In the News

More Payers Leaning Into High-Acuity, At-Home Care Could Be ‘Game Changer’

Home Health Care News | By Andrew Donlan 

Hospital-at-home care had a breakthrough moment in the U.S. after the onset of COVID-19.

At the end of 2022, the $1.66 trillion omnibus spending bill made sure that the financial setup that helped get hospital-at-home programs off the the ground during the pandemic would not go away once the public health emergency ended.

But the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver is now just one part of the larger shift to high-acuity home-based care. While that funding mechanism remains, organizations are also finding new ways to fund hospital at home – and new models to bring into the home.

Medically Home – one of the early adopters of a business model tailored around enabling hospital-level care in the home – recently unveiled its “ED in Home” model, which is meant to bring emergency department care into a patient’s home.

“Our primary focus is to build the core chassis to decentralize care,” Medically Home CEO Rami Karjian told Home Health Care News. “So, what you’re seeing here with ED in Home is a natural extension of that primary focus to decentralized care to another use case.”

The Boston-based Medically Home partners with health plans, health systems and other providers to enable hospital-level care in the home, namely through coordinating in-home clinician visits and supplying the necessary technology, medication and equipment.

Its financial backers include the Mayo Clinic, Kaiser Permanente, Baxter International Inc. (NYSE: BAX), Global Medical Response and Cardinal Health Inc. (NYSE: CAH).

The ED in Home program was officially announced in January, though thousands of patients had already been cared for underneath it at that point. While it’s live in Massachusetts, Medically Home is actively working on bringing it to other states across the country, though Karjian declined to name specific ones at this point.

“Adding ED at Home is another use case, and it’s particularly powerful today, because of the access challenges that COVID exposed,” Karjian said. “Patients don’t want to go to the hospital, they don’t want to be in the hospital, they’re finding it harder and harder to get to a hospital. This brings the hospital front door to them in a way that inpatient care alone couldn’t.”

More payers getting involved

CMS and the Acute Hospital Care at Home waiver were the primary drivers of health systems delving into hospital at home in 2020 and 2021. But the model is no longer a niche service offering.

Because of home-based care’s ability to drive down costs, there’s an increasing amount of payers and providers willing to engage.

“The commercial payers are really starting to accelerate the rollout and adoption of this,” Karjian said. “We’ve had a number of the commercial payers in a number of states come to us and just say, ‘How can we work together, along with the health systems, to accelerate this and maybe even provide some of the funding that would allow this to progress?’ So, that’s very exciting.”

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Despite Hardball Tactics With Home Health Providers, MA Plans Have High Gross Margins

Home Health Care News | By Patrick Filbin
Insurers are reporting much higher gross margins per enrollee in the Medicare Advantage (MA) market than in other health insurance markets, according to a new Kaiser Family Foundation analysis.
At the same time, many Medicare Advantage plans continue to play hardball with home health providers by rationing utilization and offering low rates.
The KFF analysis took a look at financial data in four insurer markets: Medicare Advantage, Medicaid managed care, individual (non-group) and fully insured group.
In 2021, MA insurers reported gross margins averaging $1,730 per enrollee. That was at least double the margins reported by insurers in the individual/non-group market ($745), the fully insured group/employer market ($689) and the Medicaid managed care market ($768). Source: KFF
There is still some margin pressure for MA plans, as the Centers for Medicare & Medicaid Services (CMS) is looking to increase oversight of them and claw back overpayments in the near-term future.
While MA pays almost the same as traditional Medicare in a hospital setting, for instance, skilled nursing facilities and home health agencies are often paid far less by MA for services.
“Medicare Advantage plans have both higher average costs and higher premiums (largely paid by the federal government) because Medicare covers an older, sicker population,” KFF reported. “While Medicare Advantage insurers spend a similar share of their premiums on benefits as other insurers in other markets, the gross margins — which include profits and administrative costs — of Medicare Advantage plans tend to be higher.”

