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.
The Centers for Medicare & Medicaid Services (CMS): Extends American Rescue Plan Spending Deadline for States to Expand and Enhance Home- and Community-Based Services for People with Medicaid (6/3) - Announced today, the U.S. Department of Health and Human Services (HHS), through CMS, is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports. This policy update marks the latest action by the Biden-Harris Administration to strengthen the health care workforce, help people receive care in the setting of their choice, and reduce unnecessary reliance on institutional care.
CMS: Independence at Home (IAH) Demonstration Year Seven Results Fact Sheet Published (5/23) - In Performance Year 7 of the Demonstration (2020), CMS found that the expenditures for IAH practices’ applicable beneficiaries were approximately 18.0 percent (equating to $42.3 million) below their spending targets, an average reduction of $6,585 per beneficiary. All 10 IAH participants (nine practices and one consortium) reduced the per-beneficiary-per-month (PBPM) expenditures relative to the practice’s PBPM spending target. A total of 6,436 beneficiaries were enrolled in the Demonstration at 10 participating practices.
Research and Polling
Journal of Nursing Management: Home-based care nurses' lived experiences and perceived competency needs: A phenomenological study (5/31) - This study explores home-based care nurses' practice experiences in order to understand their competency and needs. Following data analysis, four themes emerged: (1) Full spectrum of patient care, (2) autonomy in nursing practice, (3) beliefs in person-centered care and (4) enhancing supportive systems. These findings suggest a need for better understanding of the broader scope of nursing practice in home-based care to improve nurses' transition experience. This includes performing autonomous assessments, making decisions and managing social related matters.
Matrix News: The Next Generation of EHRs in Home-Based Care (5/27) - This survey polled Home Health Care News and Matrix News readers on the relationships between home health providers, their electronic health records (EHRs) and their technology vendors, as well as the finite needs shaping the next generation of EHRs. What the survey conductors found is that EHRs have inherently changed the way home-based care providers operate, but they are not a one-size-fits-all solution. Providers want more out of their EHR platforms and vendor relationships. Beyond software and solutions, they are looking for trusted partners. Additionally, survey respondents stated that improving patient care and increasing operational efficiencies are among the greatest ways EHRs deliver value, surpassing compliance, clinical efficiencies and billing. As the industry evolves, and care becomes increasingly more coordinated and tech-enabled, so will the capabilities and demands of EHRs.
Kidney Medicine: Utilization of Home Dialysis and Permanent Vascular Access at Dialysis Initiation Following a Structured CKD Education Program (5/27) - This study leveraged the experience from Kidney Smart® (DaVita Inc.), a structured CKD education class implemented across the United States, to test the association of CKD education on clinical outcomes among patients starting dialysis, with emphasis placed on minimizing biases and confounding. Findings indicated that attending a CKD education class prior to starting dialysis resulted in positive clinical outcomes, including reduction in hospitalization and mortality rates. Broad implementation of structured CKD education may result in more patients choosing home dialysis as their first treatment option and reduce the risk of adverse outcomes in the crucial early period after dialysis start.
International Journal of Nursing Studies: Nurse-in-the-loop smart home detection of health events associated with diagnosed chronic conditions: A case-event series (5/25) - This study explores a partnership between nurses and smart homes for automated remote monitoring and assessing of patient health. Authors present a series of health event cases to demonstrate how this partnership may be harnessed to effectively detect and report on clinically relevant health events that can be automatically detected by smart homes. The results found evidence that continuous sensor-based monitoring of patient behavior in home settings may be used to provide automated detection of health events. Nursing insights into smart home sensor data could be used to initiate preventive strategies and provide timely intervention.
Health Affairs: Hospital At Home Is Not Just For Hospitals (5/24) - Most research and proposals for implementing home hospitalization programs assume they are an extension of hospital operations and assume hospital costs and reimbursement. But there are cost and other advantages to building home hospitalization on the foundation of home-based care providers, whose expertise includes keeping patients safe and healthy at home. Hundreds of thousands of Medicare patients could benefit from these services, and physicians, hospitals, and policymakers need to work together to make this a reality.
