The Legislative Battles Moving Health Home Is Fighting On Behalf Of Home-Based Care

Whether it’s home health, personal or in-home primary care, many home-based care advocacy groups and trade associations have been able to establish their organizations as champions of a particular lane.

It’s upon this foundation that the Washington, D.C.-based Moving Health Home has been able to lay the groundwork for its goal of mobilizing policymakers to thrust health care into the future, and into the home.

What sets Moving Health Home apart from many of the existing advocacy-focused organizations is the cross-sector approach it has taken.

Right out of the gate, Moving Health Home was able to call a distinctive set of organizations its  members. This includes heavy hitters like Amazon Care (Nasdaq: AMZN), Intermountain Healthcare, Home Instead Senior Care, Signify Health Inc. (NYSE: SGFY) and many more.

Editor’s note: Late Wednesday, Amazon confirmed that it was shutting down Amazon Care.

Currently, Moving Health Home has 27 member organizations.

The upside of bringing all of these organizations together is the ability to address various aspects of home-based care in a way that promotes holistic care, and expands care-at-home opportunities on multiple fronts.

Home Health Care News recently caught up with Moving Health Home Founder Krista Drobac to discuss all of this and more. Highlights from that conversation are below, edited for length and clarity. In addition to her position at Moving Health Home, Drobac is also a partner at consulting firm Sirona Strategies.

HHCN: The Moving Health Home coalition was originally formed last year. The goal was to change federal and state policies to expand at-home care. Can you start with briefly recapping some of the gains you’ve seen on this front since the coalition’s inception?

I think we are starting to break through on the idea of expanding more care in the home.

Originally, we would say health care in the home, and people would think of home health or home and community-based services (HCBS) and Medicaid. What we’re saying is, those two sets of benefits are foundational to care in the home, but we can do so much more. We can do in-home primary care, diagnostics, more dialysis, more in home infusion, hospital-at-home. The sky’s the limit in terms of what can be done in the home, through technology and various personnel, but there are policy barriers that need to be broken down. I think we have finally started to break through Congress, and other policymakers, thinking only about home health care or HCBS.

Moving Health Home’s member organizations are from a diverse set of home-based care backgrounds. Can you talk about the significance of having all of these organizations as part of the coalition?

We think that it’s important to have cross-sector representation in the coalition. There are already well-established associations in town that represent the interests of an industry. There are really good home health or HCBS established groups in town. Kidney dialysis and infusion have well established associations. We wanted to have the broader message not be about any one particular service. We wanted it to be about the patient wanting to be at home, and what services do we need to offer for a patient to have a real option to be at home.

I’ll give you an example. If you have pneumonia today, you’re more likely to be admitted into a hospital. You might see the home infusion industry advocating to increase the ability for a patient to go home if they have pneumonia. But think about all the other services that then also need to be available. Maybe, for example, personal care services. Do you have someone that is in the home that can help you? We’re trying to look at the patient in the center of a care episode and then all of the different services that need to be available, instead of one use case and one service that may not be enough for a holistic episode of care.

What are Moving Health Home’s current areas of focus?

Our goals are really to change policy. There are state policies that need to be changed, but we’re focused at the federal level. Our federal priorities center around three pieces of legislation, as well as some administrative changes that we are working with the Biden administration to try to put in place. The legislative initiatives center around hospital at home, SNF at home and then a broader expanding care in the home bill.

For hospital at home, we do have a full legislative proposal. We are trying to socialize that proposal on the Hill. As a baseline, we need an extension of the Acute Hospital Care at Home waiver that was issued during the public health emergency. If we’re not able to get the extension, we do actually have a demonstration project that Congress could drive to allow patients to continue to have this service in the home. It’s not just the legislation that we’re working on, it’s also educating people about care in the home. We have a video in the works right now showing how patients can receive hospital-level care at home. We also share evidence and statistics around how it’s working today with the hospitals that are offering it.

For SNF at home, we are supporting the Choose Home legislation that was put forward by the home health industry. Our ideal scenario would be that a patient could be admitted to the home and then discharged to the home, if we had a hospital-at-home and a SNF-at-home program.

The third piece of legislation is more of a catch-all bill that includes all of the other things that need to be available to patients. Primary care, diagnostics labs, personal care services, dialysis, home infusion — all those sorts of things that are also central services in the home. That bill is the cross-sector, cross-industry, holistic, patient-centered bill that is the centerpiece of what we’re working on.

One of things we’re also working on with the Biden administration is rebalancing the primary care codes to not disincentivize out of institution care. CMS made changes to E/M codes that were budget neutral. They took money from the E/M codes that are used outside of institutions and increased care codes for inside institutions. We’d like to see those rebalanced, so that there isn’t a disincentive for primary care outside of an institutional setting.

What are some of the biggest challenges Moving Health Home has had to navigate since the launch of the coalition?

We did a survey last year about the perception of care in the home among Americans — not just of seniors. We found that the perceptions among Americans are very good. They think that you can receive high-quality care in the home.

Among policymakers, though, we get a lot of questions about how we provide high-quality care for a high-acuity patient in the home. Our job is a lot of education on how the services are provided. Then secondarily, what are the policy barriers to providing this care?

Then it’s the process of inspiring members of Congress and other policymakers to want to make these changes. The pandemic has helped a lot with this. Now there’s experience with care in the home. We can point to that experience and say, ‘It’s really good for patients and good for caregivers.’ We want to inspire lawmakers to want to make this a priority of theirs. I see this as a new frontier that we’re still building the foundation for.

You recently wrote an op-ed about how the cuts that home health proposed payment rule would essentially erode the effort to increase home-based care. Can you talk about the issue with the proposed rule?

I have to admit to being completely incredulous that we would consider cutting home health reimbursement right now. Think about the fuel costs and the workforce costs. Those two things alone should make us want to increase reimbursement for home health. Home health agencies are struggling to find people and obviously struggling to cover fuel costs. The idea of cutting home health right now just seems ill timed. We don’t want to have to be in a position where we’re defending the foundational aspects of care in the home, we want to build on those aspects. We can’t build on home-based care as it exists today if that foundation is eroding. We’ve stepped back to work with the home health industry to try to present the evidence for why these home health cuts are ill-advised.

We’ve had to mobilize completely around the cuts, so that’s really where we’ve been getting most involved.

Obviously, all the time that we’re spending working on this is time that we’re not spending on building on that foundation. It’s disappointing that these cuts were proposed. We’re hoping to see a final rule that rolls this proposal back.

Though home health care agencies really relied on telehealth amid the pandemic, providers aren’t reimbursed for delivering these services. What do you think it will take to finally move the needle on this?

As I mentioned, part of what we see our job being is inspiring policymakers to see the home as a site of care for the future. It’s where we should be moving.

If we can build the underlying support for the idea of care in the home, we’re better equipped to then make arguments for why all of these pieces need to be strong. I guess the contribution that we’re trying to make is broader messaging around the future, and how each of these pieces goes together. This is not just a home health care problem. This is an American senior wanting to age in place problem.