Moving Health Home Update |
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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.
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Check out our website and Twitter for more information |
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We invite you to sign this urgent letter to Congress in support of extending the AHCAH Waiver. The sign-on deadline is COB, Friday, May 3.
In early March, a small representative group of cross-industry collaborators sent a letter with more than 60 organizations urging the House and Senate to extend the AHCAH Waiver for at least five years. Now, we would like to extend this opportunity to sign on to a letter at the individual level for all interested parties. We feel it is important to show not only organizational support of the model, but also support from patients, family/friend caregivers, health care workers, health care administrators, advocates, researchers, local/state/federal policymaker, and vendors.
Note that this sign-on letter is at the individual level and each individual name will be displayed in the letter.
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September 1
MHH added a MHH in the News webpage, which highlights MHH's advocacy, policy development, coalition building, and more!
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Moving Health Home Updates
Moving Health Home: MHH Submits Statement for the Record for House Ways & Means Committee Hearing on Care in the Home (3/12) - Moving Health Home submitted a statement for the record to the House Ways & Means Committee, for the hearing, “Enhancing Access to Care at Home in Rural and Underserved Communities.” MHH focused its comments on:
- The need for a five-year extension of the Acute Hospital Care at Home (AHCaH) program;
- Data around Americans wanting to age in place; and
- The integration of technologies toward a care model where home is a site of clinical service.
MHH was thrilled to support MHH member Intermountain testifying before the House Ways & Means Committee about the importance of ensuring access to care in patient's homes. MHH worked closely with the Committee staff in advance of the hearing to educate members on the opportunities presented by hospital at home, and largely care in the home. Additionally, several MHH members participated in the expo prior to the hearing, where MHH members showcased and educated Congress what care in the home looks like.
Selected Coverage -
McKnights Home Care: House Committee Hearing 'Setting the Stage' for Home Care (3/18) - A House Ways and Means Committee hearing reinforced congressional support for home care. Home-based kidney care and telehealth were two big topics of discussion. Nathan Starr, medical director of home services and tele-hospitalist programs at Intermountain Health, advocated for the expansion of home-based services such as hospital-at-home. “I have personally seen patient, family, community, and caregiver benefits of care at home,” Starr said. “Our positive experience has reinforced our commitment to increasing access to care at home. That is also why we are so pleased to be here today to advocate for the federal health policy changes needed to enable and support current and future hospital-at-home and patient needs.”
Deseret News: Rep. Moore (R-UT) Wants More Americans to be Able to Access Health Care from Home (3/12) - The committee was tackling “enhancing access to care at home in rural and underserved communities,” an issue personal to Moore, the vice chair of the House Republican Conference. “Finding telehealth opportunities for ailments or conditions that could be solved” at home would give his family more flexibility, he said. The Ways and Means Committee invited Dr. Nathan Starr, a medical doctor and the lead of the tele-hospitalist program at Intermountain Health, headquartered in Salt Lake City, to testify about the policies necessary to support current and future at-home care. Rep. Moore interviews Dr. Starr on the importance of care in the home.
Moving Health Home: MHH Co-Leads Over 65 Organizations Urging Congress to Extend the Hospital at Home Waiver (3/11) - MHH co-led a letter, signed by over 65 organizations, urging Congress for at least a 5-year extension of the Acute Hospital Care at Home waiver program (AHCaH) before its expiration at the end of 2024. "Without an extension, Medicare beneficiaries will lose access to HaH programs that have been demonstrated to provide excellent clinical outcomes and lower the costs of care.”
Selected Coverage -
Home Health Care News: Hospital-At-Home Stakeholders Push For Acute Hospital Care at Home Waiver Extension
Modern Healthcare: Providers, Vendors Urge Congress to Extend Hospital-at-Home
McKnights Home Care: Hospitals, Home Care Press Lawmakers to Extend Hospital-at-Home Waiver
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Congress
House of Representatives: Legislative Proposals to Support Patient Access to Telehealth Services (4/3) - The House Energy & Commerce Committee, Health Subcommittee announced a legislative hearing on telehealth legislation. Most notably, Reps. Wenstrup (R-OH) and Blumenauer (D-OR) hospital at home waiver extension bill is included in this legislative hearing.
Commonly bills that are included in legislative hearings or markups are only from members that are on the Committee. In this case, Reps. Wenstrup (R-OH) and Blumenauer (D-OR) are on House Ways & Means Committee, so it is unusual for their bill to be included in this E&C legislative hearing. However, that means there is a lot of support to get this legislation moving.
