CMS Launches ‘Unprecedented’ Hospital-at-Home Strategy to Manage Latest COVID-19 Surge

In an effort to increase hospital capacity amid the current COVID-19 surge, the U.S. Centers for Medicare & Medicaid Services (CMS) on Wednesday announced “unprecedented” flexibilities around providing hospital-level care for patients in their homes.

Similar to CMS’s recent allowances surrounding telehealth, the agency’s latest efforts are focused on lifting barriers that could potentially hinder care during the public health emergency, CMS Administrator Seema Verma said in a statement.

Wednesday’s flexibilities aren’t coming out of thin air. Instead, they build off the success and learnings of the nation’s existing hospital-at-home models, pioneered by organizations like Johns Hopkins and Mount Sinai.

“With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond,” Verma said.

Through CMS’s “Acute Hospital Care At Home program,” eligible hospitals will be granted “unprecedented” and “comprehensive” regulatory flexibilities to treat certain patients in their homes. The agency clarified the new flexibilities are aimed at acute care in the home and very different from “traditional home health services.”

In addition to building new capacity, CMS’s program is also a means to support established hospital-at-home programs, which have mostly had to rely on payment mechanisms outside of the Medicare fee-for-service world. CMS believes that with proper monitoring and treatment, acute conditions such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) can be treated in the home setting.

Wednesday’s move received praise from Dr. Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine.

“CMS made a terrific decision in recognizing the value of hospital-at-home care for the public health emergency,” Leff told Home Health Care News in an email. “Hospital-at-home is well proven to provide high-quality hospital-level care in patients’ homes for many acute conditions — and patients and their families love it.”

Similarly, the move drew applause from Contessa, a company that helps organizations provide hospital-level care in the home through its Home Recovery Care model.

“Given the tremendous strain COVID-19 is putting on our health care system, access to home hospital care has never been more important,” Travis Messina, CEO of the company, said in an email. “The teams at CMS and CMMI expertly executed this hospital-driven model. Hospital-level care requires appropriate clinical oversight from hospital leaders.”

Messina added that his team is “thrilled” Mount Sinai Health System, one of Contessa’s partners, was already approved for CMS’s new model due to its extensive experience with the hospital-at-home concept.

Under the program, participating hospitals will be required to implement screening protocols prior to delivering care in the home. Participants will need to screen for both medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic-violence concerns.

Participating hospitals will also need to provide in-person physician evaluation before starting care in the home.

Additionally, a registered nurse is required to perform evaluations on each patient — in person or remotely — daily.

“Acute Hospital Care at Home is for beneficiaries who require acute in-patient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis,” CMS noted.

Wednesday’s announcement from CMS has roots in its Hospitals Without Walls program, which was first established in March. CMS’s Hospitals Without Walls program loosened regulatory restrictions in order to enable hospitals to provide services in other settings.

Over the years, the hospital-at-home model has gained a reputation for providing better outcomes at a lower cost. Despite this, the model has still mostly existed as a niche service line for providers in the U.S.

Recently, the COVID-19 emergency has served as a catalyst for renewed interest in the model.

Currently, Brigham and Women’s Hospital, Huntsman Cancer Institute, Massachusetts General Hospital, Mount Sinai Health System, Presbyterian Healthcare Services and UnityPoint Health are being approved for CMS’s new program.

“We’re at a new level of crisis response with COVID-19, and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” Verma’s statement continued.

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Highmark Health, Contessa Expand Joint Venture Delivering Hospital-Level Care in the Home

Highmark Health has announced it is expanding its joint venture relationship with Contessa, a company that helps organizations provide hospital-level care in the home through its Home Recovery Care model.

The expansion comes at a time when more health systems and hospitals are looking to redirect acute care into the home setting to maintain capacity and avoid spreading the COVID-19 virus.

Highmark Health is the Pittsburgh, Pennsylvania-based parent company of Highmark Inc., Allegheny Health Network (AHN) and HM Health Solutions. Highmark Health’s businesses include Highmark Health Plan, a hospital and physician network, as well as home- and community-based services.

Founded in 2015, Nashville, Tennessee-based Contessa partners with health systems and health plans through its increasingly popular Home Recovery Care model. Backed by Health Velocity Capital, BlueCross BlueShield Venture Partners and other investors, Contessa has raised more than $10.5 million since launching, according to Crunchbase.

As part of the new JV expansion, two of AHN’s hospitals in Pennsylvania — Forbes Hospital in Monroeville and AHN Jefferson Hospital in Jefferson Hills — will offer Home Recovery Care.

