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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Will you be at the HLTH 2022 conference this year? Moving Health Home will be there!
Moving Health Home will host a meet-up for members, partners, funders, and others dedicated to expanding home-based health care options for Americans. We plan to meet at 6 PM PT (local time) on Monday, November 14th. The location will be in the venue expo, and be confirmed upon RSVP.
Please RSVP if you plan to or are interested in joining us. We hope to see you there!
Centers for Medicare & Medicaid Services: CMS Asks for Public Input on Establishing First, National Directory of Health Care Providers and Services (10/5) - As part of the Centers for Medicare & Medicaid Services’ (CMS) ongoing work to improve access to care, reduce clinician burden, and support interoperability throughout the health sector, CMS released a Request for Information (RFI) seeking public input on the concept of CMS creating a directory with information on health care providers and services or a “National Directory of Healthcare Providers and Services” (NDH). A CMS-led directory of data, health information and more could be of use to home-based care providers from a general data-tracking perspective. For additional coverage, see Home Health Care News.
Administration for Community Living: 2022 National Strategy to Support Family Caregivers: Federal Actions (9/21) - The Administration for Community Living (ACL) released their 2022 National Strategy, which highlights home-based services as one way to support family caregivers. Some actions to improve home-based services include a report by the Assistant Secretary for Planning and Evaluation (ASPE) on home modifications to support care in the home, ACL funding opportunity to connect older adults and caregivers to local support resources, among others.
House of Representatives: Murphy, Miller-Meeks, O’Halleran Introduce Bill to Improve Medical Device Interoperability (9/29) - Reps. Miller-Meeks (R-IA), Murphy (R-NC), and O’Halleran (D-AZ) introduced the Better Interoperability for Devices (BID) Act (H.R. 9067), which would require the Secretary of HHS to submit a report on the interoperability of medical devices. “I’m glad to partner with Reps. Miller-Meeks and O’Halleran on this important legislation to ensure the highest medical device standards for home-based care, telemedicine, clinical care, and data sharing,” said Rep. Greg Murphy, M.D.
Senate: Warner, Collins & Blumenauer Introduce Bipartisan, Bicameral Legislation to Expand Access to Advance Care Planning (9/16) - Sens. Warner (D-VA) and Collins (R-ME) introduced the bipartisan and bicameral Improving Access to Advance Care Planning Act (S.4873), which would help more Americans access critical advance care planning (ACP) services by allowing social workers to provide ACP services, removing beneficiary cost-sharing, and promoting increased education for providers on current ACP codes, and improved reporting on barriers to providing ACP services and billing the corresponding codes. Rep. Blumenauer (D-OR) introduced the companion legislation in the House (H.R. 8840).
Research and Polling
Health Affairs: Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas (10/5) - Residents living in rural America have the highest percentage of disabilities requiring personal care but have the least access to it. The report noted that caregivers living in rural areas lacked access to reliable public transportation, making it difficult and more expensive for them to reach patients. The report urged policymakers to get creative in finding solutions to the caregiver shortage, including increasing wages, providing retention bonuses and compensating workers for travel and travel time. For additional coverage, see McKnights Home Care.
Quality Management in Health Care: Intermountain Healthcare's Hospital-Level Care at Home Program (10/1) - Due to overwhelming patient volumes in hospitals as a result of the coronavirus disease-2019 (COVID19) pandemic, hospital-level care at home (HLCH) has emerged as a strategic initiative for many health systems. During the early phases of the COVID-19 pandemic, Moving Health Home member Intermountain Healthcare’s Enterprise Leadership Team and Castell aimed to initiate an HLCH initiative, identify appropriate patient populations in a novel pandemic for safe HLCH admission, and ease capacity constraints within a strained health care system, admitting the first patient to phase 1 of a modernized HLCH in May 2020. The Intermountain HLCH program was designed to be scalable across large rural geographies. The value proposition of Intermountain’s HLCH program will be assessed in future research focused on the process of HLCH care delivery, patient outcomes, implementation outcomes, and financial implications for the health system and health plan.
