Home Care Act of 2021 has been gaining momentum on Capitol Hill over the past several months. If enacted, the legislation would enable certain Medicare patients to receive extended care services as an add-on to the existing Medicare home health benefit for 30 days following a hospital stay.
In addition to receiving skilled nursing or rehabilitation services from their home health provider, for example, a patient could potentially receive meals, non-emergency transportation, remote patient monitoring, and other services. The idea is to give today’s highly diversified in-home care providers more flexibility and financial support to keep at-risk Medicare beneficiaries at home and out of costlier facility-based settings, in turn saving the U.S. health care system hundreds of millions of dollars a year.
Co-sponsors of the newly introduced Choose Home bill include Senators Ben Cardin (D-Md.), Susan Collins (R-Maine), Maggie Hassan (D-N.H.), James Lankford (R-Ohio), Bob Casey (D-Pa.) and Cynthia Lummis (R-Wyo.).
AARP, The National Association for Home Care & Hospice (NAHC), LeadingAge, Allies for Independence, and Moving Health Home 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.
You can find the MHH Choose Home Fact Sheet here and the MHH Letter of Support here.
Healthcare IT News: Intermountain expands reach, broadens offerings of hospital at home program (8/6) - Intermountain has long been an innovator in providing hospital-level care at home, and predicts that the trend will only increase, given the cost savings and better outcomes it can enable, and the fact that many patients prefer it. Intermountain points to research that shows some patients spending a smaller proportion of the day sedentary (12% vs. 23%) or lying down (18% vs. 55%), with less frequent 30-day readmissions (7% vs. 23%). This past March, Intermountain, along with other major health systems and technology services such as Amazon Care, launched the Moving Health Home initiative – with the goal of "[changing] the way policymakers think about the home as a site of clinical service."
Home Health Care News: Hospice Provider Compassus Sees a Future Delivering High-Acuity Care in the Home (7/20) -Compassus has long solidified its spot in the increasingly crowded hospice field. But as the company continues to move forward, it’s positioning itself as an all-around post-acute care provider, with the core of its model being home-based care. They are also a founding member of Moving Health Home, a coalition formed to advance all sorts of home-based care, including hospital-at-home models. “The goals of Moving Health Home align with how Compassus is innovating home-based care delivery and transforming the future of health care,” Deal said in April. “We know receiving care at home is the preference of most patients, results in higher quality and patient and family satisfaction, and lowers overall cost.”
Franchise Times: Healthcare Franchises Race to Boost Home Care (7/28) - “The pandemic showed us how important it is to keep the most vulnerable safe at home,” BrightStar Care CEO Shelly Sun said, noting death rates from COVID-19 among elderly residents at skilled nursing facilities and other group settings. In March 2021, her franchise joined Moving Health Home, a new coalition aimed at changing federal and state policy to enable the home to be a clinical site of care. Home Instead and Right At Home, both home healthcare franchises, are also members of the new coalition along with non-franchise members.
Medicare Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT); and
Pioneer ACO Model.
Evaluation data for the HHVBP Model showed cumulative gross savings of $423 million in the first three years of the model (2016–2018). The evaluation has shown that this value-based purchasing model has led to higher quality in home-health agencies within model states compared to home-health agencies in non-model states, and to a reduction in unplanned hospitalizations and use of skilled nursing facilities in model states compared to non-model states.
Representatives DelBene, Welch, LaHood Introduced Bipartisan Legislation to Incentivize Value-Based Health Care (7/24) - The Value in Health Care Act would modify the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The bill specifically amends many of the program parameters of Medicare’s Alternative Payment Models (APMs). The changes would increase participation in these value-based health programs that are designed to improve the quality of care and health outcomes for seniors while lowering costs. Many of the proposed changes in the bill would make it easier for value-based care arrangements to be more innovative in how and where they deliver care, such as the home.
