The two organizations had already merged – and named a new leader – but had not yet announced a new name or brand.

The National Alliance for Care at Home (the Alliance) aims to provide resources, education and information to assist members in expanding their organizations. Additionally, the Alliance will serve as the collective voice of the member community, advocating for policies that promote the delivery of high-quality care for patients and their families.

The logo of the National Alliance for Care at Home pays tribute to the past while also representing the future. It combines visual elements that symbolize NAHC and NHPCO, the legacy organizations that have merged to form this new alliance. The logo concept was developed based on input from a workgroup of members, who have had a significant influence on the Alliance’s brand.

The Alliance The Alliance

The Alliance also launched its integration website today at AllianceForCareAtHome.org. The new site not only provides information on the organization, but also serves as a single sign-on hub for members.

The new website includes an updated “Find a Provider” tool to assist consumers in locating home care, home health, hospice and palliative care providers. In the upcoming weeks, Alliance members will have access to a total of 29 online member communities, facilitating the professional exchange of ideas and best practices. A new website is set to launch in 2025 at the current URL, consolidating the key features from both NAHC and NHPCO’s legacy sites. Throughout the development of the new site, the Alliance’s integration site will act as a gateway to access resources from the two legacy sites.

“Providers offering various forms of care at home have always looked to our national associations to help create a shared vision for the future,” Kenneth Albert, chair of the Alliance’s transition board, said in a statement. “It took imagination, dedication and guts to take on the tough conversations about combining two organizations, each with more than 40 years of history. This Alliance will be the leading authority on transforming care in the home. We will implement that mission under a new name that welcomes providers across the care continuum to join–the National Alliance for Care at Home. The logo shows people coming together, hand in hand. That is exactly what we will do in this new Alliance–work collectively to imagine what the future of care in home settings can and should look like, and then to bring that vision to reality.”

In March 2023, NAHC and NHPCO announced they were exploring collaboration opportunities. This initiated a member consultation and input process which led to an agreement to combine the two organizations into a new Alliance, with integration work beginning July 1, 2024.

On Aug. 26, the Alliance announced that Dr. Steve Landers would become its first CEO. The Alliance will continue integrating NAHC and NHPCO operations into a single organization through the remainder of 2024 and into 2025.

The post NAHC, NHPCO Merger Becomes ‘National Alliance for Care at Home’ appeared first on Home Health Care News.

Landers is the former CEO of the Visiting Nurse Association (VNA) Health Group, a nonprofit home health, hospice and palliative care operator that serves patients in Ohio and New Jersey.

He left the company last year and became the president and CEO of Hebrew SeniorLife, a Harvard Medical School-affiliated senior living provider that is also a research and educational organization. After nearly a year there, Landers opened up his own venture, Landers StratAGEy, in May of this year.

Now, he’ll be tasked with leading the NAHC-NHPCO Alliance, which is set to have a new name itself in the coming months. NAHC and NHPCO began integrating on July 1, and together are the largest home-based care advocacy organization in the country.

NAHC President William A. Dombi has been a part of the transition, and is set to retire at the end of the year.

“The Alliance members provide a wide range of high-quality home- and community-based services that promote comfort, dignity and independence,” Landers said in a statement. “I’m so proud to become a part of this organization, and am eager to serve. I’ve had the opportunity in my career to see the health care industry from many vantage points, and in this new role with The Alliance, I will use all that I have learned to make a difference for our members as we continue to expand to meet the growing public needs for our care.”

Outside of his time at VNA Health Group and Hebrew SeniorLife, Landers also spent time at the Cleveland Clinic and at John Hopkins School of Public Health.

“Providing leadership around policy and advocacy efforts is critical to our mission at The Alliance,” Transition Board Chair Ken Albert – who also serves as the CEO of Andwell Health Partners – said in a statement. “Throughout his career, Dr. Landers served the field as an effective policy advocate, shaping policy at both the state and federal levels. We are thrilled to welcome him as our inaugural CEO, and I know he will build an extraordinary team to offer value for our members.”

Landers is a logical fit given his extensive experience in all service lines related to home-based care.

“Dr. Landers’ rich and diversified experience makes him the ideal candidate to lead our membership as our organization evolves,” Alliance Transition Board Vice Chair Melinda Gruber added. “Working alongside community health workers and within our patients’ homes, he understands what we need as frontline caregivers and advocates.”

The post NAHC-NHPCO Alliance Names Dr. Steve Landers As Inaugural CEO appeared first on Home Health Care News.

Grand opening, grand closing.

Hospice providers began to work with Medicare Advantage (MA) via the Value-Based Insurance Design (VBID) demonstration in 2021. At the end of 2024, the “hospice carve-in” model will cease.

