On a Tuesday earnings call, Walgreens CEO Tim Wenworth – who took over as the company’s chief leader in October of last year – said the company would be “reorienting” its business to focus on retail pharmacy.

“WBA is reorienting to its legacy strength as a retail pharmacy-led company,” Wentworth said. “This reorientation allows us to leverage our key strategic assets of consumer trust, convenience and relevance. Our position of trust stems from the millions of face-to-face interactions our consumers have with our pharmacy personnel every day, and we will continue to take actions now – and for the long term – to be the first choice for retail pharmacy and health services. Having earned our consumers’ trust – indeed, our reason to exist – we also want to be accessible and convenient, but we need to be appropriately sized.”

Wentworth said that of Walgreens’ over 8,000 stores, around 6,000 are profitable. With that in mind, and in order to be “appropriately sized,” the company is closing a majority of the stores that are not profitable.

That is part of an effort to balance its budget sheet, too. Its reorientation to retail pharmacy follows a strategic review of assets, which took place earlier this year after Wentworth took the helm.

Walgreens has poured over $6 billion into the home- and community-focused primary care provider VillageMD, but has recently reduced the latter’s physical footprint. VillageMD is a part of Walgreens’ U.S. Healthcare segment, which also includes the post-acute care platform CareCentrix.

While health care services and the U.S. Healthcare segment were emphasized as priorities moving forward in 2021 and 2022, Walgreens now appears to be moving away from that – for the most part.

“We believe our reorientation to retail pharmacy has a bright future,” Wentworth said. “We’re engaging in a multi-year program with a long-term goal of an appropriately sized and well positioned fleet of stores, and an industry-leading customer experience in both retail and pharmacy across consumer channels. And we continue to believe that the adjacent strategic businesses in which we’ve invested can incrementally contribute to value creation over the longer term.”

Wentworth also called VillageMD “not a crucial part of the business moving forward.”

Walgreens’ peer, CVS Health (NYSE: CVS), has also experienced financial turbulence of late, after heavily investing in health care services over the last few years. While Walgreens has VillageMD and CareCentrix, CVS Health has Oak Street Health and the home-focused, value-based care platform Signify Health.

Overall, the strategic decision to focus more on health care services after the height of the COVID-19 pandemic has not gone smoothly for either company.

“Many of our actions across this turnaround will take time, but I am confident that we have the right team, the right focus and the right strategy,” Wentworth said.

Overall, Walgreens’ fourth quarter sales increased 6% year over year to $37.5 billion. Fourth quarter operating losses, however, totaled $978 million.

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“It’s a distinctive part of the culture of UnitedHealth Group that we continue to strive to deliver on our financial commitments to you through changing environments and unforeseen challenges,” UnitedHealth Group CEO Andrew Witty said during the company’s third-quarter earnings call on Tuesday. “As we look to 2025 … we remain in a dynamic period for the health care sector. Amid this, it’s important that we continue to invest in the durable value creating capabilities of this company that support our 13% to 16% long-term growth objectives.”

Despite this current operating environment, Witty expressed optimism about the company’s ability to grow in the years to come.

The company already owns the home health giant LHC Group, and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED), another one of the largest home health providers in the country.

One of the elements laying the groundwork for growth is UnitedHealth Group’s commitment to the transition of the health system to value-based care, Witty noted.

“At UnitedHealth Group, we’re purposefully organized to support the transition to value-based care,” he said. “It requires deep engagement with patients, setting the foundation to move to more coordinated care, connecting patients to primary care earlier, driving clinically accurate diagnoses more effectively, recognizing and managing chronic conditions and slowing disease progression. We’re seeing the benefits of this work come to fruition.”

Specifically, individuals who receive care services under Optum’s value-based models are more likely to receive cancer screenings. Optum is UnitedHealth Group’s health care services arm.

These individuals are also better positioned to control their diabetes and hypertension, compared to those under fee-for-service Medicare. Plus, they are 10% less likely to visit the emergency room, or be readmitted to hospital.

UnitedHealth Group’s value-based care models incorporate home-based care services, such as house calls, home health care and other in-home visits.

For the third quarter of 2024, UnitedHealth Group brought in revenues of $100.8 billion, a $8.5 billion increase over the prior year period.

Optum’s Q3 revenue was $63.9 billion, a $7.2 billion increase over the prior year.

“This was driven by an increase in both the number and type of care services we offer and the patients we serve, especially in the home and among those with complex needs,” John Rex, president and CFO of UnitedHealth Group, said during the call.

UnitedHealthcare’s Q3 revenue was $74.9 billion, a $5 billion increase over the previous year.

“Indications are tracking favorably as we head into 2025, reflecting continued strong uptake of UnitedHealthcare’s innovative offerings,” Rex said. “Our Medicare Advantage plans, on offer this fall, balance providing as much benefit stability as possible for seniors, while contending with the CMS funding cuts, IRA changes and expected care patterns.”

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The closure was cited as due to economic reasons, according to a notice filed with the state Department of Labor on Oct. 10.