Annals of Emergency Medicine: 181 Hospital System Acute Care at Home to Prevent Emergency Department Visits (10/1) - Previously, the use of acute hospital-level care at home (hospital-at-home) for patients who are chronically ill has led to decreased medical costs, amount of sedentary time for patients, and hospital readmissions. Our large integrated health care system identified the need to develop a mechanism through which to prevent frequent emergency department (ED) visits in chronically ill patients and hospital admissions for patients requiring limited hospital resources. We addressed this by creating a home acute care program called Urgent Dispatch. The objective of this study was to provide a descriptive analysis of the patient population utilizing the program and identify potential emergency department visits within seven and 30 days of program enrollment.
Aging and Disability Business Institute: Policy Spotlight: Telehealth and the Role of the Aging Network (9/27) - The Aging and Disability Business Institute and the National Council on Aging developed a policy spotlight, Telehealth and the Role of the Aging Network, which provides an overview of changes to telehealth that have occurred due to the pandemic, outlines the current challenges related to access and identifies opportunities for expanding telehealth.
NORC at the University of Chicago: The Center for Discovery Program Evaluation: How the HealthE6® Model Can Support Healthy Aging (9/27) - A report, prepared by NORC at the University of Chicago (NORC), found that older adults can age successfully in a wide range of care settings as long as they are engaged, eat nutritious meals and live in an adaptive environment. The Center for Discovery has developed a model of residential care that could serve as an example of how seniors can live independently and with integrity. For additional coverage, see McKnights Home Care.
The Milbank Quarterly: Hospital-at-Home: Multistakeholder Considerations for Program Dissemination and Scale (9/23) - Hospital-at-Home (HaH) is a home-based alternative for acute care that has expanded significantly under COVID-19 regulatory flexibilities. The post-pandemic policy agenda for HaH will require consideration of multistakeholder perspectives, including patient, caregiver, provider, clinical operations, technology, equity, legal, quality, and payer. Key policy challenges include reaching a consensus on program standards, clarifying caregivers’ issues, creating sustainable reimbursement mechanisms, and mitigating potential equity concerns.
JAMA Health Forum: Association of the Home Health Value-Based Purchasing Model With Quality, Utilization, and Medicare Payments After the First 5 Years (9/23) - Home health value-based purchasing was associated with lower utilization and spending and slight improvements in quality of care. The researchers established two cohorts of home health patients. One cohort consisted of home healthcare patients who were in states with a CMS home health value-based purchasing and the second consisted of patients in the 41 comparison states. States with the home health value-based purchasing model saw lower utilization, slower Medicare spending growth, and better quality of care in some areas. For additional coverage, see Health Payer Intelligence.
AHIP: Medicare Advantage: Delivering Better Value for America’s Seniors (9/21) - Many Medicare Advantage (MA) plans offer transportation and meal delivery benefits, in-home support services, and companion care—all to help meet the unique care needs of the people they serve. A study found that MA delivers better value for patients, consumers, and taxpayers. The study also found that MA is actually significantly less expensive, even accounting for all the extra benefits and services the program provides, such as in-home support services.
Home Health Care Services Quarterly: Quality of Care in Home Health Agencies With and Without Accreditation (9/18) - According to research from New York University Rory Meyers College of Nursing, home health agencies (HHAs) that are accredited are more likely to perform better on several national indicators of quality of care. They found that accredited HHAs performed better on the three commonly used quality indicators: timely initiation of home care, preventing hospitalization and preventing emergency department visits. The findings suggest the importance and necessity of timely revising and updating accrediting standards and criteria by the accrediting organizations.
Moving Health Home Mentions
Politico:Corporate America sees opportunity in health care, but needs an assist from Congress (9/25) - In-home care has surged during the COVID-19 pandemic as hospitals tried to keep more beds open by treating patients from their homes. Retail giants see it as a business opportunity. The companies think they can provide equally effective or better care in a setting patients prefer at a lower cost to their businesses. A new care model that stresses telemedicine and at-home care makes sense. Telehealth advocates want Congress to pass provisions that allow high-deductible health plans to continue to offer telehealth before customers reach their deductibles, in-home acute care and prescribing of controlled substances via telehealth.
“Even if we just got an extension and not some broader, deeper hospital-at-home program, at least it sends the signal we need to the market,” said Krista Drobac, founder of Moving Health Home, a group aiming to expand at-home care. “Congress is interested in this.”
