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.
Hospital at Home provides acute-level care at home and has existed since before the COVID-19 pandemic. While decades of research show that the model provides high-quality care, there was not widespread experience with the model until the establishment of the Acute Hospital Care at Home waiver during the Public Health Emergency.
Join us to hear from policymakers and health care organizations from across the industry with the common goal of ensuring Hospital at Home is a widely available option for patients.
Krista Drobac, Founder, Moving Health Home
Jay Gulshen, Health Advisor, House Ways & Means Health Subcommittee
Dawn Doe, VP, Value Based Programs, Continuing Health at Advocate Aurora Health
Jordan Holland, VP, Value Based Contracting, Compassus
Maulik Majmudar, MD, Chief Medical Officer, Biofourmis
Kevin Riddleberger, Chief Strategy Officer, DispatchHealth
Moving Health Home Joins McKnight’s Home Care Podcast to Discuss the Coalition's Priorities(9/1) - Less than two years after it was established, Moving Health Home is affecting change in Washington, DC. The coalition of healthcare providers dedicated to expanding care in the home is concentrating on the growth of three main areas: hospital-at-home, postoperative care in the home and the array of other services now available in the home, such as dialysis, home infusion and personal care services. Krista Drobac, executive director of the organization, talked to McKnight’s Home Care in a Newsmakers podcast about the pandemic’s role in creating the organization, the main challenge the coalition is facing and how Medicare Advantage is helping to support the mission.
Response to Request for Information on Medicare Advantage(8/31) - Moving Health Home (MHH) was pleased to submit comments to the Centers for Medicare & Medicaid Services (CMS) request for information to inform potential future rulemaking on various aspects of the Medicare Advantage (MA) program. MHH focused on how CMS, through its existing authority, could encourage home-based care through MA network adequacy standards. MHH expressed that CMS has an opportunity to better incentivize clinical care in the home by going beyond existing standards.
Home Health Care News Interviews Moving Health Home to Talk About Legislative Battles (8/24) - Whether it’s home health, personal or in-home primary care, many home-based care advocacy groups and trade associations have been able to establish their organizations as champions of a particular lane. It’s upon this foundation that the Washington, D.C.-based Moving Health Home has been able to lay the groundwork for its goal of mobilizing policymakers to thrust health care into the future, and into the home. What sets Moving Health Home apart from many of the existing advocacy-focused organizations is the cross-sector approach it has taken.
Department of Health and Human Services (HHS):HHS Expands Home and Community-Based Services in Five New States and Territories for Older Adults and People with Disabilities (8/22) – The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) demonstration program. The Biden-Harris Administration is committed to ensuring all seniors and people with disabilities receive the care they need, and this investment is the latest action to help people receive care in the setting of their choice and reduce unnecessary reliance on institutional care.
Research and Polling
AARP: Family Caregiver Considerations for the Future of Hospital at Home Programs (8/31) - The Hospital at Home (HaH) model shifts care into the home setting and delivers acute hospital-level care to eligible patients where they live instead of in a hospital. This brief presents four detailed Family Caregiver Considerations that HaH models can incorporate into policy and program design to best support patients and family caregivers. Each is thoroughly explained in the full report.
Implement Science Communications: Hospital In Home: Evaluating Need and Readiness for Implementation (HENRI) in the Department of Veterans Affairs: protocol for a mixed-methods evaluation and participatory implementation planning study (8/29) – The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. This study aims to systematically gather evidence from the 12 HIH programs and to develop a participatory approach to engage stakeholders, assess readiness, and develop/adapt implementation strategies and evaluation metrics.
JAMA: Comparison of Home-Based vs Center-Based Cardiac Rehabilitation in Hospitalization, Medication Adherence, and Risk Factor Control Among Patients With Cardiovascular Disease (8/25) – This study focused on the associations of home-based vs center-based cardiac rehabilitation (CR) with hospitalizations, medication adherence, and cardiovascular risk factor control among diverse patients with cardiovascular disease and high risk. The results showed that participation in home-based CR was associated with fewer hospitalizations at 12 months compared with participation in center-based CR.
PLos One: Barriers, enablers and acceptability of home-based care following elective total knee or hip replacement at a private hospital: A qualitative study of patient and caregiver perspectives (8/24) – The purpose of the study was to facilitate the implementation of home-based care following an elective total knee or hip replacement in a private hospital. The study explored patient and caregiver barriers and enablers and components of care that may increase its acceptability.
