Monique Frahm, Care Educator with Trualta, has been named a 2024 Memory Care Innovation Award Winner.

To become a Memory Care Innovation Award winner, an individual is nominated by their peers. The candidate must be a high-performing employee who knows how to put vision into action, and serve as an advocate for those living with memory-related disorders and the committed professionals who ensure their well-being.

Frahm sat down with Home Health Care News to talk about accepting the hard-to-solve aspects of memory care, supporting caregivers and personalized approaches to care.

What drew you to working in memory care?

Before beginning my career at Trualta, I had experience working as a Registered Nurse in hospital and home care settings. I often cared for individuals with dementia and assisted their families in their care. I quickly recognized the many nuances that come with this condition and the care required. It is complex and incredibly individualized. This drew me to work more closely with memory care and family caregivers. Hence, my career at Trualta began.

A large portion of our caregivers are caring for someone with dementia. Assisting them in this long and challenging journey is incredibly rewarding. I respect all of them very much, and I am honored to assist them in their journey as much as I can.

What’s your biggest lesson learned since starting to work in memory care?

We don’t have all the answers. As much as we want all the answers and we want to be able to fix every problem or gap that there is, we don’t and we can’t. My personal mission is to help as many people as I can. Caregivers come to me for guidance and solutions to their problems.

While I always do absolutely everything I can to help, I often wish that I had a magic wand to fix problems that I can’t fix. Caregivers need more time in their days. They need more support, in terms of respite support, financial support and emotional support. While I can help in some aspects, I can’t fix it. That is a hard pill to swallow, but it’s also an incredible source of motivation to keep going, to keep finding solutions and to keep working to close those gaps.

If you could give advice to yourself looking back to your first day in the industry, what would it be and why?

Believe in what you know, but never stop learning. Your knowledge, training and life experience will guide you, but your willingness to listen, learn and adapt will lead to impactful change in people’s lives. Continuous learning is what leads us to success. It is through a collective effort of perpetual learning and adaptation that we can address complex issues, develop innovative solutions, and make a lasting difference in memory care.

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

Transformative.

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

If I could change one thing with an eye toward the future of memory care, it would be to enhance the personalization of care approaches, recognizing the highly individualized nature of memory care for each patient. Every person experiencing memory loss has a unique set of experiences, preferences and needs that should be at the core of their care plan.

Understanding their life history, interests, daily routines and personal preferences allows for the creation of tailored care strategies that resonate on a personal level. By continually adapting and evolving these personalized care plans in response to the patient’s changing condition and preferences, we ensure that care remains relevant and effective. This deeply personalized approach not only improves the quality of life for patients but creates a more sustainable environment for caregivers, ultimately leading to more successful memory care outcomes. Personalizing experiences has been one of Trualta’s focuses, and we’ve seen the benefits of it.

What is the biggest obstacle to being innovative in memory care, and how do you try to overcome that obstacle?

A big obstacle to innovation in memory care often lies in resistance to change. In my experience, caregivers and patients may resist change due to comfort with current care practices or fear of added complexity. Involving caregivers and patients early in the innovation process can foster trust and address their specific needs and preferences. Overall, fostering a culture of openness to innovation and continuous improvement is crucial in overcoming resistance to change.

What quality must all Memory Care Innovation Award winners possess?

I believe that all Memory Care Innovation Award winners must embody a profound commitment to enhancing the lives of individuals affected by cognitive conditions, both those receiving care and those providing it. This commitment entails an unwavering determination to improve the quality of care, however that may look in their field of work. For me, this commitment is embodied through my role at Trualta, where we focus on delivering high-quality education and consistent support. This is where my commitment to memory care lies.

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Darci Henry, Care Coach with Trualta, has been named a 2024 Memory Care Innovation Award Winner.

To become a Memory Care Innovation Award winner, an individual is nominated by their peers. The candidate must be a high-performing employee who knows how to put vision into action, and serve as an advocate for those living with memory-related disorders and the committed professionals who ensure their well-being.

