Unveiled in November, the initiative has been growing rapidly, especially of late. On its end, CMS hopes the emerging hospital-at-home models can increase acute care capacity and keep patients where they’re most comfortable.
Allegheny Health Network (AHN) was the eighth organization to have its hospital-at-home program approved by CMS. It was given the go-ahead under an expedited process due to its experience with the model prior to the government initiative.
Pittsburgh, Pennsylvania-based Highmark Health is the parent company of AHN. Its businesses include a hospital and physician network plus home- and community-based services, as well as the Highmark Health Plan.
AHN’s “Home Recovery Care” program is facilitated by a joint venture with Nashville, Tennessee-based Contessa Health, a home-based care startup that has cut its teeth shifting hospital-level care into the home.
Now that its program is certified through CMS, it can be offered to Medicare beneficiaries in the regions that AHN serves.
“We’ve been looking at ways that we could provide high-quality, effective clinical care — in other places beyond the hospital — way ahead of the pandemic,” Christina Weir Ripley, VP of clinical transformation at Highmark Health, told Home Health Care News. “And as we were going through that evaluation process and looking for ways to get there, that’s when we landed on our JV partner, Contessa.”
Contessa was a logical match. It had worked with other hospital-at-home models before, including Mount Sinai Health System’s, which was one of the earliest in the U.S.
AHN began offering its program to Medicare Advantage beneficiaries in January 2020.
For AHN, patients can be admitted into the Home Care Recovery program in multiple ways. They can be admitted after an emergency room visit or in-patient visit, as well as upon observation in the hospital — or without going to the hospital at all.
The organization had already treated dozens of patients in the program before it applied for a waiver from CMS. That led AHN to believe that the transition to the Acute Hospital Care at Home Initiative would be seamless.
AHN also had a natural advantage: It owns and operates its own in-house home care services, which play a key role in the hospital-at-home concept.
“As far as the home health agency piece of it, we certainly had an advantage here as an enterprise, because we own and operate a number of different home care businesses,” Weir Ripley said. “So we were able to utilize a pretty strong and structurally organized home health network to assemble and deliver the care.”
Before the newly launched CMS program, a major barrier to hospital-at-home models was reimbursement. Reimbursement will likely continue to be a challenge moving forward, considering CMS has only made its new waiver available during the public health emergency.
“I think probably our biggest hope is that through the CMS waiver, there’s a demonstration of the value of this type of program,” Weir Ripley said. “We clearly believe in it. We implemented this ahead of the pandemic. We’re hopeful that CMS is going to codify a more permanent reimbursement path so we can continue to offer this once we get past the public health emergency.”
There were just 56 hospitals approved by CMS as of Jan. 4.
Working with patients at home
AHN’s capabilities within the home are extensive, Dr. Harshit Seth, the medical director of the Home Recovery Care model, told HHCN.
When AHN does treat patients within the home, it most often deals with COPD, pneumonia, asthma, acute renal failure and other conditions. Recently, that list also includes COVID-19.
Currently, AHN is working on treating COVID-19 patients with more advanced therapy treatments and expanding its overall offerings.
“With the program, we can decompress our hospitals, which have censuses that are blowing up,” Seth said. “I’m glad that we did this because of the pandemic, and because we can take some of these patients and keep them away from the infection. But the other reason why we started this was because the overall patient satisfaction and overall quality of care has been shown to be better — and the complications happen less.”
U.S. hospital beds were over 70% filled as of Jan. 13, with nearly 18% of them occupied by a COVID-19 patient, according to data from the U.S. Department of Health and Human Services (HHS).
The preliminary results of AHN’s program from a patient-satisfaction perspective have been good, one of the most promising aspects thus far, Seth noted.
“Everybody loves when they can be at home and get the care there, and we also have quality protocols and escalation protocols in case of an unforeseen event,” Seth said. “There’s no visitations in the hospital, which patients don’t like. So there’s a lot of mental health problems happening in patients, especially our older patients.”
Alternatively, at home, loved ones can even help with the recovery process.
In Pennsylvania, over 75% of in-patient beds were filled as of Jan. 13, with over 20% of those filled by COVID-19 patients. Nearly 80% of all ICU beds were also occupied, according to the HHS data.
As hospital-at-home models become more popular and more beneficial to both patients and health care organizations, those that have recognized the perks of home-based care prior to the COVID-19 crisis may have the upper hand.
“This is, for us, the beginning of starting to extend the type of care that we can provide in the home,” Weir Ripley said.
The post Allegheny Health Network Expands Hospital-at-Home Program as CMS Waiver Total Hits 80 appeared first on Home Health Care News.
Despite backing from most of the home health industry, the HHVBP Model — first implemented in 2016 — had seemingly hit a speedbump in recent years. Apart from a handful of minor modifications, the model only remained active in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee.
With more than one-quarter of its home health agencies currently located in HHVBP states, the Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED) has been among the biggest supporters of value-based purchasing. The company has persistently urged the Center for Medicare & Medicaid Innovation (CMMI) to expand the model for over a year.
“There’s still a perception out there that there is a high level of fraud in home health care — and that’s simply not true,” Amedisys CEO and President Paul Kusserow told Home Health Care News. “I think having to prove ourselves on the quality front and being willing to take risk on quality is absolutely the right thing for us.”
So far, even just the limited HHVBP Model has been able to achieve overwhelmingly positive results.
Since implemented, the model has contributed to a 4.6% improvement in home health agencies’ quality scores, in addition to average annual Medicare savings of $141 million, federal statistics show. On top of those points, agencies in HHVBP states have been able to significantly lower the costly utilization of hospitals and skilled nursing facilities (SNF).
“This has been extremely good,” Kusserow said.
As part of its push for an expanded HHVBP Model, Amedisys brought in Washington, D.C.-based research and consulting firm The Moran Company. The home health giant asked Moran to dig deeper into past results and explore what a nationwide rollout would eventually look like.
After cranking the numbers, the research firm estimated that a 50-state HHVBP Model would result in about $6.3 billion in savings over a 10-year period, using Congressional Budget Office (CBO) scoring methodology.
“We engaged in a very long dialogue [with CMMI] and exchanged a lot of data to push this forward,” Kusserow added.
Inside the advocacy process
Besides the whopping $6.3 billion in savings, Moran also determined that a nationwide rollout of the Home Health Value-Based Purchasing Model would lead to better post-acute care outcomes for Medicare beneficiaries and more ways for the U.S. Centers for Medicare & Medicaid Services (CMS) to identify high- and low-quality providers.
In many ways, the advocacy efforts around HHVBP were so effective because they were driven by “the power of a good idea,” according to David Kemmerly, the chief legal and government affairs officer at Amedisys. Instead of having to artfully persuade CMS and CMMI to expand the model, his team’s job was more about giving policymakers the objective information they otherwise lacked.
“They have to go make their case with the actuaries before they can expand something,” Kemmerly told HHCN. “So we helped arm CMS with the data and information they needed.”
It took more than facts and figures, however.
To help advance HHVBP, Kusserow communicated regularly with CMMI Director Brad Smith, the former CEO of home-based palliative care provider Aspire Health who joined the CMS Innovation Center in early 2020. Kusserow and Smith had already “known each other a long time,” thanks to their shared experiences in Nashville, Tennessee, and standing as Rhodes scholars.
“When [Smith] went to Washington, he called me up and said, ‘What should I be thinking about?’” Kusserow said. “Obviously, he was asking a lot of people that. I said, ‘I really think there’s something to value-based purchasing in home health. I’d really like you to look at it.’”
At first, CMMI decision-makers were concerned about home health provider buy-in.
While Amedisys and others sought to advance HHVBP, others were slightly skeptical, especially early on. More than a few home health operators believed HHVBP was just another piece of government regulation, with others too preoccupied with the Patient-Driven Groupings Model (PDGM) to worry about alternative payment mechanisms.
On its end, Amedisys worked hard to boost the industry’s understanding and acceptance of HHVBP, Kemmerly said.
“There’s a bit of politics involved,” he noted. “[Smith] asked us early on, ‘Where is the industry on this? And can you bring the industry to the table?’”
CMMI and CMS are committed to expanding the Home Health Value-Based Purchasing Model, but there are plenty of questions left to answer and improvements that can be made.
On a basic level, it’s still unclear whether policymakers will try to expand HHVBP through a standalone proposal or through the annual rulemaking cycle. Additionally, it’s not yet known whether that future expansion will be national or more incremental, possibly adding another dozen or so states to the current nine-state mix.
Scott Levy, the senior vice president of government affairs at Amedisys, was in the trenches for most of Amedisys’ advocacy battle on HHVBP. In all likelihood, CMS will pursue a 50-state expansion and implementation through the annual rulemaking cycle, Levy speculated.
“I’m just merely reading between the lines, but our discussions [with CMS] and our data presented to them was all based on the idea of a nationwide expansion,” he told HHCN.
Along with answers to those questions, Amedisys is also pushing for improvements to the HHVBP Model itself.
In 2020, home health providers were exposed to 6% upside and downside risk, depending on their quality performance. That figure increases to 7% and 8% in 2021 and 2022, respectively.
But it’s almost impossible to come close to that full upside or downside as the model is currently structured.
“The upside has been good for us. It’s generally quite positive,” Kusserow said. “But we feel the curve is too clustered toward the center. It is very hard to get the full rewards or to get the full penalties.”
In 2018, the payment adjustment in HHVBP ranged from a 1.5% penalty for providers in the lowest-10th percentile to a 1.5% bonus for providers in the highest-10th percentile, according to an investment note from Bank of America. CMS previously stated that the average adjustment was a 0.85% bump in 2018.
“Companies out there with good technology, good tracking systems, good checklists, good verification processes and very good clinical operations are the ones that are going to continue to do well and thrive under this, for sure,” Kusserow said.
A possible complication to HHVBP expansion plans could have been the transition to a new Biden administration, which is guaranteed to bring changes to CMMI, CMS and throughout the U.S. Department of Health and Human Services (HHS).
Yet the team at Amedisys doesn’t see that as an issue, considering the model’s origins.
“[HHVBP] was actually rolled out by the Obama administration,” Levy said. “It was proposed during the fall of 2015 for a January 2016 implementation.”
Initially, the two entities will provide chemotherapy to clinically eligible and fully insured CTCA patients through a pilot program in the Atlanta area. The partnership will leverage Coram — a specialty CVS branch that delivers infusion therapy services — as well as CTCA’s experience as a top oncology care provider.
The main goal of the pilot is to keep immunocompromised patients away from the COVID-19 virus. But it could also lay the groundwork for future cancer care in the home.
Although it will begin solely in Atlanta, the program is set to expand geographically over “the next few months.”
“The program is a major advancement in in-home cancer care because it leverages CVS Health’s Coram home infusion capabilities and CTCA’s expertise as a top oncology care provider to give patients who may have delayed their care due to COVID-19 the flexibility to receive treatment from the safety and comfort of home,” Sree Chaguturu, the SVP of CVS Health and CMO of CVS Caremark, told Home Health Care News in an email.
CVS Health is a diversified health care company that employs nearly 300,000 individuals across its network. Coram, on its own, is able to reach 97% of the U.S. population.
Meanwhile, CVS Caremark is the prescription benefit management subsidiary of CVS Health.
On its end, CTCA is a national oncology network of hospitals and outpatient care centers that offers an integrated approach to cancer care. As part of its mission, the organization combines surgery, radiation, chemotherapy and immunotherapy, among other services, to care for patients.
“There is a critical need for providing in-home therapy where possible to safely treat patients who are immunocompromised,” Chaguturu said. “As this program expands to other geographies, we anticipate home-based cancer care as being more widely available to patients seeking treatment during and beyond the pandemic.”
The CVS-CTCA program will be available to patients with breast cancer, lung cancer, prostate cancer, colorectal cancer, and head and neck cancers, as well as a few others.
In April, CVS Health partnered with UCLA Health to ease the burden on hospitals during the COVID-19 crisis by increasing its home-based care capacity. That move specifically allowed Coram to increase its capabilities.
The specialty branch now serves more than 205,000 patients in home-based and outpatient settings per year.
Moving forward, Coram will use its nurses and technology to begin administering chemotherapy cycles. Patients will still begin their first cycle of infused chemotherapy in the hospital or an outpatient care center. After that, however, a patient can transition home and continue receiving those services.
The program will also provide regular telehealth visits and digital therapeutic check-ins from both Coram and CTCA staff.
Ultimately, the goal is to leverage the partnership and appropriate technology to continue delivering critical cancer care, while increasing patient satisfaction and reducing emergency room visits and COVID-19 exposure.
The program will likewise help ease anxieties that currently come with receiving health care. The public health emergency has kept patients — with cancer or other conditions — from receiving the care they need.
“For a variety of reasons, COVID-19 has caused far too many people to skip or delay treatments,” Dr. Chevon Rariy, the CTCA telehealth program director, said in a press release. “We’re seeing a 50% reduction in infusions, and, while a slight delay in treatments may have been appropriate at the pandemic’s onset, data is now pointing to increased mortality risk with every month of delayed care.”
Cancer care is often far more complex than other care delivered at home.
That’s why cancer care’s advancement to home-based settings has largely stalled, Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told HHCN in November.
“You can’t bring a radiation machine to somebody’s house to do proton therapy. You just can’t,” Cannady said then. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”
But the partnership between CVS Health and CTCA does offer a glimmer of hope. The more cancer patients are treated at home, the more likely it is that the industry will hone in on the possibilities of expanding that care further in the future.
The post CVS Health Partners with National Oncology Network to Offer In-Home Chemotherapy appeared first on Home Health Care News.
Omaha, Nebraska-based Right at Home — an international home care franchise system with roughly 500 domestic locations — is working to stay ahead of the curve.
In part, that means launching new service offerings to better target “boomer consumers,” a population that prefers to take charge of their aging-in-place strategy. It also means accelerating market development with a mix of de novos locations, new franchise openings and acquisitions.
To learn more about Right at Home’s 2020 and plans for 2021, Home Health Care News recently caught up with CEO and President Brian Petranick. Highlights from that conversation are below, edited for length and clarity.
HHCN: Can you start by briefly recapping Right at Home’s 2020, if that’s even possible after all the challenges you had to face?
Petranick: It was an interesting year. And this is a good time for this conversation, because I’ve been doing a bunch of reflection on 2020 over the last few weeks. I always get very reflective this time of year.
Let me start off by saying that I am incredibly proud of our team, including both our franchise system and our corporate-owned locations. I’m so proud of everybody, top to bottom in our network, in addition to our international partners. With COVID-19, we saw the real concern surface toward the end of February. Then all sudden, by March, it was like, “Oh my god! Here we are. We’ve got a potential pandemic on our hands.”
I’m sure every organization out there did some level of projecting, thinking about worst-case scenarios. We certainly did. And you know what? We never came close to that. We had about a six-week period of time where our business faced pretty significant losses. That was from March 1 to the middle of April. From that point on, we’ve been building back up and growing very steadily. We actually had a record level of volume across our system during the last week in February, right before the pandemic became “official.” We had our highest amount of volume in the domestic U.S. system — ever.
Well, we got back to that volume. We even exceeded those record numbers by September. We’ve been hanging around that all-time high, breaking records week after week. We’re on a pretty good trajectory here. But with that being said, we know infection rates shot up right after Thanksgiving and may rise again due to the winter holidays.
Again, I would say, in summation, that I’m incredibly proud of our year and our people. I’m proud of the way people responded. I know they’re tired. They’re fatigued. But they’re resilient. We’ve learned a lot about our team here at Right at Home, in terms of how we can respond to a crisis and how quickly we can make decisions. There are so many positives that have come out of this really awful year, at least from that standpoint.
How did Right at Home grow in terms of number of new territories or new locations?
We probably had a little bit lesser growth in that area than we’ve had in the past. Some of that is obviously due to the pandemic. But looking back on 2020, we are finishing up with a handful of — maybe about 10 — new operating territories. Some of those are corporate-owned, while some are new franchises that have opened.
What were the biggest challenges you had to navigate in 2020? I know you already mentioned fatigue, for example. There’s, of course, personal protective equipment (PPE) procurement.
I think it was broadly managing the volume and the speed of change in an efficient and effective manner. Early on, there was so much information flowing from different sources — PPE policies, infection protocols and more. We had to figure out, at the corporate level, how to get all of that information and filter it in a meaningful way to the people who are operating the local offices.
Our goal was to take that information and give our team the tools to act on it without having to think a whole lot. Instead of operators having to do their own extensive research, we wanted to say, “Hey, we’re here. This is what we know. This is what we’re learning. Here’s how you need to apply this in your business.”
There was a lot to decipher. But out of everything, I think we got the most questions about dealing with the Paycheck Protection Program (PPP) loan and PPE protocols. Understandably, there was also confusion about cities being shut down, with caregivers sometimes being in this murky area of “essential” or “non-essential.”
So much changed on a daily, even hourly basis. Ultimately, I think our biggest success was our ability to take all of that information and rapidly distribute it in a meaningful way, allowing our partners to focus on their caregivers and clients.
The debate around home care staff being “essential” from a regulation standpoint surprised me. Was that somewhat revealing to you? Seems like there’s a ton of advocacy left to do.
Exactly. I think, to some degree, it was eye-opening. But we’ve always known that some people, policymakers and insurance companies don’t truly understand what it is that we do. When policies are rushed out the door during a pandemic and you see that you’re not included in something important, it crystalizes that idea.
It’s good and bad. The bad is that it highlights how others view our industry at the moment. And the good is that we can more clearly see where there are opportunities to start open discussions about home care.
Listen, policymakers have been trying to figure it all out. They also need help. Right at Home — independently, as well as a part of the bigger coalition of the Home Care Association of America (HCAOA) and other advocacy groups — continues to get in front of policymakers to have those key conversations. That will benefit us, long term.
It’s going to be interesting to watch as policymakers and others start writing new policies and reimbursement schedules around shifting more care into the home. Do they really understand the dynamics of the home environment and all the different types of care delivery models?
How about two or three predictions for the new year. What do you expect for home care in 2021, maybe even looking beyond COVID-19?
None of this is probably going to be a surprise for you. But I would start by saying that we’re clearly on a path where there is just more change, more disruption coming. I’m talking about changes in the health care system, changes in U.S. demographics, changes to reimbursement models — all of those things. As we think about home care in 2021, we need to expect more change.
This acceleration to the pace of disruption is partly due to the pandemic. That isn’t doing anything to slow the changes down. But we’re also coming off of a presidential election. There could be some big philosophical changes coming into the White House. For as much as people want 2021 to be calm and a year where we get back to normal, there will be a lot to navigate. I think it’s going to be a lot like 2020, just in different ways.
With all that disruption will likewise come an increase to the level of sophistication within home care. Operators — independent home care providers and individuals who are part of a franchise system — will have to become more sophisticated in their approach to business. Wage pressures are increasing. Service costs are increasing costs. The traditional structures of health care are evolving, with more Medicare Advantage opportunities and new initiatives, including hospital-at-home programs. Operators will need to be overall more sophisticated to succeed.
What else? I would say — again, not shocking — there will be more collaboration between home health, home care and the broader health care sector. There’s just so much focus right now on bringing down the cost of care. The best way to do that is with stronger collaboration across the board.
A final prediction for 2021 is that the “boomer consumer” will take centerstage. We’re starting to deal a lot more with baby boomers — and they just have very, very different demands in regard to the care they want. They want to control that care and how they interact with their care providers. We should see a lot more focus on the boomer consumer outside of health care, too.
What’s an example of that? How is your “boomer consumer” different than the traditional home care consumer from a generation before?
It’s a great question. Some of this will probably be overly broad, but I think the generation before — the post-depression era, let’s say — was a generation that didn’t question their doctors. If a doctor said, “Here, this is what you need,” then they just did it. They were raised to listen to their doctors. That’s not the boomer generation or any other generation. They’re the WebMD generation, the Google generation. They’re used to going in and searching for answers on their own. And they’re used to getting what they want.
Boomers have had a lot of resources. They’re typically wealthy, as a group. They’re used to BMWs, Starbucks and those types of things. I think they’re going to expect more from their home care providers, more from all of their health care providers.
We’ve already seen some of that, right? If you look at the way hospitals were in the 80s and, to some degree, the 90s, you had to pay all kinds of money for a private room. Now, some of these hospitals are like hotels. You get a single room. You’re ordering off of menus. We’ve all got different expectations now.
We’ve already operationalized some of those changes, but there’s definitely more coming because we’re still on the leading edge of the baby boom generation. At the end of the day, they want more communication, more choice and a better experience.
How about two or three predictions for Right at Home? What specific goals or strategies did you have in mind for 2021?
You’ll definitely see from us more accelerated market development. I don’t think that’s a secret. At this point, everybody knows we’re opening up more corporate-owned locations, where we’re doing de novos. That means going into markets where we don’t have offices now and opening from scratch. We’re also growing through acquisition of independents in some of the markets where we’re interested in going. We’re still franchising. We’re just kind of agnostic to how we grow. But we want more market development. That’s No. 1.
No. 2, we’re thinking about all these changes that are happening in health care. We want to make sure we’re moving in the right direction. We want to make sure that we’re buttoned up on our data and thinking strategically about how we’re leveraging our data. We’re going to continue to put a lot of focus on our, like I talked about earlier, sophistication level. We know that we need to position ourselves best for working with the broader health care system and home health partners.
Lastly, we’re looking at all kinds of different ways to broaden our value proposition to our clients. That partly means hitting on what the boomer consumer wants. We’re not thinking about ourselves as just a home care company. How do we think broader? Where are there other opportunities to add to our own value proposition? There are some really interesting models out there that we’re looking at.
What do you mean by that?
Care coordination is an example. To use one analogy: Most people, when they build a custom home, they don’t do it themselves. You could hire a plumber. You could hire an electrician. You could hire a framer. You can hire all of those people individually. You can have somebody come in and put your foundation in and do your grading and all of that stuff. You don’t need the contractor.
But what the contractor does is make it easy. The contractor becomes the middleman and coordinates all of those other things. All you have to do, as the homeowner, is decide on design, your choice of your tile, your carpet, your paint. I think there’s going to be more of a demand for that type of service in home care.
If you think about it, there’s probably 5,000 different pieces of technology that somebody can bring into the home to help with the aging process. Well, who in their right mind has time to research 5,000 pieces of technology, from a consumer perspective? Or 50 home care companies? Or 20 transportation companies? I think there is an opportunity for somebody that can come in and help people manage the broader aging process, not just one aspect of it.
What else is important to touch on?
One of the things we have to be very, very cognizant of is the impact of COVID fatigue. I can’t stress that enough. We’ve had a strong year at Right at Home. I’m incredibly proud of our team. But we’re tired. People are just tired after operating at really, really high levels for nine or 10 months. COVID fatigue is real. It’s a challenge, but people are going to have to fight that off as best as they possibly can in 2021.
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But in a broader sense, QMG wanted to stick to its commitment to “transform health care” — and that’s why it began investing in the home. That’s also why the organization is clear about its hospital-at-home program’s origins.
QMG had been looking to implement something similar for at least three years. The program is coming to fruition at the peak of the COVID-19 pandemic, but that is merely a coincidence.
After a sit down with Dr. Tom Price — who formerly served as the secretary of the U.S. Department of Health and Human Services (HHS) — its physician-led board decided to pursue what was then an out-of-the-box option and invest in hospital-level care at home.
“The board has had a main purpose of delivering quality health care more cost effectively,” QMG Interim Chief Medical Officer Dr. Rick Noble told Home Health Care News. “We realized the federal government was looking at all out-of-the-box options on being able to deliver quality care, … and that’s when we started looking at the hospital-at-home model.”
Quincy, Illinois-based QMG has over 155 doctors, nurse practitioners and physician assistants that offer care to about 250,000 people in 16 locations throughout Illinois, Iowa and Missouri.
Hospital-at-home models have always made sense, at least from cost-savings, comfortability and logistical standpoints. What was lagging was a reimbursement method from the U.S. Centers for Medicare & Medicaid Services (CMS) that made it worth it.
That has begun to change, and CMS has now approved over 50 hospitals under its new hospital-at-home initiative. Dubbed “Acute Hospital Care at Home,” the initiative is designed to give hospitals unprecedented flexibilities to treat hospital patients where they live.
“We thought that the federal government may at some point in time be moving toward this type of a program,” Noble said. “And so we stuck to it.”
John Hopkins and others pioneered the model in the 90s, with Mount Sinai and others hopping on board since.
QMG will be doing the same. It has entered into a licensing agreement with Johns Hopkins to facilitate its own version of the organization’s hospital-at-home model.
“This way, we won’t have to reinvent the wheel,” Noble said. “We basically purchased their best care protocols that we’re going to implement.”
It’s been a process that’s taken over two-and-a-half years to materialize. QMG is hoping to be fully operational with its program by mid- to late-2021.
“I think we were way out ahead of the curve,” Noble said. “We started it for the right reasons. And then all of a sudden, here’s a situation that shows not only us — but hopefully others such as CMS — that these programs are really needed and that they should be reimbursed. Because this isn’t going to be the last health issue that’s going to occur in the next 50 years and put a burden on our health care system.”
QMG put out a press release announcing its hospital-at-home efforts in November, though the program is not fully operational yet.
It did so because it wants to accomplish a few things first through awareness, Noble noted.
“What we want people to know is that they can expect change to occur, that we in the health care community are fluid, and we’re willing to change and look outside the box,” Noble said. “We don’t want to feel like they only have one option. I want them to know that we are proactively looking at a way to [make sure they have options] in the future.”
Generally, the hospital-at-home program is set to treat low-acuity patients that would normally have shorter hospital stays. For instance, patients who have mild congestive heart failure, shortness of breath, COPD, emphysema, skin infections or pneumonia, among other conditions.
Those patients, if they qualify and would like to be treated in the home, will be overseen by a team of physicians, therapists, nurses and rehab specialists when applicable.
“If we can really refine this and allow physicians to lead, it will just show how much we can change the scope of healthcare delivery,” Noble said. “And it’ll benefit us down the road as well.”
The post Quincy Medical Group Goes All In on Hospital-at-Home Program appeared first on Home Health Care News.
Founded in 2017, Miami-based Papa is a membership-based platform that mostly connects college students — or “Papa Pals” — and older adults. Papa Pals provide seniors companionship and general assistance, including transportation services and similar task-based help.
By providing such valuable services, Papa hopes to lower an individual’s chance of hospitalization and other negative health events. On a more human level, the company simply wants to help seniors stay connected, especially amid “an isolation epidemic” linked to the COVID-19 virus.
Papa doesn’t just do family on-demand anymore, however. It recently expanded its services to include health management, with the launch of Papa Health in December.
Papa Health is a virtual care platform that gives seniors access to Papa Docs, a network of board-certified and licensed clinicians that includes doctors, nurse practitioners and behavioral health providers.
The national availability of Papa’s services supports expansion with the company’s health plan partners for Medicare Advantage, Medicaid and employer benefits, Papa founder and CEO Andrew Parker told Home Health Care News.
“Papa can support health plans across the country now,” he said. “We’ve proven that we can go from just south Florida to many states, and now we feel very excited about expanding nationally. Health plans are now able to support these members socially, and they recognize that social determinants of health have huge negative impacts on people’s lives.”
Currently, Papa’s services are available through health plan providers such as Aetna, AvMed, Florida Blue Medicare, Humana, Priority Health, Regence Blue Shield and others.
For potentially isolated seniors across the U.S., Papa’s national push means addressing the loneliness epidemic head-on.
In 2019, 34% of adults between the ages of 50 and 80 reported feeling a lack of companionship or isolation, according to data from the University of Michigan. That figure has undoubtedly worsened due to the public health emergency.
“Just imagine an 80-year-old woman living by herself,” Parker said. “She doesn’t really know how to use technology, doesn’t have that many family members, doesn’t have a car — a lot can go wrong in this situation. Pairing her with a Pal that calls her, video chats and, when appropriate, shows up to be a friend and provide companionship … is life-altering for these older adults.”
As a company, pulling off this national expansion required a team-wide effort, along with a platform that supported this major move.
“It was all hands on deck, everything from tech to sales, recruiting, account management, finance,” Parker said. “It also has a lot to do with our platform. We’ve built this incredibly robust platform that, from a technology perspective, manages visits and the data collected, the interactions, and who we pair [together]. That system has been built from the beginning for us to be able to scale nationally.”
In addition to Papa’s national expansion, the company also launched a new app with the goal of improving user experience for its Papa Pals.
“We built a Papa Pal app, which is the platform that the Pals used to access visits, review their members, take on more jobs,” Parker said. “We took feedback from thousands of Pals … to really understand exactly what is the most critical thing to provide the best experience.”
Landmark Health, for example, is one of 51 direct-contracting entities (DCEs) already participating in the upcoming “global” and “professional” options, both of which were first introduced by the Center for Medicare & Medicaid Innovation (CMMI) in early 2019. Meanwhile, Capital Caring Health, Housecall Providers and five others have launched Advanced Illness Partners (AIP), another DCE.
“We’re excited to participate in CMMI’s innovative program to bring advanced illness care upstream and serve patients with complex, chronic disease in the home setting for the long-term,” Dr. Eric De Jonge, director of geriatrics at Capital Caring and AIP’s chief medical officer, said upon the organization’s formation.
Not everyone in health care shares the excitement, however. In fact, some value-based care veterans believe the emerging direct-contracting models are inherently flawed, particularly the most recently unveiled “geographic” option.
Among the skeptics is the National Association of Accountable Care Organizations (NAACOS), the Washington, D.C.-based advocacy organization that represents hundreds of ACOs across the U.S. and roughly 6 million beneficiary lives.
Initially, NAACOS saw direct contracting as a natural extension of the proven ACO models from CMMI and the U.S. Centers for Medicare & Medicaid Services (CMS), its senior vice president of government affairs, Allison Brennan, told Home Health Care News.
The organization’s tune has changed, though, after digging through the details.
“We were really looking forward to direct contracting as a natural outgrowth and an opportunity to build on lessons learned from previous models,” Brennan said. “As some of the details were released, which happened gradually over the course of over a year, we looked at the meat on the bone, so to speak, and saw there were challenges for legacy ACOs to participate and have an opportunity to be successful.”
Broadly, the ACO concept is a market-based solution that brings physicians, hospitals and other providers together to collectively manage care, with the overall goal of lowering costs and improving health outcomes.
While there are different shades of ACOs, most fall under the Medicare Shared Savings Program (MSSP), the largest value-based payment model in the country. As of January 2020, there were at least 550 active MSSP ACOs.
When it comes to the professional and global direct-contracting options, NAACOS and its members have multiple concerns, Brennan explained.
One basic issue, she said, is the missing emphasis on actual providers, especially as more and more DCEs are being spearheaded by new entrants into the Medicare space. Originally, “direct contracting” was known as “direct-provider contracting,” with the “provider” reference ultimately being dropped.
“It was an interesting evolution in the discussion around the model to see it go from ‘direct-provider contracting’ to ‘direct contracting,’” Brennan noted. “And I think that’s telling. It’s been disappointing, because we think that the provider should be at the heart of these payment models.”
Another issue is the weighting system that CMS and CMMI plan on using for historical expenditures and eventual capitation amounts.
As currently set up, the global and professional direct-contracting options financially favor organizations that are new to value-based care, putting legacy ACOs at a disadvantage.
“The weighting of baseline years in a benchmark is one of many key decisions that has to be made [that] has repercussions about how successful an ACO or DCE, in this case, can be in the model,” Brennan said. “Where legacy ACOs have already reduced spending over the years, the weighting of the most recent benchmark year 2019 is not in their favor.”
NAACOS detailed those and other concerns in a Dec. 16 letter sent to CMMI Director Brad Smith.
While NAACOS has nuts-and-bolts worries about the global and professional direct-contracting options, it has wholesale concern about the geographic option.
NAACOS strongly supports the continued transition of Medicare Parts A and B away from fee-for-service payment and toward a system that rewards value over volume. But the geographic option is too untested and too different for implementation any time soon, according to Brennan.
It could also be detrimental to Medicare beneficiaries, she added.
“A [geographic option] DCE could have a care coordination program that could be duplicative of what a beneficiary’s primary care practice already has in place,” Brennan said. “I think there’s a potential to also see some administrative overlap and waste that’s created, which would be the opposite of one of the goals of the model.”
The NAACOS letter to CMMI goes on to argue “the vast majority of beneficiaries will have no idea what a geographic DCE is and what mandatory beneficiary participation will mean for their care.”
ACOs honing in on home-based care
Direct-contracting concerns aside, Brennan said she was pleased to see more ACOs embrace in-home care in 2020.
In the past, home health and home care providers often felt excluded from some ACO relationships. Increasingly, ACOs now recognize home-based care as an easy, effective way to bring health care costs down while boosting quality.
“ACOs have seen the value of in-home care for a variety of reasons,” Brennan said. “Oftentimes, it’s preferable for families and patients. Also, when appropriate, it’s frequently less expensive than a more costly facility-based stay.”
The COVID-19 pandemic has only further showcased that value.
“I think one of the low-hanging fruits that a lot of ACOs look at is how can we provide the right care in the right setting,” Brennan continued. “There’s a lot of promise with home care. I think this year, during the pandemic, we’ve seen an even greater emphasis on keeping people at home when it’s appropriate, or returning them to a home-based setting for care as soon as possible [following an acute stay].”
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UNC Health is a state-owned integrated health care system based in Chapel Hill. The organization is made up of 12 hospitals, 350 clinics and various clinical programs from the University of North Carolina School of Medicine.
Meanwhile, Medically Home is a Boston-based company that brings acute-level care into the home. As part of its model, Medically Home sends clinicians into the home, along with technology, equipment, medication and supplies.
UNC Health will offer its acute care at home program to patients at two of its hospitals by mid-year. The plan is to eventually roll out the program at UNC Health’s 10 other hospitals over time.
As part of the new program, certain COVID-19 patients will now be able to receive medical services — including IV therapies, oxygen treatments and ultrasounds — in their homes. The program will also be for some non-COVID patients with conditions such as heart failure, pneumonia, COPD, cellulitis and more.
UNC Health physicians and nurses will monitor these patients 24/7 through Medically Home’s technology platform.
The program’s model of care is predominantly a 30-day length of stay, split between an acute phase and a restorative phase.
Generally, patients will be able to enter the program through two mechanisms, Matt Smith, UNC Health’s vice president for well care and specialty services, told Home Health Care News.
“One would be through the emergency department,” he said. “They would have an opportunity, through various screenings of acceptability for the program. The other option that we’re putting forward to utilize this infrastructure is a model of an early discharge. In that case, a patient would be able to be discharged early from the hospital, after they’ve stabilized, and would finish out the remainder of their stay in the home.”
Last year saw a number of health care organizations roll out hospital-at-home or similar programs in an attempt to lessen the capacity issues the COVID-19 emergency created.
UNC Health may be the latest health system to launch a hospital-at-home program, but even prior to the public health emergency, relieving capacity issues was top of mind.
“This came just from being a large academic health system in a growing area and in a state where there are laws and regulations around how many hospital beds you can build,” Smith said. “We looked at it as, if patients are clinically comfortable and able to be effectively cared for in the home, as an alternative care environment, it was best to build an infrastructure and offer that.”
In November, the U.S. Centers for Medicare & Medicaid Services (CMS) announced “unprecedented” flexibilities that would open doors for health organizations offering hospital-level care for patients in their homes.
Since then, CMS has approved at least 56 hospitals and health systems under its hospital-at-home initiative.
While UNC Health isn’t part of the new CMS initiative, Smith believes it’s a step forward.
“I think it only helps to think through the ability to care for more patients in this model,” he said. “The [ability] to leverage [hospital-at-home] and have it in communities is a great thing. It just helps support the initial direction we had taken.”
UNC Health does have plans to eventually apply for CMS’s waiver.
For now, UNC Health is looking to the future of its own hospital-at-home program. The health system is in talks with other North Carolina hospitals about offering the service in prospective partnership arrangements.
“We’re happy to explore this model with others,” Smith said. “Patients are often transferred to Chapel Hill or from other communities because of the care that can be provided. There are already existing partnerships in terms of the coordination of patient care. I think where we can save costs together is by creating a coordinated care team that can really do the same things for those communities.”
Ultimately, Smith believes that expanding these services locally is a net positive for patients and the organizations that would potentially partner with UNC Health.
“The more that this care model is out there, the better it is for patients. And the better it is for all of our health systems working within that,” he said.
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Notes from HLTH VRTL 2020: The future of healthcare post-COVID and anticipated impacts of changes on the care of autoimmune disease.
On Friday, Deerfield Healthcare Technology Acquisitions Corp. (Nasdaq: DFHT) announced it is acquiring CareMax Medical Group and IMC Medical Group Holdings for $364 million and $250 million, respectively.
The New York-based Deerfield — a special purpose acquisition company — says it plans on merging the two senior care organizations and taking the combined enterprise public.
After doing so, the combined entity will be renamed “CareMax Inc.,” with a Nasdaq ticker symbol to come later.
“CareMax’s differentiated health care delivery model, focused on care coordination with vertically integrated ambulatory care and community-centric services, ensures that members receive the right care at the right time in the most efficient setting,” Deerfield noted in a press release. “The goal of CareMax is to intercede as early as possible to manage chronic conditions for its patients in a proactive, holistic and tailored manner.”
As currently structured, CareMax and IMC Medical Group are each technology-enabled providers of value-based care to seniors. Both companies are headquartered in Miami.
Following the combination, CareMax will oversee 26 wholly owned medical centers in Florida, serving roughly 16,000 Medicare Advantage (MA) members in value-based contracts, in addition to thousands of others in managed care.
Overall, CareMax will have partnerships with 19 different payers, including affiliates of Anthem (NYSE: ANTM), Humana (NYSE: HUM), United Healthcare (NYSE: UNH), Centene (NYSE: CNC) and Florida Blue.
On top of its brick-and-mortar medical centers, CareMax will own CareOptimize, a technology platform that is used by health care providers across the U.S.
Approximately 64% of CareMax patients are dually eligible for Medicare and Medicaid, according to Deerfield.
“Our patients live in medically underserved communities where the hospital has become the first, and often only, option for health care,” the blank-check company highlighted in an investor presentation. “We specifically focus on access and quality for underserved communities.”
Ultimately, Deerfield hopes to create a vertically integrated “one-stop shop” for its patients.
Although a chunk of the business will be focused on center-based care, CareMax’s whole-person approach to health will also tie in home health visits and house calls. Other wrap-around services for seniors will include primary care, transportation and healthy meals, plus other offerings focused on social determinants of health.
CareMax will likewise leverage virtual care tools, which have grown exponentially more popular during the COVID-19 pandemic.
