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.
Check out our website and Twitter for more information
NEW MEMBER ALERT
WellSky Joins Moving Health Home Coalition
Centers for Medicare & Medicaid Services (CMS): Guiding an Improved Dementia Experience (GUIDE) Model (7/31) - On July 31, 2023, CMS announced the Guiding an Improved Dementia Experience (GUIDE) Model, which aims to support people living with dementia and their unpaid caregivers. CMS is accepting letters of interest for the GUIDE Model through September 15, 2023, and will release a GUIDE Request for Applications (RFA) for the model in Fall 2023. The model will launch on July 1, 2024, and run for eight years. Specifically, the GUIDE Model will offer a standard approach to care, including 24/7 access to a support line, as well as caregiver training, education, and support services. This will allow people living with dementia to remain safely in their homes for longer and improve quality of life for both people living with dementia and their unpaid caregivers.
National Institute on Aging: Help Shape the Future of Dementia Home- and Community-Based Services (7/26) - The NIA announced the Community Care Network for Dementia (CaN-D), which would develop valuable data tools to aid analysis of the structure, processes, and outcome measures of dementia home- and community-based services (HCBS). HCBS support people living with dementia in multiple aspects of daily life, including personal care, medication management, meal preparation, social engagement, and cognitive stimulation. Expression of interest are due by August 15.
CMS: End-Stage Renal Disease (ESRD) Treatment Choice (ETC) Model Lays Strong Foundation for In-Home Renal Care (7/24) - CMS released its first annual evaluation of the ESRD ETC Model, which found modest early gains in home dialysis training and transplant rates, laying a strong foundation for the future of in-home renal care. The model, which was introduced Jan. 1, 2021, was designed to push for greater utilization of in-home renal care services. By supporting patient selection of home dialysis and transplant through enhanced patient education, and other strategies, the model is intended to result in lower Medicare payments while preserving or enhancing quality of care for beneficiaries. For additional coverage, see McKnights Home Care.
CMS: Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule (7/13) - On July 13, 2023, CMS issued the Calendar Year 2024 (CY2024) Physician Fee Schedule (PFS) proposed rule, which makes payment and policy changes under Medicare Part B. In the rule, CMS is proposing payment for caregiver training services and to extend the in-home additional payment for COVID-19 vaccines for three other preventive vaccines - pneumococcal, influenza, and hepatitis B vaccines. Comments are due September 11.
Senate Health, Education, Labor & Pensions (HELP) Committee: Chairman Sanders (I-VT) Introduces Legislation on Primary Care (7/19) - Sen. Sanders (I-VT) introduced the Primary Care and Health Workforce Expansion Act, which would improve access to and the quality of primary health care, expand the health workforce, among others. Specifically, the legislation includes a fund of $2 million annually over the next five years to establish a technical assistance center to support the direct care workforce and family caregivers. The section-by-section can be found here. See Chairman Sanders' (I-VT) statement here.
Senate: Sens. Capito (R-WV) and Baldwin (D-WI) Introduced Bill to Strengthen Palliative and Hospice Care Workforce (7/12) - On July 11, Sens. Baldwin (D-WI) and Capito (R-WV) introduced the Palliative Care and Hospice Education and Training Act (PCHETA) (S. 2243), which would meet the growing demand for serious illness care by investing in training, education and research for the palliative care and hospice workforce. Specifically, the bill includes training for inter-professional team-based palliative medicine, including home care.
Research and Polling
NEJM Catalyst: Advancing the Future of 'Care Without an Address' (7/26) - The Future of Health, an international community of senior health leaders, collaborated with the Duke-Margolis Center for Health Policy to identify what priority actions health delivery organizations and policy leaders can take to implement the “Care Without an Address” model, a fundamental paradigm shift that centers care around the patient in a comprehensive, coordinated manner regardless of location. Care Without an Address can include home visits, assistance with activities of daily living, home-based primary care, as well as technology-enabled remote care and other services (e.g., community paramedicine).
WellSky: The Evolution of Care: An Annual Care Delivery Report (7/25) - Referrals for post-acute services, especially home care, are growing, but staffing shortages and higher-acuity patients at discharge are making it tougher for hospitals to connect patients with care after their stays. The volume of post-acute referrals has risen higher than pre-pandemic levels. Higher referral rates reflect a growing need for post-acute services. WellSky reports that staffing challenges contribute to lower quality of care, prolonged wait times and overall lower satisfaction among patients. For additional coverage, see McKnights Home Care.
American Medical Association (AMA): The State of Health at Home (7/18) - AMA released a report, which outlines the concept and benefits of delivering care to patients in their home environments. Advancements in digital and health care technologies have paved the way for the return to care at home when appropriate and underscores the potential of health at home programs as an option for various types of care, including acute, chronic, preventative, and end-of-life care, while promoting personalization and better patient outcomes.