Milliman: Hospital-at-Home: Should Payment Models Focus on the Hospital or the Home? (May 2022) - This study assessed payer costs under different Hospital at Home payment models and their implications for the adoption of Hospital at Home. The authors identified two payment models for Hospital at Home patients (a top-down approach based on current payments for hospital-based care, and a bottom-up approach separately pricing the elements of non-hospital care that come with Hospital at Home) and developed cost of care models for a Hospital at Home episode of care split into acute and 60-day post-acute care. The study found that the top-down approach costs approximately $17,500 per episode, and the bottom-up approach costs approximately $10,500. The authors conclude that the right balance between the high payer cost/health system revenue from the top-down model and the lower payer cost/health system revenue from the bottom-up approach will likely be determined locally, based on the resources and market power of hospitals, home health agencies, and payers.
BMC Nephrology: Evaluation of the experience with the use of telemedicine in a home dialysis program—a qualitative and quantitative study (May 2022) - The objective of this study was to evaluate whether telemedicine provided through telemonitoring can improve the ongoing relationship between the doctor, the nurse and the patient. The results showed that patients and nurses had positive experiences with telemonitoring and highlighted feelings of being cared for and improved confidence, although they indicated that telemonitoring does not replace face-to-face visits.
HIT Consultant: Is It Finally Time for Hospital-at-Home or is Time Up? (5/31) - The pace of growth [in hospital-at-home] could be threatened if CMS discontinues the waiver program, which is set to expire when the current public health emergency (PHE) expires. On April 13, President Biden extended the PHE until at least July 2022. A bipartisan bill, the Hospital Inpatient Services Modernization Act, would further extend the waivers for another two years. Advocacy groups, including Advanced Care at Home Coalition and Moving Health Home, along with organizations including the American Hospital Association, are lobbying for a more permanent solution.
Home Health Care News: A ‘Persistence of Patient Harm’: Hospital Failures Highlight Need for Home-Based Care Investments (5/30) - A May OIG report suggests that policymakers consider a more permanent replacement for facility-based care alternatives, ensuring that hospital-at-home programs can continue thriving moving forward. That’s something hospital-at-home stakeholders are certainly pushing for, specifically in the form of the Hospital Inpatient Services Modernization Act. “There’s a lot of interest and support for the waiver,” Jeremiah McCoy, director of policy and government relations at Moving Health Home, previously told HHCN. “We just need to continue to build on that and make sure that the Hill is hearing what everyone’s saying, not only for what the opportunity has been during the pandemic, but what this means for a future iteration of the acute care home model in Medicare.”
News and Market Developments
Healthcare Dive: Rite Aid forays into care delivery for rural seniors with new Homeward partnership (6/2) - Rite Aid is the latest pharmacy giant to step into clinical care delivery through a new partnership with rural home care startup Homeward. Under the deal announced Tuesday, Rite Aid pharmacists will direct eligible customers to Homeward’s clinical services, including annual wellness visits, health screenings, diagnostic testing, virtual visits and in-home care. Homeward will also be able to park its mobile clinician units at Rite Aid’s rural locations, with the goal of allowing senior customers to see a provider and pick up their prescriptions in one visit. The companies are starting the partnership in Michigan, with the opportunity to expand to Rite Aid’s 700 rural locations across the U.S. over time.
Health Leaders: Michigan Medicine Embracing Home-Based Medical Care (6/1) - Clinicians and patients are being encouraged to use the "in between" care offered in the health system's hospital at home and post-acute care at home programs. Michigan Medicine offers two key pathways in the Care at Home initiative—a hospital at home program called Hospital Care at Home and a post-acute care program called Completion at Home. The Completion at Home program has achieved a 50% reduction in emergency department utilization and 50% reduction in readmissions.
Fierce Healthcare: Humana rebrands Kindred at Home as CenterWell in 14 more states (6/1) - Humana is transitioning Kindred at Home to its CenterWell brand in 14 additional states. The second phase of the transition brings the number of states where Kindred has made or begun the switch to 21, Humana said. Updating the branding is a key step in integrating Kindred at Home into Humana's broader healthcare services enterprise. “During the pandemic, the amount of care delivered in the home surged, further validating to patients and providers alike that home is an effective site for the care of many conditions. As a result, we expect increased levels of adoption of care in the home to continue,” said Andy Agwunobi, M.D., President of Humana’s home business.