Henry sat down with Home Health Care News to talk about her journey into the memory care field and how resistance to change can suppress true innovation. During the conversation, Henry also discussed the funding landscape and how memory care required a tailored approach to each individual’s situation.

What drew you to working in memory care?

From a young age, I was naturally drawn to older adults, as I was raised in my grandmother’s beauty shop in rural Missouri.

I spent countless hours reading to the ladies while they sat under the hair dryer during their weekly “wash and set.” This was a formative experience, and I followed my interest in older adults to college where I studied gerontology.

My passion for memory care was ignited during this time when I had the opportunity to complete a practicum in a memory care facility. I fell in love with the field, felt a profound connection to the residents and their families, and made the decision to pursue my passion as my career.

What’s your biggest lesson learned since starting to work in memory care?

After working in memory care for 18+ plus years, I’ve learned that every family’s situation is unique.

No two experiences are the same, and this diversity requires a deeply personalized approach to care. This line of work requires flexibility and empathy.

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

If I could change one thing about the future of memory care, it would be access to care, support and resources to all families, regardless of their circumstances. Every family deserves the highest quality of care and support, but too often, disparities in resources can lead to unequal experiences.

What is the biggest obstacle to being innovative in memory care, and how do you try to overcome that obstacle?

The biggest obstacle to being innovative in memory care is often funding. Innovation requires investment in technology, education and people.

Additionally, resistance to change from both organizations, regulatory bodies and families can suppress innovation. It can be difficult to venture from traditional methods of care.

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

Essential.

The future of memory care is essential. We are facing an aging population and with that comes increasing rates of dementia and related conditions. Innovation is crucial to ensure quality of life, dignity, safety, personalized care, and ongoing support for caregivers and families.

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Kim Mulquin-Shumway, VP of clinical compliance at Nevvon, has been named a 2024 Memory Care Innovation Award Winner.

To become a Memory Care Innovation Award winner, an individual is nominated by their peers. The candidate must be a high-performing employee who knows how to put vision into action, and serve as an advocate for those living with memory-related disorders and the committed professionals who ensure their well-being.

Mulquin-Shumway sat down with Home Health Care News to talk about what it will take to elevate memory care in the U.S., the role technology could play in that and more.

What drew you to working in memory care?

My personal experiences and professional background have uniquely shaped my interest in working in memory care. In my teens, my uncle was diagnosed with Alzheimer’s disease. I witnessed firsthand the stress and challenges my aunt went through trying to take care of him at home. Later, in my young adult years, when I was raising my children, my grandmother’s battle with dementia provided a deep, personal insight into the challenges and needs associated with memory-related health issues. These experiences fostered a profound empathy and understanding, reinforcing the need for safe, personalized, high-quality care.

Professionally, I have been a nurse for 35 years and have been involved in health care quality for over 25 years. Much of my career has been in the post-acute industry, focusing on quality improvement and education. As I worked in the long-term setting in the realm of quality improvement, it became evident that the residents and staff working in the dementia wing needed special care and training.

This blend of personal and professional experiences not only drew me to this field but also equipped me with the skills and understanding necessary to excel in caring for individuals with memory impairments.

What’s your biggest lesson learned since working in memory care?

The biggest lesson learned is the importance of personalized care. Working with residents, families and staff in memory care highlighted how each individual’s experience with memory loss is unique, requiring tailored approaches that respect their history, personality and current abilities.

My experiences have taught me about the resilience of families dealing with memory diseases and the critical support networks needed for both patients and caregivers. Providing personalized care not only improves the quality of life for those with memory conditions but also supports caregivers in delivering the most effective and empathetic care possible.

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

If I could change one thing with an eye toward the future of memory care, it would be integrating more advanced technology and data analytics into the care process.

This could include using AI-driven tools for personalized care planning, real-time monitoring systems to improve patient safety, and predictive analytics to better understand and manage the progression of cognitive decline.