Senators Burr, Bennet Introduced Bipartisan Legislation to Enhance Accessibility of Innovative At-Home Treatments For Wound Care(7/20) - The Better Wound Care at Home Act serves to update payment rules at CMS to give Americans better access to cutting-edge technology and treatment options used in home health settings. “The need for at-home treatment has been underscored during the COVID-19 pandemic,” said Senator Bennet. “We can improve the health and quality of life of our seniors by giving them access to appropriate care that incorporates cutting-edge technology from the comfort of their homes. This bipartisan legislation will help home health care workers provide their patients with the best, highest-quality care in their own homes while reducing hospital visits and health care costs.”
Representatives Guthrie and Nunes Announced Healthy Future Task Force Subcommittees and Chairs; Focus on Personalized Care(7/19) - House Energy & Commerce and Ways & Means Republicans Brett Guthrie (KY) and Devin Nunes (CA) launched five new health panels that will lay out House Republicans’ health care agenda and craft legislative proposals as part of the GOP’s Healthy Future Task Force. One of the panels will focus on doctor-patient relationships and aims to empower Americans to have a personalized health care plan with their providers. From the MHH perspective, we believe to offer personalized and patient-centered care, we must remove barriers across our health care system limiting care in the home. As such, we will advocate for the panel to prioritize home-based care.
Research and Polling
Clinical Journal of the American Society of Nephrology: COVID-19 among Adults Receiving Home versus In-Center Dialysis (8/4) - In-center hemodialysis (HD) patients face greater communicable disease risks, including drug-resistant bacterial colonization and viral hepatitis, compared with home dialysis patients, who limit these risks, avoiding three-times weekly travel to dialysis clinics for treatments. Minimizing the high coronavirus disease 2019 (COVID-19) morbidity in dialysis patients is essential. This research explored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive rates, COVID-19–related hospitalization, mortality, and intensive care unit (ICU) admission by dialysis modality.
Home Health Care Services Quarterly: "I felt useless": a qualitative examination of COVID-19's impact on home-based primary care providers in New York (7/23) - This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. The paper adds to the literature by describing these providers’ experience in managing care of vulnerable population of homebound older adults during a pandemic, and providing strategies for managing health care workers’ well-being during this and future crises.
Quil: Homes as Healthcare Hubs (7/19) - This white paper discusses how to connect health at home to fit the growing consumer demand for home-based healthcare solutions. The paper tracks trends in consumer health engagement and loyalty; identifies approaches to engage caregivers; and targets patient and caregiver needs for healthcare at home. Key findings include:
Satisfaction in care is not enough. An estimated 80% of patients would consider switching from a provider they were happy with if they found another, more convenient provider.
An estimated 72% of patients report having a medical provider recommend health interventions in a tailored fashion is "very important."
America's caregivers spend an average of 32 hours a week serving as a caregiver in addition to their full-time jobs.
News and Market Developments
Intermountain Healthcare: Intermountain Healthcare Expands Access, Convenience, and Equity of Care for Patients Through Hospital-Level Care at Home Program (8/5) - Intermountain Healthcare has expanded the reach and offerings for hospital-level care at home services available to patients and is now treating COVID-19, as well as other acute and chronic clinical conditions, since initial launch of the program in May 2020. Hospital-level care at home is now available to patients from 12 of Intermountain’s hospitals in Utah, from Logan to St. George (385 miles), with an additional hospital location being added this summer. These services are offered as an option to Intermountain patients who meet specific clinical and non-clinical criteria who come in through an emergency department visit or have been admitted to the hospital and qualify for early discharge.
Fierce Healthcare: Current Health ramps up home-based care services with Workpath, ScriptDrop partnerships (8/4) - Current Health has launched a curated network of in-home service partners that will integrate with its remote monitoring platform. As part of the launch, Current Health will offer platform integrations with Workpath for in-home blood draws and also with ScriptDrop to enable medication delivery. “By developing a robust network of in-home service partners, we hope to support our customers by filling any gaps in their workforce so they can focus on delivering high-quality care at home," said Chris McCann, CEO and co-founder of Current Health. Workpath and ScriptDrop are the first of many partnerships that Current Health plans to develop at a local, national and global level, ranging from transportation services to in-home infusion therapy. The company will provide an open application programming interface (API) to allow partners to easily make services available within the Current Health platform.