This will have an impact on home health providers who offer hospice services, obviously. But the failure of hospice’s fit within VBID points to larger problems that exist somewhere between home-based care providers and MA plans.

Since the Centers for Medicare & Medicaid Services (CMS) announced the end of hospice carve-in on Monday, hospice providers – many of which also provide home health care – have mostly applauded the move.

I reached out to multiple leaders throughout the week to get their takes, and one told me he was happy to see a “dysfunctional system go away.”

VBID was designed to help modernize the MA program. Along the way, hospice care and other tangential services were supposed to become a larger part of the program.

But plan and provider interest dwindled over time. Plus, providers weren’t exactly in the position to thrust themselves into a new payment system with more administrative legwork at the end of 2020 and in the beginning of 2021. There was something else going on during that period, too, I recall.

Thus, for now, home health providers will continue with the arduous task of working harmoniously with MA plans. Hospice providers, for now, are spared from that.

In this week’s exclusive, members-only HHCN+ Update, I dive into what CMS’ ditching of the hospice carve-in means for home health and hospice providers generally. I’ll also get into what it may mean for that space between home-based care providers and MA plans moving forward.

What providers think

Our sister site, Hospice News, has covered this story extensively throughout the week and gathered comments from many provider leaders and advocates. You can read most of those comments here.

I’ll highlight a couple here, too.

“This is a huge victory for patients’ access to quality care and for hospice providers who have continually identified challenges with this demonstration including concerns about VBID giving [Medicare Advantage Organizations (MAOs)] the ability to limit patient choices,” Ben Marcantonio, COO and interim CEO of the National Hospice and Palliative Care Organization, said in a statement.

Generally, providers and advocates believed doing away with the hospice carve-in was the right move. But many also wondered what may come next, recognizing the need for future innovation.

“Innovation remains vitally important,” Blue Ridge Hospice CEO Jason Parsons told Hospice News. “I believe what we’ve learned from the demonstration can spur innovation in other ways such as changes in concurrent care, palliative care payments, innovations around quality and access, and spurring organizations to elongate their continuum, as Blue Ridge has done with our PACE program, for example.”

Ultimately, the hospice carve-in was not laid out with enough thought behind it. Furthermore, it did not give providers enough time to consider how to best engage with it, particularly at a time when COVID-19 was peaking.

Many providers did adjust operations, though. Providers with the means tried to gain more scale to better account for a landscape with the hospice carve-in.

“The Medicare carve-in is something that hospices have been thinking about, planning for and talking about for years,” Nate Lamkin, president of the Fort Collins, Colorado-based Pathways Hospice, told Hospice News in 2021. “There was a rush not just in hospice and home health, but really in all sectors of health care to scale up. Our collective scale puts us on the radar of payers in a way that smaller, individual nonprofits wouldn’t be.”

It was also affecting the M&A market in other ways, VitalCaring President Luke James told me Thursday.

“It was impacting several deals we were looking at, especially smaller deals, in the $8 million to $15 million range, if the sellers were in a market with more exposure to it,” James told me. “Because the feedback we were getting from sellers was, ‘This payer is awful to work with in this market,’ or collectability is an issue, that DSOs are lengthened. … It was muddying the waters a little bit there, because we’re having to forecast what that looks like and the growth payers will have in given markets.”

That means it was affecting the leverage sellers had in certain markets, too, where VBID and the hospice carve-in may have been more prevalent, but also more of a problem.

New Day Healthcare CEO G. Scott Herman also told me the VBID system for hospice was a little bit “complex” and also “incomplete.”

The space between

In theory, the Medicare Advantage program is supposed to mirror the traditional Medicare program.

That theory doesn’t always work in practice. Home health providers will be the first ones to tell you so.

But the hospice carve-in also mirrors the supplemental benefit ups and downs that home care providers have seen with MA.

In 2024,13 Medicare Advantage Organizations (MAOs) were participating in the hospice carve-in, providing coverage through 78 health plans in 19 states, according to Hospice News. That was down from 2023, when 15 MAOs participated with 119 health plans in 23 states.

Similarly, supplemental benefit offerings in general increased steadily at first, but then began a downturn.

From 2020 to 2023, there was a 364% increase in plans offering the in-home support services (IHSS) benefit, which can be administered through the primarily health-related pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway.

In 2024, however, only 847 plans are offering IHSS as a supplemental benefit, a decrease from the 1,308 plans offering the benefit in 2023.

With VBID, MA plans struggled to create meaningful networks of providers to deliver hospice services. Providers, on the other end, were frustrated by increased administrative burden and payment issues.

Likewise, MA plans have found difficulty satisfying home care needs for their members, finding the home care industry too fragmented. Organizations like The Helper Bees have created solid networks on behalf of plans, but plans haven’t been able to do that themselves.

