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.
Americans Are Comfortable Receiving Care in the Home
70 percent of those surveyed are comfortable with care in the home citing that familiarity helps alleviate anxiety and improve communication. This is especially important for those from underserved and minority communities.
Americans Are Confident in the Quality of Receiving Care in the Home
73 percent of adults are confident in the quality of receiving care in the home.
85 percent of caregivers are confident in the quality of receiving care in the home.
88 percent of adults were satisfied with the clinical care services they received in the home.
Americans Prefer and Would Recommend Care in the Home
85 percent of people who have had experience with care in the home would recommend it to family and friends.
Americans Support Expanded Care in the Home
A bipartisan majority of consumers say it should be a priority for the federal government to increase access to clinical care in the home (73 percent Democrats, 61 percent Republicans).
White House: Biden Administration Will Expand Free, At-Home COVID-19 Testing (12/2) - The more than 150 million Americans with private insurance – who now are able to get tests covered in physician offices, pharmacies, and clinics with no cost sharing – will also be able to get at-home tests reimbursed by their insurance. For those not covered by private insurance, in addition to more than 20,000 federally-supported free testing sites across the U.S., at-home tests will be distributed through key community sites, such as health centers and rural clinics.
Centers for Medicare & Medicaid Services (CMS): HHS Seeks Public Comments to Advance Equity and Reduce Disparities in Home Dialysis (12/1) - CMS issued a Request for Information (RFI) to solicit stakeholder and public feedback that will be used to inform potential changes and future rulemaking to improve the organ transplantation system and seek to enhance the quality of life of those living with organ failure. In addition to these topics, the RFI seeks feedback on home dialysis, for example:
What are patient barriers to dialysis modality choice?
What are reasons for differing rates of home dialysis by race/ethnicity?
With regard to home dialysis, how can CMS ensure adequate safety standards such as appropriate infection control behaviors and techniques are enforced?
What can CMS do to increase availability and use of home support resources with regard to home dialysis?
If more patients choose home dialysis, would there be systems and infrastructure in place to support this?
To what degree does telehealth and remote monitoring technology impact decisions of home dialysis use?
CMS Center for Medicare and Medicaid Innovation: Evaluation of the Independence at Home Demonstration: An Examination of the First Six Years (11/30) - The Independence at Home (IAH) demonstration provides incentives to home-based primary care practices that meet certain requirements to encourage lower cost, higher quality care. As part of the IAH demonstration, practices can earn incentive payments if their patients’ Medicare expenditures are below the practice’s target expenditures and the practice meets required standards for a set of quality measures. The $41 Per Beneficiary Per Month (PBPM) in savings was lower than the $330 PBPM in savings from Year 5 and the $282 PBPM in Year 4. CMS said the decrease from Year 5 was caused mainly by one practice quitting the demonstration project. The project started with 18 participants but only 12 participated in Year 6. The IAH model has never been open to new participants.
Research and Polling
Journal of Healthcare Management: Accuracy of the Simplified HOSPITAL Score in Predicting COVID-19 Readmissions - Exploring Outcomes from a Hospital-at-Home Program (11/23) - The simplified HOSPITAL score is a tool that predicts 30-day potentially avoidable readmission (PAR). Scores of 0 to 4 predict a 30-day PAR risk of 6.4%, while scores ≥ 5 predict a 30-day PAR risk of 17.3%. The goal of this study was to assess the simplified HOSPITAL score’s accuracy in patients with COVID-19 and explore outcomes related to a hospital-at-home program. Researchers found that the simplified HOSPITAL score was accurate in patients with COVID-19 and can be used to direct resources toward those predicted to be at increased risk for readmission and to assess outcomes from readmission reduction strategies. They concluded that hospitals at home may be a promising strategy to decrease readmissions in patients with COVID-19.
Health Services Research: Frontline Provider Perceptions of Implementing Home-Based Palliative Care (HBPC) Covered by an Insurer (11/21) - In a series of focus groups with providers, researchers found that despite a very favorable perception of private payer-contracted HBPC by frontline providers, reimbursement alone does not account for all of the barriers to implementing and sustaining HBPC programs outside of closed health systems. Challenges associated with patient accrual/referral were found to be critically important to HBPC programs and were driven by multiple players (providers, patients, and families) and mostly low palliative care health literacy. Addressing low palliative care health literacy among patients and providers alike may help to improve the chances of HBPC success.
News and Market Developments
New York Times: Democrats' Bill Would Go Far Toward 'Patching the Holes' in Health Coverage (12/1) - The bill would expand health care access for children, make insurance more affordable for working-age adults and improve Medicare benefits for the disabled and older Americans. In regards to care in the home, the bill would provide $150 billion to allow more elderly and disabled people on Medicaid to qualify for subsidized care in their homes or at community programs, helping them avoid moving to a nursing home.
STAT News: 7 Policies in Biden's Spending Plan Aimed at Health Equity (12/1) - Embedded in the nearly $2 trillion plan are billions of dollars to help make health care services more accessible and affordable for Americans. This includes $150 billion for home-and community-based services for elderly and disabled people. The funding could also help increase pay rates to providers to support the home health workforce who are disproportionately women of color.
