July 7, 2023

Welcome to the Moving Health Home newsletter!

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.

Please send any news or events to rlam@movinghealthhome.org for future inclusion in this newsletter.

Congress

Medicaid and CHIP Payment and Access Commission (MACPAC): Comment Letter on the Notice of Proposed Rulemaking (NPRM) on Ensuring Access to Medicaid Services (6/30) - In a comment letter to the NPRM on ensuring access to Medicaid services, MACPAC encourages the Centers for Medicare and Medicaid Services (CMS) to work with other federal agencies and stakeholders to consider the implications of defining the direct care workforce, such as for data reporting, payment rates, and training requirements. The current lack of a standard definition has made it difficult to collect data on this workforce. For example, the U.S. Bureau of Labor Statistics collects data on home health and personal care aides, but there is no unique standardized occupational code for direct support professionals. 

Medicare Payment Advisory Commission (MedPAC): June 2023 Report to the Congress: Medicare and the Health Care Delivery System (6/15) - MedPAC released its June 2023 report to the Congress, which includes a mandated report on the evaluation of a prototype design for a post-acute care prospective payment. The Commission presents an evaluation of a prototype design of a uniform prospective payment system for post-acute care providers—skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. 

Senate: Sens. Schatz (D-HI) and Wicker (R-MS) Lead Bipartisan Group Of 60 Senators In Reintroducing Legislation To Expand Telehealth Access, Make Permanent Telehealth Flexibilities (6/15) - Sens. Schatz (D-HI), Wicker (R-MS), Cardin (D-MD), Thune (R-SD), Warner (D-VA) and Hyde-Smith (R-MS) led a bipartisan group of 60 senators in reintroducing the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4189/S. 2016). The CONNECT for Health Act of 2023 will expand coverage of telehealth services through Medicare, which would allow patients to choose to receive care at home.

Senate: Lawmarkers Reintroduce Bipartisan, Bicameral Legislation to Increase Access to Medicare Home Infusion Benefit (6/14) - Sens. Warner (D-VA) and Scott (R-SC), and Reps. Buchanan (R-FL), Dingell (D-MI), Harshbarger (R-TN), and Sewell (D-AL) reintroduced the Preserving Patient Access to Home Infusion Act (H.R. 4104/ S. 1976), which would protect access to Medicare’s home infusion benefit by making clear that pharmacy services for home infusion therapy can be reimbursed and sets an appropriate rate for such services. 

Specifically the legislation would:

• include pharmacy services as part of covered home infusion therapy under Medicare, encompassing assessments, drug preparation and compounding, and care coordination and documentation;
• direct CMS to pay 50% of the nursing rate on home infusion days when a nurse is not present;
• allow nurse practitioners and physician assistants to establish and review the plan of care for home infusion therapy.

Senate Committee on Veterans' Affairs: Sen. Tester Seeks Answers from Administration on Improving Veterans' Access to Long-Term Care and More (6/8) - Senate Committee on Veterans' Affairs Chair Tester (D-MT) pushed officials from the Department of Veterans Affairs (VA) and the Centers for Medicare and Medicaid Services (CMS) to improve access to quality long-term care at a hearing on June 7. 

“The Veteran Directed Care [VDC] program provides veterans the opportunity to receive long-term care services in their homes by providing them with the budget to hire workers to assist them with certain activities,” said Sen. Tester. “On the 18^th of April, President Biden released an Executive Order which, among others things, directed VA to consider expanding VDC to all VA medical centers by the end of next year…would you give us an update on the projected timeline for expanding that program to all VA medical centers?”

Administration

Centers for Medicare and Medicaid Services (CMS): Calendar Year (CY) 2024 Home Health Prospective Payment System Proposed Rule (CMS-1780-P) (6/30) - On June 30, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which would update Medicare payment policies and rates for Home Health Agencies (HHAs). The proposed home health payment estimates that Medicare payments to HHAs in CY 2024 would decrease in the aggregate by 2.2 percent. 

CMS: CY 2024 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule (CMS-1782-P) (6/26) - On June 26, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment rates and policies, and includes requests for information under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. This rule also provides a bundled payment rate which includes a training add-on payment adjustment for home and self-dialysis modalities, an outlier payment for high-cost patients, and add-on payment adjustments for certain drugs, equipment and supplies. 

