October 6, 2023

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

Moving Health Home: MHH Responds to House Ways & Means Rural RFI (10/3) - MHH submitted comments to the House Ways & Means Committee request for information on addressing chronic disparities in access to health care in rural and underserved communities. MHH provided comments on workforce investments and several in-home innovative models as described in the Expanding Care in the Home Act (H.R. 2853). MHH urges Committee to consider the Expanding Care in the Home Act (H.R. 2853). 

Moving Health Home: MHH Submits Comments to the Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule (9/11) - MHH submitted comments on the proposed rule for the CY 2024 Medicare Physician Fee Schedule (PFS). Specifically, MHH commented on the proposed payment for caregiver training services and policies related to continuing the additional payment for at-home COVID-19 vaccinations and other preventive vaccinations. 

Congress

Senate: Senate Introduction of the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (S. 3021) (10/4) - On October 4, Sens. Sinema (I-AZ), Blackburn (R-TN), and Klobuchar (D-MN) introduced the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (S. 3021), which would permanently extend certain in-home cardiopulmonary rehabilitation flexibilities established in response to COVID-19. Rep. Joyce (R-PA) and 29 bipartisan cosponsors introduced the companion legislation in the House (H.R. 1406) on March 7.

Senate: Sen. King (I-ME) Introduced the Preventative Home Visits Act (9/27) – On September 27, Sen. King (I-ME) introduced the Preventative Home Visits Act (S. 2941), which would provide coverage of preventative home visits under Medicare and ensure the accessibility of telehealth services.

Senate Finance Committee: Aging in Place: The Vital Role of Home Health in Access to Care (9/19) – The Senate Finance Committee held a hearing which discussed the Medicare home health benefit and the surrounding landscape, particularly given proposed cuts to home health reimbursement by CMS. Witnesses described the effects of cuts on home health agencies and provided data points to describe the current state of the home health industry.

The Hill: Protect Medicare Patients’ Right to Get Care at Home (9/18) – This op-ed highlighted the importance of home health care for older Americans and individuals with disabilities. Home health care provides a safer, more personalized, and cost-effective solution for post-hospitalization recovery. Despite its benefits, Medicare is proposing significant cuts to home health care services, which will total more than 9 percent starting in 2024, resulting in a $20 billion reduction over the next decade. To address this issue, lawmakers have introduced the Preserving Access to Home Health Act to prevent these cuts and explore long-term solutions.

House of Representatives: Rep. Fitzpatrick (R-PA) Introduced the Joe Fiandra Access to Home Infusion Act of 2023 (9/12) – On September 12, Rep. Fitzpatrick (R-PA) introduced the Joe Fiandra Access to Home Infusion Act of 2023 (H.R. 5397), which would provide coverage of external infusion pumps and non-self-administrable home infusion drugs under the Medicare program.

House of Representatives: Rep. Balderson (R-OH) Introduced the Expanding Remote Monitoring Access Act (9/12) – On September 12, Rep. Balderson (R-OH) introduced the Expanding Remote Monitoring Access Act to ensure appropriate access to remote monitoring services furnished under the Medicare program. The legislation was discussed during a House Energy & Commerce Health subcommittee legislative hearing, where Dora Hughes Acting Director of the Center for Clinical Standards and Quality in CMS, committed to working with Congress on this bill.

Medicare Payment Advisory Commission (MedPAC): Medicare’s Acute Care Hospital at Home Program (9/7) – During a session of MedPAC’s September public meeting, Commissioners discussed key considerations related to Hospital at Home (HaH) programs, especially as it relates to available data on patient experience and costs. Commissioners broadly expressed support of HaH and the overall movement toward care in the home. They also discussed a need for more data on patient access, caregiver experience, cost, and equity.

Administration

National Institutes of Health: NIH to Address Unmet Clinical Needs in Testing, Monitoring, and Treatment Technologies (9/21) – The National Institutes of Health (NIH) is advancing the development of home-based and point-of-care health technologies by awarding grants to six technology research and development centers forming the Point of Care Technology Research Network (POCTRN). These centers will receive a total of $9.6 million in the first year of a five-year grant period. The aim is to develop innovative point-of-care devices that address unmet medical needs in the United States and globally, improve the delivery of health care closer to the patient and ultimately enhance outcomes.