Enhancing technological integration would not only improve efficiency and outcomes but also empower caregivers with better tools and insights, leading to more proactive and tailored care strategies for individuals with memory impairments.

What is the biggest obstacle to being innovative in memory care, and how do you try to overcome that obstacle?

One of the biggest obstacles to innovation in memory care is often the resistance to change and the challenge of securing funding for new initiatives. Many health care organizations are slow to adopt new technologies and methods, especially when they involve substantial shifts in traditional care models or funding.

Building strong cases for innovation through evidence-based research is crucial to overcome these hurdles. Demonstrating new approaches’ effectiveness and potential cost savings can help persuade stakeholders. Networking with industry professionals and participating in forums can provide opportunities to learn from others’ successes and failures, which can be invaluable in navigating the complexities of health care innovation.

Additionally, partnering with technology firms and academic institutions can lead to pilot programs showcasing the benefits of innovative practices. These pilot programs can serve as proof of concept, making it easier to argue for broader implementation across the care spectrum.

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

Progressing

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Soon, one of the government-backed efforts to offer assistance to those organizations will end. The U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday that its advanced and accelerated payment program tied to the cyberattack will end July 12.

“In the face of one of the most widespread cyberattacks on the U.S. health care industry, CMS promptly took action to get providers and suppliers access to the funds they needed to continue providing patients with vital care,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Our efforts helped minimize the disruptive fallout from this incident, and we will remain vigilant to be ready to address future events.”

Whenever something completely derails the operations of America’s health care ecosystem, CMS has the authority to grant advanced and accelerated payments to providers that are paid via Medicare or Medicaid.

Effectively, these types of programs function as a short-term loan, giving home-based care providers and others access to capital at a time when their books are in disarray.

“Launched in early March, the [Change Healthcare] payments were designed to ease cash flow disruptions experienced by some Medicare providers and suppliers, such as hospitals, physicians, and pharmacists, due to the unprecedented cyberattack that took health care electronic data interchange Change Healthcare offline in February,” CMS explained in a Monday announcement.

In total, Change-related accelerated payments have been issued to over 4,200 Part A providers, such as hospitals, totaling more than $2.55 billion.

CMS also issued 4,722 advance payments, totaling more than $717.18 million, to Part B suppliers, including doctors, non-physician practitioners and home health agencies, according to the agency.

Many of the providers that capitalized on these pre-payments have already made good on their loans. In fact, of the thousands of payments disrupted, 96% have already been recovered, CMS noted in its announcement.

“A lot of these players only need to find one hole in the boat to get in,” Ben DeBow, founder of Fortified, recently told Home Health Care News. “Once they’re in, they can navigate around. If you’re running on an unsupported legacy platform, then that is not under support anymore. That is a common way into a lot of organizations. Some recent ones came in on a company that were running Windows Server 2003. That’s a very old platform.”

Change Healthcare, a part of UnitedHealth Group (NYSE: UNH) subsidiary Optum, reported enterprise-wide connectivity issues in late February. Not long after, health care providers began experiencing technical difficulties.

On Feb. 26, a ransomware group took responsibility for the attack.

By March, CMS began offering relief to health care providers, and lawmakers began to call out UnitedHealth Group leaders for how they handled the situation. At the start of May, UnitedHealth Group CEO had to testify in front of Congress to answer questions about the cyberattack and his company’s response.

“This hack could have been stopped with cybersecurity 101,” Sen. Ron Wyden (D-Ore.) said during the Senate Committee on Finance hearing.

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As it has been to most other parts of health care, prior authorization has long been problematic for home health providers and patients. That’s been increasingly true as more insurers have started to adopt systems and processes that use predictive analytics and algorithms to guide their decision-making, too.

In the Senate, the legislation – the Improving Seniors’ Timely Access to Care Act – was introduced by Sens. Kyrsten Sinema (I-Ariz.), Roger Marshall (R-Kan.), Sherrod Brown (D-Ohio) and John Thune (R-S.D.). Companion legislation was likewise put forth in the House, led by U.S. Reps. Mike Kelly (R-Penn.), Suzan DelBene (D-Wash.), Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.).