Home Health Care News: Home-Based Care Providers Are Raising Expectations for Their Technology Partners (5/31) - Home-based care providers looking to grow, or even just to survive, are increasingly turning to technology to do so. A major part of that is EHRs, and according to a new survey conducted by MatrixCare and Home Health Care News, providers are generally unsatisfied with their EHR vendor relationships. Providers want more customer support, ongoing education and training from their EHR vendors. On a scale of 1-10, providers gave their EHR vendors a 6.2 rating based on their current level of satisfaction. However, the desire for automated workflows and more efficiency continued to resurface in respondent answers.
The Hill: Congress must stand up for dialysis patients like me (5/31) - Nieltje Gedney, the executive director of Home Dialyzors United, published an opinion piece emphasizing the need for protections of both office-based and home dialysis. She urges CMS to work with Congress on fundamental reforms to the Physician Fee Schedule and reverse the clinical labor cuts to dialysis specialists, which would force medical specialty providers, including vascular access providers, to cease operations, leaving patients with fewer options.
Home Health Care News: How EMS Workers Can Supplement the Home-Based Care Workforce (5/31) - When Medically Home announced that it had received another round of funding in January, the investment was led by a diverse group of companies. One of those investors – Global Medical Response (GMR) – has become a partner now that has changed the way Medically Home staffs its cases in the home. And the blueprint could be one of the longer-term solutions to curb the home-based care staffing crisis. Teaming up with GMR allows Medically Home to tap into talent pools that “don’t exist in the brick and mortar,” Rami Karjian, the CEO and co-founder of Medically Home, said at the HHCN Staffing Summit. As such, Medically Home is benefitting from a new labor pool – a labor pool that other home-based care providers could too take advantage of – while GMR is also providing care to a new group of patients. And instead of transporting these patients to brick-and-mortar hospitals, they’re intervening and caring for them at an earlier stage.
Fierce Healthcare: CVS Health rolls out virtual primary care service (5/30) - Retail drugstore giant CVS is rolling out a virtual care service that gives consumers access to primary care, on-demand care, chronic condition management and mental health services. Eligible Aetna and CVS Caremark members will be able to use the virtual primary care service to access healthcare services on demand, whether at home or in a retail or community-based setting. Members also will have the option of being seen in person at an in-network provider, including CVS MinuteClinic locations. The virtual solution will roll out to Aetna members starting Jan. 1, 2023, and for eligible CVS Caremark members during the second quarter of 2023.
Washington Post: The good and bad about home medical tests (5/30) - At-home tests are convenient with transparent costs, but the quality of these home tests can vary dramatically, and some may have confusing results, lead to unnecessary follow-up testing and treatments, and delay needed care. The article recommends consulting a doctor before using a home medical test, checking whether the test is authorized to be marketed by the FDA, checking storage directions, and following test instructions in order to have the most accurate reading from a home test.
Fierce Healthcare: Encompass Health sets July 1 target for its home health, hospice spinoff (5/27) - Enhabit Home Health & Hospice, the upcoming spinoff from inpatient rehabilitation and home care company Encompass Health, is expected to become an official separate entity on July 1, according to a new U.S. Securities and Exchange Commission filing. The new publicly traded entity would include Encompass' 252 home health and 99 hospice locations. The former claimed nearly $225 million in net operating revenue across 2021 while the latter brought in a net $49 million. “The Encompass Health Board of Directors believes that the separation of its inpatient rehabilitation business and the [home health and hospice business] into two independent, publicly-traded companies will provide significant benefits to both businesses and their stakeholders,” Encompass wrote in its announcement.
RevCycle Intelligence: Home Healthcare Providers Share Thoughts on Value-Based Care (5/27) - The survey, conducted by Home Health Care News (HHCN) and AlayaCare between March 9 and April 4, 2022, reflects responses from 224 home-based care providers on how value-based care has impacted the home healthcare industry. Home healthcare providers reported that better client outcomes and increased patient satisfaction were among the top benefits of value-based care. Data collection and data sharing are common challenges for healthcare providers when transitioning to value-based care.