Administration for Community Living (ACL): ACL Awards $3.6 Million to Improve Support for Family Caregivers (9/20) – ACL announced four new cooperative agreements, totaling over $3.6 million, in support of the 2022 National Strategy to Support Family Caregivers. The project period is September 30, 2023-September 29, 2027. Grantees will develop, test, and disseminate new approaches for supporting family caregivers, using the Strategy as a roadmap.

Assistant Secretary for Planning and Evaluation (ASPE): Direct Care Worker Wages (9/1) – Despite the essential role direct care workers (DCW) play in the lives of over 20 million Americans, DCW wages fall short of making jobs competitive with other entry level positions with similar requirements. To better understand the extent of the wage gap between DCWs and other workers, this brief presents results of a descriptive analysis comparing state-level median wages of DCWs with median wages of workers employed in other entry-level jobs. 

Research and Polling

Journal of the American Geriatrics Society: Caregiver Burden in a Home Hospital vs Traditional Hospital (10/3) - Hospitals are standard of care for patients with acute illness, but hospitalization can result in heavy financial burden and iatrogenic risk, particularly in older populations. An alternative to inpatient care, “home hospital” provides acute hospital-level care in patients' homes. There is are concerns around caregiver burden due to participation in hospital at home programs. This study found that caregiver burden is mild to moderate upon admission and discharge in both home and traditional hospitalization. The results suggest that these programs are a viable alternative for acutely ill patients with caregivers insofar as it is unlikely to cause undue burden on caregivers.

Journal of the Catholic Health Association of the US: Double-Duty Caregiving: Clinicians Caring for Others at Work and Home Need Support (9/30) – Many health care workers are becoming double-duty caregivers, caring for patients at work and loved ones at home. This dual role takes a toll on their physical and mental health, leading to stress and burnout. However, the extent of this issue is often underestimated, as health care workers do not always disclose their caregiving responsibilities to their employers. Innovative solutions and support programs are needed to address the unique challenges faced by double-duty caregivers in health care.

The American Journal of Managed Care: Defining a Path Toward Improved Heart Failure Care (9/7) – The article discusses strategies to enhance the quality of heart failure (HF) clinical care while reducing costs. To provide patients with lower-cost care and improved quality of life (QOL), including reductions in hospital readmission, the study suggests novel care delivery approaches like hospital-at-home and digital tools. Accordingly, patients with HF who received at-home care, including telephone support from physicians, reported lower depression levels, improved QOL, and longer time to readmission than did patients who received hospital-based care.

Clinical Journal of the American Society of Nephrology: System-Level Strategies to Improve Home Dialysis: Policy Levers and Quality Initiatives (9/6) – This article highlights the importance of advocacy and policy changes in improving the quality of care and support for patients on home dialysis. While there is growing recognition of the value of home dialysis for patients seeking independence and flexibility, most dialysis patients in the United States still receive treatment in health care facilities. The article discusses trends in home dialysis use, the evolving understanding of high-quality care for home dialysis patients, and policy and advocacy efforts in the US and other countries.

Health Affairs: Home-Based Medical Care Use in Medicare Advantage and Traditional Medicare in 2018 (9/5) – In 2018, the utilization of home-based medical care varied between Medicare Advantage and traditional Medicare. Medicare Advantage beneficiaries were 31 times more likely (18.6 percent) to have exactly one such visit compared to traditional Medicare beneficiaries (0.6 percent). This discrepancy likely stemmed from the incentives within the Medicare Advantage program to accurately code all diagnoses. However, when it came to multiple home-based medical care visits, they were less common in Medicare Advantage (1.6 percent of beneficiaries) compared to traditional Medicare (2.1 percent of beneficiaries).

News and Market Developments

Fierce: Costco Expands Healthcare Footprint, Teams Up with Sesame to Offer Members $29 Virtual Care Visits (9/25) – Costco is partnering with startup Sesame to offer special discount pricing on outpatient medical care services, including telehealth, to its members by booking appointments directly through their Costco memberships. According to Costco executives, bringing health care into their home allows Costco members to have access to care in a setting that’s right for them and the opportunity to develop long-term doctor-patient relationships with a Sesame provider.