Food and Drug Administration (FDA): Center for Devices and Radiological Health (CDRH) Seeks Public Comment (6/28) - FDA's CDRH is seeking public comment to increase patient access to at-home use medical technologies. As part of its push to advance health equity, the FDA has posed a series of home-care questions to the medtech industry, including a query about how it can support the development of devices for use in non-clinical care settings. Other questions cover how digital health technologies can support home-based healthcare, the device design attributes that facilitate use outside of clinical settings and methods for generating data to inform regulatory reviews.

Department of Health and Human Services (HHS): Administration for Community Living (ACL) Proposes Update to Older Americans Act Program Regulations (6/15) - The U.S. Administration for Community Living is seeking input on proposed updates to the regulations for its Older Americans Act (OAA) programs. The proposed rule is the first substantial update to most OAA program regulations in 35 years. The proposed rule clarifies requirements across many programs and establishes regulations for those that have been authorized by the OAA since the last update of the rule, such as ACL’s state and tribal caregiver support programs. Comments are due August 15. 

Research and Polling

DispatchHealth: The Role of High Acuity In-Home Care During the COVID-19 Public Health Emergency: Overview, Impact and Outlook (6/28) - DispatchHealth released a white paper highlighting how its unique model of care was applied nationwide to address the needs of patients, providers, and payers during the public health emergency. DispatchHealth had a firm stake in the ground before the pandemic, with teams in multiple markets nationwide and several payer and health system partnerships supporting in-home high acuity care. However, the pandemic created a unique opportunity for DispatchHealth's distributed, home-based health care delivery ecosystem to become a lifeline and change the well-being trajectory for hundreds of thousands of patients nationwide.

Center to Advance Palliative Care: Spotlight on Home-Based Palliative Care (6/21) - A report by the Center to Advance Palliative Care (CAPC) and Palliative Care Quality Collaborative (PCQC) found that few patients died on home-based palliative care services. A total of 30.9 percent were discharged from the home-based palliative care program to hospice. Some 44 percent of patients remained in the program in the reporting period. The findings indicate that patients were were not imminently dying but living with a serious illness and living with their palliative care needs, which is exactly where home-based palliative care can have an impact. For additional coverage, see McKnights Home Care. 

Journal of Clinical Pathways: Study Published in Journal of Clinical Pathways Finds Home Infusions Improve Clinical Outcomes, Lower Costs (6/13) - A study by Cigna Healthcare found that site-of-care redirection is associated with favorable clinical outcomes and increased access and affordability for peg­filgrastim, an injection used to prevent infection in cancer patients. The results showed that patients experienced better outcomes when the injection was administered in a home setting rather than a nonhome setting. These findings confirm that home infusion of complex and expensive specialty medications presents new opportunities to maximize access, improve effectiveness, increase affordability, and enhance convenience for patients. For additional coverage, see Cigna's press release. 

Centers for Disease Control and Prevention (CDC): Quick Stats on Adults Who Received Care at Home (6/9) - During 2021, 11.9 percent of adults aged 18 and older received care at home from a friend or a family member during the past 12 months. The percentage of adults who received care during the past 12 months was similar among adults aged 18–44 years (9.8 percent) and 45–64 years (10.5 percent), then increased with age to 13.8 percent among those aged 65–74 years, 19.4 percent among those aged 75–84 years, and more than doubled to 39.8 percent among those aged ≥85 years. This supports research demonstrating that more seniors want to age at home. 

Conduit Health Partners: How an Innovative Three-Way Collaboration Leads to Better Patient Outcomes and Convenience (6/5) - A partnership between Medical Mutual, Conduit Health Services and hospital-at-home provider DispatchHealth has resulted in high rates of consumer satisfaction. As a part of the partnership’s structure, Medical Mutual patients can call the 24/7 Conduit nurse-first triage line. Should the registered nurse (RN) determine that the patient meets established criteria for a home visit, they confer with Dispatch for further evaluation. If Dispatch deems a home care provision is necessary, it sends a mobile unit made up of either a nurse practitioner or physician assistant and a medical technician to the patients’ home. As the partnership has been in place over the past two years, 95.8 percent of patients have been “satisfied or very satisfied” when calling the nurse line. Patients have also been satisfied by DispatchHealth’s ability to provide 60–70 percent of traditional ED care in the comfort of a patient’s home. For additional coverage, see McKnights Home Care.