Upon closing, CareMax will be led by CEO Carlos de Solo, who founded CareMax Medical Centers in 2011 and CareOptimize in 2015. Bill Lamoreaux, the current CEO of IMC Medical Group, will become executive vice president of CareMax.
Richard Barasch, the veteran health care executive at the helm of Deerfield, will serve as executive chairman of the combined company upon closing. Barasch also has ties to home health equipment company AdaptHealth Corp. (Nasdaq: AHCO), which went public last year.
“Value-based care, built upon the premise of providing extensive primary care, is recognized as an effective way to lower health care costs and improve patient outcomes in Medicare Advantage, especially for dual-eligible beneficiaries and those with chronic conditions,” he said in a statement. “We believe that CareMax operates a best-in-class delivery model supported by a highly scalable technology backbone.”
The $364 million price tag for CareMax Medical Center and CareOptimize will be a mix of cash and stock. Current equity holders of CareMax Medical Centers are primarily the founders and executives of the company.
The $250 million purchase of IMC Medical Group will also be a mix of cash and stock. The company’s current equity holders include private equity firms Comvest Partners and Athyrium Capital Management.
To finance the acquisitions and merger, Deerfield will sell $400 million in stock to multiple investors, including Fidelity Management & Research, Maverick and Eminence Capital, as well as funds and accounts managed by BlackRock. RBC Capital Markets will provide debt financing.
Assuming no redemptions of Deerfield public shares, the current owners of CareMax Medical Centers and IMC Medical Group will collectively own 27% of the combined enterprise.
“We are excited to invest and partner with [Deerfield] as part of the combination of these two best-in-class, value-based primary care organizations,” Roger Marrero, a senior partner at Comvest Partners, said in a statement. “Primary care has always been the gatekeeper for most health care spend, and we believe this model represents the best way to improve quality outcomes and manage costs across the health care continuum.”
Moving forward, CareMax will pursue a dual strategy of organic growth and acquisitions. The company projects organic revenue growth of 15% over the next few years, noting that figure could be higher depending on future transactions.
Deerfield estimates that CareMax will have an initial market capitalization of about $800 million, with approximately $233 million of cash on its balance sheet. The combined company’s total pro forma enterprise value will be $692 million at closing.
“CareMax plays a significant role in the lives of our members by providing accessible, quality medical care and comprehensive social activities and services,” de Solo said in a statement. “Seniors represent the most significant opportunity to lower the national health care spend, and we believe that CareMax possesses the technology, knowledge and know-how to continue to bend this cost curve.”
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Moderna and BioNTech, two rising stars in biotech, were in the limelight this year with their pioneering mRNA vaccines against COVID-19. Just who are these companies and who is behind them, asks Richard Staines.
A year ago, the names Moderna and BioNTech were known mainly to those who followed biotech and pharma dealings.
But the tragic events of 2020 have meant these companies have become household names as their trailblazing mRNA vaccines became the first to be approved by regulators against the COVID-19 scourge.
Compared with many of the established names in pharma these companies are young upstarts but they have managed to achieve what other big names in the industry have failed to do and harness the power of mRNA to make medicine.
Their technology is based on synthetic messenger RNA – short for ribose nucleic acid – which is a short transcript of a longer DNA code.
As it’s just a messenger molecule, it does not affect the body’s own genetic code when it is injected as a vaccine – but what it does do is instruct cells to code for copies of a certain protein.
In this case that is the “spike” protein seen on the surface of the coronavirus that it uses to invade host cells.
The body produces antibodies against the protein, which neutralise the virus in the event of an infection.
It’s a revolutionary approach that allowed the vaccine to be made within a few days of the SARS-CoV-2 genetic code becoming available – what’s taken months are the rigorous clinical trials that proved the vaccines were safe and effective.
There has been considerable anxiety over whether using such an untried technology would be the best approach against COVID-19.
What the companies have now proved is that the technology can be used to make safe and effective vaccines in record time.
The companies are based on opposite sides of the Atlantic – Moderna was founded in Massachusetts in 2010 under the name ModeRNA Therapeutics by a team of investors two years after BioNTech began operating from a small lab in Mainz, Germany.
But both drew on the mRNA technology developed by Katalin Kariko from the University of Pennsylvania and her collaborator Drew Weissman, an immunologist from Boston University.
Together the pair had managed to find a way to get the human body to accept strands of mRNA without an immune reaction, by tinkering with the chemical make-up of the molecule.
It was a landmark discovery that meant a technology once derided as being a pipe dream could have applications in the real world as a medicinal therapy.
Moderna’s founders were led by Derrick Rossi, a post doctorate fellow from Stanford University who championed the technology to a team from Flagship Ventures, a Massachusetts firm founded and run by Noubar Afeyan.
CEO Stephane Bancel was hired the following year from France’s bioMerieux and Moderna went on to raise more than $2.6 billion in a series of private funding rounds, while fiercely guarding any details about the technology it was developing.
This changed in 2018 when Moderna went public with what was at that time the largest IPO in biotech history.
The launch raised $500m from investors using what is arguably the slickest stock market ticker out there – MRNA.
Its portfolio of products was broad – including a drug being developed with AstraZeneca for cardiovascular diseases, a cancer immunotherapy and a potential Zika vaccine.
While Moderna blazed its investment trail and tried to find ways to make sure its mRNA vaccines did not produce dangerous immune reactions, a small biotech called BioNTech had licensed in the technology from Kariko and Weissman.
Run by husband-and-wife team Ugur Sahin and his wife Ozlem Tureci, BioNTech wanted to use the technology to create individualised cancer therapies.
Matthias Kromayer, a general partner at the German investment fund MIG that helped found BioNTech in 2008, said he first met the pair 15 years ago and was immediately intrigued.
He told pharmaphorum: “They are very good doctors, scientists and entrepreneurs. Whatever they were beginning they did it with the end in mind.”
The company began to strike several deals with big pharma companies to develop cancer drugs and in 2013 hired Kariko, who had spent years working on mRNA at Penn, to oversee the mRNA work as senior vice president.
Fast-forward to the beginning of 2020 and the companies realised that they would have to quickly change their research priorities to vaccine development as the coronavirus pandemic began to emerge in China.
Kromayer said the risks and opportunities to take on the coronavirus vaccine challenge were huge for BioNTech, which only went public on the Nasdaq at the end of 2019.
He said: “It was a risk – if (the vaccine) had failed it would have shed negative light on mRNA tech. But it was a once in a lifetime opportunity.”
But according to Kromayer the BioNTech team were confident that mRNA was the solution to the coronavirus problem, as mRNA sequences can be generated in such a short amount of time.
“You can manufacture mRNA vaccine overnight and still it is stable,” said Kromayer.
The rest is history – Pfizer stepped in and licensed the technology, choosing the most promising of four potential mRNA vaccines from BioNTech.
Both Moderna and Pfizer’s shots aced the quickly convened clinical trials and became the first vaccines to make it to market less than a year after the pandemic began.
Thanks to the innovation there are hopes that peoples’ lives may return to normal as 2021 progresses but according to Kromayer this is just the tip of the iceberg for mRNA therapeutics.
The founders of both Moderna and BioNTech realised early on that this is far more than just a vaccine and could be used to tackle diseases that have proved impossible to tackle with the previous generations of medical technology.
Rossi, who left Moderna in 2014 had initially thought it could be used to reprogramme cells to act like stem cells but realised its potential after a bruising encounter with Robert Langer, the legendary MIT scientist and entrepreneur.
According to Kromayer potential uses include pre-emptive vaccines for diseases such as Parkinson’s as well as to create personalised cancer therapies.
Kromayer concluded: “The message is that mRNA based medicines are not just here to serve as vaccines it is much, much, more. This will revolutionise medicine over the next 10-15 years in areas we do not even imagine.”
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Prior to the COVID-19 pandemic, an increasing number of payers and health care providers began to recognize the value of non-medical home care, particularly when it comes to chronic disease management and preventative care. That recognition has grown even stronger in 2020, with home care often playing a leading role in emerging care delivery models, including hospital-at-home and SNF-at-home programs.
That momentum will continue in 2021, most home care executives believe. To stay relevant, though, agencies will need to embrace new technologies, invest in staffing and boldly go where no home care operator has gone before.
For a clearer picture of home care’s future, Home Health Care News asked 14 executives to look into their crystal balls and describe what lies ahead. You can read their predictions below, edited for length and clarity.
HHCN previously shared our executive forecast for the home health industry on Dec. 14.
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We all know that 2020 was unarguably one of the most difficult years in recent history. One aspect of the pandemic that influenced senior care is that aging in place as well as the demand for home care accelerated. And it will continue to accelerate in 2021. We predict that there will be a significant change in the mindset of seniors to favor aging at home instead of in congregate residences such as long-term care facilities, plus assisted living and independent living communities.
This influx of demand for home care will come with its own challenges, mainly the need for additional qualified staffing. As home care industry leaders, we need to ask ourselves, “How can we make caregiving a profession that will attract the ‘best’ talent in the coming years?” Regardless of the hardships that the pandemic caused, we need to view these challenges as potential opportunities in both business and in life.
— Mario D’Aquila, COO at Assisted Living Services Inc.
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Demand is running high for caregivers and senior homes. We believe we’ll see a wave of ingenuity and innovation in senior living solutions. We’ve seen the tiny home movement model on TV that’s popular with millennials; we think we might also see that with seniors as well to help combat the loneliness epidemic. The idea is that older adults have their own bedroom, bathroom and living space, but they’ll walk down a short path to join others for meals and engagement.
The tiny home park allows caregivers to operate more easily because the seniors are aggregated more so than they are in a traditional neighborhood home. This model allows seniors to maintain their independence but also offers much higher engagement with others.
Companies will try to bust that loneliness and isolation bubble we’re seeing so much of, which has only been escalated in 2020.
— J.J. Sorrenti, CEO of Best Life Brands
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Heading into 2021, the need for home care will drastically increase as a result of the COVID-19 crisis. Over the past year, it has become evident that in-home care is a much more attractive option for families looking to care for their aging relatives, without needing to place them in a restrictive or possibly unsafe nursing home or long-term care facility. They’ve learned that there is a huge difference between aging at home while being in your own community and aging in a facility where you have little to no control.
Individuals don’t want to put themselves or family members into a situation where they are restricted from their family. This lesson has been burned into the minds and psyches of people who are aging — and their search for non-medical home care and assistance with daily living activities is going to strengthen the home care industry in the coming years.
— David Savitsky, CEO of CareBuilders at Home
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Personal Care benefited from amazing positive awareness in 2020. I predict that there will be a divergence in 2021 — of agencies who stay the course, and those who capitalize on this awareness and press the advantage for greater utilization within the health care continuum and attention from payers.
I foresee this divergence also spreading to include agencies that innovate on how they recruit, retain, train and incentivize their caregivers, and those that continue to struggle with enough staff. I feel we will look back on this time as a watershed moment in home care, where we truly saw advancement in the industry. 2021 is the year to truly make that a reality.
— Jeff Wiberg, CEO of Family Resource Home Care
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While we can’t wait for 2020 to end, 2021 probably won’t be much different for the first half of the year. We are looking at 2021 being a bifurcated year. More of the same for at least the first quarter and probably most of the second quarter, but we should start to see some significant relief from the virus by late spring of next year as the vaccine hits our communities broadly. Nonetheless, we have to prepare ourselves for potential glitches in the role-out of the vaccine and that helping hospitals discharge COVID-positive patients may consume more of the year than we hope. We are continuing to stock up on PPE and hire and train aides for COVID cases, but it would be great to get to a point where we are throwing away PPE in 2021!
— John Bradshaw, CEO of Georgetown Home Care
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After a year like this one, where every business and employee has had to adapt, I expect 2021 to continue to drive innovations that bring care to the consumer, leverage new technology and increase our talent pools.
From hospital-at-home programs to home care agencies innovating their offerings, each will bring solutions that increase independence and the ability to live at home longer. Integrated solutions bringing care and support to the home will enable consumers to be more compliant with care plans and will enhance revenues.
I predict this innovation will come from two approaches. One, strategic partnerships will help optimize the consumer experience and reduce redundancies. Second, technological solutions that help manage a consumer’s ongoing care and anticipate changes in health proactively.
My final prediction: We will experience new candidate pools for positions across the health care continuum. Those companies with strong training programs will be able to differentiate themselves and will see faster growth. By retooling workers from other service industries into meaningful, needed roles in health care, home care especially may see dramatic improvements in staffing and quality.
— Emma Dickison, CEO of Home Helpers
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In 2021, providing home care is going to be harder but the quality of care will be much better. It’ll be harder since COVID-19 isn’t going away, but it’ll also drive improvement in care quality through better infection control, faster restaffing when a caregiver reports flu-like symptoms and other innovations that pay dividends into the future. This means the bar to operate becomes higher. Home care companies will have to invest more in technology and tools to deliver the new level of expectation — likely leading towards further consolidation in the industry
— Seth Sternberg, co-founder and CEO of Honor
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2021 will be all about people and technology. Every industry webinar talks about the need to create an engaged and empowered workforce. It’s no longer a talking point — industry survival depends on it. Every company without a specialized caregiver engagement focus will lose. Business models that address caregiver wages will win.
This year has demonstrated more than ever the need for “touchless” strategies to serve the customer and the employees. Virtual onboarding and virtual visits will become the baseline. Stakeholders will expect real-time interventions.
— Andrea Cohen, co-founder and CEO of HouseWorkers
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COVID has been a catalyst for a major shift in how we serve seniors. 2021’s opportunity lies in more data, analytics and partnerships. Isolation is fatal! Providers need to start moving their models away from high-touch-only, to high-touch and high-tech. There is tremendous opportunity to connect to value-based opportunities, which require more analytics to provide better care across integrated delivery systems and prove efficacy. High-tech augments high-touch and intelligently and thoughtfully supports our ability to address workforce demands, cost, and meet the growing need for effective whole-person community-based options.
— Joel Theisen, CEO of Lifesprk
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In 2021, as we transition out of the COVID-19 pandemic into a normal way of life, we will begin to see the marriage between the “old way” of how traditional home care was done with the “new way,” including technology-process integration. As home care agencies are looking to stay ahead, we will see a major shift toward telehealth services over traditional aide services while we look to continue placing an emphasis on keeping patients both healthy and happy in the comfort of their own homes. 2020 has taught home care clients the necessity of including a tech component within their homes. As patients have become more comfortable with this change, we will continue to see an increasing number of seniors seek out home care technology alongside an aide as part of their home care solution.
— Josh Klein, CEO of Royal Care and Emerest
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After an unprecedented year in 2020, home care needs to stay the course on its momentum prior to the pandemic and the tailwinds after. The desire for seniors to age in their home has increased even more since the pandemic, and the best news is that the health care system is supporting that as well. Home care agencies must look to data-driven outcome strategies to help families understand their loved one’s ability to age safely in their home. Agencies who embrace partnerships and technology solutions will enable this to happen. 2021 offers a bright future for those agencies that adapt to a value-based care environment.
— Peter Ross, CEO and co-founder of Senior Helpers
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In 2020, we asked, “Who or what is essential?” Our caregivers were heroes before 2020, but the year brought their heroics into the spotlight. The goal in 2021 and beyond is to never forget this fact. As more and more baby boomers become senior citizens, they will require companionship and assistance at home or at a facility, not just clinical care. We must focus on recruiting and retaining by attracting new caregivers and welcoming back the heroes sidelined due to the pandemic. We will also need all in the non-medical care industry to embrace existing and emerging technological services, such as those designed to connect receivers with loved ones or doctors. We saw tremendous success among our own receivers and expect the efficiency and quality of these systems to improve and grow in popularity in 2021.
— Howard Algeo, director of business development and training at Seniors Helping Seniors
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In 2021, I think the home care industry will see proof that the private equity groups that are consolidating the industry are creating huge competitive advantages over smaller independently-owned businesses and franchisees. Any home care agency that operates in a top-20 market and is under $15 million in revenue in their local market will continue to struggle in caregiver recruiting, online marketing and operational efficiency. Our industry is just starting to see what can happen when you scale a business nationally, with geographic concentration of caregivers, clients and referral sources in local markets.
— Jim Kimzey, CEO and founder of Tender Rose Dementia Care Specialists
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Home care has long been an underappreciated element of health care. The vital role it has played during COVID-19 reminded the industry — and society — of the value of providing quality in-home care to keep vulnerable populations safe. In 2021, I predict that home care will ride this momentum by supporting managed care organizations to reduce overcrowding in hospitals and extend their ambulatory care management bandwidth while lowering costs. I predict an increase in Medicare Advantage plans that offer home care as a supplemental benefit. Because of the compelling data and positive outcomes that demonstrate the holistic benefits that home care provides to its members and the plans, it’s a no-brainer to meet this demand similar to what we witnessed in the past with outpatient physical therapy (PT) and hospice care.
— Ryan Iwamoto, president of 24 Hour Home Care
The post Turnover, Tiny Homes and New Technology: 2021 Predictions from 14 Home Care Executives appeared first on Home Health Care News.
Since then, exactly 51 direct-contracting entities (DCEs) have signed up for either the ”global” or “professional” options. Among them is Huntington Beach, California-based Landmark Health, an in-home medical care provider that cares for tens of thousands of complex patients each year.
“We, as an organization, have been interested in a model like this for traditional Medicare beneficiaries for a long time,” Chris Johnson, vice president of corporate strategy and development for Landmark, told Home Health Care News.
Founded in 2014, Landmark has built its business model on delivering comprehensive in-home medical care to chronically ill older adults. Today, its physician-led multidisciplinary teams work alongside patients’ existing health care providers in 16 states and dozens of metropolitan areas.
Traditionally, Landmark has operated within the Medicare Advantage (MA) landscape, helping health plans bend the cost curve by reducing avoidable ER visits and hospitalizations. But thanks to the new direct-contracting model from CMS and its CMS Innovation Center, the company will soon be able to expand its reach to also care for fee-for-service Medicare beneficiaries.
And that will fundamentally transform Landmark, according to Johnson.
“We see this as something that allows legacy health systems and medical groups, as well as newer entrants like Landmark, to be able to bring new innovative models of care to the market,” he said. “We see it as something that will measure us and reward us on our ability to improve outcomes and reduce the overall cost of care for patient populations, without being beholden to the traditional fee-for-service payment system.”
Landmark officially announced its participation in the direct-contracting model on Nov. 23. Other DCEs, according to CMS records, include home-based care pioneers like Lifesprk, Oak Street Health, VillageMD and more.
“We’ve always been very interested in exploring ways that we can move from serving what today is traditionally a Medicare Advantage population into traditional Medicare as well,” Johnson emphasized.
‘A really big contract’
Since launching, Landmark has gained backing from General Atlantic and Oxeon Partners. It has similarly secured several prominent partnerships, including ones with Aetna, Blue Shield of California and Harvard Pilgrim Health Care.
The care provider’s foray into the direct-contracting model shouldn’t come as a surprise to those who are familiar with the company. In fact, innovation and alternative payment models are actually part of Landmark’s DNA.
Before current CEO Nick Loporcaro took over as CEO in September 2018, Landmark was led by founder Adam Boehler. In April of that year, Boehler left Landmark to run the CMS Innovation Center, a tenure that ultimately ended this year.
Overall, the implementation period for the global and professional direct-contracting options runs from Oct. 1 of this year through March 31, 2021.
Of CMS’s direct-contracting pathways, the professional option offers a lower risk-sharing arrangement, with participants being exposed to 50% upside and downside risk. It comes with “primary care capitation,” a capitated, risk-adjusted monthly payment for enhanced primary care services.
Meanwhile, the global option offers the highest risk-sharing arrangement, with participants on the hook for 100% savings and losses. It comes with two payment options: Primary care capitation or “total care capitation,” a capitated, risk-adjusted monthly payment for all services provided by participants plus the preferred providers they work with.
“You have full upside and downside risk for the total cost of care of the beneficiaries that you’re seeing,” Johnson said.
In some ways, direct-contracting is similar to how MA plans operate.
Broadly, CMS sets a base rate at the county level for different patient populations. Each DCE then has to work against the base rate, figuring out where they can improve patient care and curb overall spending.
“We almost think of this as just adding a new contract,” Johnson said. “It’s just that this is a really big contract.”
Landmark will start caring for patients under the direct-contracting model in April. When that time comes, it will have an opportunity to profoundly expand its business.
Currently, Landmark has about 12 million Medicare beneficiaries across its national footprint. Of those, more than 7 million are in traditional Medicare — people Landmark wouldn’t be able to reach without direct contracting.
“The reason we get really excited about it is, you know, part of our mission is to transform the care in the communities that we serve,” Johnson said. “As things stand today, we’ve really been limited. We’ve thought about ways that we could participate with traditional Medicare, but we just couldn’t make our business model work in the fee-for-service world.”
On top of the global and professional options, CMS also recently unveiled plans for a geographic direct-contracting model. With the initial performance period slated for January, the geographic option would pay participants for lowering total cost of care for Medicare beneficiaries in a given marketplace.
“The Geographic Direct-Contracting Model is part of the Innovation Center’s suite of Direct-Contracting models and is one of the Center’s largest bets to date on value-based care,” current CMS Innovation Center Director Brad Smith said in a statement.
CMS is considering 15 geographic regions in which to test the model, though ultimately the agency will select only a maximum of 10. The areas under review include: Atlanta, Dallas, Denver, Detroit, Houston, Los Angeles, Miami, Minneapolis, Orlando, Phoenix, Philadelphia, Pittsburgh, Riverside, San Diego and Tampa.
Each of these areas includes 150,000 to 700,000 beneficiaries.
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That’s according to Chris Booker, a partner at the Nashville, Tennessee-based venture capital firm Frist Cressey Ventures, which has itself frequently invested in the at-home care space.
“From a home health perspective, the market connects with COVID, because now everything is moving into the home,” Booker said during the Home Health Care News Capital+Strategy event earlier this month. “Really, health care is just moving into the home, [in general]. And so that’s what we’re seeing, in particular on the venture side.”
Frist Cressey Ventures is a VC fund focused on accelerating the growth of high-potential health care enterprises through value-added partnerships. It invests in technology and service businesses that provide solutions for higher quality of care, system integration, patient outcomes, population health and well-being.
Its portfolio includes companies like CareBridge, Aspire Health and Ready, a home-based care startup that coordinates a team of “Ready Responders,” individuals trained as EMTs, paramedics and nurses.
“So there’s definitely a lot more venture capital moving in this direction,” Booker said. “But what we’re seeing is it being more earlier-stage venture capital, in the markets that aren’t as mature.”
Those less mature markets include areas that have really exploded during the public health emergency: home-based primary care, home-based urgent care and hospital-at-home models.
In those areas, regulation has not yet caught up to the market. Reimbursement and logistics can be a struggle at the outset, but firms like Frist Cressey Ventures are willing to take on some of that risk when investing in companies that are moving toward more home-based and innovative futures.
Palliative care, for instance, was gaining popularity years back in a way that those new models are now.
William Frist, a former U.S. senator and one of the founders of Frist Cressey, started Aspire Health in 2013. Aspire then became the largest palliative care provider in the U.S. before it was acquired by Anthem (NYSE: ANTM) in 2018.
Alongside Brad Smith, the current leader of the Centers for Medicare & Medicaid Services’ Innovation Center, Frist capitalized off of one of those less mature markets.
The firm sees the same potential in the new models that have picked up traction during the COVID-19 crisis.
“We’re also seeing some things go into the home that I never in my career thought we would see,” Booker said. “Surgeries, for example, or mobile anaesthesia. … So from a venture standpoint, instead of just your traditional health models, we’re looking at some of these newer models that are going to be delivered to the home that you can kind of [count] as home health.”
Some of the home-based companies that have garnered attention from venture capitalists recently are Papa, the senior companionship on-demand startup; DispatchHealth, an urgent medical care provider; and, again, Ready, which announced a $54 million Series C round in September.
DispatchHealth also has launched a hospital-at-home model, joining other companies such as BayCare and Lifesprk, which have either launched hospital-at-home programs on their own or facilitated them in the last year.
“People are looking to take risks,” Booker said. “And they realize that some of the services that can be offered now are really able to lower the overall cost of care.”
VCs won’t be the only players looking into home-based care either. Hospitals will also be trying to find ways into the home, with individuals shying away from institutional-based settings, Booker said.
“One of my predictions for the next year is that you’re going to see a atypical investors, like large hospital systems, starting to acquiring some of these assets to build the kind of hospital-health care future of the model, which is the hospital and home health kind of merging into one,” he said.
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Currently, Miami-based Papa is a membership-based platform that mostly connects college students — or “Papa Pals” — and older adults. The goal of that connection is to provide companionship and general assistance, including transportation services and similar task-based help, in turn lowering the odds of hospitalizations and other negative health events.
With the launch of Papa Health, the company expands its services to include health management. This means virtual primary care, urgent care and chronic care management through the Papa platform.
The new services are building on and enhancing the company’s current capabilities, Papa founder and CEO Andrew Parker told Home Health Care News. Thanks to the rollout, Papa will now be a mix or social and clinical services to address the holistic needs of its members.
“Papa historically has provided — and still very much so does, as our core products — companionship and support to older adults and families through health plans,” Parker said. “With Papa Health, we’re now able to continue our mission of supporting older adults and families throughout the aging journey, by not only providing them curated companionship but also curated care.”
“Curated care” is something many aging services operators are trying to advance. Despite progress in breaking down care silos across the continuum, senior care is often still too fragmented.
Through Papa Health, members will be able to connect virtually with “Papa Docs” for appointments. Papa Docs are part of a network of board-certified and licensed clinicians that include MDs, nurse practitioners and behavioral health providers, put together by Papa’s chief medical officer, Dr. Ford Brewer.
Papa Docs can, for example, provide care plans or prescribe medicine. Papa Pals are also in the mix, to do things like help navigate appointments, provide transportation or help with care facilitation.
“If [members] need a lab test, for example, a Papa Pal will go and pick the member and take them to get the lab tests,” Parker said. “When the test is uploaded to the internet and onto our platform, the member will be able to have a review of that lab with the doctor. We’re launching Papa Health as a foundation of our products so that we support members socially and clinically.”
This isn’t Papa’s first time supplementing its core services.
Amid the COVID-19 emergency, Papa launched “Assistance from a Distance,” a virtual platform that enables Papa Pals and seniors to connect during quarantines and stay-at-home periods. Papa Health is a natural progression of Assistance from a Distance, according to Parker.
“Our platform, which has always been HIPAA-compliant and secure, can effectively provide virtual and in-person services, whether it be companionship or Papa Docs,” he said. “We see virtual as a very important component, but we also see in person as an important component. Through our platform, we’re able to support members with all of those modalities. Sometimes they need to go to the doctor, sometimes their blood needs to be drawn, so it’s a really flexible configurable experience for the varying needs of the members.”
Papa’s latest move shouldn’t come as a surprise to those who have been paying close attention to the company, financially backed by Magnify Ventures, Canaan Partners, Initialized Capital and several others in addition to Comcast.
At the beginning of the year, Papa threw its efforts behind revamping the company’s brand. The aim was to move away from its “grandkids-on-demand” branding to the more all-encompassing “family-on-demand” label. This was a move that Parker made with an eye toward future opportunities.
Over the past few years, the company has also raised more than $31 million in funding while forming partnerships with health sector giants, such as Humana Inc. (NYSE: HUM) and Aetna, a CVS Health company (NYSE: CVS).
For now, the company remains focused on the launch of Papa Health and what it means going forward.
“A big focus of mine right now is that we’re launching this particular product,” Parker said. “It’s a significant undertaking and incorporates capturing data from the health plans improving the lives of their members. It’s a pretty big initiative.”
Papa is planning to be in all 50 states by January 2021, according to the company.
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Some of the same problems that existed then still exist today, including a siloed care delivery system and a volume-based payment mentality. But COVID-19 could play a hand at changing that, with home-based care providers leading the way.
Kramer serves as a special advisor to the National Investment Center for Seniors Housing & Care (NIC), which he started in 1991. He served as the president until 2017, when he stepped into a role as a strategic director.
When COVID-19 arrived in March, there was a slew of new issues to deal with.
“COVID, on one hand, has made things more challenging because people are just overwhelmed with the pressures of the disease and how to address it for themselves for their workforce,” Kramer said during the Home Health Care News Capital+Strategy event. “At the same time, though, I do think there has been a propelling forward in terms of moving away from a silo- based approach.”
In April, Kramer launched Nexus Insights to facilitate discussion and debate on what person-centered senior care should look like to “rethink the aging industry.”
Working across the continuum of care to help break down those silos is a start. Doing so also encourages value-based care, according to Kramer.
Creating a home-based care environment that involves risk, where agencies are willing to bet on themselves and what they can do for patients, will help reshape the landscape.
“Part of what we see happening … is that we’re moving from a post-acute focus,” Kramer said.
Now, a pre-acute mindset is taking hold, which home-based care insiders have been touting in the past year. But Kramer prefers the term “peri-acute.”
“Peri-acute means we’re putting a moat around the acute care hospital,” Kramer said. “And your goal as a health provider, and particularly as one taking risk for the health care dollar spend for that individual, is to do everything you can to keep that plan member, that patient, that resident from having to cross that moat.”
Some of the provisions that the Centers for Medicare & Medicaid Services (CMS) has made during the public health emergency have played a hand in advancing the way home-based care is delivered.
Additionally, the Patient-Driven Groupings Model (PDGM) has moved the industry in the right way, despite it’s warts, Kramer believes.
If there is an incentive for home-based care providers to prevent those hospital admissions, which most already hone in on, the system will be more cost-effective and healthy for everyone.
“I think those that are most willing to break down silos are those that have the most incentive to do so,” Kramer said. “And the ones who have the most incentive are those that are holding some degree of the risk for the dollar spent for that individual.”
That would include insurance plans, Medicare Advantage (MA) plans, Medicare, Medicaid, LTSS plans, physician groups and others.
But it’s also about those who partner with them — and that’s where home health and home care providers come in. If value is prioritized, home health and home care providers will undoubtedly be more valued as well.
As long as they can prove their worth.
Home-based care providers stepping in
Family & Nursing Care, a home care company based in Silver Spring, Maryland, believes it can prove its worth. It has before.
Its census has been hurt since COVID-19 began, but it’s hoping its innovative partnerships — and the value they provide — can help bring it back.
“I think everybody’s hurting right now,” Mitch Markowitz, the VP of business development at Family & Nursing Care, said at Capital+Strategy. “I’m just so sorry that there are a lot of clients, a lot of family members who are taking chances with their loved ones, and they’re not getting the help that they need.”
Family & Nursing Care has partnerships with assisted living and senior living facilities, as well as hospitals.
Kramer believes the hospitals are the furthest behind when it comes to value-based, integrated care. But they are still the center of the U.S. health care system.
“Hospitals have been forced to face the fact that people don’t want to go there,” Kramer said. “They want to do everything they can to avoid it, which makes the hospital more seriously consider partnerships to deliver care out into the community and not always have a model that starts with an admission.”
For Family & Nursing Care, that means it has to show hospitals the way.
“There’s got to be something in it for the hospitals in order for them to make those partnerships worth it,” Markowitz said.
In Maryland, unlike the majority of the states, hospitals are also incentivized to keep patients at home. Home care and home health companies can help them do that.
“We’re helping facilitate these conversations in a different way than we ever had before,” Markowitz said. “And that’s probably what’s helping us work with these different types of providers.”
COVID-19 has, as Kramer put it, “propelled us into our future faster.”
As care becomes more integrated and value takes hold over volume, it will create massive tailwinds for the home care and home health providers who are able to make strategic partnerships and prove what they can do to keep health risks and costs down.
“Those partnerships, to me, are absolutely key,” Kramer said. “But none of this is possible if you can’t communicate the data about the individual quickly. That’s what one of the silver linings of COVID has been — it has forced us to enter the 21st-century world of digitization.”
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Papa, an on-demand companionship service company, set out to address a loneliness epidemic when it launched in 2018. Today, quarantines and infection fears have created an environment for seniors that’s lonelier than ever.
Likewise, Tomorrow Health — a medical equipment company focused on the home — has seen the lack of access to the right resources for in-home care patients worsen during the public health emergency.
The atmosphere is now filled with contradicting headwinds and tailwinds, but ultimately, these companies are hoping their worth has shone through it all.
“There is not a skilled nursing facility in all of our futures. We simply can’t afford it, the government can’t afford it,” Chuck Hector, the chief revenue officer at Papa, said Tuesday during the Home Health Care News Capital+Strategy event. “We’re going to have to live at home.”
Miami-based Papa partners with Medicare Advantage (MA) plans to address social determinants of health in seniors. Its “Papa Pals,” usually college students, visit seniors at their homes to help them with daily activities or to keep them company.
“Many of us are going to need [assistance] to be able to support us and help us a few times per month — going grocery shopping and doing those basic things,” Hector said. “We’ve seen terrific expansion of our services both in-home and virtually.”
When COVID-19 surfaced in the U.S., Papa launched “Assistance from a Distance,” a virtual platform to help Papa Pals and seniors connect during quarantines and stay-at-home periods.
The virtual platform won’t replace in-person visits from Papa Pals in the future, but has forced Papa to invest in a digital service that will be available to the seniors they serve in the future. Papa Pals have also helped seniors acclimate to technology, in general, during the pandemic, which has helped them connect with their families and other health care providers.
On Tomorrow Health’s end, the company has noticed two primary trends since COVID-19 began spreading throughout the country.
“The first was the acceleration and the growth in demand for home-based care,” Vijay Kedar, the founder and CEO of Tomorrow Health, said during Capital+Strategy. “We also saw tremendous access issues across the market because many folks couldn’t get access to the critical medical equipment they needed.”
Tomorrow Health was built to address that problem, which existed before COVID-19, Kedar said.
The New York City-based startup is backed by venture capital firm Andreessen Horowitz. Its primary goal is to build out an Amazon-like service to navigate the in-home medical equipment landscape.
Tomorrow Health’s capabilities have grown significantly since it was launched earlier this year, and it even partnered with the New York City mayor’s office to help facilitate needed equipment to providers and patients in the area while the city was the epicenter of the COVID-19 crisis.
“We’ve also been a partner to a range of [providers] to assist them in leveraging our technology and operations to streamline their workflows and enable them to serve patients more holistically and more effectively,” Kedar said. “But most importantly, it’s given us the opportunity to serve a wide base of patients in need, many of which have been either infected or affected by the COVID-19 pandemic.”
Avoiding the roadblocks
Regulation has always been a roadblock for home-based care providers, as well as businesses adjacent to the home health and home care industries.
An obvious example is the barriers — both from a regulatory and operational perspective — that have been in place for virtual care to be conducted.
“Converting to a digital solution has been so significant for us,” Hector said. “And after 10 years and the telemedicine space, I’m still scratching my head. I’m like, ‘Oh, it only took a pandemic for us to get utilization to where it needed to be.’”
But the regulatory challenges that Papa and Tomorrow Health face go beyond basic virtual challenges.
“There have been many unexpected challenges,” Hector said. “If a state shuts down in-home services, for example, what does that mean to the person or the member receiving life-saving cancer treatment or kidney dialysis? So, we’d have to quickly lobby with those health plans to work within the context of those state mandates, to make sure that we were providing services that were accepted. Under these extreme circumstances, that posed a pretty big barrier.”
Papa went, as Hector said, from being the fun, in-home services company to being a clinical lobbyist vying against regulations with pretty large consequences.
Additionally, Papa has been tracking closely the dispute between California and rideshare companies such as Uber and Lyft. Having to provide gig workers — or Papa Pals — with benefits as full-time employees would be a major pain point for the company.
“That would become an operational showstopper for us,” Hector said. “Our Papa pals are college students and youthful workers that prefer the flexibility of being able to work whenever they want.”
Still, despite the regulatory hurdles that have become even more confusing during a public health emergency, Kedar is bullish that the health care system will look better in the end.
“We saw in many of our payer dialogues coming into this year that home-based care was a top-five priority for many organizations, and with the COVID pandemic, that has accelerated to either a top-one or top-two priority,” Kedar said. “We’ve seen our partners take tremendous strides to meet the new needs of the new normal. And it has resulted in, ultimately, what I think is a much more sustainable and more resilient health care operating ecosystem.”
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The news comes roughly two weeks after the U.S. Centers for Medicare & Medicaid Services (CMS) made a major announcement about allowing “unprecedented” flexibilities when it comes to offering hospital-level care for patients in their homes.
As a company, Denver, Colorado-based DispatchHealth offers mobile high-acuity services through its emergency medicine-trained teams. Currently, the company operates in 18 states across the country.
MultiCare is a not-for-profit health care organization that includes seven hospitals across Washington state.
Through the new program, MultiCare patients will receive care services that include nursing, durable-medical-equipment delivery, physical therapy and care coordination. All of those are important pieces of the care puzzle, DispatchHealth CEO Dr. Mark Prather told Home Health Care News.
“Essentially, what occurs is that a patient with a medical condition that would warrant in-patient hospitalization, but meets criteria for the home, could be effectively admitted to the home and receive the same level of care,” Prather said. “We screen every patient for medical appropriateness, and we also screen the homes for environmental appropriateness.”
Patients in the program have access to a physician and registered nurse, plus direct access to the 911 system through DispatchHealth’s personal emergency response system. The system allows DispatchHealth to remotely monitor each individual patient 24/7.
“We provide that acute hospital phase, and sometimes that lasts anywhere from three to five days,” Prather said. “Our program also adds an additional layer of service, in that we continue to monitor our patients after the acute phase of their hospitalization. We continue to watch them anywhere from 14 to 30 days after they’ve been hospitalized in their home. That entails continued monitoring daily and check-ins by our nurse.”
DispatchHealth, which has raised more than $216.8 million since launching in 2013, views its role in the partnership as the provision of the technology and infrastructure, as well as the clinical physician and advanced practice provider labor.
One of the aims of the new program is to alleviate hospital capacity during the recent COVID-19 surge. DispatchHealth isn’t alone in this effort.
Throughout the public health emergency, a number of health care organizations have launched hospital-at-home or similar programs in an attempt to remove the burden on hospitals.
For DispatchHealth, it made sense to launch this program with longtime partner MultiCare because of the organizations’ progressive approach to care, as well as the health system’s aggressive move toward value-based care, according to Prather.
“[MultiCare’s] goal is to reduce total cost of care, and they view moving care into the home, as opposed to providing more care in the hospital setting, as an avenue for that,” he said. “That is perfectly aligned with our mission of movement of care into the home, and firing on all cylinders relative to the triple aim of lowering the cost of care, improving patient outcomes and improving patient satisfaction.”