The workforce reductions occur as the Louisville, Kentucky-based firm plans to discontinue all its home care services in order to concentrate on its senior living business. The company established its Nassau County home care agency to support the 30 assisted living facilities it operates across the state.

The home care business’s closure is reportedly unrelated to the industry consolidation of the Medicaid-funded Consumer Directed Personal Assistance Program (CDPAP) participants in New York next year. Atria does not accept Medicaid.

“After careful consideration, we have made the decision to discontinue operations at Atria Home Care in an effort to focus on our core business of social model senior living communities,” an Atria Senior Living spokesperson told Home Health Care News. “We are working with all home care customers and employees on a transition to other home care providers and are committed to supporting our employees and clients through these changes over the next several weeks.”

Founded in 1996, Atria Senior Living provides independent and assisted living and memory care facilities for adults with dementia or Alzheimer’s disease in more than 300 communities across 43 states and seven Canadian provinces, according to its website.

Atria’s portfolio of brands includes Coterie Luxury Senior Living, Atria Signature Collection, Atria Senior Living, Atria Park, Holiday by Atria and Atria Retirement Canada. The privately held management company employs more than 13,000 caregivers and has approximately 36,000 residents.

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Caribou Rewards, a rewards and engagement application built to elevate care agencies to world-class employer status, has announced its official partnership with Right at Home, becoming the national in-home care provider’s preferred rewards and recognition partner for their 433 locations throughout the United States.

Right at Home franchises undertook a 6-month competitive pilot program to inform vendor selection, which was initiated at the end of 2023 in an effort to improve overall caregiver experience.

Specifically, they set out to increase staff engagement, bolster recruitment efforts, and improve caregiver retention. To determine the choice partner, Right at Home compared performance data and qualitative feedback from caregivers, office staff, and agency owners.

Caribou’s mission is to fuel excellence across organizations through automated rewards and recognition programs designed to make caregivers feel seen and valued. In September, Right at Home US selected Caribou after achieving exceptional results in the pilot program, illustrating positive business outcomes for all participating franchises.

“Simply put, Caribou won in every category,” says Jessica Schultz, director of people strategy at Right at Home. “Caribou continues to drive new integrations, and new build-outs to fit our needs. Their adaptability, and their willingness to listen and learn, was unmatched. Plus, their customer service level was superior, and their platform readiness was mature.”

Caribou’s automation capabilities played a vital role in the selection process, as Right at Home franchises prioritized ensuring office staff had no extra work on their plate while administering a new program that seamlessly integrated with their existing scheduling system.

“Our aim is to help our agency partners become outstanding employers and great businesses through a technology-enabled culture that puts caregivers first. This partnership signals Right at Home’s commitment to being an industry leader in using technology to improve the caregiver experience, as well as overall business performance,” says Christian Alaimo, Caribou’s co-founder and chief operating officer.

“The results with Right at Home franchises show how powerful rewards and recognition can be for any in-home care agency’s growth goals and operational efficiency,” Alaimo says.

Within six months, Right at Home pilot franchises saw 15% growth in active staff, 15% improvement in Electronic Visit Verification, and a 65% improvement in retention for new hires.

“Since our inception, Caribou has helped agencies improve their operational efficiency while directing money back into the pockets of caregivers,” says Alaimo. “We’ve put over 5 million dollars in the pockets of hard-working caregivers. It’s a virtuous cycle that positively impacts every stakeholder in the ecosystem.”

Rosaleen Doherty, co-owner at Right at Home Boston, has been using Caribou since 2022, and notes the success she has had with the platform.

“Caribou is a way for us to reach people across our entire company, and help them be seen for the great work they do. We know this equates to job satisfaction, and that’s what we’re all aiming for with our teams,” Doherty says. “Thanks to Caribou, we have a tool in our toolbox that helps us reward our team easily and immediately — without any extra administrative work.”

To date, upwards of 3,000 Right at Home caregivers across eleven states are using Caribou with their local Right at Home office to get points, redeemable for cash incentives, for clocking in and out, referring qualified candidates for open roles, completing important onboarding tasks, or picking up extra shifts.

“We’re excited to see how this partnership evolves year after year, and our Right at Home franchises will be thrilled to have access to a tool like Caribou that their caregivers love,” says Schultz.

Caribou fuels excellence across entire organizations; improving retention, recruitment, and staff performance, all while improving overall operational efficiency. Caribou’s referral programs have generated thousands of hires for agencies, moving the needle on the caregiver shortage that impacts the lives of millions. Find out more about Caribou’s mission at www.caribou.care.

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This comment was an anomaly, in terms of its brevity. While most respondents expressed similar sentiments, they chose to utilize more words to do so.

Overall, providers went into detail about the specific challenges they are facing in their market, and why the proposed payment rule would impact access to care.

Below are the comments Home Health Care News thought stood out from providers, as they see their margins decrease year over year.

Some comments have been edited for length and clarity.    