Some home care organizations never sought after the MA dollar, predicting trouble. Others are still invested, but their patience is wearing thin.

In the end, MA plans desperately need a wide range of home-based care providers to deliver care to their members. Adequate home health, hospice and personal care will undoubtedly keep their post-acute care costs down.

But for now, some things just don’t work in MA. That’s a bummer for forward-thinking providers who have adjusted to provide care for MA beneficiaries, but also an issue that plans need to solve.

Until they do, the bridge between MA plans and home-based care providers will remain under construction.

The post CMS To End Hospice MA Carve-In: Insights For Home-Based Care Providers appeared first on Home Health Care News.

The new board will oversee the transition to a new, consolidated organization if, and when, the merger is completed. The merger is expected to be completed in 2024.

The transition board includes 20 members with a wide variety of experience in the home-based and post-acute care spaces.

“Across the continuum of serious illness care, providers are looking to the future working to ensure we can continue to provide high-quality, patient-centered care even as patient needs and payment models shift,” Melinda Gruber, proposed vice chair of the transition board, said in a statement. “The association representing providers should be similarly future-focused. This proposed transition board is the right group of people at the right time to take NHPCO and NAHC into the future to continue providing value for our current and future members.”

Melinda Gruber is the vice president of Corewell Health.

In October, NAHC President William A. Dombi announced that his organization and NHPCO were planning to merge. The plan came with what Dombi described as an “aggressive timeline,” hoping the merger would be done by 2024.

From now until the potential merger, NAHC and NHPCO will be operating business as usual and will work as two separate entities. If the merger is finalized, the two will then integrate their businesses together and will work on a combined strategy that will be put in place for 2025.

As far as Dombi’s future with the association, he is expected to stay on board through 2024 to see through the potential merger. After that it is still up in the air.

“The intention is that I’m here through 2024,” Dombi told HHCN in October. “With an expectation that, assuming we come together somewhere in the middle of the year, then I’m there in the role of the new organization as the president emeritus. Something like that.”

The organizations have been moving forward under the guidance of a steering committee made up of members of both NAHC and NHPCO, with support from the consulting firm McKinley Advisors.

“This proposed transition board is made up of experienced veterans of the care at home community, who possess the vision to understand both the opportunity and obligation to build an even stronger future for our sectors of the American health care delivery system,” NAHC’s board chair Ken Albert said in a statement. “Fulfilling our pledge to return the home to the center of American health care will require a new organization with the expanded expertise of both NAHC and NHPCO. I am very confident that this talented group of leaders is up for the challenges ahead, and that our collective focus will remain on the needs of our members as they endeavor to meet the demands of providing high-quality health care.”

Albert is currently CEO of Androscoggin Home Care + Hospice, as well as board chair for NAHC.

Proposed members of the transition board include:

• Ken Albert, CEO, Androscoggin Home Healthcare + Hospice (transition board chair)
• David Causby, CEO, Gentiva
• Trisha Crissman, interim president and CEO, CommonSpirit Health at Home
• Melinda Gruber, vice president, Corewell Health (transition board vice chair)
• Demetress Harrell, CEO, Hospice in the Pines
• Susan D. Lloyd, president and CEO, Delaware Hospice, Inc.
• Tarrah Lowry, COO, Trustbridge / Empath Health
• Christine McMichael, executive director, Hospice & Palliative Care Federation of Massachusetts
• Mark Morse, CEO, Enclara Pharmacia
• Mary Myers, retired president, Johns Hopkins Home Care Group
• John Olajide, CEO, Axxess,
• Bob Parker, chief clinical officer, Kindful Health
• Susan Ponder-Stansel, CEO Alivia Care, Inc.
• Sara Ratcliffe, executive director, Illinois HomeCare & Hospice Council
• Lynne Sexten, CEO Agrace Hospice and Palliative Care (transition board secretary)
• William Simione, CEO SimiTree, (transition board treasurer)
• Jennifer Sheets, NAHC board member, former CEO, Interim Healthcare, Caring Brands International
• Beth Slepian, president and CEO, Granite VNA
• Dave Totaro, chief government affairs officer, BAYADA Home Health Care
• Nick Westfall, CEO, VITAS Healthcare

The post NAHC, NHPCO Announce Transition Board Ahead Of Potential Merger appeared first on Home Health Care News.

It did so by a 50-49 margin, with the vote playing out almost entirely along party lines. Sen. Susan Collins of Maine was the only Republican who voted to confirm Becerra.

Becerra — the first Latino HHS secretary — was originally nominated by President Joe Biden in early December. The former House Democrat saw the hearing for his confirmation repeatedly delayed, however, as Republicans tried to poke holes in his past record and lack of health care experience.

The 50-49 vote was the closest for any of Biden’s cabinet picks.