“Right now, too many older Americans enrolled in Medicare Advantage are forced to deal with unnecessary delays when seeking out [care],” Sen. Brown said in a statement. “We need to update the Medicare Advantage program so it works better, faster, and is more transparent for patients and providers.”

If passed, the Improving Seniors’ Timely Access to Care Act would increase transparency around MA prior-authorization requirements and their use. It would additionally establish an e-PA process for MA plans, including a standardization for transactions and clinical attachments.

By digitizing parts of prior authorization, the hope is that some decisions could be reached faster – even in real time.

The Alzheimer’s Association, AARP, the American Hospital Association, the American Academy of Hospice and Palliative Care, and LeadingAge are among the many health and senior care groups to support the legislation.

“By removing unnecessary barriers that create delays in treatment, this meaningful bill will improve access to care for seniors and allow caregivers to spend more valuable time at the bedside with patients and less time on burdensome paperwork,” American Hospital Association Executive Vice President Stacey Hughes said in a statement

A flawed process

Broadly, prior authorization is designed to help health plans determine the medical necessity of services and minimize unnecessary services. In turn, that allows them to better contain costs and protect patients from receiving unnecessary care.

Between 2009 and 2019, the use of prior authorizations by MA plans increased substantially, previous research has found.

The process normally kicks off when a provider submits to an MA plan a request for prior authorization of services, which could include home health care services, home medical equipment (HME) and several other categories of services.

From there, the MA must decide as quickly as possible whether those services are appropriate. Plans have 14 days after receiving a standard request and 72 hours after receiving an expedited request.

Studies, government-watchdog investigations and U.S. Centers for Medicare & Medicaid Services (CMS) audits have suggested plans frequently get their prior-authorization decisions wrong.

The Medicare Payment Advisory Commission (MedPAC) highlighted the issue in its most recent report to Congress, in fact.

“Although only a small share of prior authorization requests are denied, CMS audits suggest that many denied requests should actually have been approved,” MedPAC wrote in the report. “The Office of Inspector General (OIG) found that CMS cited about half of audited MA contracts in 2015 for inappropriately denying prior authorization requests, for sending insufficient denial letters, and for missing required information such as why the request was denied or how to appeal.”

In 2021, the vast majority of MA prior-authorization reconsiderations were fully approved.

In a sample of 229,000 MA prior-authorization reconsiderations that year, 80% were returned fully favorable. Just 18% were upheld as adverse decisions, with 1% partially favorable.

“Prior authorization has been identified as a major source of administrative burden for providers and can become a health risk for patients if policies affect the treatments clinicians offer (e.g., step therapy requirements), inefficiencies in the process cause needed care to be delayed or abandoned, or poor decisions cause necessary care to be denied,” the MedPAC report continued.

For a health care provider or business, this back-and-forth can have a profoundly negative impact.

“For the past year to two years, we went from a manageable amount of prior authorizations or denials to an absurd amount of denials right off the bat … ,” one physician said in a 2023 focus group, with MedPAC noting this comment in its report. “We’ve had to hire staff just to deal with [authorizations] and denials.”

Home health and prior authorizations

Over the past two years, multiple MA plans have begun to shed prior-authorizations requirements for home health care, in particular.

In August 2023, for example, The Cigna Group (NYSE: CI) announced that it was removing nearly 25% of medical services from its prior authorization requirements.

In November of last year, Blue Cross Blue Shield of Massachusetts announced it was eliminating prior authorization for home health care.

“We know from our clinical partners that local hospitals are experiencing a capacity crunch – we’re doing what we can to help,” BCBS of Massachusetts Chief Medical Officer Dr. Sandhya Rao told Home Health Care News at the time. “By removing prior authorization requirements for home care services, we’ll help hospitals to expedite discharges at a time when many are struggling with overcrowding.