“Healing at home through Home Recovery Care offers patients many benefits,” Dr. Harshit Seth, system medical director of hospitalists services at AHN and the medical director of AHN Home Recovery Care, said in a statement shared with Home Health Care News. “Patients often feel more secure and comfortable in their home environments.”

AHN is using the Home Recovery Care program to allow eligible patients with acute medical needs to receive care in the home for conditions such as cellulitis, congestive heart failure, asthma, urinary tract infections, dehydration, pneumonia and more.

AHN is also using the model to assist with COVID-19 needs, in some cases.

“These are typically low-acuity in-patient admissions,” Christina Weir Ripley, vice president of enterprise clinical transformation at Highmark Health, told HHCN. “[For example], a stable COPD patient that has an acute exacerbation of chronic bronchitis and meets clinical criteria and insurance eligibility would have the option to receive their in-patient care in the home.”

That clinical criteria is decided upon by an emergency department physician and an admitting hospitalist physician.

Prospective patients also pass through a rigorous home safety assessment to make sure their environment is free of fall risks and other potential hazards.

Once patients have been deemed eligible, they can receive home infusion services, in-home nursing visits, telehealth visits and home medical equipment — whatever it takes to keep them healthy and out of an acute setting.

As for Contessa’s role within the partnership, the company mostly provides operational support.

Contessa’s data demonstrates the Home Recovery care model dramatically improves patient satisfaction and reduces both mean length of stay and readmission rates,” Contessa CEO Travis Messina said in a statement. “We are thrilled to bring this level of care to AHN Forbes and Jefferson and allow patients to recover in an environment that is best suited for their needs, which is often the home.”

Additionally, Contessa is responsible for hiring some members of the clinical team who are embedded in the emergency departments. This includes the recovery care coordinator, who is a registered nurse that’s responsible for organizing the patient’s care, including communication between the emergency department physician and the hospitalist.

Contessa first partnered with Highmark Health last November at AHN’s Allegheny General Hospital in Pittsburgh.

It has a long track record of similar partnerships, too. Prisma Health, Marshfield Clinic Health and Ascension Saint Thomas are just a few of the health care organizations the company has teamed up with over the years.

This made them an attractive partner in Highmark Health’s eyes, according to Ripley.

“They’re one of the leading capability partners in this space,” she said. “As we were looking to adopt this model in the market as a part of our virtual health and home-first strategy, we had assessed a number of different capability partners.”

The Home Recovery Care model uses a value-based reimbursement methodology that was specifically designed and implemented with Highmark, according to Ripley.

“It is a specific reimbursement methodology that the JV has constructed with Highmark,” she said. “Essentially, the Contessa joint venture is in a value-based reimbursement arrangement with Highmark as the insurance plan.”

Despite the model’s ability to lower costs and hospital readmission rates, reimbursement has been one of the biggest barriers to widespread implementation of hospital-at-home programs in the U.S.

Such efforts are much more common abroad, particularly in England, Spain and Italy, for example. That’s rapidly changing, though, with Mount Sinai, Medically Home, Lifesprk and others also leading the charge on the hospital-at-home movement, pioneered in the U.S. by Johns Hopkins decades ago.

HHCN previously connected with experts from both Mount Sinai and Johns Hopkins during the first month of the COVID-19 emergency.

“In times of crisis, things that people wouldn’t normally think about or things they would think about sort of on a slow-burn basis start to get some traction,” Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine, told HHCN in April. “Crises have a way of making things happen.”

Though it’s still in its early days, Home Recovery Care is already resulting in positive outcomes for Highmark Health, according to Ripley.

“The length of stay and readmissions have been very favorable,” she said. “We’ve had a number of patients who have given personal statements about how much they appreciated being able to receive that care in the home. From a clinical quality perspective, we think that one of the most favorable pieces to this model is the care continuity and coordination that occurs after they’re discharged from that acute phase.”

The model has also been an advantage throughout the COVID-19 emergency.

“We viewed home recovery care as a significant option for us as we went through a surge capacity planning,” Ripley said. “Fortunately, in our market, we did not see a surge as we had initially anticipated, but we continue to see Home Recovery Care an advantage that we have to offer.”

Highmark Health has plans to further expand the program to the organization’s Delaware and West Virginia markets in 2021.

“We are currently in discussions to expand the program to additional parts of the Highmark footprint,” Ripley said. “We are in the process of establishing what that will look like.”

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