U.S. News & World Report: Survey Reveals Seniors Want to Age in Place (5/23) - According to a survey from U.S. News & World Report's 360 Reviews, ninety-three percent of US adults plan to age in place, which increases the need for health-related technologies. Nearly half of respondents who use assistive, health-related technology say general aging is their primary reason for adopting it, with additional reasons including impairments in mobility, hearing, vision and cognition. The top six devices that have made it easier to age in place are medical or health-related apps, service-related apps including food and grocery delivery, wearable health trackers, smart home technologies, hearing assistance-related devices and medical alert devices. For additional coverage, see McKnights Senior Living. 

News and Market Developments

7 Wire Ventures: Home is Where the Health Is (6/28) - Today, 71 percent of consumers face major frustrations throughout the traditional health care journey, including long wait times and impersonal visits. Receiving care in the home offers immense potential to receive convenient, high-quality care affordably. Averted downstream conditions, avoidance of unnecessary ED visits (by an estimated 19%), lower utilization of lab orders, imaging, and consultations, and reduced wait times are just a few of the many benefits these models boast. For health care providers, health at home solutions leveraging remote monitoring and diagnostic tools can enable clinicians to have an informed view of consumer health when treating patients virtually.

McKnights Home Care: It's Time for New Approaches to Help Older Adults Age at Home (6/27) - Studies show an overwhelming number of older adults want to age independently at home. Most believe that to age in place, they’ll only need a caregiver to help out from time to time, but this is simply not the case, more often than not. In actuality, aging in place requires a variety of community-based services that must be brought into the home to ensure the needs of older adults are met. Many older adults lack a complete understanding of the services and benefits that may be available to them. Consequently, it’s very common to see a misuse or underutilization of these benefits.

Modern Healthcare: Behavioral Health Care Moving into the Home (6/28) - As patient care increasingly moves into the home, some home health providers are adding services to tap into the $80 billion behavioral health sector. In January, Elara Caring began offering behavioral health services to Medicare patients in 11 of the 16 states it serves. Bringing mental health services into the home also could help fill a void in rural communities where the nearest facility-based behavioral health providers can be at least 50 miles away.

Home Health Care News: WellBe Senior Medical’s Expansion ‘Testament To Market Demand’ For Home-Based Primary Care (6/26) - WellBe Senior Medical has expanded its services to, now, reach more than 75,000 patients. The Chicago-based WellBe offers home-based medical care services, including integrated mobile urgent care, in six states: Georgia, Illinois, Ohio, Utah, West Virginia and Pennsylvania. The organization partners directly with health plans, health systems, and provider groups to work with their patients — typically the top 10 percent of seniors that have complex conditions.

Axxess: Axxess and Naveon Partnership Provides Care at Home Industry With Serious Illness Education (6/26) - Axxess and Naveon partnered to bring serious illness education modules to care at home organizations. The partnership represents the shared commitment of providing innovative solutions and resources across the care at home continuum. The partnership between Naveon and Axxess will support patients and families in understanding their illness and options for care, among others. 

Home Health Care News: Emory Healthcare's At-Home Care Strategy (6/23) - DispatchHealth has formed a new partnership with Emory Healthcare to offer Emory patients follow-up and high-acuity medical care in the home. The forward-thinking health care organizations will need an at-home care strategy to ease access burdens for patients so that patients that need care, receive care. The partnership will allow Emory patients to request DispatchHealth for services and assistance with viral infections, COPD exacerbations, congestive heart failure and other ailments. 

McKnights Home Care: Elara Caring Plans to Offer SNF-at-Home (6/22) - The demand for care in the home has never been greater than it is today, Scott Powers, CEO and chairman of Elara Caring, told McKnight’s Home Care in a Newsmakers podcast. In the next five years, the provider of home care services in 225 locations across 16 states is hoping to develop its skilled-nursing-at-home capabilities, grow its behavioral health offerings, and become a Medicare Advantage convener, a risk-bearing entity that builds networks and does utilization management.