***

Within our market, the incidence of home health admissions that include wound care and specifically the types of wounds included within this proposal are increasing. Any decrease to reimbursement for HHAs who are treating these types of wounds would be detrimental to patient care. The cost of supplies continues to increase like everything else in the economy and labor costs to access skilled nurses or therapists who actually have proper wound care treating in these types of cases are also increasing.

In our agency, we recently had to refer a patient who was sent to us to another agency due to the patient’s insurance. The patient developed a pressure wound and the nurse who was sent to treat the patient was not properly trained in wound care. Over the next few weeks, the patient reported that the wound was increasing in severity and he was concerned that the nurse did not seem to know what she was doing. He requested that she get some additional help. The nurse brought her supervisor to observe the wound care provided and ask if it was proper or adequate. The supervisor instructed her that the only thing she could do correctly at that point was call an ambulance for the patient. The patient had developed gangrene in the wound and was transported to a hospital. A few weeks later, the patient’s leg was amputated just below the knee. The result of amputation resulted in significantly higher expense to Medicare than paying for adequate wound care wound cost. Worse, the patient’s quality of life is now irreversibly affected by loss of limb.

I understand the need to try to reduce expenses and cut costs across our federal budget. Home health is a great program that allows for significant improvement in patient outcomes while decreasing hospitalization. I strongly encourage Medicare to consider increasing spending for home health companies to provide quality supplies and hire or train their staff with the necessary certifications and skills needed for advanced care in the home. While the expense for home health may increase, I don’t think it’s a surprise that the rate of hospitalization will decrease and that significantly decreases the overall cost of health care while also improving patient outcomes.

— Primary Home Health LLC

***

I am an administrator of a small independent home health care agency in Calumet City, IL. Every year we are fighting for survival and every year CMS is proposing to cut reimbursement and adding more regulations. Unfortunately, it is the same this year. There has got to be a way that you come up with a plan to stop this madness. It is difficult to pay nurses and have enough people in the office to maintain all of the regulatory requirements. Can you please remove some of the regulations so we can get back to the business of taking care of patients? You just extended RCD 5 additional years. You have extended HHVBP. You have added NOAs but didn’t remove any regulatory burdens nor have you given an increase in reimbursement. The hospital systems are dropping home health agencies like flies in Illinois because it appears we are not valuable. Independent home health agencies are closing because they can’t provide care, pay field staff and keep up with the regulatory burdens put upon us by you. We need a break, please!

— Deirdre Hezekiah Onwukwe

***

I would like to express my concerns regarding the recently released proposed rule for the CY2025 Home Health Prospective Payment System (HH-PPS). As an occupational therapist and a former home health provider, the proposed changes could significantly impact access to quality occupational therapy services for Medicare beneficiaries. Reducing payment for key occupational therapy services raises alarms about the sustainability of these essential services, which play a crucial role in enhancing the well-being and independence of patients in their home environments. It is required to maintain focus on ensuring that Medicare beneficiaries receive the highest quality of care, and adequate compensation for occupational therapy. I urge CMS to reconsider these proposed payment reductions to ensure that patients continue to receive the necessary occupational therapy services for their recovery and overall health.

— Vera Gallagher

***

While we appreciate CMS’ efforts to combat fraud, waste, and abuse, CMS must provide clear guidance to any provider under a PPEO, including the timeline for reviews, the process for any appeals, and the criteria for when sanctions and penalties are imposed.

CMS’ proposed rate reduction does not consider the high costs of inflation, staffing shortages, turnover, and labor stresses that home health providers are facing. Combining those challenges with significant cuts to funding would reduce our patients’ access to life-changing care. This affects the patients who need us the most who may not have the funds and are most vulnerable.

The most vulnerable populations rely on our high-quality care and these cuts will restrict their access to care, particularly in rural and underserved areas.

Changes to the wage index will move some agencies from an urban designation to a rural one, thereby further reducing their reimbursement at a time when rural agencies are facing increased challenges recruiting and retaining employees.

We give excellent care to all who need us and even give charity/indigent care as we can but further cuts to our funding would make it almost prohibited. Our clinicians work very hard and they are not given annual raises, in fact some have not had a raise in almost 3 years. Home health is not an easy job, it is an act of the heart and yet they give everything they have to the patients and community we serve!

— Seaport Scripps Home Health

***

My home health agency serves rural Wyoming. With the high cost of supplies, labor, recruitment and overall cost to service a rural area, the proposed Rule will nearly eliminate our ability to continue to service these areas. We are currently facing high inflationary wages And stiff staff competition with the hospital and other health care providers. A 4% reduction in our reimbursement will only exacerbate the issue.

The 5% wage index cap also prevents our rural communities from obtaining a market rate wage that allows us to hire competitively.

The need for home health in rural communities is only becoming more and more necessary. This rule will prevent all home health agencies from being able to have sustainable reimbursement to service rural communities.

CMS needs to consider the overall stress home health agencies are under with the current economic environment. CMS should consider a reimbursement increase of 5%.

— Symbii Home Health and Hospice Wyoming

***

Compared to CY 2024, CMS estimates a decrease of 1.7% in Medicare payments to HHAs for CY 2025. Henry Ford Health is concerned that the annual update to the home health payment rate has not kept pace with significant increases in the cost of labor, medical supplies and other resources needed to provide high-quality care to our patients.

