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.
WellSky, a health and community care technology company, has joined the Moving Health Home coalition. WellSky offers services that support providers caring for patients in the home with purpose-built technology, analytics, and tech-enabled services that help them deliver better, more efficient care. “The pandemic clearly demonstrated that the home is a viable site of care, and that the future of health care is at home,” said Krista Drobac, founder of Moving Health Home. “Our coalition strongly believes that by enacting policies that support providers and reduce barriers, we can make home-based care accessible to all patients who prefer it.”
Moving Health Home Updates
Rock Health: Krista Drobac Will Speak At Rock Health Summit (9/27) - Founder of MHH, Krista Drobac will speak at this year's Rock Health Summit at the Health in the Home: Innovations in Care panel. Don't miss out and register here.
Moving Health Home: MHH Comments on the Calendar Year (CY) Home Health (HH) Prospective Payment System Proposed Rule (8/29) - MHH submitted comments to the Centers for Medicare and Medicaid Services (CMS) CY 2024 HH proposed rule. MHH notes that cuts to home health providers threatens our collective mission to achieve a broader set of home-based care options for patients, which is the preferred site of care for the majority of Americans. MHH also notes HH services are the underpinning of home-based services in Medicare program, and urges CMS to build on that foundation instead of divesting.
Moving Health Home: MHH Responds to the Administration for Community Living (ACL) Notice of Proposed Rulemaking (NPRM) (8/15) - MHH submitted comments in response to ACL request for public input on proposed updates to the Older Americans Act Regulations. First passed in 1965 and last reauthorized on March 25, 2020, the OAA authorizes a wide range of programs and services, most of which focus on helping older adults age in place. In its comments, MHH asked ACL to consider home as a clinical site of care when medically appropriate and preferred by the patient. In addition, we applaud ACL for addressing at-home nutrition and updating its definitions of a caregiver.
NEW MHH WEBPAGES
MHH added two new webpages. These pages will serve as a resource for policymakers and organizations interested in advancing care in the home.
Department of Health and Human Services (HHS): Health Resources and Services Administration (HRSA) Announces $100 Million to Grow Nursing Workforce (8/10) - HRSA announced awards of more than $100 million to train more nurses and grow the nursing workforce. These investments will address the increasing demand for registered nurses, nurse practitioners, certified nurse midwives, and nurse faculty. As more patients are choosing to receive care in their homes, growing the nursing workforce will ensure a more cost-effective and improved experience for people to obtain care through emergent home-based models.
Assistant Secretary for Planning and Evaluation (ASPE): Caregivers and Long-Term Services and Supports (8/15) - ASPE released four reports on caregivers and long-term services and supports (LTSS). As the United States population ages, a larger proportion of individuals will likely need and use long-term services and supports (LTSS). Much of this support is provided by informal (i.e., unpaid) caregivers. This project built off previous ASPE work modeling LTSS needs and expenditures, as well as work that explores how key demographic changes will affect the supply of informal caregivers for older Americans.
For many years hospitals and payers have experimented with providing acute hospital care in a beneficiary’s home in place of the traditional stay at a hospital. CMS established the Acute Care Hospital at Home (ACHaH) program in November 2020. Commissioners will review and discuss the findings on September 8, 2023.
House of Representatives: Rep. Scott (D-VA) Introduced the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act of 2023 (7/18) – On July 18, Rep. Scott (D-VA-3) introduced the Direct CARE Opportunity Act (H.R.4720), which would direct award grants for the recruitment, retention, and advancement of direct care workers who face challenges like low wages, tough working conditions, and economic insecurity. Direct care workers include personal care aides, home health aides, and nursing assistants who play a critical role in providing daily assistance to millions of older Americans, people with disabilities, and others with chronic care needs.
Journal of General Internal Medicine: Effects of Home-Based Primary Care on Hospital Use for High-Need Medicare Patients: An Observational Study (8/1) – This observational study aimed to determine if home-based primary care (HBPC) for high-need, high-cost Medicare patients reduces hospitalizations and inpatient expenditures. Utilizing a retrospective cohort analysis of patients before and after their first HBPC visit, the study revealed that although HBPC didn't significantly reduce total hospitalizations, it did show a reduction in potentially avoidable hospitalizations after 2 years.
