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.
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Moving Health Home Updates
McKnights Home Care: Moving Health Home Urges Biden to Expand Commitment to Home-Based Clinical Care (2/6) - In a letter to the president last week, Moving Health Home urged the administration to make a commitment to clinical care in the home in its 2024 budget that goes beyond Medicaid home- and community-based services. The group called HCBS “the tip of the spear” in what is possible for in-home medical care, such as hospital-at-home and skilled nursing facility-at-home.
“We ask that you work to remove regulatory barriers to ensure all patients may choose to receive clinical care in the home and take advantage of the convenient, high-quality care that comes when patients receive home-based care, Importantly, we believe that care in the home contributes to health equity by giving historically disenfranchised populations the option to receive care on their own terms.”
Centers for Medicare and Medicaid Services (CMS): Public Health Emergency (PHE) Resource Update, Implementation of Hospital at Home Waiver Extension (2/6) - CMS released updated materials on the transition and operational wind down of flexibilities enabled by the COVID-19 emergency declarations. As such, CMS is accepting waiver requests for the Acute Hospital at Home (AHCAH) individual waiver. As a reminder, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023 provided more than $1.7 trillion to fund various aspects of the federal government, including an extension of the AHCAH individual waiver. CMS will continue to release updated guidance here.
White House: In State of the Union, President Biden to Outline Vision to Advance Progress on Unity Agenda in Year Ahead (2/7) - In advance of President Biden's State of the Union address, the White House released a four-part Unity Agenda focused on areas where members of both parties can come together and make additional progress for the American people. Most notably, the President Biden mentioned the need to grow home- and community-based services. For additional coverage, see McKnights Home Care.
Research and Polling
Home Health Care News: As Value-Based Care Gains Popularity In Health Care, So Can In-Home Cancer Care (2/14) - As payers look to achieve high-quality, accessible and affordable cancer treatment, there is an increasing interest in value-based approaches — particularly in at-home cancer care. According to a study from Manatt Health, one of the main strategies for value- and health-system based cancer care is to accelerate the delivery of care outside of brick-and-mortar settings. The key for providers is to build a program that the physicians have confidence in, while creating a communication system so that the patient and provider are on the same page.
ATI Advisory: Skilled Nursing Facilities (SNFs) Retook Higher Discharge Share Than Home Health Agencies in Early 2022 (2/10) - After the public health emergency was declared in March of 2020, hospital discharges bottomed out the following month. While they ticked back up in 2021 and 2022, they still remain 25 percent lower than they were in February of 2020. And while home health care gained a greater share of post-acute referrals compared to SNFs early on in the pandemic, there’s been normalization since then. Specifically, from November 2021 to February 2022, SNFs consistently received a higher share of discharges than home health care agencies. Those months looked more similar to pre-pandemic months. The results suggest that providers needs additional support for the high volume of patients looking for home health services. For additional coverage, see Home Health Care News.
HHAeXchange: HHAeXchange Homecare Survey: 80 Percent of Caregivers Say Impact On Patient Health and Well-Being is Their #1 Motivator (2/10) - HHAeXchange, a provider of homecare management solutions for providers, managed care organizations, and state Medicaid agencies, announced the results of a new survey of more than 1,400 caregivers across the nation. The survey aimed to better understand how caregivers are feeling amidst the impact of the COVID-19 pandemic on the industry, as well as the growing aging population and greater desire to receive care at home, increasing the demand for homecare. It also highlighted what motivates them the most about their work, despite new challenges and demands, and how technology empowers them to do their jobs. One important tool caregivers cited in the survey was technology. They said having access to innovative technology, such as mobile apps that record patient observations, could help them deliver better outcomes to patients. Notably, 67 percent of caregivers polled said access to that kind of technology could induce them to spend more time with their patients. For additional coverage, see McKnights Home Care.
ESRD National Coordinating Center: A Change Package to Increase Home Dialysis Use (2/10) - This change package is intended to support dialysis facilities and End State Renal Disease (ESRD) Networks in increasing the number of patients using home dialysis modalities, which include peritoneal dialysis (PD) and home hemodialysis (HHD). The change package includes actionable change ideas, collected from top-performing dialysis facilities that have increased the use of home dialysis. The change ideas presented are intended as a menu of interventions from which program leaders can choose to implement within their facilities.
Home Health Care News: CMS’ Rate Cuts Have Had Varying Levels Of Effect On Home Health Providers (2/9) - CMS released its 2023 final payment rule for home health care, which many providers believe that the final rule will have an impact on their business in the near- and long-term future. A survey found that, when asked if they believe the final rule will have an impact on their finances in the near future, 60 percent of respondents said it would be “somewhat” impactful on their business. Respondents also noted that there would be some margin pressure, but that ultimately they would be okay. In the long-term — looking towards 2024 and beyond — 50 percent of respondents believe that the final rule will be somewhat impactful in terms of business, while 20 percent of respondents believe that it will have an extreme impact on their business. On the flip side, 9 percent of respondents do not think it will be impactful at all.
