How 3 Home-Based Care Organizations Are Addressing Access-To-Care Issues In The Home

In some ways, addressing access-to-care issues is the ethos behind all at-home care. Moving care into the home, after all, eliminates numerous barriers that keep individuals from receiving care.

Even though closing care gaps is in home-based care providers’ DNA, some are taking that a step further and focusing on a set of very specific challenges, including underserved populations.

Diverse care initiative

One company, HCR Home Care, is doing that through its partnerships with predominantly Black churches in Rochester.

Founded in 1978, HCR Home Care’s service lines include physical therapy, occupational therapy, nursing, care management and personal care. The company operates in 26 counties in New York state.

HCR Home Care began working with churches to reach Black seniors as a response to racial health disparities. The company calls the effort the Diverse Care initiative. The initiative is partly funded by the greater Rochester Health Foundation and the Farash Charitable Foundation.

“After COVID hit, we were seeing that there were a lot of disparities,” Deanna McEwen, a nurse and corporate compliance officer at HCR Home Care, told Home Health Care News. “We were seeing that more people of color were dying from COVID, but it was also being fueled by other things, such as heart disease or respiratory diseases. I thought to myself, what can we do to make a difference? I ended up speaking with leadership to say, ‘I feel as though people of color are not accessing health care.’”

Indeed, HCR Home Care’s Diverse Care initiative is timely. Last year, researchers found racial, ethnic and socioeconomic inequities meant less access to high-quality home health care services for Medicare patients, according to a study published in Health Affairs.

Black patients, in particular, had a lower probability – by 5.6 percentage points – of using a high-quality home health agency, according to the study.

As part of the initiative, HCR Home Care identified roughly 134 churches in the community. Currently, the company has connected with 90, and are actively working with about 20.

The decision to partner with churches in order to reach Black seniors was intentional, according to McEwen.

“Typically, in the black community, the church is the hub,” she said. “If somebody’s getting married, they go to their pastor, if they want their child christened, they go to their pastor. If there’s a funeral, they go to their pastor, if they need marital counseling, or advice, they always go to their pastor. We thought, why should health care be any different? We wanted the pastors to understand what our goal was, and that was to help our most vulnerable population, which are our black seniors.”

The company takes a unique approach to how it works with each church, according to Kesha Williams, an LPN and the field coordinator for the Diverse Care initiative at HCR Home Care.

“Each church is different, so I let the pastor set the tone of how they think our program will work best for their church,” she told HHCN. “One church that stands out is New Life Fellowship. They’ve said, ‘As a member here at this church, you have access to this health care organization.’ At other churches, I’ve gone to a couple of senior groups once a month, just to talk and spend time with them, while they have lunch, socialize with them and answer any questions that they may have.”

Other times, the Diverse Care initiative has done presentations at the congregations, organized health fairs, or taken part in different community events.

The overall goal is to build sustainable and lasting relationships with these churches and their members.

“I don’t want to come to your church, give a presentation, and say how great my company is,” Williams said. “I want to create a long-lasting relationship for you to call me up and say, ‘Kesha, [a church member] fell and broke her hip. Do you think you guys can touch base with her, she’s at this hospital?’”

Since launching the initiative, McEwen and Williams have noticed a slight increase in Black patient referrals, but the goal is to reach even more.

“We realized that this is not going to just change overnight, we still have work to do,” McEwen said. “We’re not giving up on it. We understand that there’s still progress that can and will be made. We’re just taking it one step at a time.”

Bringing care to rural communities

Homeward has long set its sights on bringing home-based primary care to rural communities. In fact, it’s the driving force behind the company’s business model.

“We know that in the rural health care market, the outcomes for people who live there are drastically worse, to the tune of 23% higher mortality,” Dr. Jennifer Schneider, CEO and co-founder of Homeward, told HHCN. “We know that a large reason for that is access. In fact, if you look, there’s half the number of primary care doctors in rural areas compared to urban areas, and there’s 10% of counties in rural U.S. that have zero health care providers in them.”

Schneider noted that specialty care is even worse, there is one eighth the number of total specialists.

People living in rural communities face a number of challenges, according to Schneider.