Home Health Care News: WelbeHealth's Michael Le on the Future of Innovative At-Home Care Models (6/20) - WelbeHealth, a Program of All-Inclusive Care for the Elderly (PACE) operator, has improved health outcomes and lowered costs through preventive care. Dr. Michael Le, Chief Medical Officer of WelbeHealth, discussed their model and also touched on other care delivery models he finds interesting, and the importance of collaborations between PACE organizations and home-based care providers. 

McKnights Home Care: The Future for Senior Care Within Medicare (6/20) - As of 2023, Medicare primarily covers home health care services that are considered skilled services. This includes medical services provided by health care professionals such as nurses and therapists. However, Medicare does not cover non-skilled personal care services, which are essential for seniors who require assistance with activities of daily living and instrumental activities of daily living. The future of senior care within the Medicare realm is more than likely to witness a greater integration of technology and coordination between home care agencies, hospitals, primary care providers, specialists, and community-based organizations. With such a rapidly aging population, there is a pressing need to adapt and expand Medicare’s coverage to meet the evolving needs of seniors.

Home Health Care News: SCAN Group CEO Sees Patient Engagement As Major Opportunity For Home-Based Care Providers (6/20) - During a panel at the Home Care Innovation + Investment Conference, SCAN Group CEO Dr. Sachin Jain noted one of the biggest opportunities that home-based care providers have today is to dive deeper into patient engagement. Home-based care has a unique ability to activate and engage patients with their own care because of the preferred setting it occurs in. Measuring that engagement provides an opportunity for innovation. 

Harvard Business Review: A More Humane Model for Eldercare in the U.S. (6/15) - The U.S. health care system is not set up to improve the quality of life of the most vulnerable, chronically ill, elderly people, especially those who are poor. Older poor people often face loneliness, depression, a lost sense of purpose, and an inability to live independently in their homes. This article examines PACE Southeast Michigan, which lets older adults continue to live at home as long as possible, can serve as a model for improving the needs of this population. 

McKnights Home Care: 'H' Sign, A Longtime Hospital Symbol, Now Stands for Home (6/15) - Andy Slavitt, former head of CMS says the home is replacing the hospital as the center of the health care system. During the Home Care Innovation + Investment Conference, Slavitt said: "We can say with good confidence ‘H’ is going to stand for home. It's not going to stand for hospital any longer." He noted that those services traditionally created as hospital wraparound services — everything from primary care to dialysis — are now shifting to the home. 

Modern Healthcare: Home Health and Nursing Schools Partner as Care Moves to the Home (6/13) - Duke University launched a four-year program this spring with a $3.9 million federal training grant aimed at helping better prepare nurses for a growing trend in healthcare: treating patients where they live. Patient preference, technology and new health insurance payment models, such as value-based care, are driving health care into the home. Home health firms are becoming more proactive in reaching out to nursing schools about opportunities in health care.

Fierce Healthcare: Equality Health Rolls Out In-Home Care to Address Medical, Social Needs of Underserved Patients (6/12) - Equality Health, a company that aims to improve access to value-based care for underserved populations, launched a new program to provide staff for home-based care, delivered in-person and virtually, to patients facing complex medical issues. The Health at Home program aims to set patients up for success and bridge them back to the PCP for continuity of care, rather than replace their primary care doctor. The program generally runs for three months. The company's in-home services can help close gaps in care and support patients which then helps independent primary care practices succeed in value-based care and payment arrangements.

Home Health Care News: Home Health Providers See Age-Friendly Accreditation as Competitive 'Differentiator' (6/12) - Last year, the Community Health Accreditation Partner (CHAP) received part of a $2.3 million grant from The John A. Hartford Foundation (JAHF) to bring the Age-Friendly Health Systems movement to home-based care. Almost a year later, home health providers have implemented the framework and are seeing it as a potential differentiator moving forward. As more care is moved to the home, age-friendly advocates believe this is a way to elevate the industry as it gains a brighter spotlight. Beginning in April, home health providers across the country have had the option to achieve a certification for Age-Friendly Care at Home.

Chief Healthcare Executive: Mount Sinai Shares Lessons from Hospital-at-Home Program (6/12) - Mount Sinai launched one of America’s first hospital-at-home programs in 2015. Ania Wajnberg, associate professor in the department of medicine at the Icahn School of Medicine at Mount Sinai, told Chief Healthcare Executive in a March interview that she’s heartened by its progress. Mount Sinai has seen a low readmission rate and shorter hospital stays.  Now, the key is to develop them to scale so they can serve more patients. 

