The vast majority of Americans prefer to age in place and receive post-hospital care in the home.
Despite that fact, current reimbursement structures from fee-for-service Medicare and Medicare Advantage (MA) often leave providers operating on thin ice. Conveners rationing home health services is another hurdle that needs to be cleared, according to Jennifer Sheets, a long-time home health executive who serves on the board of directors for both the National Association for Home Care & Hospice (NAHC) and the Research Institute for Home Care.
In this Future in Focus interview, Home Health Care News speaks with Sheets about her advocacy efforts and what’s needed to better support providers moving forward. During the conversation, Sheets also discusses some of the ways that back-office technology has greatly benefited providers.
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?
Sheets: While the pandemic was incredibly challenging for the health care system as a whole, the silver lining for us is that it helped push our industry forward by 10, 15 years, in terms of the community’s knowledge of home health care. For more than 50 years, the home health care industry has stood at the ready, but only in the past three years has it become abundantly clear that home-based health care clinicians are an integral part to how this country can meet the increase in demand.
Our own research shows that over 90% of Americans would, now, prefer to receive post-hospital care in the home. That’s a huge shift in consumers’ health care preferences.
People seem to all be saying what we should all want to hear – that value-based care is needed, and home care plays a huge role in that. At the same time, in action and actual operations, people are continuing to look at just that silo, or their little piece of the health care continuum, versus looking at the lifetime trajectory of a patient’s health care journey, and how to bring real value and cost-efficiency. We’ve got Medicare cuts hitting us, and Medicaid proposed rules hitting us.
Earlier this summer, I was speaking with the CEO of a large value-based care and insurance carrier. He was talking about value-based care and how much we need home health care as a part of that. He was also unaware that the payer side of their corporation was offering rates that were not sufficient for us to even be able to take those patients.
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?
It’s funding – plain and simple.
Home-based care stakeholders have been working for better reimbursement for decades, but unfortunately, this debate still persists today.
The bare-minimum funding, which the home health care industry receives, undervalues the superior health outcomes. It also perpetuates low wages for our workers. When a worker can go and work at a fast food restaurant and make more than they can make providing this critical care to at-risk people, there’s something wrong.
It really impacts our ability to recruit and retain caregivers, and to reach the individuals that need the care.
In your view, what are the top 2-3 ways that technology specifically has advanced home-based care in recent years?
I’ve seen the adoption of business software really be a game-changer for providers. Providers have seen real benefits. The solutions offered by a company such as Axxess are an example of that. Axxess gives providers the ability to choose from a suite of applications to enhance operational efficiencies and improve people’s lives at home.
At the clinician level, we are always looking for ways to leverage technology to streamline workflows and on-the-job processes for home health providers.
Ultimately, we want nurses and clinicians at the bedside. We want them to have as much time as possible to do their work for patients and not be bogged down with paperwork, tracking things down and the administrative stuff.
What emerging technology trend do you see disrupting home-based care most over the next 5 years, and why?
We’re seeing more large-scale tech companies move into the home health care space given the obvious vast opportunities here.
On the whole, providers are increasingly looking to connect their electronic health record systems with customer relationship management software capabilities, as we’re seeing the industry shift more to consumer-focused technology. We’re seeing a lot more home-based technology that’s focused on wearables, wellness prevention and population health.
The challenge is, who’s going to pay for it? We don’t get reimbursed for this kind of technology, so is that burden going to fall on the consumer? That’s a question we got to answer together.
We have to be careful. We have to make sure that we leave room for human validation and true individualized care plans and pathways. AI is meant to suggest, but a human needs to validate, and I think we really need to remember that.
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?
There are so many ways that we can move the needle. I, along with my fellow industry leaders, are pushing through our advocacy efforts, our awareness efforts and our education efforts.
I would say the biggest thing that’s needed is getting the U.S. Centers for Medicare & Medicaid Services (CMS) to recognize the value of home health care and withdraw additional proposed payment cuts.
No. 2, for me would be ensuring accessibility and education opportunities for hospice.
No. 3 would be continuing to work to pass the bipartisan Preserving Access to Home Health Act. This bill has been sponsored by Democrats and Republicans. It’s currently under review in Congress and seeks to halt any payment cuts until 2026. It seeks to facilitate time for providers to work together with the government on a solution.
That’s what we need. We need to come to the table and talk about how we increase access while also driving efficiency and stretching that health care dollar.
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 think the home-based industry has been steadily gaining recognition and demonstrating its value to payers in recent years, including insurance companies and government programs. Payers are increasingly acknowledging the benefit of home-based care in terms of cost-effectiveness, patient outcomes and patient satisfaction.
The problem, again, is that the rate and the reimbursement structure for those services does not support or recognize that same value.
How are you and the organizations you serve contributing to those efforts?
I would say while progress has definitely been made, it’s really important to note that home-based care still faces challenges, in terms of recognition-based reimbursement models, regulatory frameworks and standardized metrics for demonstrating value.
Continued advocacy, research and collaboration among stakeholders is crucial for further advancing the recognition and the integration of home-based care into payer systems. Our fight for better reimbursement rates and recognition at the federal level absolutely leads to enhanced recognition from payers and increased opportunities to collaborate with them.
Looking ahead again, what’s on your advocacy to-do list for the rest of 2023?
It looks a lot like last year’s list. Our current advocacy priorities are all centered around the fight for greater federal recognition and funding.
What trends, challenges or opportunities do you see helping – or hindering – the advancement of home-based care over the next 12 months?
Like we’ve talked about, I think we continue to face massive headwinds from federal, state Medicare Advantage, commercial payers, in the efforts to advance the home health industry forward. I, and the organizations I work with, have been extremely vocal about our opposition to proposed rate cuts, the general lack of appropriate funding from Medicare Advantage and conveners reducing the number of visits that a patient can receive.
All of these things have the potential to absolutely devastate access to home health care services. It’s what keeps me up at night.
Those in our industry are left wondering, “How can a home health care provider even plan, when billions in cuts are looming over our heads starting in 2024?”