News and Market Developments
McKnights Home Care: Landmark Health CEO Chris Johnson: In-home primary care is now mainstream (10/6) - Landmark Health CEO Chris Johnson believes the more the merrier when it comes to big firms like CVS Health and Amazon pushing healthcare into the home. Landmark has been doing that for chronically ill seniors for nearly a decade. In this McKnight’s Home Care Newsmakers Podcast, Johnson talks about how moving healthcare into the home can improve the healthcare system and reduce costs.
McKnights Home Care: CVS Health moves deeper into the home with Aetna, Emcara Health partnership (10/6) - CVS Health has announced a new partnership between Aetna Better Health of Florida and Emcara Health. Tennessee-based Emcara will provide in-home primary care, behavioral assessments and social determinants of health assessments to adult Aetna Medicaid members. Multidisciplinary teams comprising physicians, community health workers, nurse practitioners, registered nurses, physical and behavioral health coordinators and clinical social workers will deploy into homes. The teams will collaborate to remove barriers to health care, such as transportation, food access and behavioral health.
Home Health Care News: Another Home Care Provider Finds Success In Value-Based Care Initiatives (10/4) - For years now, home-based care providers have been vocal about shifting more to value-based care. Home care providers, in particular, have been taking greater steps to make this a reality. One home care company that exemplifies this is the Dallas, Texas-based Outreach Health. Outreach Health has even been able to intervene on behalf of a senior that is having difficulties with their primary care provider. Home care providers are generally in the early stages of becoming more active participants in value-based care.
Home Health Care News: Why DispatchHealth Doesn’t Anticipate A Slowdown In Hospital At Home (10/4) - As regulatory uncertainty lingers around hospital at home, Moving Health Home member, DispatchHealth believes there is still plenty of momentum behind the model. Educating members of Congress and other policymakers on the value of hospital at home is a top priority for players in the space as DispatchHealth leans further into the model. Securing an extension for the hospital-at-home waiver program is step one. "We need to be able to provide the ability for organizations to identify these patients outside of just the ER to be admitted to the program.” Kevin Riddleberger, co-founder and chief strategy officer for DispatchHealth.
Home Care: ComForCare & At Your Side Home Care Launch Dementia Training Program (10/4) - Of the 5.8 million Americans living with Alzheimer's disease or other types of dementia, most remain in their homes throughout the progression of the disease. This option can allow greater comfort, familiarity and quality of life compared to institutional care. Although there are benefits to aging at home, research reveals individuals and families dealing with dementia at home face significant disease-related and social challenges; thus, there is an urgent and growing need for more dementia-capable homecare services. In light of the situation, stakeholders—including policymakers, administrators, families and people living with dementia—continuously emphasize interdisciplinary staff training to create a more dementia-capable workforce.
McKnights Home Care: Home care has a people problem; technology has the solution (10/4) - The U.S. population is aging, and 70% of baby boomers want to age in their homes, which often requires them to receive support from a caregiver. The problem is that the home care industry and society as a whole are struggling to keep up with demand. It’s time for home care providers to embrace innovation in the form of technology solutions. Technology doesn’t have to replace the human element in home care. Rather, it can strengthen personal care by helping create job stability and professional development opportunities to invigorate current and future generations of professional caregivers.
Hospice News: MA Palliative Care Benefits See Little 2023 Growth, But Payer Interest Remains High (10/3) - Only 10 new Medicare Advantage (MA) plans will offer home-based palliative care as a primarily health-related benefit for 2023, but payers may be offering those services through other programs. Among Medicare Advantage supplemental benefits, in-home support services and caregiver support saw the most year-over-year growth for 2023. The number of plans offering home-based palliative care will rise to 157 next year from 147 in 2022. For additional coverage, see Health Payer Intelligence and Home Health Care News.
Bionews: Healthy at Home Program Will Test COPD Preventive Care, Health Costs (10/3) - The University of Massachusetts Chan Medical School and Wellinks have launched “Healthy at Home,” a program to investigate whether virtual care can prevent recurrent illness and reduce health-related costs for people with chronic obstructive pulmonary disease (COPD). The six-month program will test the feasibility of virtual preventive care and if it complements current treatment and management plans to improve patient outcomes and reduce costs.
mHealth Intelligence: How Virtual Care Uptake Can Support Seniors Aging in Place (9/29) - The concept of aging in place is growing popular as more seniors live longer and more active lives. A virtual home can make this a reality. There are clear health benefits to enabling seniors to age in place and a widespread desire among seniors to do so. But aging in place requires a technology infrastructure that ensures seniors have access to care as and when needed.