Fierce Healthcare: Simple HealthKit Inks Deal with Walmart to Expand Access to At-Home Tests (6/12) - Simple HealthKit has inked a deal with Walmart to bring at-home diagnostic tests, including diabetes, respiratory wellness and sexual wellness labs. Through Walmart's website, customers can purchase tests by Simple HealthKit's health care infrastructure including testing, follow-up and treatment. Walmart customers who order at-home testing will be provided with physician oversight through Simple HealthKit’s end-to-end system. Those who receive abnormal test results will be connected with a provider at no additional cost. Patients can also opt to review results and treatment plans with their preexisting primary care provider. 

NEJM Catalyst: The Role of Home-Based Care in Tackling Social Determinants of Health (SDOH) (6/12) - Seeing patients in their homes can make a huge difference in assessing and addressing their social determinants of health, rather than just relying on office visits, says Chief Operating Officer for Optum Home & Community Care Kristy Duffey. House calls can surface issues that would not come up in the provider office, decrease hospital visits, and improve patient health. Kristy Duffey sits down with Edward Prewitt, Editorial Director for NEJM Catalyst, to discuss addressing SDOH in home-based and community care.

America's Health Insurance Plans (AHIP): Hearing Statement to Senate Finance Committee on Consolidation and Competition (6/8) - AHIP offered four recommendations to the Senate Finance Committee on Consolidation and Competition to support healthy competition and lower health care spending in the health care industry. Specifically, AHIP recommended reintroducing the Improving Access to Home Dialysis Act along with other efforts to support home dialysis. In addition to enacting supportive legislation, policymakers should withdraw support from legislation incentivizing higher dialysis prices. For additional coverage, see Health Payer Intelligence. 

Home Health Care News: The Pros, Cons And Inevitability Of Caregiver Registries In Home-Based Care (6/7) - As in-home care providers try to keep up with the demand for services, companies that facilitate caregiver registries are hoping to fill a gap in an employee-needy marketplace. Hallmark Homecare is a North Carolina-based at-home care recruiting company that connects caregivers with patients. Essentially, companies like Hallmark Homecare maintain a database or registry of caregivers who have been screened, background-checked and evaluated on their skills and qualifications. Those companies then use referral sources to connect caregivers to patients in need of in-home care based on specific needs and preferences.

McKnights Home Care: Pennsylvania Master Plan for Older Adults to Include Home Care Input, Providers Say (6/5) - As part of the May 23 executive order signed by Gov. Shapiro, the Pennsylvania Department of Aging will be tasked with developing a 10-year plan focused on older adults before Feb.1, 2024. The Pennsylvania Department of Aging, alongside a working group made up of members of the state’s long-term care council, will be responsible for finding ways to eliminate barriers to advancement for older adult Pennsylvanians and identifying gaps in services and programs that have a negative impact on seniors.

Home Health Care News: Inbound Health Expands Into In-Home Post-Surgical Care For Elective Surgery (6/2) - Inbound Health, an enablement platform that helps health systems and health plans develop hospital-at-home and SNF-at-home programs, is expanding to include post-surgical care for general surgery. Through its expanded offerings, Inbound will take on patients who have received general surgery by meeting patients at the end of their surgery in an ambulatory surgery center, allowing them to recover in their home or meeting patients at the end of the surgery in an acute care setting, shortening their length of stay in the hospital by allowing them to recover at home. 

Upcoming Events

July 11-14, Moving Health Home Co-Chair, "Virtual National Advanced

Health Care at Home Summit."

August 23, National Home Infusion Association, "Home Infusion Payor Summit." 

August 30-31, Home Health Care News, "Future Conference." 

October 8-11, "HLTH 2023."

October 15-17, National Association for Home Care & Hospice, "Home Care and Hospice Conference and Expo." 

October 23-24, Home Care Association of America, "National Home Care Conference." 

November 9, Modern Healthcare, "Hospital at Home Virtual Briefing."

December 7, Aging Media Network, "Continuum Conference." 

Please subscribe to this newsletter and send any news or events to rlam@movinghealthhome.org for inclusion in this newsletter.