Journal of the American Geriatrics Society: Care disruptions among the homebound during the COVID-19 pandemic: an analysis of the role of dementia (8/23) – Seriously ill people with dementia living at home may be particularly vulnerable to disruptions in their care during times of crisis. The study sought to describe care experiences of those receiving home-based primary care in New York City during the COVID-19 pandemic and compare the experiences of people with and without dementia.
News and Market Developments
HomeCare: Luna Unveils Program to Reduce Post-Acute Care Costs (9/01) – Luna, an in-home physical therapy (PT) platform, today announces the launch of a value-based savings program for orthopedic practices to reduce post-acute care costs by 55% to 70%. While hospital-at-home continues to shake up health care, the latest rapid-growth sector is outpatient PT-at-home - a more cost effective approach over traditional home health, which consists of the same high quality PT services that patients typically receive at a clinic—delivered in the comfort of their own home.
Fierce Healthcare: Humana finalizes rebrand of home health division from Kindred at Home to CenterWell (9/01) – Humana has finished its rebranding of the home health division CenterWell from Kindred at Home, which the insurer acquired in August of last year. “The rollout of the CenterWell Home Health brand reinforces our efforts to expand our home health capabilities to meet the needs of our patients,” said Andy Agwunobi, president of Humana’s Home Solutions division, in a press release.
Hospice News: St. David’s HealthCare Expands Into Hospice, Home Health with HCA-Brookdale JV Assets (8/31) – Texas-based St. David’s HealthCare has expanded its services to include hospice and home health care in and around the City of Austin. St. David’s HealthCare was formed through a partnership between hospital operator HCA Healthcare and two nonprofit organizations — St. David’s Foundation and Georgetown Health Foundation. “[Brookdale home health and hospice] provides us with a large platform that complements our local provider systems,” said HCA Healthcare CEO Samuel Hazen during an earnings call. “Additionally, we believe the home will become a more important setting for health care in the future, with continuing growth in demand.”
RevCycle Intelligence: Home-Based Cardiac Care Led to Fewer Subsequent Hospitalizations (8/31) – Home-based cardiac care led to fewer hospitalizations and better clinical outcomes for patients compared to care received in a hospital setting, according to a study published in JAMA Network Open. In addition to fewer hospitalizations, home-based care participants had better program adherence than center-based care participants. Patients in the home-based cohort lived farther from their medical center, indicating that the strategy helped increase access to cardiac rehabilitation for some patients.
Home Health Care News: Proposed Payment Rule Would Make Care Access Difficult For Complex Home Health Patients (8/31) – It’s no secret that the home health proposed payment rule for 2023 is viewed unfavorably by the majority of stakeholders. It has received pushback for a number of reasons – namely a rate cut – but many also believe that if the rule is finalized, it will threaten care for complex home health patients. What’s considered a complex patient can vary, but patients with some type of heart failure, chronic respiratory diseases and cancer are examples.
Healthcare Dive: Walgreens completes majority stake acquisition in CareCentrix (8/31) – More consumers are looking for cheaper sites of care as hospital expenditures skyrocket, causing care delivery to increasingly shift outside of the inpatient setting. A surging senior population is also expected to escalate demand for care at home and in the community, instead of in the hospital. As a result, healthcare companies are scrambling to snap up a share of the growing at-home care market. Walgreens announced it planned to acquire CareCentrix in October as the Illinois-based retailer looks to bolster its new Walgreens Health segment. The company said it hopes CareCentrix and its data analytics capabilities will help Walgreens address the needs of patients with complex and chronic conditions transitioning out of the hospital.
Gothamist: Home care workers turn to New York City Council to outlaw 24-hour shifts (8/31) – A bill that would make it illegal for home health aides to be assigned to shifts of more than 12 hours at a time is gaining steam in the New York City Council, after a similar piece of legislation stalled in the state legislature. If successful, the measure would represent a major step forward for grassroots labor activists who have been fighting for years to end a practice in which New York home care workers are assigned to 24-hour shifts and paid for just 13 hours of their time.
Cision PR Newswire: Fresenius Medical Care Wins Major Award to Support U.S. Veterans with Industry-Leading Dialysis Care (8/30) – Fresenius Medical North America's (FMCNA) Renal Therapies Group, the leading provider of kidney care products, will be a company of choice to help treat the more than 35,000 military veterans receiving dialysis from the U.S. Department of Veterans Affairs (VA). The VA awarded a five-year contract to FMCNA in five different categories, the most of any medical device company, including home dialysis machines, critical care equipment, water purification systems, and in-center hemodialysis.
