March 1, 2024

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 rcheung@movinghealthhome.org for future inclusion in this newsletter.

Administration

Centers for Medicare and Medicaid Services (CMS): Transforming Maternal Health (TMaH) Model (2/28) - CMS held an overview webinar for the Transforming Maternal Health (TMaH) Model, which provided new details about the model framework, elements, and payment structure. CMS also released additional model resources, including a payment design fact sheet and technical assistance fact sheet. Most notably, the TMaH requires elements of home monitoring of diabetes and hypertension as part of its model. 

Department of Health and Human Services (HHS): HHS Announces a Multi-Pronged Effort to Strengthen Direct Care Workforce (2/27) - HHS announced  several new initiatives and resources from ACL’s Direct Care Workforce (DCW) Strategies Center to address the dire shortage of professionals who provide the services many older adults and people with disabilities need to live in the community. hese include two technical assistance opportunities to help states strengthen their systems for recruiting, retaining, and developing direct care workers; a national hub to connect states, stakeholders and communities to best practices and other resources related to the direct care workforce; and a webinar series for states and stakeholders focused on a range of direct care workforce topics.

Administration for Community Living (ACL): 2024 Final Rule to Update Older Americans Act Regulations (2/6) - On February 6, ACL released a final rule to update the regulations for implementing its Older Americans Act (OAA) programs. The 2024 final rule aligns regulations to the current statute, addresses issues that have emerged since the last update and clarifies a number of requirements. It aims to better support the national aging network that delivers OAA services and improve program implementation, with the ultimate goal of ensuring that the nation's growing population of older adults can continue to receive the services and supports they need to live – and thrive – in their own homes and communities. Moving Health Home provided comments on the notice of proposed rulemaking last fall. 

Congress

Senate: Introduction of the At Home Observation and Medical Evaluation (HOME) Services Act (2/7) - On February 7, Sens. Rubio (R-FL), Carper (D-DE), and Blackburn (R-TN) introduced the At Home Observation and Medical Evaluation (HOME) Services Act (S. 3756), which would establish a new pilot program that would test coverage of outpatient observation services furnished outside a hospital under the Acute Hospital Care at Home initiative. 

Research and Polling

Nature: The Hospital at Home in the USA - Current Status and Future Prospects (2/27) - The annual cost of hospital care services in the US has risen to over $1 trillion despite relatively worse health outcomes compared to similar nations. These trends accentuate a growing need for innovative care delivery models that reduce costs and improve outcomes. HaH—a program that provides patients acute-level hospital care at home—has made significant progress over the past two decades. Technological advancements in remote patient monitoring, wearable sensors, health information technology infrastructure, and multimodal health data processing have contributed to its rise across hospitals. In this review, researchers evaluate the peer-reviewed evidence and discuss the promises, challenges, and what it would take to tap into the future potential of HaH.

NEJM Catalyst: Rural Access to the Cancer Hospital at Home Care Model (2/21) - Rural residents being treated for cancer face multiple barriers to appropriate care because they live far from the specialized cancer care facilities where they receive their treatment, and the necessary travel is arduous, time consuming, and often prohibitively expensive. At home, symptoms from treatment or progressive disease fluctuate, leaving patients without local specialty resources to respond to these changes. To address this disparity, Huntsman Cancer Institute (HCI) implemented Rural Huntsman at Home (Rural HH), adapted from its urban hospital-at-home program, to provide acute and subacute care at home to patients in isolated areas at a distance from HCI.

Journal of Palliative Medicine: Home-Based Care Allow People to Age in Place (2/15) - A study published by Rutgers University found seniors that have used home-based care service prefer home-based hospice services. Published in the Journal of Palliative Medicine, researchers found that the observed outcomes could stem from the identification of health issues that may complicate end-of-life care prior to engaging in it, making it easier for seniors to age in place in their own homes. 

