February 3, 2023

Welcome to the Moving Health Home newsletter!

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.

Please send any news or events to jmccoy@movinghealthhome.org for future inclusion in this newsletter.

Moving Health Home Updates

Home Health Care News: How The Public Health Emergency Helped Cut Regulatory Red Tape For Home Health Agencies (1/31) - With the public health emergency (PHE) set to finally end on May 11, home health stakeholders are finding that the impact won’t be as disruptive as once feared. This is because most of the biggest issues have already been addressed by Congress and the Centers for Medicare & Medicaid Services (CMS). The Acute Hospital Care at Home waiver, which was originally tied to the PHE, was extended through the omnibus spending bill. “We were successful in decoupling the waiver related to acute care in the home from the PHE at the end of last year when we secured the two-year extension,” said Krista Drobac, founder of Moving Health Home. “Now we’re focused on educating Congress about the other barriers that didn’t get waived during the PHE but are necessary for providing patients more options in the home.” Moving Health Home is pushing for a bill that will potentially be introduced in the House.

Congress

Senate: Sens. Moran, Tester, and Hassan Introduce the Elizabeth Dole Home Care Act (1/30) - On January 30, Sens. Moran (R-KS), Tester (D-MT), and Hassan (D-NH) introduced the Elizabeth Dole Home Care Act (S. 141), which would improve certain programs of the Department of Veterans Affairs for home and community based services for veterans. Most notably, the bill would expand access to home and community-based alternative care programs to veterans at all VA medical facilities, as well as to veterans living in U.S. territories and Native veterans enrolled in IHS or tribal health programs.

Senate: Sen. Casey and Rep. Dingell Introduce Bill to Provide Historic, Permanent Investment in Home Care for Seniors and People with Disabilities (1/26) - Sen. Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, and Rep. Dingell (D-MI) introduced the Better Care Better Jobs Act (H.R. 547/S. 100), which would enhance Medicaid funding for home care. The legislation would also help address the 650,000 people on home- and community-based services waiting lists. For additional coverage, see Home Health Care News and McKnights Home Care.

Administration Activity

White House: Statement of Administration Policy (1/30) - President Biden released a Statement of Administration Policy, which ends the PHE and the national emergency on May 11. The Acute Hospital Care at Home waiver and other home health provisions were extended in the omnibus spending bill. For additional coverage, see McKnights Home Care, Home Health Care News. 

CMS: Revisions to Hospice-Appendix M of the State Operations Manual and the Hospice Basic Surveyor Training (1/27) - CMS released guidance that provided detailed revisions to Appendix M of the State Operations Manual and CMS Hospice Basic Surveyor Training. The guidance adds a sampling strategy in which surveyors are expected to survey patients in three levels of care — inpatient, home care and continuing home care — as well as those who are live discharges. The sampling also includes surveying bereavement care, which is of particular significance to many nonprofit providers who have robust bereavement programs. For additional coverage, McKnights Home Care. 

Center for Medicare and Medicaid Innovation: Evaluation of the Independence at Home Demonstration (1/27) - The Independence at Home (IAH) demonstration is a congressionally mandated test of whether a payment incentive and service delivery model for providing home-based primary care reduces health care spending and improves quality of care for chronically ill and functionally limited Medicare beneficiaries. The report found:

• IAH beneficiaries received many more primary care visits and somewhat fewer specialty care visits than did comparison beneficiaries;
• IAH beneficiaries received a larger share of visits from NPs than comparison beneficiaries;
• Many IAH beneficiaries used home health services extensively, and IAH practices tended to have close relationships with home health agencies;
• Performance on the claims-based measures tied to incentive payments was high in Year 6, and performance remained high during Year 7, despite the COVID-19 pandemic; and
• IAH likely reduced total Medicare spending in Year 7, but the estimated reduction cannot be generalized outside of the first year of the pandemic or to other home-based primary care practices.

Research and Polling

American Journal of Nursing: What's the Future of Hospital at Home in the United States? (2/1) - Programs offering hospital at home model have proliferated since 2020, but payment and regulatory structures to address equity, oversight, and sustainability are needed. This editorial piece highlights the nursing role in this program as well as how hospital at home treats the whole patient. Social determinants of health are no longer just abstractions when nurses and other providers see patients in their homes and communities.

