‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care

After one of the closest and most hotly contested campaigns in modern history, President-Elect Joe Biden addressed the nation on Saturday from an outdoor platform in Wilmington, Delaware.

While it’s far too early to say what the first 100 days of a Biden administration will look like from a detailed policy perspective, the president-elect has made one point abundantly clear. It’s time to get to work — and that work starts with the COVID-19 pandemic.

“Our work begins with getting COVID under control,” Biden said during his victory speech. “We cannot repair the economy, restore our vitality or relish life’s most precious moments — hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us — until we get this virus under control.”

As the United States inches closer toward the macabre milestone of 10 million total coronavirus cases, the Biden administration’s response to the ongoing pandemic will need to be wide-ranging and thorough, touching on everything from vaccine development and distribution, to additional rounds of relief for health care providers. Long-term care and protecting America’s senior population will also need to be at the very center of its response.

“I will spare no effort — or commitment — to turn this pandemic around,” Biden continued.

In the weeks and months leading up to his victory this past weekend, Biden — a soon-to-be 78-year-old man himself — suggested a deep appreciation of home-based care.

In July, for example, the former vice president outlined a $775 billion plan to overhaul the nation’s caregiving infrastructure, which is mostly made up of women and people of color. As part of that plan, Biden said he hoped to create upwards of 3 million new caregiving and education jobs over the next decade, while likewise creating pathways for former caregivers to re-enter the workforce.

The plan additionally called for a $450 million boost for senior care, with some of those funds dedicated to improving wages and labor conditions for in-home care workers.

“Home health workers do God’s work, but aren’t paid much,” the then presidential candidate said on social media. “They have few benefits, and 40% are still on SNAP or Medicaid. It’s unacceptable. I’ll give caregivers and early childhood educators a much-needed raise.”

Biden hasn’t just highlighted his appreciation of home-based care in broad strokes and policy promises. In addition to his $775 billion plan, the president-elect has repeatedly brought attention to very specific, innovative programs that typically only industry insiders know about.

That includes making nuts-and-bolts references to CAPABLE, the increasingly popular program out of the Johns Hopkins School of Nursing designed to support aging in place by coordinating nursing, therapy and handyman services in the home.

“To hear him really describe [CAPABLE] was thrilling,” Sarah Szanton, the Johns Hopkins professor who helped create the program, recently told Home Health Care News.

Protecting America’s seniors

Moving forward, Biden and his staff will likely try to secure additional resources for home-based care providers and other long-term care operators. In its official policy plan for nursing home regulations, for instance, the Biden team stated it would invoke the Defense Production Act to increase the overall supply of PPE.

The campaign was highly critical of the Trump administration for failing to coordinate sufficient distribution of testing supplies and personal protective equipment (PPE) early on, so a lack of action on that front would only be viewed as hypocritical.

Currently, “protecting older Americans” is one of the main priorities featured on the Biden-Harris Transition website. That fact that hasn’t gone overlooked by those in the aging services space.

“We appreciate the Biden-Harris Transition team’s announcement regarding its COVID-19 response,” Argentum CEO James Balda said in a statement. “The specific emphasis on protecting at-risk populations, which includes older adults and those who serve them, as well as a focus on the efficacy of vaccine distribution, is critical to controlling the spread of this virus.”

Argentum is the country’s largest senior living association.

The Biden-Harris Transition team announced the formation of its 13-person Transition COVID-19 Advisory Board on Monday. The advisory board will be led by former FDA Commissioner Dr. David Kessler, former Surgeon General Dr. Vivek Murthy and Dr. Marcella Nunez-Smith, a Yale physician and researcher.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” President-Elect Biden said Monday.

Notably, the advisory board also includes Dr. Atul Gawande, the surgeon and writer who founded Ariadne Labs, a joint center between Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health.

Gawande — former CEO of Haven, the health care venture founded by Amazon, Berkshire Hathaway and JPMorgan Chase — has been a staunch supporter of palliative medicine and end-of-life care. His participation on the board could signal a focus on those areas during the duration of the public health emergency.

The Coalition to Transform Advanced Care (C-TAC) said it has been encouraged by a number of Biden campaign proposals that have the potential to improve the lives of the seriously ill, particularly in home- and community-based settings.