Health Affairs: Bridging The Home-Based Primary Care Gap In Rural Areas (2/7) - With 7.5 million older adults in the US either completely or partially homebound, there is significant demand for receiving care in the home. Rural adults on average are also older, have higher rates of chronic disease and disability, and have greater unmet mobility needs compared to urban residents yet lack reliable transportation, which impedes care access and can result in being functionally homebound. Ongoing hospital and nursing home closures further reduce access to health services and increase the likelihood of treatment delays. Offering care in the home setting can help alleviate these challenges, advance equitable access to health care, and support Age-Friendly Health Systems. The authors explore opportunities to redesign care models given the unique needs of rural communities and policy and payment reforms to scale home-based primary care (HBPC) access.

Kidney360: Cardiovascular Outcomes in Home Hemodialysis and Peritoneal Dialysis Patients (2/1) - A study published in Kidney360 found that among home dialysis modalities, home hemodialysis (HHD) appears to have a slight cardiovascular advantage compared with peritoneal dialysis (PD). In a study of 68,645 patients who initiated home dialysis from 2005 to 2018, according to the United States Renal Data System, the adjusted risk of cardiovascular events was a significant 8 percent lower in the HHD than PD group. Stroke risk was a significant 42 percent lower and the risk for acute coronary syndrome was a significant 17 percent lower with HHD vs PD.

Minnesota Hospital Association: Minnesota Hospitals Say 65,000 Days of Care Were Avoidable if Patients Had Somewhere To Go (1/31) - One in six days of inpatient care is unnecessary now in Minnesota hospitals — a level of inefficiency that is causing backlogs in emergency departments and leaving patients waiting hours to receive treatment. The Minnesota Hospital Association issued that finding after surveying 101 hospitals across the state and discovering that a backlog, which emerged during the pandemic, is becoming a permanent problem. Patients spent 65,000 more days in inpatient hospital beds than needed in the five-month period ending in October — after the COVID public health emergency had ended.

Clinical Journal of the American Society of Nephrology: Evaluation and Measurement Properties of a Patient-Reported Experience Measure for Home Dialysis (1/23) - Researchers from University of Washington and Stanford University created a Home Dialysis Care Experience survey, to understand patient-reported experience measures for patients undergoing home dialysis. The Home Dialysis Care Experience survey is a 26-item measure that includes one composite scale and two global rating scores and is an informative tool to evaluate patient experience of care for home dialysis. 

News and Market Developments

Becker's Hospital Review: Three Predictions for the Future of Post-Acute Care (2/28) - Robust in-home care, advances in technology and seamless access to nursing facilities are some of the ways leaders anticipate post-acute care may change in the next 50 years. This article reviews future work from the American Association of Critical-Care Nurses, Stony Brook University Hospital, and Northwell Health Staten Island University Hospital. 

Modern Healthcare: What In-Home Senior Care Brings to Medicare Advantage (2/27) - An aging population and an increase in chronic conditions among older adults are driving partnerships between Medicare Advantage plans and at-home care companies, though it could take time to see savings from such programs. WellBe Senior Medical, Harmony Cares and Patina Health are working with insurers including UnitedHealth Group, Aetna and BlueCross BlueShield to provide home-based primary care to vulnerable older adults. Being in a patient’s home gives providers a better perspective on how social determinants of health, such as food, housing and isolation could be affecting their overall health.

Fierce Healthcare: Signify Health Expands to Offer In-Home Testing for Heart Arrhythmias (2/27) - Signify Health is expanding its in-home diagnostics offering to include a test for heart arrhythmias. Atrial fibrillation, the most common type of arrhythmia, can be asymptomatic, and there are likely between 1.26 million and 1.52 million undiagnosed cases. Through the program, Signify members who are at risk for an arrhythmia are identified, and then its clinical teams will test for contraindications. Members will asked to wear a continuous ECG patch, which tracks continuous cardiac activity, and, after 14 days, the team will review the results for signs of irregular heartbeat.

The Leader News: Harris Health Begins Hospital at Home Service to Improve Patient Access and Comfort (2/27) - Harris Health System launched its Hospital at Home service. The system hopes will help enhance access for all patients and improve the flow of patients through congested emergency departments. Harris Health hopes to achieve similar results. In simple terms, patients with non-life-threatening conditions like urinary tract infections, cellulitis and hypertensive urgency can receive hospital care at home and not be admitted into a hospital bed, which can then be used for more complicated patient cases. “Hospital at Home and the team provide the same comprehensive care the patient would receive at the hospital, all in the comfort of their home,” explains Rohan Dwivedi, director of operations, Harris Health Hospital at Home.

