As Value-Based Care Gains Popularity In Health Care, So Can In-Home Cancer Care

As payers look to achieve high-quality, accessible and affordable cancer treatment, there is an increasing interest in value-based approaches — particularly in at-home cancer care.

In fact, one of the main strategies for value- and health-system based cancer care is to accelerate the delivery of care outside of brick-and-mortar settings, according to a new study from the legal and consulting firm Manatt Health.

“Home care has a tremendous opportunity to manage cancer symptoms at home and would be a really good partner for cancer programs,” Donna O’Brien, national advisor with Manatt Health, told Home Health Care News. “My advice to home care agencies would be to build cancer expertise, but build it with your hospital in mind in a way where you’re meeting their business and clinical care needs.”

Cancer care in the home

When compared to other developed countries, the U.S. has fallen behind in at-home cancer care.

Certain barriers have kept it from growing in popularity domestically, but with the rise of value-based care, there is a lane for it to gain traction.

In June, the Center for Medicare & Medicaid Innovation (CMMI) launched the Enhancing Oncology Model (EOM), an alternative payment model seeking to incentivize providers in oncology practices to offer “whole-person” and value-based care.

The rising costs of cancer care is one of the reasons CMS has been pushing for value-based care, O’Brien and her colleagues wrote in the study.

According to Manatt Health, U.S. cancer-related health care costs are expected to grow by 34% between 2015 and 2030, to $246 billion.

Because of that, health systems and payers will likely start looking toward the home.

“With CMS being focused on trying to avoid returns to the hospital for symptom management, there’s an incentive for both the hospitals and home care teams to work in a different way going forward,” Megan Ingraham, managing director for Manatt Health, told HHCN. “An incentive to ensure that patients’ symptoms are being managed effectively.”

Nevertheless, like most new models, there are still financial barriers to work through.

For example, a cancer patient has to be eligible to be an at-home care patient.

“They have to be homebound, and a lot of these [cancer patients] aren’t homebound, but they’re able to be cared for at home,” O’Brien said. “There’s a financial barrier that doesn’t make it possible for home care to get funded, unless there’s some other kind of creative arrangement.”

On the provider side, home-based care agencies should start to pitch themselves as a business partner to hospitals and health systems, she said.

“A lot of the pitch is, ‘Why should the patient stay in the hospital with symptoms like nausea or dehydration when they can be at home being treated for those?’” O’Brien said.

The key for providers is to build a program that the physicians have confidence in, while creating a communication system so that the patient and provider are on the same page.

Reimagine Care

One of the reasons why in-home cancer care hasn’t taken off as quickly as it has in other countries is because of the fragmentation of the industry, O’Brien said.

“The continuum of care is often a collection of disconnected parts,” she said. “Some are doing it already, but if we could find a way to link them around the patient, then you could have a better care model.”

One of those companies that is doing exactly that is Reimagine Care.

Reimagine Care is a Nashville-based in-home cancer care enabler that provides technology-enabled services to health systems and oncologists to deliver home-centered, value-based cancer care.

When Aaron Gerber and his co-founder started Reimagine Care two years ago, they made two distinct decisions: to focus solely on oncology and to prioritize partnering with providers.

“That doesn’t mean payers aren’t important, but we really wanted to have a model that’s provider first, payer second,” Gerber told HHCN. “We built a model that works in fee-for-service and in value. It works better in value. We’re looking to accelerate to value as quickly as we can with our provider partners, but we built a model that essentially meets them where they’re at.”

After securing $25 million in funding, Reimagine Care now has three provider partners and is in talks to secure two more in the first quarter of 2023. The company is responsible for providing care to over 1,000 patients per month both virtually and in the home.

Securing those provider partners — which include academic medical centers, large community health care systems and independent oncology practices — have all come from meeting four specific needs.

“There are four key areas that resonate the most,” Daniel Goodman, senior VP of commercial operations at Reimagine Care, told HHCN. “The partners that we’ve talked to all want to provide a tremendous patient experience, they want to address issues with staffing, they need help with capacity and they’re also looking to do something differentiated in the market.”

The use of technology has undoubtedly helped patients and providers warm up to in-home cancer care.

“Patients, providers and payers have also become increasingly comfortable with the movement of higher-acuity care to the home and hospital at home is a great example of that,” Gerber said. “Normally those patients would have been admitted to the hospital. Now those patients can be managed in the home.”

Making the shift to value-based care is something Gerber has long been an advocate for.

Although there are challenges that come with that shift, he sees an increasing opportunity in managing those costs through at-home cancer care delivery.

“We need the alignment of incentives,” Gerber said. “We’ll be able to move some of the lower-complexity, lower-margin drugs from the hospital to the home without any substantive value-based agreements in place. But to really move some of the medium- and higher-margin drugs that are going to generate the level of savings that the payers are really looking for, that’s where those value-based agreements become really important. The payers are essentially providing the fuel to enable that shift from the hospital, or hospital-based clinic setting, to the home.”