Fierce Healthcare: SCAN acquires The Residentialist Group to launch new home health provider, Homebase Medical (5/27) - SCAN Group, the parent of SCAN Health Plan, acquired The Residentialist Group, the insurer's first outside acquisition in its history. TRG offers clinical care to frail and vulnerable seniors in their homes, SCAN said. The group's operations will be merged with SCAN's in-house home care program, HealthCHEC, to form Homebase Medical, which will provide palliative care, chronic disease management, care transition management and health assessments in patients' homes. Homebase Medical will serve SCAN members as well as seniors enrolled in other health plans.
Home Health Care News: Home-Based Care Stakeholders Echo US Surgeon General’s Health Care Workforce Shortage Concerns (5/26) - Home-based care stakeholders agree with the U.S. Surgeon General Dr. Vivek Murthy that burnout among the nation’s health care staff could lead to an even more severe worker shortage. LeadingAge’s leaders have continued to fight for policy that would enhance the lives of a home-based care employees. “Unfortunately, there isn’t a silver bullet of any kind,” Jenna Kellerman, director of workforce strategy and development for LeadingAge said. “There’s no one solution. Recruitment, retention, training, organizational culture, diversity, equity and inclusion. These are all things that need focus. There’s not one thing that’s honestly more important than the other. They all need to be addressed in parallel. Many hands make light work.”
Fierce Healthcare: Medtronic joins forces with DaVita to launch new kidney tech company (5/26) - Medtronic and DaVita plan to launch a new company together sometime in the next year, they announced Thursday. The unnamed new venture will draw on DaVita’s decades of experience as the leading provider of dialysis services in the U.S., as well as Medtronic’s own expertise in developing medical technologies across healthcare including in kidney care. The company will develop a range of new kidney care tech, with a specific focus on at-home treatments that’ll make dialysis more easily accessible, offering an alternative to the typical schedule of in-clinic sessions three times a week.
Home Health Care News: New Data Illustrates Just How Different Each Home Health Market Really Is (5/25) - More than two years after the implementation of the Patient-Driven Groupings Model (PDGM), home health operators are still trying to make sense of its bottom-line impact. Initial deep dives into PDGM have suggested the overhaul contributed to home health spending being down as much as 21.6%. New data from consulting firm SimiTree further confirms that total home health reimbursement has gone down since the implementation of PDGM, according to Director of Data Christine Lang. Despite the general reimbursement downturn, home health providers that are looking to grow in new and existing markets should still feel good about opportunities to do so, she noted.
The Hill: Congress must protect vulnerable chronic kidney patients(5/25) - Reps. Tom O'Halleran (D-AZ) and Larry Buschon, M.D. (R-IN) published an opinion piece in the Hill promoting their bill, the Renal Anemia Innovation Support and Expansion (RAISE) Act (H.R.2934). This legislation represents a much-needed regulatory update to the Medicare program that will allow thousands of high-risk chronic kidney disease patients to safely treat their iron deficiency anemia in the home setting by taking an alternative FDA-approved oral therapy — thus avoiding unnecessary contact with others while reducing strain on our already embattled health care system.
Inside Health Policy: Researchers: Home-Based Care For Aging Patients Would Fill Telehealth Gaps (5/24) - Care for elderly patients could best be served by shifting to a home-based primary care model, two physicians and geriatric care researchers argue. They say this model would fill some health care access gaps posed by telehealth. According to their article published in Health Affairs, the COVID-19 pandemic has shown health care cannot be tied exclusively to physical facilities. Key players in this ecosystem, the researchers said, would include a variety of health care stakeholders: payers, hospital systems, pharmacies, home-based care programs, and state and regional programs. It would have links to traditional care when needed for patients.