Much of this cut is attributable to a 4.067 percentage-point decrease that is a result of the behavioral assumption adjustment. CMS’ behavioral assumption adjustments are in direct response to regulatory changes that home health providers are required to follow since implementation of the PDGM on January 1, 2020. These behavioral assumptions are challenging because they are punishing home health providers for decisions brought on by regulatory change. For instance, one reason for lowering payments under the behavioral assumption adjustment was the assertion that there would be an increased volume of “home health periods of care” that would receive a comorbidity adjustment resulting from considering all 24 comorbidities on a claim rather than just five. Specifically, the intent of the PDGM was to rely more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment groups, with 432 possible case-mix adjusted payment groups.

As a result of the effects of these changes – as well as to PDGM calculations, low-utilization payment adjustment (LUPA) threshold and outlier reimbursement – HHAs will experience even deeper cuts than the 1.7%. Henry Ford Home Health Care estimates that the reduction is closer to 2.3%.

— Henry Ford Health

***

You continue to cut reimbursement to providers and limit access to services that impact independence, member health, sustainability for providers, and ability for members to remain at home. You cut these services and then blame the providers for poor outcomes. By limiting access to these services, Medicare in the end spends more money to provide services to members in hospitals and skilled nursing facilities. It is time to support members in their home and maintain their health in the first place. It is far less expensive for Medicare to treat people who are healthy enough to recover than to provide services once diseases have progressed and prognosis is far less positive.

— Anonymous

The post ‘We Need A Break, Please!’: Home Health Providers Sound Off On CMS Over Rate Cuts appeared first on Home Health Care News.

“Health literacy is a state of knowledge and comfort that allows you to navigate the world and achieve wellbeing,” Danielle Brooks, director of quality health equity at AmeriHealth Caritas, told Home Health Care News. “It is critical to navigating, supporting and advocating for yourself when experiencing a medical or health-related need.”

AmeriHealth Caritas, based in Newtown Square, Pennsylvania, is a national managed care solution provider.

Limited health literacy significantly impacts Medicaid members, with 60% having basic or below-basic literacy, compared to only 24% of those with employer-sponsored coverage, according to the Center for Health Care Strategies. This demographic includes people aged 65 and older, individuals with lower incomes, those with lower education levels, people with limited English proficiency and minorities.

Furthermore, low health literacy rates lead to higher hospital use, higher mortality rates and higher health care costs. Improving rates could prevent one million hospital visits and save over $25 billion annually, according to the Centers for Disease Control and Prevention (CDC). Health literacy is essential in home care because it can affect a patient’s ability to understand and follow their treatment plan.

Oftentimes, patients also don’t realize that home health care or home care are options available to them.

“The complexity of the health care system and health concerns like COVID-19 require strong literacy skills to find, understand, evaluate and use health information to make informed decisions,” Sabrina Kurtz-Rossi, assistant professor at Boston’s Tufts University School of Medicine, told HHCN. “Compelling sources of health information, including inaccurate information on social media and the internet, intensify the need for improved health literacy for all.”

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) have listed improved health literacy as organizational priorities. Specifically, HHS has included it in its Healthy People 2030 initiative.

Organizations and professionals can enhance their health literacy by implementing proven strategies. These include addressing questions in simple, non-medical language and creating and testing written materials for the intended audience, as per the HHS.

It’s important to consider that any patient may face challenges in understanding health information. Adults with limited literacy often feel ashamed of their abilities and may conceal their difficulties. Conducting informal client assessments can help identify individuals with limited literacy skills.

“Organizations should start by asking themselves this question,” Brooks said. “What do we need to do to reach our clients in a way they understand and that speaks to them? Materials and messaging need to be presented in a way that is most easily understood by clients and resonates with them. Employees must learn how to incorporate health literacy into their work every day.”

State contracts often require insurers serving Medicaid enrollees to have materials available in multiple languages, written at a sixth-grade reading level or lower, and have member-facing staff who can speak languages other than English.

“It is important to have data on how your current and potential clients understand and process information,” Brooks said. “This includes not only what languages they speak but also factors like age, education level, gender identity, sexual orientation and family structure. This information provides important insights into their needs. It is about communicating to members in a way that is most easily understood and actionable.”

The CDC recommends asking patients how often they need help reading written material from their doctors or pharmacies and asking them to explain instructions in their own words to show that they understand. Use videos, models and pictures to help clients learn. Listen to concerns without interrupting and consider clients’ cultural and linguistic norms when developing messages. Use certified translators and interpreters to adapt to language preferences.

“There are validated tools for analyzing written health information for reading ease and accessibility,” Kurtz-Rossi said. “These include the Patient Education Materials Assessment Tool, the CDC Clear Communication Index, and the Readability, Understanding and Actionability of Key Information on Informed Consent Forms (RUAKI) Indicator. Readability formulas can tell you the reading grade level at which a material is written but do not assess layout and design, cultural relevance or other features that help make information accessible.”

