Category: Benefits of HBPC

Blue Shield of California targets patients with complex needs in house call program

Post author By Jim Nonneman
Post date June 17, 2019

May 22, 2019 | by: Paige Minemyer | FierceHealthcare.com

Blue Shield of California has teamed up with Landmark Health to offer more house calls to members with chronic conditions—at no additional cost.

The insurer has enrolled 3,500 people in the program over the last year and has provided 15,000 in-home visits in that opening window, Blue Shield announced Wednesday. The key, the team told FierceHealthcare, is making sure both members and physicians understand that this is not meant to replace primary care providers (PCPs).

Instead, Landmark’s providers work alongside a patient’s existing PCP to provide care, particularly in the case of an urgent emergency to avoid a pricey, unneeded hospital admission.

“We see this as a real strategy—comprehensive, coordinated care for a physically vulnerable population,” said Malaika Stoll, M.D., senior medical director at Blue Shield of California. Read the full article

Benefits of HBPC HCCIntel

A Large-Scale Advanced Illness Intervention Informs Medicare’s New Serious Illness Payment Model

Post author By Jim Nonneman
Post date June 10, 2019

June 2019
Written by: Brad Stuart, Elizabeth Mahler and Praba Koomson
Publication: HealthAffairs.org

Abstract

Patients with advanced illness receive fragmented, hospital-based care that is unaligned with their preferences near the end of life. We describe a team-based intervention that provides home-based, coordinated care to more than 2,000 seriously ill patients daily in nineteen urban, suburban, or rural counties in California. In the last month of life, compared to matched Medicare beneficiaries in similar counties, this program reduced hospital days by 1,361 per 1,000 beneficiaries, hospital deaths by 8.2 percent, inpatient payments by $6,127, and the total cost of care by $5,657 per beneficiary. The Centers for Medicare and Medicaid Services (CMS) has announced a new Medicare payment model for serious illness care, based in part on this program. To inform model development and implementation, we describe lessons learned about changing the focus of care for advanced illness from hospital to home, broadening care coordination to achieve system integration, and developing methods for payment and quality accountability that transform care delivery.

Beneficiaries with advanced illness (also called “serious illness”) account for 4 percent of the Medicare population but 25 percent of its costs. Advanced illness refers to late-stage chronic illness, when one or more conditions become serious enough that general health and function decline and treatments begin to lose their impact—a state that progresses to the end of life.¹ Patients with advanced illness often undergo unwanted, avoidable, and costly hospitalizations near the end of life.

Neither current Medicare reimbursement nor the present portfolio of the alternative payment models of the Centers for Medicare and Medicaid Services (CMS) adequately finances home-based care to remedy this, and available services are underused and overstressed. Medicare pays for home hospice care, but many enrollees don’t benefit from its services because they are not admitted until days before death, often following intensive hospitalizations.² Lacking a major expansion initiative, palliative care fellowship training programs will not meet the burgeoning demand as the US population ages.³

New clinical and payment models are needed, particularly for the two-thirds of beneficiaries enrolled in fee-for-service Medicare, to integrate fragmented delivery systems and incentivize providers to create team-based care at home for patients and their families and caregivers. The Coalition to Transform Advanced Care (C-TAC), a not-for-profit organization representing over 150 US health systems, health plans, hospices, community-based organizations, and leading consumer and patient advocacy organizations,⁴ has proposed such a delivery and payment model for patients with advanced illness⁵ to the Center for Medicare and Medicaid Innovation (CMMI). The model, called Advanced Illness Management (AIM), was developed at Sutter Health, a large integrated health system in California. CMMI has announced a new serious illness payment model based on C-TAC’s proposal and another from the American Academy of Hospice and Palliative Medicine.⁶

In this article we describe the piloting, scaling, and testing that formed the backbone of C-TAC’s model. Based on that experience, we share lessons learned that could inform CMMI’s efforts to improve care for Medicare beneficiaries with advanced illness.

Read the full article

Benefits of HBPC HCCIntel

CMO Dr. William Shrank on Humana’s physician strategy, ‘Medicare for All’ and home care as the Netflix of healthcare

Post author By Jim Nonneman
Post date June 6, 2019

Morgan Haefner | June 4, 2019 | Beckers Hospital Review

Humana wants to do for healthcare what Netflix did for home entertainment.