MLive: Michigan Paramedics are Making House Calls to Treat COVID Positive Patients with Antibody Infusions (12/1) - Huron Valley Ambulance paramedics have rolled up to homes and apartments in Ford Expeditions at least 713 times so far this year, donned specialized spacesuit-like hoods and other protective equipment and treated COVID-positive people. They’re there to deliver an antibody treatment (delivered via IV) on an emergency basis as a way to keep high-risk patients from getting sicker and flooding hospital wards. Tt has been a way to reach truly homebound patients and brings hospital resources to patients’ doors, expanding the capacity of the health system.
HomeCare: How CalOx Changed Their Delivery Model During the Pandemic (12/1) - Sending patients home from the hospital or ER with necessary home equipment saved time and created a more efficient model for CalOx. They partnered with hospital’s clinical teams to provide complete at-home setups that included a portable oxygen concentrator and pulse oximeter. They trained hospital staff on patient education and setup and developed a protocol that specified when the users should report back to the hospital. The company’s respiratory therapists conducted a telehealth visit with each new patient within 24 hours to make sure they were using the equipment correctly and kept a spreadsheet with data on each patient—data they shared with the hospitals. The majority of patients who received this set up typically they would recover at home within two to three weeks after which CalOx would pick up the equipment.
OrthoSpringNews: The Christ Hospital Health Network Partners with IncludeHealth to Bring Physical therapy into Patients' Homes (12/1) - Using IncludeHealth’s MSK-OSTM technology that makes specialized musculoskeletal (MSK) care in the home possible, the Christ Hospital team can pair already coordinated in-person care with an at-home virtual PT solution to track and monitor patient progress in the pre and post-operative periods.
MarketWatch: The Future of Healthcare is Right Here at Home (11/30) - In the wake of the COVID-19 pandemic, a growing number of older patients are more eager than ever to avoid hospitalization. Depending on their condition, many can receive the full complement of professional services in their home, paid for by Medicare as if they were in the hospital. In-home visits “invert the relationship” between doctor and patient, when the clinician is invited to enter the patient’s home. As technologies advance and as people age who are comfortable with computers and cellphones, home-based delivery of medical care is likely to grow, especially if CMS continues to fund acute care at home.
Healthcare Innovation: Care New England Scaling Up Home-Based Care Programs (11/29) - The Rhode Island-based health system is launching an acute hospital-at-home program in partnership with Biofourmis, a remote monitoring platform. Care New England’s ACO, Integra Community Care Network, has 150,000 members covered by Medicare, Medicare Advantage, Medicaid and commercial plans.
OncLive: Home Infusion Trend Stirs Debate (11/24) - While in-home cancer therapy programs increased due to the pandemic, there is opposition from oncologists who are concerned about the implications for patient safety and the potential impact on community practices that provide in-house infusion services. Specifically, the American Society of Clinical Oncology (ASCO) has expressed reservations about the safety of routinely administering anticancer drugs in patients’ homes and the Community Oncology Alliance (COA) has declared its staunch opposition. We can anticipate that as drug delivery systems continue to evolve, the debate over in-home infusion is likely to intensify.
Home Health Care News: Signify Strives to Find 'Happy Medium' of At-Home, Virtual and Clinic Visits (11/22) - The increased visibility that in-home evaluations allow is why Signify has tried to cut down on virtual visits as the pandemic has subsided. While virtual visits remain a major part of its platform, they still don’t offer the comprehensiveness of an in-person evaluation. Signify CEO Kyle Armbrester said earlier this year that patients have offered feedback on their visit preference, and that they prefer when they’re visited in the home. Part of the reason why is likely Signify’s ability to address social determinants of health (SDoH) when they’re in the home . As of early November, the company had connected members close to 400,000 times with social services in their communities.
Healthcare Innovation: Physical Therapy Joining Care-at-Home Movement (11/22) - Georgia-based Emory Healthcare has partnered with a California company called Luna to bring outpatient physical therapy treatment to patients’ homes. Luna says its turnkey service helps health systems like Emory improve the profitability of their rehabilitation services by expanding access to care, improving adherence, enhancing patient experience, and reducing referral leakage. The service includes on-site therapy and telehealth PT, when appropriate. In addition to Emory, Luna said it is collaborating with other health systems, including Scripps Health, Rothman Orthopaedic Institute, Resurgens Orthopaedics, and Modern Orthopedics.
NY State Department of Health: NY State of Health Announces New "Care at Home" Pilot Program (11/22) - The new pilot program called NY State of Health, Care at Home aims to help New Yorkers shop for safe and reliable home care services for themselves or their loved ones on a private pay basis. NY State of Health, Care at Home is a simple way to connect patients with trusted home care professionals from licensed home care services agencies (LHCSAs).
Beckers Hospital Review: UCI Health Launches Hospital-at-Home Program with Dispatch Health (11/22) - Orange, Calif.-based UCI Health is partnering with at-home care provider DispatchHealth to launch a hospital-at-home program. UCI Health patients who are at high-risk of readmission will receive access to DispatchHealth Bridge Care, a service that provides proactive in-home care 24-72 hours after a patient is discharged from an acute care hospital. The program is designed to increase care access, improve patients' experience and reduce the cost of care.