Active engagement is also vital to improving clients’ health literacy and ensuring they receive the best care. Engaged clients are more likely to follow treatment plans and work with their caregivers to make informed decisions.

Caregivers should encourage questions, ask clients to express concerns, and readily offer information during visits. Open communication helps build relationships between clients and caregivers and may make clients feel more comfortable asking questions about their conditions.

“The ten attributes of literate health care organizations provide a framework for how organizations can ensure clear communication and understanding,” Kurtz-Rossi explained. “Health-literate organizations strive to provide equitable and understandable information and services using evidence-based health literacy interventions, including plain language in written and oral communication and teach back to confirm understanding. Other health literacy tools and resources can help organizations engage leadership, prepare the workforce, create a shame-free environment and use plain language print materials and websites.”

Caregiver literacy is also a concern

It is important to note that caregivers also have a range of health literacy skills.

“Health literacy is a multifaceted concept which reflects not only individual-level skills but also the unnecessary burden placed on clients and caregivers by an overly complex health system,” Rachel O’Conor, assistant professor at the Center for Applied Health Research on Aging at Chicago’s Northwestern University, told HHCN. “Thinking about health literacy as both an individual skill, but also an organizational trait, can be helpful for agencies to consider as they seek to promote health literacy among their caregivers.”

A recent study showed that 44% of caregivers demonstrated adequate knowledge, 36% demonstrated marginal knowledge and 20% had low health literacy skills. In adjusted analyses, caregivers with marginal and low health literacy demonstrated worse overall performance on health tasks and poorer interpretation of health information presented on print documents and recall of spoken communication. As a result, these caregivers demonstrated poor performance on everyday health tasks with which they commonly assist older adults. The application of health literacy best practices to support better training and capacity-building for caregivers was found to be warranted.

Researchers suggested online training modules to promote caregiver communication with health care clinicians. Following health literacy best practices, these modules should be developed using plain language and cultural inclusion.

“To ensure caregivers are equipped to provide a high level of care, agencies should provide skills-based training on how to assist with health-related tasks,” O’Conor said. “The training could incorporate health literacy best practices in order to promote comprehension and application of the information.”

O’Conor said that she has found that the inclusion of both spoken and print information can promote recall, as well as breaking the information into manageable pieces for better comprehension.

“All corresponding information needs to be easy to understand,” she said. “Passing a simple test demonstrating competency may be reasonable to ensure proficiency in these skills. This act of demonstrating proficiency is in essence the application of teach-to-goal procedures, which is a common health literacy best practice to promote comprehension of health information.”

Home-based care agencies that prioritize personal and organizational health literacy can benefit from multiple positive outcomes. Expanded literacy can improve client health outcomes, decrease emergency department visits by ensuring clients seek preventative care, reduce the number of dosing errors, help clients manage chronic conditions and increase satisfaction.

“Caregivers have a unique role to play when it comes to tailoring and communicating treatment plans to meet the unique needs of individual clients,” Kurtz-Rossi said. “Doctors are one important point of content, but it takes a health care team – including family members – and each member of the team needs to listen to client concerns and communicate plans and services clearly. Clear communication builds trust. When a client is engaged with and trusts their caregivers, they are more likely to follow recommendations.”

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Michael Martin, VP of network management at tango, has been named a 2024 Future Leader by Home Health Care News.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors, and the committed professionals who ensure their wellbeing.

Martin sat down with Home Health Care News to discuss how reimbursement structures can positively change the future of home health care.

What drew you to this industry?

My mother has worked for post-acute and home health companies for several decades. I was exposed to that at a very early age.

So when I came of age and was able to come around her office, I got a chance to get additional exposure that way. I always had just an understanding of the health care industry, specifically the post-acute industry, through her. After college, I kind of experimented in sales and a few other industries, but I just fell back on what I knew, which was home health. And so my first job, my first real salary position, was working for a home health company. And my career took off from there.

What’s your biggest lesson learned since starting to work in this industry?

The biggest lesson that I’ve learned is that if you are wanting to transform the way providers service their members, I think you have to take a hard look at how they’re reimbursed.

Sitting on this side, where I oversee a network of providers, it’s really important that the way we reimburse providers shifts behaviors towards outcomes versus anything else. I learned that lesson working for VillageCare, where I oversaw their bundled payment program, and I just watched how that transformed the entire facility. I helped manage that program on their behalf, and at the time, I think they were managing about 11 bundles.

And you just saw how a capitated payment model, where you’re taking full risk, changes things. You see discharge, length of stay drop. You see partnerships in the community improve, things like starting the discharge planning process at the point of admission became a familiar sight. And it improved outcomes in a major way.

If you could change one thing with an eye toward the future of home health care, what would it be?

I would change the way providers are reimbursed. If I could, I would orient them all to ideally a full-risk arrangement, and at the very least, an upside arrangement, where they’re getting bonuses based on the value that they’re creating.

In a word, how would you describe the future of home health care?

Bright.

What quality must all Future Leaders possess?