Humana’s CMO William Shrank, MD, said the insurer’s strategy for its 16 million members, most of whom are Medicare Advantage enrollees, is to meet patients where they are — at home.

“If you look at the movie industry, you see there was a time when people used to go to the retail outlet to buy or rent their DVDs, and now there’s a better service that’s more convenient. It’s more personalized in the home,” Dr. Shrank told Becker’s Hospital Review during an in-person interview June 4. “That’s our goal. Our goal is to be that more progressive solution that is patient-focused, convenient, integrated and meets patients where they are. It’s more of a Netflix kind of thing.”

For Humana, this means better leveraging data, technology and analytics to be proactive, and reaching out to patients before medical issues arise to provide appropriate services in their bedrooms, kitchens and living rooms.

It’s a different tactic than competitors like CVS Health/Aetna and UnitedHealth Group have used, but Dr. Shrank said that to Humana, home-based care is the future of healthcare. The insurer’s investments are evidence: Humana and two private equity firms bought Louisville, Ky.-based post-acute care provider Kindred Healthcare in a $4.1 billion deal, with the trio also buying hospice operator Curo Health Services for $1.4 billion.

Here, Dr. Shrank further discusses Humana’s at-home strategy and answers questions on the payer’s primary care moves, its partnerships with hospitals and the possibility of “Medicare for All.”

Editor’s note: Responses have been lightly edited for clarity and length.

Question: CVS/Aetna just announced plans to open 1,500 “HealthHubs.” UnitedHealth’s Optum is acquiring physicians. Amid these moves from competitors, what’s your physician strategy?

Dr. William Shrank: The large payers — at least the three of us focused heavily on Medicare Advantage — are blurring the lines between payer and provider. We’re thinking more holistically about how we manage a population rather than figuring out how to pay claims. We are all taking a little bit of a different tactic. Ours is focused on the home, on meeting patients where they are. United is going to buy more and more primary care docs, and CVS is doing more in the retail space. We think the future of healthcare is going to be in the home. Read the full article

Benefits of HBPC HCCIntel

ACOs Commonly Use Home Visits for Complex Patients During Care Transitions

Post author By Jim Nonneman
Post date June 6, 2019

June 4, 2019
Authors: Taressa K. Fraze, Laura B. Beidler, Adam Briggs, and Carrie H. Colla
commonwealthfund.org

The Issue

Years ago, it was not uncommon for physicians to make house calls. But in the past 50 years, care has largely transitioned to physicians’ offices. Office-based visits are more efficient, and reimbursement for home visits can be challenging under fee-for-service payment. However, there are advantages to home visits: they can improve health outcomes, and they can decrease spending on patients with complex needs, including patients with chronic conditions and those recently discharged from the hospital. With support in part by a six-foundation collaborative that includes the Commonwealth Fund, Peterson Center on Healthcare, Robert Wood Johnson Foundation, SCAN Foundation, John A. Hartford Foundation, and Milbank Memorial Fund, researchers looked at whether health care providers contracted with accountable care organizations (ACOs) were more likely than non-ACO practices to employ home visits. The study, published in Health Affairs, used 2017–2018 survey results as well as data obtained from interviews with 18 ACO leaders.

What the Study Found

ACO physician practices were more likely than non-ACO practices to conduct home visits for complex patients within 72 hours of hospital discharge (25.7% vs. 18.8%).
ACOs using home visits tended to be larger (include a hospital or contract with more physicians) and more likely to be part of an integrated delivery system than ACOs that did not use home visits.
More than 50 percent of ACOs that participated in risk-bearing payment arrangements, such as episode-based bundled payment, employed home visits. In comparison, only 30.2 percent of ACOs that did not have risk-bearing contracts used home visits.
In addition to using home visits as part of a care management or care transitions program for complex patients, ACOs used home visits for patients who were noncompliant or nonresponsive with office-based care.
Postdischarge visits were common, but some ACOs also used home visits on an as-needed basis, such as when care teams sense something is not right with a patient or a patient cannot be reached by phone or other means.
Care team members who conducted home visits included care management staff, nurses, social workers, health coaches, and pharmacists.
Looking at only Medicare ACOs, the researchers saw no significant differences in quality scores or likelihood of achieving shared savings between ACOs that used care transition home visits and those that did not.

