MA-Home Care Referrals Skyrocketing, healthAlign Data Reveals

By Andrew Donlan 

The convener platform healthAlign has a front-row seat to see how home care is being utilized in Medicare Advantage (MA).

Andy Friedell, the company’s founder and CEO, has always been bullish on home care’s growing prevalence in MA, even when providers began to shy away from it a bit after initial excitement over supplemental-benefit updates in 2018 and 2019.

“We have pretty good insight into what you see take place over a period of time when these public policy changes occur,” Friedell said at HHCN’s Home Care Conference last December. “And to us, while this was a seemingly small change in the Medicare regulations, allowing more flexibility for MA plans to offer some of these services at home … can create a huge shift over time.”

The Annapolis, Maryland-based healthAlign is a convener of home-based care services. It operates a platform that makes the delivery of services more seamless when at-home care entities and health plans are working together.

Medicaid was originally healthAlign’s focus, but that eventually changed with the amendments made to MA. The company works more with personal home care providers, but is just getting into home health care as well, Friedell told HHCN. The Helper Bees acquired healthAlign last year.

Since Friedell spoke at the Home Care Conference, home care usage has increased significantly among MA plans, at least according to its healthAlign’s internal data.

“We received 2,000 member referrals in all of 2021 and 12,000 in the first six months of 2022,” Friedell said. “We helped MA plans fulfill 2,500 encounters in the home during the first week of August, which was about 10 times what we saw in the first week of August in 2021.”

That increase has come as MA plans are giving members the choice to self direct benefits into the home, which is creating a growing marketplace for at-home care services, Friedell said.

Home care companies are increasingly falling into two camps when it comes to engaging with MA plans on non-primary health related benefits and Special Supplemental Benefits for the Chronically Ill (SSBCI).

Some providers believe that working with MA plans is imperative, as more seniors and Medicare beneficiaries are signing on with those plans. Others believe that the economics are not there yet to make it worth their while.

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Keeping COVID at Bay

National Institute for Health Care Management

People who previously had COVID-19 are becoming reinfected from new omicron subvariants. The pace of COVID-19 deaths has plateaued since May, with 12,500 Americans dying of COVID-19 in July. The Pfizer antiviral Paxlovid keeps high-risk COVID-19 patients out of the hospital. 

• Boosters: Second boosters for people under 50 are on hold for shots reformulated to target the omicron subvariants. The Biden administration recently purchased 66 million doses of Moderna’s variant-specific booster. 
• Long COVID: Federal reports on long COVID provide information on getting help and highlight the need for further research on the condition. About one in eight adults develop symptoms of long COVID. Risk factors include socioeconomic deprivation and smoking.
• Children and COVID: Over 40% of parents of children under five say they will definitely not vaccinate their child against COVID-19. A recent study found omicron is better at invading children’s noses than previous variants. Fortunately, children have stronger antibodies than adults.

Resources & Initiatives:

• Learn how many lives a fall booster campaign could save in the U.S.
• A medical analyst explains what precautions families should take as children return to school. 
• Kaiser Health News released a Q&A on everything you need to know about Paxlovid.
• Learn more about children’s vaccinations and getting vaccinated against COVID-19 from Blue Cross Blue Shield of Louisiana and Independence Blue Cross.

Ultrasound Imaging Gets Small and Wearable

National Institutes of Health | By Vicki Contie

Ultrasound is a noninvasive technique that lets clinicians peer inside the body to monitor health or diagnose disease. Imaging sessions are generally brief because ultrasound often requires the expertise of trained technicians working in medical settings.

Several research groups have been seeking more versatile approaches that would allow longer-term ultrasound monitoring in a variety of settings via wearable devices. To date, most of these efforts have provided relatively low-resolution images or are unable to visualize deep tissues or organs.

Now, an NIH-funded research team led by Dr. Xuanhe Zhao at the Massachusetts Institute of Technology has developed a new type of wearable ultrasound patch that overcomes many of the limitations of earlier approaches. This multi-layered device is about the size of a thick postage stamp, and it adheres to skin in both wet and dry environments. The device was described in Science on July 29, 2022.

Ultrasound works by first placing a probe, or transducer, on the body. The transducer emits high-frequency sound waves that enter the body and bounce off internal tissues, creating echoes that are captured and transmitted to instruments that translate the data into pictures or videos. A soft gel applied between the skin and probe helps to enhance soundwave transmission.

The patch created by Zhao’s team used several advanced techniques to combine all of these ultrasound components in a miniature package. A thin, rigid array of ultrasound probes sits atop a tough but flexible hydrogel layer. An elastomer membrane protects the hydrogel from drying out, and a bioadhesive binds the probe strongly to skin. The combination of a rigid probe array and flexible hydrogel-elastomer layers enables more stable and higher-resolution imaging than other wearable ultrasound devices that are thin and stretchy.

The researchers tested the patch on 15 human volunteers. They showed that the device could be comfortably worn for at least 48 hours. Depending on placement, the patch could provide continuous imaging of blood vessels, heart, muscle, diaphragm, stomach, or lung. The heart or lungs could be stably and continuously imaged even while volunteers were jogging or cycling.

Despite the patch’s potential for on-the-fly mobile imaging, the device currently must be hooked to computer systems for intensive data processing. But Zhao and his team foresee future possibilities:

“We envision a few patches adhered to different locations on the body, and the patches would communicate with your cellphone, where AI algorithms would analyze the images on demand,” Zhao says. “We believe this represents a breakthrough in wearable devices and medical imaging.”

Home Health Proposed Rule Comments Due August 16^th

If you have not already done so, please comment on the 2023 Home Health Proposed Rule by Tuesday, August 16^th. Comments can be made through the following link:

https://www.federalregister.gov/documents/2022/06/23/2022-13376/medicare-program-calendar-year-cy-2023-home-health-prospective-payment-system-rate-update-home

We have also included a draft comment letter template for you to use for your comments (in the event that you need it). CMS has to review and respond to every comment, so let’s let them know what we think and what the impact of the proposed rule would be should it remain in its current form.

It’s also important that we reach out to our Senators and Representatives and ask them to support the Preserving Access to Home Health Act (S.B. 4605), which would freeze the current payment rate in place, with the exception of annual market basket updates, through 2025. 

Calls and personal messages are best, but if you are short on time, a message has been pre-drafted and can be sent in seconds from the NAHC Virtual Advocacy Center.  

Contact us with any questions – and remember, comments to CMS are due Tuesday!