It’s time that policymakers and payers see the value of home-based care as more than the “piggy bank” for the U.S. health care system.

That’s according to Deborah Hoyt, senior vice president of public policy for Dallas-based home health, hospice, palliative and home care technology company Axxess. In this Future in Focus interview, Home Health Care News catches up with Hoyt to learn more about in-home care providers’ ability to lower costs and improve patients’ outcomes, particularly after the release of the Medicare Home Health Proposed Rule.

During the conversation, Hoyt discusses how the U.S. Centers for Medicare & Medicaid Services (CMS) and MedPAC are critical partners as home health providers lead in redefining the nation’s healthcare transition to the home. She offers an inside look at how Axxess is advancing the industry at large through technology innovation and federal advocacy.

HHCN: To start, I’ll ask you to look back over the past few years to the very beginning of 2020. From then until now, how would you describe the overall progress home-based care has seen in the U.S. – and what are some of the best examples of that advancement?

Hoyt: It’s absolutely clear that home-based care has become the desired and established protocol to ensure the quality patient outcomes that CMS and payers are looking for.

Our sector’s 125-year history, beginning with community based VNAs, has always been centered around our nurses’ expertise at chronic care management. Recent interest by hospitals and payers to get a foothold in the home space just can’t replace the deep knowledge of our workforce and the people skills necessary to succeed in a decentralized home-based care delivery model. I believe that as an industry we’re well positioned to continue moving forward and lead in terms of the evolution of an even higher level of care at home.

In what ways has your own organization advanced during this period?

Axxess has grown exponentially since 2020 thanks to our people, partnerships, and solutions. Today we serve a greater number of home-based care clients of all sizes across all sectors. With our recent acquisition of Complia Health, Axxess is expanding our innovation which enables our provider clients to accept more patient referrals, improve their efficiency through automation and AI, reduce staff time and improve profitability. Our goal at Axxess is to partner with providers so they can leverage technology to streamline business operations in a way they’re saving any place they can across the business to maximize compliance and minimize expenses.

Looking ahead, what is the single most important thing that needs to happen in order to further accelerate home-based care in the U.S., and why?

Our sector really needs financial security. That means fair Medicare, Medicaid and Medicare Advantage reimbursement paired with regulatory predictability.

CMS’ process for developing payment and regulatory policy for home health and hospice based on MedPAC recommendations from outdated data is just unsustainable from the provider perspective. With unpredictable changes disrupting provider finances and business operations on an annual basis, there is no capacity for thoughtful long-range planning, workforce development or process improvement. This form of policymaking hurts our sector on many levels but most importantly forces us into a defensive posture and does not give us the breathing room for innovation to compete with new models like hospital at home.

In your view, what are the top 2-3 ways that technology specifically has advanced home-based care in recent years?

Technology is key to advancing any industry, and I think that we’re now seeing a real ability to create efficiency in provider documentation. I think that’s critical in this environment where good field nurses and QA are in short supply and audit scrutiny is increasing.

Handheld phone applications have been a game changer for clinicians out in the field who can complete their full documentation in real time, send it through to QA and to billing without the need to go back to an office, sync their device to a laptop or rely on a patient’s Wi-Fi access. Agencies need to get paid quickly and Axxess excels at revenue cycle management.

Lastly, one of the things we’re focusing on at Axxess is making sure that the providers can leverage their technology tools, get paid faster and free up the revenue they need. The end game is providers being able to care for more patients to meet the needs of their community and grow their business.

What emerging technology trend do you see disrupting home-based care most over the next 5 years, and why?

Health care is the only sector that hasn’t kept up with what consumers are demanding in terms of 24/7 access. Right now, it might take 48 hours or longer for a patient to receive an initial visit in the home after a referral.

That’s not good enough. People want 24/7 on-demand care, particularly in the home. With staffing challenges expected to be ongoing, efficiency enabled by technology is the only way we are going to get there.

Axxess created a mobile staffing solution modeled after how Uber revolutionized the ride share business. It has taken our team over 10 years, but it has reinvented the way that people can access home-based care. Licensed and vetted clinicians create a profile through the Axxess Care app much like Uber drivers. Providers can access this on-demand workforce to fill shifts, or the clinicians work independently to pick up available visits in their geography. Axxess has created a virtual workforce of more than 10,000 qualified individuals in all 50 states. With the growth in demand for home-based care, this bold tech move will transform the sector globally.

When we think about advancing home-based care, we can talk about moving the needle with a variety of key decision-makers and gatekeepers. Looking exclusively at the policy space, what are some home-based care advancements you’d like to see turn into reality?

We really need to have an honest conversation about Medicare home health profit margins and have the appropriate data to help us tell that story. Post-acute care – particularly home health – has been the piggy bank for health care delivery in the United States, and it’s just not fair.

The “fire drill” mentality that CMS creates for our industry with each release of a proposed rule is so stressful on providers. We spend an extraordinary amount of time and money as an industry reacting, responding, meeting with Congress and advocating against the CMS and MedPAC rule language in an attempt for financial and regulatory fairness.

The policy positions just don’t support the payment model and the value of health care delivery in the home. I’d say that home health and hospice have been extending the solvency of the Medicare program, but CMS, Congress and providers really need to come together and find a sustainable solution.

If we can make a change in the policymaking process and use our energy as a sector more effectively in partnering with CMS and MedPAC in a way that demonstrates our value through the use of current data, we may be able to advance the process to one where we engage in a more collaborative and productive way. NAHC and PQHH have made big strides over the past few years to move us to a better position. Axxess is fully engaged and committed alongside the associations, provider sector, and with key members of Congress as a “united voice” for this change.

Then there’s also advancing home-based care and advocating on behalf of providers in the context of payers, including managed care. What degree of progress has the home-based care field made in communicating their value to payers, in your view?

I certainly think that payers recognize the value of home-based care or else they wouldn’t be actively acquiring some of the largest home-based care players in our space.

The industry has now embraced Medicare Advantage to some degree, particularly the larger more forward-thinking organizations. We need to realize that as providers we bring significant experience and leverage. We should and could be having more strategic conversations resulting in more mutually beneficial wins for both parties.

How are you and your organization contributing to those efforts?

Axxess is all-in as an industry provider partner. Starting with our CEO, down through our leadership team, and all of our “Axxessians”, we are committed to supporting the industry in any way possible through grassroots and grasstops advocacy. We have a growing Axxess PAC and an active Axxess Advocacy Network to educate our employees on federal issues and the impact on our home health, hospice and home care clients. We are in Washington DC regularly for key meetings with Members of Congress, hold seats on all the various boards of the national advocacy organizations and are an active engine for innovation and change.

Looking ahead again, what’s on your advocacy to-do list for the rest of 2023?

Working alongside the National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (PQHH) to stop the additional reimbursement cuts proposed for home health. Also, our Chief Technology Officer, Andrew Olowu, serves as co-chair of HCTAC and is working with providers and technology partners leading on efforts with CMS around promoting interoperability, data security and digital quality measures.

What trends, challenges or opportunities do you see helping – or hindering – the advancement of home-based care over the next 12 months?

We need to move CMS from the current process of issuing annual proposed rules to a partnership discussion around the value of home health and hospice to the full health care continuum and our sector’s contributions to Medicare cost savings overall.