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.
MHH seeks your organization's endorsement of a letter urging Congress to extend the Acute Hospital Care at Home waiver as part of the next government funding package. Signatures are due by COB on Friday, January 14.
Fierce Healthcare: 2022 forecast: 7 predictions for what lies ahead for health equity (12/22)- Current Health is a member of Moving Health Home, a collaboration between stakeholders advocating for policies that enable at-home care for all. What's really needed for home-care success are better payment models, and McCann expects to see a lot of focus on that area from the Centers for Medicare and Medicaid Services (CMS) and commercial payers as well. Hospitals that work with Current Health are also working on broadening payer relationships in order to expand access to care at home.
HealthLeaders: 6 Best Reimbursement Stories of 2021 (12/20) - Amazon Care aims to strengthen in-home care by linking on-site and virtual services. It includes independent pilots as well as a multi-partner Moving Home Health coalition that is "dedicated to advancing home-based care policies and reimbursement models." The company's home-delivery prescription business is growing as well, including with payers who have spoken on background with HealthLeaders regarding their Amazon contracts.
Senate Finance: According to recent reports, Build Back Better (BBB) is currently stalled in the Senate and negotiations seem to have ended. When, if at all, negotiations ramp up again is unknown. MHH has been following BBB negotiations because of the home-based care provisions included, such as investments into home- and community-based services and permanent extension of the Independence at Home demonstration. The Independence at Home model, originally authorized in the Affordable Care Act, tests the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions.
Department of Health and Human Services (HHS): Two New Over-the-Counter At-Home COVID-19 Tests Brought to U.S. Market Quickly by Biden-Harris Administration (12/29) - The tests have received emergency use authorization (EUA) by the Food and Drug Administration (FDA) after being evaluated through the Administration’s new accelerated pathway to support FDA review of tests with potential for large-scale manufacturing that HHS announced two months ago. HHS Secretary Becerra stated that "adding two new authorized tests will give Americans more options for testing at home, which helps keep people safe and provides peace of mind."
The Centers for Medicare & Medicaid Services (CMS): Extensions of CalAIM to Support Greater Health Equity Across Communities, Focus on Care in the Home (12/29) - CMS approved the California Department of Health Care Services’ (DHCS’) request for a five-year extension of its Medicaid section 1115 demonstration and a five-year extension of its Medicaid managed care section 1915(b) waiver. The demonstration and managed care 1915(b) combination, re-named “California Advancing and Innovating Medi-Cal” (CalAIM), includes important provisions to advance health equity, fund key services, like home and community-based services for underserved communities, and improve access to care. Among several priorities, the extended programs create an easier pathway to support care for people outside of traditional health care settings.
HHS: HHS Emphasizes Healthy Aging to Delay Onset of Alzheimer’s Disease and Related Dementias (12/27) - HHS Secretary Becerra announced the release of the annual update to the Department's National Plan to Address Alzheimer's Disease, which includes a new goal focused on work being done to promote healthy aging and reduce the risks that may contribute to the onset of Alzheimer's disease and related dementias. This year's report includes a new action item entitled "Determine progress made in rebalancing Medicaid long-term care toward home and community-based services among older adults." Through this project, HHS will assess the extent states have “rebalanced” Medicaid-funded long-term services and supports (LTSS) from institutional LTSS to home- and community-based services between 2015 and 2019.
CMS: The Agency Issued a Final Rule Furthering Their Commitment to Strengthen Medicare by Expanding Access to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (12/21)- This final rule establishes methodologies for adjusting the Medicare DMEPOS fee schedule amounts and procedures for making benefit category and payment determinations. Of note to home infusion providers, the agency is not finalizing its interpretation of the “appropriate for use in the home” requirement in the definition of durable medical equipment as it applies to certain external infusion pumps. Additionally, the agency is excluding infusion drugs from the DMEPOS Competitive Bidding Program.
Research and Polling
Parks Associates: Health at Home: New Era of Healthcare (January 2022) - This whitepaper examines the state of the virtual care market, particularly the shift from facility-centric care to healthcare at home, including hospital-to-home, chronic care, post-discharge care, and remote diagnostic care. As more and more healthcare activities take place from home, passive continuous monitoring solutions and new technology such as artificial intelligence will be critical to communications between providers and patients. In addition, new solutions that offer overnight monitoring will play a critical role in helping to fill the gaps, particularly in assessing patient deterioration or changes in health conditions.
Journal of the American Geriatrics Society: A mixed-methods evaluation of home-based primary care in dementia within an integrated system (12/22) - In this study, researchers examined the effects of home-based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Their objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end-of-life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC. This mixed-methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata-matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Care experience was captured through caregiver interviews. Although HBPC for PLWD was associated with a similar risk of hospital utilization compared to a matched non-HBPC comparison group, HBPC resulted in more patient-centered end-of-life care for decedents. Prospective studies of HBPC that further elicit and address unmet needs are warranted.
Journal of the American Geriatrics Society: Medicare-funded home-based clinical care for community-dwelling persons with dementia: An essential healthcare delivery mechanism (12/22) - The objective of this study was to determine how home-based clinical services currently support people with dementia, and what factors shape access. Researchers identified 6664 community-dwelling adults age ≥ 70 years enrolled in fee-for-service Medicare. Annual assessment of dementia status was determined via self-report, cognitive interview, and/or proxy assessment. Receipt of four types of home-based clinical care was assessed annually. What they found is that although almost half of community-dwelling persons with dementia receive home-based clinical care, there is significant variation in utilization based on race/ethnicity and environmental context. Increased understanding as to how these factors impact utilization is necessary to reduce potential inequities in healthcare delivery among the dementia population.