Several senior care organizations have already released congratulatory statements to Becerra for his confirmation, including the Partnership for Medicaid Home-Based Care (PMHC).

“[PMHC] congratulates Xavier Becerra in receiving confirmation from the Senate to serve as the Biden administration’s secretary of the department of health and human Services,” PMHC Chairman David Totaro said in a statement shared with Home Health Care News. “PMHC looks forward to working with Secretary Becerra to fulfill the Biden administration’s goal of expanding access to home- and community-based services by addressing the institutional bias within the Medicaid law and regulations.”

The National Hospice and Palliative Care Organization (NHPCO) similarly applauded the confirmation.

“Secretary Becerra’s commitment during his confirmation hearing to expanding care for those facing serious and life-limiting illness demonstrates real leadership on a timely and critical issue,” NHPCO President and CEO Edo Banach noted.

With the HHS secretary role solidified, attention will now turn to figuring out who is going to officially run the U.S. Centers for Medicare & Medicaid Services (CMS). Biden nominated Chiquita Brooks-LaSure — a former policy official who played a key role in guiding the Affordable Care Act through passage and implementation — in February.

Among the many areas where a Becerra HHS may different than its Trump-era predecessor is Medicare Advantage (MA).

Former HHS Secretary Alex Azar and former CMS Administrator Seema Verma were strong supporters of MA, pushing several policies and regulatory changes to boost enrollment while granting new flexibilities to health plans.

Generally, Democrats haven’t been as supportive of MA. Political insiders have even told Home Health Care News that some in party leadership have already preached the importance of keeping traditional Medicare and MA on equal footing.

The Better Medicare Alliance (BMA) hopes to see the MA-friendly policies of the last four years continue, however.

“Throughout our time together in Congress, I saw firsthand Secretary Becerra’s deep concern for improving health outcomes and reaching underserved communities with the care they need,” BMA President and CEO Allyson Y. Schwartz, a former member of Congress, said in a statement. “We aim to continue our dialogue with Secretary Becerra about the ways that Medicare Advantage is doing exactly that.”

This isn’t the first time that Becerra was in the spotlight this week.

On Monday, he also was part of a coalition of district and city attorneys in California that filed a lawsuit against Brookdale Senior Living Inc. (NYSE: BKD), alleging the submission of false nursing home staffing data to the federal government and improper resident discharges.

The lawsuit covers 10 Brookdale-operated skilled nursing facilities in California.

“We are holding Brookdale accountable for artificially increasing its profits by cutting corners when transferring or discharging its patients,” Becerra said in a statement announcing the lawsuit. “It lured individuals to its facilities through false promises about providing the highest quality care.”

Brookdale has denied the allegations.

The post Xavier Becerra Confirmed as HHS Secretary appeared first on Home Health Care News.

What you need to know from Friday-Sunday (May 8-10)

— Help At Home, a Chicago-based home- and community-based care services company, launched a fund for workers affected by COVID-19. The company contributed $1 million to the fund right off the bat.

— Key economic advisers within the Trump administration are bracing for the unemployment rate to climb above 20% in coming months, according to The New York Times. The rising unemployment will likely cause some individuals to seek work within the in-home care space, which has historically dealt with a surplus of consumer demand but a shortage of labor.

— Pennsylvania Gov. Tom Wolf granted civil immunity to health care workers on the front lines of the COVID-19 fight this week. The executive order does not, however, cover “willful misconduct” or “gross negligence.” It also does not extend to the owners of health care operations.

— Nearly half of home care organizations are unable to obtain sufficient PPE for their workers, a new Home Care Association of America (HCAOA) survey found. Other highlights from the survey: about 90% of respondents applied or are applying for the Paycheck Protection Program (PPP), with 71% offering or planning to offer paid sick leave. On average, fewer than 10 workers per surveyed home care organization have requested sick leave.

— LHC Group Inc. (Nasdaq: LHCG) leadership explained how the company is bouncing back from coronavirus disruption. In the week ended March 28 alone, the provider saw 8,585 missed visits.

— The Trump administration is reportedly working to contain an outbreak of the COVID-19 virus inside the White House.

What you need to know from Thursday (May 7)

— Unemployment filings reached 3.17 million last week, bringing the total to 33.5 million over the past seven weeks, the Department of Labor (DOL) reported Thursday.

— The ongoing coronavirus outbreak should cause state regulators to rethink nonmedical home care licensure requirements. That’s according to Judith B. Clinco, the founder and president of Catalina In-Home Services Inc. She discussed the topic in an op-ed published by the Arizona Daily Star. “Nonmedical home-care is a vital segment of the caring professions, but it’s unique in its lack of state oversight,” Clinco, who is also founder of the CareGiver Training Institute, wrote.