GE Healthcare: GE HealthCare and Biofourmis Collaborate to Extend Patient Monitoring Outside the Hospital with Virtual Care-at-Home Solutions (2/26) - GE HealthCare and Biofourmis announced a strategic collaboration aimed at enhancing continuity of care by enabling safe, effective, and accessible care in the home to support the patient journey beyond the hospital setting. The collaboration leverages the combined expertise of two market leaders to scale and deliver innovative care-at-home solutions. The goal of the GE HealthCare-Biofourmis collaboration is to enable more patients to go home earlier, and offer an alternative to facility-based care with the comfort and peace of mind that they are receiving high quality care at home with the intent of driving healthy behaviors in patients by managing them remotely. Moreover, insights from Biofourmis' FDA-cleared, AI-guided algorithms can help care teams deliver efficient, personalized care at home.

Home Health Care News: Chapters Health System CEO On Prioritizing Value-Based Care Initiatives In The Home (2/26) - Chapters Health System, a community-based nonprofit organization, provides a range of home-based care services to about 120,000 patients. It has been approaching value-based care as a priority for quite some time now, and with urgency.  The goal for Chapters is to treat patients holistically, and view all of its patient care services – whether home health, hospice, palliative, or primary – as part of a larger risk- and value-based ecosystem.

Lee Health: Health Care in the Comfort of Your Home (2/21) - Lee Health announced its partnership with DispatchHome, which allows care at home. In addition to treating patient's illness or injury, the care team will call in any prescriptions, update your doctor and handle billing with your insurance company.

FamiliesUSA: Policy Agenda to Achieve Meaningful Health System Transformation (2/20) - Families USA and four of our consumer advocacy partners- American Heart Association, National Consumers League, National Partnerships for Women and Families, and Third Way released an agenda, which outlines six policy priorities necessary to shift America’s health care payment and delivery system away from the inefficiencies of fee-for-service and toward population-based economics that truly meet the health needs of people in the U.S. Specifically, it recommends policymakers to pursue policy options that would allow for home visits. 

Healthcare IT News: RPM Strategies For Moving From Discharge to Hospital-at-Home Care (2/19) - Cindy Gaines, RN, chief clinical transformation officer at Lumeon, explains why making the home another part of the care continuum is so crucial – and discusses the technologies that can make it happen. 

USA Today: Kidney Dialysis at Home Should Be Far Easier to Get, So Why Don’t We? (2/18) - Few patients know about home dialysis, yet it could give patients personalized treatment options. Dr. Ywaram Reddy, a nephrolohist at the University of Pennsylvania shares a story of a person living with kidney failure and a patient advocate, on new ways to improve access to home dialysis for people living with kidney failure. 

American Medical Association (AMA): How Do You Boost Chronic Care At Home? Call in the Geeks (2/16) - For a patient with a chronic condition who is coming home from the hospital, it can be overwhelming trying to follow discharge instructions. After a trying hospital stay, the last thing they may want to worry about is how to install a self-measured blood pressure monitor. But what if there were a way to take the guesswork out of technology installation and use? Officials at the Geisinger integrated health system partner with Best Buy's Geek Squad to deliver, install and activate remote-care management devices in a program that includes over 300 patients from the health system. 

Biofourmis: Biofourmis and WellSpan Health Collaborate to Deliver High-Quality Hospital-Level Acute and Post-Discharge Care to Patients at Home (2/15) - Biofourmis announced a partnership with WellSpan Health, an eight-hospital integrated delivery system. Biofourmis will support the enterprise-wide expansion and management of a bundled program that includes hospital-level and post-acute care at home. The Biofourmis platform will be interoperable with WellSpan's Epic electronic medical record (EMR) system to enable operational efficiencies through a unified user experience, enhanced patient management capabilities, and billing documentation.