DispatchHealth has an increased opportunity to treat more patients due to the recent Medicare hospital-at-home waiver, announced on Nov. 25. Plus, the company has attracted the attention of other hospitals and health systems that are looking to possibly form partnerships at this time, according to Prather.
Currently, there are at least seven hospital groups approved to offer hospital-at-home under CMS’s new waiver. MultiCare applied for this waiver last week.
“Although we’re in 29 markets across the country today, we have 14 strong hospital system partnerships — and that number is growing,” Prather said. “I think each hospital system is taking a look and seeing whether this meets their goals and their needs, but we are fielding those questions.”
While Prather believes CMS’s recent flexibility will further open the door for hospital-at-home — a concept that in the past has struggled to gain traction in the U.S. — he saw the model making a dent even before last week’s news.
“If you look at the medical literature, the rationale for a home hospitalization program is really compelling. … We’re going to look at this and say it’s just frankly better care and it’s at a much lower cost,” he said. “Why wouldn’t we do it?”
In addition to the launch of its hospital-at-home program, DispatchHealth is rolling out Clinic Without Walls with MultiCare.
Clinic Without Walls provides virtual care with additional hands-on support. This means a DispatchHealth medical technician helping a patient virtually connect with a MultiCare physician during a home visit.
Typically, the medical technician assists with a guided medical exam. For example, assessment of the lungs, ears or throat.
The program attempts to fill the care gaps that arise from more traditional telehealth programs.
“During the early stages of the pandemic, we certainly moved aggressively to telehealth visits,” Prather said. “There were some patients that weren’t addressed in that movement. Think of the patient who is memory-impaired or the very sick and polychronic patient. It’s hard to evaluate them over a video. Those are also the patients that are at most risk, in terms of COVID exposure, when we bring them into a clinic setting.”
Looking ahead, Prather expressed his excitement over what he sees as a larger movement toward care in the home setting.
“I think the desire to have care where we’re most comfortable has been there for quite some time, and now it’s much more obvious because of the pandemic,” he said.
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Before joining Uber (NYSE: UBER), Trigub owned his own startup focused on the aging population. For the past 15 or so years, his family has even operated one of the largest privately owned home care agencies in the San Francisco Bay Area, From the Heart Home Care.
Trigub, who left Uber in September, is now launching an in-home care startup of his own: MedArrive.
“At the end of the day, Uber is a massive technology company with lots and lots of competing priorities,” Trigub told Home Health Care News. “I don’t think anyone would disagree, but it’s really not a health care company as its primary initiative. For me, I really wanted the opportunity to do more in health care.”
Along with co-founder Inna Plumb, Trigub officially unveiled MedArrive to the world on Thursday.
Backed by Redesign Health, Kleiner Perkins and Define Ventures, the San Francisco-based startup is built to be a bridge between increasingly popular telemedicine services and in-person, physical care.
With the launch, MedArrive likewise announced $4.5 million in seed funding.
“Our core belief is that clinical care is moving away from the traditional four walls of a clinical setting or a hospital setting, with more and more care being delivered into the home,” Trigub, the CEO of MedArrive, told Home Health Care News. “And frankly, [care] has to, given the environment we’re in with the pandemic.”
As part of its business model, MedArrive is looking to help payers and traditional health care providers extend more services into the home. That includes vaccinations, testing, urgent care, chronic care management and more.
The main labor force in MedArrive’s model is made up of EMTs, paramedics and other emergency medical service (EMS) professionals.
“For a variety of reasons, we think it’s one of the most underutilized, understaffed resources in health care,” Trigub noted
In addition to its in-person, hands-on care, however, MedArrive will also coordinate physician-led telemedicine services in the home.
“Telemedicine has grown at an exponential rate because of the pandemic,” Trigub said. “But telemedicine can’t do everything. There’s no physical contact. There’s no, as we like to say, ‘humanity.’ MedArrive is a bridge between on-site clinical care and telemedicine.”
Bringing services into the home
In part, MedArrive’s entrance into the in-home care market reflects the success of similar startups.
Since its inception in 2013, for example, DispatchHealth has grown from mostly an on-demand urgent care company to a diversified home-based care provider that has raised more than $203 million.
The new startup’s launch is also emblematic of the wave of health care innovation brought on by the COVID-19 pandemic, especially around the home.
The Andreessen Horowitz-based Tomorrow Health launched in April with its sights set on becoming an Amazon-like service for in-home medical equipment. Papa, Ready and Honor have all raised millions of dollars in recent months.
Looking back at this year, Trigub said, it’s likely that 2020 accelerated innovation around in-home health care by years — maybe even decades.
“There’s always going to be a need to go into a hospital setting. Obviously, you’re not going to get a surgery done in your home,” he said. “We see the ‘health hub’ being the home environment, where people are comfortable, where they feel safe. And certainly, many of our underserved populations lack transportation or lack the ability to go to see a primary care physician, so we want to bring those high-quality services into the home.”
Currently, MedArrive — which already has more than 20,000 EMS providers in its national network — is targeting Florida as its first market. Its $4.5 million in seed funding will allow the startup to continue building out its platform while expanding into additional markets in months to come.
“We hope to be live with a handful of payers and providers by the middle of or early Q1 of this coming new year,” Trigub said.
In the nick of time
Timing wise, it was important to get MedArrive up and running sooner rather than later. Among its early goals, the startup hopes to assist health care organizations looking to distribute flu vaccines and, when available, COVID-19 vaccines.
As recommended by the Centers for Disease Control and Prevention (CDC), older adults and high-risk populations are among those who will get priority access to a vaccine. Some health care experts have argued that “the home” should be the primary vaccination site.
“[For this population], just going to the clinics, to the hospitals, to the drive-thru testing centers, wherever the COVID-19 vaccine is going to be made available, is a challenge,” Marc Rothman, chief medical officer of Signify Health, previously told HHCN.
On his end, Trigub is walking away from Uber Health after a highly successful run.
Over the past few years, Uber Health has made major inroads with Medicare Advantage (MA) plans looking to address social determinants of health. It has also steadily added to the list of home health and home care organizations it works with.
“I always believed in the concept of creating marketplaces and efficient platforms, especially in health care,” Trigub said. “When most people think of Uber, they think of an Uber picking up a millennial at a bar on a Friday night or delivering a burrito. But frankly, we had a tremendous impact on our most underserved populations.”
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The dependent variable is the number of drugs in the pipeline for indication category, and the key independent variable is the natural log of the FDA review time for drug category C. The drug pipeline data comes from AdisInsight and the review time comes from the [email protected] database. The regression also controls for whether the drug is receives priority or orphan status (also from Drugs @FDA), the development cost and the market size. The development cost is endogenous so the authors use the number of pages in an NDA submission, the number of Phase III clinical trials and the Phase III trial sample size. The vector of market characteristics include disease mortality and morbidity (from World Health Organization data by disease), all‐payer drug expenditures (from the Medicare Expenditure Panel Survey, MEPS); number of drugs on the market (also from MEPS); and drug prices (from Express Scripts/Medco and Redbook).
The authors find that:
The average FDA review time for drugs approved after 1999 is 466 days, or about 1.3 years, but …it takes anywhere from 46 days (Eloxatin) to 1827 days (Prialt) for a drug to complete the review process that gives a drug a green light to be marketed. Post‐PDUFA, many NDAs were eligible for a special review status. About a half of the drugs in our sample received a priority review status, and about 20% were classified as orphan, on average by disease category.
Using the regression specification described above, they also find that longer review time decreases the number of drugs in the pipeline.
A doubling of the review length is associated with approximately six fewer drugs in the development pipeline in that disease category. This implies that a one‐sixth increase in review length is associated with approximately one fewer drug in development; with a mean review length of 466 days, this implies that each 78 extra days of review are associated with one fewer drug in development.
One challenge of this study is that pipeline decisions are made years in advance. Thus, longer review time may also impact the decision for early phase drug development, but the data the authors use is from a fairly limited time period 1999 to 2005. Given that the drug development timeline is typically more than 10 years, this study estimates the impact over a relatively short time period. The study also ignores the regulatory process in other countries as well, and their impact on drug development. While the US is the largest pharmaceutical markets, the regulatory environment in other countries–particularly in Europe–may affect investment decisions.
Nevertheless, it is clearly logical that additional regulatory burden and delays in time to market clearly do affect this study does contribute to pharmaceutical firms investment decisions. Budish et al. (2015) find that firms often invest in oncology indications for late stage disease because the time for trials to read out is much shorter. To expedite the FDA review process, in 1992 Congress passed the Prescription Drug User Fee Act (PDUFA) which allowed the FDA to charge fees to pharmaceutical firms to expedite the review process. These payments fund just under half of all drug reviews.
This study does add to the literature on how pharmaceutical firm R&D respond to incentives. For instance, Acemoglu and Linn (2004) found that a potential market size affects affects the number of new drugs that get to market. Other studies have found that higher profits boost pharmaceutical firm R&D investments, for instance the advent of Medicare Part D (Blume-Kohout and Sood 2013) and changes in patent law (Williams 2017). Perhaps the best-known paper–Dubois et al. 2015–found an elasticity of innovation with respect to market size of 0.23, suggesting that $2.5 billion of revenue is required to bring a new drug to market based on drug development costs. The paper by Chorniy et al. (2020), despite some limitations, helps add to this literature.
- Chorniy A, Bailey J, Civan A, Maloney M. Regulatory review time and pharmaceutical research and development. Health Economics. 2020 Oct 19.
In a Wednesday announcement, CMS unveiled new, comprehensive flexibilities that allow hospitals to provide their services “in locations beyond their existing walls.” To secure those flexibilities, hospitals must apply for a special waiver via an online portal, with experienced hospital-at-home organizations eligible for “an expedited process.”
So far, seven hospital systems have received waivers, including Mount Sinai Health System in New York City, one of the earliest adopters of the hospital-at-home model. In 2018, a team of Mount Sinai researchers led by Dr. Albert Siu found that its hospital-at-home program resulted in shorter lengths of stay, fewer ER visits and stronger clinical outcomes compared to traditional in-patient care.
Despite those and other promising findings, the hospital-at-home idea has been slow to catch on in the U.S. due to reimbursement challenges, at least compared to countries where it’s much more common — Australia, Israel, Spain and elsewhere.
CMS’s new hospital-at-home strategy will likely change that, according to Siu.
“While we were collecting this critical evidence base, we started to work closely with CMS and provide input on the model and how it could be leveraged more broadly and more strategically,” said Siu, who serves as chair emeritus of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “We were able to bring hospital-level services into the homes of our patients throughout New York City, but the one obstacle we faced was, how do we pay for this? To facilitate widespread adoption, we needed a mechanism of reimbursement that would capture a larger portion of the Medicare population.”
In part, CMS is backing the hospital-at-home model due to the coronavirus pandemic, which has stretched hospitals dangerously thin. As of Sunday, a record 93,238 patients were hospitalized due to the virus, according to the COVID Tracking Project.
Mount Sinai admitted its 1,000th hospital-at-home patient during the peak of the public health emergency.
In addition to Mount Sinai, the other hospital systems with waivers include Massachusetts General, the Huntsman Cancer Institute, UnityPoint Health, Presbyterian Healthcare Services and Brigham Health Home. Mercy Hospital St. Louis was approved for a waiver on Monday, a CMS spokesperson told Home Health Care News.
More will join that list in days to come, as many have already been working with private hospital-at-home operators — DispatchHealth, Medically Home and Contessa among them — prior to new CMS flexibilities.
Rami Karjian — co-founder and CEO of the Boston-based Medically Home — told HHCN this is a “transformational moment” for high-complexity patients everywhere.
“By decoupling high-acuity patient care from hospital buildings, CMS is enabling hospitals to care for patients in their homes with a model that has been widely shown to deliver better clinical results, higher patient satisfaction and lower costs,” Karjian said in an email.
‘It’s very exciting’
DispatchHealth — the on-demand in-home care provider based in Denver — launched its own hospital-at-home service line in November 2019.
Similar to other models, it has achieved incredible results thus far. Data released by DispatchHealth in October, for example, found that its Advanced Care program saved an average of $6,200 per individual by keeping them away from the traditional hospital setting.
Additionally, hardly any of the high-acuity patients DispatchHealth treat in the home end up back in a brick-and-mortar hospital, according to Dr. Mark Prather, the company’s CEO. In fact, DispatchHealth’s hospital-at-home offering has been “one of the better things” Prather “has ever been involved with as a clinician,” he noted.
Last week’s news from CMS now adds further fuel to the fire.
“It’s very exciting,” Prather told HHCN. “A lot of us have been disciples of home-based care for many years. I think this is another step forward in opening the aperture for care delivery in the home.”
Under CMS’s new flexibilities, developed in tandem with The Hospital at Home Users Group, participating hospitals will need to provide in-person physician evaluation before starting care in the home. On top of that, a registered nurse is required to perform evaluations on each patient — in person or remotely — daily.
While CMS officials mostly touted last week’s move as an effort to boost capacity as hospitals navigate through worsening COVID-19 surges, hospital-at-home programs will likewise help keep complex populations out of acute settings in the first place.
That’s been a focus of DispatchHealth’s model, Prather said.
“Many of the patients we care for are high-medical needs, high-social needs patients,” he said. “They may not have COVID, but they could have a congestive heart failure exacerbation. By keeping them in the home, we are limiting their exposure to COVID.”
Applying for a waiver
Experienced hospitals participating in the hospital-at-home waiver program will be required to submit monitoring data on a monthly basis, according to CMS. Those without experience will be required to submit data on a weekly basis.
While experienced hospitals will be placed into a fast-track waiver process, those new to the hospital-at-home concept will have to go through a “more detailed waiver request” that “emphasizes internal processes that prove capability of treating acute hospital care at home patients with the same level of care as traditional in-patients.”
If a hospital system has multiple hospitals providing acute hospital care at home, each facility will need to request a waiver.
“However, if the services are run by the same group within a health system, CMS understands that each request could appear very similar,” agency officials clarified.
A hospital-at-home program does not have to be physically administered within a hospital, but a hospital must accept responsibility for the program in order to satisfy the Conditions of Participations.
Moreover, the program must be integrated within a hospital to a “sufficient degree” to ensure that rapid escalation of care is seamless.
As hospital-at-home programs become more common, Prather stressed it will be important to develop additional standards to ensure high-quality care.
The CEO said he has high expectations for DispatchHealth’s program, even after the pandemic subsides.
“There are already significant tailwinds to home care delivery,” Prather said. “It’s, frankly, what consumers want, regardless of the pandemic. We’re very encouraged by the movement at CMS, and I do think that it will continue to open doors.”
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Richard Burke became the longest-serving director of UnitedHealth Group after he founded the company. He’s now taking a shot at one of the hottest new trends on Wall Street — SPACs — to delve into the senior care market.
The Scottsdale, Arizona-based SPAC, currently dubbed “Senior Connect Acquisition Corp.,” is planning on capitalizing off of the tailwinds that the U.S.’s aging population provides. The company is especially interested in honing in on social determinants of health (SDoH), home-based care services and other health platforms, financial filings suggest.
The SPAC is additionally interested in financial and legacy services, as well as senior lifestyle businesses, in general, as parts of its operating model.
It hopes to sell “30 million units” valued at $10 to raise that $300 million. Each unit will consist of one share of common stock and one-half of a warrant, which is exercisable at $11.50, according to Renaissance Capital.
The proposed deal size would command a market value of $375 million.
UnitedHealth Group is a diversified health care company that offers a broad spectrum of products and services through UnitedHealthcare and Optum. UnitedHealthcare provides health care coverage and benefit services, while Optum provides information and technology-enabled health services.
Simply put, SPACs are an increasingly popular alternative avenue to going public. Often referred to as “blank check” companies, SPACs raise money through an IPO and then search for an acquisition target.
After a merger has been completed, the target becomes a listed stock.
The Wall Street Journal has previously detailed how 2020 became a record year for SPACs.
San Francisco-based Clover Health, a Medicare Advantage insurer with a home-based focus, announced that it was going public with a SPAC in October.
On his end, Burke has led five different companies in addition to UnitedHealth Group. He will now hold the positions of chairman and CEO for Senior Connect Acquisition Corp. He currently serves as a managing partner at Rainy Partners, a Scottsdale-based business management consulting firm.
On top of his health care background, Burke also has an interesting history in professional sports. Burke bought the Winnipeg Jets, an NHL team, in the 90s, then brought them to Arizona before selling the franchise at the turn of the century.
Senior Connect Acquisition plans to list on the Nasdaq under the symbol “SNRHU.” The company originally filed to go public in early October.
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In some ways, large health systems with home-based care arms were able to navigate this shift more seamlessly.
As another COVID-19 surge sweeps across the U.S., Avera Health’s [email protected] COVID Care Transitions program, for example, has been an asset when it comes to providing care and preventing adverse health events.
Sioux Falls, South Dakota-based Avera is a health system with more than 19,000 employees and physicians. The company — South Dakota’s largest private employer — has over 300 locations across five states.
For Avera, caring for patients in the home setting has long been part of the company’s toolbox. The company first established its [email protected] Care Transitions program eight years ago, with the goal of reducing hospital readmissions and emergency room visits.
Under the program, the company provided skilled nursing services, physical therapy, telehealth, occupational therapy and more.
When the public health emergency continued to worsen, Avera, like most health care organizations, looked to preserve hospital resources such as personal protective equipment (PPE). Creating its [email protected] COVID Care Transitions program, which leverages telehealth, allowed the system to do this.
“When COVID came about, we were concerned about PPE limitations,” Dr. Chad Thury, medical director of [email protected], told Home Health Care News. “We still service our patients at home that need it, … but for the most part, we are monitoring our COVID patients through home monitoring, software products, phone calls and virtual visits. That has allowed us to ramp up and make our home care team much more efficient.”
Being a large health system gave Avera the resources the company needed to get its program off the ground immediately, according to Thury.
“We had a strong home health division with our [email protected] business unit,” he said. “We also have [home medical equipment] stores throughout our region, so we were set up to get patients oxygen, pulse oximeters and stuff like that.”
Avera’s prior efforts to increase home monitoring among its post-discharge patients — congestive heart failure, in particular — also ensured that the company had the infrastructure in place to care for COVID-19 patients at home.
The [email protected] COVID Care Transitions program focuses on monitoring and caring for patients categorized as “moderately sick.”
“As they progress in their symptomatology, we can get them an oxygen monitor. We can even get them oxygen,” Thury said. “We can have them on oxygen for a number of days, being monitored at home, instead of having to put them in the hospital.”
Ultimately, that allows Avera to save hospital beds for patients who have more severe symptoms and require higher levels of care.
In addition to its [email protected] COVID Care Transitions program, Avera set up a 24-hour COVID-19 hotline in March. The hotline allows patients to call for information on testing and treatment.
Overall, Avera has treated 3,000 COVID-19 patients through its [email protected] COVID Care Transitions program. Just 5.3% of those patients have required hospitalization.
“Every day our nurses get a list of their patients,” he said. “They know which ones are Tier 1, meaning high-risk, symptomatic, a lot of comorbidities, oxygen is going down. Then you have Tier 2, meaning moderate risk, maybe a little symptomatic. Tier 3 patients are high-risk, but they’re maybe not having symptoms yet, or they’re just mildly symptomatic.”
Another thing that benefited the program was utilizing a language line to provide interpretation services. Roughly, 26% of Avera’s COVID-19 patients spoke languages other than English.
“In South Dakota, part of our initial rise in COVID cases was related to a protein plant,” Thury said. “A lot of the workers there are people that have immigrated to the United States, so they speak multiple different languages.”
As part of these efforts, the health system also worked with its marketing team to develop medical information materials in multiple languages for patients.
Another population Avera needed to navigate caring for was the local homeless community, according to Thury.
“Providing home-based care to the homeless population was difficult,” he said. “We have a community health center in Sioux Falls that we were able to work with. We developed relationships with the city, county, within different regions. Some places had, for instance, hotels that we could ultimately put a homeless patient in. We had the ability to monitor them while they had COVID and then keep them isolated as well.”
As the public emergency continues, Thury believes that health systems should strongly consider implementing a program that allows them to provide care in the home.
“For places that aren’t doing something like this — I think it is greatly beneficial,” he said. “I get emails or messages almost every day from patients that we care for, and they are just amazed at the service and are just so happy that they were able to stay home.”
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Since co-founding the business with his wife, Ginger, in 1994, Myers has helped lead LHC Group Inc. (Nasdaq: LHCG) through parts of five presidencies as chairman and CEO. A new administration with Joe Biden in the White House would make that six.
Although President Donald Trump has yet to formally concede due to his team’s ongoing legal challenges to the 2020 election, Myers’ roles at LHC Group and the Partnership for Quality Home Healthcare mean he must plan ahead for all outcomes. Since last year, he’s been working to make sure home health care maintains its rising position, regardless of the political landscape.
Home Health Care News sat down with Myers for an inside look at those policy efforts. In addition to the 2020 election, LHC Group’s top executive also touched on recent COVID-19 vaccine news, emerging post-acute care trends, the future of the Center for Medicare & Medicaid Innovation (CMMI) and more.
Highlights from HHCN’s conversation with Myers are below, edited for length and clarity.
HHCN: Looking back, what have the past four years meant for in-home care?
Myers: I think the data speaks for itself. Pre-COVID, we had a significant, measurable tailwind. Policy has been moving in our direction. I think that was influenced heavily by all the investments we’ve made in data-driven policy work in D.C., especially over the last decade.
When COVID happened, it took those tailwinds and put them on steroids.
We’re already going in the direction of shifting more care into the home. We’ve been able to bring that shift about thanks to the industry’s work, paired with the insights from Dobson DaVanzo & Associates and the others we’ve brought in as objective third parties. These groups have looked at the claims data, proving beyond a shadow of a doubt the efficacy of the home health benefit and our ability to create favorable outcomes at much lower costs.
Apart from demonstrating the value of home health care over the years, the industry has also been able to improve its standing with the U.S. Centers for Medicare & Medicaid Services (CMS). Providers have drastically lowered improper payments, for example.
I think back to the late 90s. There was a group of us — some of the original home health pioneers — who got together and decided to invest in data. We had the courage to invest in data to not only show where the opportunity was, but how we could improve. We looked at who the bad actors were.
Rather than the whole industry being viewed as problematic, we started holding those bad actors accountable. I think we gained a lot of credibility from that.
Those efforts helped CMS hone their skills on what to look at. They’re much more targeted now in their approaches, and I think that’s good for everyone.
Looking ahead, what are some of the things that might change? What could a potential Joe Biden administration mean for LHC Group and other in-home care providers?
Well, historically, Democrats have been more favorable to health care, generally. I think that is still true today. If we’re positioned with reliable data to give us a seat at the table going in, I think that’s important.
At the Partnership for Quality Home Healthcare, we started preparing for this potential outcome last year. LHC Group is represented by former U.S. Senator John Breaux, who is a former board member of ours. He’s still very active. I talk to Senator Breaux every other day.
We reached out and brought in former Senator Blanche Lincoln during the summer. We started orienting her specifically for this potential outcome. She’s at Lincoln Policy Group, as is Tom Scully, a former CMS administrator who also represents the Partnership. Another name is former U.S. Representative Joe Crowley. We’re working with him as well.
We have the right story. We have the right messengers, people who know President-Elect Biden and all the likely players who will be in his administration. I think we’ve positioned ourselves very well.
And we weren’t just planning for this outcome. We had strategies for both potential outcomes.
One of the things Biden has talked about is “Medicare at 60.” What would that mean for the home health industry?
The obvious impact is volume. Volume would be increased.
But I do believe we’re going to have a divided government, so I don’t expect to see anything too big happen. I don’t think we’re going to see anything transformative.
You’ve been in this business a long time. You and your wife, Ginger, started the business from your kitchen table. How disruptive is it when there’s an administration change?
It’s a great feeling to be able to say what I’m about to say — and mean it 100%. Today, I don’t think it’s that big of a deal. That’s because the data and the policy momentum are already on our side.
Back in the 1990s, we didn’t have much of a position. We just had, you know, some people who would support us. For me, that was folks like Senator Breaux and others. We were cobbling together data and support for home-based care, but we didn’t have overwhelming evidence gathered by independent, third-party experts like we do today.
This is going to be my sixth president. I’ve seen all the different political landscapes. I’ve seen a White House controlled by Democrats. I’ve seen Republicans having both the House and Senate. I’ve seen all the different combinations.
In our experience, the highest risk has been when one party controls both the House and Senate, never mind who’s in the White House. But listen, I think we have a favorable landscape right now. Yes, we have some Senate races that still make things very tight. But Democrats in the House are seeing their numbers go the wrong way, so it’s unlikely they’ll do anything way out there.
And Biden is largely considered a moderate, someone who works across the aisle, much like Senator Breaux did.
CMMI has tested out a number of alternative payment models over the past four years. Overall, it has launched 54 since its formation, with officials often citing the Home Health Value-Based Purchasing Model as one of the most successful. How has LHC Group performed under that?
We’ve performed well in the nine initial states where we’ve had the opportunity.
There’s also the Comprehensive Care for Joint Replacement (CJR) model. We’ve done significant work there with Ochsner and had great success. That has informed a lot of our strategies around skilled nursing facility (SNF) diversion and other efforts to move patients downstream.
I would also point to our broader and deeper experience with accountable care organizations (ACOs). We’re very proud of that. We’ve really come a long way with ACOs. I’d say the two biggest levers we’re pulling in that regard are preventative measures and care management on the front end, then, when patients do need care, leveraging home health care to the greatest extent possible.
Would you support a nationwide expansion of the Home Health Value-Based Purchasing Model?
Yes. The details are always important, but given a choice between strict fee-for-service versus some sort of value-based purchasing, we’re always going to take the value-based option.
What do you think a Biden administration would mean for value-based care? Would it be more of the same — or would there be a drastic difference?
I haven’t seen any evidence or indicators where I’d say “drastically different.” I think Democrats tend to lean into provider-based care. They’re not as much in favor of Medicare Advantage as Republican administrations, in my view.
I’m a big believer that providers should have — if not full control — a more meaningful stake in the risk pool. I think some of the CMMI demonstrations support that. You get the best of both worlds when providers have that seat at the table. You get lower costs and quality outcomes.
Earlier this week, Biden’s transition team unveiled members of its COVID-19 task force. It includes Atul Gawande, a former FDA commissioner and several others, but no in-home care experts. What are your thoughts on that?
I think we’ve learned over the years that there are a lot of ways to influence the process without having somebody officially named to a particular position. We know this through our experience with the Medicare Payment Advisory Commission (MedPAC).
I think there are more people favorable to home-based care policy than one might think. But, sure, we’d love to have somebody on the task force who’s directly involved with the home health industry.
If you had to look in your crystal ball right now, what’s one prediction for home health, hospice and personal care moving forward?
I think care in the home, across the board, is going to be the “ask” of patients. It’s also going to be the very first inclination of referral sources.
In the past, home-based care hasn’t been an afterthought, but it wasn’t always at the top of the list. Let’s take SNFs, for example. In the past, if a patient qualified for SNF, then they would typically get referred to SNF. Referral sources would automatically think it was the safest route for them, from a risk perspective.
But now, they see the risks associated with going to an in-patient setting. I’ve seen patients, families and referral sources acknowledging that risk more than ever. They’re saying, “You can be cared for at home, if that’s what you want to do.”
That conversation is happening with discharge planners and referral sources everywhere. It’s happening at a level that we weren’t seeing pre-COVID. I don’t think we’re going to go backwards on that. It’s a new normal.
Pfizer and Moderna came out and said they’re very close on COVID-19 vaccines. Once those are ready to distribute, what role should home health providers play?
Well, it’s almost not fair for me to answer that. Of course I think home health workers should play a role. And we’re all familiar with the phrase “social distancing” now. What better place to bring the vaccine to people than in their homes? Why would you bring everyone to a centralized location for a vaccine?
I think our front-line workers and the people they care for, including the elderly, should also be among the first to receive a vaccine. I’d like to hear arguments against that.
What has you excited about 2021?
There’s a lot to be excited about. Having been in the industry as long as I have been, I don’t know if 20 years ago I really believed I would see the day with this much opportunity.
I couldn’t see it from where we were back then. We were just fighting for survival. To see this opportunity intersect with our preparation as an industry and our ability as individual providers to care for patients downstream, it’s incredible. It’s what dreams are made of.
I couldn’t be more excited for or proud of our industry. It puts some pep in my step and makes me want to keep doing this for a really long time.
On Monday, Dallas-based AccentCare and Rosemont, Illinois-based Seasons revealed they’ll soon join forces to create a new post-acute care powerhouse. While the decision to merge made sense due to the companies’ similar geographic footprints, their complimentary services and a variety of other reasons, it was also a strategic response to the changing needs of the U.S. health care system.
“I think there are a few overlying trends that are taking place in the marketplace that we’ll … be better positioned to take advantage of,” AccentCare CEO Steve Rodgers told Home Health Care News.
Since the start of November, the United States has had more than 2 million new coronavirus infections, bringing the nation’s grand total to more than 11 million cases since spring. Health systems and hospitals are once again nearing a breaking point, with many already at max capacity or stretched dangerously thin on the staffing front.
In fact, just a day before AccentCare and Seasons unveiled their merger plans, Rodgers was on the phone with the COO of a major health system in the Upper Midwest. During the call, the health system executive noted how one of its hospitals had dozens of incoming COVID-19 patients at a time when 35 ICU nurses were out because of community-related coronavirus exposure.
“They’ve got about 35 to 40 patients they need to get out of the hospital that they’re asking for help with,” Rodgers said.
To extend capacity and redirect patients, more and more health systems are turning to in-home care providers like AccentCare, Seasons and others. Their pursuit of innovative home-based care models started to pick up in 2019, but it has since intensified due to the coronavirus.
For proof, one need only look at the several hospital-at-home programs that have popped up over the past eight months, with the latest example being Quincy Medical Group in Illinois, which has its own program in the works. “A number of” health systems have specifically asked AccentCare to accelerate their hospital-at-home activities, Rodgers confirmed.
“[COVID] has elevated the complexity of the patients coming out of the health systems,” he said. “And what you need is a greater and a wider breadth of capability to be able to take care of those patients.”
Alone, AccentCare and Seasons were already two of the biggest post-acute care players in the home health and hospice spaces, with each delivering a wide range of services. Together, though, they’ll be better able to care for those high-acuity patients coming from their health system partners.
The two companies expect to finalize their merger before the end of 2020, pending regulatory approval. Once they do, the combined enterprise will offer home health, hospice and personal care services across 225 sites of care in 26 states, employing nearly 30,000 workers.
Overall, the AccentCare-Seasons combination will have more than 60 partnerships with health systems and physician practices, collectively providing care to more than 175,000 patients and families annually.
“Health systems are beginning to feel it,” Rodgers said. “And they’re calling us up, asking for help.”
Moving forward, in-home care providers with a breadth and depth of services will be best positioned for hospital-at-home models and similar opportunities related to shifting care away from acute settings. In all likelihood, the merger between AccentCare and Seasons will be followed by even more industry-shaping deals to come, with technology also factoring into the equation.
“The other thing that you’re going to continue to see is just an acceleration of technology into the home,” Rodgers said. “If you’re a larger organization, you’re more able to make the investments in the technology and the services that you can use to support your strategic partners out there.”
In addition to strengthening its ability to take on complex patients from acute settings, AccentCare’s merger with Seasons gives it newfound access to physician services, another advantage in today’s health care ecosystem.
“One of the more difficult areas for us to coordinate is physician services,” Rodgers said. “Seasons brings a very advanced medical group practice in each state they do business in. Although that practice is very hospice-focused now, we see it as an opportunity to be able to expand our capabilities into more complex populations, to supplement the community-based physician services that are available.”
Internally, AccentCare is beginning to once again feel the impact of the COVID-19 virus across some of its markets, particularly around staffing. The company — backed by private equity firm Advent International — currently operates across more than 179 locations in 17 states.
It was among the very first home health providers to speak publicly about the coronavirus and its response strategy.
“We’re beginning to see pickup in a number of marketplaces, especially with those that have positive diagnoses above 50 per 100,000, or 100 per 100,000,” Rodgers said. “You’re seeing an increase in employee absenteeism associated with positive cases out there.”
Seasons Hospice & Palliative Care is also feeling the effects of the current surge, CEO Todd Stern told HHCN. Continued access to patients in facility-based settings has been one specific challenge, he noted.
“We’re seeing a little bit more of the restricted access,” Stern said. “But the demand continues to be there.”
Seasons offers end-of-life care services to more than 30,000 patients a year, with operations spanning 19 states and 31 Medicare-certified programs.
“There’s no shortage of need for our services,” Stern said. “It’s quite the opposite.”
Starting in the spring, Charlotte, North Carolina-based Atrium Health, one of the nation’s largest integrated health systems, implemented a system that allowed patients with less severe COVID-19 cases to opt into an at-home care option.
Atrium Health oversees 50 hospitals, 44 urgent care centers and 45 emergency centers spanning three states. The health system has about 14 million patient encounters annually.
“Virtual hospital programs have the potential to provide health systems with additional in-patient capacity during the COVID-19 pandemic and beyond,” Kranthi Sitammagari, a physician from the Atrium Health Hospitalist Group, wrote in the Annals of Internal Medicine study.
Patients were first tested for COVID-19 across Atrium’s network of emergency departments, primary care clinics, urgent care centers and external testing sites. Those who tested positive were given the choice of being cared for virtually at home or in the hospital, if their symptoms were severe enough.
Virtual options included Atrium’s home-based virtual observation unit (VOU) or its virtual acute care unit (VACU).
The VOU was designated for low-acuity patients who could be managed remotely with daily check-ins from RNs. The VACU was for patients with mild-to-moderate symptoms who would otherwise be sick enough to be admitted to the hospital.
VACU patients were set up with a hospital bed, medical equipment and videoconferencing tools within 24 hours. Additional follow-up services included oxygen assistance, medical treatments, daily virtual physician rounds, vital-sign monitoring, twice-daily nursing assessments and more.
Nearly every single patient who tested positive picked Atrium’s hospital-at-home option when given the choice, Stephanie Murphy, the medical director of the program, told Medscape Medical News.
From March 23 to May 7, Atrium treated 1,477 patients at home after receiving a COVID-19 diagnosis. That accounted for 64% of all of its COVID-19 patients from that time period.
On average, the 1,477 patients “stayed” in the hospital-at-home settings — the VOU, VACU or both — for 11 days. Of the 1,293 patients that received care in the VOU only, just 3% required in-patient hospitalization.
Patients admitted to the VACU most often received supplemental oxygen or a respiratory inhaler. Other resources provided from Atrium were intravenous fluids and antibiotics, when appropriate.
Even when a patient’s symptoms increased to a point where their care plan needed to be intensified, patients mostly elected to keep receiving that care at home. A part of the reason for that, Murphy told Medscape Medical News, was because they wanted their loved ones to be able to visit them.
Hospital-at-home models have become increasingly popular. A slew of health care organizations, including DispatchHealth, BayCare and Lifesprk, have either launched hospital-at-home programs on their own or facilitated them in the last year.
Programs will likely continue to pop up moving forward, too, as recent COVID-19 surges across the country have put hospitals back into crisis mode.
In the week spanning from Nov. 4 to Nov. 11, nearly 20% of American hospitals dealt with staffing shortages. That number increased this week, according to data provided to The Atlantic by the U.S. Department of Health and Human Services (HHS).
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One such in-home care company is Tender Rose Dementia Care Specialists, which has been the largest one-on-one dementia care provider in its market since 2009.
“All of our clients have dementia. All of our caregivers are highly trained memory care professionals,” Jim Kimzey, the company’s founder and CEO, told Home Health Care News. “Our mission is to improve the quality of life of people living with dementia and their families. It’s not just about keeping them safe and taking care of their physical needs.”
San Rafael, California-based Tender Rose’s service lines include personal assistance, companion care, “couples care” and live-in care. The company — launched by Kimzey and his siblings after their mother passed away following her own battle with Alzheimer’s disease — currently has eight locations across the state.
Nationally, there are more than 5 million people age 65 and older living with Alzheimer’s disease — a number that is estimated to grow by roughly 14 million by 2025, according to statistics from the Alzheimer’s Association. Alzheimer’s disease is the most common form of dementia, with others including vascular dementia, Lewy body dementia and more.
While dementia is prevalent across the general U.S. population, it’s especially present in the home-based care space. One home care provider, for example, recently told HHCN that almost 80% of its clients have a primary or secondary diagnosis of Alzheimer’s or another form of dementia.
As the CEO of Tender Rose, Kimzey believes that there’s value in a company that specializes in delivering dementia care in the home setting. When it comes to caring for seniors with dementia, Tender Rose takes what it calls a “person-centered, activity-based care approach.”
“The biggest difference, I see, between what we do, and what traditional home care does is … we get to know the person who has dementia,” he said. “We engage them in activities that bring them joy and meaning, at whatever level they can still participate. What traditional home care tends to do is focus on the physical needs of the client. Everything is about activities of daily living (ADLs) or instrumental activities of daily living (IADLs).”
One example of keeping a person with dementia engaged, Kimzey said, might be introducing an activity that’s both task-oriented, but one that also allows the individual to flex his or her “creative muscle.”
That kind of approach is generally far more effective than dictating commands or carrying out a random assortment of activities to simply pass time, according to Rachael Wonderlin, a dementia care consultant and author.
“I’m thinking something small, like bringing a little wooden birdhouse to your client’s home and saying, ‘Hey, we’re going to be putting this out in the garden. I could really use your help painting this,’” Wonderlin told HHCN. “That’s a whole hour-long activity where they’re engaged, doing something fun and purposeful. There’s a clear reason why they’re doing it.”
Although home care providers frequently serve individuals impacted by dementia, their expertise is sometimes limited. In fact, in cases where a senior living with dementia doesn’t suffer from any physical limitations, traditional in-home care can fall short.
“One of the things that happens is the person with dementia may actually be physically healthy and they don’t need that much help with ADLs,” Kimzey said. “If a traditional caregiver walks through the door and thinks, ‘My job is to help you when you need to go to the bathroom, bathe, eat or get dressed,’ the person with dementia is like, ‘I don’t need help with any of that. You can leave.’”
The majority of Tender Rose’s clients have had previous bad experiences with traditional home care agencies or with the private caregivers who they’ve hired. Specifically, issues arise when the caregiver hasn’t received training to deal with dementia, according to Kimzey.
“The caregiver who isn’t trained in dementia care — one who doesn’t really focus on quality of life or person-centered activity-based care — has a much higher probability of triggering agitation that creates behavioral problems,” he said.
While many companies have dementia-education programs for their caregivers, these programs are not always comprehensive.