JAMA Network: Barriers and Facilitators to Home Dialysis Among Latinx Patients with Kidney Disease (8/15) – A qualitative study investigated the barriers and facilitators experienced by Latinx individuals with kidney failure who undergo home dialysis treatment. The study found that barriers included misinformation, immigration-related obstacles, limited education, and challenges with maintaining the dialysis equipment. On the other hand, facilitators for home dialysis included an improved lifestyle and healthy support systems. The study suggests that addressing these reported barriers and leveraging facilitators can inform new strategies that enhance access and uptake to home dialysis for Latinx individuals with kidney disease. For additional coverage, see Modern Healthcare.
Journal of Computer-Mediated Communication: Negotiating the Capacities and Limitations of Sensor-Mediated Care in the Home (8/23) – This article explores a system of sensor-based communication for people living at home with conditions such as dementia. By analyzing interviews with people using this service, their caregivers, as well as health care professionals working on the system and researchers and developers involved in its delivery, results show that the capacities of such systems to communicate effectively are not assured by technological features alone.
News and Market Developments
Beckers Hospital Review: Tennessee Health System Expands Hospital-at-Home (HAH) program (8/31) – Covenant Health has expanded its hospital-at-home program, Covenant Health Advanced Care at Home, to two medical centers in the past five months allowing 20-30 percent of patients receiving hospital care to now access it virtually. Their program combines in-home hospital services, virtual care, and remote monitoring while also providing a range of services like medication management, laboratory services, IV treatments, rehabilitation therapies, and diagnostic tests.
Fierce Healthcare: Humana Launches In-Home Primary Care Through CenterWell (8/30) - Humana announced that its senior-focused primary care business, CenterWell will offer in-home primary care to seniors who receive care at select locations in Georgia and Louisiana. The new Primary Care Anywhere program harnesses the capabilities of Heal, which Humana acquired earlier this year. Patients will be able to receive a number of services traditionally performed in the doctors' office, such as blood draws, vaccinations and prescription management, in the more convenient home setting.
McKnights Home Care: Hospital-at-Home Faces Uncertain Regulatory Future, but Market Continues to Expand (8/29) – Despite the looming uncertainty of a permanent HAH program, there is growing interest in providing more in-home acute care. On August 25, home care company Resilient Healthcare partnered with Community Hospital Consulting to extend HAH offerings to residents of 40 states. Pointing to widening health disparities, the companies are putting a particular emphasis on residents of rural areas, who disproportionately experience limited access to health care.
Home Health Care News: Aware Recovery Care Is Bringing Substance Use Disorder Treatment To The Home (8/28) - Aware Recovery Care is offering addiction treatment services in the home. The company's program is an innovative longitudinal in-home care model that treats a disease as a chronic disease, and approaches that from the standpoint of providing whole-person care over an extended period of time. Currently, the company has 16 value-based agreements with insurance providers.
Healthcare IT News: Will CMS' Acute Hospital Care at Home Waiver Program Become Permanent? (8/28) – In less than three years, CMS’s Acute Hospital Care at Home waiver program has expanded to 125 health systems and 289 hospitals, in 37 states. With it set to end at the end of 2024, Healthcare IT News interview Kuldeep Singh Rajput, CEO and founder of Biofourmis, a remote patient monitoring and telehealth technology company, his expert views on the program, challenges such as managing IT systems or scaling these tech-enabled models, and how to overcome those challenges. Rajput also describes how CMS’s two-year extension could lead to a permanent program.
Home Health Care News: How Home-Based Care Helped the Medicare Shared Savings Program Generate $1.8B In Savings (8/25) – CMS announced that the Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion in 2022. Of the highest-performing and innovative Accountable Care Organizations (ACOs) involved, some generated savings by integrating home-based care models into their programs. This has been an ongoing record since 2020 as health systems and ACOs expand their home care offerings. In fact, a 2022 study found that two-thirds of ACOs used some sort of home-visit activity.
