In this twice-monthly newsletter, you will find 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.
This newsletter recaps current events and research. Please send any news or events to firstname.lastname@example.org for future inclusion in this newsletter.
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Featured Research: Hospital-at-Home Program Excels During Pandemic Surge
The use of a hospital-at-home program to expand capacity during pandemic surges in Boston was critical to helping contain costs and keep patients out of the hospital.
In a new article published in the Journal of General Medicine, researchers highlighted how Brigham Health Home Hospital functioned during a COVID-19 pandemic surge in Boston. They found that a small home hospital team was able to create substantial inpatient capacity while delivering high-quality acute care at home.
Staffing Efficiencies: The hospital-at-home program, which oversaw 65 patients, was staffed each day by one physician, one to two nurses, and one mobile integrated health paramedic. In comparison, the overflow field hospital, which oversaw 394 patients, was staffed by 124 providers and 331 nurses.
Cost Containment: The field hospital treating overflow COVID patients cost >$75,000/patient whereas the traditional hospitalization comes in at around $15,000/per patient, and the hospital-at-home program was 35% less than that.
Treatment Success with Complex Patients: More than half of these patients had chronic conditions or comorbidities including cancer, diabetes, and heart failure. Of the 65 patients, only two required escalations to a facility for more intensive care, and the remainder were discharged to home or home health.
Health Affairs Blog:Innovation at the Centers for Medicare and Medicaid Services (CMS): A Vision for the Next 10 Years (8/12) - CMS Administrator Brooks-LaSure, Liz Fowler, Meena Seshamani, and Dan Tsai published a blog in Health Affairs about their vision for the CMS Innovation Center over the next decade. In the blog, they provide key learnings from the past 10 years and priorities for the future. For example, driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve system transformation. CMS did include a reference to innovations in care delivery in the home: “CMS must support innovations in care delivery to drive optimal health outcomes. Some providers may need additional tools, for example, to deliver care to patients in their homes and communities.”
Senate Democrats Adopted the Budget Resolution(8/11)- After more than 14 hours of continuous amendment votes, the chamber adopted on party lines a 92-page framework for Democrats’ $3.5 trillion package that includes health priorities such as hearing, dental and vision benefits for Medicare, closing the Medicaid gap, and lowering the Medicare eligibility age. Additionally, the blueprint included mention of home- and community-based services. The budget resolution now goes to the House for a vote. The text of the resolution can be found here and the Democratic blueprint can be found here.
Senators Warner (D-VA) and Scott (R-SC) introduced the Preserving Patient Access to Home Infusion Act (S.2652) (8/5) - This bill would preserve patient access to home infusion therapy under the Medicare program. Specifically, the bill provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services provided in home infusion — including essential pharmacist services — into the reimbursement structure. Preliminary analysis of the legislation suggests that the measure will create savings for patients and taxpayers by moving care into more cost-effective home settings.
Research and Polling
Current Health: 81% Of Health Systems Plan to Increase Investment in Care at Home (8/18) -In this White Paper, Current Health highlights new research exploring perceptions, adoption, and trends in remote care delivery. The research – based on a survey of 250 health system decision makers – found that 89% of health systems expanded their use of remote care technology in response to the COVID-19 pandemic, and 81% expect their organization to increase those investments in the next 12 months.
Health Affairs: Making Alternative Payment Models Work for Patients (8/13) - Authors offer the following three ways that policymakers and practitioners can integrate patient-centered elements into alternative payment models (APMs):
Emphasize access to community- and home-based care options to meet patients where they are;
Build capacity to address patient needs holistically to impact social determinants of health and advance health equity; and
Increase points of communication between providers and patients to strengthen care.
The three home-based care models the authors promoted in the article were home-based primary care, hospital-at-home programs, and home- and community-based services.
Kaiser Family Foundation (KFF): State Medicaid Home and Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey (8/10) - There were 277 HCBS waivers in Fiscal Year (FY) 2018. Overall, 41 states responded to KFF's survey by mid-July 2021, accounting for 87% of total HCBS spending nationally in FY 2018, though response rates for specific questions varied. Key findings include the following:
Important data gaps remain, with just under half of responding states tracking COVID-19 vaccination rates among Medicaid HCBS enrollees.
The Medicaid HCBS provider infrastructure declined during the pandemic, with two-thirds of responding states reporting a permanent closure of at least one provider.
Over half of responding states reported early plans for the new American Rescue Plan Act temporary enhanced federal funds for Medicaid HCBS.
News and Market Developments
McKnight's Senior Living: Humana Completes Kindred at Home Acquisition (8/18) -Kindred at Home’s home health operations will be integrated into Humana’s Home Solutions business and will adopt Humana’s payer-agnostic healthcare services brand, CenterWell. That operation will transition to CenterWell Home Health at the beginning of 2022. Humana plans to maintain a minority interest in Kindred’s personal care and hospice businesses.
McKnight's Senior Living: Hospital-at-Home a Huge Opportunity for Home Health Agencies (8/17) - The recent deal between home health giant Amedisys and hospital-at-home leader Contessa Health could be the wave of the future. That’s the prediction of David Levine, M.D. who helped develop the successful hospital-at-home program at Boston’s Brigham and Women’s Hospital. Levine said home health agencies have seasoned nurses and therapists on staff, and many of those agencies already have long-standing relationships with hospitals that could be leveraged for hospital-at-home programs.
Fierce HealthCare: Fresenius, Cigna Expand Value-Based Kidney Care Partnership (8/17) - The two first launched the team-up in 2017, and the new agreement extends the arrangement through 2023. The program, which falls under Cigna Collaborative Care, was the insurer's first value-based effort for kidney care. The program uses incentives to engage with providers around better outcomes, affordability and patient satisfaction. Cigna members have access to FMCNA's 2,600 dialysis centers and home dialysis options to manage their care.
