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.
On October 20, Emcara Health, a national value-based medical group launched by PopHealthCare, announced it joined Moving Health Home. “As the momentum for more care in the home intensifies among patients, caregivers, advocates, and policymakers, we are pleased to welcome new stakeholders to the table that embody our mission. During the pandemic, the value of clinical care in the home was demonstrated, and we look forward to working with Emcara Health and all of our members to ensure home-based care is part of the future.”
Home Health Care News: PopHealthCare Leans into Home-Based Care with Emcara Health (10/27) - GuideWell Mutual Holding Corporation subsidiary PopHealthCare recently launched value-based national medical group Emcara Health. The new company will focus heavily on home advanced primary care for seniors. Though newly launched, Emcara Health has already joined the ranks of Amazon Care and Intermountain Healthcare in advocating on home-based care’s behalf. Emcara Health announced last week that it has become a member of Moving Health Home, a home-based care advancement coalition that counts the aforementioned companies as members.
Congress: Build Back Better Act Includes Permanent Extension of the Independence at Home Demonstration (11/3) – The latest version of the reconciliation package, as of November 3, released from the House Committee on Rules included a permanent extension of the Centers for Medicare and Medicaid Services (CMS) Innovation Center Independence at Home model. Additionally, Section 132001 appropriates $60 million in fiscal year 2022, available until September 30, 2031, to administer the program and would remove beneficiary and provider caps. The Independence at Home model, originally authorized in the Affordable Care Act, tests the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions.
Subcommittee on Health of the Committee on Energy and Congress: Hearing on "Caring for America: Legislation to Support Patients, Caregivers, and Providers" (10/16) - In written testimony to the Committee, Alan Levine, Chair of the Board and Chief Executive Officer at Ballad Health, recommends that CMS expand and support payment for innovative care delivery, including Hospital at Home programs. "Beyond education and training dollars, Congress should encourage CMS to reimburse for the services provided by many of these positions, continue to push for well-designed Value-Based Payment programs in fee for service, expand telemedicine and hospital-in-the-home programs and promote Medicare Advantage and Medicaid Managed Care total cost of care arrangements with providers that are proven to reduce hospital and emergency department utilization."
CMS: Final Medicare Physician Fee Schedule (11/2) – CMS issued a final rule that announces policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues to begin on or after January 1, 2022. The Calendar Year (CY) 2022 PFS final rule includes several provisions related to care in the home potentially relevant to MHH members and its priorities. Among these are:
Telehealth Provisions, Including Allowing Home as an Originating Site for Mental Health Services;
Feedback on Administering Non-COVID-19 Vaccinations in the Home;
Provisions Related to Administering COVID-19 Vaccinations and Monoclonal Antibodies in the Home; and
Clinical Laboratory Fee Provisions Related to Laboratory Specimen Collection and Travel Allowance for Homebound Patients.
For more details, you can read the official CMS press release and fact sheet. Or, view here for the MHH summary using the password "ACCESS."
CMS: CY 2022 End-Stage Renal Disease Prospective Payment System Final Rule (10/29) - CMS issued a final rule that updates payment rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2022. Changes impacting home dialysis include:
Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Applications - CMS approved a TPNIES application, for the first time, for a home dialysis machine for CY 2022. The technology will receive the TPNIES for two calendar years.
The Home Dialysis Payment Adjustment - An upward adjustment on home dialysis and home dialysis-related claims with claim service dates between January 1, 2021, and December 31, 2023, the initial three years of the ESRD Treatment Choices (ETC) Model.
A Health Equity Incentive to the improvement scoring methodology for both the home dialysis rate and the transplant rate.
A two-tiered approach to address disparities in home dialysis and transplant rates through the ETC Model’s benchmarking and scoring methodology.
Additional modifications to the ETC Model, including changes to the home dialysis rate and transplant rate, the achievement and improvement benchmarking and scoring methodology, and a process for sharing certain beneficiary attribution and performance data with ETC Participants.
CMS: Webpage Launched to Share Innovative State Actions to Expand Medicaid Home and
Community-Based Services (10/21) - There is a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding ($12.7 billion) made available by the American Rescue Plan Act of 2021 (ARP).