Read the full article

Benefits of HBPC HCCIntel

York Hospital Increases Services for Older Adults

Post author By Jim Nonneman
Post date June 5, 2019

Anne M. Mozingo | [email protected] | 06/04/2019

YORK — In order to increase services for elders in its coverage area, York Hospital has created the Center for Older Adults with geriatric specialists providing comprehensive care in its new clinic and house calls to those who cannot make the trip to see their primary care physician for a variety of reasons.

The Center for Older Adults opened in February and soon will be increasing clinic hours to two days a week, said Dr. Elizabeth Castillo, a hospitalist and geriatric specialist working with geriatric Nurse Practitioner Barbara Roberge and Nurse Practitioner Erin Morgan, who has been conducting home visits for the Older Adults House Calls Program since November.

“This home visit program is something old that is new again,” said Morgan. “I know in the past doctors often made house calls and it may have been the majority of their work. Now there is a focus on having physicians and nurse practitioners to get back in the home. It’s a bit of a trend.”

There is an important distinction between this program’s house calls and home nursing visits that have existed for decades for those patients being released from the hospital. Morgan, as a nurse practitioner, can diagnose, prescribe, order laboratory tests, similar to the services doctors and nurse practitioners offer in office and clinic settings.

“So, it’s like they are going in to see their physician or nurse practitioner in the office but I’m coming to their home instead,” Morgan said. “I work in collaboration with the primary care physicians, working on the same medical record and working together on a plan of care for the patients.”

Patients are referred to Morgan by their primary care physicians when they have some acute medical concern, but it is difficult to physically get into the doctor’s office due to a fall, trouble walking or mental or memory challenges.

“We do not handle urgent care situations because patients need to wait 24 to 48 hours to be seen. If it’s an emergency, they need to go to the ER,” said Morgan, who has been doing home visits in Massachusetts as a geriatric nurse practitioner and is thrilled to work in York, where she grew up.

The focus on elder care is new to York Hospital and is a result of Dr. Castillo’s arrival last fall. She moved to York from North Carolina with extensive training and experience in geriatric medicine, said Jody Merrill, York Hospital’s lead of marketing.

“Leadership recognized that there is a significant need in the area for specialists in geriatric care,” Merrill said.

The Center for Older Adults provides comprehensive outpatient consultations for older adults who need more time or more frequent visits than a regular primary care visit. Castillo and Roberge stay in close contact with the patient’s primary care provider while an interdisciplinary team of medical, nursing, rehabilitation, nutrition, pharmacy and behavioral medicine is available for those older adults who have experienced some decline in the past year and have been referred for this service. Read the full article

Benefits of HBPC HCCIntel

Ascension’s Chief Community Impact Officer on Providing Care Outside the Hospital

Post author By Jim Nonneman
Post date May 28, 2019

Author: Samantha Liss | May 22, 2019 | HealthcareDive

Tamarah Duperval-Brownlee is Ascension’s first chief community impact officer, which means she is in charge of helping guide the hospital operator’s new strategic vision to reimagine the best way to care for those in communities across the country. Duperval-Brownlee, a family physician, is responsible for helping Ascension pivot away from its focus on hospital campuses to better care for patients outside hospital settings.

The company’s new position comes as nonprofit healthcare organizations are under increasing scrutiny. Earlier this year, Senate Finance Committee Chairman Chuck Grassley, R-Iowa, wrote to the IRS requesting an investigation into whether nonprofit hospitals are living up to their charitable obligations and asking for more information on the agency’s oversight of the facilities.

Healthcare Dive asked Duperval-Brownlee a few questions about her new role.

HEALTHCARE DIVE: You’re in a very pivotal role in a very pivotal time in healthcare, especially for health systems as they transition away from traditional hospital campuses. How do you begin that transition?

TAMARAH DUPERVAL-BROWNLEE: My role isn’t necessarily to be the one to make the decision. Our markets are evaluating and doing their own discernment to understand what the right size needs of the population are, then I come in and provide the perspective to that. It’s about being able to leverage what we know from community health needs assessment, population trends, working with our strategy team and the like.