McKnights Home Care: DispatchHealth Partners in Study Addressing UTI Testing (9/29) - In-home care provider DispatchHealth is teaming up with diagnostics testing firm Pathnostics to address one of the most commonly diagnosed ailments in older adults: urinary tract infections (UTIs). DispatchHealth’s clinical providers will enroll an estimated 6,800 patients in the study, while providing care to them in their homes. Patients will be followed to determine if and how health outcomes and management are affected based on whether the UTI diagnosis and subsequent treatment is based on a Guidance UTI or SUC.
Home Health Care News: How Home-Based Care Providers Can Win Over Policymakers, Payers (9/28) - As Medicare Advantage (MA) enrollment grows, providers need to prove their agency’s value in order to maintain a sustainable business. Meanwhile, policymakers need to understand the value of home health and home care for favorable, future-facing regulations to be implemented or withheld. In a world where the value of care is taking precedence over the volume of care, it’s important to show payers that home-based care is cost-effective and improves outcomes.
Forbes: Health Care Technology Is Enabling Millions Of People To “Age In Place” (9/27) - “Aging in Place” refers to individuals aging in their own homes rather than moving into nursing homes or other types of care facilities. Recently, the University of Pittsburgh announced that it would be starting its Healthy Home Laboratory project, aimed at “Building tech-enabled solutions to support health and independence at home.” The Pitt Healthy Home Laboratory is a community laboratory that brings the best science into home settings to maximize health and safety.
Home Health Care News: Kaiser Permanente, Geisinger, USMM Share Secrets to Home-Based Care Innovation (9/27) - AT the Home Health Care News' FUTURE event, Kaiser Permanente, Geisinger, and U.S. Medical Management (USMM) discussed what makes their companies innovative and what disruptions they are making in the home. Specifically, they noted that communication in home-based care programs is key.
Hospice News: Rippl to Offer Home-Based Mental Health Care for Seniors After $32 Million Seed Round (9/28) - Rippl, a new company offering mental health care to seniors, began operations today following a $32 million seed funding round. The company foresees opportunities to collaborate with other providers in the care continuum, including primary care physicians, home health, and hospice and palliative care organizations. Rippl’s care model is designed to provide tech-enabled, 24/7 access to mental health care for these patients in their homes. The company plans to use its seed-round capital to hire and train clinicians, build out its technology platform, and launch two pilot networks, initially in Seattle and surrounding markets.
Becker's Payer: Independence Blue Cross, Penn Medicine Partner on Value-Based Care Through Co-Ownership of Tandigm Health (9/28) - Independence Blue Cross and Penn Medicine are partnering on a value-based primary care model centered around co-ownership of Blue Cross' physician network subsidiary, Tandigm. Tandigm currently supports a network of 400 primary care physicians (PCPs) and manages care for 110,000 patients. In the future, the model may allow Tandigm PCPs to add specialty care, advanced home care and off-hours virtual care. The new model begins Jan. 1.
Advanced Care Life Services: Advanced Care Life Services Introduces the New Hospital to Home Approach (9/27) - Advanced Care Life Services, an in-home caregiver agency, announced its new Comprehensive Care Response Team (CCRT). CCRT allows patients to bypass the need of a facility stay and receive the same services in the comfort of their own home. The program provides a full range of in-home care needs, dementia, hospice, and end of life care is provided, including in-home care.
McKnights Home Care: PHI National Roll Out Senior Home Aide Guide and Training Program (9/27) - A new guide and training program from PHI National could help home care providers elevate the role of caregivers and retain staff. The guide is designed to help home and community-based services providers implement a care integration senior aide (CISA) program which allows caregivers to train for advanced roles within agencies. Integrated home care models have shown great potential in pilots. PHI National created and tested an advanced role for home care workers in 2015- 2016 called the Care Connections Senior Aide. Home health aides received 240 hours of training in key topics and were elevated to salaried aide positions.
Home Health Care News: Home Health Care Among Settings Where Masks No Longer Required, CDC Says (9/26) - The Centers for Disease Control and Prevention (CDC) issued guidance that ended a blanket indoor mask requirement which applied to workers in home health care, nursing homes, hospitals and other health care settings.