“Giving one day, or half of a day, to a slideshow about dementia is not enough to actually teach people and encourage a dementia-positive environment — or even the ability to market [that an agency has] trained in dementia care,” Wonderlin said. “A two-hour presentation on dementia is not enough for somebody to be able to go into a situation and provide care.”
To that end, Tender Rose trains its caregivers based on methods popularized by Teepa Snow, the owner of Positive Approach to Care and a thought leader in the dementia care space. Positive Approach to Care is an Efland, North Carolina-based company that provides dementia care training, services and products across the globe.
Snow’s methods emphasize the importance of in-person and hands-on training that utilizes roleplaying and interactive discussions.
For Tender Rose, training is only a small part of differentiating itself from traditional home care providers. Tender Rose is also highly selective when it comes to recruiting its caregivers.
“Our labor strategy is to cherry-pick the best dementia caregivers in the industry,” Kimzey said. “We’re looking for the best of the best. We’re not looking for housewives who want a part-time flexible job to get a little extra spending money. We’re looking for professionals who need to work, who love doing dementia care and are good at it.”
In order to retain caregivers, the company offers a higher-than-average pay rate of $23.62 an hour. In comparison, caregivers earned a median hourly wage of $12.80 in 2019, according to PHI data.
Additionally, Tender Rose’s benefits package for caregivers includes health insurance, 401(k) plans, paid-time off and consistent hours with long-term clients.
For providers looking to truly take on dementia care, Kimzey reminds them that it’s crucial to constantly work to improve these care services.
“No matter how good you are at dementia care — you still have room for improvement,” he said. “We’ve been doing this for 11 years and we think that we do it better than just about anybody. And we aren’t nearly as good as we’re going to get. Don’t ever get complacent about how good you’re doing.”
The new feature — dubbed “Care Hub” — allows Alexa voice assistant users to link their account to the account of the senior they are taking care of. Once the senior accepts the invitation to link accounts, the caregiver can then view information on their daily activity and send alerts.
“Once that connection is established, the care recipient doesn’t need to do anything and can go about their day as normal,” Toni Reid, vice president of Alexa Experiences and Echo Devices at Amazon, told CNBC.
In a blog post, Amazon noted that users have praised “the simplicity of the voice service.”
In addition to supporting general connectivity, Care Hub also allows seniors to reach their caregivers by saying a command — “Alexa, call for help” — when emergency situations occur. In these instances, the caregiver will receive an immediate push notification, allowing them to respond to avoid a potential hospitalization.
While Care Hub is marketed towards informal caregivers — spouses, family, friends or neighbors supporting a senior — the offering could eventually make a difference in the professional home care world. Many home care companies have experimented with in-home monitoring through Alexa or similar voice-enabled devices, though actually leveraging those tools on a day-to-day basis is still relatively uncommon.
One example is Wilmington, Delaware-based ChristianaCare, which recently unveiled its “Home Care Coach,’ a HIPAA-eligible Alexa tool that was designed specifically for the company.
“Voice assistants are in millions of homes in the U.S.,” Randy Gaboriault, chief digital and information officer at ChristianaCare, told Delaware Business Now. “By leveraging this technology, we are creating a new model of care within patients’ homes to support the best health outcomes possible.”
ChristianaCare provides skilled nursing, rehab, after-hospital care and other services to more than 8,000 patients in Delaware.
It’s easy to see Care Hub quickly building momentum and attracting new users, considering both the nation’s aging population and Amazon’s position in the smart-speaker market. According to some estimates, nearly 70% of U.S. smart-speaker owners use an Amazon device, with rivals like Google and Apple lagging behind.
Care Hub isn’t Amazon’s first foray into the home. In September, the company announced plans to expand Amazon Care, a virtual care clinic that allows its employees to gain access to in-home care and telehealth services.
The company has also dipped its toes in the senior care space, with talks of a possible partnership with AARP back in 2018. The nature of a partnership was centered around designing technology for aging populations.
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That’s according to a new report unveiled Wednesday by CareCentrix, a national at-home care organization that manages more than 26 million lives across over 8,000 provider locations.
While the coronavirus has solidified those views, the bulk of consumers and payers began to support in-home care long before the calendar turned to 2020, CareCentrix CEO John Driscoll told Home Health Care News. That’s partly why, he said, the Hartford, Connecticut-based CareCentrix has invested so heavily in the technology, data and ancillary services needed to support home-based care.
“We at CareCentrix believe that care at home should be the main course, not an alternative dessert,” Driscoll said.
Originally founded in 1996 by major home health provider Gentiva, CareCentrix coordinates a wide range of services delivered in the home — everything from traditional post-acute care services to innovative community-based palliative care models and more.
Since then, the Summit Partners-backed CareCentrix has grown to a company that does “a couple billion dollars in revenues” each year, according to Driscoll, who took over as CEO in 2013.
“We want to be the ‘connective tissue’ that provides the care management, data and analytics as part of this care-traffic-control [concept],” he said. “We want to support plans and their goals of transitioning more care into the home. And we want to support patients with the information they need to make sure they’re getting what they deserve.”
To better understand the U.S. health care system’s shift toward the home, CareCentrix enlisted Quadrant Strategies to poll 1,000 U.S. adults on their care preferences and perceptions. At the same time, the company teamed up with KRC Research to survey several dozen health plan executives on how home-based care fits into their current and future strategies.
The findings couldn’t be any more encouraging for in-home care providers.
“What jumped out at me in this report was how high the demand is for home alternatives for patients — and how clear plans were that more options need to be provided,” Driscoll said.
Consumers call for more
For years prior to the COVID-19 pandemic, it had been widely reported that Americans would rather age in place than move into a senior living community or nursing home. But as consumers live through the ongoing public health emergency and read about the dangers of facility-based care, many are hoping all health care shifts into the home.
Of the 1,000 adults surveyed by CareCentrix and Quadrant Strategies, nearly three-quarters said they would prefer recovering at home instead of a medical facility following a serious health event.
Additionally, nearly seven in 10 said they would prefer to get health care at home if their other options included a trip to the doctor’s office, hospital or skilled nursing facility (SNF).
The U.S. set another single-day record for coronavirus cases on Tuesday, as the total number of new infections exceeded 136,000, according to Johns Hopkins data. There have been more than 10 million cases overall, with many linked to long-term and acute care facilities.
As hospitals again face capacity problems, some have turned to technology to monitor patients in the home setting. But that only goes so far, according to Driscoll.
“COVID exposes both the opportunity and the challenge to provide more care at home,” he said. “COVID accelerated telehealth, for example, but it has also exposed the fact that you do need a partner like CareCentrix — or somebody like us — to provide the support, the management and the follow-on care to make sure patients aren’t lost.”
While consumers are interested in receiving intermittent care in the home, perhaps in the form of increasingly popular hospital-at-home or SNF-at-home models, they’re also open to more preventive-focused care, the CareCentrix report suggests.
Of those surveyed by CareCentrix and Quadrant Strategies, 63% of consumers said they would prefer to get preventive care at home to avoid the doctor or a hospitalization. Their interest isn’t limited to traditional home health or home care services, either.
Broadly, the report suggests consumers want to receive a variety of services in the home, including physical and occupational therapy, as well as mental health support, nutrition assistance and chronic disease management.
That’s one of the reasons CareCentrix recently expanded into palliative care, acquiring Turn-Key Health in May.
Payers eager to embrace home care
Arguably, the most exciting highlight from the CareCentrix report is how bullish payers are on home-based care.
Of the 76 health plan executives that CareCentrix and KRC Research spoke with, 97% said they agreed that more care at home is better for insurers and their members. A similarly high percentage said they agreed that treating members at home is often more cost effective in the long term than treating them in a facility.
“I think the message from health plans is that, universally, they want to transition more care to the home,” Driscoll said. “But as you get into the details, they’re clearly going to need partners to help them get there.”
CareCentrix — recently rumored to be on Anthem Inc.’s acquisition wish list — has seen that heightened interest firsthand.
Historically, the company has predominantly operated in the fee-for-service and commercial spaces, Driscoll explained. Currently, though, 80% of its new business is coming in the form of Medicare and Medicaid managed care, plus new value-based care agreements.
When it comes to technology, 91% of surveyed payers said advancement in telehealth or remote care monitoring has encouraged them to shift care into the home. Almost all of them said telehealth and remote monitoring have now made it easier to provide continuous care in the home.
“As our technology gets better, you should be able to do more and more at home,” Leslie Norwalk, former acting administrator for the U.S. Centers for Medicare & Medicaid Services (CMS) under President George W. Bush, said in the report. “And the more of that you can do in a setting that’s the patient’s home, the better.”
Of the payers surveyed, 49% said they have already increased the availability of at-home health care options for their members where possible. Nearly one in three are in the process of increasing at-home care options.
More than anything, payers want in-home care partners that can demonstrate cost reductions and provide smooth hospital-to-home transitions, the report states. Additionally, payers want partners that can control long-term costs and reach members wherever they’re located.
Having experience in both government and commercial lines of business is also a positive, according to the report.
“We’ve continued to invest in providing more options to patients and plans,” Driscoll said. “We’ve continued to invest in providing care in the home.”
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Digital health innovation conference Frontiers Health kicks off its 2020 edition this week, although the majority of the conference will be held online because of the COVID-19 pandemic.
This year, Frontiers will be a global Hybrid conference. In line with the “new normal” situation, the format of the 2020 edition will be hybrid, combining online global streaming together with offline events and activities held at hubs in multiple locations such as Italy, Germany, Finland, Spain, the USA and more.
It will be dedicated to digital health innovation in the context of the “new normal”, focusing on telemedicine, digital therapies, breakthrough technologies, patient-centricity, healthcare transformation and ecosystem development.
This year’s programme will start at 2.00pm CET on both days with plenary sessions (talks and panels) and parallel break-out sessions (masterclass, workshop, deep-dive formats) in the unique Frontiers style.
The iconic Start-up Discovery sessions have also moved online opening more opportunities to connect with both earlier stage and more established digital health start-ups.
Highlights of day one include a welcome performance by musician Korinami, with visuals by designer Joe Ferrari.
Healthware Group CEO Roberto Ascione will open the conference with Frontiers Conferences CEO Matteo Penzo.
This will be followed by a keynote speech on digital health during Germany’s EU Council Presidency by Dr Gottfried Ludewig, director general digitalisation and innovation at the Federal Ministry of Health, Germany.
View the live coverage from day one at Frontiers Health 2020 from 14:00pm CET on 12 November below and we will also have live coverage from day two from 13 November (The live blog may take a moment to load.)
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In 2020, the virus has disrupted traditional cancer care in several ways, including by delaying procedures originally scheduled for long ago. COVID-19 has also made some seniors affected by cancer wary about the idea of voluntarily entering hospitals while being immuno-compromised.
Entering patients’ homes for cancer treatment could go a long way in curbing at least some of these issues. While meeting senior cancer patients where they are helps with accessibility and comfortability, it also potentially improves outcomes, according to health experts.
But there are still barriers to surpass to get to a point where in-home cancer care is more prevalent across the U.S. And as of now, there is no real data even being kept on how common in-home cancer care is, Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told Home Health Care News.
“In terms of at home care for cancer treatment, I just don’t know that we have data to report on that yet,” Cannady said.
Established in 1913, the Atlanta-based American Cancer Society (ACS) is a health organization dedicated to eliminating cancer. It has more than 250 regional offices throughout the U.S.
Cannady specifically has been working on support mechanisms for caregivers dealing with ancillary cancer treatment in the home. Without additional help, cancer can sometimes become as much of a burden on the caregiver as it is on the patient, especially for ones who are not medically trained.
As a useful tool, the ACS and Cannady have developed a comprehensive guide for caregivers to better deal with patient issues that caregivers may be unfamiliar with.
COVID-19’s impact on cancer care has been considerable in 2020, Cannady noted. It’s likely that the fall out will take a while to fully materialize, too.
“There’s just been so much uncertainty around COVID. Also facility liability [is a concern], if there’s exposure to immunosuppressed patients and potentially caregivers,” Cannady said. “Those treatment delays are causing major issues.”
Cannady expects that there will be an uptick in late-stage prognoses in patients, particularly when it comes to breast cancer and possibly colon cancer. Late-stage intervention can lead to worse outcomes.
The question, then, is whether or not at-home care could help ease some of the constraints that COVID-19 has put on cancer care, generally. And if so, why more health systems and providers haven’t jumped at the opportunity.
“I do think [at-home cancer care] could be a viable option,” Cannady said.
How at-home cancer treatment works
The concept of at-home cancer care has yet to gain steam in the U.S., but oncologists have pushed its potential worth. In 2019, authors in the Journal of Clinical Oncology (JCO) pointed to the model’s success abroad and argued it could have similar success domestically.
Done correctly, in-home cancer care could mean lower costs for payers and better outcomes for patients.
“The building blocks for an oncology hospital at-home are already in place in the United States,” the authors wrote in JCO. “Management of many specific cancer-related symptoms and complications is feasible in the home setting. Outpatient management of low-risk febrile neutropenia is as safe and effective as inpatient management, at half the cost.”
The University of Utah’s Huntsman Cancer Institute’s Huntsman at Home program is an example of what the future of cancer treatment could look like.
In tandem with the nonprofit organization Community Nursing Services, the program provides care to patients who want an alternative to the hospital.
“We offer our services primarily to give patients an alternative to being in the hospital, but also to help decompress our hospital,” Dr. Anna Beck, the medical director of Huntsman At Home, told HHCN. “We try to take patients who are on the road to recovery, who are in the hospital, and get them home quicker. Since COVID hit, we also try to offer an alternative to hospitalization for other appropriate patients.”
Huntsman At Home assists with symptom management from chemotherapy or treatment as well as pain management from the cancer itself. The team works collaboratively with the oncologists, as well as other specialists like surgeons on things like post-operative care.
Additionally, the program provides routine home health such as physical therapy and occupational therapy, and also deploys social workers to help out with the psychological effects and caregiver support.
Right now, during COVID-19, Huntsman At Home only works within a 20-mile radius of the hospital, but it is gaining flexibility around that. Patients within that range are typically more comfortable coming into the hospital anyway, partly because the Huntsman Cancer Institute has beautiful facilities, according to Beck.
But there was also a no-visitor policy in place at some points, and there may be another one in the near future as surges persist around the country. In that case, the at-home program allows loved ones to play a bigger part in the patient’s cancer journey, which can be highly beneficial.
“It was a tough thing for many patients to come to the hospital and not be able to have their loved ones or their support system with them,” Beck said. “And for many, that can be a bit of a deal-breaker.”
Without visitors, and without the facility and resources that the Huntsman Institute has, the model could be even more applicable elsewhere, Beck suggested. For patients who have less desirable hospital conditions, being able to be treated at home as much as possible could represent a massive upgrade.
Still, while Beck said she is aware of some institutions conducting some limited chemotherapy in the home, Huntsman At Home is currently not doing so. Instead, the team does more limited intervention-type work with patients.
Huntsman At Home currently offers more than what a traditional home health agency would be able to provide. But in-home cancer care could also be a worthwhile opportunity for home-based care agencies to consider in the future.
Access and potential barriers
The increase in telehealth has been a tailwind for the Huntsman At Home team. Virtual tools allow medical experts to deliver care without driving as much as they did before COVID-19.
But access is still one of the major problems in cancer care — and one that at-home programs could address.
“That’s true especially in a place like Utah, where we have a huge rural and frontier population,” Beck said. “If we want to take care of patients throughout the Intermountain West, we have to be able to do it in such a way that it’s convenient for them, and it keeps them in their environment where their support system and their job is.”
It’s about delivering care where patients need it most — not just where it’s convenient for health systems and providers, Beck said.
Rural patients without nearby hospitals often have massive burdens placed on them during treatment, forcing them to schedule entire days around getting to a place where they can be screened and receive treatment or care.
But you can’t bring everything into a patient’s home — at least not yet. While there are examples of chemotherapy being delivered at home, there are still a slew of logistical struggles to get past.
“You can’t bring a radiation machine to somebody’s house to do proton therapy, you just can’t,” Cannady said. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”
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Between 2000 and 2016, deaths per 100,000 population across the 15 most common tumor types declined by 24%. Additionally, 10.2 new indications were approved per year across the 15 most common tumor types. Cancer drug approvals were associated with statistically significant deaths averted in 2016 for colorectal cancer (4,991, p = 0.004), lung cancer (33,825, p < 0.001), breast cancer (11,502, p < 0.001), non-Hodgkin’s lymphoma (6,636, p < 0.001), leukemia (4,011, p < 0.001), melanoma (1,714, p < 0.001), gastric cancer (758, p = 0.019), and renal cancer (739, p < 0.001). Between 2000 and 2016, new cancer treatments were correlated with 1,291,769 (p < 0.001) total deaths prevented across the 15 most common tumor types.
Do read the whole article here.
The health system recently announced it will provide access to acute-level care in the home to help care for patients battling COVID-19, heart failure and COPD, among other possible conditions. BayCare is launching the hospital-at-home program through its home-based care arm, BayCare HomeCare.
The new program will operate as a hybrid model, combining the company’s home health service lines, remote patient monitoring, virtual visits and in-person visits, according to BayCare Vice President Dr. Jacquelyn B. Cawley, who also serves as CMO for ambulatory care and clinical integration.
“The nurse will actually go into the home and do a combination of face-to-face visits, as well as virtual visits,” Cawley told Home Health Care News. “With the remote patient monitoring, we’ll be able to monitor vital signs, … the nurse there in the home will also help host that virtual visit with a provider while being the eyes and ears.”
As one of the largest health care systems in Florida, BayCare operates 15 hospitals that serve four counties. BayCare HomeCare serves roughly 6,000 patients daily and covers 13 counties.
Through the hospital-at-home program, BayCare will also administer IV therapy, IV medications, IV hydration and other services.
As an organization, BayCare had its sights set on entering the hospital-at-home space for a while.
Still, the ball didn’t get rolling until the impact of the COVID-19 public health emergency hit, according to Cawley.
“We were very hard hit in Florida, and we wanted to help to decompress the hospital and our emergency departments,” she said. “In our home care, we were taking COVID-positive patients from the emergency departments, as a way to help mitigate the numbers of patients that they had. We were also taking early discharges from the hospital into either a hotel, an alternate care site or into their home setting.”
After tackling COVID-19 patients, providing hospital-level care at home on a permanent basis seemed like a natural progression for BayCare.
“We could bring pretty much everything that they would get in a hospital to the home setting for those appropriate patients safely,” Cawley said. “We were able to prove that with our COVID-positive patients, and we’ll be moving forward with that population, especially now that we’re starting to see the numbers increase again.”
As the end of the year approaches paired with a normal flu cycle, many health care providers are gearing up for an influx of new coronavirus patients.
While the model has gained a reputation for providing better outcomes at a lower cost, hospital-at-home has still mostly existed as a niche service line for providers in the U.S.
This was until 2019, when it seemed that the hospital-at-home model began to gain ground. A number of providers across the country implemented programs, including Highmark Health, CommonSpirit and Prisma Health.
For many providers, the prospect of launching a new hospital-at-home program can be daunting. Moving into this space requires an organization to have a strong clinical staff and operational support in place.
Being a large health system gave BayCare an advantage in this regard, according to Cawley.
“BayCare has a lot of resources and assets, as a large health system,” she said. “We had everything with home care already set up, as far as the remote patient monitoring. We have the nurse support. We already had that virtual platform, and we also had a specialty pharmacy IV therapy that was done through our nurses.”
Additionally, as a large health system, BayCare had urgent care providers and a robust on-demand virtual urgent care service.
With all of BayCare’s resources at its disposal, the key challenge was making sure everything came together coherently.
“Most of the resources we already had in place; it was just about how to coordinate them and bring them all together,” Cawley said. “We worked very closely with the hospital, with the emergency departments on what the workflow is. We have clinical criteria that we use, that we developed with our ED physicians, our hospitalist physicians and others in the community to really identify who are the best patients for this type of home-based service.”
When it comes to hospital-at-home models, reimbursement has always presented a challenge for providers looking to enter the space. Lately, that has become easier to navigate, according to Cawley.
“One of the reasons we chose to go with home care-based services is because we had a methodology to bill through home care appropriately, as long as we had a provider order and the patient was eligible for it,” she said. “We had a mechanism to bill for physician visits virtually once COVID came about. So there’s been more opportunity in 2020, between Medicare allowing for remote patient monitoring, and then more recently with COVID, for all of our payers to actually support virtual visits.”
Cawley believes the COVID-19 emergency has had a significant impact on the hospital-at-home model. Anecdotally, the interest in implementing similar programs continues to grow.
“When we talk to our counterparts across the country, everyone is either doing, planning or piloting something along the lines of this,” she said. “As long as we have the continued support of Medicare and other payers to support virtual care, I think we’ll be able to continue to move to this.”
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The New Orleans-based company now has a new goal in mind: vaccine deployment.
Ready plans on distributing thousands of flu shots this winter, both for the standard public health benefits and to build out contingency plans for when a COVID-19 vaccine becomes widely available.
In the six major markets where it operates, the home- and community-based services company has already conducted thousands of in-home COVID-19 tests. The safest and most effective way to deliver vaccines will also be in the home, some experts believe.
No COVID-19 vaccine has received emergency-use authorization or full approval in the U.S., but some experts — including Dr. Anthony Fauci, the nation’s top infectious disease authority — are bullish one will be available in spring or summer 2021. Ready wants to be prepared for the potential role it can play.
“The next piece in terms of using that [Series C] funding is actively working to deploy vaccines,” Carl Marci, the chief psychiatrist at Ready, told Home Health Care News. “And we will start with flu vaccines as a trial to sort of work through the workflows with our Responders, putting [best practices] in place.”
As part of its operating model, Ready deploys “Ready Responders” — individuals trained as EMTs, paramedics and nurses — into patients’ homes. All Responders are connected to Ready’s platform through their phones and are also equipped with iPads, as well as various testing and monitoring equipment.
GV — the venture capital arm of Alphabet Inc. (Nasdaq: GOOGL), the parent company of Google — played a large part in Ready’s most recent funding round. Overall, the company has raised $107 since launching, according to Crunchbase.
“We recognize the importance of flu immunizations, especially during what could be a ‘twindemic,’ so it’s very important everyone gets that flu shot,” Marci said. “So we’re rapidly trying to deploy that. And a lot of that is also in anticipation of a COVID vaccine. When it comes, we want to be ready.”
Ready currently serves the Louisiana communities of New Orleans, Baton Rouge, Houma and Shreveport. It also operates in New York — where it expanded when COVID-19 cases intensified — as well as Baltimore, Las Vegas, Los Angeles, Washington, D.C., and Reno, Nevada.
Its next step is to expand services in Texas and Pennsylvania in the near future. It will additionally seek to continue expanding in the places where it already has a stronger footprint.
Even as it expands, COVID-19 testing remains a priority. The company has continued its efforts, with eyes focused on the holiday season and helping family members safely gather.
Specifically, Ready is using antigen testing and the BD VeritorTM System for rapid detection of the virus. Once Ready receives necessary CLIA approvals, it will expand rapid testing to additional markets outside of New Orleans.
“In terms of its sensitivity, specificity and its ease of use at the point of care, it really felt like a great option for us,” Marci said. “So we went down the path to secure a vendor, get tests and work through the protocols, which we’ve done in New Orleans.”
Moving into mental health
In addition to testing and various physical health screenings, Ready is venturing into mental health.
“We had a crisis in mental health before COVID,” Marci said. “And COVID has exacerbated many of the cracks and fissures in our society and health care system. The issues around mental health only got bigger.”
There has been a considerable increase in mental health issues during the COVID-19 crisis, most health care consumer surveys suggest. In turn, access to support services has become an even bigger issue, Marci said.
The mental health focus is a part of Ready’s Community Care program, which is live in both Louisiana and Nevada. The program is one of Ready’s core service lines, and its goal is to assist its partners with “high-utilizers” and hospital “frequent flyers,” or patients who experience adverse health events at higher-than-normal levels.
Many times, such high-risk patients are hospitalized with a health concern that they believe to be strictly physical, though the root cause is actually tied to mental health. Initial hospital review often does not reveal that underlying mental-health trigger.
“Usually those surface-level health problems are the physical manifestation of the issue, but it could really be that a patient is anxious or depressed,” Marci said. “And they’re anxious or depressed because they have housing insecurity, financial insecurity or job insecurity.”
The Community Care program’s purpose is to work with these patients in a comprehensive way to address their physical, mental and social health needs. Then Ready bridges the gap in their care and connects them to the resources they need.
The program doesn’t just connect patients to outside resources available locally, however. Now, the company is hiring its own licensed clinical social workers to form longer-term relationships with individuals with mental-health needs in its network.
“We’re excited to see where it goes,” Marci said. “[Having] the Responder in the home, making that face-to-face, intimate connection is vital. Our Responders are from the community, so they know the neighborhoods and they’re familiar faces, not some complete stranger in a white coat.”
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Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other care facilities. In 2020, UnitedHealthcare had more MA enrollees than any other group.
“We know the majority of older adults want to stay in their homes and communities as they age, and UnitedHealthcare continues to design plans that place the home at the center of health care support and delivery,” Steve Warner, senior vice president of Medicare Advantage in UnitedHealthcare’s Medicare & Retirement division, told Home Health Care News.
America’s largest health insurers — UnitedHealthcare, Humana Inc. (NYSE: HUM), Aetna, Blue Cross Blue Shield plans and others — have built out their home strategies in a variety of ways.
In some cases, that has meant the launch of internal in-home primary care and remote monitoring programs to better track members’ social determinants of health. In others, it has meant partnering with in-home care providers to offer the types of new supplemental benefits that the U.S. Centers for Medicare & Medicaid Services (CMS) has increasingly signed off on over the past few years.
“The interconnectedness of the health care system means that every touchpoint along a consumer’s health care journey is important,” Warner said. “Particularly for high-risk individuals and others who depend on a variety of needs being addressed from home, the people who provide these services are an integral piece of a shared community of support.”
On its end, UnitedHealthcare says it’s doing more than ever to support health and wellness from the comfort, safety and convenience of the home.
In 2021, most of its plans, for example, will include HouseCalls, a program that offers Medicare and Medicaid members a yearly in-home visit with a licensed clinician. The company expects to complete nearly 1.7 million HouseCalls visits for members in 2020.
HouseCalls has been particularly valuable during the COVID-19 pandemic, too, with the number of home visits in the third quarter growing by nearly 30% year over year, according to UnitedHealth Group CFO John Rex, who addressed the topic during an Oct. 14 earrings call.
“We continue to deepen our engagement with those seniors most in need, increasing the distribution of remote digital sensor kits to collect and monitor vital health data and address gaps in care generated by the pandemic,” Rex said at the time.
‘Health is more than medical care’
Apart from its HouseCalls program, at least six UnitedHealthcare plans are offering in-home support services under the “primarily health-related” supplemental benefit pathway in 2021, according to state-level data compiled by Washington, D.C.-based research and consulting firm ATI Advisory.
In comparison, only two UnitedHealthcare plans offered in-home support services supplemental benefits this year.
Geographically, the two UnitedHealthcare plans offering in-home support services in 2020 covered slightly more than two dozen counties. Next year, the six plans doing so will cover more than 250 counties, according to ATI Advisory’s data.
“They have made a very significant, clear increase in the coverage,” ATI Advisory CEO Anne Tumlinson told HHCN. “I think it speaks a lot to the power of these benefits.”
Overall, 429 MA plans will offer in-home support services across 36 states and Puerto Rico next year. Many more will also likely offer home-focused supplemental benefits through the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway in 2021.
These trends in supplemental-benefit design are, in part, linked to the realization that a large chunk of a person’s health is ultimately impacted by functional ability and social factors, including access to food, friends and transportation.
“We know that health is more than medical care, and that factors outside a doctor’s office play a significant role in influencing a person’s health and well-being,” Warner said. “This reality factors into how we design our plans and support older adults.”
UnitedHealthcare isn’t just coordinating and covering services that take place within its members’ homes.
At times, it’s even helping to provide the home in the first place.
“At an enterprise level, UnitedHealthcare continues to make significant investments in affordable housing as part of the company’s ongoing efforts to remove social barriers to better health for people in underserved communities,” Warner said.
Since its affordable housing initiative kicked off in 2011, the company has worked with a range of advocates to invest more than $500 million in developments that increase access to housing, health care and social services.
Telehealth is ‘here to stay’
The U.S. tallied 91,530 new COVID-19 infections on Election Day, adding to the skyrocketing cases numbers reported in the past week.
The COVID-19 pandemic is changing the health care landscape, Warner recognized, but it isn’t altering UnitedHealthcare’s commitment to helping members access the care they need. That’s true whether they reside in a clinical setting or at home, he added.
To maintain that commitment, UnitedHealthcare has turned to more telehealth solutions.
“In just one month earlier this year, for example, more than 12% of our UnitedHealthcare Medicare members had a telehealth visit with their doctor – up from just a fraction of a percent last year,” Warner told HHCN.
In 2021, all standard MA plans from UnitedHealthcare will offer telehealth visits with a $0 copay.
“As in-person visits resume, telehealth utilization is moderating, but remains significantly higher than the pre-COVID baseline,” Warner said. “We believe higher utilization and increased comfort level in embracing telehealth is here to stay.”
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The numbers don’t lie: The COVID-19 emergency has officially ushered in a new age of telehealth in the U.S.
But while in-home care providers and other organizations have embraced telehealth to deliver virtual visits to patients, many have also leaned into it as a way of streamlining operational processes.
One such company is Excelin Home Health, which has been using telehealth to automate the return-to-work assessments the company conducts on a daily basis with its staff during the COVID-19 pandemic. Specifically, Excelin turned to Synzi, a St. Petersburg, Florida-based company that provides virtual visit and messaging tools via its telehealth platform.
“We populate a daily screening questionnaire, and it comes up on [our clinicians’] app every single day,” Alicia Marr, CEO of Excelin, told Home Health Care News. “The clinicians can open that app and answer that line of questions first thing in the morning.”
After completing the questions, their responses are sent back to the Excelin manager for that particular location. In turn, managers can automatically know which staff members are available to safely work with patients based on their symptoms.
Moulton, Texas-based Excelin is a Medicare-certified home-based care provider that has 12 locations across Texas and California. Its service lines include home health, hospice and private-duty home care services.
Currently, the company has roughly 500 employees and serves about 2,000 clients.
Prior to implementing its automated return-to-work assessments, Excelin relied on a manual process to help with COVID-19 staffing protocols.
In order to get an accurate headcount of which caregivers were available to work and which had COVID-19 symptoms, agency administrators had to individually text or call each one of their staff members, using spreadsheets to track responses.
“Think about the time spent calling and asking every staff member those questions, keeping a manual log that risks information being inaccurate,” Marr said. “It was really burdensome for the staff.”
A number of other issues also resulted from Excelin’s previous manual process, she noted.
“Sometimes, the staff member wouldn’t answer all the questions. There would be interruptions, or it would just take such a long time for one or two callers to get through the list of all the employees,” Marr said. “It was a very tedious process. If there was a symptom that was identified, that meant you had to stop, call the manager and reconcile that. That means everybody still left on the list is delayed from receiving a call.”
Having caregivers independently submit questionnaires through the app has allowed for greater operational efficiency, according to Marr.
That’s particularly important at this point in time, when agency margins have been tightened due to rising personal protective equipment (PPE) costs and other expenses.
Additionally, the company’s current return-to-work assessments system has been an asset when it comes to staying compliant with regulatory requirements.
In general, telehealth has been at the forefront of Excelin’s COVID-19 response. The company began offering telehealth services to all of its patients at the start of the public health emergency.
“We were very committed to wanting to support our communities and caring for the COVID-19 population,” Marr said. “When we developed our internal protocol for caring for patients, telehealth was very much a part of that protocol. We felt it was very important to protect our staff, to preserve our PPE and to protect our patients.”
Excelin’s is using telehealth services with roughly 15% to 20% of its patient population. This includes care coordination, medication reconciliation and touchpoints for high-risk patients.
“That was very much a part of the dialogue that we had with our referral sources from Day 1,” Marr said. “‘Let’s talk about telehealth and how we’re going to incorporate it into that plan of care.’”
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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.
Most of the digital health experts we spoke to for this issue of Deep Dive made one thing clear – no one can really say what the future holds for digital tech in the pharma and healthcare industries.
But this isn’t necessarily a bad thing – our interviewees also stressed that if companies can remain adaptable and innovative, there are myriad opportunities to thrive during and after COVID-19. In this issue we hone in on some of the tech that is set to change healthcare forever – including VR, AI and digital therapeutics – and look at how pharma can best harness themWe also examine how the pandemic is affecting digital sales, patient support programmes and HCP consultations, and speak to some exciting digital start-ups that are bringing new ways of managing health into systems like the NHS.
The key elements driving the success of digital health
Ahead of Frontiers Health 2020, steering committee members Roberto Ascione and Paul Tunnah from Healthware give us their thoughts on the trends driving the bright future of digital health
A “pivotal moment” for digital health adoption
Former chief digital officer for the NHS, Juliet Bauer, is now applying her experience to the private sector through video consultation firm Livi. She shares her thoughts on how well the NHS is integrating digital health and what the public and private sectors can do to further boost adoption
What will the digital health ecosystem look like post-COVID?
Digital health had already been building a presence before the pandemic, but the tools it offers have been essential to counter the disruption caused by the coronavirus, reports Richard Staines
Germany’s digital health changes will boost digital therapeutics in Europe
Digital therapeutics are gaining momentum worldwide and offer developers, including pharma, both a huge opportunity and a stimulating market access challenge, say Olaf Schoeman and Emanuele Arcà
Digital therapeutics: Why human psychology is key to adoption
How can we boost low adherence rates for digital therapeutics? The psychology of the ‘therapeutic alliance’ might help
Navigating the NHS as a digital start-up
We speak to finalists from the Greater Manchester Future of Health accelerator to find out how digital start-ups can overcome the challenges small companies face in bringing their technologies into the NHS
Building the infrastructure for successful digital health start-ups
2020 might go down as the year digital health truly begun to boom – but to continue thriving, health tech start-ups will need a strong support network and an environment that fosters innovation.
Two decades of digital: the changing habits of pharma and HCPs
When Chris Cooper launched his ‘European Prescriber Guide’ software twenty years ago, he was among a select few taking digital in pharma seriously. He tells pharmaphorum how pharma can learn from the past to enter an innovative future
Thriving in COVID-19 with flexible marketing strategies
Pharma sales is set to change forever. To keep afloat in the current climate, teams need to embrace flexibility and remember that traditional content won’t work in new contexts, say experts from Syneos Health
VR, COVID and ensuring safety with cutting-edge tech
Not too long ago virtual reality (VR) tech might have seemed like a dream, but now it’s being harnessed by the healthcare industry for a wide variety of purposes
3 innovations booming during COVID and how to adopt them successfully
Research Partnership’s Vicki Newlove explores research into digital change during COVID-19 to find out what business questions pharma needs to address to succeed with innovations.
A new dawn for clinical trial management
It’s time for pharma to take a 360-degree view of its clinical trial data and step into the future with near real-time study management.
• Read the latest issue Deep Dive: Digital Health Innovation 2020 in full
pharmaphorum’s digital magazine Deep Dive provides objective, issue-driven views, analysis, high-level interviews and unique research for pharmaceutical companies, biotech firms and the wider healthcare sector.
In 2020 Deep Dive will have special focuses on disruptive technologies in pharma, R&D innovation, market access and commercialisation, oncology, sales & marketing innovation, digital health and patient engagement. Subscribe to future issues of Deep Dive.
The post Deep Dive: Digital Health Innovation 2020 appeared first on .
Quil Assure, which is slated to launch in 2021, is designed to help caregivers monitor senior’s movements. It incorporates ambient sensors and voice-activated technology in order to accomplish that mission.
A voice-based unit, which is 4G-enabled, is placed in the senior’s home. The caregiver then downloads the Quil Assure app to stay connected with that older adult.
Here’s how it works after being set up in the home: Quil Assure sensors monitor and gauge what is considered “normal” activity for an individual senior. Over time, it learns patterns and is able to alert caregivers when something unexpected happens.
Remote patient monitoring tools like Quil Assure have seen exponential growth in terms of utilization during the COVID-19 pandemic, with the global market is forecast to reach $2.14 billion by 2027, according to a June analysis by Reports and Data.
“That’s an ambient experience for the senior at home,” Carina Edwards, CEO of Quil, told Home Health Care News. “Those ambient sensors detect falls. they can also connect you to a 24/7 call center if you need some help. But more importantly, they’re able to use the voice-based speaker. The senior doesn’t have to use any technology outside of a button on top of the speaker to connect with those folks on their mobile devices and coordinate their caregiving needs.”
Digital health platform Quil is the result of a joint venture first formed in 2018 between Comcast NBCUniversal and Independence Health Group. The Philadelphia-based company serves providers and consumers.
Working under the Comcast NBCUniversal and Independence Health Group umbrella gives Quil distinctive positioning as a company, according to Edwards.
“I think being the joint venture of Independence Health Group, with their deep knowledge of health care from the payer perspective, and also the tech-savviness and scale of Comcast are what gives Quil a unique advantage in the marketplace,” she said. “When you think about our technology at scale, we’re not your traditional startup.”
Edwards pointed out that when Quil launched its Quil Engage product offering last year, the company was able to quickly scale the technology and deliver it to 1.3 million Independence Blue Cross members during the public health emergency. Quil Engage uses in-home motion sensors to help patients post-surgery.
Additionally, the company was also able to scale Quil Engage to 83 million viewers on the Comcast network.
Quil’s latest product is focused on informal or unpaid caregivers, meaning the spouse, the daughter, the niece, the nephew, the neighbor and others supporting the senior, according to Edwards.
In the U.S. alone, roughly 44 million people take on informal caregiver responsibilities. These caregivers assist with activities of daily living (ADLs) and possibly even medical tasks, according to San Francisco-based nonprofit Family Caregiver Alliance.
In the future, the company would like to roll out a B2B version of Quil Assure that could be offered by health care providers as well.
In-home care providers, in particular, aren’t far from the company’s mind. The company’s senior leadership has aspirations that include home health companies.
As aging in place remains the overwhelming popular preference among seniors, with COVID-19 further fueling this desire, it follows that technology will play a key role in making this feasible.
It will be especially important to create new technology that adapts to seniors instead of making seniors adapt to technology.
“Nine out of 10 seniors want to stay in their current home for over the next 10 years,” Edwards said. “When you start thinking about new technology, no senior wants cameras on them. They don’t want to feel like they’re being watched. When we brought this solution from concept into what we’re going to be piloting in December, it was really to have simple technologies that stayed into the background.”