Home Health Care News: How Home-Based Care Providers Can Prove Their Worth to Payers (8/17) - Home-based care is going to be a larger part of health care’s future. As a result, it’s beginning to attract considerable attention from entrepreneurs and other innovators. In 2020, 97% of surveyed health plan executives said they believed that more care needs to shift into the home, according to a CareCentrix report. But as new trends arise with the shift toward the home, including new technology, partnership opportunities and payment models, it’ll be up to each provider to decide whether or not it’s worth it to explore them.
Catholic Health World: Hospitals Partner up to Offer Hospital-at-Home Services(8/15) - When the doctor overseeing his care at Ascension Saint Thomas Hospital Midtown in Nashville gave Clinton Hammock the option of finishing his treatment for his cardiac condition at home, Hammock said yes. The hospital-level treatment that Hammock got in the comfort of his home came courtesy of the hospital and its partnership with Contessa Health, a provider of acute home care services. The care model aligns with a growing movement to provide some forms of acute care outside hospitals or nursing facilities
MarketWatch: Opinion by Kevin Riddleberger: Hospital-Care-at-Home Worked During the Pandemic - Now the Key is to Expand it (8/13) - In this opinion piece, Riddleberger highlights the strengths of in-home care and why now is the time to expand it. Hospital-care-at-home reduces costs at a magnitude of between 19% and 30% lower than in traditional inpatient care. He emphasizes that the model has had great success with seniors and with the emergence of the more contagious delta variant, there is ongoing benefits of keeping seniors out of the hospital. The next step is to take what lessons learned and refine the process, and improve Medicare practices even beyond the pandemic.
Home Health Care News: Signify Health CEO: Demand for In-Home Care Services 'High as Ever' (8/11) - Signify Health Inc. is encouraged to know that its clients are satisfied with its in-home evaluations. Although virtual visits gained significant popularity amid the pandemic, patients see major upside to Signify’s in-person visits. CEO Kyle Armbrester reports that "“We believe virtual evaluations will continue to play a role in the second half, but we’ve found that health plan members prefer our in-home evaluations, which can go much deeper in their assessments, including to determine social and behavioral needs, and perform diagnostic tests and other preventive services.”
Fierce Healthcare: Cigna, Blue Shield of California back Cricket Health's $83.5M funding round (8/9) - The series B funding round was led by Valtruis, which is focused on investing in companies with value-based and health-at-home models. Existing investors Oak HC/FT and Cigna Ventures as well as K2 HealthVentures also participated, and the round included a strategic investment from Blue Shield of California. The company plans to use the financing to drive rapid expansion of its services, executives said in a press release.
Home Health Care News Events:
Demo Day (August 19) - Virtual. See the latest demos from leading companies, and see how their solutions can help you thrive in this fast-growing and changing environment. All demos are pre-recorded and will be available for you to watch at your convenience.
FUTURE(September 30) - Chicago, IL. FUTURE delivers big picture thinking on trends shaping home health that executives need to consider as they develop their plans to invest and grow their businesses.
Home Care Conference (December 9) - Chicago, IL. It will bring together home care senior and regional executives, investors, and other professionals to explore non-medical home care trends and challenges in staffing, technology, sales, and marketing.
Elizabeth Fowler, JD, PhD, CMMI Director and CMS Deputy Administrator is among the keynote speakers and has publicly stated moving health into the home as a CMMI topic of interest and exploration. Early bird registration rates expire on Friday, July 23.
NASHP’s 34th Annual State Health Policy Conference: State Health Policy Unmuted(September 21-22) - Join hundreds of state leaders, from all 50 states and DC, as NASHP discusses the timely, cutting-edge issues facing state health policymakers, and highlights innovative solutions shared by the nation’s leading experts on topics including: lowering Rx costs, hospital costs, Medicaid, health insurance marketplaces, telehealth, social determinants of health, behavioral health, and more. This is a great opportunity to get a pulse on state priorities and opportunities to promote moving health into the home, especially as states grapple with improving health equity and lowering costs. Early bird registration rates expire on Friday, August 27.
National Association for Home Care and Hospice Conference and EXPO (October 3-5) -New Orleans, Louisiana. The Home Care and Hospice Conference and EXPO is the premier and largest educational and networking event for home care and hospice providers, owners, and industry leaders. The EXPO features over 150 companies represented each year, offering a wide variety of products, services and cutting-edge technologies. Additional details are TBA.
Virtual Hospital at Home User Group Annual Meeting(October 28) - As a pre-conference to the American Academy of Home Care Medicine’s meeting, the User Group will be hosting a day-long meeting that will include presentations from national leaders, panel discussions, and working sessions focused on practice and policy concerns, as well as a poster session, a photo/video contest, and much more.
American Academy of Home Care Medicine Virtual Annual Meeting(October 29-30) - At their annual meeting, you will have the opportunity to explore innovative models of care, learn evidence-based best practices, discover new strategies to improve care coordination through interdisciplinary care, and acquire the skill set to implement rapid performance improvement at this year’s conference. Example sessions include:
SNF at Home: Successes and Challenges of Launching a Home-based Post-Acute Care Program. This session will focus on describing successes, challenges, and lessons learned involved with launching a SNF-at-Home program.
Home-based Medical Care: Evolving from Fee for Service to Global Risk. Such models in the US have struggled because of the inability to have a sustainable business model in a fee-for-service payment system, in particular, Medicare fee-for-service. In this session, we discuss the conditions needed to allow a home-based medical care model to thrive and grow.