House of Representatives: Introduction of the At Home Observation and Medical Evaluation (HOME) Services Act (H.R. 7742) (3/20) - On March 20, Reps. Castor (D-FL) and Buchanan (R-FL) introduced the At Home Observation and Medical Evaluation (HOME) Services Act (H.R. 7742), which would implement a pilot program to expand the scope of hospital-at-home care in the United States. Sens. Rubio (R-FL) and Carper (D-DE) introduced the companion legislation in the Senate (S. 3756) on February 7.
House of Representatives: House W&M Blog “We’re Keeping Patients Independent and Healthier at Home For Longer.” (3/14) - As the Ways and Means Committee explores ways to preserve and improve at-home care, witnesses urged the Committee to look at reforms that give patients and doctors more certainty, embrace the potential of new technology to offer the same level of care at lower prices, and consider guardrails that improve quality.
- Before the hearing, the Committee held a hands-on discussion with five entrepreneurs highlighting new technologies that are improving health care for rural and underserved Americans. Members heard about and saw firsthand cutting-edge technology that is improving patient health at a lower cost to patients, providers, and taxpayers.
- For patients who are forced to drive hours for a single appointment, at-home care can be a good supplement to initial care at a doctor’s office or hospital. Health Subcommittee Chairman Buchanan (FL-16) highlighted that at-home care benefits patients regardless of geography, but patients who have to travel greater distances will save more time getting critical care.
- MHH member Dr. Nathan Starr: “The feedback we’ve gotten from patients has been really positive. Having done a lot of virtual care myself, it is really fun to be able to tell a patient, ‘If we brought you up to our center in Salt Lake City, I would take care of you. I am telling you, we can do the exact same things we would do down there. You’re going to get the exact same care.’ That is incredibly reassuring. The other thing we see all the time is many of these patients who live in rural areas don’t want to leave. We’ve heard many times, ‘I would rather die than go up there and have to deal with all that.’ The fact that we can care for them where they are in place is hugely powerful.”
House of Representatives: The Hospital Inpatient Services Modernization Act Discussion Draft (3/12) - During the House Ways & Means Committee hearing on enhancing access to care at home in rural and underserved areas, Reps. Wenstrup (R-OH) and Blumenauer (D-OR) released a bipartisan discussion draft of legislation that would extend Hospital Care at Home waivers to December 31, 2027. Additionally, the discussion draft would also extend the Centers for Medicare and Medicaid Services (CMS) report to Congress to September 30, 2027.
House of Representatives: House Ways & Means Committee Hearing on Care in the Home (3/12) - On March 12, the House Ways & Means Committee held a hearing to examine opportunities and challenges in enhancing access to care in patients' homes and modernizing care in rural and underserved communities. MHH worked closely with the Committee staff in advance of the hearing to educate members on the opportunities presented by hospital at home, and largely care in the home.
Medicare Payment Advisory Commission (MedPAC): Medicare’s Acute Hospital Care at Home Program (3/8) - In this session of MedPAC’s March public meeting, Commissioners reviewed updated information about the Acute Hospital Care at Home (AHCaH) program, including findings from interviews with participating providers. Commissioners were mixed in their responses of the AHCaH program. Some Commissioners were concerned about the small evidence pool as well as cherry picking patients that qualify for the model. Most Commissioners supported the model, as it improves patient-centered care and moves care away from facility-based care. The same Commissioners supported extending the waiver to allow for additional time for data collection. The chapter in the report only provides Congress background on AHCaH and does not provide recommendations on policy action. The chapter on AHCaH will be included in the June 2024 report.
Senate: Senate HELP Ranking Member Cassidy, Chair Sanders, Colleagues Seek Information from Stakeholders on Older Americans Act Reauthorization (3/7) - Senate HELP Ranking Member Cassidy (R-LA), Senate HELP Chair Sanders (I-VT) led 7 bipartisan Senators in a request for input from stakeholders on policies the Committee should consider during the reauthorization of the Older Americans Act (OAA). Specifically, the senators asked for feedback on the effectiveness of pandemic-era flexibilities, as well as policies enacted by the 2020 reauthorization, in responding to the needs of older adults across the United States.
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Acute Hospital Care at Home Waivers Tracker
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321
HOSPITALS
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133
SYSTEMS
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37
STATES
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Administration
White House: Fiscal Year (FY) 2025 President's Budget (3/11) - On March 11, President Biden released his FY 2025 budget request. The budget proposes $130.7 billion in discretionary funding (a $2.2 billion or 1.7 percent increase from the 2023 level) and $1.7 trillion in mandatory proposed budget authority for the Health and Human Services Department (HHS) in FY 2025. Notable care in the home requests include funding for in-home nutrition services for older adults, caregiver and family supports, among others.