I think it’s multifaceted, but I would say patience and empathy, those are incredibly important. It’s important that we have diverse backgrounds. I think that although the future is bright, we live in a very fragmented environment. And I think that just health care in general is very complicated for the common person. It’s also very dynamic and complicated to health care professionals.

It’s changing all the time, and if you get too lax, you get left behind. Leaders that are at the forefront of this, that are able to keep up, and frankly, pave new paths, have to have the patience to bring everyone else up to speed. And part of that is being empathetic about not only your team, but your clients, your partners in the community – putting yourself in their shoes. That’s vital for any sort of innovation.

To learn more about the Future Leaders program, visit https://futureleaders.agingmedia.com/. 

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Less than a month before election day, the Democratic and Republican candidates for president are dueling over home-based care plans.

Vice President Kamala Harris announced on “The View” this week a proposal that would allow home care to be administered through traditional Medicare.

On the same day, former President Donald Trump and his campaign released a rebuttal, pointing toward home care-related policy implemented from 2017-2020, plus additional plans for a potential second term.

Harris’ proposal is a more lofty one. It would also – if implemented – create a massive tailwind for home care providers across the country. But, as LeadingAge President and CEO Katie Smith Sloan pointed out after the proposal, “we cannot overstate that without staff, there is no care.”

Trump, meanwhile, pointed to expanded supplemental benefits in Medicare Advantage (MA) as a way for seniors to access more home care-related services. His campaign team also focused on economic points that it believes will make aging in place easier for Americans under his leadership.

In this exclusive, members-only HHCN+ Update, I make the mistake of venturing into the presidential candidates’ plans for home-based care. Specifically, I examine how viable the plans are, and what they could mean for providers, if implemented.

Home-based care takes center stage

Home-based care providers were likely pulling their hair out over the predictable confusion that arose from Harris’ proposal Tuesday.

Home health care is already a robust benefit provided under the Medicare program, and generally includes services delivered to seniors after an acute health event.

Home care is not currently available under traditional Medicare, however, and generally includes non-medical services to help with activities of daily living.

The only place where home care is paid for under Medicare is through MA supplemental benefits, and MA pays for just a sliver of all home care provided currently.

So, yes, Harris’ proposal would be groundbreaking, if implemented. It would completely change the scope of the Medicare program.

As for the companies it would directly impact, pick a notable name in home care.

Currently, home care providers have a large addressable market: seniors with the ability to pay out of pocket for home care services; Medicaid beneficiaries in need of home- and community-based services (HCBS); veterans in need of home care, paid for through Veterans Affairs (VA); and a small portion of MA beneficiaries and long-term care insurance clients.

If home care were paid for by Medicare in the future, that would take the concept of “unlimited demand” to a new level. There are over 30,000 home care agencies in the country, almost all of which would have a new market opportunity if Medicare became another means to pay for home care.

The one potential downfall for providers would be former private-pay home care clients being able to use Medicare to pay for services. Private-pay home care doesn’t come without challenges, but it remains one of the most profitable forms of home-based care business.

Home health providers – which already provide care to Medicare beneficiaries, almost exclusively – would also see a business boon. Many of them already provide home care, and the ability to care for clients through one revenue source in both service lines would be massively beneficial.

After all, home-based care is responsible for one of the only successful Center for Medicare and Medicaid Innovation (CMMI) demonstrations of late. The Home Health Value-Based Purchasing (HHVBP) Model – now implemented nationwide – has already saved Medicare billions, and is likely to save many more billions moving forward.

“We think access to personal care services could at least double from six million customers today. By our estimate, the extra spending would expand the [total addressable market] by ~30% to $110 billion per year,” Macquarie Capital wrote in an analyst note this week. “Since Medicare covers home-based medical services, we expect a wider adoption of the integrated care model following added personal care services coverage. This could also expedite the transition to value-based care. Providers could benefit from aligned incentives, streamlined operations and cost synergies.”

Then comes the question of viability, however.

Harris is not the first person to propose such an idea. Home care stakeholders have suggested it for years, but so have other policymakers.

“When the Affordable Care Act was passed, a component similar to this was included and that ultimately was stripped out,” Tyler Giesting, a director of health care and life sciences at West Monroe, told me this week. “I think we’ve seen it fail in the past for reasons that come down to: can it be economically viable? The challenge would be getting something like this passed, in the way that it has been described so far.”

The Harris campaign has suggested that it would pay for the proposal, in part, by cutting Medicare payments for drugs. It estimated that the proposal would cost around $40 billion per year.

But other estimates suggest that it would cost closer to $400 billion.

Harris sees the proposal as a way to aid the “sandwich generation” – adults that have aging parents to take care of, as well as children. Those responsibilities make it tough to maintain employment.

For Harris, the key would be to convince the right stakeholders of the overall value of home care. It wouldn’t be enough to just prove that more Americans could continue contributing to the economy if they had additional help at home for their older relatives.

Harris’ team would need to instead pitch this as a long-term cost savings project. If more seniors had access to home care, less seniors would be driving up U.S. health care costs in hospitals, emergency rooms and more costly brick-and-mortar facilities.