NEJM Catalyst: The Future of Home and Community Care (8/30) – Over the last couple decades, the advent of risk-based capitation and value-based care has revitalized the home care industry. By making the provider accountable for quality and total cost of care, value-based reimbursement has unlocked the provider’s time and has allowed for funding more intensive care. Financial incentives become unhinged from volume and instead are aligned with improving patient outcomes by providing the right care, at the right time, in the most appropriate setting. Perhaps most important of all in the restoration of home care is the burgeoning popularity of Medicare Advantage (MA) plans and the care for dual-eligible populations
Home Health Care News: CHAP Bringing ‘Age-Friendly Health Systems’ Initiative Into The Home (8/30) – Community Health Accreditation Partner (CHAP) has 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. Broadly, the age-friendly framework is a patient-centered care focus. It concentrates on the “4Ms” – what matters, medication, mentation and mobility. Both home health and hospice agencies are invited to participate in the accreditation. CHAP’s leaders believes that this is the start of a new standard of care for home-based care agencies, and also think age-friendly accreditation could be a differentiator for agencies that get receive the distinction after this initial grant.
Home Health Care News: Best Buy Leveraging Home-Based Care Capabilities As ‘Long-Term Investment’ (8/30) – Like with many of its retail peers, home-based care and aging services has become a key area of focus for Best Buy. These peers include heavy hitters like Amazon and Walmart. Together, these companies exemplify the ways that retail has begun to gain a foothold in health care, home-based care and aging services.
Medpage Today: Knock Knock, the Nurse Is at the Door (8/30) – In a recent Becker's Healthcare article, a nurse from National Nurses United raised criticisms and concerns about the growth of hospital-at-home programs. Deidre Rolli, BS, RN, the nurse manager for UMass Memorial Health Hospital at Home encourages her fellow nurses to look through a new lens as Hospital at home fundamentally changed her view of how care should be delivered.
Home Health Care News: The Fastest Growing Companies In Home-Based Care (8/29) – A number of home-based care providers – and businesses in the aging services sector at large – are among some of the nation’s fastest-growing companies. One of these companies, connectRN, is a platform meant to aid nurses and other care professionals trying to find work. “We are definitely continuing to learn about the needs in the home health space,” Cora Jaulin head of home health business previously told Home Health Care News. “There continues to be a shortage of labor. Therefore, it’s sort of perfect timing for us to jump into this space to help our home health partners really think through how to serve up opportunities for a home health clinician, and to continue to deliver on our overall promise to offer choice and opportunity.”
McKnights Home Care: Home-based care expands under SCAN’s health equity initiative (8/29) – The Centers for Disease Control and Prevention is leading efforts to close health equity gaps. Those who lack access to healthcare can become sicker and put more of a burden on the healthcare system, driving up healthcare costs.Many providers, including home care firms, are including health equity in the development of diversity, equity and inclusion plans. “A lot of organizations talk about why it’s important to talk about disparities, but in our case it actually took tying our compensation to reducing disparities to really get the organization aligned around it,” SCAN Health Plan President and CEO Sachin Jain told McKnight’s Home Care Daily Pulse. “That is where a lot of the ingenuity, creativity and drive came.”
Hospice News:How Proposed Cuts to Home Health Payments Could Impact Hospice M&A (8/29) – Disruption in home health reimbursement has an influence on the hospice mergers and acquisitions market, particularly among the rising number of companies offering both services. The most recent example is the 2020 implementation of the Patient-driven Groupings Model (PDGM). Uncertain about how this new payment system would impact their businesses, a number of strategic buyers shifted their 2020-2021 M&A pipelines towards their hospice segments.
Home Health Care News: Why Johns Hopkins Home Care CEO Isn’t Worried About Home-Based Care’s Future (8/28) – Johns Hopkins Home Care Group is attached to one of the top health systems and educational institutions in the country. It’s often a place where health care breakthroughs take place and new home-based care ideas are formed. And yet it still deals with pain points that are all too familiar to most home-based care agencies across the country: staffing woes, rate cuts and inflation.
