In this series, Health Evolution is examining the year 2021 in health care through the lens of our eight imperatives. We will be examining the trends that were at the top of CEOs’ minds throughout the past year and what may come in 2022. This week: Engaging health consumers
Strengthening system resilience
Confronting the mental health crisis.
Realizing medical breakthroughs
Amid the funding craze in digital health, there is an arms race happening within home-based health care as major payers, providers, retail giants, health IT companies, and other organizations work to broaden their offerings in the burgeoning space.
Take for instance, CVS Health. At the annual JP Morgan Healthcare Conference, CVS Health CEO Karen Lynch said that said that the company will “expand our home health services capabilities that we offer in the marketplace using a model that integrates health programs for complex populations.” Meanwhile, UnitedHealth Group COO Dirk McMahon recently said on an earnings call that “home-based clinical care initiatives at Optum and UnitedHealthcare are central to improving near- and longer-term health outcomes for people with medical, behavioral and social need.”
As another example, Humana has strategically grown its Medicare Advantage plan offerings, which often rely on home-based health care services to lower costs and improve outcomes in value-based arrangements. In 2021, it acquired one of the largest home-based health services companies in the country, Kindred at Home, for $8.1 billion. It has also made strategic partnerships with numerous companies in the home-based health care space such as DispatchHealth and Papa. In the retail world, Best Buy Health acquired Current Health, which provides a care at home platform that combines remote patient monitoring, telehealth and patient engagement for providers.
“As seniors increasingly choose Medicare Advantage, there is a meaningful opportunity for home health organizations to engage differently with patients, and [MA] payers to more holistically address patient needs, improve health outcomes and reduce the total cost of care for health plans and share appropriately in this value creation,” Humana CEO Bruce Broussard said on a recent earnings call.
At the center of this trend are consumers. More and more patients who would rather receive hospital-level care at home than in the hospital. According to a survey from Moving Health Home (MHH), a coalition of health care organizations advocating for improved access to home-based care, 73 percent of adults are confident in the quality of care they would receive in the home. The overwhelming majority of people who have received home-based care were satisfied (88 percent) and would be likely to recommend to family and friends (85 percent).
Another survey, from the Partnership for Quality Home Healthcare (PQHH), found more than nine in ten Medicare beneficiaries (94 percent) say they would prefer to receive post-hospital short-term health care at home. Only 3 percent say they would prefer a nursing home.
Mayo Clinic is all in on hospital at home
Mayo Clinic is one prominent health system that has leaned into home-based care. The organization launched an advanced care at home model in 2020 that provides various health services to qualified patients within their home. Michael Maniaci, M.D., physician leader for advanced care at home at Mayo Clinic, said the idea was originally proposed in 2018 by the company’s CEO Gianrico Farrugia, MD.
“He said that more care in the home, especially high acuity care, which really wasn’t done on a large scale until that time, is the future of Mayo,” said Maniaci. “We took our first patient in July of 2020, which was planned before COVID was even around. Obviously, it ended up being good timing from that perspective and the regulatory measures were moving to favor us scaling up more rapidly.”
The regulatory measure Maniaci is referring to is CMS’ Acute Hospital Care at Home program, a waiver that allowed eligible hospitals with regulatory flexibilities to treat eligible patients in their homes via telemedicine and virtual health technologies. The program was announced in November 2020 and will be in place for the duration of the COVID-19 public health emergency. However, Mayo and a number of other hospitals are hoping to convince CMS to enact measures that will allow for this to continue permanently.
I see virtual care spreading not just into the home, but all settings, such as a church or a mission when there’s a disaster, as opposed to sending one hundred doctors out to one area.
Michael Maniaci, MD, Mayo Clinic
“We have wonderful health care institutions and 10 miles away there are people who can’t get there. If we decentralize health care and give everyone access to care via virtual care, we can reach more people, keep them healthier and that saves money in the long run for the health system,” Maniaci says. He notes that he is pushing to partner with rural health care institutions to employ the hospital at home model and improve access in underserved areas.
Mayo aligned with another hospital at home pioneer, Kaiser Permanente, to help form the Advanced Care at Home Coalition. The group is advocating for extending the waiver past the public health emergency and potentially having the CMS Innovation Center (CMMI) test an advanced care at home delivery model. Maniaci says the coalition wants to work with the government to set the rules for an at-home care model and ensure participants are practicing correctly with patient safety at the forefront.
The model Mayo deploys goes beyond the CMS diagnostic related group coverage guidelines and spans a 30-day bundle. While this means the at-home model ends up costing Mayo out of pocket, it allows the institution to provide the best care it can for patients and prove the value of doing this longitudinally, Maniaci says. It also helps prevent readmissions, unnecessary procedures and keeps beds open for people who need it the most. Most prominently, it’s improving patient satisfaction.
“Our patients adopted quickly. I am sure COVID helped with that, but almost every single one of our patients in this model has rated it five out of five stars. They love the experience. They love the attention. I am not rushing them, seeing them in a hospital room for five minutes and then leaving. I’m in their home, it might be a virtual connection, but I’m there. They’re sitting on their couch with their dog and their family, I get to learn about them, their environment, and set an individualized care plan for them at home,” Maniaci says.
Beyond the federal regulatory issues, Maniaci says that each state has different rules and regulations on how medicine can be practiced in this type of setting. For a national brand, such as Mayo, this can be challenging. He also notes that the supply chain issues plaguing the country mean there are often less resources to take care of a patient in the home rather than the hospital.
Not going anywhere
The Advanced Care Coalition is not the only effort from the industry to push forward with home-based health care flexibilities offered by CMS, which has seen participation from 90 health systems and 197 hospitals in 34 states. Moving Healthcare Home, the coalition that sponsored the consumer survey from above, wrote a letter to Congressional leaders this week urging them to extend the Acute Hospital Care at Home waiver for another two years.
The letter was signed by 48 stakeholder organizations, including health systems, home health agencies, value-based care companies, non-profit entities, home infusion groups, and more. As is often the case in health care, CMS will lead the way for private insurers to act. While some payers, such as Humana, are making strides toward hospital-at-home, most don’t have the structure to reimburse for these programs. These types of coalitions seek to change this long-term reimbursement obstacle.
Regardless of how quickly CMS acts on these requests, Pandora’s Box has been opened. There is no going back when it comes to virtual care and home-based health care, Maniaci says. People have been introduced to a world where virtual care is a reality, which means they will continue to drive this trend forward.
“I see virtual care spreading not just into the home, but all settings, such as a church or a mission when there’s a disaster, as opposed to sending one hundred doctors out to one area. International care will be the same. One day I’ll be treating patients in my command center, not just across the country, but across the world, so we can share our expertise as opposed to spreading people out. I don’t think it’s ever going to go away. I think it’s only going to be intensified as we’ve seen with every other industry,” says Maniaci.