CMS: Alabama’s Section 1115 Demonstration to Improve Access to Home and Community-Based Services is Approved (10/21) - CMS approved the new Medicaid section 1115 demonstration in Alabama, entitled the
“Community Waiver Program.” This new opportunity in the state’s
Medicaid program will increase access to home and community-based services, and
allow the state to meet the needs of additional individuals who prefer to get
long-term care services and supports in their home or community rather than an
CMS: Innovation Center Strategy Refresh Paper Released (10/20) - In their newest white paper, the CMS Innovation Center lays out their vision for the next decade of Innovation Center activities. They state the goal is a health system that achieves equitable outcomes through high-quality, affordable, person-centered care. The paper goes on to outline the five strategic objectives that will drive this transformation: 1) Drive Accountable Care, 2) Advance Health Equity, 3) Support Innovation, 4) Address Affordability, and 5) Partner to Achieve System Transformation. In the paper, the CMS Innovation Center recognized the value of care in the home, specifically supporting patient and caregiver needs and preferences by exploring payment waivers and flexibilities that allow more home-based care.
Research and Polling
Annals of Internal Medicine: Early Uptake of the Acute Hospital Care at Home Waiver (AHCaH) (10/26) - Early analysis of the AHCaH individual waiver suggests rapid uptake and a strong appetite across a diverse array of hospitals, with the potential for significant capacity creation with a stable but slower uptake over time. In contrast to rapid uptake among large hospitals (8.9%) and major teaching hospitals (13.2%), few rural hospitals (0.1%) have thus far received a waiver. For-profit hospitals have similarly not yet substantially entered the scene. Barriers to uptake may include the potentially temporary nature of the AHCaH individual waiver resulting in hesitancy of hospitals and health systems to commit to HaH implementation, local resource limitations during the pandemic, state regulations, and whether private payers will follow with similar payment mechanisms.
Avalere: More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022, Including In-Home Supports (10/19) - The Medicare annual election period (AEP) for 2022 began on October 15, 2021. Until December 7, all Medicare beneficiaries can select a new Medicare Advantage (MA) or a standalone Part D plan (PDP) for 2022. Ahead of the AEP, CMS publishes information on MA and PDP premiums, benefit offerings, and Star Ratings. Avalere analyzed these data to assess changes in the number of MA plans offering select types of non-medical supplemental benefits. In 2022, the most commonly offered benefit of the 4 that they analyzed is meals (68%), followed by transportation (39%), nutrition (30%), and in-home support services (11%). The percentage of plans offering these types of benefits will increase from 2021 to 2022, with the largest increases for nutrition and in-home support.
Kaiser Family Foundation (KFF): Home And Community-Based Services And Seniors’ Health Care Needs (10/15) - In their October Health Tracking Poll, KFF asked adults about the home and community-based supports they are giving or receiving. Key findings include:
One in five adults in the U.S. report receiving ongoing support for daily activities such as bathing, dressing, or remembering medications.
One in five adults in the U.S. say they are providing those types of services of ongoing support for a close friend or family member.
Many unpaid caregivers say providing support to friends or family members has caused them to worry or stress (77%), experience worsening of their own mental health (50%), financial strain due to inability to work (42%), or worsening of their own physical health (38%).
News and Market Developments
Business Wire: Current Health Selected to Power Parkland Health & Hospital System's Hypertension Monitoring Program (11/4) - Parkland Health & Hospital System – one of the largest health systems in Dallas, Texas – has selected Current Health, the leading enterprise care-at-home platform, to support patients with hypertension from the comfort of their own homes. As part of the program, patients will receive a wireless blood pressure cuff that is pre-configured to stream blood pressure data into Current Health’s device-agnostic platform. Additionally, patients will also be provided with a Home Health Hub that includes internet connectivity and a tablet so they can respond to daily symptom questionnaires and receive real-time reminders to take their blood pressure.
WSJ Venture Capital: Hospital-at-Home Trend Will Accelerate, Forrester Predicts (11/4) - According to Forrester Research Inc., rising financial pressures on hospitals will spur a growing number of them to offer patients the option to be treated in their home in 2022, a trend that creates opportunity for startups. The pandemic has magnified financial strains on hospitals and moving some medical care to the home is one solution that could reduce crowding and costs.
Market Research: Home Infusion Therapy Devices Market is Expected to Total $3.8 Billion, Growing at a CAGR of Over 6.5% Through 2031 (11/4) - According to a recent study by Future Market Insights (FMI), sales of home infusion therapy devices are expected to top $2 billion in 2021. Home infusion therapy devices are used for the intravenous administration of medicines. It is commonly prescribed for patients with serious infections and specialized diseases when orally administered medicines are not or comparatively less effective.