That is already a battle home care providers face. They are regularly trying to convince payers that more home care equals less overall cost. But a concrete plan, and concrete evidence of those potential savings, would have to be laid out.

“It’s one thing to have this idealistic proposal perspective, and it’s another to actually put it into action with a detailed plan,” Giesting said. “Then, there’s also getting it passed and put into law.”

A detailed plan is key. Even if we accept the idea that more access to home care could ease burden on Americans, while also keeping overall health care costs down, the implementation of the proposal through Medicare would need to be tirelessly thought out.

For instance, New York’s Consumer Directed Personal Assistance Program (CDPAP) – which allows family members to be paid to care for loved ones in need of home care – has been a fiscal disaster for the state.

Self-directed care has potential. It allows unpaid caregivers to be compensated, and for home care recipients to direct their own care. But it’s also hard to oversee.

For what it’s worth, if the proposal did move forward, I think the best way to go about it would be to prioritize care from existing, quality home care agencies. Agencies that train and vet their caregivers, ones that have been providing care professionally for a long time.

Trump proposals

The Trump campaign’s home care proposals are more understated. And, like Harris’ plans, more details would be needed to project true impact – for potential home care beneficiaries and providers.

“President Trump will prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages and supporting unpaid family caregivers through tax credits and reduced red tape,” the Trump campaign wrote in a release, in preparation for Harris’ announcement this week.

The campaign also evoked MA supplemental benefits. MA supplemental benefits – through the primarily health related pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway – were created during Trump’s presidential term.

The benefit that allows for home care services is dubbed In-Home Support Services (IHSS). MA plans have pulled back on offering IHSS in 2024, however.

“The Trump administration provided new Medicare Advantage supplemental benefits that included modifications to help keep seniors safe in their homes, respite care for caregivers, transportation coverage, additional in-home support services and assistance and non-opioid pain management alternatives,” the release continued.

The campaign also pointed out other indirect factors that have led to home care inaccessibility of late, such as inflation, which it believes it can continue to bring down.

Spotlight and policy

Home-based care being in the nationwide spotlight is a good thing for providers and older Americans.

But it’s also worth taking stock of where that spotlight has gotten us before. The Biden-Administration has been laser-focused on home care, but mostly HCBS through Medicaid.

Meanwhile, home health providers have been left behind. Advocates are in the throes of a three-year long fight against continued rate cuts from the Centers for Medicare & Medicaid Services (CMS), as other home-based care proposals are taking shape from both campaigns.

Home health providers are seeing their traditional Medicare payments cut, while also receiving payments from MA plans that often don’t cover the cost of care. All the while, MA penetration continues.

In April of 2023, I wrote about why federal support for home-based care is missing the mark.

While proposals from both campaigns this week contain some good elements, that fact remains true.

As home-based care takes center stage once again, Medicare-certified home health providers are forced to stand behind the curtains, at a time when their margins are evaporating.

“I would also want to remind the Biden, Harris administration that the existing Medicare home health program is under assault currently, and has been since 2020, with billions of dollars in cuts that have diminished access to care, so I think that investment and a stabilization of the existing Medicare home health benefit is something that is also needed,” Partnership for Quality Home Healthcare CEO Joanne Cunningham told HHCN this week. “With this news, I would just offer that recommendation and reminder.”

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WellSky’s latest report pulls data from the company’s network of more than 2,500 hospitals, accountable care organizations (ACOs) and physician practices, as well as 130,000 providers across the country. WellSky is an international software and professional services company.

Overall, the report shows that securing timely post-acute care options for patients is a pain point for hospitals. Even though home health referrals increased by 6%, acceptance rates were only 34.5%.

Tim Ashe, chief clinical officer at WellSky, believes that this is the biggest challenge the health care system is currently facing.

“Demand is increasing, patient acuity continues to expand, and then you layer in the workforce challenges and the supply side constraints that those shortages present, and you have a capacity problem in the post-acute markets, including home health,” he told Home Health Care News. “The 34.5% acceptance rate is really indicative of home health organizations wanting to take those referrals, but in many instances they are constrained either by supply, availability, capacity in general, or the ability to take on particular payers.”

Ashe noted that this is a “troubling dynamic” creating a bottleneck across the system.

“Patients need the level of care that home health provides, yet the capacity to care for all of those patients is constrained,” he said.

The report also found that patients discharged to home health care saw a 7% increase in average hospital length of stay.

“While home health agencies want to accept these referrals, they can’t, and so these patients are sitting longer in the hospital,” Ashe said.

Ashe pointed out that these challenges were an opportunity for providers to continue to seek out technology solutions that improve care planning and deployment.

Along these lines, the report also came to the conclusion that generative AI and predictive analytics could be a gamechanger.

“We see the implementation and integration of AI capabilities being a good fit inside of the provider’s workflow,” Ashe said. “It has to be intuitive. And it has to be done in a way that is part and parcel to the clinician, or the provider agency, being effective and efficient in how they’re scheduling, how they’re planning and how they’re deploying care. Ultimately, that leads to them being more enabled to provide higher quality care, and a higher volume of services to more patients.”