Home Health Care News: ‘A Huge Opportunity’: Behind Health Systems’ Home-Based Care Initiatives (9/25) – Health systems and hospitals, such as Upstate University Hospital and Intermountain Health, are increasingly focusing on providing care in patients' homes to expand their reach and better address community health needs. Both organizations have seen positive outcomes from their hospital-at-home programs, with reduced readmission rates and medical expenses. However, shifting care into the home comes with coordination challenges, regulatory uncertainties, and reimbursement remains a major concern. Despite these challenges, health systems continue to explore home-based care options and anticipate growth in this area.

Home Health Care News: How LHC Group, Compassus, Choice Health at Home Are Building ‘Next-Generation Home Health Platforms’ (9/20) – Home-based care providers are evolving into next-generation entities to thrive in modern health care. Organizations like Compassus focus on integrated senior care, including home health, hospice, palliative care, infusion therapy, and advanced care management. PathWell emphasizes the Medicare Advantage population, and Choice Health at Home invests in its employees, embraces palliative care, and adopts remote patient monitoring. 

PR Newswire: Mercy Launches First Hospital-at-Home Program in St. Louis Region (9/20) – Mercy, in collaboration with Maribel Health, has launched its Mercy Hospital-at-Home program, providing hospital-level care in patients' homes. The program covers all aspects of clinically appropriate care and is managed by an interdisciplinary team of doctors, nurses, pharmacists, and others who oversee patients through in-person and virtual visits. The program aims to reduce the burden on hospitals, provide high-quality care in the home, and meet the changing needs of patients.

Becker's Hospital Review: CVS Leans into Primary Care (9/19) – CVS Health is planning to expand its primary health care services and leverage analytics and technology to enhance preventive care. CVS Health aims to personalize care by using analytics and technology to reach patients where they are, offering services such as automated reminders and virtual care for routine screenings.

MedCity News: Remote Patient Monitoring: Gaining Insight into Patient Health from Afar (9/18) – Remote patient monitoring (RPM) demonstrates several benefits for clinicians and patients, including the advantages of easy access to patient data, enhanced management of chronic conditions, and unprecedented boosts in efficiency. RPM is revolutionizing health care by allowing clinicians to monitor patients' vital signs and conditions remotely. Additionally, it enhances efficiency by prioritizing patient needs and optimizing workflows, reducing hospital visits, and readmissions.

PR Newswire: Caring for Caregivers: Prioritize Brain Health to Reduce the Risk of Alzheimer's Disease (9/18) – Home Instead, an in-home care provider for older adults, is expanding the role of caregivers to support individuals with Alzheimer's. The stress, sleep deprivation, and lack of self-care that caregivers often experience can contribute to the development of the disease. With 80 percent of Alzheimer's care provided in the home, Home Instead aims to protect the well-being of Alzheimer's caregivers. 

McKnights Home Care: Peer-to-Peer: Mass General Brigham Strengthens Hospital-at-Home Efforts Despite Expiring Waiver (9/18) – Mass General Brigham's Home Hospital program, launched in 2016 and expanded in 2022, allows patients to receive hospital-level care in their homes. Despite the uncertainty of the Acute Hospital Care at Home waiver's expiration at the end of 2024, the program continues to grow and adapt. Mass General Brigham has found success in patient outcomes and experiences, as well as cost savings and reduced readmissions, compared to inpatient care. The program offers comprehensive services, including pharmacy, medication, hydration, infusions, diagnostics, remote patient monitoring, transportation, and more.

Home Care Magazine: Best Buy Health, Geisinger Expand to Improve Chronic Disease Management at Home (9/14) – Best Buy Health and Geisinger are expanding their partnership to provide in-home care for patients with chronic conditions. Geisinger launched its ConnectedCare365 chronic care management platform in 2021 and has enrolled more than 1,100 patients in remote patient monitoring programs. Best Buy Health, through its Geek Squad agents, delivers, installs, and activates remote care management devices for these patients.  Best Buy Health and Geisinger plan to design a comprehensive package of technology and services to support health care organizations in managing chronic conditions at home.

McKnight’s Senior Living: Demand for Direct Care Workers Expected to Outpace Availability: Report (9/13) – The demand for direct care workers, including home care workers, nursing assistants, and residential care aides, is expected to rise significantly over the next decade. The direct care workforce is projected to add over 1 million new jobs between 2021 and 2031, making it the fastest-growing job sector in the country. 