Home Health Care News: Study Shows Home-Based Caregivers Can Help Stave Off Dementia (8/28) – The study utilizes self-reported data from the U.K. Biobank, a biomedical database that encompasses over 500,000 participants across the United Kingdom. The study examines if there’s a connection between dementia and sedentary activities. It took into account the questionnaire responses of more than 145,000 participants. The findings from this study are a reminder for home-based care companies – and their caregivers – to look for opportunities to incorporate mentally engaging activities into their care delivery plan.
McKnights Senior Living: CCRC acquires care management company for home-based care (8/26) – Waverly Heights, a continuing care retirement / life plan community in Gladwyne, PA, is expanding its care management operations with the acquisition of care management company GrayCare. The business now is called GrayCare by Waverly Heights, and the CCRC says it will complement Waverly Care at Home, the retirement community’s one-on-one private duty home care service for both CCRC residents and older adults who live in the greater community.
mHealth Intelligence: New Jersey Hospital Launches Hospital-at-Home Program (8/25) – A collaboration between Sena Health and Salem Medical Center has combined several aspects of technology and provider expertise to create a hospital-at-home program known as Salem Acute Care at Home, which aims to provide acute care for patients at home. Together with Sena Health, Salem Medical Center has created the Salem Acute Care at Home program to offer various at-home care services for patients, ranging from telehealth to a provider visiting them in their homes. In-person visits may occur as frequently as twice daily, and remote patient monitoring is continuous. Patients are admitted into the program through the emergency department, where clinicians confirm their eligibility.
Home Health Care News: How Home-Based Care Providers Take On Risk To Avoid Risk (8/25) – Taking risk has been a hot topic on the home health and home care conference circuits for some time now. That will heat up more moving forward. Two realities are driving providers to take on risk themselves. Home health providers, in particular, could be in sink-or-swim territory in five months. All the while, payers have become increasingly involved in the home-based care business. Risk makes more sense than ever.
Patient Engagement HIT: Top Patient Experience Benefits for Home Healthcare (8/25) – With an aging senior population, the US medical industry is increasingly focused on home healthcare as a means to not only cut costs but also improve the patient experience. Home healthcare improves patient experience via quality of life, better palliative care, convenient care access, and detection of social determinants of health.
Healthcare Finance: Health systems urge Congress to address Medicare reimbursement for home infusion (8/25) – Dozens of health systems, hospitals, and group purchasing organizations are asking Congress to pass legislation to address Medicare reimbursement for home infusion services. In a letter sent to congressional leaders, health systems, hospitals and GPOs, representing more than 600 hospitals and over 5,000 sites of care across all 50 states, are urging lawmakers to pass the Preserving Patient Access to Home Infusion Act. The bill provides technical clarifications that would remove the physical presence requirement, ensuring payment regardless of whether a healthcare professional is present in the patient's home. The legislation includes essential pharmacist services in the reimbursement structure.
Revcycle Intelligence: AHA Voices Concerns About Home Health Medicare Reimbursement Update (8/24) – The American Hospital Association (AHA) has urged CMS to reconsider the Medicare reimbursement update for home health agencies proposed in the Calendar Year 2023 Home Health Prospective Payment System (PPS) Rate Update. In a letter to CMS Administrator Chiquita Brooks-LaSure, AHA expressed concerns about the proposed Patient-Driven Groupings Model (PDGM) behavioral offset, market basket update, and productivity adjustment.
Home Health Care News: Merger To Form Home-Focused, $2.4 Billion Kidney Care Company InterWell Health Completed (8/24) – The formation of a value-based kidney care powerhouse was completed Wednesday. Officially formed now is InterWell Health, which came together through a merger of InterWell, Fresenius Health Partners and Cricket Health. The kidney care market has undoubtedly been booming of late. The need in the U.S. for kidney care is also huge. All the while, the prevalence of at-home kidney care programs has been growing, which InterWell believes it will accelerate.
Home Health Care News: How Home-Based Care Providers Are Changing To Meet New Workforce Demands (8/23) – Demand for home-based care continues to rise. Thus, more workers are needed. “There’s not a one-size fits all strategy to recruit and retain caregivers across personas,” Brandi Kurtyka, CEO of MissionCare Collective, told Home Health Care News in an email. “For instance, a career caregiver is different from someone working a care job on the side and different from a retiree. We’re starting to see agencies adjust their approaches from a one-size-fits-all to meet people where they’re at.”
