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.
Patients, providers, and caregivers want care in the home to be an available option. In contrast to Fee-for-Service Medicare, Medicare Advantage plans have the flexibility and incentives to offer home-based care alternatives for beneficiaries. A recent analysis shows that Medicare Advantage plans are answering the call for more access to care in-home through benefit offerings, such as in-home support services and home-based palliative care. Join the Better Medicare Alliance and Moving Health Home for this joint webinar to discuss the value, barriers, and future of in-home care in Medicare Advantage. We hope to see you on August 11 at 1:30 PM ET.
Response to Request for Information (RFI) on Primary Care (8/1) - Moving Health Home (MHH) was pleased to respond to the Department of Health and Human Services (HHS)RFI on the initiative to strengthen primary health care. MHH highlighted policy solutions to expand and improve primary care through home-based options. MHH looks forward to working with the HHS Office of the Assistant Secretary for Health (OASH) to ensure in-home care is a central part of its strategy to strengthen primary care in the United States.
Centers for Medicare and Medicaid Services (CMS): Request for Information on Medicare Advantage; Opportunity to Focus on Home-Based Care (8/01) - CMS' request for information seeks input from the public regarding various aspects of the Medicare Advantage program. Responses to this request for information may be used to inform potential future rulemaking or other policy development. To be assured consideration, comments must be received by August 31, 2022. MHH will submit comments related to opportunities to expand access to home-based care in Medicare Advantage.
CMS: First-Ever Home- and Community-Based Services Quality Measure Set Released by CMS (7/21) - In July, CMS released the first-ever set of nationally standardized quality measures for Medicaid-funded Home and Community-Based Services (HCBS) that is intended to promote more common and consistent use of nationally standardized quality measures in HCBS programs, create opportunities for CMS and states to have comparative quality data on HCBS programs, and drive improvement in quality of care and outcomes for people receiving HCBS. Letter to State Medicaid Directors
CMS: Calendar Year 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule Released; Includes Home-Based Behavioral Health Provision (7/15) - The Centers for Medicare & Medicaid Services (CMS) is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. “The proposals in this rule, if finalized, will expand access to care options in rural communities and permanently allow behavioral health services to be provided to people in their homes.” said CMS Administrator Chiquita Brooks-LaSure.
HHS: Renewal of Determination That A Public Health Emergency (PHE) Exists (7/15) - On July 15, Secretary Becerra renewed the COVID-19 PHE declaration for another 90 days. Renewal of the PHE provides for several CMS waivers to continue, including those enabling care in the home, such as expanded use of telehealth and the Acute Hospital Care at Home program.
House of Representatives:Reps. Sewell, Buchanan Introduce Bipartisan Legislation to Protect Access to Home Health Services (7/29) – U.S. Reps. Terri Sewell (D-AL) and Vern Buchanan (R-FL) introduced H.R. 8581, the Preserving Access to Home Health Act of 2022. This bipartisan legislation would help preserve access to home health services for seniors and Americans with disabilities by preventing proposed cuts to home health payment rates from taking effect. Sens. Stabenow (D-MI) and Collins (R-ME) also introduced companion legislation in the Senate: Preserving Access to Home Health Act of 2022 (S. 4605)
United States Senate:Appropriations Chairman Leahy Releases Fiscal Year (FY) 2023 Senate Appropriations Bills; Includes Home-Based Care References (7/28) - Sen. Murray (D-WA) introduced the Report for the Departments Labor, Health and Human Services, Education, and Related Agencies for FY 2023 Appropriations (S.4659), which would make appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2023. The report language includes several directives related to home-based care, for example home- and community-based services, home-delivered meals, and at-home diagnostic testing. Bill Text; Bill Summary; Report Language
Research and Polling
Healio News: Patients who Receive CKD Education are Likely to Choose Home Dialysis at Initiation (7/27) - Compared with patients who did not receive chronic kidney disease education, those who did were more likely to choose home dialysis and a permanent vascular access at initiation. In a matched retrospective cohort study, researchers examined adult patients with CKD who participated in a CKD education program before dialysis and matched individuals who did not receive education before dialysis initiation. Analysis found that “Novel approaches are needed to ensure that all patients with advanced CKD have access to predialysis education and ensure broad implementation of structured programs.”
