Home- and Community-Based Services Are a Safe Bet

Study: Value-Based Care Lowers Hospitalizations, ER Visits in Medicare Advantage

Fierce Healthcare / By Paige Minemyer 
 
Value-based care can drive down acute care episodes such as hospitalizations and emergency room visits among Medicare Advantage beneficiaries, a new study shows.

The research, published in JAMA Network Open and led by analysts at Humana and Harvard, found MA members treated by doctors in advanced value-based care models saw 5.6% fewer hospitalizations and 13.4% fewer emergency department visits compared to those treated in fee-for-service arrangements.

Value-based care models have been adopted in Medicare Advantage more rapidly than in traditional Medicare, Medicaid and commercial insurance.

"This is just more ammunition that value-based care works," said William Shrank, M.D., chief medical officer at Humana and one of the study's authors, in an interview with Fierce Healthcare.

Humana has seen notable success within its own member population through value-based care. In its most recent value-based care report, the insurer found that the members enrolled in its value-based care programs had a 60% lower risk of readmission after 30 days.

A majority (67%) of Humana members are cared for by a provider in a value-based care arrangement, according to the report.

Shrank said that while the insurer has tracked its own internal data for some time, Humana wanted to build the volume of evidence further with data that could be published in a peer-reviewed journal like JAMA. Participating in value-based care is not a simple or easy process for many providers, so having that database may make the pitch a bit easier, he said.

Having a rich collection of data can also be a valuable asset in continuing to iterate on existing models, making them work better for members, Shrank said.

"I hope that we as an industry, as a sector do a better job of evaluating and understanding the impact of value-based care on the member," he said.

Bill to Expand HCBS for Veterans Introduced in Congress

Bipartisan legislation to ensure that veterans are able to receive care in their home for as long as possible has been introduced in the House of Representatives. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act of 2022 (H.R. 6823) would expand and improve expand the home and community-based services (HCBS) programs within the Department of Veterans Affairs (VA), and align public policy with improved outcomes and patient choice, which is to stay in their own home.

NAHC supports this bill, as it will make much needed improvements to the delivery of HCBS for veterans, enabling options in how and where they receive care, while also working to address workforce shortages and support family caregivers.

Specifically, this legislation would:

• Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.

• Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.

• Coordinate expanded VA home care programs with other VA programs.

• Establish a pilot project to address home health aide shortages.

• Providing respite care to caregivers of veterans enrolled in home care programs.

• Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.

• Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

The legislation is led by Representatives Julia Brownley (D-CA) and Jack Bergman (R-MI) and NAHC thanks them for their leadership on this important issue.

At introduction, Rep. Brownley stated, “Over half of all veterans that use VA are over the age of 65, age, combined with their unique health needs, makes many elderly veterans especially vulnerable to going into nursing homes and institutional care. Our nation’s veterans deserve the right to age comfortably and with dignity in their homes.

“I introduced the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act to ensure that every veteran has access to the care they need, when and where they need it. The focus of my legislation is to keep veterans in their homes for as long as possible, if they want, bringing them the care they need to the place they feel most comfortable, and ensure that every VA medical center has these necessary support programs.

“By expanding home and community-based services, veterans will have the assistance needed to remain members of their communities, to be present in their family lives, to support their caregivers, and to age with dignity.”

Rep. Bergman added, “As the studies show and as many of the older Veterans throughout our Nation will attest, care in home settings is often preferable to care in a clinical facility. This is especially true for those disabled and elderly Veterans living in the rural and remote communities of Michigan’s First Congressional District. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act recognizes this reality.”

MedPAC Issues March 2022 Report to Congress: Medicare Payment Policy

From NHPCO

Summary at a Glance

As previously reported, on March 15, 2022 the Medicare Payment Advisory Commission (MedPAC) released its March 2022 Report to the Congress: Medicare Payment Policy. The hospice chapter provides MedPAC’s analysis of the current state of hospice – beneficiary access to care, quality of care, and Medicare spending and margins. MedPAC found that “the indicators of payment adequacy for hospices are positive” and therefore concluded the chapter with the following recommendations for Congress:

“The Congress should:

• For fiscal year 2023, the Congress should eliminate the update to the 2022 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent.

• The Secretary should require that hospices report telehealth services on Medicare claims.”

MedPAC noted that the rationale for the Commission’s March 2021 cap recommendation is due to aggregate payments being “more than sufficient to cover providers’ costs” and concluded that aggregate payments “should be reduced by wage adjusting and reducing the hospice aggregate cap, an approach that focuses payment reductions on providers with the longest stays and high margins.” NHPCO continues to highlight the unintended consequences of the MedPAC recommendations on beneficiary access and quality of care delivered by hospice providers. NHPCO has been actively engaged with MedPAC staff and Commissioners on these issues and submitted official comments multiple times regarding the potential impact of any cut to aggregate cap. We have specifically expressed concern about the impact on access, quality, and cost containment in rural and underserved areas and have requested that MedPAC revisit the original intent of such a cap and relevance today.

Note: Providers should remember that MedPAC is an advisory body that makes recommendations to Congress. Even with a unanimous vote in favor of any recommendation, including modifications to the hospice aggregate cap, Congress must adopt the necessary legislative changes to put these recommendations into effect

Omnibus Provides Diverse Funding Options For Health Care Workforce

Inside Health Policy / By Bridget Early

As a worsening health care workforce crisis continues to plague providers across the country, federal legislators envision a financial fix including $1.3 billion for the health care workforce in the fiscal 2022 omnibus spending package, which passed the House and Senate this week and would address staffing shortages and bolster retention efforts across a multitude of struggling sectors.

Legislators and stakeholders have discussed a number of ways to slow the skyrocketing rates of resignations and retirements that have been exacerbated by the COVID-19 pandemic. Student and educator loan forgiveness, increased graduate medical education slots, fast-tracked visa processes for foreign national providers, and broad additional funding for facilities have all been considered.

The omnibus funding encompasses all of these options, according to an explanatory statement that accompanies the legislation, with a special focus on groups experiencing the most acute worker shortages, including nurses, maternal care specialists, behavioral health specialists and rural providers.

Loan forgiveness and scholarships. The omnibus package includes $3.5 million in scholarships for disadvantaged students to educate midwives. The explanatory statement says this is meant to address the national shortage of maternity care providers and the lack of diversity in the maternity care workforce.

For nurses, the package includes $280.5 million for staff education and retention efforts, loan forgiveness and scholarships, which experts have recently lauded as a prime method of expanding the nursing pipeline. A complementary fund for loan forgiveness for nurse faculty would receive $28.5 million, the explanatory statement says.

The omnibus package also includes several separate funding pots for the education of health care providers, the explanatory statement says, such as $55 million for medical student education; $20 million for graduate psychology education; $24 million for substance use disorder treatment and recovery loan repayment programs; and $5 million for pediatric subspecialty loan repayments...

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