Additionally, this past April, Point32Health announced that it is removing prior-authorization requirements for the first 30 days of home health care.

“We continuously evaluate all our programs to ensure our members are receiving the highest quality of care and work closely with our provider partners to decrease their administrative burden wherever possible,” Dr. Hemant Hora, senior medical director at Point32Health, previously told HHCN.

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Zenyth Partners – a New York-based investment firm focused on growing health care companies from early-stage businesses into larger platforms – announced Thursday it has made an investment in LifeCare Home Health Family. Financial details around the investment were not disclosed.

Based in Irving, Texas, LifeCare is an in-home care provider that delivers home health and private-duty home care services across 10 affiliated branches. Its footprint includes locations in Texas, Florida and Nevada – with more states likely coming soon.

“We’re thrilled to partner with the Zenyth team, who we have known for over 5 years now,” Dean Alverson, CEO of LifeCare, said in a statement. “We’re proud of the success we’ve had to date and are excited at the prospect of what we can achieve with the resources and expertise that Zenyth brings to bear.”

Brentwood Capital Advisors and Holland & Knight served as financial and legal advisors, respectively, to LifeCare. Edgemont Partners and Alston & Bird served in the same roles for Zenyth.

As an investor, Zenyth already has some experience in the realm of home-based health care.

One of its portfolio companies is Helping Hands Family, which provides clinic-, home- and school-based applied behavior analysis and related services to children impacted by autism spectrum disorder. Zenyth has helped expand that business to more than two dozen markets in the Northeast and Mid-Atlantic U.S.

LifeCare stood out to Zenyth due to its management team, track record of same-store sales growth and commitment to clinical quality, according to the investment firm.

“Our partnership with LifeCare represents the realization of a years-long thesis in the post-acute care space,” Tim Abbot, principal of Zenyth, said in a statement. “We’re impressed by the differentiated clinical outcomes that LifeCare has been able to sustain and believe that, on that basis, the company is optimally positioned for continued success as the industry increasingly rewards sophisticated agencies that provide the highest-quality care and a superior patient experience.”

Following Zenyth’s investment, LifeCare Home Health Family plans to expand its geographic footprint and also add to its service lines.

Brands under the LifeCare umbrella include Haven Home Health, EverCare Health Services, Complete Home Care, Care First Home Health Care and Beyond Faith Home Care, according to the organization’s website.

Relative to historic highs in 2020 and 2021, investment activity across the home health and home care markets has been down over the past couple of years.

While that’s true, health care-savvy investors remain bullish on the at-home care value proposition.

“The underlying motivation to invest remains strong,” M&A advisory firm Mertz Taggart write in its Q1 dealmaking update. “Private equity and the public market institutional investors understand the value home health provides to the health care system as a whole. In today’s value-based care movement, many believe skilled home health remains key to reducing overall costs.”

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Brad Harris has been appointed CEO of Home Health Care Solutions.

Part of Miller’s Health System, Home Health Care Solutions is a diversified in-home care provider that delivers services across the majority of Indiana. The company’s offerings include traditional home health services, along with behavioral health care, telehealth monitoring and more.

Harris replaced Home Health Care Solutions founding CEO Mahmood Iqbal on June 1, according to a local news report. Iqbal had served in the CEO role for more than a decade before handing over the reins to Harris.

As CEO, Harris will oversee the strategic direction and operations of Home Health Care Solutions on a statewide basis.

“Brad’s extensive background in health care administration and his established understanding of the organization’s values make him well-suited for this leadership role,” Patrick Boyle, president and CEO of Miller’s Health Systems, said in a press release. “Brad has been an integral part of our business lines inside of Miller’s Health Systems, and we have confidence Brad will guide our Home Health Care Division forward in each of the communities we serve throughout the state of Indiana.”

Harris began his career at Miller’s Health Systems in 1987.

“Home Health Care plays a crucial role in helping patients recover and maintain their well-being,” Harris said in the release. “I look forward to working closely with our talented team to deliver exceptional services to our patients and their families.”