Journal of America's Physicians: Moving Care Into the Home During COVID-19 (Fall/Winter Issue) - The CMO of Landmark health, a home-based care provider, provided comments on and support for the home-based care model. Acute care in the home removes COVID-19 exposure risk that patients would be incurring in a hospital setting. Care at home providers are partners with primary care providers, and offer additional support for patients with complex chronic conditions. Lastly, while telehealth is a more convenient and flexible option for most, there are barriers to this type of care in technological challenges or poor internet connections. Thus, acute care at home providers should still have in-person engagement with their patients in order to both surpass these barriers and to prevent social isolation.
Kidney360: The In-Center Hemodialysis Unit, Yet Another Obstacle to Home Dialysis (December 2021) - Researchers used the 2017 United States Renal Data System data of patients with incident End-Stage Kidney Disease (ESKD) in the continental U.S. to evaluate the impact of driving distance to dialysis units on dialysis modality choice. Many efforts to improve one form of dialysis, peritoneal dialysis (PD) uptake in the United States have been focused on the promotion of PD, including the ESKD treatment choices model providing at home dialysis payment adjustment as well as attempt to expand the number of home dialysis units. The prevailing thought in the United States has been: if you build it, they will come. The results indicated that either patients who choose peritoneal dialysis do not seem to be as bothered by distance to dialysis than those who choose in-center hemodialysis, or patients who choose hemodialysis do so because of proximity.
News and Market Developments
Home Health Care News: Compassus Names New CEO, Doubles Down on Building a ‘Full Continuum of Home-Based Care’ (1/5) - David Grams will be taking the helm as Compassus’ next CEO. Compassus offers home health care services, plus infusion therapy, palliative care and hospice care. The company operates in 200 locations across 30 states. Grams stated: "As value-based care changes the landscape of health care, we look forward to further leveraging our expertise in delivering a full continuum of standard to complex and advanced illness care in the home".
BusinessWire: United States At-Home Care Market Report 2021: Size, Trends & Forecast with Impact of COVID-19 to 2025 (1/5) - The US at-home care market has increased during the years 2017-2020 and projections are made that the market would rise in the next four years i.e. 2021-2025 tremendously. The US at-home care market is expected to increase due to the aging population, increasing prevalence of chronic diseases, increasing per capita personal income, low-cost setting, etc. Yet the market faces some challenges such as lack of supporting infrastructure, the risk to patient safety, etc. Moreover, the market growth would succeed by various market trends like increasing use of telemedicine, increasing acute care utilization, etc.
Forbes: Even After Covid, Could Congress Ignore The Long-Term Care Needs Of Older Adults? (1/3) - Instead of providing temporary increases in federal funding for dozens of programs, lawmakers appear to be focused on permanently expanding just a handful. However, focusing on these few will result in Congress dropping many other proposals, possibly including some that benefits older adults, other people with disabilities, and their families such as Medicaid home and community-based services (HCBS). If Congress fails to increase federal funding for Medicaid HCBS, Medicaid benefiaries who could otherwise avoid nursing homes will be forced into these facilities by an outdated payment and delivery model.
ProPublica: They Were the Pandemic’s Perfect Victims (12/28) - Nearly 18,000 more dialysis patients died in 2020 than would have been expected based on previous years. That staggering toll represents an increase of nearly 20% from 2019, and resulted in the nation's dialysis population shrinking for the first time in decades. The rate of COVID-19 hospitalizations of dialysis patients from March to April 2020 was 40 times higher than the general population. Home dialysis, which has been shown to be safer for patients during the pandemic, is out of reach for many, especially Black and Latino patients. Advocates had pushed for greater access to home dialysis before the pandemic, and the need for home infusions is more apparent now than ever.
Fierce Healthcare: Looking ahead to 2022: 12 healthcare execs offer their predictions (12/28) - One of the predictions is regarding virtual care in the home. As stated by Milan Shah, CEO at Biofourmis: "Beyond telehealth visits, 2022 will see increased adoption of hospital-at-home and remote patient management because healthcare providers have seen how feasible it is, and payers are recognizing the inherent cost savings. Most importantly, patients much prefer to be at home instead of a hospital and all stakeholders are realizing that optimal outcomes can be achieved outside of a medical facility. That shift means healthcare organizations will need to work closely with virtual care providers to ensure their networks—and patients’ personal health information (PHI)—is protected from any vulnerabilities."
Boston Globe Amid Surge in Patients, Hospitals Treat More People at Home (12/22) - With COVID cases rising again and the health care system stressed, hospitals are under greater pressure to find new ways to take care of patients. UMass Memorial Hospital has developed a new home hospital program to treat patients, which patients, providers, and industry representatives express their support for in this article.
McKnights Home Care: Peer-to-Peer: Landmark Health CEO Chris Johnson on a new ‘expectation’ of in-home care (12/21) - Landmark plans on expanding their footprint to at least four more states and to continue to provide for their current communities. Johnson states that capitation-style arrangements with providers and other value-based care models are crucial for the transition to home-based care. Landmark's goal is that eventually, in-home medical care will become the expectation for communities and patients.
Home Health Care News: ‘Delivering Value Requires Transformation’: How Humana Is Tearing Down Silos, Accelerating Home-Based Care Innovation (12/19) - Humana executive Greg Sheff discussed the ways in which Humana is involved and interested in growing into within home-based care. As an insurance provider, Humana has seen an increased interest in at-home care in the increased number of claims and in how their members are seeking care. As a care provider, the company has also seen an increased demand for services in home health and home-based primary care. In 2021, Humana acquired Kindred at Home, which is being rebranded as CenterWell Home Health. The company also leveraged a number of strategic partnerships that placed it further into the home.