Assess how the evolving landscape including policy, coverage, and payment impacts health at home programs.
Determine whether your practice or organization should build your health at home program internally or partner with another organization.
Consider required training to strengthen your mobile workforce, which is a core component of health at home programs.
Ensure you understand the unique and varied circumstances of each home environment and plan for the patient and caregiver experience in detail.
Develop the infrastructure up front that will provide the necessary tools to appropriately handle the flow of resources and information to provide patient care as required by your specific program.
California Advancing and Innovating Medi-Cal (CalAIM): Targeted Use of Agencies for Personal Care Services (7/12) - California’s In-Home Supportive Services (IHSS) Medicaid program is the most common way people receive personal care. However, San Mateo County, CA discontinued its contract mode in 2018, due to funding reallocation. A study found that in the years following, per member, per month (PMPM) spending and utilization in the county increased for institutional long-term care, acute inpatient care, post-acute skilled nursing facility services and emergency departments. The findings suggest that the contract mode allowed patients to connect with caregivers, thereby reducing long-term care utilization and lower hospitalization rates. For additional coverage, see McKnights Home Care.
American Journal of Preventive Medicine: The Health and Economic Impact of Expanding Home Blood Pressure Monitoring (5/12) - Home blood pressure monitoring is more convenient and effective than clinic-based monitoring in diagnosing and managing hypertension, but there is limited evidence of the economic impact of home blood pressure monitoring. This study aims to fill this research gap by assessing the health and economic impact of adopting home blood pressure monitoring among adults with hypertension in the U.S. The study found that home blood pressure monitoring could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, particularly among racial and ethnic minority groups and those living in rural areas. For additional coverage, see McKnights Home Care.
News and Market Developments
McKnights Home Care: Best Buy Grows In-Home Care Presence with Assistance Services (8/3) - Technology retailer Best Buy is expanding its home care offerings with services to keep older adults healthy, connected and comfortable in their homes. The company’s revamped Lively program offers support for patients and caregivers alike. Lively is a service that gives home care patients tools to gain medical and nonmedical assistance.
Fierce Healthcare: Startup Uptiv Health Launches Infusion Care (8/2) - Uptiv Health launched as a new hybrid infusion care company with a focus on reshaping the patient experience. Today, infusion therapy typically happens in a hospital or hospital outpatient setting and tends to be more expensive. Looking to reset the infusion therapy experience, Uptiv Health takes a patient-centric approach– offering appointments after working hours and convenient scheduling for patients and 24/7 access to healthcare staff via the Uptiv Health app.
Fierce Healthcare: Signify Health Launches In-Home Testing for Chronic Kidney Disease (8/1) - Signify Health is expanding its services with the addition of a new in-home testing option for chronic kidney disease. The company will provide in-home health evaluations to its Medicare Advantage members at no additional cost, including urinalysis and estimated glomerular filtration rate testing. The goal is to better support early detection, diagnosis and management of kidney disease.
Fagen Wasanni Technologies: From Hospital to Home How Connected Care is Improving Post-Discharge Patient Monitoring (7/30) - The transition from hospital to home can be a challenging period for patients, particularly those with chronic conditions or complex care needs. However, the advent of connected care is revolutionizing the way post-discharge patient monitoring is conducted, enhancing the quality of care and improving patient outcomes. By enabling continuous monitoring and timely intervention, connected care can help to identify and address these issues early, thereby reducing the risk of readmission.
Modern Healthcare: Payment Concerns Not Stopping New Hospital-at-Home Programs (7/27) - Hospital-at-home is attracting a new field of providers who say they can sustain the model despite uncertainty over how Medicare will reimburse for the service in the future. Senior health company Lifespark, which provides primary care, home health and hospice services, plans to launch a hospital-at-home program by year's end.
Home Health Care News: Biofourmis Continues to Grow, All Through Better Home-Based Care Enablement (7/26) - As health care providers look to shift more care into the home, Biofourmis is cementing its spot as a home-based care enabler for its partners. Home Health Care News recently caught up with Ross Armstrong, the chief commercialization officer at Biofourmis. During the conversation, he touched on Biofourmis’ clinical outcome success and where the company sees the most growth opportunity moving forward.
mHealth Intelligence: Why the Hospital-at-Home Model is a High Priority for ChristinaCare (7/26) - ChristianaCare's hospital-at-home program has cared for more than 500 patients since December 2021, resulting in high patient satisfaction and improved outcomes. In an interview with mHealthIntelligence, Katie Muther, RN, director of nursing and strategic partnerships at ChristianaCare's Center for Virtual Health,detailed the hospital-at-home program, implementation challenges and strategies for success, and the benefits reaped from the program since its launch.