McKnights Home Care: CMS’ home health plan will damage seniors’ quality of life (8/23) – Bipartisan lawmakers recently introduced new legislation, the Preserving Access to Home Health Act of 2022, to combat proposed cuts to home health services by the Centers for Medicare and Medicaid Services (CMS) that would take effect in 2023.Without action, the CMS plan would implement a 7.69% permanent payment reduction and additional $2 billion in “clawback cuts” for payments of critical home health services delivered to seniors and people with disabilities during the pandemic. This could result in as much as $18 billion in cuts to home healthcare providers over the next 10 years. This is unacceptable, especially as census data show the number of older adults continues to grow rapidly.
Cision PRWeb: BrightStar Care® Expands its Corporate Footprint with Eight Unit BrightStar Owned Acquisition (8/23) – BrightStar Care, the leading home care and medical staffing franchise with more than 365 locally owned and operated locations nationwide, announced today that it is acquiring eight BrightStar Care locations from its franchisee David Strassburg. BrightStar Care created BrightStar Owned to expand the brand’s corporate-owned footprint and utilize these agencies as testing sites for new technologies and processes to advance its franchised locations. BrightStar Owned agencies will also pilot new payer and reimbursement models and accept Medicare Advantage plans and other key national account referrals as part of its business model.
Healthcare IT News: Health tech startup partners on hospital-at-home care (8/23) – Following several major healthcare organizations expanding into advanced home-based care, Philadelphia-based Sena Health will help deliver the Salem Acute Care at Home for patients of Salem, New Jersey-based Salem Medical Center. The hospital-at-home startup has the capacity to provide up to 23 hospital-level services at home for medical conditions that would typically require hospital stays as well as care coordinators that are available 24 hours per day, 365 days per year.
Home Health Care News: Resilient Healthcare Lands Another Major Partner In Hospital-At-Home Arena (8/22) – The home-based care provider Resilient Healthcare has partnered with the Dallas-based White Rock Medical Center (WRMC) on transitional care and hospital-at-home programs. One of the programs the two are partnering on will be a part of the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver, and the other will not be. Resilient – a pioneer in the high-acuity care in the home space – sets up their partnerships so that success is not contingent on the public health emergency and CMS’ waiver.
Healthcare Finance: Home health agencies protest 2023 proposed payment rate cuts (8/22) – Home health agencies have written to the Centers for Medicare and Medicaid Services protesting the proposed 4.2% payment rate cut in the 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements Proposed Rule. LeadingAge told CMS that "if finalized as proposed, reducing Medicare home health payments by an aggregate 4.2% including a 7.69% negative adjustment to the base payment, coupled with an effort to recoup an additional $2 billion from home health providers, will have a devastating effect on older adults who rely on these services."
Chief Healthcare Executive: The new frontier: AgeTech and hospital-at-home (8/21) – By the year 2030, one in six people will be aged 60 years or older. This large demographic is aging, and its members overwhelmingly want to do so while remaining in their homes. The growing “age in place” phenomenon means seniors will require additional support from the family, friends, and healthcare professionals who serve as their caregivers.
Pharmacy Times: Digital Transformation, Shift to Home Care Delivery Have Significant Implications for Specialty Pharmacies (8/19) – Digital health represents a key component in helping patients safely manage therapy at home and in helping oncology-focused specialty pharmacies gather real-world data relevant to the interests of prescribers, pharmaceutical manufacturers, and payers. This article examines the rise of digital health, the changing site of health care in the United States, and the implications for oncology-focused specialty pharmacies.
tctMD: AHA Urges More Home-Based Dialysis in Advanced Kidney Failure (8/18) – The American Heart Association (AHA) is throwing their support behind a new initiative to increase the use of home dialysis in patients with advanced kidney disease. In a scientific statement published in Circulation, the AHA says there is enough evidence showing that these home-based therapies can improve cardiovascular risk factors—and potentially outcomes—compared with traditional dialysis performed three times a week in a healthcare setting.
Fierce Healthcare: Chartis: Number of systems exploring hospital-at-home to double over next 5 years (8/18) – The number of health systems looking to install a hospital-at-home program is expected to double in the next five years, even as the fate of the program remains in limbo, a new survey found. The survey, released earlier this month by the Chartis Group, showed more systems are leaning into hospital-at-home, which enables patients to get hospital-level care in their homes. The survey also found that more health systems are looking into digital-first primary care and remote patient monitoring to offer more personalized care.