— LetsGetChecked, an in-home health testing startup, raised $71 million, according to Axios. The fundraising round was co-led by Illumina Ventures and HLM Venture Partners.

— During a virtual press conference with several senior care providers, LeadingAge demanded more action from policymakers to help keep older adults and the workers who care for them safe. “Aging services providers … have not been able to get the PPE or testing they need to protect older Americans or their employees,” Katie Smith Sloan, president and CEO of LeadingAge, said.

— Amedisys has received roughly $100 million under the CARES Act Provider Relief Fund, the company reported during a first-quarter earnings call Thursday. It is taking a cautious approach to using that emergency money until federal policymakers provide further clarity, however.

What you need to know from Wednesday (May 6)

— Brookdale’s home health care segment has faced major disruption due to the fact COVID-19 hit during the transition to the Patient-Driven Groupings Model (PDGM). CEO Cindy Baier provided a home health update during a Q1 earnings call Wednesday.

— Less than a day after the Trump Administration announced plans to phase out the coronavirus task force, which was created to monitor, contain and mitigate the coronavirus, the president walked back his comments. Instead of disbanding, the task force will shift its focus to developing vaccines and reopening the economy, President Trump said Wednesday.

— The coronavirus death toll in the U.S. has topped 71,000, though the daily number of deaths and new infections are falling. In New York alone, nearly 5,000 of those deaths have been connected to nursing homes or adult day care facilities.

— The latest numbers come as Vice President Mike Pence — who leads the coronavirus task force — says the country has made “the tremendous progress.” Still, the battle against the coronavirus is far from over, and the U.S. still has months of fighting left. In fact, new estimates suggest that COVID-19 deaths could double by early August, with infection rates expected to rise again as businesses reopen.

— In New York, more than a dozen children have been hospitalized with a mysterious illness that experts believe could be linked to the coronavirus. Symptoms are similar to those experienced with Kawasaki disease, a rare illness in children that involves inflammation of the blood vessels. Children in Europe have reported similar symptoms. The development may be something for pediatric home health providers to keep an eye on moving forward.

What you need to know from Tuesday (May 5)

— A new report out of Ohio suggests that many of the workers dubbed “essential” during the COVID-19 crisis live near the poverty line. That includes home health aides in the state.

— President Trump suggested on Tuesday the White House’s coronavirus task force could be shut down and replaced with “something in a different form,” The New York Times reported. The news comes as the U.S. moves into what the president called “Phase 2” of the country’s response strategy.

— ConcertoHealth, a California-based provider of in-home care, is working with health departments in Washington state to expand community- and home-based COVID-19 testing for at-risk and vulnerable populations.

— Respiratory therapists have played an outsized role in the fight against COVID-19. Not only are they critically important for patient care, but they also deal hands-on with vital equipment for the patients, which greatly increases their risk of contracting the virus.

— Home health and hospice deal flow has been uprooted due to the COVID-19 virus, according to Irving Levin Associates. April 2020 saw 66% less deals than the same month a year ago.

— The American Health Care Association (AHCA) and the National Center for Assisted Living (NACL) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA) Tuesday to request $10 billion in emergency funding. The funding, the organizations said, would go to nursing homes and assisted living communities to assist them during the COVID-19 outbreak. Additionally, they asked for further support in regards to testing and additional PPE.

— A 29-year-old single mother in Florida is recovering after battling COVID-19. The woman credits her primary care doctor, who helped establish home health services through Baptist Health. “The home health care nurses were just amazing and they truly are heroes,” she told Action News Jax reporters

What you need to know from Monday (May 4)

— The Trump administration announced Friday that it would be replacing the HHS inspector general, who had highlighted issues with its COVID-19 response in an early April report. The administration nominated Jason Weida to take over the position. Weida previously worked in the Office of Legal Policy.

— It’s not just the home health industry that is looking for more federal support. Last week, the CEO of the National Hospice & Palliative Care Organization (NHPCO) told Hospice News that while NHPCO has appreciated the Trump administration’s efforts thus far, more help is needed as the hospice community continues to deal with the COVID-19 crisis.

— Having amassed tens of thousands of deaths since March, nursing homes are pushing for states to grant them emergency protection against an influx of lawsuits claiming they provided insufficient care. According to AP News, at least 15 states have enacted some sort of protection against COVID-19-related lawsuits for nursing homes. Home health and home care providers may push for similar protections moving forward.

— Home-based care providers and their patients continue to be hit hard by the COVID-19 virus. But in-home care is still not given the attention it deserves, Politico reiterated.

— Though progress has been made, ensuring caregiver safety is still an issue nationwide. A Colorado home care worker, for example, claims she has not received coronavirus training and pays for her own PPE.

For daily updates from the week of April 27, click here.

For daily updates from the week of April 20, click here.