White House: 2024 State of the Union (3/7) - In a State of the Union speech, President Biden gave a brief nod to home care. “Imagine what that could do for America … Imagine a future with home care and elder care so seniors and people living with disabilities can stay in their homes and family caregivers get paid what they deserve!,” he said. A fact sheet published by the Biden administration prior to the speech touted his accomplishments in increasing home- and community-based services.
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Research and Polling
BMC Medicine: Inpatient-Level Care at Home Delivered by Virtual Wards and Hospital at Home (4/2) - Technology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence of effectiveness to explore implications for practice and research. Low-certainty evidence suggests that none of technology-enabled care at home models we explored put people at higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation.
Health Affairs: Can Hospital At Home Finally Hit Its Tipping Point? Lessons From The Hospitalist Field (3/26) - The COVID-19 pandemic catalyzed important regulatory changes and supply-chain investments that have markedly eased previous financial and logistical barriers to HaH. Hundreds of health systems sought and implemented the Centers for Medicare and Medicaid Services’ (CMS’s) HaH waiver and invested in the ecosystem necessary to provide high-quality care at home. Four years after the onset of the pandemic, however, headwinds for HaH adoption remain. For HaH to achieve its full potential, advocates may find lessons in the decisions, missteps, and successes of hospitalists in their early days.
Palliative Care and Social Practice: The Determinants of Actual Place of Death Among Noncancer Patients with End-Stage Chronic Health Conditions (3/19) - As older adults increasingly prefer to receive end-of-life care in their homes, new, community-based options will be critical to help patients achieve a home death. Many patients’ preference for death at home comes down to the existing support systems in their communities. Patients and caregivers require social resources to support them. Home palliative care is underutilized by patients, and many regions have health policies in place to support home-based palliative care. This inadequacy results in a lower quality of life, a higher likelihood of hospitalization for uncontrolled symptoms and exacerbated caregiver burden.
The Commonwealth Fund: Addressing the Shortage of Direct Care Workers: Insights from Seven States (3/19) - An issue brief from The Commonwealth Fund examines how seven states are trying to strengthen their direct care workforces and outlines opportunities for federal and state policymakers to catalyze that progress. Key findings include:
- Enhanced federal funds provided through Medicaid during the pandemic catalyzed state action.
- State recruitment and initiatives are underway but will take time to realize.
- Investing in and professionalizing the direct care workforce is critical to addressing shortages.
- State and federal policymakers must work together to strengthen the direct care workforce.
Innovation in Aging: Home Care Worker Continuity in Home-Based Long-Term Care: Associated Factors and Relationships With Client Health and Well-Being (2/23) - To best treat patients in the home, caregiver continuity is key. But for patients receiving more hours of care, maintaining that continuity is a difficult task. Receiving care from the same home care worker over time may be a key contributor to better client health and well-being in home-based long-term care. High home care worker continuity facilitates consistent observation, allows for adjustments to care that address changing needs over time, and helps home care workers build client-specific knowledge and interpersonal rapport.
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News and Market Developments
Boston Medical Center: Boston Medical Center Advances Equitable Patient Access with BMC Hospital at Home (4/3) - Boston Medical Center (BMC) announced its new Hospital at Home service, which will give eligible patients the opportunity to receive high-acuity, hospital-level healthcare from leading providers and recover in the comfort of their own homes with this new remote acute care unit. The clinical offering, called Boston Medical Center Hospital at Home, will improve care access, equity in care options, and convenience for patients.
Forbes: Finding A Path To Serving Special Needs Children In The Comfort Of Their Homes (4/2) - Discharge planning teams at children’s hospitals are tasked with helping families navigate their transition back home. However, in many cases, lack of caregiver readiness (caregiver training, inadequate housing that requires home modifications, health of primary caregiver, insufficient respite care, etc.), coupled with nursing shortages, can lead to long waiting times before a nursing agency can assign skilled nurses to fill needed shifts. Factors that need to transform care for children with special health care needs include: payment reform, networks, and better pediatric home-health support.
Executive Home Care: Executive Home Care Offers Solutions for Caregiver Stress During National Stress Awareness Month (4/2) - In recognition of National Stress Awareness Month, Executive Home Care, a provider of in-home care services, highlighted the importance of managing stress for caregivers. The company is dedicated to providing support and solutions to alleviate the pressures faced by those caring for loved ones, emphasizing the critical role of self-care in maintaining a healthy lifestyle.