Children:Home-Based Care for Children with Serious Illness: Ecological Framework and Research Implications (7/26) - Improving home-based care for children and families requires a comprehensive, multilevel approach that accounts for and examines relationships across home environments, communities, and social contexts in which children and families live and receive care. This study proposes a multilevel conceptual framework, guided by Bronfenbrenner’s ecological model, that conceptualizes the complex system of home-based care into five levels.
Alzheimer's & Dementia:Home Health Utilization Association with Discharge to the Community for People with Dementia (7/26) - The objective of this study was to identify home health utilization factors associated with successful discharge to the community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD). The study found that home health utilization characteristics were associated with the ability to successfully remain in the community for 30 days after discharge from home health without experiencing unplanned readmission or death for this national cohort of Medicare beneficiaries.
Home Health Care News: Seniors Want to Age in Place, But They Still May Not Know What That Means (7/25) - While home-based care is a space booming with opportunities and potential tailwinds, much of it remains theoretical for the time being. The vast majority of seniors want to remain at home as they age, according to a new study from Cross Country Workforce Solutions Group, which is a division of Cross Country Healthcare. 91% of the adults surveyed – aged anywhere from 50-79 – had not proactively researched the care they may need as they grew older. Over a third – 34% – had not even thought about their future care needs.
Clinical Advisor: Outpatient Palliative Care Improves Quality of Life and Health Care Utilization (7/19) - Early outpatient discussions about palliative care were associated with improved functionality while home-based palliative care delivered by nurse practitioners lead to decreased health care utilization, according to results of two studies presented at the 2022 American Association of Nurse Practitioners (AANP) National Conference held June 21 to June 26, 2022, in Orlando, Florida.
News and Market Developments
Home Health Care News: CVS Health Looking To Enhance Capabilities Through Home Health Care (8/03) – CVS Health is one of many large corporations that have expressed a desire to revolutionize the “consumer experience” in health care. To do so, the company will continue to try to enhance its health service offerings in three categories: primary care, provider enablement and home health care.
MIT Management: The 4 Trends Driving Platform Adoption in Health Care (8/03) – “Health care is beginning to understand the economic power of platforms, especially in a data-rich environment,” said Randall Williams, M.D., managing director of the consultancy Digital Care Advisors. “The industry is in an early phase of experimentation.” In this article, Williams and other speakers discussed how four major trends are driving platform adoption in health care — and how they’re transforming everything from staffing to scheduling to the expansion of virtual and home-based care models.
Home Health Care News: Homeward Raises $50 Million, Forms First At-Risk Partnership (8/03) – Homeward officially launched in March behind the leadership of Livongo veterans Kendale and CEO Jennifer Schneider. Its plan is to focus on improving access to primary and specialty care in rural communities, partly through a home-based care approach. Homeward announced it had raised $50M in a Series B. It also announced its first at-risk partnership with Priority Health, a contract that will allow Homeward to manage up to 30,000 Medicare Advantage patients in rural Michigan.
HomeCare: Hospital at Home for COPD Patients (8/02) – In 2020, the Centers for Medicare & Medicaid Services (CMS) introduced the Acute Care Hospital at Home (ACHaH) program, which provided a waiver enabling the use of virtual care models to manage acute patients at home and benefit from the equivalent inpatient fee-for-service payment. Although still in its infancy, the ACHaH reimbursement model makes home health care more economically viable for patients with acute exacerbations of COPD and other acute conditions.
Home Health Care News: MedArrive Partners With Brave Health To Combine At-Home Care, Behavioral Health Services (8/02) – The at-home care provider and coordinator MedArrive has partnered with Brave Health, a virtual-first behavioral health provider specifically focused on the Medicaid population. MedArrive coordinates care between providers and health plans, and also utilizes EMS workers to deliver care in patients’ homes.
Fierce Healthcare: Industry Voices—Can Care at Home Succeed in the Long Term? Not Without Interoperability (8/02) – Care-at-home programs promise improved patient experiences and outcomes by generating data about a person’s health and environment and enabling communication with care teams. Without interoperability, care-at-home programs will struggle to impact patient care, quantify success and unlock long-term value. Effective care at home isn’t just about vital sign readings but also the conversations patients have with their care teams, their engagement with daily tasks and, ultimately, patient outcomes.
HomeCare: CMS Announces Optional Medicaid Home Health Benefits for Children With Complex Needs (8/02) – The United States’ Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), has unveiled guidance on a new Medicaid health home benefit for children with medically complex conditions. This new optional benefit helps state Medicaid programs provide Medicaid-eligible children who have medically complex conditions with person-centered care management, care coordination, and patient and family support. CMS anticipates that the new benefit will help these children receive the care they need, including across state lines.
