The COVID-19 virus should spur a new global payment system that unlocks the capabilities of home-based care for a wider range of patients, Humana (NYSE: HUM) executives argued in a new op-ed published Thursday.
That payment system would encourage a greater use of home-based care services, allow more patients to be eligible for them and increase innovation in the space, Humana CMO Dr. William Shrank and Susan Diamond, Humana’s home business president, stated in the op-ed, published in the Journal of the American Medical Association (JAMA).
Louisville, Kentucky-based Humana — one of the largest Medicare Advantage (MA) players in the U.S. — operates Humana At Home and Kindred at Home.
Kevin Volpp, a professor of medicine and medical ethics at the University of Pennsylvania, was also a co-author of the piece.
“In health care, there has been a shift toward provision of home services, with substantial growth in areas such as provision of home infusion therapy and remote monitoring of blood glucose levels,” the authors wrote.
COVID-19 has accelerated that shift.
Among its recommendations for improving the home-based care ecosystem, the joint article suggests that the recent Centers for Medicare & Medicaid Services (CMS) waivers that provide more “homebound” status flexibilities should continue to expand and become permanent.
“[CMS] provided a waiver for homebound status in the setting of the COVID-19 pandemic, which, when combined with regulatory relaxation and the recent rapid adoption of telehealth, will allow for more rapid development of new clinical models at home,” the authors said.
Right now, the worry is that the current restrictions stymie at-home innovation.
“The payment system should encourage clinicians to recommend whatever service will produce the most health benefit for a given price without distortions, such as payment being offered only for visits in a medical facility,” Shrank, Diamond and Volpp maintained.
The ideal model for home-based care would encourage health systems and health plans to work together in an effort to advance home care through technology and a consideration of social needs.
The goal, according to the authors, is to achieve a system that is more sensible for all, first considering the patient.
“The payment model would incentivize clinicians and health care organizations to deliver services most likely to benefit the patient considering the cost and alternative uses of that resource,” they wrote. “If a health system is only paid when a clinician sees patients in the office, the clinician is unlikely to enroll the patient in unreimbursed home-based services.”
Additionally, the proposed model would emphasize delivering care services where they are best fit to be delivered.
“The proposed model would meet patients where they are,” the authors stated. “Whether clinicians are formally in a risk-sharing arrangement or not, system designers should view provision of care in the site that will be most efficient in improving health in developing care delivery innovations. Insurers only paying for in-person visits as a way of verifying that care was actually provided should become a thing of the past.”
Furthermore, the model would encourage clinicians and health care organizations to take into account analytics that would prioritize a long-term view over short-term cost-saving measures. Preventative and treatment services would also be valued similarly.
“Analytics should be used to systematically identify patients who are at elevated future risk to guide interventions that proactively lower risk,” the authors wrote. “For instance, cancer treatment should consider the cost relative to the benefit, and smoking cessation program attendance should be encouraged even if it does not save money in the short term.”
Creating a payment model that will encourage innovation in the home is a crucial step for payers to unlock all the benefits of home-based care.
Adopting new clinical models in COVID-19 is necessary, but long-term sustainability should also be considered.
“It is time to move beyond the limited definitions of home care currently used by Medicare and create payment models that support innovation of care provided in home-based settings,” the authors said.
Companies featured in this article:
Centers for Medicare & Medicaid Services (CMS), Humana, JAMA, Journal of the American Medical Association