For daily updates from the week of April 13, click here.

For daily updates from the week of April 6, click here.

For daily updates from the week of March 30, click here.

For daily updates from the week of March 23, click here.

For daily updates from the week of March 16, click here.

HHCN encourages you to reach out to us individually or at Editor@HomeHealthCareNews.com for story ideas, tips or general feedback.

The post Coronavirus Daily Update: Home Care Providers Target PPP Funding; White House Reacts to Internal Outbreak appeared first on Home Health Care News.

For some, that optimism will now have to be put on hold.

Although CMS is now accepting applications to participate in its Primary Care First payment models, the agency has delayed an official launch until the start of 2021.

Initially, CMS had expected the models to go live on Jan. 1, 2020.

Broadly, Primary Care First is one of two main pathways in the overarching Primary Cares Initiative, another step in policymakers’ plans to empower patients, drive better outcomes and shift care into the home. The second pathway is the Direct Contracting option.

Combined, the Primary Care First and Direct Contracting pathways create five new, risk-based payment models.

While physicians largely serve as the quarterback of care under the different models of the Primary Cares Initiative, at-home care providers will likely play key partner roles in stabilizing and observing complex patient populations in the home.

Meanwhile, hospice and palliative care organizations can participate exclusively in the Seriously Ill Population payment option of Primary Care First, either directly or by partnering with a primary care practice.

“It can be expected that primary care practitioners in any of the five iterations of the demonstration project would embrace home health services and hospice care as vital partners in managing their patients’ care needs in the community, as well as in transition to home from an in-patient setting,” National Association for Home Care & Hospice (NAHC) President William A. Dombi previously told Home Health Care News.

LHC Group Inc. (Nasdaq) Chief Strategy and Innovation Officer Bruce Greenstein described the Primary Cares Initiative as “one of the most exciting announcements from CMS in a while” shortly after it was promoted.

“Why does this matter for us in the home care industry? We know if you look at national health care expenditures where the highest spending occurs, [it’s] in institutions — typically hospitals,” Greenstein told HHCN. “Overwhelmingly, hospitalizations are appropriate, but there’s still a lot of institutional uses of care that are inappropriate. That would be an unnecessary cost, and that’s where [we] as an industry come in.”

Despite enthusiasm from health care providers, CMS has yet to release important details about how the Primary Cares Initiative will actually work.

Consequently, industry advocates believe the delay on the Primary Care First pathway is appropriate.

“It would be a mistake to launch this in 2020, and it is certainly responsible to delay the demo by a year,” Edo Banach, president of the National Hospice and Palliative Care Organization (NHPCO), told HHCN sister site Hospice News. “I wouldn’t be surprised if it were delayed further given some of the implementation concerns.”

Additional reporting by Jim Parker

The post CMS Pumps Brakes on Primary Care First Launch appeared first on Home Health Care News.

The Centers for Medicare & Medicaid Innovation (CMMI) on Friday morning announced it is expanding the MA Value-Based Insurance Design (VBID) model, using VBID to test out several wide-ranging updates to MA offerings, including a hospice carve-in set to take effect in 2021. Hospice care is currently not allowed as a benefit covered in MA plans.

The Centers for Medicare & Medicaid Services (CMS) introduced VBID in seven states in 2017, opting to expand the model in 2018 and again in 2019. Language included in the Bipartisan Budget Act of 2018 requires VBID to include all 50 states and territories by 2020.

Although CMS’ updates to VBID allow for more benefits focused on managing chronic conditions and telehealth services, its groundbreaking move to open the door for hospice in the MA program likely has the bigger potential impact.

Specifically, beginning in the 2021 plan year, the VBID model will test allowing Medicare Advantage plans to offer Medicare’s hospice benefit. The change is designed to increase access to hospice services and facilitate better coordinate between patients’ hospice providers and their other clinicians, according to CMS officials.

In addition to updating the CBID model for Medicare Advantage, CMS also highlighted notable changes to the Part D Payment Modernization model related to lowering prescription drug prices.

“The American health care system is very different today than it was 13 years ago when the Medicare Advantage and Part D programs were launched in their current forms, but due to the slow pace of change in government, these programs have not been fully updated to reflect today’s realities,” CMS Administrator Seema Verma said in a statement. “Today’s announcements are prime examples of how CMMI can test policies to modernize CMS programs and ensure that our seniors can access the latest benefits.”

Federal health care policymakers plan to monitor the impact of Friday’s changes to the respective models moving forward. If successful in improving quality of care and reducing medical costs, the models can be expanded in scope.