PYMNTS: AI Moves Into Homes, Hospitals As Connected Home Care Grows (11/3) - The University of Massachusetts Amherst and Brigham and Women’s Hospital recently announced the opening of the Massachusetts AI and Technology Center for Connected Care in Aging and Alzheimer’s Disease (MassAITC), seeking breakthroughs in home care. Funded in part by a $20 million grant from the National Institute on Aging (NIA), MassAITC’s stated mission is to advance in-home connected care as “90% of older Americans would prefer to stay in their homes as they age,” but with Alzheimer’s presenting daunting challenges. The use of artificial intelligence (AI) by hospitals is now hitting its stride after a long ramp-up as more systems and facilities sink serious dollars and effort into connected healthcare.
New York Times: Biden Promised to Fix Home Care for Seniors. Much More Help May Be Needed. (11/1) - The latest Democratic proposal would funnel $150 billion toward subsidized home and community-based care. Supporters say the new health care money would shift Medicaid’s decades-long bias away from nursing home care as well as keep more older adults at home rather than in institutions. However, many experts doubt promises that this round of funding can fix a system as broken as home care, especially as the growing retirement of the boomer generation requires more assistance to stay independent and strains health care funding. Jonathan Gruber, a health economist at M.I.T., said the $150 billion would provide home services for potentially one million more people and create about 400,000 new jobs, which could include jobs for caretakers like family members who are unpaid but unable to go to work.
BioSpace:Outset Medical’s Tablo® Hemodialysis System Receives Landmark TPNIES Approval From CMS (11/1) - Outset Medical, Inc. announced that its Tablo® Hemodialysis System has received the first-ever approval from CMS for a Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES). This pioneering decision will help encourage healthcare providers to embrace new technology enabling more patients to dialyze at home and reclaim their independence.
Healthcare Financial Management Association: Hospital-at-Home Care Promises to Reshape Healthcare Delivery in the United States (10/30) - Speaking about research evaluating Mount Sinai Health System's Acute Hospital Care at Home waiver program, Linda DeCherrie, MD said that they "have done studies showing we have higher patient satisfaction than in the bricks-and-mortar hospital, and we believe that comes from the much more personalized care we can deliver." She went on to share that a hospital-at-home program can be instrumental in promoting cost effectiveness of health — improved outcomes at lower patient costs — including accounting for social determinants of health (SDoH). Care providers can more easily perceive patients’ real-life circumstances so they are in a better position to assist patients in dealing with challenges stemming from SDoH, which also can contribute to greater satisfaction among both patients and care providers.
HME News: Hospital-at-Home: HME Providers Wanted (10/29) - Hospital-at-home isn’t a trend, it’s a movement, and it needs HME providers, says Rami Karjian, co-founder and CEO of Medically Home Group. Even if an HME provider doesn’t currently have a contract or agreement with their local hospital or health system offering hospital-at-home programs, they shouldn’t let that deter them, because those hospitals and health systems need scale, says Karjian.
NPR The Pulse: Podcast Episode - Health Care at Home (10/29) - On this episode, NPR explores what it takes to bring medical services into people’s homes. This includes stories about a new push to provide chemo at home, what it would take to provide high-level care, and what it’s like working as a home health aide.
Healthcare Finance News: The Rise of Hospital at Home (10/28) - The concept is not new, but, like telehealth, at-home hospital-level services became a necessity for all health systems when acute-care beds filled during the first surge of the COVID-19 pandemic. Hospitals saw that hospital at home worked so well, both for the patient and for the economic benefits, that the model is being pursued beyond the pandemic.
Humana: Humana Healthy Horizons Launches Louisiana Statewide Mobile Clinic Initiative with Ochsner Health (10/27) - Two new mobile clinics will soon bring a wide variety of health services to thousands of Louisianans. Humana Healthy Horizons has committed $400,000 to the mobile clinics, which will be operated by Ochsner and will travel up to six days a week, throughout the year, to vulnerable and underserved areas of Louisiana where there is an increased need for both physical and behavioral health care. The mobile clinics will offer biometric and cancer screenings; provide educational opportunities, including classes about nutrition, physical activity, tobacco-free living and mental health; and connect Louisianans to health care resources. The clinics may also offer physical exams, blood work, vaccinations and immunizations, access to telehealth and will be used to provide disaster recovery services for Louisianans in areas hardest hit.
Home Health Care News: Home-Focused Primary Care Startup Patina Health Raises $57M (10/26) - Patina Health – a primary care startup focused on delivering care in the home – announced a Series A funding round of $57 million. The company came out of stealth with the announcement, detailing its plans as well as its lead investors: Andreessen Horowitz and GV, the latter of which is Google’s (Nasdaq: GOOGL) venture capital arm. Other investors in the seed and Series A rounds included F-Prime, Rock Springs Capital and Viking Global Investors.