Health Affairs: Omnibus Spending Bill And Hospital-At-Home: A Roadmap To Ensure Enduring Change (1/25) - The Acute Hospital Care at Home (AHCaH) initiative was one of many programs initiated by Medicare under the regulatory flexibilities of the COVID-19 public health emergency. AHCaH allowed hospitals to receive waivers and Medicare to reimburse for “hospital-at-home” (HaH), a care delivery paradigm in which inpatient-level care is delivered to patients in their home. Although HaH was implemented in response to the exigencies of COVID-19, it has the potential to become a feature of everyday care delivery in the US. Congress has given CMS a runway to create change; regulators now have two years to show whether HaH will be temporary or transformative.

The Commonwealth Fund: Medicare Beneficiaries of Color More Likely to Rely on Unpaid Informal Caregivers for Home Health (1/18) - Medicare beneficiaries of color are more likely to use unpaid, informal caregivers, like family caregivers, for their home health care than White beneficiaries, which likely contributes to the poorer health outcomes experienced by home healthcare recipients of color. People receiving care from low-rated home health care agencies tend to see more adverse outcomes, while there is also an increased risk of mortality for those primarily getting their home healthcare from informal, unpaid caregivers. Ensuring that Medicare beneficiaries have equitable access to high-quality home health care providers merits greater attention. Medicare plays a pivotal role as a safety net for older U.S. adults. Targeting policies to reduce health disparities among the aging in Medicare could subsequently have a profound effect. For additional coverage, see Patient Engagement HIT.

Gerontological Nursing: Home-Based Care Provider Perspectives on Care Refusal During the COVID-19 Pandemic (1/1) - Acute and chronic disease management continues to shift toward a health care in the home model, yet literature discussing continuity of home-based care services during PHEs, is scant. This study explore older adults' decision making around home-based care service continuation during the coronavirus disease 2019 (COVID-19) pandemic. Four themes emerged, including two related to older adults' decision making around refusal of in-home care and two related to HBCPs' responses to care refusals. Fear of COVID-19 infection motivated older adults to make care-related decisions that were incongruent with their health needs, including refusal of care in the home, despite receiving education from HBCPs. These data highlight a need for tools to help HBCPs better support patients through decision-making processes about care continuation during COVID-19 and future infectious disease pandemics. For additional coverage, see U.S. News & World Report. 

Your Next Hospital Bed Might Be at Home (1/26) - In a time of strained capacity, the “hospital at home” movement is figuring out how to create an inpatient level of care anywhere.

News and Market Developments

Home Health Care News: Federal Trade Commission (FTC) Unlikely To Challenge UnitedHealth Group-LHC Group Deal (1/31) - The FTC will reportedly not challenge UnitedHealth Group’s deal for LHC Group Inc. after all. Both companies stock rose Tuesday after that news surfaced. The Lafayette, Louisiana-based LHC Group is one of the largest home health providers in the country. Its 29,000 employees deliver home health, hospice, facility-based and home- and community-based care to patients in 37 states and the District of Columbia. Since the announcement of the deal in late March of 2022, UnitedHealth Group and LHC Group have received multiple requests from the FTC. The former has agreed to buy the latter for $170 per share.

McKnights Home Care: New York Provider Groups Pressure Governor Hochul on Home Care Legislation (1/31) - New York state provider groups are turning up the heat on Governor Hochul (D) to include the New York Home Care First Act in the 2024 budget proposal. The Home Care First Act would ensure that home care is a priority option for patients who might otherwise be referred to an institution for care. It also provides funding for programs that support home care, as well as funding for caregiver training. The legislation was first introduced a year ago but was left out of the final fiscal 2023 budget. HCA and two other provider groups penned a letter to Hochul that highlighted ways hospitals and home care agencies can successfully collaborate to provide both medical and behavioral health at home.