“Clearly, the big issue for us is CMS’ announced plan to test coverage of hospice as part of the MA benefit — and this is a big deal,” Theresa Forster, the National Association for Home Care & Hospice’s vice president for hospice policy, told Home Health Care News. “However, we also note CMS’ interest in reducing spending under Part D, and given the attention over the last several years related to spending under Part D for hospice patients, this is an area we will also closely reviewed to determine whether there is any direct impact.”

Besides opening the door for a hospice carve-in, other important updates geared toward 2020 include allowing MA plans to provide reduced cost sharing and additional benefits to enrollees in a more targeted fashion than has previously been allowed, including customization based on chronic condition, socioeconomic status — or both. That customization even applies for benefits not primarily related to health care, such as transportation, a major serve line for several home health and home care providers.

Additionally, starting in calendar 2020, participating Medicare Advantage plans can provide telehealth services as a replacement for in-person visits, as long as the plans continue to cover face-to-face appointments for the same issues

The deadline for plans to apply to participate in the VBID in 2020 is March 1.

“It is unclear whether or not VBID-participating plans will be required to cover hospice, although we anticipate that coverage would be based on a plan’s decision,” Forster said. “Coverage could start out slowly. But this starts the ball rolling on a change that could have a very dramatic impact on the hospice benefit, hospice programs and hospice beneficiaries.”

CMS has steadily chipped away at the MA program’s rigidity since the start of 2018.

In April, CMS officially announced that certain in-home care services would be allowed as supplemental benefits for MA plans in 2019. Plans have already begun taking advantage of the newfound flexibility by offering home-focused benefits, though home care experts expect the bulk of that opportunity to come in 2020 or 2021.

Alexandria,Virginia-based National Hospice and Palliative Care Organization (NHPCO) partnered with the Better Medicare Alliance in August. NHPCO leadership described the partnership as a means to help figure out what a possible policy carve-in for hospice under the MA program would look like.

Expanding the Medicare Advantage program has been a hot topic, especially as benefificaires continue to enroll in MA plans over traditional Medicare.

MA enrollment is projected to be at an all-time high in 2019, with 22.6 million beneficiaries signed up for the program, according to CMS. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019.

As an organization, NAHC has largely opposed a broad hospice MA carve-in, Forster said.

“We have a host of concerns based on our home health members’ experience with Medicare Advantage,” she said. “These include the fact that many plans do not offer the same home health benefit as is provided under fee-for-service, pay reduced rates for coverage, require prior authorization and are extremely late in making payment. These issues are very troublesome.”

Additionally, MA plans have strong incentives to secure care at the lowest cost possible, Forster said, noting that incentives are not balanced out by quality measures that make the plans accountable for supplying high-quality, well-coordinated care for patients with advanced and terminal illness. NAHC also has concerns about possible tensions that may arise between determinations of need made by the hospice interdisciplinary team and the MA plan about coverage of services and supplies — including different levels of care.

NAHC plans to review details on CMS’ plans as they are released and is seeking additional dialogue with agency officials.

Similar to NAHC, NHPCO has also expressed concerns about a hospice MA carve-in.

“First and foremost, NHPCO is concerned about any changes that will adversely impact patient and family access to care,” NHPCO President Edo Banach said in a statement provided to HHCN. “To the extent that this expansion of [VBID] is about enhanced access and a potential opportunity to ensure that more beneficiaries will get better interdisciplinary care when it is most appropriate, we are encouraged. If this demonstration restricts choice and access, we will take appropriate action.”

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But though the hospice industry may be on its own island when it comes to the MA program, it at least appears to be building new bridges.

The National Hospice and Palliative Care Organization (NHPCO) announced Monday that it’s partnering with Better Medicare Alliance (BMA) to help figure out what a possible policy carve-in for hospice under the MA program would look like. Specifically, NHPCO and BMA plan to foster meaningful discussion about potential changes among stakeholders and identify gaps in understanding that need to be more thoroughly researched.

“First and foremost, NHPCO and BMA are partnering to inform our members and allies regarding the opportunities and challenges of a hospice MA carve-in model or proposal,” NHPCO President and CEO Edo Banach told Home Health Care News via email. “There is some debate regarding whether a hospice MA carve-in is inevitable or not.”

Alexandria, Virginia-based NHPCO is the country’s largest not-for-profit membership organization representing hospice and palliative care programs and professionals.

Washington, D.C.-based BMA is a nonprofit advocate coalition of more than 100 ally organizations, including providers, trade associations, aging services groups and health plans. More than 400,000 individual senior advocates focused on strengthening the MA program are also among BMA’s ally members.

“We have several organizations in our coalition who are providers and plans providing palliative care,” Allyson Y. Schwartz, BMA president and CEO, told HHCN via email. “Given our interest in the continuity of care in Medicare Advantage, we think it’s worth it to have this discussion to see what are the opportunities and challenges.”

