Former U.S. Senate Majority Leader Bullish on Hospital at Home, Social Determinants of Health

Health care is migrating into the home — and the hospital of the future will have no address.

That’s according to former U.S. Senate Majority Leader Bill Frist, who highlighted the steady march of health care into residential settings and away from traditional institutions last week during a Health Care Council of Chicago investment event.

Other major trends reshaping America’s health care ecosystem include a heightened role for physicians, more empowered consumers and a greater prioritization of social determinants of health through community-based services.

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“As I look to the coming months and years, I think the biggest tailwind is this whole concept of moving the hospital to the home,” Frist — who now serves as co-founder and partner of Nashville, Tennessee-based Frist Cressey Ventures (FCV) — told Home Health Care News following the event. “I see this massive movement away from hospitals. There are always going to be hospitals, but with telemedicine, with better outreach, technology and the engagement of individual patients, that will be accelerated over time.”

As a two-term senator from Tennessee, a former organ transplant surgeon and current health care investor, Frist carries a well-known and respected voice within the home-based care industry. In addition to his role at FCV guiding acquisitions and divestitures, he sits on the boards of Select Medical (NYSE: SEM), AECOM (NYSE: ACM) and Teladoc (NYSE: TDOC), as well as the Kaiser Family Foundation and several other organizations.

Frist’s background also includes being the co-founder of Aspire Health, acquired by Anthem Inc. (NYSE: ANTM) in May 2018. At the time of the deal, Aspire Health was the largest non-hospice, community-based palliative care provider in the country.

Overall, there are multiple drivers behind health care’s shift into the home, Frist said.

The most significant factor, however, is the expansion and value of the home health industry itself.

“Today, with technology and a larger armamentarium, [health care] can be delivered in large part through the telephone, through connectivity, through engagement, by access and resources within a community,” he said. “But who facilitates that and who has to carry it? The technology is the tool, but it’s going to come back to home health providers, people who are experienced, people who are trained in empathy, people who are already comfortable in the home.”

Monetizing social determinants of health

Frist is not the only person who’s optimistic about the hospital-at-home concept.

Mount Sinai launched its own hospital-at-home program in 2014 as part of a three-year Centers for Medicare & Medicaid Services (CMS) Innovation Center grant. So far, the program has seen encouraging results, with participating patients seeing lower readmission rates and fewer emergency department visits.

Bruce Leff, director of the Center for Transformative Geriatric Research and a professor of medicine at Johns Hopkins University, is likewise bullish on the hospital-at-home model. There are currently hospital-at-home programs in California, New Mexico, Texas, Louisiana, Wisconsin, Ohio, Tennessee, Florida and several East Coast states.

“If this were a drug, it would be a blockbuster drug,” Leff previously told HHCN.

As an early-stage venture capital firm, FCV focuses on accelerating the growth of high-potential health care enterprises through value-added partnerships. Some of its recent investments include Monogram Health, Regroup Therapy and 180 Health Partners.

Apart from FCV, Frist also serves as a partner at private equity firm Cressey & Company, which manages more than $1 billion in health care investments. At Cressey & Company, a number of investments Frist has helped spearhead have revolved around social determinants of health, or non-medical factors such as nutrition, transportation and social isolation.

PurFoods, for example, provides meals to individuals and older adults receiving care in the home. PurFoods operates in 35 states and is one of the largest providers of meals to patients covered by Medicaid.

“One of the big trends that I see is this increased understanding of the importance and value of community-based services, which include long-term support services and all of the social determinants of health,” Frist said. “Health care is not health, and health is not health care. Health care contributes to health, but health means the well-being of the patient.”

Figuring out how to monetize social determinants of health should be a focus for health care investors moving forward, he said.

Loneliness is roughly equivalent to smoking about 15 cigarettes a day, past AARP research has found. Additionally, socially isolated older adults are more likely to be sicker, die sooner and have higher health care expenses than seniors who retain social connections.

Addressing social determinants of health has grown into a pillar issue and core part of its overarching strategy for insurance giant Humana Inc. (NYSE: HUM). In fact, Humana is in the midst of a pilot using “grandkids on-demand” startup Papa to help keep its members in the Tampa, Florida, market better connected.

Policymakers catching up

In general, health care’s move into the home is nothing new, Frist said, noting that decades ago doctors regularly traveled into their patients’ dwellings under the housecall model.

Chris Booker, also a partner at FCV, along with Bryan Cressey, echoed that idea.

“Home health — doing stuff in the home — is nothing new,” Booker told HHCN. “This was happening 40 years ago, and we’re just starting to come full-circle. Jimmy Carter was actually the first president born in a hospital, which always blows my mind.”

“What we’re seeing is that if you can keep somebody in their home, the outcomes are better in a lot of scenarios than institutionalizing them,” he added.

While FCV and other investors have been quick to see the value of home-based care, federal lawmakers haven’t been quite as quick to catch on, despite bipartisan support.

That is starting to change, as demonstrated by the introduction of S. 433 and other pieces of legislation aimed at eliminating or tweaking the behavioral adjustment aspects of the Patient-Driven Groupings Model (PDGM), which the home health care industry widely opposes.

Introduced earlier in February by Senators Susan Collins (R-Maine), John Kennedy (R-La.), Bill Cassidy (R-La.), Rand Paul (R-Ky.), Debbie Stabenow (D-Mich.), Doug Jones (D-Ala.) and Jeanne Shaheen (D-N.H.) S. 433, if passed, would require CMS to base Medicare reimbursement rates on observed evidence, while capping losses or gains to 2% per year.

“At the policy level, the policymakers … have pretty much followed a straight line, a moderate slope of improvement when it comes to understanding the importance of home care in terms of safety, outcomes, quality and cost,” Frist said. “That curve is starting to increase at a much faster rate.”

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