McKnight's Senior Living: The new world of home health will center around hospital-at-home, SNF-at-home, experts say (8/4) - The pandemic has helped to give rise to innovative models such as hospital-at-home and skilled nursing facility (SNF)-at-home. But to be part of these programs, home health agencies need to prepare. That is according to a home care CEO and a technology expert, who spoke Tuesday at the National Association for Home Care & Hospice’s Financial Management Conference. Hospital-at-home is growing fast, the speakers noted. As of April, 116 hospitals in 53 systems across 29 states had Medicare-approved hospital at home programs. To be part of these models, agencies should consider which one is right for them, find the right partners and have the right technology. They will also need to think about their payment structure and whether revenue will come per patient, per visit, shared savings or a combination of all.
Health Evolution: COVID-19 related Medicare waiver is a tipping point for hospital at home (8/4) - “There have been around 140 or 150 hospitals that have applied for and received the waiver,” says Linda DeCherrie, MD, Professor of Geriatrics and Palliative Medicine and Clinical Director of Mount Sinai at Home. She says the number would have been higher, if not for the uncertainty surrounding the pandemic. “I am hoping there is some Senator who thinks this is important enough and will introduce a bill or add it to a bill to extend the current waiver for a few more years,” says DeCherrie. “We should then use that time to develop a long-term payment strategy for hospital at home." Outside the hospital at home space, the larger home health market is expected to rapidly grow over the coming decade, with a renewed commitment from CMS and more investments poured into innovators in this space, including Prospero Health, Dispatch Health, Landmark Health, WellSky and others.
pharmaphorum: Fresenius launches VR-based training for home dialysis patients (8/4) -Fresenius has launched a virtual reality based training program for people undergoing home dialysis in Germany, its home market, ahead of a rollout in other countries later this year. The VR system is designed for use in patients undergoing peritoneal dialysis. The hardware (VR glasses and a controller) is accompanied by various training software modules that guide patients through the steps of the dialysis process, including hygiene practices, setting up and dismantling the dialysis apparatus, and bag changing. Crucially, the technology also allows nursing personnel to train several people at once, freeing up time for other tasks, and the standardized approach means every patient receives the same information, delivered in the same way.
Portland Business Journal: Bringing the hospital home: Taking high-level care beyond hospital walls (8/3) - Hospital at Home approaches come backed by years of data showing they are effective. In April 2020 Kaiser Permanente launched its program “KP@HOME.” With KP@HOME, patients are digitally connected to a KP doctor who checks in daily. At any time, doctors can order hospital-level care, right down to medically tailored meal delivery. Meanwhile, a nurse practitioner conducts regular home visits and paramedics can administer medication as needed to a patient in their home. Patients can also initiate face-to-face meetings with their nurse via a tablet, phone, or medical alert bracelet.
Worcester Business Journal: UMass Memorial launches at-home hospital service (8/3) - UMass Memorial Health accepted its first patient into the new telehealth program, Hospital at Home. Along with virtual vital-sign monitoring and visits from doctors, patients can have medications and therapy delivered to their homes. The team aims to care for five new patients per day in August, and 10 per day in September. UMass Memorial received funding from the Centers for Medicare & Medicaid Services in May for the program.
PopHealth Podcast: DispatchHealth Co-Founder Kevin Riddleberger (8/2) - Tune in to this episode where Kevin shares how Dispatch has grown into 18 states and how Dispatch has lead the way preventing emergency department visits and bringing healthcare home.
MEDPAGE TODAY: Bring House Calls Into the 21st Century (8/2) -In-home care has demonstrated the ability to facilitate high-quality care and patient health outcomes across a broad range of applications. In-home care can also be a resource for providers to address gaps in our healthcare system. Meeting patients in their home is an effective way to expand providers' reach without the investment in building new clinics or labs, a key solution to the vast care deserts across the country. This expansion of access and ability to offer those in medically underserved areas high-quality care is important to advancing health equity. What's needed next is for the healthcare system to be willing -- as we've begun to see with telemedicine -- to test, measure, and analyze where and when in-home care can deliver on the triple aim of higher quality care, lower costs, and an improved patient experience.