In general, MA plans are offered by private-sector insurance companies that receive a set amount of money from the federal government to provide Medicare benefits for their beneficiaries. While MA plans cover all Medicare services, most also offer extra coverage, such as vision, hearing and dental coverage.

Companies that offer MA plans have ample leeway in how they manage care, but in theory, they’re incentivized for achieving positive health outcomes and high patient satisfaction. MA has been gaining market share in recent years and has become a more prominent payer for home health companies—many of which also offer hospice. Additionally, recent policy changes have expanded the scope of home care benefits that MA plans are allowed to offer.

Even so, the way the MA program is set up is fragmented for end-of-life care.

Under current policies, MA enrollees who elect hospice remain in their MA plan, but most services end up transferring over to fee-for-service Medicare.

The Medicare Payment Advisory Commission (MedPAC) has long criticized that split as confusing. In at least two separate reports—one in 2014 and another in 2016—MedPAC recommended to Congress that MA plans assume both clinical management and financial responsibility for the hospice benefit.

“We cannot afford to miss an opportunity to bring key stakeholders to the table to discuss the issues and plans hospices may face with a hospice MA carve-in knowing that, ultimately, it’s the care of Medicare beneficiaries and their family caregivers that is paramount,” Banach said.

BMA will bring a familiarity with MA to the partnership, while NHPCO will bring its hospice and palliative care expertise. The goal of the partnership is to create policy that would result in a more robust care continuum extending into palliative care and greater hospice access to patients with advanced illnesses.

Written by Robert Holly

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Specifically, the case is an example of how patients sometimes must forgo the comfort care that hospice can provide in order to keep receiving life-extending care such as dialysis. The situation is another example that shows how the system needs to change, Edo Banach, president and CEO of the National Hospice and Palliative Care Organization (NHPCO), told HHCN via email.

On July 2, 60-year-old Angel Perez went crabbing just before sunrise at a popular local hotspot. It seemed like a typical crabbing trip until the next day, when Perez’ right leg became swollen, turned red and broke out in blisters.

While crabbing, Perez had apparently come in contact with the vibrio vulnificus bacteria, which, in turn, infected his bloodstream, the Cumberland County Department of Health reported. If not caught in time, vibrio vulnificus can cause flesh-eating disease, or necrotizing fasciitis.

About 80,000 Americans get some form of vibriosis each year, according to the Centers for Disease Control and Prevention. Most cases are estimated to be brought on by eating contaminated food, typically resulting in about three days of illness with no lasting effects.

People with compromised immune systems, especially those with chronic liver disease, are more likely to get vibrosis. Perez had been battling Parkinson’s Disease prior to being exposed to the flesh-eating bacteria.

About one in four vibrio vulnificus infection cases ends in death.

In addition to being a tragic story, Perez’s high-profile case once again shines a light on a serious dilemma that many patients face when considering hospice care.

Hospice care, covered by Medicare, Medicaid and most private insurers, is benefit that prioritizes palliative care over curative care for individuals with a life expectancy of six months of less. Medicare does not pay for dialysis treatment and hospice care at the same time, though, so patients receiving treatment for kidney failure have to willingly give up life-prolonging care to receive various hospice offerings designed to support comfort and bereavement.

Roughly half of all Medicare beneficiaries die receiving hospice care.

Only 20% of Medicare patients with end-stage renal disease use hospice prior to death, however.

Family members are reportedly looking for a long-term health facility capable of attending to Perez’s unique and growing needs—including dialysis—as he continues his battle with the infection.

Hospice services were initially considered, buy quickly determined to be insufficient, according to a GoFundMe page with updates on the fisherman’s condition.

“While the idea of using a hospice facility was briefly considered, the decision was ultimately made the it wouldn’t adequately see to his most pressing needs,” a recent update stated.

Doctors at an urgent-care facility first thought Perez had a minor bacterial infection, The Washington Post reported. On a second trip to a hospital’s emergency room, doctors diagnosed cellulitis. It wasn’t until a third trip that they started to suspect the flesh-eating bacteria.

Bacteria had reportedly found an open sore or a cut on Perez’s ankle.

“Hospice was created to focus on comfort measures that are not, by design, life-extending,” NHPCO’s Banach said. “Dialysis is generally thought of as an intervention intended to lengthen a person’s life. In the case of the individual in New Jersey, palliative care services may allow this man to continue with dialysis but provide measures to decrease his pain and suffering.”

Besides turning to hospice less frequently, Medicare patients receiving dialysis have been shown to utilize hospice care for shorter periods when they do.

“Medicare generally does not pay for concurrent palliative and curative services. This is wrong,” Banach said. “This is why we are working on building a health care delivery system that would allow for person-centered, interdisciplinary care that does not require a patient to forgo beneficial services because of a reimbursement structure.”

Written by Robert Holly

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