Home Health Care News: The Next Frontier In Home-Based Care Recruiting: Gen Z And Millennial Workers (8/01) – There are a number of potential avenues to take to address the staffing needs in home-based care over the next decade. To do that, home-based care providers are doing a few things, including: establishing transparent lines of communication to these generations, offering competitive benefits and recruiting through non-traditional channels.
Home Health Care News: Fall Risk Continues To Be An Aging-In-Place Barrier, Government Watchdog Reports (7/29) - There is a significant need for federal programs that aim to prevent older adults from falling to work together and share information. Doing so, government watchdogs say, will make the home a safer place to age. That was one of the key takeaways from a recent report published by the U.S. Government Accountability Office (GAO), which took a closer look at fall prevention and home modification programs on the federal level.
Home Health Care News: CenterWell to Take Center Stage for Humana After Restructuring (7/27) - Humana Inc. is restructuring. It will make its CenterWell arm, which includes its home health and primary care capabilities, one of two business units. The goal is to simplify the company’s organization and strategy moving forward. Formerly known as Kindred at Home, CenterWell Home Health is the rebranded home health organization of the Louisville, Kentucky-based Humana. Humana’s home-based care strategy continues to be a priority.
Home Health Care News: While Grateful for ARPA Funding Extension, HCBS Providers Worry About Long-Term Implications (7/27) - Home care providers likely exhaled a sigh of relief when the American Rescue Plan passed last year, earmarking funds intended to enhance home- and community-based services (HCBS). “The pandemic exacerbated this need and want among consumers for home-based care, but because these increases aren’t permanent, we can’t make permanent changes to wages for our staff – impacting our ability to recruit and retain quality individuals to meet the growing need,” Jennifer Sheets, CEO and president of Interim Healthcare, told Home Health Care News.
Businesswire:Dialyze Direct Partners with CommuniCare Health to Provide On-Site Dialysis (7/27) - Dialyze Direct, the nation’s leading provider of home hemodialysis services in Skilled Nursing Facilities (SNFs), announced today it has partnered with CommuniCare Family of Companies, one of the nation’s largest post-acute care providers, to conduct onsite hemodialysis services at its facilities around the U.S. Dialyze Direct’s continued growth with like-minded healthcare providers has further solidified the company’s position as the foremost home hemodialysis provider to SNFs in the United States.
mHealth Intelligence: FL Healthcare Org Aims to Enhance At-Home Care Through Virtual Services (7/26) - To create a successful at-home care system, Lee Health partnered with Health Recovery Solutions (HRS) to implement virtual resources, aiming for lower levels of hospital readmissions and emergency room visits. HRS develops novel ways of telehealth and remote patient monitoring, driven by the goal of assisting providers and working toward an optimal clinical system.
Home Health Care News: Amid Proposed Payment Cuts, Home Health Advocates Are Considering Greater Picture (7/26) - Although it may seem like the federal government is picking on the home health industry in recent weeks, at least they are paying attention to an industry that continues to grow and is in high demand. Many insiders — including William A. Dombi, the president of the National Association for Home Care & Hospice — will be quick to criticize the Centers for Medicare & Medicaid Services (CMS) about the new proposed payment rule, for instance. Dombi painted a rosier picture for the relationship between the two by pointing out CMS’ desire to expand the Home Health Value-Based Purchasing (HHVBP) Model.
Hospice News: NAHC’s Dombi: ‘Workforce Shortage Affects All of Society’ (7/25) - The home-based care workforce shortage has social and economic ripple effects, according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC). Demand is outstripping supply for home-based care, said Dombi. Home-based care providers are rejecting upwards of roughly 30% of referrals because providers lack the clinicians to sustain the volume, he said. “This is something that affects all of society. This is not an issue of you as an employer of home care workers not having enough workers. It’s not even an issue of a person who needs care, getting access to care, it affects all of society,” Dombi said at the conference.
Home Health Care News: Elevance Health – Formerly Anthem – Has Big At-Home Care Plans (7/25) - Elevance Health Inc. is committed to expanding its at-home care offerings as the insurer solidifies its growth plans for 2022 and beyond. “Certainly, home is a critical component in that regard,” Peter Haytaian, executive vice president of Elevance Health and president of Carelon, said during the company’s Q2 earnings call. “I think [that’s clear] when you look at our acquisition of myNEXUS and its focus on the home through utilization management tools and capabilities and partnering with a very vast network of providers.”