NBC News: As Emergency Room (ER) Overcrowding Worsens, Hospital at Home Helps Ease the Crisis (2/7) - As emergency room doctors nationwide plead for help to ease patient overcrowding, the one federal program that could fix the crisis is poised to lose funding. A federal program called “Acute Hospital Care at Home,” or Hospital at Home, is designed to free up hospital beds, allowing patients to recover in their own beds. It was started by the Centers for Medicare and Medicaid Services in 2020 to help ease hospital strain during the pandemic. Ninety-seven percent of ER doctors said they experienced patient boarding times of more than 24 hours. 

UC Davis Health: UC Davis Health Launches At-Home Care Program Transforming Post-Angioplasty Care (2/7) - UC Davis Health announced the launch of a digital care program for patients who have undergone a Percutaneous Coronary Intervention (PCI). The program leverages the UC-NOW text-messaging platform to provide post-discharge care and Clinii to asynchronously monitor patients’ vitals. The UC Davis Health care team will monitor the data of 200 patients daily and take preventive measures to improve health outcomes and potentially help reduce hospital readmissions.

University of Utah Health: Beyond Hospital Walls - A Nurse's Perspective (2/7) - For London Davis, being with a patient in their home is a special experience. Davis is a nurse for the Huntsman at Home program at the Huntsman Cancer Institute. Emergency department readmission rates for home care patients are similar to those who stayed in the hospital. But Heal at Home patients are much more satisfied with their experience. Ninety-four percent of them say they are “likely or very likely” to refer someone to the program.

Home Health Care News: CenterWell Home Health and BrightStar Care Hope to Inspire New Home Health Nurses Through Pipelines (2/5) - In recent years, home-based care providers have seen the value in being more hands on when it comes to building home health nursing pipelines. In order to pull this off, several providers have partnered with universities to create programs that will, ideally, lead to wider talent pools. CenterWell Home Health partnered with Nell Hodgson Woodruff School of Nursing, Emory University’s nursing school, to create the CenterWell Home Health Home Lab at the Emory Nursing Learning Center (ENLC). 

Upcoming Events

April 11, Home Health Care News, “Capital + Strategy”

April 16-17, Hospital @ Home, "Navigating the Future of Hospital at Home." 

June 3-4, American Health Care Association/National Center for Assisted Living, "Congressional Briefing." 

August 21-23, Home Health Care News, “Future Conference”

October 28-29, Home Care Association of America, "National Home Care Conference." 

Previous Events, Videos, and Podcasts

McKnights Home Care, "Right at Home Focuses on Caregiver Engagement." Due to demand, Right at Home, a firm that focuses largely on personal care, has set a goal of hiring 26,000 nonmedical caregivers in the United States this year. To help engage prospective employees, it is using new recruitment tactics, employing technology to onboard and build relationships with employees, and providing valuable training programs, they told McKnight’s Home Care in a Newsmakers podcast.

mHealth Intelligence, "Using RPM Tools to Bring Cancer Care into Patient's Home." Remote patient monitoring (RPM) is changing the chronic disease management landscape by allowing clinicians to track patient outcomes and assess their needs on a continuous or near-continuous basis. In cancer care, remote monitoring can help clinicians manage symptoms and provide timely treatment for patients, enhancing patient outcomes and experience. Glen Peterson, DNP, ACNP, RN, an associate professor of hematology at the University of Colorado Medicine, and his research team discovered when they set out to assess an RPM-supported in-come care program for bone marrow transplant and CAR T-cell therapy patients.

Home Health Care News, "How A Home-Based Care Provider Weans Itself Off Fee-For-Service Reliance." Alivia Care CEO Susan Ponder-Stansel sat down with HHCN and its sister site, Hospice News, to chat about that value-based care journey – and more – last month at Home Care 100 in Scottsdale, Arizona. The Jacksonville, Florida-based Alivia Care provides home health care, hospice care, personal care, palliative care, advanced care planning and other services across Northern Florida and Southern Georgia.

McKnights Home Care, "Home Care Has a Lot To Offer Innovative Payment Model." Katy Lanz, founder and principal of TopSight Partners shares with McKnight's Home care Daily Pulse that the shift to value-based care has he potential to change every aspect of care, from payment structures to referral systems, and beyond. With payment rates up for grabs and patient outcomes on the line, it’s time for home care companies to become fully immersed in value-based care. 

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