Ashe emphasized the importance of using these solutions to automate and eliminate administrative burdens, in order to improve access to care.

The report also highlighted some of the regulatory shifts taking place in the health care market, including the Transforming Episode Accountability Model (TEAM), ACO Primary Care Flex (ACO PC Flex) and the Making Care Primary (MCP).

“All of these regulatory changes and models are shifts and require us to educate ourselves, to prepare and make sure that we’re able to meet the requirements that CMS introduces,” Ashe said. “I see it as a positive and continued movement towards value-based care. At the end of the day, that improves quality. If done right, it reduces cost, which is a critical aspect to making sure that we have a sustainable health care market going forward. Ultimately, it’s the right thing to do for patients.”

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According to court documents, Zakia Khan and Ahsan Ijaz owned two Brooklyn-based social adult day care organizations, Happy Family Social Adult Day Care Center Inc. and Family Social Adult Day Care Center Inc., and a financial intermediary called Responsible Care Staffing Inc.

These organizations were involved in the New York Medicaid Consumer Directed Personal Assistance Services Program (CDPAP), which allows family members of Medicaid recipients to receive payment for helping the recipients with daily activities.

Starting around October 2017, marketers Elaine Antao, Omneah Hamdi and Manal Wasef reportedly directed Medicaid recipients to Happy Family, Family Social or Responsible Care in exchange for kickbacks and bribes. In return, the marketers allegedly paid kickbacks and bribes to Medicaid recipients for social adult day care and CDPAP services that the organizations billed to Medicaid – services they either did not provide or services that were influenced by those kickbacks and bribes.

Ansir Abassi, Ansir Zaib and Amran Hashmi purportedly managed Happy Family and Family Social along with the marketers. To carry out the kickback scheme, Khan, Antao, Ijaz, Abassi and Hamdi allegedly used business entities to launder the fraud proceeds and generate cash to pay kickbacks and bribes. Seema Memon, an employee of Happy Family who was previously charged by complaint on July 1, was also indicted.

“As alleged in the indictment, these defendants orchestrated a years-long scheme to defraud Medicaid of tens of millions of dollars for social adult day care and home care services that they did not provide,” Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division, said in a statement. “The defendants allegedly paid cash bribes and kickbacks to recruiters and Medicaid recipients as part of a scheme to enrich themselves at the expense of vital programs for senior citizens. The charges make clear that the Criminal Division will not tolerate schemes that brazenly steal from federal health care programs.”

Khan has been charged with several offenses, including conspiracy to commit health care fraud, three counts of health care fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, paying health care kickbacks, conspiracy to commit money laundering, and money laundering. If found guilty, she could face a maximum penalty of 20 years in prison for each count of conspiracy to commit money laundering and money laundering, ten years in prison for each count of conspiracy to commit health care fraud, health care fraud, and paying health care kickbacks, and five years in prison for conspiracy to defraud the United States and to pay and receive health care kickbacks.

Abassi, Antao, Hamdi and Ijaz face charges of conspiracy to commit health care fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, conspiracy to commit money laundering and money laundering. If found guilty, they could be sentenced to a maximum of 20 years for each count of conspiracy to commit money laundering and money laundering, ten years for conspiracy to commit health care fraud, and five years for conspiracy to defraud the United States and to pay and receive health care kickbacks.

Hashmi is facing charges of conspiracy to commit health care fraud, three counts of health care fraud, conspiracy to defraud the United States, and paying and receiving health care kickbacks. If found guilty, he could be sentenced to a maximum of ten years for each count of conspiracy to commit health care fraud, health care fraud, and paying health care kickbacks, as well as five years for conspiracy to defraud the United States and to pay and receive health care kickbacks.

Memon is charged with conspiracy to commit health care fraud, conspiracy to defraud the United States, and paying and receiving health care kickbacks. If convicted, she faces a maximum penalty of ten years for each count of conspiracy to commit health care fraud and paying health care kickbacks and five years for conspiracy to defraud the United States and pay and receive health care kickbacks.

Wasef faces charges of conspiracy to commit health care fraud, conspiracy to defraud the United States, and conspiracy to pay and receive health care kickbacks. If found guilty, she could face a maximum penalty of ten years for conspiracy to commit health care fraud and five years for conspiracy to defraud the United States and to pay and receive health care kickbacks.

Since March 2007, the Health Care Fraud Strike program, consisting of nine strike forces operating in 27 federal districts, has prosecuted over 5,400 defendants who have overbilled federal health care programs and private insurers by over $27 billion.

“The crimes outlined in this indictment took advantage of a network that offers essential health care and other services to those in need,” Interim Commissioner Thomas G. Donlon of the New York City Police Department (NYPD) said in a statement. “Let it be clear: anyone who attempts to profit by defrauding the system will face consequences, as these schemes drain already limited resources and deprive beneficiaries of crucial funds. I commend our NYPD investigators and federal law enforcement partners for their continued collaboration.”

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