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The funding round was led by venture capital firm 7wireVentures, and investment firm Pitango HealthTech.
Homethrive has earmarked the new funds to be used in a number of areas, Dave Jacobs, co-founder and co-CEO of Homethrive, told Home Health Care News.
“We’re going to accelerate our penetration into health plans, and also accelerate our penetration into the self-insured employer market,” Jacobs said. “Additionally, we are investing considerably to build out the technology stack that will power the service we provide to those different markets.”
Homethrive’s staff of social workers provides clients with a comprehensive care plan for older adults, as well as coaching, personal assistance and concierge services. The Chicago-based company — which has 50 employees — services the private-pay market, long-term care insurance companies and Medicare Advantage plans.
While Homethrive’s aim is to facilitate aging in place, Jacobs expressed that this goes hand-in-hand with addressing the social determinants of health.
“We think that they are very interrelated,” he said. “We think that by addressing the social determinants of health, whether that’s food insecurity, isolation, loneliness, transportation or home safety, we can make it much easier for people to age at home.”
Homethrive said its Series A round comes on the heels of the COVID-19-related spotlight that has been placed on home-based care.
Jacobs believes that people overwhelmingly prefer to be cared for in their own home — a preference that has become a necessity due to the public health emergency.
“People had different choices, they could be at home, or they could oftentimes go to a senior living community, and now because of COVID people are much more reluctant to move out of their home,” Jacobs said. “We have a number of members who were in senior living communities and their families have brought them back home.”
Many of the company’s clients are also people who are unable to provide in-person support to their aging family members.
“The challenge is families not being able to spend time with and do things to help their aging loved ones,” Jacobs said.“They’re not able to travel, they’re not able to go see them … so they need help in navigating those things. Also, the incidence of depression, isolation and loneliness have gone up because those older adults are more cut off from other services and organizations that they would otherwise engage with.”
Looking ahead, Homethrive is focused on further solidifying itself in the home-based care space.
“We have spent the last two years proving the model, making sure we can deliver results and that we can really affect caregivers and older adults in a very positive way,” Jacobs said. “Now, our focus is on really accelerating that and improving the efficiency through which we provide that service.”
That’s according to the LZ 200, an annual report conducted by the aging-focused advocacy organization LeadingAge and Ziegler Healthcare Investment Banking. Chicago-based Ziegler is a privately held investment bank specializing in home health care and senior living, among other areas.
“This LZ 200 report is one of our most important publications in helping inform the senior living and care industry during such a critical year,” Dan Hermann, the president, CEO and head of investment banking at Ziegler, said in a press release. “As the industry strives to provide the best care during the COVID-19 pandemic, these insights on the largest not for-profit senior living organizations provide an opportunity for providers and industry stakeholders to further adapt to this challenging moment.”
The LZ 200 examines the characteristics each year of the largest nonprofit senior living organizations. This year, it found that 51% of the top-200 now offer some sort of home- and community-based services, a 1% increase from 2019.
Trinity Health Senior Communities, the Evangelical Lutheran Good Samaritan Society, Presbyterian Village of Michigan, Holland Home and Concordia Lutheran Ministries are the five largest providers.
The home- and community-based services include home health care, home care, continuing care at home (CCaH) models, PACE programs, hospice and adult day services.
Three organizational offerings grew this year: home health, CCaH models and adult day care, while the remaining areas stayed on par with the 2019 report. Still, home care remained the most popular, with 34% of the organizations including that service line in 2020.
Of the largest 25 providers, 64% offered some sort of home- or community-based service.
“I am heartened to see that even through the pandemic, these organizations that are part of the LZ 200 continue to offer the home- and community-based services,” Brendan Flinn, the director of home- and community-based services at LeadingAge, told Home Health Care News. “It’s promising that there’s stability and frequency in home- and community-based services being offered.”
It makes sense, too. Even before COVID-19, non-home-based care providers were recognizing a shift into the home.
In fact, a LeadingAge report that came out before the public health crisis showed that well over 500 nursing home operators had closed since June 2015. The disruption since has been well documented and considerable, but the overall devastation is not yet totally clear.
“I think there’s definitely a lot of opportunity for home- and community-based services just based on that,” Flinn said. “I’d say there’s a continued and increased want among older adults for different options.”
LeadingAge represents more than 5,000 aging-focused organizations nationwide, including home-based care agencies.
CCaH continues to grow
CCaHs, sometimes referred to as home-based continuing care retirement communities (CCRCs), are a concept that has been gaining traction in recent years.
CCRCs are long-term care living situations that allow seniors to age in the same place during their advanced years through an all-encompassing approach. CCaHs take the same approach into the home.
In a post-COVID-19 world, the concept makes even more sense. Over 10% of nonprofit senior living providers now offer CCaH, according to the LZ 200, and that number is likely to increase moving forward.
“We’re hearing that across the board in the CCRCs and the PACE programs, [for instance],” Chris Hendrickson, managing director and a home health expert at Ziegler Healthcare Investment Banking, told HHCN in August. “Anything that involves some type of resident, these programs are contemplating and starting to actually migrate more toward in-home models.”
Dee Pekruhn, LeadingAge’s director of life plan community services and policy, has noticed the same trend.
“There has been enhanced interest among CCRCs in learning more about the CCaH model since the pandemic, and more are starting to see why diversification into this service line can really be a pipeline for their communities,” Pekruhn told HHCN.
Though the number of operators offering the model — 11% — seems low, CCaH has only gained notoriety as a concept in the last few years.
But more providers offering CCaH, coupled with COVID-19 implications, could mean significant growth for the model over the next five years or so.
“Once providers resurface from the haze and start to look at home- and community-based programs more seriously, I think we’ll see a surge in CCaH,” Pekruhn said. “That, coupled with increased consumer demand and understanding of the CCaH model, will potentially create a real uptick in patronage of the model.”
“As people realize what that can mean for their lives and their organizations, I do think it will gain in prevalence and popularity,” she added.
Adult day concerns
It’s not all rosey for home- and community-based providers, however. While adult day offerings increased this year among senior living providers, operators are generally not in a great place due to the COVID-19 crisis, Flinn said.
Many adult day centers have remained closed months after the pandemic took foot in the U.S., either on a voluntary basis or by law.
Even for the ones that have opened, they’ve done so at an extremely limited basis. A center that generally has a capacity of 50 may be operating at say, 30% to 40% capacity, with only 15 to 20 clients allowed in at a time.
“There’s implications for the folks who were receiving those services in person who may not be anymore,” Flinn said. “There’s implications for family members of folks who receive those services who lost that support or don’t have that support in the same capacity. But also, there’s harsh implications for the providers themselves.”
While most aging-focused industries have taken a hit due to COVID-19, that trouble has either subsided or been mitigated by government assistance. That’s not necessarily the case for adult day.
“Other types of organizations that have seen significant impact from COVID, like nursing homes, also have the income of being reimbursed for providing that care,” Flinn said. “When adult day facilities closed, the revenue went right out the door with them.”
Nursing homes — and even Medicare-certified home health providers — have been provided significant relief from the federal government during the public health emergency.
Adult day centers, on the other hand, have been spared very little.
“When a new relief package comes together, adult days need to be included to ensure not only that they’re able to reopen in a safe manner, but also so they are able to continue to operate as the pandemic comes to an end — and beyond that,” Flinn said.
Adult day services are a key source of support for middle- to lower-income families caring for senior loved ones.
That’s because the pricing can be more manageable. At an adult day center, one caregiver can take care of a handful of patients at a time, which is an alternative to private, one-on-one care.
“If those types of providers are not able to survive as a result of not having revenue and not receiving relief, there could be huge implications for those communities down the line,” Flinn said.
Those expansion plans are built around a substantial infusion of new capital, too. The San Francisco-based Honor announced Tuesday it has raised $140 million in Series D funding, led by Baillie Gifford, plus funds and accounts advised by T. Rowe Price Associates Inc. Rocks Springs also participated in the fundraising round, in addition to existing investors Andreessen Horowitz, Thrive Capital, Prosus Ventures and 8VC.
To date, Honor has raised $255 million since its launch in 2014.
Timing wise, the Series D news comes at a time when home-based care is more important than ever due the COVID-19 virus and all the challenges it presents in terms of facility-based care and senior isolation, co-founder and CEO Seth Sternberg told Home Health Care News.
“We’re in an environment right now where caring for the elderly in their homes is super critical,” Sternberg said. “And caring for the elderly in a completely safe way, with completely consistent protocols and completely consistent standards.”
Originally founded as an on-demand home care company, Honor has since pivoted its business strategy to one based on integrated partnerships with independently owned and operated home care agencies. Through its partnership model, Honor uses its technology infrastructure to take over billing, scheduling, staffing and other back-office functions for a negotiated share of agency revenue.
The startup currently partners with more than 40 home care agencies in six states, serving more than 1,000 total communities. Its “Care Pros” have helped provide more than 5 million hours of care to older adults and other individuals since 2014.
“We believe investing is about identifying companies that can deliver transformational growth on the back of long-term structural changes,” Baillie Gifford’s Anika Penn said in a press release. “Honor has demonstrated their ability to leverage technology to elevate and expand services to older adults who want to remain in their homes, and to improve conditions for home care aides. We are excited to partner with the team as they scale up and drive improvement throughout the ecosystem of this $30 billion industry.”
This is a developing story. Please check back shortly for updates.
Burlingame, California-based CareLinx is a tech-enabled home care platform that connects seniors and their families to its nationwide network of 400,000 caregivers. The company was acquired by Generali Global Assistance in 2017.
Under terms of the partnership, CareLinx clients with high levels of functional needs will receive free initial visits with physicians through Doctor On Demand. In part, the move is a response to the COVID-19 emergency, Robin Glass, president of Doctor On Demand, told Home Health Care News in an email.
“As we all know by now, seniors are at highest risk of contracting and dying from COVID-19, given their age and likelihood of having at least one pre-existing chronic condition,” Glass said. “We believe that by offering high-quality, personal care in their homes, where they can remain safe, we can have a profound impact on their immediate well-being and longer-term health.”
Doctor On Demand is a San Francisco-based health care platform that gives users virtual access to physicians, psychiatrists, therapists and a care coordination team. In July, the company raised a funding round of $75 million, led by private equity firm General Atlantic.
Since the start of the public health emergency, Doctor On Demand has seen a sharp increase in its business.
In March, when the COVID-19 emergency began, Doctor on Demand recorded a 154% year-over-year increase in its new member registrations among the 65-and-older age group.
“COVID showed us all — providers and patients alike — that we can put much of the front-line, day-to-day traditional brick-and-mortar primary care online,” Glass said. “We’ve already seen that once patients try virtual care, they are likely to come back time and time again – even prefer the experience to in-person care.”
While some have predicted telehealth utilization to level off, Glass said she believes that virtual care can sustain its surge if companies focus on forging relationships with patients.
CareLinx’s desire to partner with Doctor On Demand stemmed from the company’s recent move to make its services available to Medicare Part B beneficiaries, Sherwin Sheik, CEO of CareLinx, told HHCN in an email.
“[Doctor On Demand] has done an amazing job building out their capabilities to address the needs of Medicare Part B beneficiaries,” Sheik said. “A large portion of CareLinx customers have Medicare Part B, and we have seen great interest from our clients to be able to access a doctor on demand safely at home amid COVID. We are continuing to explore additional ways our partnership can better serve geriatric and high-risk patients with functional needs at home.”
As a home care operator, Sheik believes the combined efforts with a primary care organization strengthens its services.
“CareLinx’s innovative approach amplifies the effectiveness of remote telehealth clinical teams by using tech-enabled caregivers who serve as their eyes, ears and arms in the homes of patients,” he said. “This partnership of telehealth coupled with tech-enabled home care, we believe, will become the future of health care, as it safely keeps patients at home, thereby reducing the cost of care and improving outcomes.”
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U.S. Department of Health and Human Services (HHS) Secretary Alex Azar believes that COVID-19 has led to a health care revolution, one that will include a larger focus on care in the home.
Specifically, Azar thinks the increase in telehealth usage and a stronger focus on social determinants of health will be major influences in a more value-based health care system in the U.S moving forward.
“One of the instructive experiences from COVID-19 has been the vastly expanded role of telehealth,” Azar said Thursday at the Medicare Advantage Virtual Summit, hosted by the Better Medicare Alliance. “We went from about 14,000 virtual visits in Medicare fee-for-service each week before the pandemic to nearly 1.7 million virtual visits a week, at the peak. There’s no undoing this revolution.”
Although the ongoing public health emergency has increased the need for home-based care, the federal government has recognized the crucial part it plays in the health care system for years. That recognition is partly reflected by the evolution of Medicare Advantage (MA), Azar said.
“We’ve already worked over the past several years to create permanent flexibilities … in Medicare Advantage, expanding the ability for plans to pay for virtual check-ins and a wider variety of circumstances, allowing patients to receive this care from the convenience of their home rather than a doctor’s office,” the HHS secretary added.
Additionally, through the changes that have occurred to telehealth during the COVID-19 crisis, rural residents will begin experiencing easier access to care, Azar said.
Rural access to care has long been an inequity of the U.S health care system.
The COVID-19 pandemic has also exposed the disparities in care for both underprivileged and chronically ill populations. The expanded MA benefits — both the primarily health-related ones and those under the new Special Supplemental Benefits for the Chronically Ill (SSBCI) program — are a way to address those disparities moving forward, Azar believes.
“We want to support you in addressing these disparities and health challenges in a holistic way,” he said. “And that has informed our efforts to expand the array of supplemental benefits that MA plans can offer.”
Last month, the U.S. Centers for Medicare & Medicaid (CMS) released new data in a 2021 MA preview. It revealed that 738 plans are offering primarily health-related supplemental benefits in 2021, a 46% increase compared to the nearly 500 plans that did so in 2020.
It also showed that 920 plans are offering benefits under SSBCI pathway next year, a nearly 400% increase compared to the 245 plans that did so this year.
“All of you have made it a priority to address social determinants of health,” Azar said. “And that is an area of great interest for us as well. Addressing costly and debilitating chronic conditions can sometimes be impossible without addressing particular non-health needs. And MA allows you to do that in a way that focuses on value outcomes and a patient’s individual needs.”
Zeroing in on social determinants will be easier with more MA plans carrying SSBCI benefits in 2021 and beyond.
In general, the pool of MA beneficiaries is also getting larger, which will help providers reach and care for more individuals.
The actuarial firm Milliman recently examined growth in MA enrollment over recent years; the firm’s results showed an increase of 60% in MA enrollment from 2013 to 2019. Enrollment among beneficiaries in traditional Medicare only increased 5% during the same time frame.
“This independent report offers an eye-opening look at Medicare Advantage’s explosive growth,” Allyson Schwartz, the president and CEO of the Better Medicare Alliance, said in a press release. “And with dramatic growth in enrollment among dual-eligible beneficiaries, we know that supporting health coverage for our most vulnerable seniors means supporting these individuals’ choice of Medicare Advantage.”
Last November, in-home care provider DispatchHealth partnered with a payer and launched Advanced Care, its own hospital-at-home model.
The initial results of that model are in, after the provider “hospitalized” 27 patients within their own homes.
Of the patients treated at home by DispatchHealth’s team, none were readmitted to the hospital within a 30-day period, none died unexpectedly and none experienced a serious safety event. Additionally, only 7% of cases were escalated to the emergency department.
Another major result that further underscores the value of hospital-at-home models: DispatchHealth’s Advanced Care saved an average of $6,200 per individual by keeping them away from a traditional hospital setting.
“We’ve been successful in helping our patients with complex medical needs avoid unnecessary hospital admissions and post-acute facility-based care,” DispatchHealth CEO Dr. Mark Prather told Home Health Care News in an email. “These outcomes show we’re ready to continue leading the industry shift to provide more advanced clinical care in the home.”
Denver, Colorado-based DispatchHealth offers a variety of health care services in the home through its mobile, emergency medicine-trained teams. Those services, for example, include the delivery of IV fluids for seniors dealing with dehydration or intervening with cardiology-focused care when a patient is experiencing congestive heart failure exacerbations.
Once the provider’s services are requested — either via its mobile app or website — a care team arrives at the patient’s home, typically within a two-hour time frame.
The company is now in over 20 cities and continues to grow rapidly, especially as the ongoing COVID-19 crisis has kept seniors at home. Its first hospital-at-home program was focused in the Denver market, though more markets are likely on their way thanks to Advanced Care’s promising results and a recent influx of capital.
In June, DispatchHealth announced it had landed $135.8 million in growth capital led by Optum Ventures in a Series C funding round. Since it launched in 2013, DispatchHealth has raised more than $216.8 million in total.
Launching Advanced Care
For DispatchHealth, launching a hospital-at-home model was the next logical step to extending its services across the health care continuum, Dr. Patrick Kneeland, the company’s VP of medical affairs and its leader of the Advanced Care program, told HHCN.
“This is even more true with COVID, that if you give an option for safe, high-quality and reliable care in the home as a substitution for hospitalization, patients are likely to want that and like that,” Kneeland said. “And that’s certainly borne out. We similarly expect and have built a model that provides that high-quality, high-acuity care at a lesser cost than what it would be in an in-patient setting.”
The objective of the Advanced Care program is to effectively treat the more common issues among seniors that cause hospitalizations, such as COPD, pneumonia, heart failure and other, similarly severe conditions.
“In some ways it was a logical extension of the model that already existed,” Kneeland said. “And in other ways, it was a new opportunity to apply similar concepts to hospital-level care in the home.”
On average, patients within the program completed a high-acuity phase in 3.8 days and a transitional phase in 12.5 days with care from a team of nurses, advanced practice providers, therapists and physicians.
Because DispatchHealth’s background is in at-home urgent care, its referral system works seamlessly with its new model.
About two-thirds of its referrals are from within its own network, with one-third coming from primary care providers (PCPs) that are now familiar with the Advanced Care option for their patients.
And that one-third from PCPs is increasing quickly, Kneeland said.
Historically, a “predictable percentage” of patients within each of DispatchHealth’s markets would have a condition that caused an escalation that required hospitalized care. Now, the alternative is for the on-site team to report back the condition of the patient and see if they are fit for the Advanced Care model.
“At that point, we actually walk through a set of evidence-based algorithms that we’ve created and integrated into our software platform to check for clinical safety,” Kneeland said.
The Advanced Care model is built for high-acuity patients, but not for patients who will need to be transferred to the ICU, for example.
DispatchHealth also conducts an environmental risk assessment to ensure that the home is suited for a multiple-day hospital-at-home plan of care.
The data that has come back from Advanced Care in its early stages puts it ahead of a lot of similar programs, Kneeland said. For instance, 30-day readmission rates are significantly lower than what DispatchHealth has observed in those other programs.
“We were aiming to achieve outcomes like this,” Kneeland said. “At the same time, I think what we’re seeing is probably more impressive than what myself or other team members maybe would have expected in terms of those outcomes. And we do think we’ll be able to continue to achieve these outcomes as we scale.”
Outcomes lead to scale
Dispatch Health is building momentum off the data and the outcomes it has achieved in its patients.
In August, the Pacific Northwest-based health system MultiCare reported that its urgent care partnership with DispatchHealth led to a reduction of $1,509 in cost, on average, per patient.
That led to MultiCare’s interest in working on a hospital-at-home program with DispatchHealth. The company is now hoping to scale the model across more of its current markets, and new markets as well, as its footprint expands.
“There’s a lot of interest in this model, and there’s a lot of folks who are wanting to work with DispatchHealth, whether they’re payer partners or health systems,” Kneeland said. “We’re in discussions right now with a number of groups.”
In the coming weeks, it’s set to announce its most recent partnership, which should be launching next month.
Additionally, DispatchHealth hopes to launch Advanced Care in at least four new markets in 2021.
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WellSky announced Tuesday it has entered into an agreement to acquire CarePort Health from Allscripts Healthcare Solutions (Nasdaq: MDRX), a health care information technology provider. The deal is for $1.35 billion, according to Allscripts.
WellSky is an international software and professional services company with clients that include home health providers, hospital systems, blood banks, labs, hospices, government agencies and human services organizations. The company is jointly owned by private equity firms TPG Capital and Leonard Green & Partners, which teamed up with WellSky this July.
Boston-based CarePort is a care coordination software company that connects health care providers and payers, an increasingly important function as Medicare Advantage enrollment continues to soar and as the U.S. health care system steadily shifts away from fee-for-service models.
Currently, CarePort serves 1,000 hospitals and health systems, plus 110,000 post-acute provider locations.
CarePort was an attractive acquisition target for WellSky because of the natural alignment between both organizations, Bill Miller, CEO of WellSky, told Home Health Care News in an email.
“WellSky is committed to investing in care coordination and interoperability solutions, and CarePort was the obvious choice — based on its superior technology, market leadership and national presence,” Miller said. “We’ve been impressed with CarePort’s proven track record as the leading post-acute care coordination platform in the U.S.”
CarePort’s $1.35 billion price tag represents more than 13 times the company’s revenue over the past 12 months. It’s also roughly 21 times CarePort’s non-GAAP adjusted EBITDA over the trailing 12 months
As part of the deal, CarePort’s customers and more than 200 employees will join WellSky.
“This agreement is another all-around win for Allscripts, as it unlocks significant value for our shareholders, enables us to increase our focus on our core business and brings our CarePort customers the benefit of continued investment under new and very strong ownership,” Rick Poulton, Allscripts president and CFO, said in the press release announcing the news.
For WellSky, the planned purchase of CarePort allows the company to better manage the acute care discharge process, as well as keep track of patients across post-acute care settings, including home health care.
Additionally, the deal will allow home health providers to streamline their referral management and intake processes, according to Miller.
“CarePort’s EHR-agnostic platform allows home health providers to effectively coordinate patient care through real-time collaboration with hospitals, health systems, ACOs, and other post-acute providers to close gaps in care and improve patient outcomes,” he said. “This collaboration has the potential to create a meaningful, measurable difference for patients, providers and payers across even more care settings.”
Overall, CarePort represents about 6% of Allscripts consolidated revenues. Allscripts reported Q2 2020 revenues of $406 million in July.
The sale is slated to close before the end of the year, subject to clearing customary regulatory hurdles. WellSky and CarePort will continue to operate independently prior to that time.
“Joining WellSky means that we can increase vital connections between acute, post-acute and community care providers to make a meaningful difference in the lives of more patients in more places,” Dr. Lissy Hu, CEO of CarePort, said in the press release.
WellSky’s plan to acquire CarePort is closely in line with leadership remarks following the news about Leonard Green & Partners. At the time, WellSky noted the new investment would help it expand current capabilities and service offerings, particularly when it comes to analytics, telehealth and payer relationships.
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The Center for Medicare & Medicaid Innovation (CMMI) is in need of a “course correction,” top U.S. health care officials believe.
And part of that may include a national expansion of the Home Health Value-Based Purchasing Model.
Created under the Affordable Care Act, CMMI — also known as the CMS Innovation Center — supports the development and testing of innovative health care payment models. Since its formation, CMMI has developed at least 54 payment models, including the Home Health Value-Based Purchasing Model.
As U.S. health care costs continue to rise, CMMI’s work has grown increasingly important, especially around value-based care, according to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. National health care spending is expected to grow at an average annual rate of 5.4% from 2019 to 2028, outpacing the gross domestic product’s average annual growth rate of 4.3%.
But of those 54 payment models, only a handful appear to be working.
In fact, just five have shown statistically significant savings.
“In 2019 alone, over 450,000 providers participated [in those models], serving over 26 million patients,” Verma noted. “But more recently, the evaluation data for the early models have been completed. And unfortunately, the results are deeply concerning.”
Verma addressed CMMI’s progress and the future of value-based care on Tuesday during a virtual event hosted by CMS’s Health Care Payment Learning & Action Network (LAN). Verma was joined by Brad Smith, who co-founded and served as CEO of home-based palliative care provider Aspire Health before being named CMMI’s director in January.
“The Center stands in need of a course correction in model design and portfolio selection, if value-based care is to advance,” Verma said.
Providers ‘must have skin in the game’
Shifting the U.S. health care system toward value-based care is one of CMS’s many priorities, Verma remarked during the virtual event. In addition to payment, value-based care also means providing pricing transparency, strengthening interoperability and minimizing paperwork burden for providers.
When it comes to establishing more successful value-based payment models, CMMI needs to prioritize two pillars, Verma said.
First, it must step back from voluntary models “designed with an abundance of financial carrots to attract participation.”
“Models must incorporate design elements that require participants to have skin in the game,” Verma said. “Models where providers have downside risks have actually performed better.”
Secondly, CMMI needs to do a better job of developing effective, meaningful benchmarks to measure the success of value-based payment models.
Smith echoed that idea, pointing out that CMS and CMMI have been too generous or lenient in judging how new payment mechanisms are performing.
“CMMI has learned a tremendous amount over the past 10 years about value-based care arrangements, and we are grateful for the tremendous participation we have had to date in our models,” Smith said at the LAN event. “As we move into the next phase of the Innovation Center, we believe we must push even harder to move more providers into value-based care payment arrangements.”
Expanding the Value-Based Purchasing Model
While most of Tuesday’s remarks took a hard look at what CMMI has accomplished thus far, both Verma and Smith did point out several positives.
Smith, for instance, called out the Home Health Value-Based Purchasing Model as one of the Innovation Center’s most successful efforts.
Implemented in 2016, the Value-Based Purchasing Model was designed to pay home health providers in nine states based on outcomes and the value of services delivered. This year was the sixth year of CMMI testing out the model, exposing home health providers to 6% upside or downside risk based on their performance.
Home health providers in participating states have mostly supported the value-base model, with many calling for a national expansion beyond the current states of Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington.
CMMI hasn’t hinted it has any plans to do so — until now.
“As we look at our portfolio, we have other models that we believe may be able to expand in the coming years,” Smith said. “For example, our Home Health Value-Based Purchasing Model has shown significant cost savings and improvement on key quality metrics. It’s one of the examples of the models that we’re looking at to think about if we could expand it nationally in the next year or so.”
Besides the Value-Based Purchasing Model, Verma and Smith likewise pointed to the relatively new Primary Cares Initiative and the related direct-contracting model as impactful value-based care efforts.
“Last year, we announced the CMS Primary Cares Initiative, featuring the direct contracting model, which has the potential to drive quality and value across the entire system in a way that we’ve never seen before,” Verma said. “Going forward, we believe direct contracting can take an exciting new step with a geographic option, in which a set of entities would take on full risk for all eligible Medicare beneficiaries in a certain region.”
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Relationships are built over time. However, with the inability to meet face-to-face, many life sciences commercial teams are left wondering what to do next. Unfortunately, we have been truly disrupted – not only in our work environment, but in what our customers, healthcare providers (HCPs) want. A recent research report by Accenture revealed that 65% […]
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Over the years, Humana Inc. (NYSE: HUM) has dedicated itself to value-based care models as a way to drive better outcomes for its members.
Released Wednesday, its most recent annual “Value-based Care Report” again reflected more positive outcomes for the 2.41 million Medicare Advantage (MA) beneficiaries receiving care from primary care physicians in value-based payment models.
In 2019, the Louisville, Kentucky-based insurer continued to reap the rewards of its value-based focus, as it has in years past.
On average, the members in value-based care models experienced better health outcomes at a lower cost as opposed to members in fee-for-service models.
“Value-based care underscores the need to take a holistic view to help members achieve their best health,” Dr. William Shrank, Humana’s chief medical officer, said in a release announcing the findings of the 2019 report.
Humana’s individual MA members in value-based models benefited from a greater frequency of preventive care — between 8% and 19% — for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar than members in non-value-based agreements. The company’s calculations suggested that an estimated $4 billion was saved due to value-based models in 2019.
Collectively, MA members benefitting from value-based models spent 211,000 fewer days in the hospital and emergency rooms. Overall, the value-based agreements resulted in 10.3% fewer emergency room visits and 29.2% fewer hospital admissions compared to original Medicare.
“Central to this is the ability for value-based physicians to have access to a full and complete picture of patients’ health — including their clinical, behavioral and social needs,” Shrank said. “The COVID-19 pandemic further emphasizes the need to address barriers to social isolation, food insecurity and transportation among seniors. Addressing social determinants of health (SDoH) is the right thing to do.”
Between addressing SDoH, expanding its in-home care footprint and pushing its value-based care networks, Humana has been on the forefront of finding alternative ways to improve patient outcomes for years.
“Having the foundation to be able to integrate social determinants of health into the operating aspects of our business — we’ve been working on that for a decade now,” Bruce Broussard, Humana’s president and CEO, said in September during the Aging Innovation Global Healthcare Summit. “And that really proved itself out when the health care system shut down. People were isolated [inside] their homes, and there were a number of things that they needed just for basic health care.”
The moves that Humana has made toward the home include its acquisition of home health care behemoth Kindred in 2017, its SDoH-aimed partnerships with innovative auxiliary companies like Papa and SilverSneakers, and its backing of home-based acute medical care provider DispatchHealth.
Additionally, in July, Humana announced plans to invest $100 million in the at-home primary care startup Heal.
Its bullishness in home-based care, which is part of its overall value-based plan, is reflected not just in its executives’ public comments, but also its acquisitions and partnerships over the last several years.
“As seen in other industries, we believe consumers will increasingly demand health care solutions that are more convenient and personalized and [that] better meet their needs,” Susan Diamond, the segment president of Humana’s home business, told Home Health News in July. “Deeper relationships with patients are needed, including a better understanding of the home environment, to deliver comprehensive and higher quality care.”
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While payers and policymakers took a more narrow-minded perspective on innovation value in 2020, the year 2021 will bring an increased focus on a treatment’s societal value, how innovation interacts with digital technologies, and whether new innovations are able to reduce existing health outcome inequalities.
After steadily gaining steam over the last decade, in-home primary care models have reached a critical turning point in 2020.
A handful of in-home primary care businesses have received multimillion-dollar investments to expand across the U.S., for example. At the same time, the U.S. Centers for Medicare & Medicaid Services (CMS) is testing out new ways for primary care providers to treat their patients in the home setting.
Part of the Franklin, Tennessee-based GuideWell, PopHealthCare is positioning itself to capitalize on that momentum. To help scale its national network, the in-home primary care and risk-adjustment organization announced the hiring of Dr. Christopher Dodd as its new chief medical officer at the end of September.
PopHealthCare has completed over 100,000 in-home visits since launching. It currently manages the health needs of over 11,000 members with complex conditions.
In addition to PopHealthCare, the nonprofit GuideWell’s portfolio includes Florida Blue, GuideWell Connect, GuideWell Health and Diversified Service Options.
Home Health Care News recently connected with Dodd to learn more about PopHealthCare and its growth plans. Prior to his new role as CMO, Dodd served as chief clinical officer for ConcertoHealth.
Highlights from HHCN’s conversation with Dodd are below, edited for length and clarity.
HHCN: This is my first time connecting with PopHealthCare. Before we jump into things, can you please provide some brief background on your organization?
Dodd: I’ll start with GuideWell.
GuideWell is a mutual holding company that’s focused on building the future of health through innovation and collaboration. It consists of multiple companies focused on improving individual and community health. We have a laser-sharp focus on transforming the U.S. health care system, which has significant opportunities for improvement, we believe.
One of the ways that GuideWell firmly believes the system needs to be transformed has to do with the delivery of high-quality, in-home care for geriatric and vulnerable populations. With that in mind, GuideWell saw the opportunity in 2017 to acquire PopHealthCare, a private company that was leading in the delivery of in-home care for frail and vulnerable populations. On top of that, PopHealthCare also provided prospective- and retrospective-risk adjustment services for health plan partners.
GuideWell felt that PopHealthCare would be a wonderful way to transform the system by delivering better care and outcomes for populations with the most need.
PopHealthCare is under the GuideWell umbrella. But PopHealthCare also has different divisions. CareSight is the in-home primary care business, correct?
You’ve got it. There are three specific products that PopHealthCare offers to its health plan partners. CareSight is the in-home primary care line. There’s also InSight, which is how the company was initially founded. In 2005, the original physician founder saw an opportunity to develop a service that helped better understand the barriers that people were facing in living their healthiest lives possible. InSight is a sort of an in-home assessment program, which continues to this day. The goal is to provide a better lens to see the needs of individual patients.
As we identify patients who have significant care needs, that CareSight program is able to intervene and be the effector arm to help move patients from crisis to stability, in turn improving their health.
Then there’s RiskSight, which brings retrospective risk into full focus to maximize risk-score accuracy.
You were named CMO of PopHealthCare at the end of September. What were you doing before that? And congratulations, by the way!
I appreciate it. So, I’m a trained internist. I also have a background in public health. Overall, my training is really in figuring out, “How do you deliver care to vulnerable populations?” We can be talking about the geriatric population, particularly seniors who have multiple chronic conditions. But we could also be talking about frail and vulnerable non-senior populations. For example, a single mother who is living with diabetes and bipolar disorder, somebody who is at risk of losing her job from repeated hospitalizations.
My training in global health and social medicine has allowed me to closely study health care models for vulnerable populations, both in the United States and around the world. I’ve worked in Mozambique and Nicaragua, for instance, in addition to our underserved communities across the U.S. But regardless of the geographic location, I’ve come to realize the home is really the best place to deliver care.
Why is that the case? At what point did that light bulb go off?
I guess it was in the early 2000s, as I was training in what I refer to as social medicine. I had the opportunity not just to study chronic medical conditions like diabetes, heart failure and emphysema. I had unique training in the sense that I had to understand why people got sick. That was illuminating. Now, everyone’s starting to realize in greater frequency that we need to hone in on social determinants of health. It’s the social barriers and behavioral health conditions that really stand in people’s way of living their healthiest lives possible. If you don’t have the ability to understand a person’s environment, their social selves, then you’ll likely have a very difficult time collaborating with them to develop a treatment plan that addresses, in a comprehensive way, all of the barriers that they’re facing to be healthy.
When PopHealthCare named you as its new CMO, it noted that you’ll be in charge of scaling its existing network. What’s that network look like today?
That’s definitely one of the opportunities that I’m excited about. At present, PopHealthCare operates in 17 states and has relationships with 26 health plans. Those health plan partners range from local, to regional, to national health plans. One of our primary, short-term objectives is to reinforce those relationships and grow them. Why? So we’re able to care for more seniors and more vulnerable populations in our markets. But then we also want to grow that footprint and care for even more individuals moving forward.
HHCN just hosted FUTURE. During that event, Humana’s home segment president explained how she sees in-home primary care as a key part of a “home-centric ecosystem of care delivery assets.” Do other health plans share that view?
I do think there’s a growing appreciation for in-home primary care. But is home-based primary care right for everyone? Is it the best option for you or me, relatively healthy and young individuals? Not really. Maybe we’d like home-based primary care for convenience, sure. I think we need to get more focused about what the problem statement is in the U.S. health care delivery system. Obviously, it’s complex. But what we know is that 15% to 20% of patients consume 80% of the costs.
What we want to shout out loud here is that for this portion of the population, individuals who are seniors, frail or otherwise vulnerable, they need a different approach to health care delivery. The current approach of clinic-based, facility-based care just doesn’t work. By shifting to a home-based delivery model for primary care — and for what I’d refer to as complex care for frail and vulnerable populations — you’re going to deliver better care and get better outcomes. By doing so, the system wins in terms of lower total costs of care.
A couple of other points that I would add: When you look at all of health care spending, it’s something like 4% or 5% of all dollars go to primary care. For me — and I’m biased, of course, because I’m a primary care doctor — that is fundamentally wrong. There’s not enough resources and focus going into primary care. But with the increasing emphasis and acceleration of value-based care, of getting paid up front and determining how you want to spend the money to get the best health outcomes, primary care has this renewed sense of power that it has lost over the last several decades. That’s the opportunity that PopHealthCare and our health plan partners are seizing. They’re saying, “If we can get the right economic model to support this care delivery model, everybody’s going to win.”
We’ve been talking about in-home primary care generally, but what about at this particular point in time?
First and foremost, in-home primary care is important to keep the senior and at-risk population healthy. We know that the coronavirus is much more likely to create bad outcomes for people over the age of 55, and for people who have complex health and social needs. It’s a terrible thing that’s happening, but it’s been a wonderful opportunity for people like myself and for companies like PopHealthCare. By wonderful, I mean we finally get a chance to have our care model validated. It’s a chance to generate more awareness of how important it is when it comes to keeping people safe and promoting better health outcomes.
Does PopHealthCare currently work with any home health or home care agencies out there?
Everybody clearly understands the immense value that home health agencies bring to the table. At this time, we’ve decided to very much stay in our swim lane of home-based primary and complex care for geriatric and vulnerable populations. But as we’re doing that, we’re spending a lot of time developing relationships and partnerships with home health agencies, durable medical equipment (DME) suppliers, home infusion companies and others. We’re identifying those who do their work the best, making sure we have a “bat phone” to the right people.
Does PopHealthCare plan on working in any of the newer primary care models coming out of the CMS Innovation Center?
There’s a lot of excitement around what I think you’re referring to — CMS’s direct contracting models, with Primary Cares First being one of them. They’re super exciting. There’s a lot of potential there. PopHealthCare is taking a close look at those types of models. At some point soon, I think we’ll make a decision whether we want to to jump right in. But at present, we’re still evaluating.
What’s the most challenging aspect of the in-home primary care model? Is it the payment methodology? Is it the actual delivery of care and getting enough physicians who want to work in the home?
It all starts with who’s on your team. Talent acquisition is critical. While there’s a ton of great health care professionals out there, it’s not easy to find health care professionals who both have the expertise to treat heart failure and keep an eye on the social factors that play into it. You need a social-medicine orientation that allows you to look at the whole person and understand the medical needs along with the behavioral health needs, the mental health needs. You have to understand substance-use disorders and all of those social barriers to health. You have to be able to understand how to put together a treatment plan that takes into account all of these things so you can deliver the right care, at the right place, at the right time, with the right care team. So, talent acquisition is a big challenge.
The economics are critical, too. It’s expensive to deliver this type of care. Operating in a traditional fee-for-service model doesn’t work. You’ve got to get a fee structure up front to be able to fund the business. Then if you do a great job, you can have some sort of gain-share opportunity where — if you keep people healthy, home and out of the hospital, and you reduce the total cost of care — you are able to share in any savings with the health plan.
I think the other thing that’s important in terms of economics is volume. The more volume and the more patients you have in a given geography, the easier it is to deliver care.
What plans does PopHealthCare have for the year ahead? What are your goals as CMO?
