Home health care isn’t getting the full recognition of its value from payers and regulators, according to advocates and stakeholders. That’s why the home health care industry’s newest association is promoting the value of in-home care as a top priority, while also seeking to establish a firm footing almost year after launching.
ElevatingHome, which spun off from the non-profit focused Visiting Nurses Associations of America (VNAA) in April 2017, has focused on coming up with a clear strategy to become a powerful force as an in-home care advocate. Nearly a year after its announced creation, some of ElevatingHome’s priorities are beginning to take shape.
Home Health Care News caught up with Tracy Moorehead, CEO of ElevatingHome, at the association’s annual National Leadership Conference in Washington, D.C. this month to chat about the organization’s introduction to the industry, what it’s been able accomplish and its top priorities, from gathering industry leaders to communicate with one voice to influencing the new home health payment model.
What are the latest developments with ElevatingHome?
Moorehead: We didn’t officially launch as a corporate entity until July 1, so I still consider us very much a startup. We are less than a year old. [We’re] still kind of taking baby steps. Our biggest opportunity right now is still to introduce ElevatingHome to the rest of the industry, to help them understand how we are different and what we offer on behalf on the indsutry.
From the first mission ideas to today, what have you been able to put together?
Shortly after we launched on July 1, we hosted a national leadership summit. We were trying to engage as many leaders from across the country to help us incorporate their concerns and thoughts into the original strategic goals for the organization. We had 70 industry leaders join us in Chicago in July.
Coming out of that we had two really clear strategic goals. One was reintroduce the concept of home-based care across the stakeholder continuum to all levels of payers, all levels of providers and all other stakeholders and researchers.
The second, which is our top operational priority, if you will, is workforce and addressing the workforce challenges. Once we launched our strategic plan in October , we spent the last quarter of 2017 putting the framework together for the workforce initiative, and it spans our education, research, best practices and advocacy components of the org. Most tangible this year are three new modules in our best practices and quality improvement program for excellence around onboarding and recruiting and retention for the workforce.
Talk to me about adding provider members and board members that are outside the home care realm. What is the intended effect of having those voices?
The founding board and the VNAA board that really conceptualized ElevatingHome emphasized that we expand the playing field to encompass all of the providers of home-based care—not just the traditional Medicare fee-for-service (FFS) agency providers, but all models and all types and sizes of providers. Whereas for example, the contrast that VNAA was representative of the non-profit providers, ElevatingHome represents all providers in the home. And that [includes] models that are the traditional Medicare FFS but also increasingly payers that are managing networks of home-based care models. Payers and physician groups, as well as organizations that offer care in the home and community for long-term care services and supports.
Everyone in the industry has to keep in mind and recognize the traditional FFS Medicare model is not going to be the prevalent model going forward. Because of the different types of models that we have the capacity to serve—the care continuum of wellness and promotion, risk mitigation and management, and pre-acute sides of the continuum—we can utilize other types of services than physicians. And there is significant opportunity and interest in partnering with home-based care providers to support those patients, regardless of where they are on the continuum, to keep them out of the hostial in the first place, from going back to the hospital and from not utlizing the emergency room department.
Where do you see these trends fitting into consolidation that’s happening? Humana is buying in with Kindred, CVS and Aetna merging, LHC Group and Almost Family as well.
And Cigna buying Express Scripts was announced. We are seeing transformation across the board, in all levels of health care. It’s not just home-based care; it is everywhere. It’s really driven by value. Why would Cigna be buying Express Scripts if they didn’t need to better manage the pharma spend for the covered lives in their book of business? That’s why they are doing it—they see value there. They see an opportunity to better manage that value.
It’s the same thing with Humana purchasing some of Kindred in order to better manage those services for the patients in their book of business. So, I think that the consolidation and the transformation we are seeing is really indicative of how health care is changing in response to value over volume. I think payment models need to catch up a bit, to be quite honest with you, but it’s really exciting. Only 12% of the home health industry is comprised of the publicly-traded comapnies. I was kind of surprised by that because you hear about them all the time and automatically think they are taking up everything.
But it’s not a big market share.
Right, it’s not a big market share. There are still 11,000 ceritified home health agencies in this country. And I don’t even have a number for how many non-skilled, private duty folks. There is clearly an increasing need for this type of service, desire for this type of care, and increasing recognition for this type of care. You’ve got people who want it in their homes and payers who see the value of it. And you’ve got this opportunity for quality improvement based on where the care is provided. We’re seeing it now, and it’s kind of exciting to witness.
I do really think that 2018 is going to be a significant year for M&A acitivity. I do think we will still have over 10,000 home health agencies. But what you’re seeing is consolidation, even among smaller agencies. Expanding their footprint within their community and having a broader area of service is beneficial to them as they sell their value to their upstream partners.
What are you working on with regard to the home health changes in the Bipartisan Budget Act of 2018? What are the next steps for helping shape the new payment system?
We were working on this even before the proposed [HHGM] rule dropped in July this past year and have not ceased conversations with the Centers for Medicare & Medicaid Services (CMS) or congresisonal officials as we seek to help influence and impact a final payment rule that is going to be beneficial to our members. And there are certain components of a new payment rule that were codified in the Bipartisan Budget Act, but we continue to work with CMS.
We will continue to work with them on that. I don’t have all the asnwers to what the final payment rule will look like. We certainly are looking forward to the responsiveness and feedback to the information and data provided to Abt and CMS during the technical expert panel (TEP), but we are not at this point sure what the next steps will be after that TEP.
I want to back up and go back to the original vision of home care at the center of the health care system that ElevatingHome first introduced us to last year. Where do you think we are at this point?
Why do we think CMS continues to treat our industry the way they do? The short answer is we have a great vision and we are working to execute against that vision, but we are not there yet. And one of the reasons we are not there is because CMS does not understand the value proposition of what we have to offer.
Home care works. Home care is awesome. This dichotomy fuels our vision. It’s really around how we can execute against the experiences the [Atrius Health CEO Steven Strongwater] of the world are having with CMS and MedPAC and policymakers to bring along to help them understand. And that is the purpose of the research that we are doing, to really demonstrate that value proposition.
Written by Amy Baxter