Medscape: Aim to Reach 'Lofty Goal' of 80% of Dialysis Done at Home (5/24) - The rate of home dialysis in patients with kidney failure in the United States — 7% each in Black and Latinx patients and 9% in White patients — is low compared with the "lofty" target of 80% for 2025 stated in an executive order issued in 2019. Thus, it is timely to identify barriers to home dialysis — which includes hemodialysis and peritoneal dialysis — in all patients, but in these minorities specifically, and offer potential solutions. At the policy level, barriers to home dialysis include payment models that disproportionately penalize healthcare systems that provide this treatment to disadvantaged racial and ethnic minorities.
Home Health Care News: Best Buy CEO: At-Home Care Focus Is ‘Resonating with Health Care Industry’ (5/24) - After purchasing Current Health – a well-known home-based remote patient monitoring (RPM) platform – for $400 million last year, Best Buy has established itself among the likes of other top retailers that have become heavily engaged in the home-based care marketplace. Best Buy is now touting what it calls its “emerging virtual care business” and its ability to pair its existing infrastructure with the RPM technology it now has from the Current Health deal in order for seniors to age in place.
Medical Economics: Home-based primary care program saves more than $6,500 per Medicare beneficiary (5/24) - An experimental CMS program proving home-based primary care shows that it can save more than $6,500 per Medicare beneficiary while still delivering quality results across six areas of measure. The Independence at Home demonstration project selected primary care practices to provide home-based care to chronically ill Medicare patients for a three-year period. Participating practices made in-home visits tailored to an individual patient’s needs and coordinated their care.
Home Health Care News: How Homewatch CareGivers Plans to ‘Create’ More Home-Based Care Workers (5/23) - Homewatch CareGivers (HWCG) — one of the larger home care franchises in the U.S. — is trying to remain innovative as it navigates the same external headwinds as everyone else. They are invested in a workforce tool that they think will yield significant and unique results. The company has a proprietary system that identifies workers outside of the home care industry that could be a good fit for its own workforce.
Managed Healthcare Executive: The Gaps Impeding Transition From the Hospital to Home (5/23) - Researchers from the University of Michigan surveyed more than 1,200 people and reported their findings in a study published May 6 on JAMA Network Open. A majority of patients said transportation issues impeded their ability to get to follow-up appointments, the study finds. In addition, Black patients were less likely to have follow-up appointments completed or scheduled within two weeks after they left the hospital. Roughly 1 in 5 patients (21%) reported at least one concern relating to social determinants of health. That’s significant, the authors note, because patients identifying one issue among the social determinants of health were less likely to have completed a follow-up appointment with a physician. The researchers said the study illustrates a number of areas where health systems can take action to improve the care of patients.
Home Health Care News: Aging-in-Place Company Homethrive Raises $20M, Plans ‘Aggressive Expansion’ in Payer Marketplace (5/22) - The funding round – led by Human Capital, with participation from Allianz, 7wireVentures and Pitango HealthTech – will go toward Homethrive's “aggressive expansion” plans and further technology investments. And for similar senior-focused startups, the infusion of capital shows that VC interest in the space has far from cooled, despite a recent investment slowdown. Homethrive is a technology-enabled healthcare service company that "reduces work, worry, and stress for unpaid family caregivers, their loved ones, and their employers". Homethrive is offered as a benefit by self-insured employers and Medicare Advantage (MA) plans, plus Medicare supplement and long-term care insurance, and is currently available across the U.S.
Skilled Nursing News: How Home Health’s Value-Based Purchasing Model Could Further Reduce Nursing Home Utilization (5/22) - As patients continue to seek out ways to be cared for in the home over more institutional settings like nursing homes, an impending nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) Model may dwindle managed care relationships and drive care further away from SNFs. Results from a nine-state, five-year demo of HHVBP showed a 0.34 percentage-point decline in SNF use per year among home health beneficiaries. HHVBP implementation also led to $201.2 million in Medicare savings specifically tied to SNF usage between 2016 and 2020, according to the report. That’s a 4% decline in SNF service spending on average. If a nine-state demo can save $201.2 million in Medicare dollars that would normally be spent on SNF stays, a 50-state model could shift hundreds of millions – or billions – away from institutional care settings for years to come. It could be a significant macro-level consequence of value-based purchasing, if the trend continues into 2023 and beyond.