Well, let me let me say a couple of things about why I’m so excited to join the team. One of the differentiators for PopHealthCare compared to some of the other companies out there in the market is we have a philosophy that says, “No matter what your age is, you can have complex health and social needs.” So, we’ve developed a care model that is able to provide care for frail elderly patients just as well as it’s able to for people who are in their 30s or 40s, who are living with a mental health condition and a chronic medical condition like kidney disease. I think what’s even more exciting is that we’ve been able to implement our care model across different geographies with different populations and demonstrate really great ROI for our health plan partners — reduced hospitalizations and emergency department visits.
In terms of moving forward, I think that the company is going to keep making the investments that are necessary to continue to be a leader in the delivery of care for complex populations. That means having the right tech and systems in place. That means increasing our telehealth and remote patient monitoring capabilities, so that we’re able to have access to important data points in a more timely fashion.
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There has been no such thing as conventional wisdom during the COVID-19 crisis. Theories on best practices and safety measures have evolved endlessly since March.
For Louisville, Kentucky-based BrightSpring Health Services, a company that has been transparent about its road bumps and triumphs on its COVID-19 journey, one of its key takeaways has been how important access to patients is.
Early on in the COVID-19 pandemic, for example, the concept of social distancing may have gone too far. As seniors were blocked from contact with home health aides, caregivers and health workers outside of institutional settings — either due to their choice or someone else’s — their collective health took a toll.
“I think the whole situation was just an incredible reminder and reinforcement for how critical it is to be able to get to people,” Jon Rousseau, the president and CEO of BrightSpring, said last month at the Home Health Care News FUTURE conference. “And that connectivity — [or lack thereof] — was really spotlighted at a time like this.”
BrightSpring Health Services — formerly known as ResCare — is a provider of comprehensive home- and community-based health services. It provides a wide range of services across a variety of settings, caring for tens of thousands of individuals in 49 states. Among its offerings, the company provides home health, hospice, behavioral health, non-medical home care, pharmacy services and more.
In the first quarter of 2019, global investment firm KKR — an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: WBA) — acquired BrightSpring for $1.32 billion. As part of the deal, BrightSpring also merged with PharMerica Corporation.
“There are millions of people out there, whether they have behavioral conditions or whether they’re seniors, whose lifeline, day to day, is [our] people coming into their home.” Rousseau said.
BrightSpring also provides its services to patients in skilled nursing facilities (SNFs), senior living communities and hospitals.
When BrightSpring was increasingly cut off from its clients, the company’s hospitalization rates ticked up, Rousseau said. A lack of access makes those kinds of unfortunate trends a near certainty when a company is dealing with complex senior populations.
The lack of access needed to be mitigated, so BrightSpring took action to try to get to its patients in the safest manner possible to keep them healthy.
Considering how large the provider’s footprint is, it had to adjust to different requirements from its hospital, senior living, and SNF partners across the country.
“It really varied by geography and what kind of entity the [partner] was. Whether it was skilled nursing facilities or senior living facilities, they had very specific requirements and needs for you to enter their buildings,” Rousseau said. “And you had to comply with that, and you had to go out of your way to make them comfortable to help them be successful.”
On its end, BrightSpring has been open about its COVID-19 plans before many companies had even finalized theirs.
In the spring, the company published a detailed account of its COVID-19 strategy and mitigation approach in the academic journal Home Health Care Management & Practice. It focused on BrightSpring’s own battle dealing with 67 COVID-19-positive patients in the first 100 days of the pandemic in the U.S.
The company asked strategic questions to its partners on what it could do to help: What were their specific needs? How could BrightSpring help manage some of its most current, pressing challenges? What could BrightSpring do to keep its partners confident in its own abilities to keep patients safe?
“These are times where we try to go above and beyond as a partner,” Rousseau said. “In times like this, there are opportunities to try to shine for your partners. That’s a sector of the health care value chain that we’ve tried to be very focused on. Even as our whole company shifts much more to the home, there’s always going to be a critically important role for skilled nursing facilities and in other institutional settings.”
Increasing access also meant bolstering its telehealth capabilities to find any way to reach its patients, whether it was through a more sophisticated platform or simply through FaceTime on an iPhone or an iPad.
BrightSpring is hoping to get more help from the Centers for Medicare & Medicaid Services (CMS) as it relates to remote care moving forward. It also hopes that the government will respond to home-based care advocates’ pleas to shine a greater light on the need for these home-based services right now, especially given the staffing issues facing the industry at large.
“It’s a good time to advocate for the incredible value that our services provide and the wonderful work that our caregivers do to make sure that reimbursement rates are fair, and they continue to increase with cost of living,” Rousseau said.
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Signify Health, a tech-enabled provider of at-home care solutions, has teamed up with health insurer Independence Blue Cross to launch CommunityLink.
CommunityLink is a network of community-based organizations that aim to help improve the social determinants of health (SDoH) in Independence’s Philadelphia member population.
The goal of the partnership with Signify: to address the “traditional barriers between social and clinical care” and improve health outcomes by assisting with non-medical services, such as nutrition, transportation, financial support and house work, among other areas.
The partnership connects Independence’s registered nurse health coaches, Signify’s social care coordinators and local community-based organizations to coordinate care on behalf of Independence’s Medicare Advantage (MA) members.
“What’s happening is our physicians and nurse practitioners are going into the homes of Independence’s Medicare Advantage members and observing issues that members may have outside of the traditional health system,” Nathan Goldstein, Signify’s chief strategy officer, told Home Health Care News. “So when they experience food insecurity, loneliness, lack of access to transportation — things of that nature — they’re now able to trigger referrals directly into this network of community-based organizations.”
Signify Health is a value-based care company that focuses on bringing services to the home and to the community. It is one of the largest providers of house calls in the country, conducting over 1 million in-person house calls and 300,000 telehealth encounters per year through a network of physicians and nurse practitioners.
The company is also the largest convener of the U.S. Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement (BPCI) post-acute care program.
Thus far, the CommunityLink network includes these diverse, community-based organizations: Project HOME, Metropolitan Area Neighborhood Nutrition Alliance (MANNA), Penn Asian Senior Services (PASSi), Philadelphia Food Trust, Legal Clinic for the Disabled, Well Spouse and Greater Philadelphia YMCA.
The goal is to get more community-based organizations signed on in the coming months.
Just as seniors have comorbidities from a strictly health perspective, they also have “social comorbidities,” Goldstein said.
For instance, a senior may be missing primary care appointments, but instead of the reason being tied to transportation, it has to do with the fear of leaving his or her partner with dementia at home alone.
“Because at-risk patients have clinical comorbidities and social comorbidities that exacerbate them, we need to bring the same effort to coordinate the social care that we do with the clinical care,” Goldstein said.
Home health and home care organizations have not yet become a part of CommunityLink, but they could have a role in the future. Independence and Signify hope to expand the network quickly, both by adding organizations and stretching its footprint geographically.
“We’re going to expand as quickly as we can,” Daphne Klausner, Independence’s SVP of senior markets, told HHCN. “I think we need to include as many community organizations as possible. But it’s not only about expanding to community organizations, it’s also hospital systems and other types of providers, including [home-based care] agencies.”
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. It is one of the major health insurance organizations in southeastern Pennsylvania, with about 8 million members nationwide.
The CommunityLink network is based on a holistic approach, combining in-home care with a better way of managing collective health in the community. Each organization can trigger a referral for another one that a patient may need.
For example, say a community-based food organization is referred based on a patient’s inability to obtain fresh and readily available food. Then, when it begins to provide services, it realizes the patient also has transportation struggles. That organization can, in turn, refer within the network to help the patient out with transportation as well.
Beginning in 2021, clinicians and other health care providers will also be able to refer patients to the CommunityLink network.
Home- and community-based care is being leveraged by Independence and Signify, which is already a home-based care company itself. But the program is largely built on the concept that organizations that have helped their local communities for years can come together to collectively lift the population to better health.
CommunityLink is a first-of-its-kind concept, according to Independence and Signify.
“This program came out of our experience from over a decade of doing these home visits and realizing that we were seeing things in the home that were not known to the traditional health system, and that the traditional health system was not particularly well organized to address,” Goldstein said. “But there were organizations in these communities, some with a century of experience in addressing these issues, and we wanted to find a way to connect those to the traditional health system.”
While CommunityLink is new, Independence and Signify have worked together in the past. They began plotting CommunityLink pre-COVID-19.
Its purpose will be particularly useful during and after the ongoing public health crisis, however.
Addressing SDoH has been a trend within health care over the last few years, with home-based care agencies often being called upon to help address them.
Since 2018, CMS has carved out ways for MA plans to address SDoH factors, more specifically with the concept of the broader “Special Supplemental Benefits for the Chronically Ill” (SSBCI) pathway created in 2019. More than 900 plans will be including SSBCIs in their coverage in 2021, a vast increase compared to the 245 plans to do so this year.
Similar to CommunityLink, SSBCIs aim to help with transportation, nutrition assistance and other around-the-house activities.
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Medicare Advantage plan Aetna and primary care provider WellBe Senior Medical are teaming up in the Chicagoland area to serve about 2,000 patients in their homes. The partnership further highlights the growing momentum behind in-home primary care models, which often enlist the services of home health and home care providers to care for vulnerable populations.
Aetna and WellBe had already launched a partnership in July in Atlanta, where they are serving about 5,000 patients in the home.
Chicago-based WellBe Senior Medical has a vision of bringing the culture of “house calls” back onto the forefront of care. Broadly, its latest in-home primary care initiative is something that benefits all three parties: WellBe, Aetna and the patient, according to company leaders.
“Our goal is to help people age in their homes with dignity and respect. … Our model goes all the way from prevention to end of life,” Jeff Kang, the CEO of WellBe Senior Medical, told Home Health Care News. “In many ways, it’s a return to what I think is the essence of medicine.”
WellBe’s model is built to care for patients throughout their aging journey — whether that be through chronic disease care, acute care, palliative care or end-of-life care.
WellBe’s in-home care model can do about 90% of what a doctor can do at a traditional office in the home, Kang said.
An interdisciplinary team approach dictates the workflow of the licensed clinicians on WellBe Senior Medical’s staff. It is formed by physicians, nurse practitioners, social workers, paramedics and other health care professionals.
On its end, Aetna is a managed health care company that sells traditional and consumer directed health care insurance. It includes medical, pharmaceutical, dental, behavioral health, disability and long-term care plans, and it works primarily through employer-paid insurance, benefit programs and Medicare.
It has been a subsidiary of CVS Health since late 2018, another company that has shown it’s on board with moving care to the home.
In order to ease the burden of COVID-19 on hospitals, for example, CVS Health’s Coram enhanced its capabilities to treat more infusion patients in home-based settings during the early months of the outbreak in the U.S.
“Aetna is proud to collaborate with WellBe Senior Medical to deliver care to patients in the most convenient way possible,” Gregg Kimmer, Aetna’s chief Medicare officer for the Great Lakes market, said in a press release. “By seeing patients in the comfort of their own home, we can improve their health care experience.”
The house call concept seems simple and efficient enough, but it’s the efficiency that has actually plagued the model for years, at least under the traditional Medicare fee-for-service framework.
Where a house call company can see four to eight patients per day, office-based doctors can see over 20 because patients are coming to them. Even if in-home primary care has always been a better option for certain populations, it didn’t fit within a quantity-driven reimbursement model.
That’s why Aetna’s Medicare Advantage capabilities makes the partnership work, Kang said.
“Aetna is a Medicare Advantage plan. And in this model, if we can help them improve the outcomes and lower costs, we have a reimbursement mechanism where they’ll pay us to do that,” Kang said. “We actually make more money if we keep people healthy and out of the hospital, so it’s completely flipped from fee-for-service.”
In a fee-for-service arrangement, the lower volume of visits would hinder WellBe Senior Medical’s ability to stay afloat financially. The partnership with Aetna, however, incentivizes better care.
It’s also an especially useful partnership during COVID-19, when the most at-risk patients on a health plan need care most, but are also unable to get to — or are refusing — primary care more than ever.
“There has been a lot of interest in the health plan community around models like these,” Kang said. “I would say Aetna had the foresight to do something about it earlier rather than [later] — other plans are kind of a little slower to get there. … Interest in these models has been dramatically accelerated now because of COVID-19.”
WellBe will also work with home care and home health providers for physical therapy and skilled nursing needs. It also teams up with them for help with activities of daily living (ADLs).
“Right now, those home health agencies are calling the doctor in the office for orders,” Kang said. “Now, there is really a doctor in the home that they can work with to get orders done. And I think it’s an opportunity for better coordination and integration with a home-based medical group, rather than an office.
VillageMD, which just received a $1 billion investment from Walgreens Boots Alliance (Nasdaq: WBA), is another primary care provider moving further into the home that recently made headlines.
The primary care provider will be heavily relying on home care and home health providers as they do so, VillageMD CMO and co-founder Dr. Clive Fields recently told HHCN.
WellBe Senior Medical is hoping to continue to grow itself. It just signed on with another Medicare Advantage plan out of Chicago — MoreCare — which is based out of Cook County, Illinois.
Although Kang couldn’t unveil specifics yet, WellBe is on its way to a few more partnerships in Chicago and elsewhere, too.
“The system is set up with the convenience of the doctor,” Kang said. “It needs to be set up for what’s right for the patient.”
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For years, diversion between home health providers and skilled nursing facilities (SNFs) has been a big part of the industry narrative.
On their end, home health providers have reworked their operations to handle more acute patients and individuals traditionally served in SNFs. Now, home-based care providers are being even more intentional in their efforts by leaning into the SNF-at-home model.
While the idea of SNF-at-home has been gaining plenty of buzz as of late, the concept isn’t a new one, according to Leslie Palmer, administrator and clinical director at Josephine at Home.
“[In-home care providers] have known that keeping people at home typically results in better clinical outcomes,” Palmer told Home Health Care News. “It’s less expensive. And it keeps people out of the hospital. I think what’s different now is we have the opportunity to enhance that concept. Now, we’ve named it ‘SNF-at-home,’ and we’ve formalized operational aspects.”
Josephine at Home is a branch of Stanwood, Washington-based Josephine Caring Community, a cross-continuum organization that offers transitional rehabilitation, assisted living and other long-term care services, plus early learning and child care.
The nonprofit organization’s Josephine at Home business line currently offers home care services, though it’s in the process of expanding into home health care.
Additionally, Josephine at Home has upcoming plans to roll out an SNF-at-home services line.
Currently, roughly 25% of short-stay SNF episodes can be cared for in the home setting, creating an opportunity for in-home providers, according to statistics from Lincoln Healthcare Leadership.
Complex wound care and intensive therapy patients are examples of cases that can be treated within the SNF-at-home model, according to Jenn Ofelt, COO of UnityPoint at Home.
“Both of those are examples of patients that may have traditionally gone to an SNF because of an IV antibiotic or the need for daily therapy,” Ofelt told HHCN. “Both of those can easily be provided in the home if the additional layer of support that was needed by a 24-hour setting can be provided by a caregiver.”
UnityPoint at Home, a division of West Des Moines, Iowa-based health system UnityPoint, is a company that offers a range of home-based care services.
Similar to Josephine at Home, UnityPoint at Home is in the process of developing a SNF-at-home service line — and those two aren’t alone. LHC Group Inc. (Nasdaq: LHCG) and Johns Hopkins Home Care Group reportedly have SNF-at-home models in the works as well.
The fact that more and more in-home care providers are developing SNF-at-home service lines should come as no surprise. In general, more seniors and their families are looking for higher acuity care in the home setting, according to Dr. Cleamon Moorer Jr., president and CEO of American Advantage Home Care Inc.
“Families are looking for assistance with going through the logistics of, ‘How do I get a ramp installed? How do I go about getting a ventilator from a [durable medical equipment] company?’” Moorer told HHCN. “We’re finding that whole ecosystem of … [creating] a high-acuity nursing experience in a loved one’s home seems to be a gap that we’re able to step in and start filling.”
Dearborn, Michigan-based American Advantage Home Care Inc. is a provider of home health care, medical social work and other services.
The first steps
For home health providers looking to get a new SNF-at-home product line up and running, having a strong basis in home care — either organically or through partnerships — will be crucial.
“If you’re an expert in home health but not home care, then maybe look at partnering with an existing home care agency,” Palmer said. “It’s the same thing with home care — either look into forming a partnership with a home health provider or having someone who’s an expert help launch your own home health service lines.”
Having a home care component is especially important because in order to implement a successful SNF-at-home program, providers will need to replicate the 24-hour care component of traditional facilities.
Other potential partnerships aspiring SNF-at-home operators should strive for are ones with home medical equipment providers and infusion pharmacies.
“A SNF-at-home patient likely needs to be admitted the same day they leave the hospital,” Ofelt said. “Some of the elements of their plan of care include home medical equipment, such as assisted devices, a hospital bed, oxygen and IV infusion therapy needs. That infusion therapy pump and drugs all need to be delivered the same day. Having these partnerships in place will allow you to meet the clinical needs, immediately upon discharge from the hospital.”
On the staffing side, having a strong team of physical therapists, occupational therapists and speech-language pathologists is also key.
“You need to be able to staff these positions at a SNF-type level,” Ofelt said. “Prior to last October, patients went to SNFs and needed to receive a very high level of therapy to qualify for that day and for those SNFs to bill at their highest therapy rate. That needs to translate into the home. You need to be able to provide that level of therapy service.”
Providers that are looking to thrive within this space need to make sure that, on the clinical side, nursing competency is functioning at an acute level, according to Palmer.
One potential barrier for providers looking to implement this service line is that SNF-at-home doesn’t have a clear reimbursement model.
“Of course home health is reimbursed, and there’s chatter that Congress is talking about reimbursing some home care, but not the SNF-at-home program,” Palmer said. “As leaders in health care, we’re just going to proceed forward regardless of what the reimbursement looks like. We can maybe patch some of the reimbursement together.”
Broadly, SNF-at-home will need a reimbursement model that addresses the combination of care patients need.
“Traditional home health care payment will not be sufficient given these individuals will require a mix of both skilled home health care services and also home care assistance with activities of daily living,” David Grabowski, a professor in the department of health care policy at Harvard Medical School, told HHCN in an email. “The model will have to recognize these enhanced service needs.”
Looking ahead, Grabowski believes that the unified site-neutral payment model that the Medicare Payment Advisory Commission (MedPAC) has been working on might be the right catalyst for the SNF-at-home model.
“Rather than focusing on payment by setting, the unified payment model focuses on payment by condition,” he said. “For example, an individual recovering from a hospitalization for a stroke would be associated with the same reimbursement regardless of where they were discharged. Site-neutral payment would allow the care of patients in the home who previously would have been discharged to a SNF.”
The post The Secret to Setting Up Shop in the SNF-at-Home Space appeared first on Home Health Care News.
In 2018, home-based care provider DispatchHealth was enlisted by the health system MultiCare to reduce the overall cost of care in its network. The move immediately paid dividends.
In the first full calendar year of collaboration, DispatchHealth was able to work with Tacoma, Washington-based MultiCare to divert 65% of patients away from the ER, according to the company.
The partnership also yielded an average of $1,509 in savings per patient. Part of those savings were tied to DispatchHealth helping to screen for social determinants of health, something it did for 2,000 patients.
Denver-based DispatchHealth works with payers, providers, health systems and others to deliver care in the home, deploying medical teams that are available seven days per week via a phone call or request via mobile app. Most patients with insurance pay anywhere from $5 to $50 for its services.
“Every local market’s health care is a little bit different,” Kevin Riddleberger, DispatchHealth’s co-founder and chief strategy officer, told Home Health Care News. “Whether you look at the savings that we’re able to generate, the net promoter scores or the clinical outcomes — it’s always satisfying to be able to see that we’re truly making a dent on the quadruple aim in each market.”
To advance its mission of diverting all sorts of care into the home, DispatchHealth secured $135.8 million in growth capital earlier this year — with Optum Ventures leading the Series C round. Since it launched in 2013, the company has raised over $215 million in funding.
It now serves 20 markets across the U.S. and plans to be in 26 by the end of this year. It will see about 165,000 patients in 2020 and has saved over $250 million in medical costs, according to Riddleberger.
On its end, MultiCare was founded in the late 1800s. Today, the not-for-profit health system remains deeply embedded in its Pacific Northwest communities. As part of its network, it has 18,000 team members and 10 hospitals.
“The primary goal early on was to decrease the overall cost of care, because we knew that we were going into a population health environment,” Christi McCarren, the senior VP of retail health and community-based care at MultiCare, told HHCN. “And we had to find alternative ways to care for people in the community and keep them out of the hospitals. That’s what started it, … and it’s become very successful.”
DispatchHealth’s intake algorithms are a great aid to putting people on the “right side of care,” McCarren said. Because of its reliability, there haven’t been any negative outcomes from people not going to the hospital when they otherwise should have.
Normal examples of DispatchHealth’s services include teams delivering IV fluids for seniors dealing with dehydration or delivering cardiology-focused care when somebody is experiencing congestive heart failure exacerbations. A team usually arrives within two hours, according to the company.
But now that it has made its impression on MultiCare, the two health care organizations have higher aspirations for the future.
Initially, there’s the launching of “Clinic Without Walls” — a program that relies on advanced technology to provide “enhanced” virtual visits to at-risk patients living in facility-based settings.
But there’s also bigger fish to fry later on: DispatchHealth first launched its hospital-at-home program in December for Denver-based patients. MultiCare now wants to put a similar model to use in the Pacific Northwest, and the two are going in on a joint venture together.
“That’s the biggest thing I’m doing with them is a joint venture around hospital-at-home,” McCarren said. “We want to treat these patients at home in a safe environment.”
In the beginning, only a finite group of diagnoses will be treated in the model. Additionally, patients will still have to meet the criteria for hospitalization, McCarren said.
The ultimate goal of the model is to treat the most common issues facing the senior population when it comes to hospitalizations, such as heart failure, COPD and pneumonia, among a slew of other conditions.
“A 75-year-old with pneumonia, for instance, we’re able to now put oxygen right away onto that patient and admit them to our hospital-at-home service to provide ongoing treatment for them when they otherwise would have been transferred to the hospital,” Riddleberger said. “We can now keep that patient inside their home.”
DispatchHealth also provides up to 30 days of management after a hospital-at-home admission is through, Riddleberger said.
Usefulness during COVID
The partnership came at the right time. DispatchHealth has done a lot of work, in a variety of areas, for MultiCare during the COVID-19 crisis.
“They’ve helped us in so many ways,” McCarren said.
DispatchHealth has tested close to 6,000 patients in Washington, provided follow up and supportive care for COVID-19 patients and checked on and treated high-risk patients in the home.
The partnership also does not exclusively deal with seniors.
“This is a huge differentiator, to be able to say that you can treat people in their homes, and that it’s not just restricted to the senior population,” McCarren said. “For instance, moms with kids at home that don’t want to drag them to the ER when one has an ear infection, … you can imagine how useful having somebody just come to your home in that scenario is.”
The help that DispatchHealth has provided during the public health emergency will go a long way in proving the worth of the company moving forward, Riddleberger believes.
“The COVID-19 crisis, it has only put a rubber stamp on the value of delivering that care to patients — inside their home — in a safe [manner],” he said.
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The COVID-19 crisis has raised a complicated question for home-based care executives as they plan for the year ahead: Is the cost of having a brick-and-mortar office location still worth it?
Traditionally, home health and home care operators have maintained a corporate headquarters or local office as a place where administrative staff can come into work on a daily basis and where caregivers in the field can occasionally mingle with peers.
But as the cost of COVID-19 mounts, many agencies are beginning to weigh the possibility of going fully remote, as leasing real estate often comes with a steep price tag. For some, though, the thought of going completely remote feels like a logistical nightmare.
While Addus HomeCare Corporation (Nasdaq: ADUS) still wants to get its employees back together in its 185 locations, leadership acknowledged during the company’s recent second-quarter earnings call that the switch to a near-100% remote workplace was done with relative ease.
“There’s been some benefits that we’ve all obviously learned from being remote that maybe we can take into the future,” Dirk Allison, president and CEO of the Frisco, Texas-based home health, hospice and personal care services provider, said.
Specifically, Allison mentioned cutting down on travel time as a perk of going fully remote.
For agencies with less financial flexibility, getting rid of the brick-and-mortar office seems like an efficient way to reduce costs.
In the Washington, D.C., area, for example, office space costs $595 per square foot, on average, according to Statista. In Pittsburgh, it costs $140 per square foot, on average.
The telehealth boom has already forced on-the-ground workers to deliver care differently. It’s doubtful that trend is going away, Mark Kulik, managing director of M&A advisory firm The Braff Group, told Home Health Care News.
“The situation has forced people to have more open minds about how to do business and how to provide care,” Kulik said. “From an expense perspective, economically, it makes all the sense in the world to not have offices dotting the landscape.”
Apart from having a central hub for workers, the conventional wisdom in home-based care was that agencies needed to have local visibility and be on as many corners in a given area as possible. The goal: to win referrals and build relationships within the community.
Remote work and COVID-19 have changed that.
To some extent, that evolution was already taking place beforehand, Kulik said.
Generally speaking, having a physical office means keeping it secure and stocked with supplies. Accomplishing that could mean hiring additional employees, something that’s not always easy to do in a normally tight labor market.
“Everywhere you have an office, you have to have someone there responsible for the office and staff, and it’s [generally] hard to find staff,” Kulik said. “Beyond just the economics of the facility and related expenses — copy machines, phone systems, utility bills and other repair costs — it’s also the challenge of finding that quality staff. And maybe that allows you to have [fewer] open positions because you’ve been able to consolidate your operations.”
By the numbers: working remotely
Market research and education firm Home Care Pulse analyzed remote-work trends in its 2020 Home Care Benchmarking Study, released in June.
In response to the public health emergency, about 67% of home care agencies that participated in the study said they shifted sales and marketing functions to remote status. Another 72% and 51% said they shifted team meetings and payroll to remote status.
Many agencies similarly shifted office-based tasks like caregiver interviews, caregiver training and scheduling to remote status, the Benchmarking Study found.
Less than 10% of the agencies that participated in the study said they had staff working remotely prior to the COVID-19 virus.
Now, more than half said they’ll likely continue working remotely even after the virus goes away.
A smaller footprint
If home-based care operators believe they should keep brick-and-mortar offices, they’ll have to make a compelling case as to why.
That’ll be difficult to do if months of remote work went relatively smoothly.
“I think what we’ll find is that the more progressive companies and agencies will begin to adopt a smaller footprint,” Kulik said. “Especially if the lease is coming up, it will really put the issue front and center: Do we renew our lease for next three or five years or do we just go ahead [remotely]?”
The only problem is that each state’s licensing requirements are different.
For example, in Pennsylvania, a home health agency has to have an office within one hour or 60 miles of the patient’s home. Agencies looking to downsize in states such as those will obviously have less flexibility.
In some states, home care companies are bound by the same restrictions.
In a state like Michigan, however, there are no such rules — at least for home health agencies.
“Technically, you’re able to provide care for the entire state via one office,” Kulik said.
Office perks and remote drawbacks
For all of the cost savings that remote work has to offer, there are plenty of home-based care executives who still believe in the power of the office.
“I think that a brick-and-mortar office is very important,” David Savitsky, the CEO of CareBuilders at Home, told HHCN. “[For one thing], recruiting is a constant thing — we’re always recruiting and always talking to people who want to work in the home care business. And I don’t think there’s really any substitute for having someone sitting down across the desk from you and having a conversation with them.”
CareBuilders at Home — the home division of ATC Healthcare — is a national network of private-duty home care agencies. It’s currently targeting a growth plan that would bring the brand into Michigan, Illinois, Texas, Pennsylvania and New Jersey, along with parts of California.
Savitsky plans to open up new offices in the locations CareBuilders at Home is expanding into.
“When it comes to caregiver interviews, you’re sitting across the desk from someone who wants to be a caregiver, and you get a sense of whether or not they are a caring person,” Savitsky said. “Are they that person who is going to make a good impression on a client? That’s so important because it’s not just a matter of capability when it comes to home care.”
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As COVID-19 cases rise across some parts of the country, a Southwest company’s innovative care model is garnering its own attention.
Phoenix-based Sun Health At Home has reached 100 members in its home-based continuing care retirement communities (CCRCs), a unique aging-in-place concept that has been gaining traction in recent years. The CCRC-at-home model now seems to make even more sense for seniors in a post-COVID-19 world.
CCRCs, sometimes known as life plan communities, are long-term care living situations that allow seniors to age in the same place during their advanced years through an all-encompassing approach.
The communities offer a wide range of care and assistance to adjust to a senior’s needs as their health condition changes. There are close to 2,000 of these communities in the U.S., with typical monthly fees ranging anywhere from $2,000 to $6,000, depending on various factors, according to AARP statistics.
Sun Health At Home — a part of the larger senior living provider Sun Health Communities — and other CCRC-at-home models apply the same concept of allowing members to comfortably age in place. The difference: Instead of a senior living community, CCRC-at-home models are built within a member’s own residence.
That’s become an emerging trend, especially since the onset of the COVID-19 crisis.
“We’re hearing that across the board in the CCRCs and the PACE programs, [for instance],” Chris Hendrickson, managing director and a home health expert at Ziegler Healthcare Investment Banking, told Home Health Care News. “Anything that involves some type of resident, these programs are contemplating and starting to actually migrate more toward in- home models.”
Chicago-based Ziegler is a privately held investment bank, capital markets and proprietary investments firm. Among its focus areas, Ziegler deals with home health care, senior living and larger health systems, as well as other health care organizations.
After launching in 2016 as the first CCRC-at-home model in the Southwest, Sun Health At Home has been growing rapidly — attracting 28 new members per year, on average.
As of July 1, it had already had 19 new applicants in 2020, outpacing its usual member interest significantly. The great majority of those came during the COVID-19-stricken months, from March until now, Nicole Holtzclaw, membership counselor for Sun Health At Home, told HHCN.
“Since the start of COVID-19 here in Arizona, we have seen an increase in our application rate,” Holtzclaw said. “We have heard many folks echo similar concerns about avoiding a care facility, especially after reports of the virus spreading so rapidly. Providing in-home care reduces the risk of exposure and cross-contamination with other patients [and workers].”
The concept works through a wellness team that coordinates services to offer personalized support for the members. It’s a hybrid between traditional CCRCs and long-term insurance plans, all with the benefit of aging in place.
Members usually join while they’re still healthy, which takes a significant burden off of surrounding family members, keeping them from scrambling to look for the right care option once their loved one’s health condition has already significantly worsened.
The members receive a lifetime guarantee of care once they’ve opted into the program, as well as around-the-clock care.
It’s a model that readies itself for “life’s curveballs,” as Sun Health At Home puts it.
Having testimonials now to back up the model has been driving success for the company in 2020.
“The information about [our company] hasn’t changed, but our member testimonials and stories have shifted how we talk about the program’s services and benefits,” Holtzclaw said. “In one instance, a wellness coordinator fought for testing that uncovered a stage-1 cancer diagnosis that was overlooked by physicians. So, the journey to 100 members has proven the need for a program like [ours].”
The senior living space, where the CCRCs derive from, is changing.
The vast majority of adults wanted to age in place before the public health emergency, and a desire for safety and isolation has most likely accelerated that.
Additionally, senior living companies have been ravaged by COVID-19 in every facet of their business since March. Move-ins have stagnated and occupancy has fallen, which has driven revenue down.
All the while, expenses have shot up for hazard pay, personal protective equipment (PPE) and COVID-19 testing, according to Senior Housing News. Insurance premium costs have also become a cause of concern.
And the vast majority of providers don’t think the industry has hit rock bottom yet, according to a July survey by RCLCO Real Estate Advisors.
That disruption could aid the CCRC-at-home effort, which offers that aging-in-place aspect, but also may offer family members more sense of security given the senior living structure to the business.
The future of CCRC-at-home models
Another successful example of the CCRC-at-home concept is Springpoint Choice, an offshoot of Springpoint Senior Living, a Wall Township, New Jersey-based nonprofit provider of senior living communities throughout the Garden State and Delaware.
Springpoint Choice has nearly 290 members.
“There are some people that may have been planning on moving into a retirement community, but right now they’ve decided, ‘I think I’m just going to wait a little bit,’” Cecily Laidman, executive director of Springpoint Choice, told HHCN. “So they’re signing up for our program kind of as a holding pattern until they feel more comfortable moving into a community. So it can work for both the home programs as well as the communities at times.”
Springpoint also has a consulting arm. Without much marketing, it has received a marked uptick in inquiries regarding CCRC-at-home programs since the beginning of COVID-19, Laidman said.
“I think that we’re going to see a lot of organizations around the country seriously consider starting programs like this now,” Laidman said.
Currently, there are at least 30 CCRC-at-home programs in the country — a number that could increase as senior living companies diversify their business plans during and after COVID-19.
“We as an organization are seeing that these membership programs are definitely starting to get some legs,” Hendrickson said.
On its end, Sun Health At Home is aiming for 122 members by the end of 2020 and closer to 150 by the end of 2021.
The level of services is often what impresses prospective members, but can be a challenge when it comes to pricing. Some offer lifetime guarantees after one-time payments while others just require monthly payments; some do both.
“[The pricing] is definitely being sort of tested to see what that right point of elasticity is,” Hendrickson said. “That point where you’re going to gain adoption but not not feel like you’re carving into some valuable resources.”
In the future, providers in multiple sub-segments of health care could begin exploring these types of models if they have the resources, according to Hendrickson.
Companies are thinking of how they can participate in the rush to bring services into the home.
“It’s a way to wed yourself in different directions [as a provider] and leverage resources in a different way,” Hendrickson said.
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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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Today, just a fraction of community-based palliative care programs are operated by home health providers. But the Patient-Driven Groupings Model (PDGM) and a shift away from fee-for-service Medicare will likely change that moving forward.
Throughout the health care world, the term “palliative care” often carries a different meaning from one organization to the next. In its broadest sense, however, palliative care — or “comfort care” — is specialized care for individuals with serious illness.
San Diego, California-based Mission Healthcare is one of the latest home health providers to launch a palliative care offering. It did so after months of careful PDGM education and planning, CEO Paul VerHoeve told Home Health Care News.
“We’ve definitely put more energy into a lot of our acute care-related efforts,” VerHoeve said. “That partially led to why we’ve started our palliative care program. It was an offshoot of how we looked at trying to take care of our hospital-based referral sources and the needs of their patients.”
With 11 locations, Mission Healthcare is one of the biggest home health and hospice companies in Southern California. Across those two main service lines, the company cares for about 2,000 patients a day.
It launched its palliative care program about four months ago in one of its core markets with strong home health and hospice overlap. So far, a few dozen patients have gone through the program — people with complex care needs who may have otherwise been overlooked.
“We were seeing a lot of patients who were falling in between home health and hospice, but still had significant needs in the home,” VerHoeve said. “We wanted to figure out solutions to be able to make sure we could be good partners for our referral sources and that we could care for this population of patients falling into ‘no man’s land.’”
Strategically, the value of a palliative care program under PDGM comes from referrals via hospitals and other acute care facilities.
Generally, referrals from such settings — or “institutional sources” — are reimbursed at higher rates under home health care’s new Medicare payment model. That’s why many home health providers looked at ways to serve higher-acuity patients going into 2020, though the COVID-19 emergency has since changed many of those plans.
In January, 47.8% of home health referrals came from institutional sources, according to data from Strategic Healthcare Programs. In March, that figure plummeted to just 30.8%, largely due to the decline in elective surgeries.
“We spent the better part of nine months preparing for PDGM,” VerHoeve said. “Obviously, in the beginning, it’s very much trying to get yourself educated, your team educated, trying to figure out who has the good information. From there, it’s about ultimately trying to build a plan.”
On top of its palliative care program, Mission Healthcare has leaned heavily on its EMR partner during the transition to PDGM, VerHoeve said. The provider also worked hard to ensure accurate coding across its departments.
As a result of that legwork and other innovative efforts, Mission Healthcare has fared well in the new payment environment. Still, the coronavirus has made gauging true success somewhat difficult, as the company’s census and referral patterns fluctuated greatly in spring.
Mission Healthcare’s home health volumes were down 10% to 15% in March, then down about 25% compared to historical averages in April. Volume began trending upward in May, and it has continued to stabilize since.
“It’s kind of been difficult for most providers to get a clean three- or four-month period of time without a lot of disruption or noise to understand how well they’ve managed under [PDGM],” VerHoeve said.
But launching a palliative care program wasn’t just about PDGM.
It was also a way to attract the attention of managed care organizations and independent physician associations (IPAs), according to VerHoeve, who spent time at Kindred, Vitas and other post-acute care powerhouses before joining Mission Healthcare.
Typically, payers are interested in provider partners with gap-filler programs that ensure smooth transitions of care.
Mission Healthcare’s palliative care program additionally has the appeal of managing patients over time, as many program participants eventually transfer to hospice services.
“We’ve had some pretty early successes in being able to take patients that historically we wouldn’t have been able to take,” VerHoeve said. “And there are patients who have evolved into accessing other service lines within the organization. We have an opportunity to stay in touch with this patient population longer.”
Palliative care as ‘loss leader’
Mission Healthcare’s palliative care program is relatively new, but the company is pleased with early results.
“I think all the indicators are pointing in the direction that we see this as being something that we as a company are going to put some more energy behind,” VerHoeve said.
Across the industry, More home health providers would likely get into palliative care if there was a federal palliative care benefit. Currently, the simple reality is it’s tough to run a profitable palliative care line as a secondary or tertiary service.
“Palliative care is … a loss leader,” VerHoeve. “I think in most organizations, you’ve got to find creative ways to build partnerships with payers and hopefully have other business lines that can help support these programs.”
Apart from refining the budding program, Mission Healthcare has been caring for COVID-19 patients in the home. It currently cares for between 20 to 30 patients per day, mostly through in-person visits.
“We didn’t make massive investments into telehealth during this period of time,” VerHoeve said. “I think we were just trying to stay really true to our core model.”
VerHoeve expects the coronavirus to remain a challenge for the remainder of 2020.
“We made a decision very early on as a company to say yes to taking care of these patients, which we found a lot of providers were not doing,” he said. “Caring for one of these patients in the hospital setting is very, very difficult. But caring for a patient in the home environment, where there are other people and you don’t have all of the sterile techniques or equipment, is extremely challenging for a caregiver or nurse.”
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Oak Street Health (NYSE: OSH) — a rapidly growing, multi-setting primary care company that specializes in caring for seniors, especially those in underserved communities — officially went public last Thursday with an initial offering of $328 million.
The Chicago-based company sold 15.6 million shares at $21, which was slightly above its anticipated offering of $15 to $17, according to Renaissance Capital. At that pricing, Oak Street’s value was set at $5 billion, or roughly 10 times its 2019 revenue of $556.6 million.