I’ve likened it to changing the solar system. The center of that has been the hospital and the ambulatory spaces and what we can do for people and to people. But what we’re entering now, and I think it’s articulated by our strategic direction, is that the center is the person that we’re serving and ensuring that we are the preferred health partner for them so when they need to come into a site of care, we’re there. Read more:

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Payment Reform Paves The Way For Expanding Home-Based Primary Care

Post author By Jim Nonneman
Post date May 2, 2019

May 2, 2019 | Home Centered Care Institute

The field of home-based primary care (HBPC) received extraordinary news as the US Department of Health and Human Services (HHS), in collaboration with the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI), announced its groundbreaking CMS Primary Cares initiative in Washington, D.C.

CMS Primary Cares aims to improve quality, improve patient experience of care, and reduce expenditures by increasing patient access to advanced primary care services. This revolutionary payment model includes several elements specifically designed to support practices caring for patients with complex chronic needs or serious illness, the patient population that can benefit so dramatically from home-based primary care.

About 4 million vulnerable adults in the United States have difficulty obtaining or are completely unable to access office-based primary care because they are frail, chronically-ill, functionally-limited and/or homebound. In desperation, these individuals often use the emergency room as their primary care physician. Since many of these patients have multiple comorbidities, ED visits frequently spiral into a lengthy hospital admissions.

“With 10,000 baby boomers turning 65 every day and our population living longer with more chronic diseases, home-based primary care provides the optimal solution for a growing number of patients as part of a value-based healthcare system,” notes Dr Thomas Cornwell, a practicing home-based primary care physician and Founder and CEO of HCCI. “Beginning in 2020, the CMS Primary Cares initiative will reduce barriers to entry and create a financially stable model for hospital systems and practices to bring quality care to the patients who need it most.”

“Since 2017, HCCI has partnered with leading academic centers and health systems to provide high-quality two-day training programs using the nation’s first comprehensive curriculum for home-based primary care,” shares Melissa Singleton, HCCI’s Vice President of Education & Research. “We train the entire team – physicians, nurse practitioners, physician assistants, social workers, practice managers, and others. And they come to us from a diverse range of specialties, including internal medicine, family practice, geriatrics, and more.”

Dr. Cornwell adds, “With the new CMS Primary Cares initiative, we stand a real chance of attracting more providers to the field – creating universal access to best practice house call programs, making home-based primary care the national standard for treating medically complex patients who are better cared for in the home.”

HHS Secretary Alex Azar lauded the CMS Primary Cares initiative as a historic first step toward a much bigger vision, even broader than value-based care. That vision is a healthcare system where every American patient feels she’s being treated like a person, not a number; where your doctor has one focus: not what procedures to order or how to bill you for them, but how to keep you healthy and well.

HCCI applauds and supports the diligent efforts of HHS Secretary Alex Azar, CMS Administrator Seema Verma, CMMI Senior Advisor to the Secretary Adam Boehler, AAHCM (who has led the charge on advocacy for our field), USMM, Centene, Aspire, Landmark, John A. Hartford Foundation, and all the provider organizations around the U.S. who have helped make this possible.

If you are interested in learning more about HCCI or supporting the future of HBPC, visit www.hccinstitute.org.

# # #

Video Link:
Eric De Jonge, MD., President of the American Academy of Home Care Medicine shares insight about the new payment models: http://bit.ly/CMSPrimaryCares

About HCCI

The Home Centered Care Institute (HCCI) is a national non-profit organization focused on advancing home-based primary care (HBPC) to ensure that chronically ill, medically complex and homebound patients have access to high-quality care in their home. HCCI works with leading academic medical centers, health systems and industry experts to raise awareness of and advocate for expanding the HBPC model by growing the HBPC workforce through education and training and developing a research-based model for sustainable house call program implementation and growth.

Find out more at www.hccinstitute.org.

Media Contact:

Julie Sacks
Home Centered Care Institute (HCCI)
[email protected]
630-283-9230

Download a copy of the press release

Benefits of HBPC HBPC in the News HCCIntel

CMS’ new payment models aim to ease the transition to risk

Post author By Jim Nonneman
Post date May 2, 2019

Secretary of Health & Human Services Alex M. Azar Remarks American Medical Association

Written by Maria Castellucci | April 27, 2019 | Modern Healthcare

Providers and analysts are calling new value-based physician payment models announced last week by the CMS game-changers, potentially signaling a new era in which many providers are taking on downside risk and responsibility for total cost of care.