“If you think about the infrastructure, not only do the doctors not live there, but there’s much less broadband connectivity, much less public transportation, the roads are fewer far between and, often, in worse conditions than they are in urban areas,” she said. “That makes receiving care for individuals really difficult.”

Additionally, people living in the U.S. are lagging behind when it comes to primary care access. Adults in the U.S. often don’t have a regular physician, place of care, or a longstanding relationship with a primary care provider, according to a report from The Commonwealth Fund.

As part of its care delivery model, Homeward’s team of clinicians work in care pods. These clinicians deliver care through mobile clinics and local partner locations.

In order to pull this off, Homeward tackled care delivery on two levels. The first was building a technology stack that could take out inefficiencies.

“For example, I’m trained as a physician and the first time I was in a clinic with my own panel of patients, I recognized I spent nearly a third or half of my time doing paperwork, something that could be done now through the advent and improvement of technology,” Schneider said.

The other important aspect was contracting from an economic alignment standpoint.

“In our contracts, and with our ability to take care of people living in rural markets, we take what’s called global capitation, or total financial risk for these individuals,” Schneider said. “That allows us to deliver the type of care that we need to deliver that’s not sustainable in a fee-for-service environment.”

Homeward has also prioritized partnering with organizations that already exist in these rural communities.

“Health care delivery in rural markets is broken, and if we came in and we were competitive, that probably wouldn’t fix the larger problem,” Schneider said. “We may beat somebody else, but we wouldn’t fix the total problem. Our emphasis has really been around how we partner with existing care providers and assets within the community. That’s important because there’s great people doing great work.”

This has also allowed Homeward to build trust across these various communities.

Ultimately, Schneider believes that there needs to be a massive overhaul to address access-to-care issues in rural communities across the country.

“We think about health care delivery to people living in rural markets as an equity issue,” she said. “Choosing to live somewhere that’s not urban does not mean you deserve second class care. We believe that people deserve, and should receive, high class, high-quality care in these markets.”

Treating complex behavioral health at home

CEO Joe McDonough describes Innovive Health as a company that focuses on the 3% to 5% of individuals that drive roughly 50% of the costs in health care.

The Medford, Massachusetts-based Innovive is a home health company that specializes in caring for a specific Medicaid population. This patient population includes people with severe mental illnesses that also have significant, concurrent medical issues.

“They’re a very challenging population to treat and manage,” McDonough told HHCN. “They’re often resistant to care. There’s a lot of social determinants, as far as having adequate housing, adequate food supply, adequate access to medications. This is a population that continually has challenges, as far as access to care.”

The company is the largest program of its type in Massachusetts, and it recently entered the Colorado market.

Over the years, the demand for behavioral health services in the U.S. has continued to rise. Amid the pandemic, 52% of behavioral health organizations saw an increase in the demand for their services, according to data from the National Council for Behavioral Health.

More recently, companies like The Cigna Group (NYSE: CI), CVS Health (NYSE: CVS) and UnitedHealth Group (NYSE: UNH) have reported seeing a bump in behavioral health utilization.

McDonough has previously pointed out that one of its markets — Colorado — has a suicide rate that is much higher than the general population.

Plus, Innovive is often dealing with patients who experience very fragmented care.

“There’s usually a lot of stakeholders involved in these patients’ care,” McDonough said. “There’s a psychiatrist, a primary care physician, maybe a diabetic specialist, and they may have several different case managers. Getting everybody in alignment, and having communication across all stakeholders, can be a challenge.”

McDonough also noted that the company is serving a patient population that often has high hospital and ED utilization.

“We’ve seen a market decrease in hospitalizations as well as ED utilizations in this population,” he said. “This is because we provide intensive case management. We also ensure medication compliance, and coordinate with all providers to make sure that they have a treatment plan that assures the most optimal outcomes.”

This, in turn, creates value for Innovive’s payer sources.

“For instance, in Massachusetts, the average annual costs for home health has been $25,000 per year, but the cost of an average hospitalization in Massachusetts is about $38,000,” McDonough said. “We estimate that we probably save, roughly, six hospitalizations per year, as well as multiple ED events.”

Looking ahead, McDonough is looking to form joint ventures with payers in order to form creative arrangements and accelerate the company’s ability to deliver more care