With the close of the federal public health emergency, the healthcare industry is looking in retrospect at the effects of the COVID-19 pandemic. One of the most influential changes from the pandemic was the improved access to home health, through:
- Broader adoption of existing technology
- Reduced Medicare and Medicaid reimbursement barriers
- Changed patient perception of at-home care
How we got here
In the years leading up to the pandemic, home health was already in the midst of a revolutionary shift. Historically, home health was considered a low priority for health plans. Reimbursement for services was low and constrained mainly to Medicare and Medicaid populations. The majority of the staff were underpaid aides. Furthermore, the struggles with prior authorization and coverage confusion led to some patients abandoning treatment plans. In 2016, the U.S. Centers for Medicare and Medicaid (CMS) rolled out a three-year pilot program to test the effectiveness of a value-based purchasing model for home health (HHVPM) to address some of these issues. Since the program was met with great success, showing improved patient outcomes and reduced costs and provider burden, CMS announced plans to make the program nationwide in 2020, right before the pandemic hit.
Then we faced a public health emergency in March 2020, which had instantaneous effects on our healthcare industry:
- Hospitals were at capacity, especially high-acuity areas, while specialties that did not directly treat COVID-19 patients reported reduced volumes due to mandates canceling nonessential services and elective procedures
- High-risk and immunocompromised patients didn’t want to visit hospitals or have home health aides come into homes due to fear of infection
- Healthcare workers experienced increased burden and burnout, and organizations faced staff retention issues
In response to these crises and to give hospitals the flexibility to meet the rising healthcare demand, several federal regulations were passed. For example, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed in March 2020, expanded delivery of some home-based care services to advanced practice providers. Additionally, CMS announced several temporary waivers to reduce the burden on providers, ease the access to care for patients, and remove some of the red tape associated with ensuring payment for services. Though intended to be temporary, stop-gap solutions, many of the waivers had favorable, long-lasting effects and increased the use of home health as an alternative site-of-care. The relaxed regulation and increased flexibility introduced a change in how home health is perceived, both by providers when making care plans and by patients as they are considering their own care journeys.
Reflecting on these impacts and responses, we are seeing three changes catalyzed by the pandemic:
1. Broader adoption of existing technology enables effective, accessible care in the home
Two of the top areas for technology investment in 2023 are expected to be remote patient monitoring (RPM) (41%) and patient engagement tools (29%). This trend is supported by positive outcomes seen from in-home care during the pandemic. One pandemic-reactive program used RPM technology to coordinate care for high-risk COVID-19 patients in the home. For those engaged in the RPM program, the results showed lower rates of hospitalization, intensive care unit admission, mortality, and cost than those enrolled and non-engaged. These findings translated to improved patient outcomes as well as increased hospital bed access, which was extremely limited in the first wave of the pandemic.Additionally, there was a considerable popularization of telehealth services, which was strictly regulated before the pandemic. Prior to the pandemic, telehealth was often reserved for very specific cases where the patient was deemed incapable of making it to an in-person appointment. Over 28 million Medicare beneficiaries–more than two in five–used telehealth during the first year of the pandemic. Moreover, telehealth has had the most significant impact on how behavioral health services are delivered, with 43% of Medicare patients utilizing this medium, compared to 13% for office visits.
2. Reduced Medicare and Medicaid reimbursement barriers allowed for more widespread usage of home health as site-of-care alternative
Before the pandemic, it was difficult to acquire home health services because the “homebound” classification was strict, and only MDs were able to assign that status. During the pandemic, CMS adjusted some of these regulations to reduce physician burden and curtail patients’ increased infection risk and stress of being in a hospital environment.Patients who tested positive for COVID-19 and needed health services were eligible to receive them at home under the Medicare benefit. Additionally, CMS allowed occupational therapists, physical therapists, and speech language pathologists to perform and be reimbursed for initial and comprehensive assessments for all patients. The latest home health rule codified this pandemic-era shift.
Similarly, in addition to a physician, the CARES Act allows nurse practitioners, clinical nurse specialists, or physician assistants to order home health services, establish and periodically review a plan of care for home health services, and certify and re-certify that the patient is eligible for Medicare home health services.
The CARES Act also eliminated certain Medicare requirements related to face-to-face encounters, thus enabling some medical appointments to be conducted via telehealth, with combination audio and video, or even just audio. To reflect this shift in the usage of telehealth appointments, Congress increased Medicare payments for telehealth services. By changing the regulatory requirements for home health services reimbursement, home health became a more widely used alternative for both inpatient and outpatient care.
3. Shifting patient perception of in-home care promises savings opportunities for health plans servicing aging populations
As the ease and availability of comparable care at home options become more prevalent and publicly accepted, aging populations have expressed increased interest in accessing their care at home. According to a McKinsey study, 16% of respondents aged 65 and older said that they are more likely to receive care in the home post-pandemic. For this vulnerable population, receiving care at home reduces risks of infection and falls and eases burdens like transportation. Being in a familiar environment, like one’s home, is also especially beneficial for patients with cognitive impairment. In particular, it could reduce the risk of the “sun-downing,” a common symptom of patients with dementia. In appropriate circumstances, health plans can financially benefit from shifting these services to a home setting. An estimated $265 billion worth of care services for Medicare fee-for-service and Medicare Advantage beneficiaries could shift to the home by 2025. As this represents 25% of the total cost of care for these beneficiaries, the opportunity for impact is significant. By leveraging home health as an alternative site-of-care, health plans financially benefit in the short term from utilizing a lower-cost, lower-acuity setting and in the long term from reducing the risk of preventable adverse health events.
Forward-thinking health plans will use the post-pandemic recovery period as a catalyst to rethink how they can utilize home health as an alternative site-of-care to enhance provider and patient experience and reduce costs.
For more information about how COVID-19 impacted home health and how health plans can use intelligent prior authorization as a lever to better manage it, download our white paper.
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About the Author: Samantha Roushan