McKnights Home Care: Home Care Providers Cater To Centenarians (9/26) - Nonagenarians and centenarians increasingly are becoming more common in the United States — and in home care. Veterans Home Care, a St. Louis, MO-based home care company, helps wartime veterans or their spouses access the Veteran Administration’s Aid and Attendance Benefit, regularly cares for the oldest of the old. It currently has 40 clients who are 100 years old or older. The presence of centenarians at Veterans Home Care is a reality across the United States — and their ranks are growing. In 2016, there were 82,000 people in their 100s in the U.S. That number is expected to rise to 140,000 in 2030 and 589,000 in 2060.
Home Health Care News: Home Health Outsourcing Company InHome Therapy Enhances Value Proposition Through Acquisitions, Technology (9/26) - InHome Therapy, a therapy outsourcing partner for home health agencies, has tried to cement its spot as the go-to for home health providers when it comes to their therapy needs. In order to do this, the company has been focused on accelerating its growth through acquisitions. Their business model allows the company to form partnerships with agencies in markets where InHome Therapy doesn’t have a large presence. InHome Therapy’s technology development is also focused on identifying all of the aspects of a therapist’s job that are non-clinical, and finding technology solutions that will streamline these areas.
McKnights Home Care: Hospice Providers Warned to Prepare for CMS Volunteer Requirement (9/22) - Some hospice providers could run afoul of the Centers for Medicare and Medicaid Services if the agency reimposes its community volunteer requirement immediately at the end of the COVID-19 public health emergency. Many hospice providers lost volunteers during the pandemic. Some older volunteers dropped out because they feared being exposed to the coronavirus in patients’ homes or in congregant settings. Providers will need to get creative in recruiting new volunteers.
McKnights Home Care: New York Partnership Helps Seniors Modify Homes to Age in Place (9/22) - Two New York aging service providers are teaming up with home builders to help seniors age in place safely by modifying their homes. The National Association of Home Builders will provide training and accreditation through its Certified Aging in Place Specialist (CAPS) accreditation program to the New York State Office for the Aging and Association for the Aging in New York. Those organizations will then work with older adults to assess and arrange for necessary home improvements to help them remain safe by reducing falls and preventing injuries.
Stat News: Medicare is Using One of Its Biggest Hammers to Try to Fix the Dialysis System: How Providers Are Paid (9/19) - While the rate of home dialysis use has improved — from 6.8 percent in 2009 to 12.6 percent a decade later — the U.S. still falls far behind some other countries. Studies suggest patients perform just as well on home dialysis as they do with in-center treatment, and some even show patients on home dialysis fare better and receive transplants more quickly than their peers who report to the clinic. Not only has home dialysis been deemed safe for many patients, but it can boost quality of life by offering patients the flexibility to schedule treatments whenever they want. Patient advocates say the important piece is making sure everyone on dialysis is told about their options for care, whether it’s home dialysis or pursuing a kidney transplant.
Home Health Care News: Humana Set To Buy Senior-Based Primary Care Clinics For Up To $550M (9/19) - The most recent joint venture between Humana’s CenterWell Senior Primary Care arm and WCAS was a $1.2 billion investment in value-based primary care clinics. The first agreement between the two earmarked $800 million to open 67 clinics by early 2023. Moving forward, Humana is focusing on integrating the CenterWell brands – such as primary care and home health, for example – and becoming a more efficient provider of care.
mHealth Intelligence: Texas Provider Aims to Improve Patient Access with At-Home Care Program (9/19) - Known as Texas Health Care at Home, a new at-home acute care program established by Texas Health Resources aims to improve patient access and care quality for those with heart failure, chronic obstructive pulmonary disease (COPD), asthma, pneumonia, cellulitis, soft tissue infections, and other conditions. Recognizing the need for improvements in health care access, many providers are working to implement virtual care methods. Located in Arlington, Texas Health Resources has created an at-home care program with the goal of reducing readmissions to emergency departments while ensuring that patients are healing emotionally as well. Staffed with physicians, advanced practice providers, nurses, and service coordinators, the new at-home care program will provide virtual assessments for patients daily, along with in-person visits when necessary. The program will also leverage continuous remote patient monitoring (RPM).