AHA: The National Uniform Billing Committee (NUBC) Has Approved Two Codes Used in Claims For “Hospital-at-Home” Care (10/25) - The first is an occurrence span code is for "the from/through dates of a period of hospital at home care provided during an inpatient hospital stay" and the second is a revenue code for billing room and board during hospital at home. Both codes go into effect on July 1, 2022.
U.S. News: Moving Monoclonal Antibody Treatments for COVID from Hospital to Home (10/21) - Monoclonal antibodies are lab-engineered proteins that are similar to the antibodies the immune system churns out to fight infection. Those used against COVID-19 are designed to recognize the spike protein on the SARS-CoV-2 virus. The catch is that monoclonal antibodies have to be infused by a medical professional. Health systems have different ways of providing infusions, such as in the emergency room or at outpatient clinics. During a COVID-19 surge, that can tax the health care facility, and it also requires sick patients to travel. That can be a particular barrier for low-income patients.
Home Health Care News: Why Sutter Health, CVS See the Home as a 'Mainstream' Site of Care (10/20) - Speaking at HLTH, executives from CVS and other health care organizations held a discussion about managing chronic conditions in the home. While each vied for more home-friendly payment systems, they also all waxed poetic about the future of health care in the home. "Virtually any kind of disease management works better in the context of the home," said Chris Waugh, the chief design and innovation officer at Sutter Health.
Pharmacy Times: The Home Infusion Setting Remains a Critical Option for Cancer Care During the Pandemic (10/19) - The COVID-19 pandemic has put immunocompromised patients, including those immunosuppressed because of cancer or cancer treatment, at much greater risk of SARS-CoV-2 infection and serious complications than the general population. Home infusion has been shown to be not only safe and clinically effective, but also to improve patients’ quality of life and reduce health care costs. In August 2021, the Preserving Patient Access to Home Infusion Act was introduced by Sens Mark Warner (D, Virginia) and Tim Scott (R, South Carolina) to assist Medicare patients in maintaining access to home infusion therapies requiring the use of an infusion pump.
LI Herald: Care at Home or the Doctor's Office - Seniors Have Options (10/18) - Medicare's annual enrollment period (October 15 - December 7) is an important time of year during which Medicare beneficiaries can review their current coverage and evaluate whether they want to remain with their current plan or switch to a new one that is a better fit for their health care needs. Seniors should consider what type of care works best for them and in what setting they are most comfortable. Options available in many MA plans include: Senior-focused primary care centers, in-home primary care, and urgent in-home care,
CBS Minnesota: COVID-19 Near-Death Survivor Thanks Hospital-At-Home Program for Recovery (10/15) - Koesling says the isolation of the hospital was just as tough as the physical fight to survive. But things turned around, and after 15 days Koesling went home. Health Partners Community paramedic Jacob Capistrant took it from there. The Health Partners Hospital at Home program got Koesling home a week early. Capistrant kept an eye on his oxygen, vitals and conferenced virtually with his doctor, who says freeing up extra hospital beds is crucial. A win-win that helps the healing with those at-home comforts and a safety blanket of hospital-like care.
ROI NJ: Your Hospital Stay - At Home (10/15) - Imagine getting the specialized care available only from a hospital, but in the comfort of your living room. Holy Name is the first health care system in New Jersey to offer a Hospital at Home program, a government-approved approach to treatment that enables eligible patients to receive hospital services in their homes. With Hospital at Home, each patient receives two nurse visits every 24 hours. Patients’ communications and vital signs are instantly delivered to the hospital via a Wi-Fi enabled VitalCare health care tablet issued by Holy Name. Each person is assigned a personalized care team comprised of doctors, nurses, specialized therapists and others, who monitor recovery and, if needed, initiate an in-person or telemedicine visit with a physician or nurse practitioner. Patients are given the flexibility to control their care and may elect to return to the hospital at any time.
Coloradoan: Pandemic Accelerates Model of Home Hospital Care in Fort Collins (10/15) - Dr. Christine Lum Lung, a founder of Northern Colorado Hospitalists, started Origin Healthcare before the COVID-19 pandemic to bring the hospital to your home. Common causes of hospitalization that can be dealt with at home include congestive heart failure, chronic obstructive pulmonary disease, pneumonia and other infections that require antibiotics, she said. Hospital tests, including bloodwork, x-rays, infusion, and monitoring can be performed right at the patient's bedside in their own home.