“C-TAC looks forward to forging new relationships with those in the incoming Biden administration and Congress,” C-TAC Executive Director Jon Broyles said in a statement. “As we work toward building a health care system that works for everyone, it is essential that we come together to find innovative solutions that meet the needs of the sickest and most vulnerable among us, with particular attention to low-income, traditionally underserved individuals.”

Beyond home care

The advisory board may include others in days to come.

Given the pandemic’s outsized impact on people age 65 and older, additional expertise in aging — whether via gerontologists, industry leaders or researchers — would bring much value, according to Ruth Katz, LeadingAge’s senior vice president of policy. LeadingAge is a diverse association of nonprofit providers of aging services.

“We expect to see a focus on in-home and community-based services through programs in their platform on caregiving, education and workforce,” Katz said in a statement. “That’s a positive.”

Beyond directly supporting home-based care, a Democratic president in the White House and a split Congress may also mean a heightened willingness to reach across the aisle to get things done, at least compared to the past four years.

Initially, there’s bound to be friction between both governing parties, a concept reflected in the largely unsubstantiated voter-fraud concerns voiced by Republican leadership. Over time, though, lawmakers will hopefully find common ground on no-brainer, common-sense issues.

That could mean newfound momentum behind legislation with bipartisan support, such as the Home Health Emergency Access to Telehealth (HEAT) Act, a bill to provide Medicare reimbursement for audio and video telehealth services delivered by home health agencies during a public emergency. Among the bill’s backers is Sen. Susan Collins of Maine, one of the few Republicans to officially congratulate Biden on his victory.

It could also mean continued support for Medicare Advantage (MA), which, in turn, means continued support for home care. Often cited as the future of health care by Republicans, MA was actually first enacted under the Clinton administration as “Medicare Plus Choice.”

Better Medicare Alliance President and CEO Allyson Y. Schwartz reminded people of that on Monday.

“The story of Medicare Advantage is one this new administration can be proud to continue,” Schwartz, a former member of the U.S. House of Representatives, said in a statement. “We stand ready to work with President-elect Biden, Vice President-elect Harris and their team to build on this bipartisan success.”

Out of a total Medicare-eligible population of more than 62.4 million individuals as of October 2020, nearly 25.4 million had signed up for MA, federal statistics show.

Biden, of course, has also voiced support for “Medicare at 60,” a plan to allow Americans between the ages of 60 and 64 the option of buying into Medicare slightly earlier. If ever enacted, that plan would dramatically expand the population of Medicare beneficiaries able to receive Medicare-certified home health services.

The post ‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care appeared first on Home Health Care News.

Seeking Sustainable Reimbursement Model, Aging-in-Place Program CAPABLE Lands Partnership with VillageMD

As COVID-19 numbers rise heading into winter, U.S. policymakers and senior care advocates continue to explore new, innovative models that support aging in place.

One such model is CAPABLE, an interdisciplinary program out of the Johns Hopkins School of Nursing that combines nursing care, occupational therapy and handyman services. While CAPABLE, which stands for “Community Aging in Place — Advancing Better Living for Elders,” had already seen explosive growth prior to the public health emergency, interest in the model is now at an all-time high.

“This is really shining a light on, ‘Boy, we don’t want to have institutions of 100 people down a hall,’” Sarah Szanton, the Johns Hopkins School of Nursing professor who helped create the program, told Home Health Care News. “This is really showing the value of CAPABLE, beyond even what we were seeing before COVID.”

Since its first pilot location in Baltimore more than a decade ago, CAPABLE has expanded to more than 25 cities, including Chicago, Boston, Houston and several other major metropolitan areas. Soon to be included in that total, Szanton pointed out, are nine Veteran Affairs (VA) sites in Pennsylvania. 

“Smaller, one-off sites are continuing, too,” she added. “There’s a new site in Alaska that’s getting off the ground.”

To expand the CAPABLE program, Szanton and her team typically join forces with another organization. Current partnership examples include an accountable care organization (ACO), a PACE program and home health agencies, plus a Meals on Wheels agency and private philanthropies.

During the coronavirus pandemic, it’s those partnerships with home health agencies that have been particularly impactful.