Dina appoints new president

Chicago-based digital health care company Dina has named Sherman Sanchez as its new president.

Dina is a provider of digital network management and coordination solutions to help health plans and providers improve access to home-centric care. The company has raised millions of dollars since its formation, most recently closing a $7 million round at the start of 2024, led by venture capital investor First Analysis.

Sanchez has help leadership positions for health care technology firms including Pager, Cotiviti, HMS, BioIQ, NextHealth Technologies and MedeAnalytics. Prior to those roles, Dina’s new president also held business development positions at Health Data Management Solutions and Mercer.

“Sherman has a clear understanding of our market and extensive experience working with payers and providers that want to leverage digital solutions to improve home-based care,” Dina CEO Ashish V. Shah said in a press release. “He will be a valuable leader as we embark on the next phase of our growth journey, and we’re thrilled to welcome him to the team.”

Tim Coulter, who served as Dina’s interim president and chief operating officer, remains in his role as COO.

SCAN Group – parent company of SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage (MA) organizations – is also an investor in Dina.

Home health vet Tony Strange joins Care Advantage’s board

Tony Strange – the long-time home health veteran who most recently served as CEO of Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) – has joined Care Advantage’s board.

Strange’s home-based care background also includes founding Healthfield Inc. and serving as the top executive for Gentiva Health Services.

“Tony has shown himself to be an exceptional leader in the health care field through his unwavering dedication and relentless passion for growing health care organizations,” Care Advantage wrote in a company LinkedIn post.

Care Advantage is a home-based care company with more than 45 locations across America’s Mid-Atlantic region. The provider is one of the most active buyers in the home-based care market, having closed close to two dozen deals over the past six years.

After Strange left Aveanna, he was replaced by former COO Jeff Shaner.

“[Strange] leaves an enduring legacy of building one of the nation’s largest home care companies in America during an unprecedented pandemic,” Aveanna Chairman Rod Windley said at the time. “Tony’s steady and stable leadership was a welcome gift during troubled waters within our industry. It has been an honor working side by side with Tony at Aveanna and the many other companies during our career together.”

24 Hour Home Care’s Simon Close lands aging-in-place leadership role

Simon Close, the president of community supports for California-based 24 Hour Home Care – will serve on the National Aging in Place Council.

The five-person board, according to a 24 Hour Home Care press release, oversees the senior support network that connects service providers with older homeowners, their families and caretakers. The organization itself has 10 local chapters in the U.S., with members being various types of aging-in-place stakeholders.

“Serving on the National Aging in Place Council Board is an opportunity to extend the impact of the core mission and values we have at 24 Hour Home Care – reaching more lives and supporting vulnerable populations on a broader scale,” Close said in a statement.

In his role, Close oversees 24 Hour Home Care’s Community Supports Division, which prioritizes care for seniors and underserved communities by providing access to in-home care for Medi-Cal recipients and other low-income people.

Close joined 24 Hour Home Care in 2020 as VP of senior care.

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Recently, however, the health care giant has started to view value-based care as a sustainable business model that it can lean into to drive growth across its operations. And it’s home-based care that has helped UnitedHealth Group take its value-based care strategy to the next level.

“Although it’s a topic that has been talked about for probably 30 years as a theme, I would say, really, only within UnitedHealth Group and Optum are you seeing value-based care now on a scale and presence [that] allows it to operate truly as a business model,” UnitedHealth Group CEO Andrew Witty said Wednesday, speaking at an investor conference.

Specifically, home-based care – home health services, house calls and other ways of engaging with Medicare beneficiaries in the home – allows UnitedHealth Group and Optum to take a more preventative approach.

That, in turn, benefits the company as well as the health care system as a whole, according to Witty.

Optum has maintained a house calls program for years that’s available in all 50 states. As part of that program, it sends advanced practice clinicians into beneficiaries’ homes for comprehensive health assessment, with services also available virtually.

The house calls team conducts hundreds of thousands of in-home care visits annually, many of which take place in rural communities.

