News and Market Developments
Home Health Care News: Why Medicaid Could Be the Answer to Scaling Hospital at Home (11/22) – The Hospital-at-Home (HaH) model has gained traction in the U.S. through the AHCAH initiative by CMS. Experts believe that for the HaH model to scale, it needs a multi-payer environment, including Medicare, Medicaid, commercial insurers, and MA. Currently, only nine state Medicaid programs reimburse for HaH, but experts see potential for growth if more states adopt this approach. Massachusetts, for example, has made strides in this direction by covering HaH through its state Medicaid program, MassHealth. The hope is that increased Medicaid engagement in the HaH model will make it more accessible to a larger population, including underserved communities.
McKnight’s Home Care: Flawed High-Needs Standards Could Bar Thousands of Eligible Patients Under REACH, Study Finds (11/20) – The Realizing Equity, Access, and Community Health Accountable Care Organization (ACO REACH) program's high-needs eligibility criteria may limit access to care for some beneficiaries, according to research. The study analyzed the qualifications for high-needs designation under ACO REACH, revealing potential gaps in the criteria based on mobility-impairing conditions, durable medical equipment use, and Independence at Home (IAH) qualification. Researchers recommend adding IAH criteria to address equity and access issues, as the program is set for changes in 2024. Lawmakers have also shared health equity concerns about the REACH program. For more information, read the study here.
ICD Healthcare Network: Former CMS Official Shares Data Insights from Initial 11,000 Hospital-at-Home Patients (11/17) – CMS’ AHCAH initiative, which allowed CMS-approved hospitals to explore models for treating sicker patients at home, has garnered attention as Congress evaluates the future of HaH. Dr. Lee Fleisher, the former Chief Medical Officer and Director of the Center for Clinical Standards and Quality for CMS, discusses the initial findings from AHCAH in a JAMA Health Forum report. In the Q&A, Dr. Fleisher offers advice on launching or scaling HaH programs, regulatory considerations, and the program's potential future.
Home Health Care News: How Home Health Providers Can Make Clinicians Feel Less Alone When Delivering Care (11/16) – To address the challenges of complex home-based care patients, providers like VNA Health Group (a provider of home health, hospice and palliative care services) are utilizing data and decision support tools. The goal is to create a supportive ecosystem for clinicians, allowing them to leverage technology for effective clinical decision-making. As a result, VNA Health Group has observed promising results, such as a 34 percent greater healing rate for managed pressure injuries in 2022 compared to 2018.
Home Health Care News: More Providers See CCRC-At-Home Models as The Right Offering for Middle-Class Consumers (11/15) – Lisa Hoffman, Executive Director of Pathstones by Phoebe, a home-based continuing care retirement community (CCRC), highlights the industry shift towards home-based care, noting the preference of many senior living executives to age in their own homes. Hoffman envisions an at-home model between the CCRC and the Program of All-Inclusive Care for the Elderly (PACE) to address middle-market consumers. LifeSpire of Virginia, a continuing care at-home membership program, launched Lakewood at Home in 2019 to diversify revenue streams and cater to the middle market. The next step now is to raise awareness and share successful outcomes to promote at-home programs within the industry.
Home Health Care News: Humana’s Plans for Value-Based Care, Home Health M&A (11/15) – Humana released its annual "Value-Based Care Report," emphasizing the success of value-based care (VBC) for its MA beneficiaries. The report reveals that MA members in value-based arrangements had increased time with primary care physicians (85 percent of VBC patients saw their PCP, compared to 75 percent of non-VBC patients), higher rates of preventive care, and fewer hospitalizations (30.1 percent decrease in in-patient admissions for VBC patients compared to traditional Medicare beneficiaries). Humana, with approximately 5.8 million MA members, aims to strengthen its pharmacy, home health care, and primary care verticals, focusing on value-based models in home-based care.
Modern Healthcare: How Best Buy, Mass General Brigham Are Advancing At-Home Care (11/8) – Best Buy Health will support and scale Mass General Brigham's Healthcare at Home operations, offering services for acute-level patients and those recovering from illness or injury. The collaboration will involve using Best Buy's Current Health technology platform and Lively Mobile Plus personal emergency response system. The partnership aims to improve at-home care coordination through co-developed tools and expects to shift 10% of inpatient care to patients' homes over the next five years.
Geisinger: Tomorrow Health and Geisinger Health Plan Release New Data Demonstrating Improved Home-Based Care Delivery (11/8) – Tomorrow Health, a leading home-based health care platform, has collaborated with Geisinger Health Plan (GHP) to improve home-based care delivery, showcasing positive impacts on health plan costs, member satisfaction, and overall health outcomes. Tomorrow Health's approach has streamlined the home-based care process for GHP, resulting in a four-time return on investment, 95 percent member satisfaction, 87 percent end-to-end visibility of orders, 83 percent reduction in care and supply delivery times since March 2021, and positive supplier performance improvements.
Home Health Care News: How CMS’ Goal to Enroll All Medicare Beneficiaries in ACOs Could Impact Home-Based Care Providers (11/7) – CMS stated its objective to enroll all Medicare beneficiaries in accountable care relationships by 2030. Currently, around 13.2 million traditional Medicare beneficiaries are assigned to ACOs. At-home care providers, such as VillageMD, are actively collaborating with ACOs, or participating in the ACO REACH Model. Additionally, Medicare Shared Savings Program (MSSP) ACOs offer opportunities for home-based care providers to enter the space, particularly in post-acute care. Mandatory participation in ACOs may be considered in the future as CMS works toward its enrollment goal.
McKnight’s Home Care: BMA urges MA plans to improve in-home health risk assessments (11/6) – The Better Medicare Alliance (BMA) has called for increased transparency and thorough reporting of in-home health risk assessments (HRAs) in MA to address concerns about potential misuse for inflating payments. The move follows an Office of the Inspector General investigation in 2020 that revealed billions of dollars had been paid out due to improper in-home HRA practices. BMA recommends mandates for reporting HRA metrics, delivering results to PCPs, and ensuring compliance with CMS guidelines. The alliance also advocates for expanded best practices and continued attention to regulatory adherence in in-home HRAs to assess beneficiaries' overall health effectively.
Los Angeles Times: Opinion: I’m One of Millions Struggling to Care for Aging Parents. It Shouldn’t Be this Hard (11/5) – The author shares their personal experience as one of the estimated 38 million unpaid caregivers in the U.S., highlighting the challenges faced by caregivers due to the aging population, inadequate support systems, and the impact on their mental and emotional well-being. The increasing demand for home health and personal care aides emphasizes the workforce shortage and the struggles faced by caregivers that often leading to high turnover. The author advocates for immigration policy reforms, living wages for caregivers, and government subsidies to support both professional and family caregivers in providing essential care for the aging population.
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