“Almost all of the CAPABLE programs stopped, taking a pause in March and April, because everyone was only doing things that were essential,” Szanton said. “The ones that are continuing are the ones that are home health agencies actually, partly because they’re used to being in the home and they’re used to taking precautions.”

Teaming up with VillageMD

Generally, CAPABLE’s three-pronged strategy combining nursing care, occupational therapy and handyman services is meant to tackle all aging-in-place barriers. That could mean having an OT show somebody how to safely enter and exit a bathtub, or it could mean asking a handyman to fix a shaky step to prevent falls.

That approach has been proven to both improve functional ability and lower health care spending: For every $1 spent on CAPABLE, the program sees combined savings of nearly $10 to Medicare and Medicaid, past research has found.

A more recent report in the New England Journal of Medicine likewise highlighted the cost-effectiveness of CAPABLE. In it, the authors noted how the model lowered activity-of-daily-living (ADL) disability scores by 30% while reducing depression and saving Medicare $922 per member per month.

“We started CAPABLE because I was a house calls nurse practitioner, providing regular medical care,” Szanton said. “That was fine. It was convenient for people. But what I was seeing was people falling down because of old floors or banisters. I realized being able to take a bath or get to your mailbox might be more on people’s minds than whether their glucose was under control for their diabetes.”

The steady stream of results for CAPABLE has landed it plenty of interest in 2020.

In March, the Johns Hopkins School of Nursing received a $4.3 million grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) to launch a national center dedicated to improving care for people with disabilities. Part of that funding will be used to strengthen CAPABLE’s data-collection abilities and to create a model tailored to the needs of individuals living with dementia.

Additionally, some of the funding will be used to explore how to best integrate CAPABLE with doctor house call practices, according to Szanton.

That latter goal is important, considering one of CAPABLE’s latest partners is VillageMD, the value-based primary care practice that runs a sizable house calls division.

The leadership teams of VillageMD at Home and CAPABLE first met in Baltimore in early 2020, a VillageMD spokesperson told HHCN. That meeting resulted in a partnership to offer the CAPABLE program to a population in VillageMD’s Houston market.

“The CAPABLE program will be an extension of VillageMD’s comprehensive care model, resulting in improved quality of life for patients and their caregivers and reduced health costs by enabling patients to remain at home and avoid unnecessary hospitalizations and nursing home placements,” the spokesperson said.

Providing ‘critical peace of mind’

Apart from new partnerships, 2020 has also been an exciting year for CAPABLE in regard to being in the national media spotlight. In July, the U.S. turned its attention to the model after presidential candidate Joe Biden mentioned it during a speech on the campaign trail.

“Simple steps save lives, save money and provide critical peace of mind,” Biden said, referring to CAPABLE’s approach.

The Buttigeig and Bloomberg campaigns likewise touted CAPABLE, prior to Biden. Szanton was unaware the former vice president was going to highlight CAPABLE.

“My phone started to blow up driving in rural Virginia, coming home from a family trip,” she said. “It turned out that Biden had just been giving a speech mentioning CAPABLE. It was a big surprise. To hear him really describe it was thrilling.”

Moving forward, Szanton and her team are focused on advancing policy measures that would help sustain the CAPABLE model on a national level.

At the beginning of the year, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar tasked the CMS Innovation Center to look into how a dedicated payment mechanism would work.

“I have asked [the center] to explore how the CAPABLE model could be incorporated into new risk-sharing arrangements available through the CMS Innovation Center’s new payment and service delivery models,” he said at the time.

In June 2019, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) voted unanimously to recommend that CMS test CAPABLE on a larger scale “to inform payment model development.”

“From what we can tell, CMS is viewing CAPABLE as already possible to be included in value-based mechanisms like Primary Care First or Medicare Advantage plans,” Szanton said. “It doesn’t need anything, in particular, beyond what already exists in terms of the overall policy environment.”

Still, she hopes CMS can create something like a reimbursable bundle that’s similar to surgical bundles, for example, which could help support CAPABLE under traditional Medicare until the shift toward value-based care gains more momentum.

“We’re working with all of our partners and their representatives to make sure that Congress and CMS are educated about what’s going on in their districts,” Szanton said.

The post Seeking Sustainable Reimbursement Model, Aging-in-Place Program CAPABLE Lands Partnership with VillageMD appeared first on Home Health Care News.