In part, Oak Street’s bullish IPO reflects the broader need for a better way of caring for America’s sickest, most vulnerable populations. It also underscores the opportunity and value in diversified care delivery models, particularly those wrapped around in-home care, co-founder and CEO Mike Pykosz told Home Health Care News.
“I think people realize the traditional model of primary care just isn’t delivering the results that we need,” Pykosz said.
Founded in 2012, Oak Street Health currently operates more than 50 health centers across eight states, with a heavy concentration in the Midwest. The newly public company opened its latest center in North Carolina just days before its IPO.
Despite the uncertainty of the COVID-19 pandemic, Oak Street plans to launch a handful of additional hubs in Mississippi, New York and Texas later this year, Pykosz noted. Its public offering — which likely would have taken place regardless of the COVID-19 virus — will help drive that growth moving forward.
“Our care model is really predicated by investing in our patients’ care, investing more upfront in primary care and behavioral health — the resources they need to stay healthy and out of the hospital,” Pykosz said. “Obviously, investing takes capital. By [going public] now, we bring more and more resources into the company to continue our mission of expansion.”
A meaningful experience
Generally, Oak Street Health has built its business model on the idea of “quality over quantity.” In fact, the “vast, vast, vast majority” of the company’s revenue comes from its value-based contracts with payer partners, Pykosz said.
About 45% of Oak Street’s patient population is dually eligible for Medicare and Medicaid.
To deliver on value, Oak Street doesn’t just care for patients in its centers. It also has interdisciplinary home teams to treat older adults who have mobility issues — or who just prefer in-home care.
“It’s mostly in-home primary care,” Pykosz said. “There are wraparound services more around social work support, helping patients with their medication.”
By going into patients’ homes, Oak Street’s home teams also help address fall hazards and other hospitalization risks while simultaneously evaluating any concerns related to social determinants of health, such as barriers to transportation or proper nutrition.
“The most impactful and meaningful experience I’ve had at Oak Street is doing ride-alongs with our home-visit teams,” said Pykosz, a Harvard Law School graduate and former principal at Boston Consulting Group. “When we go into our patients’ homes, we really see the kind of factors that are potentially influencing their care.”
During one home visit the CEO remembers, for example, he watched a patient demonstrate how she normally got in and out of her bathtub, using the bathroom sink to support her weight. While doing so, Pykosz said he could see the sink clearly coming detached from the wall.
“At some point in time, that was going to pull off from the wall,” he recalled. “It was going to be a fall — it was only a matter of time.”
Since its founding, Oak Streeet’s multi-pronged care delivery model has seen a 51% reduction in patient hospital visits compared with Medicare benchmarks, according to company statistics. Similarly, it has also seen a 51% reduction in emergency room visits.
Apart from growing geographically, going public allows Oak Street to continue refining that model, Pykosz added.
“One of the great parts about the IPO is it brings more resources for us to both grow but also to continue investing in caring for our patients better,” he said. “The more we invest to improve our care model and keep people healthier, the more savings we generate. We can then keep using that to reinvest and drive that flywheel.”
Expanding into telehealth
In the past, Oak Street Health has operated in two spaces: its centers and the home. Earlier this year, the coronavirus propelled Oak Street into virtual care.
“We’ve always done care in the home,” Pykosz said. “But we did very little telehealth prior to COVID.”
Early on in the public health emergency, Oak Street was doing about 90% of its visits virtually, a trend that happened across the continuum of care, partially enabled by a series of telehealth waivers from the U.S. Centers for Medicare & Medicaid Services (CMS) and other regulators.
Today, Oak Street is back to doing in-person visits, though around 70% or so of its visits are still happening virtually.
“Our patients appreciated that we were there for them at a time when they needed us and were dealing with a lot of uncertainty,” Pykosz said. “Our clinicians felt they could actually make a difference for our patients virtually, but they’re excited to see the patient back in person.”
While it will likely never be a virtual-first company, Oak Street sees telehealth visits as “a nice adjacency” to its core center-based model.
‘Variations to the same theme’
Oak Street Health reported over $200 million in revenues for Q1 2020 on its S-1 — a 72% increased compared to the same period a year ago. It estimates its annual total addressable market size as about $325 billion, suggesting there’s lots of room to grow for the Chicago company.
Its recent momentum reflects the wider interest in alternative primary care models, too.
At the end of July, Humana Inc. (NYSE: HUM) announced a strategic partnership with Heal, a Los Angeles-based in-home primary care startup with operations across seven states and Washington, D.C. The partnership included a $100 million investment from Humana, which is also one of Oak Street’s top shareholders.
Meanwhile, just a few weeks before that news, Walgreens Boots Alliance (Nasdaq: WBA) and VillageMD announced a five-year, $1 billion plan to expand full-service physician services at Walgreens stores.
“I think what you’re seeing is a lot of different variations to the same theme, right?” Pykosz said. “And that’s the need to find more convenient ways to deliver higher-quality care and engage with patients.”
One of the largest health care providers in New York — and the state’s largest private employer — is leaning on a home-based care initiative to help get itself and its patients through the COVID-19 crisis.
Northwell Health is a nonprofit, integrated health care network that employs roughly 72,000 people. Headquartered in New Hyde Park, it has 23 hospitals and 14,200 physicians in its network.
Recently, Northwell Health launched a program that cares for COVID-19 patients with minor to severe symptoms by helping them stay in their homes after contracting the virus. In addition to helping patients, the program helps ensure hospital capacity during potential surges.
The idea for the program first came to fruition when hospitals were overrun in New York City in April. Providing care in the home needed to become part of the solution, so Dr. Gita Lisker created the Coronavirus Related Outpatient Work Navigators (CROWN) program.
Lisker is the medical director of the respiratory care unit at Long Island Jewish Medical Center, an affiliate of Northwell Health.
The program keeps spread to a minimum by allowing patients to recover in place. That also increases Northwell’s reach by preventing ill people afraid of the hospital from going without care.
“There was just a terrifying fear among many people to go to the hospital during this time period. Family and visitors weren’t allowed, and there were limited time interactions — even between the hospital staff and the patients in the room,” Lisker told Home Health Care News. “People were saying, ‘No matter what, I’m absolutely not going to the hospital.’”
New York has reported over 445,000 confirmed cases of COVID-19 as of Tuesday. New York City has more deaths on its own — over 23,000 — than any other state in the country.
So far, Northwell’s home-focused program has taken care of nearly 200 COVID-19 patients, including many who have been seriously ill and some who have underlying health conditions.
“We’ve learned a lot from the at-home model,” Lisker said.
The program includes a telehealth segment, run by Northwell’s pulmonologists, and an in-person group of nurses. Services offered through the program range from mobile X-rays to the delivery of IV fluids and more.
“It’s very important that we give [patients] reassurance, because there’s a lot of anxiety that’s related to the COVID-19 symptoms right now,” Lisker said.
There have been other successful hospital-at-home type models that were spawned by COVID-19. In Minnesota, Lifesprk — a home-based care provider — partnered with North Memorial Health to take care of infected patients. The Mayo Clinic and Medically Home — a tech-enabled care services provider — made a similar partnership.
To its credit, Northwell’s program has been a success thus far. Only two of the patients that were treated under the model ended up having to go to the hospital.
“Most of the [early-on hospital cases] could have been managed at home, and some just need the encouragement,” Lisker said.
One of the biggest successes of the at-home model, Lisker said, has been the peace-of-mind aspect. Patients have written letters and made phone calls since the program’s launch thanking Northwell for allowing them to stay home.
It’s been another learning experience for a patient population that may have not known about home-based care options before.
“I think [this is] going to be the way of the future,” Lisker said. “I think it’s going to be one of the beneficial things that came out of this. We’re going to realize that we are able to transition care into the patient’s home instead of into the hospital, which is just better for hospitals, patients, their families and insurance companies.”
Northwell’s home health affiliates include Northwell Health At Home and Peconic Bay Home Health Services.
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After weeks — in some cases, months — of closures due to the coronavirus, businesses across the U.S. began reopening in early June. But by July, many of those same businesses were forced to go in the opposite direction, thanks to a national resurgence of COVID-19 cases.
As shops, manufacturing plants and warehouses again attempt reopening, many are turning to traditionally consumer-facing home care providers for backup. To help prevent the spread of the coronavirus, Senior Helpers, BrightStar Care, 24 Hour Home Care and several other organizations have expanded their service lines to offer screening services for unexpected business partners.
It’s a revenue-diversification opportunity that wasn’t on the home care industry’s radar, but it’s one likely to stick around for a while, according to Senior Helpers CEO Peter Ross.
“It’s a service that you and I would never have dreamed of months ago, but it’s come to fruition,” Ross told Home Health Care News. “I wouldn’t say our numbers are better than last year because of that, but certainly it has shown our flexibility and our ability to help the community.”
With a corporate headquarters in Maryland, Senior Helpers has more than 320 home care offices in its global franchise network, which covers parts of Canada and Australia in addition to the United States.
Many of Senior Helpers’ franchise owners have struck contracts to do temperature checks and related COVID-19 screenings for local businesses, Ross said. To support them in that mission, the franchiser sent forehead thermometers to owners and created an electronic brochure to help with marketing.
“We’ve noticed a bunch of opportunities across our system,” he said. “We’ve been finding a lot of manufacturing plants, warehouses, different types of factories … weren’t taking the proper precautions to do what they needed to do.”
Illinois-based BrightStar Care — another home care franchise giant with more than 340 locations in the U.S. — has taken similar steps to help businesses safely reopen. On top of doing temperature checks, the franchiser has also connected different businesses to its personal protective equipment (PPE) distribution center.
“Outside of securing PPE inventory for BrightStar Care franchisees to ensure the safety of their caregivers and clients, we’ve also shared access to our PPE distribution center with fellow business owners,” CEO Shelly Sun told HHCN. “We want to do our part in helping communities re-open safely, so that’s why we felt it was important to share access to our PPE supplies.”
Moving into B2B
In 2019, home care agencies typically sourced the bulk of their revenue from hourly in-home care, followed by live-in care, geriatric care and alert monitoring, according to the 2020 Home Care Benchmarking Study from market research and education firm Home Care Pulse.
But many of the home care professionals who participated in the benchmarking study said they expect to generate revenue from new avenues brought on by health screenings tied to the public health emergency in 2020.
Another Home Care Pulse report highlighting the impact of the COVID-19 virus on home care had similar findings.
“In our impact report that we [previously] released, a little over 50% of businesses said that their service lines were going to adapt and change based on learnings in the middle of the pandemic versus post pandemic,” Home Care Pulse COO Todd Austin told HHCN. “This is definitely one example — screening.”
Besides helping warehouses and manufacturing plants safely reopen, Austin said he’s also heard agencies are doing screenings at airports and various retail locations.
“Home care has had a little bit of B2B exposure through providing staffing and shipping to some facilities, but it’s never been a true B2B [industry],” he noted. ‘And that’s what 2021 will likely bring. home care agencies won’t just focus on B2C, but also more B2B service lines to where they can go out and network with other businesses.”
Per its screening contracts with non-health care businesses, Senior Helpers sends in rotating teams of certified nursing assistants (CNAs) or home health aides to cover different shifts of employees going into work. It typically does temperature checks, charging by the hour for those services.
“The last thing you want to do in a factory is let an employee who’s got COVID in with another couple hundred other people, with all of them working a few feet apart,” Ross said. “Look at what happened with all the different meatpacking plants in the country because of that issue.”
A July report from the U.S. Centers for Disease Control and Prevention reported that 23 states had COVID-19 outbreaks in meat and poultry processing facilities, with 16,233 cases in 239 facilities. Those outbreaks included 86 COVID-19-related deaths.
Senior Helpers has also used its screening contracts as an organic way of touting its caregiving services, Ross said.
“People say, ‘Oh, well, tell me more about Senior Helpers.’ They might need help in the home for their mother, their uncle, their grandfather,” he said. “From our perspective, it’s just a great investment in the community to keep people safe. And it certainly helps to drive the brand.”
That organic information campaign may also inspire some people to branch out into home care, perhaps even opening their own Senior Helpers franchise location one day, Ross said. It’s something that could factor into the strong growth the franchiser has seen lately.
“We’ve been growing really well, to the tune of 25 to 30 new owners a year,” Ross said. “We’ve been bringing more people on at a higher pace during COVID.”
On its end, BrightStar Care’s locally owned-and-operated agencies have provided screening services to 270 customers, including multiple Fortune 500 companies, as of mid-July, according to Sun.
BrightStar Care screening services are typically conducted by either a registered nurse (RN) or licensed practical nurse (LPN). Services range from taking vitals and conducting screenings, to interviewing employees and documenting answers for HR files.
Rates are based on the number of hours that the RNs and LPNs serve the needs of the customer.
“We’ll continue offering screening services as long as they are needed. We are proud to be able to support our communities and businesses to ensure safe reopenings,” Sun said. “We see staffing services as a long-term opportunity since each of our agencies have RNs, LPNs and CNAs on staff and have a 20-year history of providing staffing services in addition to home care. We are able to deliver on the skilled and non-skilled services, and [we’re] ready to provide future staffing services from screening to administering vaccines.”
California-based 24 Hour Home Care officially launched “SAFER at work by 24 Hour Home Care” to help with reopenings. The independent and fast-growing home care company has a team of 3,000 on-staff screeners to not only assist businesses, but also government buildings, schools and more, its website says.
But home care providers aren’t the only ones helping businesses reopen safely. Some of the technology companies that partner with home care agencies or post-acute care providers have gotten into the screening game as well.
Dina — an AI-powered care coordination platform that works with some of the largest home health providers and health systems around — is one example.
As of mid-July, Dina has two non-health care company screening customers: one municipality and one food manufacturer, President and CEO Ashish Shah told HHCN in an email. Those customers represent roughly 1,200 users, he noted.
Dina is helping home care agencies with screenings, too. Overall, Dina has helped facilitate more than 1 million employee screenings.
“We’re seeing more non-medical home-based care agencies start to step up and ask for help,” Shah said. ‘They’re finding very creative ways to use technology to check in on their patients and staff. And we’re seeing more non-healthcare businesses adopt our screening products to do exactly what hospitals and health care providers are doing to take care of their caregivers and patients.”
Home care agencies interested in launching new safe reopening business lines should keep two key things in mind, Home Care Pulse’s Austin said.
Caregivers screening dozens or even hundreds of workers need to have necessary PPE. Additionally, agencies should consider assigning one employee to one site to limit their exposure and possible virus spread.
“The first thing agencies need to do is make sure that the individual doing the screening is isolated to that [one location], whether it’s consumer screening or employment screening,” Austin said. “That’s step No. 1.”
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The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would make certain COVID-19-related telehealth flexibilities introduced over the past few months permanent for Medicare beneficiaries. The move comes in conjunction with an executive order from President Trump to improve rural and telehealth access.
While CMS’s proposed rule potentially paves the way for more remote nursing home interventions, it doesn’t include any new changes for home health providers. Nor does the president’s executive order.
“The president’s executive order is likely to change very little about telehealth policy coming out of CMS,” Rebecca Gwilt, a partner and co-founder of health care innovation firm Nixon Law Group, told Home Health Care News in an email. “His executive order essentially encourages the Health and Human Services Secretary to take a look at ways to extend the measures taken during the public health emergency.”
The lack of change is not entirely surprising: CMS already proposed making coronavirus-inspired telehealth flexibilities for home health providers permanent in its proposed 2021 home health rule. On top of that, CMS has repeatedly said only Congressional action can usher in changes such as telehealth reimbursement for home health providers.
Because telehealth is not currently reimbursable for home health agencies, providers are struggling to navigate cash flow and patient care amid the COVID-19 emergency.
Many agencies have been left with no choice but to provide necessary telehealth services to home health patients for free. And because telehealth visits don’t count toward Low Utilization Payment Adjustment (LUPA) thresholds, agencies that provide telehealth services are often hit with a reduced reimbursement to boot.
CMS can’t change that.
However, CMS officials are urging Congress to act to expand telehealth rules, which could, in turn, trigger more home health allowances.
In addition to announcing its proposed changes to next year’s Medicare Physician Fee Schedule Monday, CMS Administrator Seema Verma urged legislators to do more to make telehealth more widely and permanently available.
“Our regulatory authority outside of the public health emergency is largely limited to the types of services that can be provided via telehealth,” Verma said Monday during a press call. “We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it. Any extension of the removal of restrictions on site of care, eligible providers and non-rural areas must come from Congress.”
Verma went on to say that Congress’s role in such changes is “essential … in following through on this historic opportunity.”
However, home health doesn’t fall into any of the three areas Verma mentioned — restrictions on site of care, eligible providers and non-rural areas — according to Gwilt.
“These buckets are applicable to Part B reimbursement for telehealth only,” she said. “Home health was largely ignored in the national conversation about supporting the expansion of telehealth.”
It’s anyone’s guess if and when any sort of Congressional help of any kind will come. But the need for such action is clear.
Amid the COVID-19 emergency, 49% of Americans have used some sort of telehealth services, according to findings from the Harris Poll. Another 91% believe such services should be covered by insurance, with 77% saying they plan to continue using telehealth in the future.
On the home health front, there’s been some talk from Congress but no action.
“I plan to introduce a bill soon to create a framework to reimburse for telehealth services provided by home health agencies,” Sen. Susan Collins (R-Maine) said back in late May.
But now, more than two months later, no such bill has been introduced.
Still, National Association for Home Care & Hospice (NAHC) President William A. Dombi is holding out hope that will change soon.
“To achieve the full value that telehealth can bring to patients in their homes we need a combination of actions from Congress, CMS, state Medicaid programs, managed care organizations and commercial health insurance companies,” Dombi told HHCN in an email.
With respect to Medicare home health services, CMS cannot make all the needed changes on its own, Dombi reinforced.
“We need Congress to amend Medicare law to directly authorize fair payment for the delivery of telehealth services under the home health benefit,” he said. “We are hopeful that we will see bipartisan legislation introduced very soon in both the Senate and the House that would establish the changes needed in Medicare law.”
Senator Lamar Alexander, a Republican from Tennessee, introduced the Telehealth Modernization Act on July 30.
Rep. Susie Lee, a Democrat from Nevada, also introduced legislation aimed at improving telehealth services for veterans cared for by the U.S. Department of Veterans Affairs on the same day.
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As home health leaders look to the future, the lessons learned from the COVID-19 emergency will likely continue to shape their efforts for years to come.
In terms of business planning, it will likely be a long while before there’s a return to a world where the coronavirus isn’t the central driver of health care strategy, outcomes and cost.
“We realize the current situation is not really going away anytime soon,” Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group Inc., said Wednesday. “We’ll continue to be flexible, creative and resilient.”
Myers made her comments at the National Association for Home Care & Hospice’s 2020 Financial Management Conference, which was held virtually due to the COVID-19 emergency.
For Baltimore, Maryland-based Johns Hopkins Home Care Group, utilizing lessons learned from the public health emergency and understanding how it fits into the company’s business model moving forward has been crucial.
“For example, prior to the pandemic, we were preparing for a huge expansion of our facilities,” Myers said. “What we realized is that we really did not need as much space as we thought. We moved that mindset from expansion to contraction and making sure our employees have the optimal experience for the non-patient-facing to be able to do that remotely.”
The COVID-19 emergency also served as a catalyst for innovation for Johns Hopkins Home Care Group, according to Myers.
“In a matter of weeks, we expanded our remote patient monitoring program exponentially to meet the needs of our health system by monitoring COVID-positive patients,” she said. “We are actively discussing strategies to further remote patient monitoring over the years to come with or without COVID.”
Johns Hopkins Home Care Group falls under the larger umbrella of Johns Hopkins Health System’s Home & Community-Based Services division, which includes four Medicare-certified home health agencies, two private-duty companies, a large home medical equipment company, 10 outpatient specialty pharmacies and three alternative care infusion sites.
Similar to Johns Hopkins Home Care Group, Always Best Care Inc. has also scaled back in terms of office space, in relation to the COVID-19 emergency.
Roseville, California-based Always Best Care is a home care franchise company that operates across 209 territories in 30 states.
As part of its COVID-19 strategy, Always Best Care has placed a greater emphasis on infection control — something that will play a larger role for all in-home care providers in 2020 and beyond, according to Sheila Davis, the company’s senior executive vice president of operations.
“One thing that we have learned within our businesses is that you have to be mindful of — and protective of — not only the clients but also of your employees as well,” Davis said at the Financial Management Conference.
While infection control has always been a major aspect of home health, the public health emergency has pushed this to center stage on the non-medical home care side as well.
Additionally, amid the COVID-19 emergency, there have been a number of regulatory exceptions, waivers and other changes.
For Kindred at Home, the Centers for Medicare & Medicaid Services (CMS) and its move to broaden the definition of “homebound” under home health rules has been critical, according to David Causby, the company’s president and CEO. CMS’s goal in the expanded definition was to expand access to home health services, especially to populations at heightened risk for contracting COVID-19.
“This is something the home health industry has been pushing for an extended period of time,” Causby said at the Financial Management Conference. “I think with COVID and … the homebound status relief, we’re really starting to see some real qualitative outcomes, in regards to being able to treat seniors in their home.”
Atlanta-based Kindred at Home provides home health, personal care and community care services in almost 800 locations across 40 states. The provider organization also offers hospice care, palliative care, skilled nursing services, social services and therapy services.
Ranked at the largest home health provider in the country in 2019 by LexisNexis, Kindred at Home operates under the umbrella of Humana Inc. (NYSE: HUM)
Like many providers, Kindred at Home has leaned on telehealth use during the COVID-19 emergency. But Causby believes more relief around telehealth use for home health care is needed.
“While there’s no reimbursement associated with that today, we believe continuing to demonstrate the outcomes and the value of this will be something that, hopefully, CMS will take a look at in the long run,” he said.
Aside from lessons learned, the three Financial Management Conference panelists shared a sneak peek of what they will be prioritizing in their companies’ annual budgets for 2022.
One common theme among the home health leaders — technology.
Kindred at Home’s focus will also be on redesigning the company’s clinical innovative programs.
“We will be focusing on building out new clinical design programs that will have a lot of the technology associated with it,” Causby said. “We’re already starting to look at how we would redesign those clinical innovative programs to possibly care for seniors over a much longer period of time. The ability for these patients not to have to end up back in the ER or an acute setting will change how clinicians think about being task-oriented.”
On the vendor side, all of this means budgeting for more growth.
“As a technology provider, we are budgeting for even more growth next year,” John Olajide, founder and CEO of Axxess Technology Solutions, said at the event. “We’re continuing to hire as our business grows rapidly, not just in the U.S. but globally as well. We’re also continuing our strategic partnerships around expanding all our interoperability solutions to ensuring that our clients are positioned for success long term.”
Additionally, John Hopkins Home Care Group has plans to invest heavily in skilled-nursing-at-home models and hospital-at-home models.
While the coronavirus has ravaged the nation’s aging population and stretched the U.S. health care system to its limits, every cloud has its silver lining.
For home health care providers, one silver lining comes in the form of increased recognition and expanded opportunities. Agencies are seeing higher levels of service demand, fewer recruitment and workforce issues and a heightened ability to divert patients away from skilled nursing facilities.
While those provider opportunities have been covered by the media, another has flown somewhat under the radar: participation in clinical trials.
Clinical trials are research studies that use a group of participants to test health-related treatments or interventions. Historically, those studies have occurred mostly in centralized settings.
In light of the COVID-19 emergency, however, home health providers have been presented with the chance to participate in such research.
Home Health Care News recently connected with Firma Clinical Research CEO Michael Woods to discuss the growing opportunities for providers to participate in the space.
Firma Clinical research is a contract research organization that provides outsourced research services to pharmaceutical and biotech companies. It specializes in drug development efforts, helping by offering advanced in-home patient visits, data management and biostatistics, medical writing, regulatory consulting, clinical pharmacology and clinical operations.
Woods told HHCN the future of clinical trials will be decentralized, with home-based care providers set to play an important role in making it all possible.
You can find that conversation below, edited for length and clarity.
HHCN: How common are home-based clinical trials currently?
Woods: Home health visits are used frequently today when there are mobility, transportation or distance issues, especially with older adults, children and people with disabilities. In addition, more procedures associated with studies are being performed in the home.
As a result, Firma Home Trial Services is seeing more sponsors using home health visits to enhance the clinical trial experience.
What has the clinical trial landscape looked like historically?
Typically, clinical trial visits involved the participant going to where the study principal investigators were practicing – in hospitals, clinics or physician offices. Some patients traveled long distances to participate in a clinical trial.
But as society in general is adapting to online interactions and home-based services, research studies are implementing new ways of engaging patients through telemedicine and home visits.
What specific opportunities do you think exist to do clinical trials in home health care? For example, are there any particular opportunities you see or do you think all trials could be done in the home?
An opportunity for sites using home health services is to reduce the patient burden. For patients whose conditions are caregiver intense, such as rare … disease patients, easing the burden and cost of travel through home health visits is helping to improve participation and retention. Including home health visits in a study can extend the reach of a site by hundreds of miles.
Firma Home Trial Services deploys and trains home health nurses who are local to research participants.
[Firma Home Trial works with outside home health agencies. It does not have its own home health line.]
Why does home health make sense for clinical trials, and why haven’t we seen it as a popular clinical trial setting in the past?
Billions of dollars were spent in the past to recruit patients to studies. Patient recruitment remains difficult, but the focus now is on enhancing the patient experience through the entire study.
In addition to the ease of home health, it also offers a safety advantage for patients who perceive risk with going to a hospital, clinic or physician office during a disease outbreak.
A Firma Home Trial Services visit occurs with personal protective equipment and social distancing to minimize the risk of disease transmission. A nurse or phlebotomist communicates in advance with each research participant to ensure visit expectations are understood and to gain the risk perspective of the participant.
What would this mean for home health providers and their patients?
Firma Home Trial Services is experiencing greater demand for our home health services. Plus, we are seeing the blurring of the line between home health care and home health research visits.
There is new focus on informed consent for research, which minimizes any therapeutic misconceptions.
What would home health providers have to do to get involved with a clinical trial? Would there be financial upsides?
More visits can mean better margins. But home health visits also support study success by helping to enhance clinical trial participation and retention, which in turn results in the more rapid collection of data necessary for the development of a drug or device.
If a home health provider is interested in supporting clinical trials, I recommend reaching out to a local university or research institution to explore a partnership for home-based health services.
What are your predictions for the future?
Where economically feasible, decentralized and patient-centric clinical trials will include an integration of home health and telemedicine.
Firma Home Trials Services is prepared to see an increasing number of health services and procedures conducted in the home, as equipment for procedures improves and becomes more mobile.
The post Home Health to Play Increasingly Important Role in Clinical Research appeared first on Home Health Care News.
Health and well-being company Humana Inc. (NYSE: HUM) has spent the past few years adding to its health care services portfolio while aggressively investing around a home-based care strategy.
The Louisville, Kentucky-based company has now revealed its latest step in that direction. On Wednesday, Humana announced a wide-ranging strategic partnership with Heal, the in-home primary care company formed in 2014 by nephrologist Dr. Renee Dua and her husband, Nick Desai.
As part of the newly announced strategic partnership, Humana will invest $100 million into Heal, fast-tracking the Los Angeles-based startup’s growth plans and propelling it into several major new markets. Susan Diamond — segment president of Humana’s home business — will also join Heal’s board of directors as part of the collaboration.
Desai, who serves as Heal’s CEO, described the addition of Diamond and her “unparalleled expertise” as a key perk for his company and its ability to make doctor house calls mainstream again.
Residential primary care visits were common in the 1930s and earlier, when roughly 40% of all patient-doctor visits took place in the home, according to researchers.
“Humana’s partnership and investment accelerate things a lot,” Desai told Home Health Care News. “Humana isn’t just a financial investor, they are a strategic partner that gives us access to patients, technologies and expertise to grow and scale our business rapidly so that millions more Americans can benefit from health care in the comfort of home.”
The strategic partnership with Humana comes just over two weeks after Heal rolled out “Heal Pass,” a monthly subscription program designed to keep vulnerable populations at home and out of emergency rooms. Offered throughout California, New York, New Jersey, Georgia, Virginia, Washington, Maryland and Washington, D.C., Heal’s doctors have delivered more than 200,000 visits to date, generally at lower costs and with more engagement than traditional in-office visits as well.
Apart from its in-person doctor visits, Heal offers its patients the option of one-touch telemedicine visits, which have been particularly important during the COVID-19 pandemic.
“The COVID-19 pandemic is a watershed moment to highlight the importance of timely and safe access to quality health care,” Desai said. “But even after COVID-19 wanes, the home remains a preferred place to get care.”
Under terms of the partnership, Humana will help Heal expand its current footprint to offer value-based, primary care via virtual and in-home encounters to new markets such as Chicago, Charlotte, Houston and others. These new markets are part of Humana’s Bold Goal initiative, which is focused on whole-person care by co-creating solutions aimed at social determinants of health and more.
Strategically, Humana sees home-based solutions as “inherently more scalable” than clinic-based ones, Diamond told HHCN.
Humana also believes home-based approaches lead to improved patient satisfaction and health outcomes.
“As seen in other industries, we believe consumers will increasingly demand health care solutions that are more convenient and personalized and [that] better meet their needs,” Diamond said. “Deeper relationships with patients are needed, including a better understanding of the home environment, to deliver comprehensive and higher quality care.”
Humana and Heal plan to launch in the aforementioned new markets in early 2021. The partnership with Humana will “not at all” change how Heal works with other insurance plans — or how it cares for patients with no insurance.
Humana At Home and Kindred at Home are among the other core parts of Humana’s in-home care mission.
Humana — which reported annual revenues of about $64.89 billion in 2019 — also recently contributed to a $135.8 million Series C round for DispatchHealth. In February, Humana additionally announced it was teaming up with Welsh, Carson, Anderson & Stowe on a new joint venture designed to expand access to value-based primary care for Medicare patients.
All of those efforts are instrumental to Humana’s home vision, Diamond noted.
“We consider primary care to be the foundational element to our strategy, given the significant role the primary care physician plays in coordinating the patient’s overall care,” she said. “Through our partnership with Kindred at Home, we offer more comprehensive and higher quality home health services through enhanced clinical models and patient support services. One other example is the ability to provide true emergency-level care to patients in the comfort of their homes, which we intend to do through our partnership with DispatchHealth, which we announced a few weeks ago.”
While its new collaboration with Humana will likely win it more national attention, Heal is used to being in the health care spotlight.
Heal was recognized by the 2020 CNBC Disruptor 50 as the 13th-most disruptive private company in the U.S. earlier this year.
The post Humana Helps Fast-Track In-Home Primary Care Company Heal’s Growth with $100M Investment appeared first on Home Health Care News.
Telehealth usage has flooded into home-based care in an exponential fashion.
Across all of health care, telehealth claim lines increased 8,336% from April 2019 to April 2020, according to data from FAIR Health’s Monthly Telehealth Regional Tracker.
Generally, the concern with telehealth has often been centered around the patient and how seniors will react to the technology. A lesser consideration has been made, however, for the workforce deploying it.
That should not be the case, industry insiders caution.
MaineHealth Care at Home has been working with telehealth in one form or another since the turn of the century. Over the years, the in-home care provider realized it needed to have a triage team dedicated to telehealth, President and CEO Donna DeBlois told Home Health Care News.
“Our telehealth visits are predominantly done by our telehealth triage team,” DeBlois said. “That way, it doesn’t take away from the productivity in the field, which works out well.”
Saco, Maine-based MaineHealth Care at Home offers home health services to eight different counties in the Pine Tree State. Its typical average daily census is 1,600 patients.
Like most home health providers, “typical” days are difficult to come by amid the ongoing public health emergency caused by the coronavirus. On its end, MaineHealth Care at Home has cared for 24 COVID-19-positive patients this year, often leveraging telehealth services to provide treatment.
On average, each telehealth visit takes only 10 minutes. It can be even less for patients further along in their care plan, DeBlois said.
But across the home health industry, not every agency has a team dedicated to telehealth like MaineHealth Care at Home. Additionally, some leaders actually prefer that team members work in both telehealth and in-person capacities.
Dr. Ethan Booker, the medical director of the MedStar Telehealth Innovation Center, is one of them.
“We think that there is tremendous value in being able to have a collection of tools to be able to take care of patients, and that includes telehealth,” Booker told HHCN. “But it obviously still includes the ability to see people in the office. We think the vast majority of providers are going to use telehealth to augment their ability to take care of patients, but will still be doing a good amount of their work in person, and that it would be a real rarity for someone to be doing just telehealth work.”
There’s “a lot of value” in being able to move back and forth, he added.
MedStar Health is an integrated health system that offers a wide range of services — including home health care — in the greater Baltimore and Washington, D.C., areas.
Moving back and forth between in-person and remote work will be the future for a lot of health care workers — particularly during the COVID-19 crisis, but likely after as well.
Clinically, working in both areas ends up being beneficial for both the patient and the provider, Booker believes. Clinicians strictly dedicated to telehealth, particularly outsiders, may not grasp the overall system as much as someone who works at both and thus understands the ins and outs of it.
“And so if you’re a doctor who’s working in the office, seeing patients periodically in the hospital, and also interacting via telehealth, you know the system really well and you can navigate people through it,” Booker said.
During the New England COVID-19 surge, Norwell, Massachusetts-based NVNA and Hospice spent a great deal of time coordinating schedules for clinicians to help juggle telehealth and in-person visits.
Full-time clinicians would work with their managers to shuffle patients around appropriately and safely so that they could have a field day and then a virtual day, NVNA Telemedicine Clinical Manager Cheryl Nelson told HHCN.
“That did several things,” Nelson said. “It was a day that they could kind of stay in and only focus on the telehealth visits and it was certainly a day of minimizing their exposure.”
NVNA offers home health, hospice and palliative care, among other services, to residents of Massachusetts. It is Medicare-certified home health agency but also deals with managed care organizations, which is a problem some home health providers across the nation deal with.
Managed care, in many cases, will pay for telehealth visits as if they were in-person. It’s been well documented that the Centers for Medicare & Medicaid Services (CMS) has not made that leap just yet.
So even though a clinician may bring the same effort to the table on a remote visit, the money coming in for the agency is not the same. Or, in NVNA’s case, it’s only sometimes the same.
That raises a question over how an agency should pay its workers while dealing with that reality.
While NVNA makes sure to keep track of which telehealth visits it’s being paid for (and which it’s effectively delivering for free), it’s more about finding the right plan of care. The agency does not change payment for full-time clinicians based on whether it got paid for the remote visits that were or weren’t conducted.
“At the height of COVID-19, [we cared most] about what was best for the patient,” Nelson said. “So the field clinicians were not paid more or less based on what type of care they provided, just assuming that the care they were providing was practice and what was best for the patient.”
Curbing workforce shortages
Coinciding with the growing amount of seniors who will need care over the next decade in the U.S. is the daunting reality of the home-based care worker shortage.
Nursing shortages have been a topic of discussion during COVID-19. Projections suggest that the industry will need to add a staggering amount of front-line workers in the next 10 years — anywhere from 630,000 to over 1 million.
The situation is so dire that presumptive presidential candidate Joe Biden unveiled a $775 billion plan for boosting the caregiver economy on Tuesday.
The workforce realities are one of the biggest reasons why DeBlois finds telehealth to be so imperative.
“I am a huge proponent of telehealth,” she said. “Particularly in nursing, we are looking at a workforce that’s limited. There are not enough nurses for the aging population that we have in front of us or that we’re caring for now. We have got to figure out how to embrace telehealth and do less touch points, get the same outcomes and the same patient engagement as we do with in-person visits.”
Some home-based care insiders believed that the mass unemployment would help with that deficit.
But if the demand is high enough, agencies may have to turn to telehealth in the future to do more with less.
“We don’t have a choice anymore,” DeBlois said. “In Maine, we happen to have an older nursing workforce — we’re already challenged with that. … We have got to figure out how to do this differently. And our only option really is technology and telehealth is right on the forefront with that.”
As pharmaceutical ingenuity hits new heights, ensuring that patients gain access to innovative medicines requires a unique combination of evidence generation and communication
Working with all stakeholders to generate evidence that communicates value, from early phase development to launch and reimbursement, is essential in therapy areas including oncology.
These are challenging times for the pharmaceutical industry as it navigates an oncology landscape offering an increasing array of new ways to target and treat cancer.
The rise of ever-more personalised treatments for different tumour types, a greater understanding of the mutations that cause cancers and the increasingly central role of combination therapies are just some of the factors that make this a particularly complicated and competitive space.
• Read the full article in pharmaphorum’s Deep Dive digital magazine
The post Commercialising innovative new medicines appeared first on .
Paige is a global digital pathology founded in 2017 by Thomas Fuchs, Dr. Sc., and colleagues from Memorial Sloan Kettering Cancer Center. The company involves computational pathology products that are targeted for patients and their care teams for effective, more informed treatment decisions. Paige has developed a platform to deliver novel technology to pathologists to transform their workflow and increase diagnostic confidence and productivity.
On Jul 21, 2020 Paige received the US FDA’s 510(k) clearance for its FullFocus Viewer to use in digital pathology. Also in 2019, Paige received the FDA’s Breakthrough Designation for its artificial intelligence technology to diagnose cancer and started its AI diagnosis with Prostate Cancer. Leo mentioned the utilization of Series B funding of $95M to “Grow, the additional funding will help us continue our work to bring our computational pathology solutions to the market that requires growing our team, building additional biopharma partnerships, building a body of evidence to support our offering, and continuing to deliver our platform to clinical use.”
“Prostate cancer is only the beginning of our work. We are also working on other cancers, including breast and bladder to name a few.”
Tuba: How has your journey been so far? Can you talk about the growth of PAIGE since 2017?
Leo: “The journey so far has been both relentless and rewarding. We have come such a long way in such a short amount of time. Paige was born out of Memorial Sloan Kettering – the top cancer care center in the world—and spun out to commercialize the tech for a more widespread global impact. In doing so, we received approval to use MSK’s pathology slides to generate novel information from them. Right now, we have over 1.5M slides and add about 100,000 new slides per month. We are proud to say we are the first digital pathology company to receive a breakthrough device designation from the FDA, giving us the approval to expedite the development. We also received a CE mark for our computational diagnostic device in prostate cancer. We put some significant building blocks in place to bring our technology to market, where it will have the most impact.”
Tuba: Can you please briefly tell me about your tools? How will these be helpful to society?