Becker's Health IT: Intermountain Health Expands RPM (4/1) - Intermountain Health is expanding remote patient monitoring to older adults with chronic illnesses. The health system is launching the pilot project for value-based care patients from Utah's Salt Lake Valley enrolled in the "house calls" program at Castell, Intermountain's population health arm. The partnership with remote patient monitoring company Sensorum Health aims to keep those patients at home by using passive sensor technology to catch any early warning signs of emerging health issues and then intervening clinically. Intermountain and Sensorum clinical staff will work collaboratively on the project. Program results are expected to be published via white papers in late 2024.
Forbes: Key Factors Behind The Adoption Surge Of Hospital-At-Home Programs (4/1) - Using advanced medical technologies for services such as medical monitoring, diagnostic testing, treatment and rehabilitation, hospital-at-home (HaH) programs are intended to bring the level of care found in hospitals directly to patients’ homes. Typically, HaH solutions cater to patients with acute conditions who can be safely managed outside a traditional hospital setting. Government reimbursement policies are essential for enabling and promoting the adoption of HaH solutions. These policies encourage healthcare organizations to invest in the infrastructure, personnel and technologies necessary for hospital-level care at home.
ChristsinaCare News: ‘Just the Best Thing Ever’—Hospital Care at Home Program Celebrates Milestone (3/29) - The ChristianaCare Hospital Care at Home program has reached a new milestone with more than 1,000 admissions since opening in December 2021. ChristianaCare’s program enables patients with common chronic conditions, such as congestive heart failure and diabetes complications, as well as infections like pneumonia, to receive hospital-level care at home through virtual and in-person care provided by a team of physicians, nurse practitioners, paramedics and others. Technology kits deployed to patient homes ensure round-the-clock access to a health care professional, along with twice daily visits from caregivers, medication deliveries and mobile laboratory services.
Health News Florida: More Hospital Patients Are Being Treated at Home as Orlando Health Expands Program (3/28) - Orlando Health is expanding its acute Hospital Care at Home program, which uses remote monitoring of patients by health professionals, to Lake and Osceola counties. he Central Florida hospital group began last year offering patients at-home care, which was made possible through a program by the federal Centers for Medicare & Medicaid Services as a way to free bed space during the height of the COVID-19 pandemic. “It's safer for patients. They heal faster, and they have better experience scores than the traditional brick and mortar" said Dr. Siddharaj Shah, quality director of the program.
Health Leaders: How Remote Patient Monitoring (RPM) Can Break the Chronic Disease Cycle in Underserved Communities (3/25) - Healthcare organizations are launching remote patient monitoring programs to forge better connections with underserved populations who might not visit the doctor’s office or clinic. RPM programs give providers an opportunity to improve access to care and care management by enabling them to monitor a patient’s care at home and connect when needed. These programs can also help providers bridge societal gaps in care and address social determinants of health.
Healthcare IT News: How RPM Can Scale and Sustain CMS' Hospital-at-Home program (3/25) - Healthcare IT News sat down with Karin Schifter-Maor to ask her about scaling the Acute Hospital Care at Home program, how remote patient monitoring can help scale the program, how RPM can make the care-at-home program affordable, and the need for centralized patient data to keep track of patients and improve health outcomes. Karin Schifter-Maor is CEO of Essence SmartCare, a senior and chronic care technology and services company.
Home Health Care News: How The Home-Focused Careforth Reduces ED Visits, Falls Through Family Caregiver Support (3/22) - The United States relies heavily on family caregivers, so much so that the Biden administration has gone lengths to support them. Still, in order for family caregivers to actually reduce the cost of care in the home, they need to be given the proper resources and education. That’s part of the thesis behind the company Careforth, which is a family caregiver support platform. Careforth provides care teams for family caregivers. Those care teams connect caregivers with local resources and provide education for dementia care, behavioral health care and other conditions. They do so via in-person at-home visits, as well as virtually.
Becker's Health IT: Mass General Brigham 'All In' on Hospital-at-Home (3/20) - Despite uncertainties over reimbursement, Mass General Brigham is "all in" on hospital-at-home care. Mass General Brigham plans to roll out additional hospital-at-home care pathways soon, treating post-operative, oncology and postpartum patients. While the program's eventual goal is to reach 10% of inpatient capacity, or upward of 200 beds, it will likely top out at around 60 or 70 beds by the end of 2024. Mass General Brigham went live with hospital-at-home technology from Best Buy Health in February. The health system uses the retailer's Current Health remote patient monitoring platform and Lively fall detection and emergency response system.
