One of the largest home care and community health organizations in the country has landed additional financial support to continue building out its home-based primary care and palliative medicine offerings.
Holmdel, New Jersey-based Visiting Nurse Association Health Group announced in January that it had been awarded a $2.5 million grant from the Parker Foundation to assist its Advanced Care Institute.
The nonprofit VNA Health Group is led by Dr. Steven Landers, a geriatric medicine physician who serves as the organization’s president and CEO, and who has taken a thought leadership role for the industry through projects such as The Future of Home Health Care.
“The funding is really for the growth and continued development of the Advanced Care Institute, allowing us to do more community outreach, add more physicians and keep some services going that are hard to sustain financially without philanthropy,” Landers, who took over as CEO in 2012, told Home Health Care News. “I’m very passionate about home-based care for frail elders. I’ve done many home-based visits myself and believe strongly in the positive impact of in-home primary medical care for low-mobility, high-risk seniors.”
In total, VNA Health Group employs more than 2,000 staff members who provide home health, hospice and public health services for more than 120,000 people each year across New Jersey and Ohio, where it operates through an affiliate.
Piscataway, New Jersey-based Parker, an offshoot of Parker Health Group Inc, is a nonprofit aging services organization that has been around for more than 100 years. Parker’s mission, according to Chief Strategy Officer Donna Silbert, is to empower older adults by helping them age safely at home.
Although it has worked with local senior centers and similar groups to support aging in place, the partnership with VNA Health Group and the related $2.5 million grant is a first for Parker, Silbert told HHCN.
“We’re looking to other people who are doing amazing work that might need some support to continue that work — and that’s where VNA Health Group really came into play for us,” she said. “Everyone wants to stay in their home as long as possible, so we feel very strongly about supporting people, helping them achieve that goal.”
Parker affiliates serve close to 1,000 New Jersey residents through skilled nursing, assisted living, adult day and post-acute services programs, in addition to its health and wellness offerings.
Advancing home-based primary care, palliative medicine
The VNA Health Group’s Advanced Care Institute has two main offerings, Landers said: home-based primary care and in-home palliative medicine. The institute serves more than 3,000 older adults at any given time.
“It’s a relatively small part of VNA Health Group overall, which is a strong home care, hospice and public health organization,” Landers said. “But it’s really important and something we’re really proud of.”
In general, home-based primary care is a critical service to homebound seniors who have difficulty in making it to doctors’ offices. Popular decades ago, the house call model is once again gaining steam, especially as technology startups streamline scheduling and the broader coordination of services.
Los Angeles-based startup Heal, for example, recently teamed up with Aetna — a CVS Health Corporation (NYSE: CVS) company — to bring its house call business into the Atlanta market.
Home-based primary care provides value to older adults and their family members through its convenience factor, Landers said. But it also presents significant upside to the U.S. health care system at large, mainly through a proven ability to reduce spending by preventing costly hospital readmissions or trips to the emergency room.
Additionally, home-based medical care can also fill dire gaps in patient care for home health and hospice companies, as communication with doctors’ offices is often challenging.
“I think the world of home health agency services, hospice care and personal care services,” Landers said. “These are essential services, but sometimes the missing piece to help a senior stay home is the medical component. The home health agency or hospice, sometimes, if there’s not strong primary care physician engagement, certain things fall through the cracks.”
Only 13% of family doctors did a house call in any given week, according to statistics from the American Academy of Family Physicians show.
The Advanced Care Institute’s team is made up of about 30 physicians and advanced practice nurses, delivering more than 34,000 in-home visits per year.
“If you look at the work VNA Health Group does with at-home primary care, they’re really supporting high-risk, older adults,” Silbert said. “Our view is that getting physicians and advanced practice nurses in there, in people’s homes, keeps them healthier, safer and out of hospitals.”
Palliative medicine — also known as comfort medicine — provides relief to critically ill patients. Most often used in hospital settings, VNA Health Group and Parker hope to expand palliative medicine availability in the community, which has traditionally been underserved in that regard.
The $2.5 million will also be used to develop and support additional programming moving forward.
Payment reform, workforce relief needed
While Landers and Silbert are both bullish on the value of home-based primary care and palliative medicine, there are several barriers to growth, especially when it comes to house calls.
Similar to the labor crunch that homes health providers and personal care services agencies face, there’s a shortage of qualified, available physicians who specialized in geriatric medicine, according to Landers.
Perhaps the bigger issue, though, is the lack of a real payment system built for home-based primary care.
“Medicare does cover home visits by physicians, but payment is really inadequate for providing comprehensive primary care at home,” Landers said. “There needs to be some payment reform — and there have been some demonstration programs and activity aimed at that, so maybe we’re headed there.”
They include the Independence at Home demonstration, which the Centers for Medicare & Medicaid Services (CMS) launched in 2012. More than a dozen sites are actively participating in the demonstration, scheduled to end on Dec. 31, 2020.
The Independence at Home demo had previously been shown to have significant savings that were up to roughly 10 times as high as those achieved by pioneer accountable care organizations (ACOs).
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