Increasingly, UnitedHealth Group and Optum have invested in home health services, too. The prime example of that is the $5.4 billion acquisition of LHC Group in 2023, with a separate multi-billion-dollar purchase of Amedisys Inc. (Nasdaq: AMED) pending.

Other wraparound services, including Optum’s behavioral health investments, add to the company’s ability to perform in a value-based care landscape by providing deeper clinical care, according to Witty.

“That’s a huge area for us, and you should continue to expect us to invest heavily in that going forward,” the CEO said, referring to the organization’s overall value-based care plan. “We believe that is, by far and away, the best way to deliver quality of care, affordable care [and] value. We still think it’s in the early innings as a business model.”

Heather Cianfrocco, the CEO of Optum, echoed those sentiments. Cianfrocco took over as CEO of Optum in April 2024, and she is now responsible for the strategic direction and overall performance of its three business segments: Optum Health, Optum Rx and Optum Insight.

Wraparound services, population health, behavioral health and home-based care are all keys to a sustainable value-based care strategy, Cianfrocco noted.

“It’s strong referrals to the right side of service, including surgery and specialty. It’s the wraparound services, like the population health and behavioral health services, that many of our patients need,” Cianfrocco said. “And it’s the home-based care that we’ve invested in, whether it’s home health services through many of the investments we’ve made, [or] it’s transitional and longitudinal care, or it’s just the really important preventive services and annual home checks that we’ve done for years that make sure our seniors have what they need at home … .”

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As it pertains to home health care specifically, MA plans have been criticized for their cumbersome prior authorization requirements and provider reimbursement rates that are typically far below fee-for-service Medicare.

What’s more, MA home health patients generally have worse functional outcomes compared to traditional Medicare patients, partly because they often receive fewer visits, according to a 2024 study from the Department of Rehabilitation Medicine at University of Washington.

Similar MA grievances can be heard from beyond home health care as well.

In response to the mounting criticism, the U.S. Centers for Medicare & Medicaid Services (CMS) has been collecting feedback on the MA program through a request for information (RFI) process. The public comment period attached to that RFI – largely focused on MA data policies and procedures – officially ended on Wednesday.

“Recommendations regarding MA data included calls for CMS to collect and release more MA data on key areas of concern, such as supplemental benefit costs and utilization, value-based payment arrangements between providers and plans, utilization management and prior authorization including denials and appeals and access to inpatient services and post-acute care, network adequacy and provider directory accuracy, competitive forces in the market such as the effects of market shifts and vertical integration and consolidation on consumers, care outcomes, and Medicare Loss Ratios (MLRs),” CMS noted in its RFI.

Overall, the RFI received hundreds of comments from MA stakeholders.

In one, a commenter summarized how they had seen multiple patients discharged from home health services after patients had changes necessitating continued visits. In the same comment, the individual explained how appealing for continued services was extremely difficult.

“These are next to impossible to get approved and the patient pays the price,” the commenter wrote. “I am so glad this is being evaluated.”

Home health care was brought up in a number of other comments, too.

“My consulting firm works with all levels of home-based services, but the Medicare agencies in highly impacted areas of Medicare Advantage plans are struggling and many now cannot take the patients on the plans because they pay far below the cost with overhead,” another commenter wrote. “This means that many Medicare patients now cannot get the services that they need.”

Broadly, commenters also raised data considerations on topics such as MA marketing activity, especially predatory behavior, care outcomes and data available in MA compared to fee-for-service Medicare.

Moving forward, the feedback will be used to guide future rulemaking, according to CMS.

“This RFI is an extension of our ongoing work on MA data as we solicit feedback from the public on how best to meet the shared goals of enhancing data capabilities to have better insight into our programs, consider areas to increase MA data transparency and propose future rulemaking,” CMS wrote in the RFI. “Our eventual goal is to have, and make publicly available, MA data commensurate with data available for Traditional Medicare to advance transparency across the Medicare program, and to allow for analysis in the context of other health programs like accountable care organizations, the Marketplace, Medicaid managed care, integrated delivery systems, among others.”