Kaiser Health News: It’s ‘Telehealth vs. No Care’: Doctors Say Congress Risks Leaving Patients Vulnerable (1/31) - The $1.7 trillion spending package Congress passed in December included a two-year extension of key telehealth provisions, such as coverage for Medicare beneficiaries to have phone or video medical appointments at home. Before the pandemic, Medicare paid for only narrow uses of remote medicine, not including care at home. If Congress decides not to continue funding for remote at-home visits after 2024, patients will have to drive again for appointments that could have been handled remotely. 

McKnights Home Care: Home is Where the Health Screening is (1/30) - Reperio Health’s home health screening kit helps to avoid the hassles of attending doctor’s appointments. Reperio’s kit, which measures health metrics such as blood pressure and glucose, is shipped to your door. Once you receive it, you take the tests, pack it back up and send it back via UPS. The kit’s patented Bluetooth technology will connect with your smartphone to provide you access to the test results in its application within 30 minutes. The company currently performs 3,000 tests a month.

Forbes: Big Retail Enters Health Care: Disruption Can Be A Good Thing (1/30) - Amazon, CVS and Walgreens are all making inroads into the primary care space, with offerings ranging from urgent care to specialty care and even in-home health, and in the process, are disrupting the status quo and how patient care moves through the system. The additional capacity and focus on in-home, specialty and primary care could not only improve access for underserved patients and those with limiting social determinants but could also help further advance pay-for-performance over fee-for-service. With the potential to increase access, boost value-based models and promote the development of new technologies to inform care as it extends into the home and community, their influence holds tremendous promise.

Hospice News: Capital Caring Health to Expand Home-Based Primary Care Service (1/30) - Virginia-based Capital Caring Health is expanding its home-based primary care program. The nonprofit hospice and senior services provider plans to offer primary care to a larger population of chronically ill patients. Home-limited seniors, particularly in underserved socioeconomic regions, often do not receive the medical care they deserve. For the underinsured and uninsured who lack equitable access to necessary medical care, this increased support enables Capital Caring Health to meet patients where they are by delivering transportation services, supplementary meals and essential medical supplies. Capital Caring launched its Primary Care at Home service in 2019. The program includes house calls by doctors, nurse practitioners and social workers who specialize in caring for seriously ill seniors, home-based diagnostic testing, telehealth and other services. 

Home Health Care News: Home-Based Care Leaders Employ New Strategies To Fix Old Problems (1/30) - In home-based care, persistent headwinds are forcing leaders to employ new strategies. Those strategies include searching for new partnerships to drive efficiency; looking outside the industry for inspiration; and taking on more value-based and risk-based opportunities. For example, MHH member BrightStar Care, a home care and medical staffing franchise, has entered a coordinated partnership with Chamberlain University. The two organizations have formed a co-branded home care rotation nurses initiative, which will officially launch in May.

Home Health Care News: With QAPIs, Home Health Providers Should Opt For Tailored Approaches (1/27) - Curating a specific plan based on a home health provider’s needs, deficiencies and vulnerabilities is key to having successful Quality Assurance and Performance Improvement (QAPI) programs. 

Health Leaders: Tampa General Launches an Acute Hospital Care at Home Program (1/26) - Tampa General Hospital in mid-2022 launched TGH at Home, a partnership with the Visiting Nurse Association (VNA) to provide in-patient-level home care to the patients in its community. Using remote patient monitoring and telehealth technology and home health visits, the hospital's physicians can receive real-time health information about a patient who is ill or recovering at home. Combined with in-person care, Tampa General can manage care for patients in their home who would otherwise be hospitalized. As part of the Acute Hospital at Home Program, CMS mandates that the health system send care providers to the patient's home on a regular basis, usually every other day, while telehealth visits are scheduled at least twice a day. 

McKnights Home Care: Risk Can Result in Big Gains for Home Health Agencies (1/26) - Home health care can potentially reap substantial financial rewards as managed care plans look to providers to take on more risk. Plano, TX-based Resilient Healthcare has taken on the full risk of patients enrolled in its hospital-at-home program. Company co-founder and CEO Jackleen Samuel said if agencies want to make more money by assuming risk they must reduce overall costs by keeping patients out of the hospital and keeping them healthy.