Color Health: The American Cancer Society and Color Health Announce Expansion of a Comprehensive Cancer Care Solution (3/18) - The American Cancer Society (ACS) and Color Health announced an expansion of their program to form a comprehensive cancer solution for employers and labor unions to support their employee and member populations across all stages of the cancer journey. As part of the expanded program, Color is running a Virtual Cancer Clinic, which includes an imaging network that provides appointment availability in less than two weeks, significantly faster than the national average, and integrated at-home screening tests remove traditional barriers to access.
The Washington Post: Finding a Doctor Who Specializes in Senior Care is Hard (3/17) - Research suggests geriatricians more effectively manage older patients’ care, but several factors dampen interest in the field. People over 65 use more health care than other age groups and make up nearly half of hospital admissions. But there are just 7,300 board-certified geriatricians in the United States, which is fewer than 1 percent of all physicians, according to the American Geriatrics Society. Right now, the United States has roughly 1 geriatrician for every 10,000 older patients. Only 41.5 percent of geriatric medicine fellowship positions were filled in late 2023, down from 43 percent in 2022. Meanwhile, the number of people over 65 is expected to grow by nearly 40 percent within the decade.
Fierce Healthcare: Momentum Behind Hospital-at-Home Continues to Grow (3/11) - Patients also have 24/7 access to medical providers through DispatchHealth’s registered nurse command center. At the same time, remote monitoring devices and biosensors provide care teams with real-time health data and will alert clinicians to any adverse change in their patient's health. Dispatch sends medical teams to patients' homes armed with mobile blood work labs, portable ultrasounds, in-home imaging and IV medication, most of the standard equipment found in hospitals, to diagnose and treat patients. Proponents of hospital-at-home services tout quality and safety benefits leading to positive patient outcomes as well as significant cost savings.
Home Health Care News: Advocate Health’s Strategies For Hospital-At-Home Expansion (3/6) - In the spring of 2020, Atrium Health — now a part of Advocate Health, post-merger — implemented a system that allowed patients with less severe COVID-19 cases to opt into an at-home care option. The move made it a pioneer in the at-home virtual health space. Three years later, the program has grown exponentially. Molly McColl, vice president for virtual and global health care at Advocate Health emphasized the importance of seamless integration between virtual tools and the overarching care delivery model of its hospital-at home program.
Penn Medicine News: Bringing the Hospital Home (3/5) - Since his 2020 diagnosis with multiple sclerosis, Steve Lengle has had good and bad days. The bad days are becoming more frequent as his condition continues to decline, causing debilitating pain, weakness, and fatigue, and affecting everything from his memory to his ability to walk. The Lengles found the help they needed through Penn Medicine Advanced Home Health (PMAHH), a program that aims to prevent hospitalizations by providing a higher level of in-home care to patients who are experiencing an acute medical concern.
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Upcoming Events
April 10, House Energy & Commerce Committee, "Legislative Proposals to Support Patient Access to Telehealth Services, Includes Hospital at Home Extension Bill."
April 11, Home Health Care News, “Capital + Strategy”
April 11, Hospital at Home Users Group, "Age-Friendly Beyond the Hospital: Innovation Hospital at Home."
April 16, Home Health Care News, "Shaping the Future of Home Care."
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."
June 14, MedPAC, "June 2024 Report, Includes Hospital-at-Home Chapter."
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, "Innovative solutions: BrightStar Care delivers customized solutions for healthcare partners." BrightStar Care is a leader in the rapidly expanding home care industry, renowned for its ability to successfully stand up complex in-home care delivery models, exceptional B2B partner solutions and nurse-led care model. With a holistic approach that spans medical staffing, private duty home care, hospital at home, commercial insurance plans and more – BrightStar Care not only fills a critical gap in the healthcare sector but its flexible solution based approach has led the network to offer innovative, high-value solutions tailored to meet each partner’s needs. As the industry evolves, BrightStar Care continues to be at the forefront, delivering a higher standard of care in the industry and positioning itself as the premier partner for future healthcare collaborations.
McKnights Home Care, "Right at Home focuses on engagement to hire 26,000 caregivers this year, CEO say." 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. How does it plan to do this? It wants to make the experience of working at Right at Home a singularly stellar one, according to CEO Margaret Haynes, and Renee Pfister, a Right at Home franchisee in the South Carolina Upstate. 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.
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