Whitepaper: The Future of Home Healthcare Post the COVID-19 Pandemic | myNEXUS®
01 . 09 . 2020
01 . 09 . 2020
Even before COVID-19 arrived and impacted the United States’ healthcare delivery system, care was moving from the facilities and offices to the home. The incentives for this migration of care were and are clear. Healthcare delivered in the home is more convenient for the patient and their family, less costly for the healthcare system, and, under the right circumstances, delivers similar outcomes to care delivered in facilities and offices.
Examples of this transition include, but are not limited to, hospital at home, telehealth physician visits, remote monitoring, home-based primary care, hospice at home, and home-based skilled nursing and therapy. Therefore, the impact of COVID-19 was not that it initiated this migration but rather that it accelerated it. A May 29, 2020 report from McKinsey and Company estimated that health professionals are now seeing 50 to 175 times the number of patients via telehealth than they did before the pandemic and that 46% of patients are now using telehealth to replace canceled in-person visits, up from the just 11% of patients who used telehealth in 2019. The report makes clear that this trend will persist and accelerate even after the pandemic abates.
Home Healthcare (HHC) with its history of managing post-acute and chronic disease is one segment of the care delivery ecosystem that is well-situated to make the most of this ever-expanding move to the home. Though most health care leaders and providers associate home healthcare with skilled nursing care, the HHC Medicare benefit also includes home-based physical therapy, occupational therapy, speech therapy, social work services, and home health aides. Further, under most Medicaid programs and some commercial plans, private duty nursing is also covered. Home healthcare agencies (HHA) have the experience and operational infrastructure to scale their clinical workforce to meet the increasing demand for care in the home, and many are experienced at using technology to monitor patients remotely. High-quality home-based skilled care can manage patients with the acute disease without increasing the likelihood of a readmission.
Further, utilizing HHC to contribute to the management of acute disease improves patient’s experience, reduces the cost of care, and reduces the likelihood of COVID-19 transmission. In fact, not only can HHC providers provide care for patients in the home that would otherwise be managed in a skilled nursing facility or a hospital observation unit, but they can also close gaps in care, test patients for COVID-192, identify and mitigate social barriers to care, assist with the delivery of primary care in the home, and link unstable patients to more intense levels of care in the home (e.g. primary care, urgent care, palliative care, hospice, and hospital at home). Finally, innovative remote technology will improve the overall quality of care that is delivered and hasten the transition to home. However, before broadening the utilization of HHC to manage additional clinical situations in the home, several barriers would have to be resolved.
First, a payment mechanism for remote care and telehealth would need to be developed. Currently, Medicare pays for HHCusing the Patient-Driven Grouper Model (PDGM). PDGM is an episodic reimbursement model that does not count remote management as part of the episode. This Medicare reimbursement methodology has been written into statute and cannot be overridden by regulatory modifications. While some network convenors have solved this challenge, for most payers and providers in the market, Medicare’s reimbursement methodology remains a barrier to the expansion of HHC services.
Second, the expansion of HHC services to manage more acutely ill patients requires collaboration across multiple care delivery settings. For example, hospital discharge planners will need to envision HHC as a viable alternative to skilled nursing care. That is, some patients that traditionally would have been managed in a skilled nursing facility post-discharge may be able to be managed successfully in the home. Identifying the appropriate post-discharge setting of care for more acutely ill patients or for those facing barriers to care in the home requires collaboration between the hospital’s discharge planning team and the HHA.
Third, managing more acutely ill patients in the home requires that the HHAs and HHC providers deliver high quality, attentive care. This includes developing capabilities for timely, comprehensive, and effective interdisciplinary communication between ordering providers (physicians and nurse practitioners) and HHA staff. Given that the industry is quite fragmented with over 12,000 providers, the quality of care can be quite variable. Thus, risk-bearing entities responsible for designing and managing HHC networks will be obligated to assess the quality of care that is being delivered by each contracted HHA in order to create a network of high-quality providers capable of managing these patients. Without this level of oversight, some contracted providers may simply not be able to provide the level of care necessary to transition the care of higher-risk patients to the home.
Fourth, as more care is moved to the home, the burden on patient’s families and caregivers will likely increase commensurately. Already caregivers provide an average of 20 hours of services per week and are heavily involved in assisting their ill family members with activities of daily living. The development of a national strategy to provide support for family caregivers will be a key dependency for the sustainability of more intensive home healthcare.
COVID-19 may or may not turn out to be a repeatable event. Regardless, multiple drivers will continue to push care to the home. As new solutions are developed to support this push, the healthcare industry should not lose sight of a pre-existing, fully capable, scalable, and proven delivery system – skilled home healthcare. Home healthcare benefit management companies have consistently delivered results for traditional homebound patients with chronic disease. Under the right circumstances, they can also deliver high-quality care for patients with more acute diseases.
We have been working hard over the past few months to develop and deploy innovative solutions that address each of the four opportunities listed above. Our website speaks to these solutions. As well, the website contains ongoing thought leadership and content related to home healthcare. Should you be interested, the myNEXUS’ team is available to meet via web-conferencing to further discuss COVID-19’s impact on care in the home.
2. Home Health Agencies: CMS Flexibilities to Fight COVID-19. https://www.cms.gov/files/document/covid-home-health-agencies.pdf
3. Ku, L. 11 Remote Patient Monitoring Companies You Should Know About. https://www.plugandplaytechcenter.com/resources/10-remote-patient-monitoring-companies-you-should-know-about/
4. Peter Hudson, R. Sean Morrison, Richard Schulz, Abraham Aizer Brody, Constance Dahlin, Kathleen Kelly, and Diane E.Meier.Palliative Medicine Reports. Jun 2020.6-17
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