Craig Mandeville

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It’s true that old habits and old routines die hard — and for decades our nation’s complex healthcare system has, in some areas, been slow to change with the times. But the past year battling the COVID-19 pandemic has shown us how quickly — and how fundamentally — we can adjust and improve care when we need to.

In a remarkably short period of time, we’ve dramatically expanded safe and convenient telehealth; we’ve witnessed rapid development and deployment of life-saving vaccines; and we can now reliably test for a potentially deadly virus at home, whereas the same testing, even in a doctor’s office, was incredibly hard to come by a little more than a year ago.

It’s clear that transforming care is possible and healthcare can, indeed, flex to meet the needs of the population. It’s time that we do so for the nation’s Medicare beneficiaries when needing care after a hospitalization — adapting post-acute care delivery to ensure older Americans and their families can select the care setting that’s most appropriate for their health, safety and quality of life.

With the support of federal lawmakers, leading home health advocates are working to ensure those changes happen soon. In fact, new bipartisan legislation introduced by Senators Debbie Stabenow (D-MI) and Todd Young (R-IN) and Representatives Henry Cuellar (D-TX) and James Comer (R-KY) — and endorsed by AARP — is designed to provide Medicare beneficiaries with expanded options for their recovery care following surgery, illness or injury.

For years, Medicare beneficiaries have overwhelmingly preferred home-based care over nursing homes, but policy restrictions have prevented many seniors from accessing it. Many patients who go to skilled nursing facilities (SNFs) after hospitalization have similar levels of disease and impairment to those who receive care at home. The main difference in these patients is that individuals ultimately admitted to SNFs often don’t have access to the kind of supplemental health care support they’ll need.

The Choose Home Care Act (S.2562/H.R. 5514) offers an opportunity to change that by enabling eligible Medicare patients to receive 

 care services as an add-on to the existing Medicare Home Health benefit — for 30 days post-discharge from a hospital. In real-world terms, it’s a law that seeks to help more seniors recover in the comfort and dignity of their homes — by offering expanded home health services like skilled nursing, therapy, primary care, personal care, continuous remote patient monitoring, meals, home adaptations, and non-emergent transportation.

Providing for comprehensive care services will help more seniors remain independent in the community and has the potential to deliver cost savings to the Medicare program. One expert 

 anticipates that the Choose Home model would generate as much as $247 million in savings annually in avoided skilled nursing facility stays.

, conducted by Morning Consult, underscores the popularity of home health and the importance of passing the Choose Home Care Act. Of the poll respondents, 86 percent of adults, including 94 percent of Medicare beneficiaries, expressed support for the legislation.

Not to be overlooked, the enhanced home health options outlined in the Choose Home Care Act are designed to improve patient and family satisfaction and increase their care options. These choices and flexibilities are especially important during the ongoing COVID-19 pandemic.

There has never been a better time for our lawmakers in Washington, D.C., to enable the delivery of more care in the home. The Choose Home approach offers bold new post-acute options, addresses gaps in care for seniors, and positions Medicare to avoid unnecessary institutional spending. This is an incredible opportunity for our nation, with an aging population, to embrace new approaches to healthcare.

Steven Landers, MD, MPH, is the president and CEO of the Visiting Nurse Association Health Group, Inc.

Craig Mandeville is founder and CEO of Forcura.

Articles

Healthcare needs to adapt so Medicare beneficiaries can select the care setting that’s most appropriate for their health, safety and quality of life when they require care after a hospitalization.

Give American Seniors the Option to Choose Home After a Hospital Discharge

The COVID-19 pandemic has forced us to rethink what can effectively be done from home. One of the most serendipitous realizations is that the home can be the safest, most cost-effective and restorative setting for delivering and receiving healthcare. While the negatives of the pandemic are too numerous to count, as the founder and CEO of a healthcare technology company, I view the movement of more healthcare services into the home setting as a positive trend that will continue even after we reach herd immunity. But this shift to more home-based care requires that providers update the technology required to deliver care effectively.

When you consider the size and medical complexities of the aging population, combined with the shrinking workforce to care for them, and the declining numbers of hospital systems nationally (leaving “care deserts” and swaths of underserved communities), it’s not hard to see how the home is poised to be a critical locus for the future of care delivery.

Yet for healthcare to come home—and for it to remain there – a different kind of infrastructure must be built. The formula for that infrastructure can be broken down into three parts: 

. This is a formula for achieving optimal results in the home health, hospice and rehabilitative sectors, where we have equipped healthcare organizations with the right tools to manage people, streamline processes, and digitize clinical documentation so they can deliver the best care possible.

Historically, “people” has meant the individuals working in the back office and the clinical teams who tend to patients. Today, this term is more universal, and it starts with 

 people, as well as the demand that healthcare be more affordable, accessible and effective. What better place than the home to satisfy all three?

During the pandemic, regulations like the 

Home Health Emergency Access to Telehealth

 (HEAT) Act propelled greater adoption of home healthcare, especially by newer market entrants. But ask any seasoned home healthcare, hospice or rehab therapy provider and you’ll learn that these experts long ago mastered how best to deliver care at home, working alongside caregivers and understanding social determinants of health before that was a buzz phrase. The challenge to these providers now is to optimize their internal operational processes to meet the demands mentioned above. Streamlined workflows to reduce administrative overhead and smart systems to accelerate cash flows are critical to growth.

With their people aligned to their goals, and their processes fine-tuned to be best-in-class, many identify technology as the differentiating factor for their successes. Most obviously, those providers who were using cloud-based software had a far easier transition to remote workforce operations than those dependent on a physical fax machine to keep their businesses running. But healthcare is exceedingly complex, and when care delivery was wrenched away from its normal boundaries, those providers who had command of their operational and revenue management processes and care coordination from a central, digital dashboard had a clear advantage over those who did not. Undoubtedly, so did their patients, who were less likely to see their care interrupted. While the exponential adoption of telehealth in the healthcare industry made headlines—and deservedly so—it’s the more foundational technology applications that will truly transform how, and where, care can be delivered.

Today’s care delivery model mostly favors providers who own and operate physical care locations, with patients at the mercy of an inflexible scheduling system and a pricing structure that may render some procedures unaffordable. Imagine a future where the model is flipped, and care providers compete to deliver care directly to a patient, in the patient’s home, according to the patient’s schedule, simultaneously reducing costs.

If anything, the COVID-19 pandemic is the catalyst that helps us realize that a patient-centric future may not be, and should not be, that far off. We will get there faster when we embrace the value, practical experience and potential of those providers who have always delivered care at home. Couple that with a sector fortified by the right people, process and technology, and I’m confident that even better care at home is on the horizon.

For healthcare to come home—and for it to remain there—a different kind of infrastructure must be built.

Craig Mandeville

Articles

Give American Seniors the Option to Choose Home After a Hospital Discharge

Healthcare Is Coming Home—Here’s How to Keep It There