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CMS PDGM Webinar and Data

CMS has announced a webinar on March 29 that will provide an overview of provisions from the CY 2023 HH PPS final rule, including behavior changes, and payment rate development. They've also released data on simulated 60 day episodes and actual 30 day periods used in their rate setting and adjustments.

Webinar registration, the released data, and additional information can be found here:


Organ Damage for 59% of Patients with Long COVID Continues a Year After Initial Symptoms

A new comprehensive study of organ impairment in long COVID patients over 12 months shows organ damage persisted in 59% of patients a year after initial symptoms, even in those not severely affected when first diagnosed with the virus.

The study, published in the Journal of the Royal Society of Medicine, focused on patients reporting extreme breathlessness, cognitive dysfunction and poor health-related quality of life. 536 long COVID patients were included in the study. 13% were hospitalized when first diagnosed with COVID-19. 32% of people taking part in the study were healthcare workers.

Of the 536 patients, 331 (62%) were identified with organ impairment six months after their initial diagnosis. These patients were followed up six months later with a 40-minute multi-organ MRI scan (Perspectum's CoverScan), analyzed in Oxford.

The findings confirmed that 29% of patients with long COVID had multi-organ impairment, with persistent symptoms and reduced function at six and twelve months. 59% of long COVID patients had single organ impairment 12 months after initial diagnosis.

A member of the research group, Professor Amitava Banerjee, Professor of Clinical Data Science at the UCL Institute of Health Informatics, said, "Symptoms were common at six and twelve months and associated with female gender, younger age and single organ impairment."

The study reported a reduction in symptoms between six and 12 months (extreme breathlessness from 38% to 30% of patients, cognitive dysfunction from 48% to 38% of patients and poor health-related quality of life from 57% to 45% of patients).

Professor Banerjee added, "Several studies confirm persistence of symptoms in individuals with long COVID up to one year. We now add that three in five people with long COVID have impairment in at least one organ, and one in four have impairment in two or more organs, in some cases without symptoms."

He said, "Impact on quality of life and time off work, particularly in healthcare workers, is a major concern for individuals, health systems and economies. Many healthcare workers in our study had no prior illness, but of 172 such participants, 19 were still symptomatic at follow-up and off work at a median of 180 days."

The underlying mechanisms of long COVID remain elusive, say the researchers, who did not find evidence by symptoms, blood investigations or MRI to clearly define long COVID subtypes. They say that future research must consider associations between symptoms, multi-organ impairment and function in larger cohorts.

Prof Banerjee concluded, "Organ impairment in long COVID has implications for symptoms, quality of life and longer-term health, signaling the need for prevention and integrated care for long COVID patients."


Home Health Leads to Higher Costs After Hip Surgery, Study Finds

McKnight’s Long-Term Care News | By Rachael Zimlich
Home healthcare services provided after hospital discharge have, in general, been associated with reduced healthcare cost and utilization. A new study examining costs after hip replacement surgery hints that such benefits may be exaggerated.
In a new study published in the Journal of Arthroplasty, researchers examined the home healthcare service records of patients who underwent elective hip replacements between 2010 and 2019. The goal was to determine the value of home health services to patients who were discharged to their homes after a total hip replacement.
The home health care group had a higher rate of emergency department visits and hospital readmissions in the initial 90-day post-operative period than the self-care group, researchers found. Length of hospital stays and total cost of care a year out from surgery was also higher in the home health care group, according to the report.
As part of the study, investigators examined rates of complications such as joint infection and hardware problems for a year after surgery. The primary medical complications observed in the post-operative period were fairly common to other surgeries and included pulmonary embolism, deep vein thrombosis, myocardial infarction, pneumonia, sepsis and urinary tract infection.
The study also found there was no significant difference in the development of these complications in the study group discharged with home health care services and the study group that was discharged to their own care.
Researchers say the study challenges previously held notions that home healthcare services after hospital discharge are associated with cost savings across the board. Instead, the study suggests that more research be done to examine patient-specific discharge needs, focusing the use of home healthcare services on the most at-risk population instead of assigning this level of care in a one-size-fits all strategy based on a specific diagnosis or procedure type.

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