Home Health Care News: Elevance Health Looking Forward To More Upside, Downside Risk Sharing (1/25) - Starting this year, Elevance Health will separate its business reports for its provider services wing, Carelon, as a way to adapt to the company’s evolving infrastructure. Elevance has touted its own at-home care offerings in the past, too. It is reaping some of the benefits that have come from its investments in home-based care and other health care services. Carelon RX and Carelon health services grew revenue by 12 percent and 27 percent in 2022 compared to 2021, respectively.

McKnights Home Care: Amedisys to Partner with Major Payer on Palliative Care Deal (1/25) - Amedisys will be taking on full risk for seriously ill palliative care patients through its hospital-at-home unit Contessa. One primary focus for Amedisys will be inking lucrative contracts with Medicare Advantage plans. At a time when many home health agencies are battling with MA plans over rates, Amedisys signed a deal last fall with CVS Health’s Aetna and is now talking with other large payers. MA plans need home health because it is a much cheaper alternative to other post-acute settings, such as skilled nursing.

Home Health Care News: Why Home Care Agencies Believe Home Health Partnerships Offer Growth Opportunities (1/24) - With the home care industry at a “pivot point,” it’s important for providers to take more control over their near- and long-term futures. Many home care companies believe they are capable of doing more in the home. Agency leaders have talked about their willingness to do more, and can do so by implementing new technologies, partnering with home health care providers and putting an emphasis on retention. It’s also beneficial for those home health providers, seeing as these partnerships would be at no cost to them. 

McKnights Home Care: HCBS Funding is Back on Biden's Radar, NAHC President Says (1/24) - The Biden administration’s plan to pump up home- and community-based services (HCBS) funding could be back on the front burner again. National Home Care & Hospice President William Dombi suggested at an opening session of the Home Care 100 conference in Orlando. Dombi said the administration is likely to revive Build Back Better, which could provide billions in federal funds to address the direct caregiver shortage in HCBS by boosting worker wages. MHH member Right at Home President and CEO Margaret Haynes also told the audience during the growth strategies session that caregivers working at home can often feel like they are marooned on a remote island, so emphasizing inclusivity is vital.

Home Health Care News: UCM Digital Health Launches At-Home Emergency Care Program With MVP Health Care (1/24) - UCM Digital Health (UCM) and MVP Health Care (MVP) announced a new program that will give MVP members access to emergency room-level care in the home. The program is dubbed Treatment in Place. First responders that partner with UCM now will have access to the UCM team, including their medical staff and team of care coordinators, to provide services for patients at their homes. EMTs or paramedics will then work with a UCM emergency medicine-trained physician virtually to quickly treat patients with non-life-threatening conditions. A program like this also gets at bigger-picture issues, like crowded emergency rooms and unnecessary trips to the hospital. 

McKinsey & Company: What to Expect in US Health Care in 2023 and Beyond (1/23) - The U.S. health care industry faces stiff economic headwinds this year that will challenge the profitability of providers. While the report expects the industry will overcome the challenges by next year, it also stated some sectors will continue to struggle, including post-acute care providers, such as home health. The post-acute segment is expected to experience zero to negative growth over the next few years. Those segments expected to experience higher growth include Medicare Advantage, ambulatory surgery centers and technology platforms. The report did offer glimmers of optimism for post-acute care providers of in-home services. It said the adoption of value-based care is expected to increase as payers and providers try to better manage care and costs, while increasing the use of “alternative sites of care.” For additional coverage, see McKnights Home Care.

Modern Healthcare: Rush and CVS Working to Get Hospital-Level Care in Minute Clinics (1/23) - Rush University System for Health is collaborating with CVS Health to integrate its services into CVS Minute Clinic locations that provide Medicare-managed care in the Chicago area. CVS Accountable Care Organization, or ACO, will work with Rush through a federal direct contracting model, ACO Realizing Equity, Access, & Community Health (REACH). Customized care will be offered for Medicare patients who begin their care journey at a Minute Clinic, including home-based care, transportation support for annual wellness visits, cost-sharing to help with co-pays, and other enhanced services and incentives. 