Home Health Care News: Walgreens Will Leverage CareCentrix for Hospital-To-Home Transitions in New Partnership (9/12) – Walgreens Boots Alliance is partnering with Pearl Health to expand value-based care offerings. Pearl Health, a provider enablement company, will help primary care providers transition from fee-for-service models to value-based care. Additionally, Walgreens will collaborate with participating providers to support patients transitioning from the hospital to home through CareCentrix, a health-at-home solutions company acquired by Walgreens in 2022. The company plans to leverage its pharmacy services and community presence to better address the needs of patients with complex or chronic conditions in home-based care.

Mass General Brigham: Mass General Brigham to Expand Home Hospital to 3 Community Sites (9/11) – Mass General Brigham Healthcare at Home is expanding its Home Hospital service to reach more patients across the region. Mass General Brigham Healthcare at Home currently operates one of the largest Home Hospitals in the country, providing acute care for patients at home who would traditionally need inpatient hospitalization. The expansion aims to increase facility hospital bed availability and shift 10 percent of inpatient care to patients' homes over the next five years.

mHealth Intelligence: Health Technologies Driving Hospital-at-Home Programs (9/7) – The H@H model, which extends care access beyond hospitals, has gained popularity, especially during the COVID-19 pandemic. RPM devices play a crucial role in this model, with various wearable and ambient tools collecting vital signs and transmitting data to care teams. Telehealth technology enables direct communication between clinicians and patients, offering synchronous and asynchronous methods for remote care. 

NYT: You Shouldn’t Have to Take Care of Your Aging Parents on Your Own (9/6) – The rising demand for caregiving in an aging society with many older Americans wanting to age in place, coupled with the financial and emotional pressures on family caregivers, calls for a new system of support. Already, around 42 million Americans are providing informal support to someone 50 or older, and many of them are struggling under the financial and psychological pressure. Legislative proposals to improve compensation, training opportunities, and support for family caregivers could alleviate some of these challenges.

Medical Economics: How Primary Care Physicians Can Use Home-Based Care Models to Reach Rural Populations (9/6) – The United States is facing a significant shortage of health care professionals, including primary care physicians, with projections suggesting a shortage of between 37,800 and 124,000 in the next decade. Rural areas are particularly affected and nearly 30 percent of rural hospitals are at risk of closing, resulting in adverse health outcomes. Primary care physicians in these areas are experiencing historic levels of burnout due to increased workloads. To address these challenges, innovative solutions such as telemedicine, remote monitoring, and home-based care initiatives are needed.

Home Health Care News: How Amedisys, Walgreens and Intermountain Healthcare Are Building 360-Degree Home-Based Care Models (9/5) – Many health care organizations, including home health providers, health systems, and retailers, are transitioning to 360-degree home-based care delivery models that encompass a wide range of services and care settings. Amedisys, a home-based care provider, expanded its services into higher-acuity care through its acquisition of Contessa Health, recognizing the need to provide more comprehensive care to meet the demands of Medicare Advantage and payer partners. Other major health care players, like UnitedHealth Group's Optum and Walgreens Boots Alliance, have also embraced home-based care as part of their strategic initiatives.

HealthTech Magazine: Remote Patient Monitoring Plays Important Role in Advancing Home Healthcare (9/1) – RPM devices are transforming health care by extending care beyond hospital walls and enabling health care organizations to monitor and manage patient health wherever they are. Remote monitoring devices are particularly valuable for tracking acute conditions, managing chronic diseases, and empowering patients to take control of their health. Health care organizations should prioritize data privacy and security, provide clear expectations for device use, and address challenges such as poor connectivity to ensure successful remote monitoring implementations.

Upcoming Events

October 8-11, "HLTH 2023."

October 12, Hospital at Home Users Group, "Virtual Hospital at Home Users Group Annual Meeting." 

October 15-17, National Association for Home Care & Hospice, "Home Care and Hospice Conference and Expo." 

October 23-24, Home Care Association of America, "National Home Care Conference." 

November 9, Modern Healthcare, "Hospital at Home Virtual Briefing."

November 29-December 1, ICD Healthcare Network, "Hospital at Home Leadership Summit." 

December 7, Aging Media Network, "Continuum Conference." 

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