American Academy of Home Care Medicine (AAHCM):Independence at Home Demonstration Program Improves Health and Reduces Costs for a Sixth Consecutive Year (7/29) - AAHCM celebrates the successful cost savings and quality achievements of those practices participating in the CMS Independence at Home (IAH) Demonstration for Performance Year 6 (F. Y. 2019). The IAH program tests whether home-based primary care reduces Hospitalizations, readmissions, and Emergency Department visits; improves health outcomes; reduces the cost of health care services; and achieves beneficiary and family caregiver satisfaction. In their report, CMS found that expenditures for the IAH Practices’ applicable beneficiaries were approximately 13.8 percent below their spending targets (amounting to savings of $32.3M), with an average reduction of $5,054 per beneficiary.
Home Health Care News: Signify Health's Home-Based Hospital Transition Program Gains Steam (7/21) -Signify announced that it has activated its “Transition to Home” program for over 50 hospitals in 12 states. The program allows Medicare patients to receive clinical and social care support as they transition from the hospital to the home, and is designed to reduce avoidable in-patient readmissions and ER visits. While the program is virtual now, that is not how Rothman nor Signify views it permanently. As things move forward, the hope is that more in-person visits can be conducted to improve the model further. Over time, Signify is hoping to not just expand the program’s offerings, but also scale it to more providers and payers across the country.
Home Health Care News Events:
Demo Day (August 19) - Virtual. See the latest demos from leading companies, and see how their solutions can help you thrive in this fast-growing and changing environment. All demos are pre-recorded and will be available for you to watch at your convenience.
FUTURE(September 30) - Chicago, IL. FUTURE delivers big picture thinking on trends shaping home health that executives need to consider as they develop their plans to invest and grow their businesses.
Home Care Conference (December 9) - Chicago, IL. It will bring together home care senior and regional executives, investors, and other professionals to explore non-medical home care trends and challenges in staffing, technology, sales, and marketing.
Elizabeth Fowler, JD, PhD, CMMI Director and CMS Deputy Administrator is among the keynote speakers and has publicly stated moving health into the home as a CMMI topic of interest and exploration. Early bird registration rates expire on Friday, July 23.
NASHP’s 34th Annual State Health Policy Conference: State Health Policy Unmuted(September 21-22) - Join hundreds of state leaders, from all 50 states and DC, as NASHP discusses the timely, cutting-edge issues facing state health policymakers, and highlights innovative solutions shared by the nation’s leading experts on topics including: lowering Rx costs, hospital costs, Medicaid, health insurance marketplaces, telehealth, social determinants of health, behavioral health, and more. This is a great opportunity to get a pulse on state priorities and opportunities to promote moving health into the home, especially as states grapple with improving health equity and lowering costs. Early bird registration rates expire on Friday, August 27.
National Association for Home Care and Hospice Conference and EXPO (October 3-5) -New Orleans, Louisiana. The Home Care and Hospice Conference and EXPO is the premier and largest educational and networking event for home care and hospice providers, owners, and industry leaders. The EXPO features over 150 companies represented each year, offering a wide variety of products, services and cutting-edge technologies. Additional details are TBA.
Virtual Hospital at Home User Group Annual Meeting(October 28) - As a pre-conference to the American Academy of Home Care Medicine’s meeting, the User Group will be hosting a day-long meeting that will include presentations from national leaders, panel discussions, and working sessions focused on practice and policy concerns, as well as a poster session, a photo/video contest, and much more.
American Academy of Home Care Medicine Virtual Annual Meeting(October 29-30) - At their annual meeting, you will have the opportunity to explore innovative models of care, learn evidence-based best practices, discover new strategies to improve care coordination through interdisciplinary care, and acquire the skill set to implement rapid performance improvement at this year’s conference. Example sessions include:
SNF at Home: Successes and Challenges of Launching a Home-based Post-Acute Care Program. This session will focus on describing successes, challenges, and lessons learned involved with launching a SNF-at-Home program.
Home-based Medical Care: Evolving from Fee for Service to Global Risk. Such models in the US have struggled because of the inability to have a sustainable business model in a fee-for-service payment system, in particular, Medicare fee-for-service. In this session, we discuss the conditions needed to allow a home-based medical care model to thrive and grow.