Leo: “Paige created a platform to give pathologists increased diagnostic confidence so they can arrive at accurate diagnoses for patients efficiently. It can also accelerate new biomarker discovery and generate new insights from the tissue. The applications are designed to relieve pathologists overburdened with the volume of cases, empower biopharma researchers searching for previously unidentified biomarkers, and help patients and care teams receive a quicker, accurate diagnosis that can help them better decide amongst their treatment options.”
Tuba: What does Paige plan to do with the new funding?
Leo: “Grow. The additional funding helps us continue our work to bring our computational pathology solutions to the market. That requires growing our team, building additional biopharma partnerships, building a body of evidence to support our offering, and continuing to deliver our platform to clinical use.”
Tuba: What is Paige planning to do to push pathology into the digital era?
Leo: “Paige is already pushing pathology into the next generation. We are taking a comprehensive approach to space. First, we are leveraging millions of images of tissue slides to give more information to pathologists within their diagnostic process and biopharma in their development endeavors. Second, to drive adoption, we are building our platform with an eye towards intuitive user experience and minimizing IT burden. Combined, our platform and our computational pathology offering stand to bring significant value to our customers.”
Tuba: What are some of the pain points you’ve had to overcome in doing so?
Leo: “I would not call them pain points, but as a new company in the space, we need to generate a body of evidence around our platform and our computational pathology solutions. We have partnered with top institutions around the world to do this and have recently published multiple papers at ASCO and in Modern Pathology, which have been very well received.”
Tuba: How does Paige’s technology work, and how does it benefit pathologists, Pharma, and cancer patients?
Leo: “We deliver advanced computational solutions for pathologists, oncologists, and the R&D community worldwide, while also working closely with biopharma companies to create custom biomarkers to improve patient care. All of this is possible because of three key assets that Paige and our founders and collaborators at Memorial Sloan Kettering have built over the past decade. The first two are how we build our computational products: platinum-grade data and our proprietary Machine Learning development pipeline.”
The foundation is our proprietary machine-learning techniques, which leverage the vast amounts of data and require no pixel-wise annotations to generate best-in-class performance. Then, once we have systems that understand cancer morphology, we can fine-tune them with far smaller datasets, like the data coming from clinical trials.
The third is the platform that I mentioned above. There is a big difference between building an algorithm and building a medical device that is easy to use and is valuable in-patient care. Our platform allows us to build products and workflows around our best-in-class computational pathology systems and deliver them globally to where they are needed most.
Tuba: As PAIGE received the FDA’s Breakthrough Designation in 2019 and started their AI diagnosis with Prostate Cancer, are you planning to expand the AI diagnosis in other indications also?
Leo: “Prostate cancer is only the beginning of our work. We are also working on other cancers, including breast and bladder to name a few.”
Tuba: What do you foresee your go-to-market strategy to be?
Leo: “Paige licenses diagnostic software to hospitals and clinical laboratories while providing custom services to the biopharma industry.”
“We work with the biopharma industry to build digital diagnostic solutions as well as tools that can be used in the many phases of drug development and clinical trials in which pathology plays a pivotal role. Revenue coming from these partnerships are bespoke, as each of these projects has different timelines and scope.”
On the clinical side, Paige offers state-of-the-art diagnostic software via software-as-a-service (SaaS) subscriptions. These subscriptions can be structured on a per-case or per-user bundle basis. The offering includes AI-powered digital diagnostics solutions, delivered via the Paige Platform (including the FDA cleared, CE-marked viewer).
Tuba: Do you have competition in this space? Who are they, and how does Paige’s product have the edge over them in your viewpoint?
Leo: “There are certainly other clinical and pharma focused competitors in digital pathology. Paige is uniquely positioned to bring computational pathology to scale across multiple cancers and biomarkers. Our diagnostic software is derived from millions of slides from one of the best cancer research hospitals in the world. This database is unparalleled. We also leverage a decade of research and development conducted at Memorial Sloan Kettering as well as an experienced leadership team with a proven track record in building and commercializing digital diagnostic technologies in other spaces.”
Tuba: When can we expect this to be available for commercial use?
Leo: “We are very committed to bringing our technology for commercial use so patients and their care teams can make faster, more informed treatment decisions. The first step has been getting our platform ready for prime time and cleared for primary diagnosis, which we have achieved in the US and Europe. Then, we got the first CE mark for a computational pathology product with Paige Prostate, which also earned FDA breakthrough designation and we are working on getting cleared in the US. Additional functionality and other cancer suites will follow shortly.”
Home-based care provider Prospero Health has spent years operating with a care model based on in-person care and supervision.
But its current model doesn’t look like it did before COVID-19 — and it probably won’t ever look that way again. Today, Prospero Health is learning to evolve with the virus, while moving into as many new markets as possible to make a difference.
The company offers a wide range of non-medical and medical home-based care services across 10 states.
In addition to hands-on care, Prospero Health helps patients with issues in their home that could be decreasing their quality of life or putting them at greater risk for hospitalization. Such services could include addressing fall risks, for example.
Since it began spreading across the country, the COVID-19 virus has put older adults and other high-risk individuals on red alert. On its end, Prospero Health’s average patient is 83 years old, a fact that forced the company to think seriously about the coronavirus very early on.
The provider’s most recent move to support its patient population was an expansion to Birmingham, Alabama, where UnitedHealthcare helped the provider identify an area in need of home-based care. UnitedHealthcare is one of Prospero Health’s insurance partners.
Prospero Health will now begin serving 100 patients in the Birmingham area, with the hope of growing its Alabama census to about 400 by the end of the year.
“Somewhat paradoxically, the emergence of COVID-19 makes it that much more imperative that people have access to care in the place that they feel the safest, which is in their home,” Doug Wenners, the founder and CEO of Prospero Health, told Home Health Care News.
While Prospero Health is based in Boston, it has a large chunk of its operations in Memphis, Tennessee. It does not plan to open a brick-and-mortar office in Birmingham.
Instead, it will leverage a scheduling software program that matches patient needs and preferences with clinicians. Clinicians will get assigned to patients within range of their home, with the software building out the most convenient schedule without sacrificing the health of the patient.
“Memphis is our other big office, as far as where we bring people for training and things like that, but we are mainly remote. Our model is really based on going to the patient,” Dr. Karen Kennedy, regional medical director at Prospero Health, told HHCN. “What we’re trying to do is hire clinicians that are in these areas so that they’re local as well. We want our clinicians to be in the same community with our patients.”
Apart from its recent expansion to Birmingham, telehealth services have also become a vital part of Prospero Health’s new care plan.
“Whether they were scheduled or unscheduled visits, we wanted to make sure that we were telephonically in touch and available to our patients,” Wenners said. “Our core care model involves 24/7 support, so we’re always available to them anyway. But we wanted to make sure that we were really doubling down on our accessibility.”
In line with that mission, Prospero gives patients 4G- and LTE-enabled tablets when they don’t have access to such devices or WiFi.
“That’s now all part of our core care model, even though it was originally in response to the need to provide access to care for patients at risk for COVID-19,” Wenners said. “So we can see patients in their home physically, which is still kind of the traditional way of serving patients, but then we augment that with telephonic and virtual tablet enabled visits as well.”
Larger expansion plans
Prospero Health is planning the same approach it is taking in Birmingham in other areas of Alabama, including Mobile, Montgomery and Baldwin. Afterward, it has its sight set much higher.
“We’re going to be in Florida and Texas next year,” Kennedy said. “We also have other expansion plans with Maryland, Michigan, Wisconsin and California being kind of the next big jumps.”
The COVID-19 virus, whether directly or indirectly, has created a health care deficit of sorts. Patients aren’t getting the kind of care they need, and that’s part of the motivation for expanding amid a health crisis, according to Kennedy.
The public health emergency has seemed to accelerate Prospero Health’s goals — not stymie them. Put optimistically, the company sees it as an opportunity.
“The need now is so much greater for home-based care and for us it’s a real opportunity to serve the patient population in need,” Wenners said.
The post Leaning on Virtual Care Models, Prospero Health Charts Course Toward Future Growth appeared first on Home Health Care News.
Long-term care centers such as skilled nursing facilities (SNFs) have taken the biggest hit as a result of COVID-19. More than 40% of all virus-related deaths have been tied to nursing homes, a statistic that is scaring away a large number of potential and former residents.
Instead of facility-based care, more seniors are now opting to receive care at home. That, in turn, is accelerating the pace of health care innovation and pushing higher-acuity patients into the home.
But UnityPoint Health was already ahead of the curve. The health system started developing its new SNF-at-home program in the middle of 2019 before the COVID-19 emergency hit.
“Our goal is definitely to provide the right level of care in the right setting,” Mag VanOosten, president and chief clinical officer of UnityPoint at Home, recently told Home Health Care News. “We really believe home is where people are meant to recover.”
West Des Moines, Iowa-based UnityPoint is a health system with hundreds of locations across Illinois, Iowa and Wisconsin. It serves patients across a total of nine geographic regions with its hospitals, clinics and home-based care offerings.
UnityPoint at Home is a comprehensive home care company that offers a range of home-based services.
Its new SNF-at-home program, which is still in development, will fall under Care at Home, which includes all of the work that UnityPoint does for its accountable care organization (ACO) and at-risk contracts.
“[Care at Home includes] things like post-discharge home visits under waivers, and the hospital-to-home program … in addition to what we’re doing on the home health side,” VanOosten said, noting that SNF-at-home program falls under her purview.
UnityPoint at Home and Care at Home are both part of the health system’s population health structure, but Care at Home is an actual clinic. VanOosten oversees both, which together include all home-based programs.
While UnityPoint has well-established home health and hospital-at-home programs, SNF-at-home is different.
“Caregiver support is the difference,” Jenn Ofelt, COO of UnityPoint at Home, told HHCN. She has primary responsibility for traditional clinical service lines, such as home health, hospice and the ancillary supports that go along with those services.
When the SNF-at-home program gets up and running, it will target a very specific population of seniors, Ofelt and VanOosten noted. They bucketed SNF referrals coming from hospitals into three groups to explain.
The first bucket is filled with patients who might not need SNF-level care, but rather, could be well cared for using home health without much additional support. These patients are typically the target of SNF-diversion efforts by home health providers, a tactic some experts expect to skyrocket as a result of COVID-19.
The second consists of residents who have especially intensive needs and appropriately require 24-hour SNF-level care.
Then there’s the third bucket, which is filled with the patients UnityPoint is hoping to help with its SNF-at-home program.
“That’s the group that is eligible [and appropriate] for skilled care, but with some additional help, we really could take them home with services that we’re able to provide either under Care at Home or with home health,” Ofelt said.
In other words, the SNF-at-home model combines home health with home care to fill each individual patient’s caregiver gap.
“Maybe that’s [at] nighttime,” Ofelt said. “Maybe that’s [for the] bathroom or for [activities of daily living]. Maybe it’s 24/7 care, but there’s a caregiver gap.”
UnityPoint’s SNF-at-home concept was born out of its successful hospital-at-home program, which has some of the best outcomes for such a model nationwide. For example, UnityPoint’s hospital-at-home program, which is modeled after the program developed by Johns Hopkins University, boasts a 3% hospitalization rate.
Those metrics caught the attention of payers, which suggested the SNF-at-home model several months ago.
“We were approached by some commercial payers who said, ‘Not only would we like you to do hospital-at-home for us, but we would like you to do SNF-at-home for us,’” VanOosten said. “[That] was the first that we had heard of it.”
Following that conversation, UnityPoint got to work developing protocols and figuring out what was necessary to make such a program work. Then the coronavirus hit, pushing program development somewhat to the backburner.
Finally, things are getting back on track.
“Now we’re back working on that and talking with our payers about that model,” VanOosten said. “We’re ready to stand that up and go live as soon as we find a private care partner.”
Because UnityPoint does not currently provide non-medical personal care services itself, it needs such a home care partner to make the program possible. After all, filling patients’ caregiver gaps is a key part of the program.
While UnityPoint has talked to multiple potential partners, it has yet to settle on one. Ultimately, it’s looking for an agency that would be a good cultural fit and would be willing to take on some risk.
“There’s a wide variation in the awareness of … how they could fit in with an ACO-type model,” Ofelt said. “We’re really looking for a partner that can see beyond that billing-the-patient-by-the-hour [model] and really [see] that value-add and proactive provision of service for a value-based arrangement and payment on the on the back end of a shared savings-type agreement.”
UnityPoint hopes to have the SNF-at-home model ready to roll out by Q4 2020.
Much like its hospital-at-home program, the model will serve patients in central Iowa, with an expected monthly census of about 10 to 15 patients, according to VanOosten.
COVID-19 case study
While the SNF-at-home program has yet to officially debut, the COVID-19 emergency allowed UnityPoint to do a small trial run of sorts.
“As a result of the pandemic, … there was a huge change in the workforce, [with] a combination of people working from home, as well as people out of work,” Ofelt said. “We were able to capitalize on that opportunity and use those caregivers that were now available to assist patients to go directly from home.”
Instead of supplementing home health with paid personal care workers, loved ones helped fill the caregiver gap to make the impromptu SNF-at-home program possible.
It became important amid COVID-19 because hospital and ACO discharge planners were having trouble getting patients safely placed into SNFs post-hospital discharge.
“[They were] reaching out to home health to say, ‘Are any of these patients able to go home?’” Ofelt said. “We had SNFs that were just flat out refusing to take new patients. We had SNFs that were putting all patients that had been in the hospital in one wing, whether they were COVID-positive or not.”
As of early July, those five patients were back on their normal trajectory of care, according to Ofelt.
The post UnityPoint Health Seeks Home Care Partner for New SNF-at-Home Model appeared first on Home Health Care News.
Heal — the rapidly growing Los Angles-based health care startup that’s trying to make doctor house calls mainstream — has launched a new offering for one of America’s most vulnerable populations.
Founded in 2014 by Nephrologist Dr. Renee Dua and her husband, entrepreneur Nick Desai, Heal is an in-home primary care provider that operates throughout California and New York, in addition to a handful of other key metropolitan markets. On Tuesday, the company announced the rollout of “Heal Pass,” a monthly subscription program designed to keep clients at home and out of emergency rooms, which are increasingly becoming overcrowded due to the COVID-19 virus.
“Every American deserves high-quality health care,” Desai, Heal’s CEO, told Home Health Care News.
In launching the new program, Heal sought to provide an affordable in-home primary care option for individuals who are uninsured or underinsured. For $49 per month, Heal Pass enrollees receive eight physicians house calls, annual physicals and next-day deliveries on medications prescribed by a Heal doctor.
In terms of timing, Heal is rolling out the new program now to help mitigate some of the negative consequences of the ongoing public health emergency and its impact on the U.S. economy.
Over the past four months, nearly 50 million Americans have filed for unemployment benefits, according to U.S. Department of Labor statistics. Many of those filers lost insurance after being laid off.
“Depending on what numbers you look at, there are between 25 million to 70 million uninsured or significantly underinsured people in this country,” Desai said. “They’re on very high-deductible, ‘basic’ plans, or they have no health insurance at all — maybe because they recently lost their health insurance through their employers.”
Instead of “health insurance,” which can often be costly, Heal Pass is designed to be “health assurance,” the CEO noted.
But while the program is meant to fill care gaps for vulnerable populations, it also has the potential to lower enrollees’ ER utilization. People often inappropriately use the ER as a doctor’s office, resulting in sky-high medical bills and overburdened emergency room staff.
About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, according to a 2019 report from health care consulting firm Premier Inc. Those unnecessary visits contribute to an estimated $8.3 billion in additional emergency department costs.
“With [doctor house calls], you can talk to a doctor, get your questions answered, get your primary care, possibly make sure this bug you think you have isn’t COVID,” Desai said. “Instead of going to the ER, you can stay in your house and stay safe. And you know the ER isn’t going to chase you down for a $2,000 bill.”
Diving deeper into telemedicine
Since launching six years ago, Heal and its team of physicians have delivered more than 200,000 patient visits while establishing collaborations with some of the health care sector’s biggest players, Humana Inc. (NYSE: HUM).
In total, Heal has raised more than $71.1 million. Its investors include American singer-songwriter Lionel Richie, well-known venture capitalist Jim Breyer, Fidelity Contrafund and others.
Traditionally, Heal’s business model has been built on in-person physician house calls, though the company always offered telemedicine options for follow-up visits. After the coronavirus began spreading across the U.S., Heal shifted to a telemedicine-first model to minimize exposure risks.
Compared to February levels, Heal has seen its telemedicine business grow “by about 21 times,” according to Desai.
“Starting around March 10, we made it mandatory that everyone had to use telemedicine first, so we can screen for COVID symptoms before you get a house call,” he said. “Now, you have the option of booking either [in-person or telemedicine] visits.”
While Heal’s telemedicine business has skyrocketed recently, its core in-person house call offering has also grown, though at a more gradual rate.
Looking ahead, Heal will look to grow Heal Pass enrollment throughout 2020 while pursuing expansions into new markets. Additionally, the company will continue to explore partnerships with Medicare-certified home health providers and non-medical home care agencies, Desai added.
Heal regularly works with many large home-based care providers already, such as Kindred at Home and Girling Home Health, among others.
“We work with many agencies around the country, from the large providers to your smaller mom-and-pop agencies,” Desai said. “They’re a source of referrals for senior patients.”
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Oak Street Health — a network of value-based primary care offices for Medicare beneficiaries — has filed the initial paperwork to go public. The Chicago-based organization announced the news Friday.
While Oak Street Health doesn’t provide home health care itself, its interdisciplinary care teams are equipped to provide telehealth visits and in-home care in addition to center-based services. Plus, its mission to help seniors age in place aligns with that of home-based care agencies, and Oak Street’s growing presence could mean more opportunities for those providers down the line.
When the initial public offering (IPO) process is complete, Oak Street plans to trade on the New York Stock Exchange (NYSE) under the stock symbol “OHS.” While the company has yet to determine the number of shares it will offer or their price, the S-1 form Oak Street filed with the U.S. Securities and Exchange Commission (SEC) lists its proposed maximum offering price as $100 million.
Founded in 2012, Oak Street Health operates more than 50 centers across eight states, serving more than 85,000 patients, mostly under capitation arrangements. It provides a variety of services, such as those in the behavioral health, pharmacy and primary care realm, just to name a few examples.
The company boasted $200 million in revenues for Q1 2020 on its S-1 — a 72% year-over-year increase. It estimates the annual total addressable market size as about $325 billion, according to the S-1.
Home Health Care News reached out to Oak Street Health for additional details on the IPO, but the company declined further comment for this story.
However, Oak Street did connect with HHCN back in 2017. At the time, then-senior vice president of growth and business development John Woolley told HHCN it was not formally partnering with any home health providers, but rather that it works with various organizations on a patient-by-patient basis.
Still, Woolley said it was open to establishing home health partnerships in the future. The idea is to serve as many seniors as possible who might otherwise struggle to remain in their own homes as they age.
“Nine out of 10 patients recommend us, but there is still a lot to be done,” Woolley said in 2017. “We are just scratching the surface for a population of patients that has been underserved.”
Then, in 2018, the company added Amedisys Inc. (Nasdaq: AMED) President and CEO Paul Kusserow to its board of directors.
Kusserow is expected to be elected to Oak Street’s board of directors once the offering is completed, according to the S-1.
“Kusserow is a valuable member of our Board due to his experience as an executive at several large health care companies and as the CEO of a public healthcare services company,” the S-1 said.
While it’s unclear what Oak Street’s relationship with home-based care providers will be going forward, it’s promising to see home health represented in its leadership.
Additionally, the more organizations working to keep seniors at home as they age, the more opportunities home-based care providers will have to help them in one way or another.
Oak Street attempting to go public comes less than a month after the company’s most recent expansion.
In June, Oak Street announced it will establish hubs in New York and Mississippi by the end of 2020. Timing wise, the expansion will allow Oak Street to serve more vulnerable populations amid the ongoing coronavirus public health emergency.
Since its founding, Oak Street has seen a 51% reduction in patient hospital admissions compared to overall Medicare benchmarks, according to the company.
“We have been able to meet the unique challenges presented by the pandemic, and our ability to adapt and provide care for our patients at this critical time is a testament to Oak Street Health’s innovative value-based health care model,” CEO Mike Pykosz said in a statement. “Our patients always come first, and with our upcoming entry into New York and Mississippi, we are furthering our company’s mission of rebuilding health care as it should be.”
The post Aging-in-place Ally Oak Street Health Files to Go Public appeared first on Home Health Care News.
Two major retail chains — Walgreens and Walmart (NYSE: WMT) — are expanding their health care reach while increasing their footprints in the home- and community-based care space.
Walgreens Boots Alliance (Nasdaq: WBA) — Walgreens’ holding company — and VillageMD announced a five-year plan Wednesday to expand the retailer’s full-service physician services at its stores. As part of the plan, Walgreens and VillageMD will add 500 to 700 more physician offices at Walgreens locations over the next five years.
The two organizations will also place further emphasis on at-home care and telehealth services.
The plan, which is dubbed “Village Medical at Walgreens,” is launching after a successful pilot at five in-store clinics in the Houston market. Now, the goal is to hire 3,600 physicians and enter 30 additional U.S. markets.
Chicago-based VillageMD, through subsidiary Village Medical, is a provider of value-based primary care services.
The at-home care initiative is not a new one for VillageMD, which began as a family practice that paid an abundance of attention to at-home care. That has continued during its transformation to a larger player, co-founder and CMO Dr. Clive Fields told Home Health Care News.
“Home care has been a part of our clinical model since the beginning and will be for as long as I practice medicine and as long as our company is focused on delivering high-quality clinical results for [patients],” Fields said.
VillageMD also recently launched its own at-home care unit, Village Medical At Home, in December 2018.
“We’re really investing in the resources, technology and training so that we can continue to expand the number of patients that we reach at home, moving from that top 1% of the risk stratification to a little bit lower,” Fields said.
Broadly, the Village Medical at Walgreens program will bring more physician offices into more Walgreens stores across the country.
But in addition to increasing access to care, it will also make things more seamless for the patient.
“We do anticipate incorporating telehealth and being able to bring specialists in a variety of different medical specialties into the home without actually disrupting the patient,” Fields said. “Wound care is a classic example because [normally] patients will be seen in a wound care center. [There’s a lot] of difficulty for the patients and family to take them or transfer them from the home to a wound care center. Telehealth and wound care match up incredibly well.”
Of the locations VillageMD and Walgreens are opening, more than 50% will be located in “Health Professional Shortage Areas” and “Medically Underserved Areas/Populations,” as designated by the U.S. Department of Health and Human Services (HHS).
Most of the clinics will be approximately 3,330 square feet, with some as large as 9,000 square feet.
“This rollout is a major advancement of one of Walgreens Boots Alliance’s four key strategic priorities, Creating Neighborhood Health Destinations,” Stefano Pessina, executive vice chairman and CEO of Walgreens Boots Alliance, said in a statement. “These clinics at our conveniently located stores are a significant step forward in creating the pharmacy of the future, meeting many essential health needs all under one roof as well as through other channels.”
Overall, roughly six in 10 Americans live with at least one chronic condition requiring multiple daily medications, according to VillageMD.
As part of the plan, Walgreens Boots Alliance will invest $1 billion in equity and convertible debt in VillageMD over the next three years, including a $250 million equity investment to be completed Wednesday.
Of that investment total, 80% will be used by VillageMD to fund the opening of the clinics and build the partnership, including integration with Walgreens digital assets. Assuming full conversion of the debt, Walgreens Boots Alliance expects to hold an estimated 30% ownership interest in VillageMD at the completion of the investment.
VillageMD and Village Medical’s network includes 2,800 physicians across nine markets. Combined, VillageMD and Village Medical are responsible for about 600,000 lives and $4 billion in total medical spend in value-based contracts.
Walmart dives into Medicare Advantage
Walmart has already dipped its toes into health care in the past. In fact, last year, the $524 billion company even established home health care partnerships with industry giants like Amedisys Inc. (Nasdaq: AMED).
Now, Walmart has quietly launched Walmart Insurance, which filed with the Arkansas Secretary of State last month, according to MedCity News. The retail giant will reportedly focus on Medicare Advantage, which has been a hot topic in home care as eligible benefits have expanded over the last couple of years.
Other retail giants that have invested in home-based care of late include CVS Health (NYSE: CVS) and Best Buy (NYSE: BBY). CVS expanded its in-home capabilities as recently as April, while Best Buy launched a five-year plan of its own to serve 5 million seniors through in-home health monitoring by 2025.
Overall, the big players seem to agree with the assertion that the future of health care is in the home.
“Just in terms of patient satisfaction, clinical results and cost-of-care quality, being able to deliver care in the home … is, in a weird way, a return back to the future,” Fields said. “And we’re looking forward to extending the services.”
It’s time for policymakers, hospitals and everyone else at the health care roulette table to bet all their chips on proactive, pre-acute home-based care.
During the coronavirus pandemic, the U.S. health care system has undergone a massive change marked by the skyrocketing use of telehealth technology and the shift away from brick-and-mortar medical appointments. In fact, from April 2019 to April 2020, telehealth claim lines have increased by more than 8,300% nationally, according to FAIR Health data.
For the most part, though, traditional home-based care has felt like a secondary priority over the past few months, with home health providers and home care agencies largely overshadowed by telehealth trends, hospital capacity concerns and the general state of nursing homes, which continue to be devastated by COVID-19.
“I think that [policymakers] have been very responsive to the needs in the hospital setting,” a Maine home health executive previously told Home Health Care News. “I do not feel that they fully understand the complexity of the patients seen by home health and hospice providers.”
Health care stakeholders may have missed the opportunity to aggressively invest in home health and home care during the initial coronavirus spike, but that door is opening wide once again. Or rather, it never really closed.
The country’s rolling seven-day average of daily new COVID-19 cases shattered all previous records on Monday for the 28th day in a row, the Washington Post reported. At the same time, hospitals across the Sun Belt are being overwhelmed by coronavirus patients, with Arizona reaching 89% capacity for intensive care unit beds and California, Georgia, North Carolina, Texas and a handful of additional states experiencing unprecedented hospitalization numbers.
The new coronavirus spikes in the South and West aren’t part of a different, second COVID-19 wave. They’re continuations of the first wave that was never properly addressed.
Overall, the U.S. death toll linked to the coronavirus hit 130,000 this week, statistics from Johns Hopkins University show. The number of total infections is approaching 3 million.
With those numbers in mind, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a leading member of the Trump administration’s coronavirus task force, is calling for urgent action.
“It’s a serious situation that we have to address immediately,” Fauci said during an online interview Monday with Dr. Francis Collins, who leads the National Institutes of Health as its director.
As part of the nation’s renewed response to the coronavirus, home health and home care need to now be front and center. Fortunately, there are several readily available actions out there that the federal government and other health care players can take to support all shapes and sizes of in-home care providers.
When it comes to home health care agencies, in particular, the U.S. Centers for Medicare & Medicaid Services (CMS) can start by reopening its advanced and accelerated payment programs, allowing operators to focus on patient care and not their finances.
Home health agencies experienced huge financial losses during the early days of the coronavirus due to patients canceling visits and the general suspension of elective surgeries. Cash flow disruptions have somewhat stabilized, but the recent resurgence of COVID-19 cases may retrigger the same anxieties and roadblocks that agencies had to previously overcome.
From March through April, CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers. Home health providers received just $1.7 billion of that before CMS shut down the programs — and many home health agencies in emerging hotspots never even had the opportunity to apply for payments, as they’re just now feeling the impact of the coronavirus.
On top of reopening its advanced and accelerated payment programs, CMS should also consider giving home health providers a more robust Medicare rate adjustment. While the National Association for Home Care & Hospice (NAHC) and other industry advocates have called for a 15% rate increase, CMS recently suggested a 2.6% reimbursement bump in its proposed payment rule for 2021.
Many home health providers won’t be able to stay afloat for much longer without additional financial lifelines. In New York alone, home-based care providers expect to lose upwards of $200 million in 2020, according to financial estimates by the Home Care Association of New York State (HCA-NYS).
“These losses have alarming implications for the viability of New York’s home care system and the necessary support it provides for patients,” Roger Noyes, director of communications at HCA-NYS, previously told HHCN.
Meanwhile, when it comes to supporting home care agencies, Congress should start by seriously considering the creation of a fund that helps operators finance hazard pay and other benefits for front-line workers in its next relief package.
It’s an idea that had been floated by House Democrats in their Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act unveiled in May. Specifically, the House bill included a $200 billion fund for hazard pay for all essential workers.
Interim HealthCare Inc. CEO Jennifer Sheets previously told HHCN she would “love to see” government-supplemented hazard pay for health care workers.
“We need to incentivize people to be on the front line, especially in a pool that’s already prone to high turnover,” she said.
Apart from financial assistance, the Trump administration and FEMA should also organize a personal protective equipment (PPE) push for in-home care providers, similar to what they did for nursing home operators back in April. In-home care agencies have had just as difficult a time securing PPE, if not greater, as they’ve been excluded from most priority lists during the COVID-19 crisis.
Outside of the government, hospitals also need to accelerate the shift toward in-home care. Many already have, including North Memorial Health Hospital in Minnesota, which recently partnered with whole-person, home-based care provider Lifesprk to offer a hospital-at-home model.
“With the outbreak and shortage of personal protective equipment (PPE), one of the just really sad things that all of us have witnessed is when someone goes into the hospital right now and is very sick, their loved ones can’t be there with them,” Dr. Carolyn Ogland, North Memorial’s CMO, previously told HHCN. “This is a way to really help our families and our patients stay together when they are sick.”
If the U.S. health care system acts quickly and invests in home-based care, it will emerge from COVID-19 stronger than ever. But the window of opportunity is closing, so stakeholders must act now.
The post Time for Policymakers, Hospitals to Bet Big on Home-Based Care appeared first on Home Health Care News.
Recently Mariah Baltezegar, MBA, Executive Director and Head of Peri- and Post-Approval Virtual Trials with Evidera, and Niklas Morton, MSc, Senior Vice President and Global Head of Digital Services with PPD, spoke with leaders of Science 37 and Medable, two companies Evidera and PPD partner with for design and implementation of digitally-enabled studies and are […]
The post Digital Approaches in the Era of COVID-19: Interviews with Science 37 and Medable appeared first on PharmaVOICE.
There are plenty of ways to engage with our TEDMED 2020 class of Hive Innovators. Whether in a Hive Innovator Meetup, the Community Lunch, where we will have the opportunity to explore the Innovator’s “What If” questions, or through TEDMED Scout: Your AR Guide to Innovation. This year, the Hive Innovator experience is powered by our partner TBWAWorldHealth.
At TEDMED 2020, the Hive Innovators will participate in curated meetup discussions around a topic that aligns to their work. Innovator Meetups are open to everyone in the TEDMED Community onsite and are an exciting opportunity to learn more about the Hive Innovators and the work they do to shape a healthier humanity. This year’s Hive Innovator Meetup topics include: New Age Diagnostics, Personalizing Digital Health, New Models of Mental Health Care, Mapping Human Health, The Power of Medical Knowledge, and Health Techquity.
Community Lunch: Celebrating Innovation with the Hive Innovators and the TEDMED Community
Delegates are invited to join the Hive Innovators and the larger TEDMED Community members for a lunch inspired by innovation. Get to know the Hive Innovators by joining them for lunch at the tables marked with their “What If?” Questions.
TEDMED Scout: Your AR Guide to Innovation
Embracing this year’s theme, “Make Way for Wonder”, TEDMED joined forces with TBWAWorldHealth to curate an experience that celebrates innovation and unlocks our sense of wonder. Throughout the event, Delegates can unlock an Augmented Reality experience, we are calling TEDMED Scout: Your AR Guide to Innovation, with their phones to get a closer look at the ideas each innovator represents. And, a virtual concierge will guide onsite networking connections between Innovators and our community like never before. After the event, the experience will live on digitally, giving anyone in the world access to the 2020 TEDMED Hive Innovators and the amazing ideas they are working to make a reality.
Register today to join us onsite in Boston and experience TEDMED 2020 in person!
We are happy to announce the TEDMED 2020 Hive Program, which will feature inspiring entrepreneurs and their organizations.
As always, this year’s Hive class is made of Innovators representing early- to mid-stage organizations across 6 categories: 1) Life Sciences & Therapeutics 2) Med-Tech & Med-Device 3) Mobile & Digital Health 4) Health Systems, Care Delivery, and Reimbursement Models 5) Advancing Science 6) Public Health
New this year, the Innovators will be a part of an interactive onsite experience powered by TBWAWorldHealth. Through this awe-inspiring experience that invokes wonder, Delegates have the opportunity to explore the power of asking “What if?” in fields from AI-driven mental health care, to novel drug discovery and development, to new models of human and animal genomics, and much more.
This year’s Innovators were carefully selected from hundreds of organizations doing groundbreaking work in health and medicine. If you’d like to nominate an organization for next year’s Hive you can do so here.
The TEDMED 2020 theme is Make Way For Wonder, and we are looking forward to convening our Community and embracing the wonders of our times, the astonishing accomplishments, incredible possibilities, and extraordinary potential for the future. So, we were thrilled when the United States Pharmacopeia (USP) decided to celebrate its 200th Anniversary with TEDMED. After all, today’s wonders are built upon a strong foundation of scientific discovery. And, humanity is especially eager for those innovations that will help people everywhere live longer and healthier lives. In anticipation of USP’s presence at TEDMED in March, we talked with Ronald T. Piervincenzi, Ph.D., chief executive officer, about the organization’s history, its current work, and its approach to building trust in the future of medicine, supplements, and foods.
TEDMED: We’re excited to have you and USP join the TEDMED Community, especially on the occasion of such a monumental milestone – USP’s 200th anniversary.
Ronald T. Piervincenzi: Thank you. I’m thrilled to introduce USP to TEDMED’s audience and look forward to meeting attendees in Boston in March.
TM: What made you choose TEDMED to celebrate this milestone anniversary?
RP: Today, we are observing an unprecedented transformation in healthcare. USP’s 200-year legacy is built on trust and confidence in healthcare systems and anticipating and responding to emerging health challenges. Our founders joined together in 1820 to protect patients from a prevalence of poor-quality medical products. The backdrop today is different in scale, geography, modalities and many other factors. But the value of our work is the same. We are exploring how to build trust in future medical breakthroughs. There are many in the TEDMED community we can learn from and engage with as we imagine what the future holds.
TM: That’s exactly what TEDMED is all about! Let’s dive in. What is a pharmacopeia and what does USP do?
RP: Simply put a pharmacopeia is an official publication that includes a list of medicinal drugs and contains how those medicines are to be prepared, directions for their use, and assays to assess medicinal quality. The United States Pharmacopeia–National Formulary, which USP publishes, is the official quality standard for medicines marketed in the U.S. It is also used in over 140 other countries. USP is the leading independent scientific nonprofit organization that collaborates with the world’s top experts in health and science to develop quality standards for medicines, dietary supplements, and food ingredients. Through our standards, advocacy and capability building, USP helps increase the availability of quality medicines, supplements and food for billions of people worldwide. As the world gets smaller and more connected, quality issues affect everyone. Diseases travel. Drug resistance grows. Fake medicines kill. The foundation of quality we’re building helps address these and other global health challenges. Whether decreasing the prevalence of substandard and poor-quality medicines or helping to curb antimicrobial resistance, we’re there across 10 global sites working to protect the health of people all over the world.
TM: This seems like a very modern approach to medicine. Why did the U.S. need a pharmacopeia in 1820?
RP: Today, people trust U.S. medicines to be among the safest in the world but that wasn’t always true. In 1820, the U.S. was a new country. Medicines were made individually and differently by physicians or apothecaries. There were no regulations or more importantly, standards, to ensure that what you received in one city was the same as another. A medicine’s strength, quality, and even its identity varied widely depending on where it was made. Simply put, before our founding in 1820, there was no way to ensure that what was on the medicine label was what was actually in the bottle. Our founders—11 independent, forward-looking physicians— were concerned about this lack of uniformity and acted to protect patients from poor-quality medicines. Three of our founders were not only physicians, but also U.S. Senators—they were the voice that the U.S. needed to ensure the quality of medicines Americans used. They established the U.S. Pharmacopeial Convention, which published the first U.S. Pharmacopeia. A great deal has changed since our founding but the importance of having quality standards for medicines and other new therapies remains—now, our work is much more global.
TM: This year’s TEDMED theme, “Make Way for Wonder,” explores how medicine and healthcare is changing. Is that a theme that resonates with you?
RP: Absolutely. Wonder and scientific discovery makes medical breakthroughs possible. But trust makes them popular. More than 800 independent volunteer scientists contribute their expertise to develop and approve USP’s standards. They help to build trust by setting clear quality expectations for medicines, dietary supplements, and foods. In turn, USP standards help manufacturers worldwide bring more quality and affordable products to market, which benefits people everywhere. A recent Johns Hopkins University study found that on average, drugs with a USP public quality standard had approximately 50% more generic manufacturers compared with medicines without such a standard. The study also found that quality standards helped facilitate pharmaceutical competition and reduce prescription drug costs in the U.S.
TM: How does a 200-year-old organization prepare for the future?
RP: New technologies and treatments—precision medicine, digital therapeutics, 3D printing, immunotherapy, gene and stem cell therapies, and artificial intelligence—have arrived or are on their way. As we prepare for dramatic breakthroughs, we must work to ensure trust and quality are established as a part of these advances. Unfortunately, trust broadly is in a precarious position across sectors. Our history has taught us that for an innovation to become a widespread reality, both quality and trust are critical to its broad acceptance. USP together with hundreds of our stakeholder organizations and partners are already working to build confidence in future breakthroughs and to anticipate and address where the gaps will be. We know that when a USP public standard is available, we help manufacturers be better able to adopt the new technology, which is often a significant cost savings. In addition to conducting workshops and roundtables on topics such as cell and gene therapies and digital therapeutics, USP is working with the MIT Center for Collective Intelligence and more than 100 leaders from health and science worldwide to explore the developments and role that trust will play in shaping people’s health between now and 2040. We will explore the project’s findings from this “Trust CoLab” with the TEDMED 2020 Community.
TM: We’ll look forward to learning more about the Trust CoLab. Until then, what else should the TEDMED Community know about USP?
RP: I mentioned our volunteer scientists earlier. I invite TEDMED community members who are committed to making the world healthier, being scientifically rigorous, and working independently from politics or the private sector, to consider becoming a Champion of Trust. They can learn more by visiting our website or by stopping by the USP Lounge in the Social Hub at TEDMED. I also encourage everyone to also learn more about USP’s past, present and future and opportunities for other collaborations with us at www.usp.org/200?utm_source=rss&utm_medium=rss.
TM: Thank you, Ron and very best wishes on the beginning of USP’s third century.
The post The United States Pharmacopeia: 200 Years of Building Trust in Medicine appeared first on TEDMED Blog.