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One of the most intriguing story lines in home-based care over the next year will be whether home health providers can successfully make themselves an integral part of hospital-at-home care in the U.S.
When hospital at home first began to increase in prevalence in 2020 due to the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver, home health providers were generally not involved in programs at all.
Since then, a few things have changed that.
Firstly, providers are being proactive. Recognizing their experience in the home setting, both home health and home care providers have begun to invest in the resources and relationships that are required to get involved with the model of care.
In 2023, over half of home-based care organizations plan to pursue higher-acuity care in the home for the first time, specifically meaning hospital-at-home or SNF-at-home care, according to a recent Home Health Care News/Homecare Homebase survey.
Providers have also gone out and acquired others – or engaged in JVs – to deliver high-acuity care in the home.
For instance, LHC Group – now a part of UnitedHealth Group’s (NYSE: UNH) Optum – partnered with SCP Health on in the summer of 2021 to better move forward “advanced care at home models,” according to LHC Group CEO Keith Myers.
Around the same time, Amedisys Inc. (Nasdaq: AMED) purchased the high-acuity care enabler Contessa Health for $250 million.
All the while, many hospital systems are discovering they may not have the bandwidth, resources, or just plain desire to launch and uphold these programs themselves.
“We’re also seeing hospitals that tried to do [hospital at home] on their own and fundamentally realized it’s way too complex for them to do on their own, and therefore they’re coming back to us and wanting to form JVs with us,” Amedisys CEO Paul Kusserow told HHCN in January.
Amedisys already has Contessa underneath its belt, as well as an extensive portfolio of hospital partners.
But it hasn’t been the only provider that has acknowledged this interest from hospital partners.
“We’re getting increasingly asked by our hospital partners to consider programs like hospital at home and ER diversion,” ElaraCaring CEO Scott Powers told HHCN in February. “It requires a different skill set, but we have the scale in our markets to make it happen.”
Both Powers and Kusserow mentioned hospital financials as one reason why those hospitals would be interesting in outsourcing this work.
“[It] gets to some of the strains that you’re seeing in the hospital balance sheets, for example, as you’re finding hospitals really have to decide what they’re going to be good at,” Powers continued. “One of those things is determining how to use their partners as best they can to care for their patients, and those are examples of where we’ve been asked to look at different capabilities and are investigating if we want to go into those at scale.”
On his end, Kusserow has also garnered unique health system knowledge through his work within them and through his work at The Advisory Board Company – a health care-focused consulting firm – earlier in his career.
“There’s those [health systems] that want to find a good partner and fundamentally drive better profitability for their hospitals, which they can with the DRGs that we take off their plate and bring into the home,” Kusserow said. “So I think there’s people that understand how the economics of a hospital really work. … And I’d say we’re seeing people that want to do this, particularly in over-bedded hospitals.”
For home health providers to become the primary drivers of hospital at home, that would also require a willingness to do so.
Some providers may not be interested in taking on a much heavier role, or investing in something that complex with shrinking Medicare fee-for-service margins. Even if that’s the case, there are still more ways to get involved.
Medically Home CEO Rami Karjian acknowledged that to HHCN just last week.
“We haven’t seen home health providers that are trying to do it independent of health systems and payer partners,” he said. “But what we have seen is, as this is starting to scale and the patient volume numbers are bigger and bigger, home health companies are saying, ‘How do we support this model of care?”
Specifically, Karjian mentioned that home health workers can be utilized in a very complementary way.
The capability that most providers probably aren’t able to meet now, however, is on-demand needs in real time.
“That’s where it’s taken a lot of additional capabilities within the home setting where we’ve been focused, but certainly, we’re seeing more interest from home health companies,” Karjian said. “There’s capabilities that home health brings that are highly complementary and are very well suited for the existing capability base.”