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Contextually, 2024 marks Year 2 of the home health, hospice and private-duty services company’s strategic transformation initiative. Aveanna went public in 2021 with high hopes, but it has since had to navigate multiple operational challenges affecting its performance.

“As we enter Year 2 of our strategic transformation, we remain highly focused on those initiatives that created positive momentum in 2023,” CEO Jeff Shaner said during the company’s 2024 first-quarter earnings call on Thursday.

Aveanna offers a range of in-home care services to both pediatric and adult patient populations, with its private-duty nursing services arm accounting for the bulk of its business. The company has locations in 33 states.

Shaner and CFO Matt Buckhalter have previously explained how allocating clinical resources to Aveanna’s best payers was among the company’s top priorities. The executives believe their company has made further progress on that front so far in 2024.

“Our Q1 results highlight that we continue to align our objectives with those of our preferred payers and government partners,” Shaner said on Thursday. “By focusing our clinical capacity on our preferred payers, we achieved year-over-year growth in revenue and adjusted EBITDA.”

As another benefit of the preferred-payer strategy, Aveanna has also experienced improvement in its caregiver hiring and retention trends, according to the CEO. By focusing its care capacity on payers willing to engage with Aveanna on enhanced reimbursement rates and value-based agreements, the company is able to invest further in its workforce, Shaner explained.

“While we continue to operate in a challenging labor and inflationary environment, our preferred-payer strategy allows us to return to a more normalized growth rate in our business segments,” he said.

Aveanna’s private-duty services segment illustrates the momentum the company has on building out its preferred-payer roster. In the first quarter alone, Aveanna added four additional preferred-payer agreements, increasing its total to 18.

Ultimately, Aveanna hopes to grow its preferred-payer-agreement total from 14 to 22 in 2024.

As for its home health business, Aveanna’s preferred-payer-strategy goal is to maintain its episodic payer mix at about 70% while returning to a more normalized growth rate, Shaner said.

“In Q1, our episodic mix was 75%, and we achieved positive total episode growth of 1.7% over the prior year’s period,” he continued. “Q1 marked the first time we’ve had sequential and year-over-year episodic growth since we entered the home health market. We also signed two additional episodic agreements within the quarter.”

Aveanna’s overall revenue was $490.7 million for the three-month period ended March 30, 2024, up 5.2% compared to $466.4 million for the three-month period ended April 1, 2023.

That increase was tied to a $22.1 million increase in private-duty-services segment revenue and a $3.7 million increase in medical solutions segment revenue. Revenue gains on the quarter were partially offset by a $1.5 million decrease in home health and hospice segment revenue, however.

In addition to its preferred-payer strategy, Aveanna’s other core focus areas include identifying cost efficiencies within the business, managing its capital structure while producing positive free-cash flow, and engaging its leaders and employees.

“Our business is demonstrating signs of recovery as we achieve our rate goals previously discussed,” Shaner said. “Home- and community-based care will continue to grow, and Aveanna is a comprehensive platform with a diverse payer base, providing a cost-effective, high-quality alternative to higher-cost care settings. And most importantly, we provide this care in the most desirable setting: the comfort of the patient’s home.”

Another highlight from the first quarter that Shaner was sure to mention during Thursday’s call: the hiring of a new chief legal officer. Aveanna announced the appointment of Jerry Perchik to the position in April.

“I would like to take a moment and welcome Jerry Perchik, our new chief legal officer, to Aveanna,” Shaner said. “Jerry has spent the last two decades dedicated to high-quality health care in the home setting. Jerry brings a wealth of experience in regulatory and legal affairs, mergers and acquisitions, and general corporate law.”

The post ‘Our Business Is Demonstrating Signs Of Recovery’: Aveanna Making Progress On Turnaround Goals, Led By Private-Duty Services Business appeared first on Home Health Care News.