Home Health Care News: How Specific Recruitment Strategies Lead To Better Retention In Home-Based Care (2/8) - In order to consistently recruit caregivers to home-based care, providers and human resource departments need to better understand what workers want and what they are struggling with. That was one of the many takeaways from a study conducted by MissionCare Collective and the National Association for Home Care & Hospice (NAHC), which focused on current caregiver challenges and opportunities. One of the high-level insights is that caregivers are seven times more likely to live in the poorest income category compared to the average U.S. population. The study also found that over half of home care workers and a third of certified nurse assistants (CNAs) rely on some form of public assistance, while 90 percent of caregivers do not have a credit card.
NPJ: The Role of Digital Technology in Surgical Home Hospital Programs (2/7) - Home hospital (HH), a care delivery model of providing hospital-grade care to patients in their homes, has become increasingly common in medical settings, though surgical uptake has been limited. HH programs have been shown to be safe and effective in a variety of medical contexts, with increased usage of this care pathway during the COVID-19 pandemic. Though surgical patients have unique clinical considerations, surgical Home Hospital (SHH) programs may have important benefits for this population. Various technologies exist for the delivery of hospital care in the home, such as clinical risk prediction models and remote patient monitoring platforms. This study reviews the institutional experiences at Brigham and Women’s Hospital (BWH) to discuss the utility of technology in enabling SHH programs and highlight current limitations.
RTI International: Study Finds People with Dementia Receive Less Health Care in Their Final Months Than People Without the Disease (2/7) - A study by researchers at RTI International, a nonprofit research institute, has found that people with dementia receive less of certain kinds of health care, particularly home health and hospice, in their final months. This is despite the fact that people with dementia functionally appear similar to those with other terminal illnesses for years prior to their death. According to the study, people with dementia appear to have the same predicted average activities of daily living (ADL) score at 17 months before death as people without dementia at six months before death. The finding suggests that people with dementia may receive less home-based care because it is more difficult to identify when they are within six months of death, a requirement to receive hospice care at end-of-life. The study builds on RTI's expertise in developing, implementing and evaluating integrated care models for individuals with complex health care needs and comes amid projections that dementia cases will double to 14 million by 2060. For additional coverage, see McKnights Home Care.
Altarum: The Health Care Workforce Crisis Arrives at the Program of All-Inclusive Care for the Elderly (PACE) Model (2/6) - A shortage of workers, especially home-based caregivers, is threatening expansion of All-Inclusive Care for the Elderly (PACE) programs. A poll of 92 PACE directors found nearly all were experiencing a workforce shortage and more than half reported higher-than-usual staff turnover. The positions most likely to be open were home-based personal care staff, nurses, drivers, and center-based personal care staff. Altarum researchers also stated the program faces tough competition for low-wage staff, such as personal care workers and drivers, from sectors, such as retail and hospitality. Still, the survey also noted that PACE does have advantages over competitors. Field research found that personal care staff in PACE programs have higher job satisfaction, with a greater sense of teamwork. They also tend to feel more valued for their opinions than direct care workers in other settings. For additional coverage, see McKnights Home Care.
News and Market Developments
McKnights Home Care: Resilient Healthcare Expands Hospital-at-Home Through Unique Partnership in Houston (2/14) - A recent partnership between Plano, TX-based Resilient Healthcare and IntegraNet Healthcare could create a new dynamic in the acute care at home model. Through the partnership, Resilient Healthcare and IntegraNet will together assume full risk of chronically ill patients, a model Resilient Healthcare founder and CEO Jackleen Samuel said this brings greater flexibility in home-based care and bigger rewards for the providers. The partnership offers two lines of care to patients in the Houston market. The first provides care coordination for chronically ill patients, including medication and behavioral health management. The second line provides hospital-at-home services to patients.
McKnights Home Care: Lessons From Tsunami Continue to Inspire California Home Care Owner (2/14) - McKnight's Home Care Daily Pulse interviewed Sam Gopinathan, owner of a nonmedical home care business, about the evolution of the home care field. Recently, he wrote a book, Connecting Is Caring: Going Beyond the Call of Senior Care in the Silver Tsunami Era, to share knowledge he has gathered as a home care owner about retirement planning.
Home Health Care News: Home Health Providers Taking On More MA Business Still Operating in the Dark (2/13) - With the shift to Medicare Advantage (MA) in home health care intensifying, some providers are struggling with the operational adjustments required to adapt. Even for the ones that recognize the need for that adaptation, there seems to be inherent road bumps in home health-MA relationship building. To combat this, a major focus this year has been teaching every level of the staff how the business operates. Letting caregivers, nurses and other staff members in on the nuts and bolts of the business has created a strong and more productive environment.
California Department of Aging: California Department of Aging Awards Nearly $90 Million in Grants to Grow Home Care Workforce (2/13) - The California Department of Aging announced the recipients last week, who became winners by proposing innovative ideas and incentives to recruit and train home care workers and family caregivers. The grantees include for-profit and nonprofit organizations, universities and training providers. The grantees will use the funds to develop and scale training programs, provide incentives and stipends for completing training, offer career coaching and provide advanced opportunities for home- and community-based direct care workers. Direct care workers can include home care aides, care managers, dementia care specialists, activities coordinators and other caregivers. Unpaid family and friend caregivers can also participate in training programs. For additional coverage, see McKnights Home Care.