Home Health Care News: For Home Care Providers, There's Untapped Potential in Long-Term Care Insurance (7/22) - While Medicare Advantage (MA) has been spotlighted as a potential new source of revenue for home care providers over the last couple of years, long-term care insurance (LTCI) has gone under the radar. The Helper Bees, an insurtech company, serves as a liaison between home care providers and health plans. Home care providers across the country are experiencing unprecedented hikes in billing rates, which is shrinking the population that can pay out of pocket for home care long term.
Health Leaders: Vanderbilt Home Care Service Simplified Chronic Disease Management (7/20) - Vanderbilt University Medical Center's chronic disease management program was initially a COVID-to-home program, but now the program serves to monitor patients' chronic conditions and enable them to take control of their health. The program uses phone calls, and additional equipment like blood pressure cuffs where patients record the values, to monitor chronic diseases. In addition to providing care, Vanderbilt emphasizes education, teaching patients how to use equipment and what symptoms to look out for.
McKnights Home Care: Reimagine Care, DispatchHealth Partner to Deliver Cancer Care at Home (7/19) - Reimagine Care, which provides technology-enabled services to support the delivery of home-centered care, and hospital-at-home firm DispatchHealth anncouned a partnership to bring cancer care into the home. Supporting patients virtually through Reimagine Care's experienced oncology clinicians, and in the home through this partnership with DispatchHealth, will alleviate many of the triage and symptom management demands on clinicians, while improving the cancer care experience for patients and their families.
NPR: Hospital-at-Home Means Family Members Must be Caregivers (7/18) - In this news story from NPR, a patient, who was a regular visitor at his local hospital recounts his experience with hospital-at-home. "Being able to be home made all the difference in the world," he says. Hospital-at-home has strong potential, but the effects on caregivers need more attention. Federal policymakers should have programs to make sure family members know exactly what will happen and are on board with it.
McKnights Home Care: Home-Based Primary Care Is A Great Example of Value-Based Care (7/18) - The field of home-based primary care (HBPC) is helping lead the charge toward successfully implementing value-based care (VBC) on a large scale. There is ample evidence that HBPC is one of the most effective means for achieving CMS’ three-part aim to provide better care of individuals and populations at a lower cost based on the quality of care. In this blog by Julie Sacks from Home Centered Care Institute, she highlights the benefits of CMS' Independence at Home (IAH) program.
Home Health Care News: The Booming Hospital-at-Home Market (7/18) - Over the years, robust evidence has emerged from numerous studies on the effectiveness of the hospital-at-home model. Despite the evidence of hospital at home’s effectiveness, two major roadblocks have impeded the model’s widespread adoption: cultural norms of health care and a lack of a clear path to reimbursement. The US has spent trillions of dollars building up the infrastructure around the hospital and will have to do the same for hospital-at-home programs.
Modern Healthcare: Why In-Home Dialysis is Growing for Kidney Care (7/18) - Efforts to move dialysis care into the home are gaining traction. New training initiatives for nephrologists, payer incentives and value-based care models are behind the transition to home dialysis. Medicare pays the same bundled rate for home dialysis as it does for in-facility treatment. The average cost for a home dialysis treatment in 2021 was nearly $50 less than a facility treatment. These barriers can be overcome with time.
Home Health Care News: Exploring Managed Medicaid Challenges in Home-Based Care (7/12) - Home-based care providers working with Medicaid managed care plans have to navigate an operating environment that is more administratively complex. Ultimately, smaller providers tend to struggle a little bit more in a managed care environment, but some home care providers have formed meaningful, constructive relationships with health plans that have lasted years.
Business Wire: Forcura Launches Enhanced Referral Technology Designed to Improve Patient Care Transitions into Home-Based Care (7/12) - Forcura, a health care workflow management company, announced significant product enhancements to its referral workflow technology, which will enable home-based care providers to improve their patient admission rates and intake processes. Through enhanced AI and machine learning technology, providers can now prioritize referrals to accept into care patients who best fit the practice’s care team and capabilities. Forcura’s technology makes this possible by automatically identifying more patient demographics and data points – including location, referral source and primary and secondary payers, then allowing intake teams to prioritize that data based on a practice’s business rules.
Health Leaders: New Technologies and Ideas Push the Hospital at Home Concept Forward (7/11) - Hundreds of hospitals across the country have launched an acute care at home program, focused on treating patients at home versus in a hospital bed. Many of those hospitals are following the Acute Hospital Care at Home model developed by CMS, which sets strict guidelines for in-person care to qualify for Medicare reimbursement. Some hospitals are trying their own ideas, mixing virtual and in-person care to target specific care gaps or populations. Confusing state laws and the uncertain future of the CMS model will continue to give health leaders inspiration to develop their own strategies for delivering care at home.