Forbes: Harvard’s Mass General Hospital Is Rolling Out A Massive Hospital-At-Home Program (7/21) - Mass General Brigham (MGB) hospital system is one of the most famous organizations in the world, known for its cutting edge clinical care, research, and innovation. In its latest venture to reduce spend while improving patient outcomes, the renowned hospital has announced a new venture: a robust hospital-at-home program. The idea will be to support patients in the convenience of their own homes. Gregg Meyer, President of Community Division and Executive Vice President of Value-Based Care for MGB explains: “…We’ve got more data to say that this is convenient and enjoyed by patients at lower costs, but by the way, it is safe. And then at the same time, the technology is getting easier and easier…”
Managed Healthcare Executive: 2 Ways Healthcare Organizations Can Implement Home-Based Care in a Cost-Effective Way (7/21) - To reduce costs, drive revenue, and improve quality of care, it’s critical for healthcare systems to understand how telehealth reduces healthcare costs and leverage home-based care with telehealth technology. A 2021 study conducted by AccentCare on telehealth implementation found that patients who received home healthcare were equal to or more satisfied than those who received traditional care. Recognizing the positive impact of technology on healthcare costs and quality brings healthcare systems one step closer to adoption. However, hospitals need to know the best ways to implement telemedicine to provide cost-effective home-based care. The article discusses two concrete ways healthcare organizations can improve patient outcomes in lower-cost care settings.
Home Health Care News: Why Socially Determined Wants to Further Involve Home-Based Care Companies in ‘Information Gathering’ (7/20) - The core of Socially Determined’s mission is figuring out what influences the decisions people make about their health care. Socially Determined is a health care analytics company with a goal to create visibility and actionable intelligence around all factors that are at play when health care choices are made. “I see an opportunity for companies in the home care space to start to think about participating in this journey together and becoming information gatherers,” Trenor Williams, the company’s CEO, said. “I don’t think we have, in this country, leveraged the home care and home health industry, their teams and team members, as part of the [intervention process] the best way that we possibly could.
The Health Site:Benefits Of Opting For Home Dialysis or At-Home Hemodialysis (7/20) - For patients undergoing dialysis treatment, regular trips to dialysis centers can affect their quality of life, putting added strain on their personal lives. Spending leisure time with family and loved ones may seem to be a thing of the past. Home dialysis or at-home hemodialysis can help in managing this stress and hassle while providing potential clinical and lifestyle benefits to patients. This is the reason why more and more patients are turning to home dialysis.
MedCity News: Elevating Patient Care from the Home (7/20) - Several years into the pandemic and the health sector continues to rely more heavily on home care solutions over hospital-based and face-to-face treatments. It is known that the pandemic served as the impetus for the shift to home-based care, thereby highlighting the risks of contracting illnesses and hospital-acquired infections (HAI). The truth is that the risk of HAIs was high before the onset of Covid-19 and skyrocketed during the pandemic, exacerbating the standard infection ratio. As a consequence, people were and still are skeptical when going to hospitals. This change in behavior has led to a rise in the adoption of home-based and telehealth solutions.
Forbes: Congress’ Epic Fail In Caring For Frail Older Adults (7/18) - Except for including about $12 billion in federal funds to temporarily expand Medicaid’s Home and Community-Based (HCBS) long-term care program in 2021, Congress has done nothing to improve the nation’s long-term care system. For those living at home, Covid-19 exposed similar shortages of direct care workers, the burdens of rising costs on families, and those risks of social isolation. Biden’s initiatives would crack down on poor-performing nursing homes and improve disclosure of quality and facility ownership. The problem with these initiatives is that many of these changes would add costs to facilities that already face severe financial stress.
STAT News: Congress: Don’t Let Hospital Care at Home Shrivel When the Public Health Emergency Ends (7/15) - During surges of Covid-19, providing hospital-level care in the home was a good alternative to receiving care in hospitals strained by historic staffing shortages and populated by people infected with SARS-CoV-2, the virus that causes the disease. Delivering hospital-level care in the comfort, convenience, and safety of patients’ homes is well suited to value-based health care systems in which physician groups and hospitals work with health plans that incentivize quality. This kind of care will stall without action by Congress to extend flexibilities for this care beyond the public health emergency. That will provide the stability and certainty that health plans and systems need to offer the personalized at-home care that patients prefer.