Home Health Care News: The Meteoric Rise Of Johns Hopkins’ CAPABLE Program (2/10) - CAPABLE is an interdisciplinary program that was created at the Johns Hopkins School of Nursing. It puts an emphasis on modest investments and short-term interventions to improve the quality of life and health of aging adults at home. Through the three pillars of CAPABLE care, caregivers collaborate with clients to increase mobility and functionality in the home. The program usually takes between four and five months and includes goal setting, action planning and recorded improvements for activities of daily living (ADLs).
McKnights Home Care: Find Opportunities to Partner with Medicare Advantage (MA) Plans, Experts Advise Home Health Agencies (2/8) - Senior manager for BerryDunn, an accounting assurance and consulting firm, highlighted that home health agencies must leverage MA plans and not avoid them. Home health can position itself to work with MA plans because of its value proposition: it is considered the lowest-cost setting for health care, it can manage a mobile workforce, and it can lower hospitalization scores.
Home Health Care News: New Bill Looks To Combat Home Health Worker Shortages Via Public-Private Partnership (2/8) - In a move to address the shortage of health care professionals, a new House bill — the Kentucky Healthcare Workforce Development Act — has been introduced in the state. Broadly, the legislation aims to combat workforce shortages by building a public-private partnership that will increase workforce training and education initiatives. The legislation would create the Kentucky Healthcare Workforce Investment Fund, which would be administered by the Council on Postsecondary Education. While the legislation is only happening at the state level, the optimal impact in its supporters minds’ would be for this to trigger a federal equivalent.
McKnights Home Care: SYNERGY Home Care Strengthens Referral Network with New Concierge Service (2/7) - SYNERGY Home Care and its more than 200 franchisees rolled out a new concierge service to ease patient transition from acute care to home. SYNERGY’s ConciergeCare offers a variety of services including transportation, medication reminders, light housekeeping, meal preparation and grocery shopping. As part of the service, the company will offer a variety of packages and prices depending on the needs of the patient. Home care firms are increasingly finding ways to provide enhanced services to patients, through partnerships with handyman services to acquisitions of new services, such as care management.
Home Health Care News: 51 Percent Of Home-Based Care Organizations Plan To Dive Into Higher-Acuity Care Models (2/7) - In 2023, over half of home-based care organizations plan to pursue higher-acuity care in the home for the first time, specifically meaning hospital-at-home or SNF-at-home care. The survey had nearly 300 respondents who identify as working for organizations that work in home-based care, typically in home health care or personal home care. Behind higher-acuity in the home, more organizations are delving into non-clinical home care services, palliative care and primary care in the home.
Home Health Care News: The Smart Way to Invest in Personal Care and Support (2/7) - At the Home Health Care News Home Care conference, Gary Bachrach, Executive Director of Business Development, Home Care Services at The Joint Commission and Vicki Hoak, Chief Executive Officer at HCAOA discuss the opportunities in the personal care and support space.
Home Health Care News: Where Hospital-At-Home Programs Go Next (2/6) - The journey of the hospital-at-home model in the U.S. is a compelling one. Much of it has transpired over the last few years, ever since the introduction of the Acute Hospital Care at Home waiver, which allowed health systems to provide acute care in the home during the public health emergency (PHE). Now that it has been extended, though, it allows providers that had not started on their programs to get going. Home Health Care News interviewed Dr. Stephen Parodi, EVP of external affairs, communications and brand at The Permanente Federation and the associate executive director of The Permanente Medical Group, to chat about the future of hospital at home.
Home Health Care News: Waud Capital Backs Post-Acute Care Veteran With $100M For New Home-Based Care Venture (2/6) - Waud Capital Partners has partnered with former Cornerstone Healthcare Group CEO Steve Jakubcanin to grow a business in the broader home care and post-acute services market. This partnership reflects the company’s strategy of working with industry leaders and positioning itself within the home-based care sector. In the past, Waud Capital has invested in Concierge Home Care, a provider of home health services that offers skilled nursing, therapy and primary care services.
Home Health Care News: Contessa Rolls Out Hospital-At-Home JV With Virginia Mason Franciscan Health (2/3) - Contessa Health has teamed up with Virginia Mason Franciscan Health (VMFH) to launch VMFH Home Recovery Care at the Tacoma, Washington-based St. Joseph Medical Center. The Nashville, Tennessee-based Contessa specializes in shifting higher-acuity care into the home. On average, the company’s model lowers readmission rates by 44 percent and decreases the mean length of a hospital stay by 35 percent, according to data from Contessa. Under VMFH Home Recovery Care, patients receive hospital-at-home care, which includes clinician support and access to the necessary medical equipment. Currently, it is only available for Medicare fee-for-service patients, but VMFH is working to expand the program to include patients under other health plans. The program also will look to widen its reach and serve other locations in the future. For additional coverage, see mHealth Intelligence.