Home Health Care News: How Evolving Joint Employment Laws Could Impact Home-Based Care (1/23) - Home-based care providers in 2023 should stay on top of regulatory and compliance changes to federal joint employment laws. The Fair Labor Standards Act and the National Labor Relations Board (NLRB) define “joint employment” as working for two or more companies, one that is responsible for their W2s and compensation and a secondary that also benefits from their services. This includes workers from staffing agencies and franchisors, among others. Joint employment laws are particularly relevant to home-based. Policymakers are already considering proposed revisions to joint employment rules that would change how you determine whether someone is an independent contractor or an employee. Those changes would – in part – affect the analysis of whether a potential employer is exerting control over a caregiver. 

PR Newswire: Orlando Health Selects MHH Member Biofourmis to Enable Optimal Hospital-Level Care in Patients' Homes (1/23) - MHH Member Biofourmis, a global technology-enabled care delivery provider, announced a multi-year agreement with Orlando Health, a non-profit health care organization that serves the southeastern United States. Orlando Health will leverage Biofourmis' solution to support its program, which will enable providers across Central Florida to safely and effectively deliver hospital-level care to patients in their homes. Orlando Health's hospital-at-home program is expected to launch in early 2023. Patient volume is expected to grow steadily as the health system gains experience with the new care delivery approach. For additional coverage, see McKnights Home Care and mHealth Intelligence. 

McKnights Home Care: Meet Addison Care, a New Face on Electronic Home Care (1/23) - The use of artificial intelligence in home care is not a new concept. Increasingly, companies are applying the technology to help quell staff shortages, streamline efficiency and expand home care access. With Addison Care, a new 3-D, customizable, animated caregiver, Electronic Caregiver’s mission is to make this technology more “human.” In addition to providing a digital companion, the software also offers medication reminders, vitals monitoring and 24/7 emergency response, among other features. This immersive experience was developed in large part thanks to the process of trial and error — and recognition that a voice-only technology like Alexa has limitations. As the number of aging people continues to increase and staffing shortages persist, Addison Care will be there to help fill in the gaps.

Chief Healthcare Executive: Current Health CEO Christopher McCann Says Care is Coming Home (1/23) - MHH member Current Health's CEO, Christopher McCann says hospitals shouldn’t fixate on the past. McCann spoke with Chief Healthcare Education during the HLTH Conference in November. He shared his thoughts on the changing healthcare landscape, how he feels Best Buy’s acquisition of Current Health has primed the company for growth, and how healthcare leaders can ensure home-based care can succeed. 

The Wall Street Journal: Caregiver Turnover Strains Households (1/22) - The Labor Department projects 25 percent employment growth in the next decade for home health and personal care aides, which includes those who work in group homes and day service programs, compared with an average expected growth rate of 5 percent for all occupations. Even with rapid growth, home care agencies can’t meet demand. More than 85 percent of the home care agencies in the 2022 HCP Benchmarking Report turned down cases in 2021 due to the shortage, and 59.7 percent consistently turned down clients. To help address the staffing problem, many home care agencies boosted incentives and bonuses.

Upcoming Events

February 8, CMS, "Unwinding Home and Community-Based Services (HCBS) Public Health Emergency (PHE) Flexibilities." 

March 25-29, National Home Infusion Association, "Annual Conference 2023." 

March 30, Home Health Care News, "Capital + Strategy." 

March 30-April 1, World Hospital at Home Community, "World Hospital at Home Congress." 

April 13, Home Health Care News, "Tech Talks."

April 15-17, LeadingAge, "Leadership Summit 2023." 

April 17-19, Axxess, "AGILE 2023." 

May 16-19, Moving Health Home Co-Chair, "Virtual National Advanced
Health Care at Home Summit."

June 6-7, Strategic Solutions Network, "Using Home-Based Medical Care Innovations to Optimize Outcomes and Cost." 

August 30-31, Home Health Care News, "Future Conference." 

October 8-11, HLTH, "HLTH 2023."

October 15-17, National Association for Home Care & Hospice, "Home Care and Hospice Conference and Expo." 

October 23-24, Home Care Association of America, "2023 Annual Leadership Conference." 

November 9, Modern Healthcare, "Hospital at Home Virtual Briefing." 

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