Inside Telehealth Policy: Lobbyists Confront Challenges in Hospital at Home Push (8/24) – Continued coverage of CMS’ Acute Care at Home program beyond 2024 have many questioning if the program should be permanent. Questions about requiring Medicaid coverage for the program, how it should be paid for, if hospitals count virtual beds in their total bed count, and establishing standard measures and outcomes in time are top of mind as lobbyists push for a permanent HAH program.
Becker's Health IT: Florida Hospital Reaches 200 Hospital-at-Home Patients (8/22) - Orlando Health's Hospital Care at Home program has reached 200 patient admissions in a matter of months. The health system launched the program in February and was the first to be approved for Medicare and Medicaid patients in central Florida. The program provides acute hospital-level care to adult patients who meet specific clinical criteria determined by emergency department and hospital staff members. Patients use portable technology to have 24/7 access to remote monitoring and virtual care from nurses and providers at the Orlando Health Patient Care Hub.
Home Health Care News: How BrightStar Care, Chamberlain University Are Building The Next Generation Of Home-Based Care Workers (8/22) - BrightStar Care and Chamberlain University are teaming up and launching a home health care didactic course under the latter’s Practice-Ready, Specialty-Focused model. As hospitals became the center of the U.S. health system, home-based care work became stigmatized. Despite the budding, integral setting of care it is, students haven’t always viewed the home as a desired place to start their careers. BrightStar and Chamberlain are hoping to change that through a program that exposes students to what it's like being a home-based care worker.
STAT News: What the Hospital-at-Home Movement Tells Us About Igniting Innovation in Health Care (8/21) – The private sector of the U.S. health system tends to adopt valuable innovations faster than the public sector due to red tape and politics. The "hospital at home" (HAH) model is an example of this. However, thanks to the COVID-19 pandemic and an extension to the CMS Acute Hospital Care at Home waiver, each sector knows just how the effective hospital-at-home programs are to reducing mortality and costs while increasing patient satisfaction. Therefore, to encourage innovation, the article suggests four key several strategies, including committing to reimbursement by influential payers, sharing information and best practices, reducing uncertainty through permanent CMS waivers, and creating consensus among professionals, society, and institutions to overcome incentives problems.
MedCity News: Opinion: We Need to Expand How We Think About Home-Based Health Care. SNF at Home is a Step in the Right Direction (8/17) – While a recent study shows that a clear majority of seniors would prefer in-home care, many are unaware of the options available to them. However, there is clear case for skilled nursing at home (SNF at home), an example of how providers are delivering enhanced clinical care in the home that is often less costly and shows greater patient improvement. This article posits that policymakers can support payers and providers alike by supporting legislation to expand home-based services.
McKnights Home Care: The Opportunities and Challenges Ahead for Home-BasedCare (8/15) – As our aging population continues to grow, the need for care is growing alongside it. However, with a projected shortage of primary care physicians and registered nurses, solutions point toward the effectiveness of home-based care. Medicare Advantage plan enrollment, which emphasizes value-based care, is helping drive the shift towards home-based care.
Home Health Care News:CVS Health Reiterates Commitment to Driving More At-Home Care in US (8/9) – CVS Health plans to increase home-based care services in the U.S., where only one percent of health care occurs at home since hospitals took center stage. In their efforts to cater to older adults' preference for convenient and comfortable home-based health care, they acquired Signify Health for $8 billion to expand their offerings. In doing so, CVS aims to make value-based care and patient engagement a key factor in their shift to health care delivery.
Modern Healthcare: Mass General Brigham Bets Big on Hospital-at-Home (8/7) - Mass General Brigham sees hospital-at-home care as a big part of its long-term future. In the short term, the nonprofit health system's plan depends on a favorable ruling from CMS. In the coming weeks, Mass General Brigham anticipates word from CMS about regulatory waivers that would enable that expansion by approving Medicare reimbursements for these services that match payments for inpatient care. CMS is still collecting data from the more than 400 hospitals in the waiver program to determine whether Medicare will continue the current payment policy or devise a new one. Whatever CMS decides is likely to provide a roadmap for private health insurance companies.