Possible COVID-19 Hotspots for Home Health Providers to Watch

For the past several weeks, home health providers throughout the country have been preparing their operations for an impending surge of COVID-19 patients.

Many — including the Visiting Nurse Service of New York (VNSNY) — have already found themselves on the front lines.

If the coronavirus continues to spread at the current rate, some home health providers will likely need to work harder than others moving forward. In particular, providers with footprints in rural, low-income areas should start thinking about shifting their COVID-19 strategy into high gear.


“The distribution of health care status across the United States is not an even distribution,” Chris Sloan, an associate principal at Washington, D.C.-based consulting firm Avalere Health, told Home Health Care News. “People are not at the same level of health across all counties. It varies dramatically — and it varies based on a lot of different things.”

To help health care organizations understand which parts of the U.S. are especially vulnerable to the coronavirus, Sloan and his colleagues at Avalere Health recently mapped out Centers for Medicare & Medicaid Services (CMS) data linked to high-risk populations.

Specifically, they used a sample of fee-for-service (FFS) Medicare claims data from 2019 to see which counties had the highest share of 65-and-older individuals living with at least one known COVID-19 risk factor. Those risk factors included underlying medical conditions like cancer, autoimmune disorders and metabolic conditions, in addition to heart and lung disease.


Examples of metabolic conditions include diabetes and obesity.

“We know where the COVID-19 cases are, and we at Avalere have all this data on health care conditions and Medicare beneficiaries, so we wanted to see how much of that lines up,” Sloan said. “We wanted to see if there are areas where — if COVID-19 goes to that county or ends up in a heavy outbreak — seniors could be at risk.”

Compared to other states, Alabama, Georgia and Florida have a noticeably large volume of Medicare FFS beneficiaries with one or more high-risk diseases, according to Avalere’s analysis. Regionally, Appalachia looks to be a potential COVID-19 hotspot as well.

On a county level, Wisconsin’s Menominee County, Kentucky’s Leslie County and Georgia’s Crawford and Treutlen counties have the highest share of Medicare FFS beneficiaries with one or more high-risk diseases. About 75% of Medicare FFS beneficiaries in those counties have at least one of the factors Avalere looked for.

“You look at a map and you say, ‘Oh, there are some places where individuals with a lot of these conditions, where seniors with a lot of these conditions are concentrated,’” Sloan said.

While there are some particularly vulnerable geographic clusters, the vast majority of FFS Medicare beneficiaries nationwide have significant underlying health issues.

Overall, about 61% of them have one or more high-risk health conditions, according to Avalere.

“This is not a surprise. We know a lot of seniors have significant underlying health issues,” Sloan said. “That’s not going to be the lead story in a newscast.”

Roughly eight out of 10 deaths reported in the U.S. have been from adults 65 years old and older, according to the U.S. Centers for Disease Control and Prevention (CDC).

Even after the immediate coronavirus crisis subsides, data on where older adults are living with underlying health conditions will be extremely important.

That information won’t just be helpful for home health providers, according to Avalere. It also has implications for future outbreaks, future spending in the Medicare program, benefit offerings by Medicare Advantage plans and the federal budget.

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