The five new voluntary payment models, which are available under the Primary Care First heading through the CMS Center for Medicare and Medicaid Innovation, vary in levels of risk, but all involve providers receiving fixed payments based on their population of Medicare beneficiaries. They’re also designed to encourage improvement on quality metrics and lower costs through bonuses and penalties.

Two of the models are essentially riskier versions of existing primary-care experiments, while the remaining three are Direct Contracting models that are new to Medicare, with two requiring providers to take on full risk. Providers and analysts alike are touting the models as a significant moment in the movement to value-based payment, which has been talked about for years with little actual adoption.

“The shift won’t happen by tomorrow, but over the next two to four years you are going to see a drastically different marketplace, and I think looking back at what actually caused it to change, we are going to look back at this moment—I think it’s potentially that significant. We will have to see how providers respond and take advantage of the opportunity,” said Dennis Butts, managing director at consultancy Navigant. Read the full article

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House Calls Can Lead to Dramatically Better Health Outcomes Among the Elderly

Post author By Jim Nonneman
Post date May 1, 2019

Doctor making a house call on an elderly man

Written by Alieza Durana | Pacific Standard | May 1, 2019

Research shows that house calls are an excellent way to deliver care, providing better outcomes and lowering costs. So why aren’t we funding more of them?

Dr. Eric De Jonge, a geriatrician at Medstar Health in Washington, D.C., is on his way to work—but not at the hospital. After parking his car, he arrives at the front door of a small basement apartment, inside of which he greets his patient: an 82-year-old man bedridden after a stroke. He checks the man’s vitals, asks about his diet and medication, and recommends a regimen of physical therapy.

Yet as De Jonge speaks with the home health aide, who had been helping with cooking, cleaning, and monitoring the patient, and with the patient’s wife, who also serves as his primary caregiver, he learns that the wife is struggling to recover from a recent open-heart surgery. No longer able to drive, she’s been unable to get to the hospital for a post-surgery check-up and has experienced hemorrhaging and other complications.

After treating his patient, De Jonge turns to enroll the wife in the same house-call program that brought him to visit her husband, promising to return for another call in three weeks to make sure she’s recuperating and feels stable and supported.

“She would have lacked medical follow-up because she was ill and dedicated to her husband, and he could have deteriorated if she hadn’t gotten back home [post-surgery],” De Jonge recalls.

Historically, house calls were the only way most people had access to health care. In the early 1900s, doctors provided house calls to patients from the cradle to the grave. But during World War II, as hospitals and medical technology developed, hospitals became the only places where patients could get X-rays and antibiotics—two medical advances that, along with other factors, helped push the United States to the current model.

Now, even though seniors often receive various forms of care in their homes—most often provided by family, as with De Jonge’s patient and his wife—they usually still have to visit a doctor or hospital for primary care. Read the full article

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CMS details new primary care payment model with range of risk options

Post author By Jim Nonneman
Post date April 25, 2019

Author Shannon Muchmore | April 23, 2019 | healthcaredive.com

CMS on Monday announced a new voluntary Medicare payment model for primary care providers. The two-pronged program has paths for small practices and large organizations and a range of options from partial shared risk to full downside risk.
The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the five-year program, called Primary Cares Initiative. It is slated to roll out in January, with a call for applications expected in about a month.
CMS is also asking for input on an additional model in the program that would give one organization responsibility for the total cost of care for an entire Medicare population in a geographic area. That model would begin in January 2021.

Center for Medicare and Medicaid Innovation Director Adam Boehler noted in a press conference unveiling the model that primary care makes up only a small fraction of the country’s total healthcare spend (and of Medicare spending), but emphasized its potential to have great affect on downstream costs and quality outcomes.

“A strong primary care foundation is essential to an effective healthcare system broadly,” Boehler said.

HHS Secretary Alex Azar said the Primary Cares Initiative represented a pivotal moment for the agency as it pushes providers toward value-based care arrangements, and he hoped the Medicare program would have ripple effects. “This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches,” he said at the press conference. Read the full article