Get to Know Medicare Home Health

Most older Americans – like Ms. Alice – want to receive care at home as they age. The Medicare Home Health Benefit offers older Americans the opportunity to receive compassionate, personalized, quality care where they feel safe and motivated to improve and maintain their health.

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CDC Adds Covid-19 Shots to List of Routine Vaccines for Kids and Adults

CNN | By Janelle Chavez

Covid-19 shots are included in new schedules of routinely recommended vaccines released by the US Centers for Disease Control and Prevention on Thursday. The immunization schedules summarize current vaccine recommendations for children, adolescents and adults, but do not set vaccine requirements for schools or workplaces.

Key changes to the schedules, published in the CDC's Morbidity and Mortality Weekly Report on Thursday, include the addition of Covid-19 primary vaccine series and recommendations on booster dose vaccination; updated guidance on influenza and pneumococcal vaccines; and new vaccines for measles, mumps, and rubella (MMR) and for hepatitis B.

The schedule also recommends additional doses of MMR vaccine during a mumps outbreak and administering inactivated poliovirus vaccine in adults who are at an increased risk for exposure to the virus.

The proposed changes were recommended by the CDC's vaccine advisers, the Advisory Committee on Immunization Practices or ACIP, and signed off on by the CDC, which worked with physicians, nurses and pharmacists on the recommendation.

The biggest change, the report's authors told CNN, is incorporating Covid-19 vaccines into both schedules.

"This means COVID-19 vaccine is now presented as any other routinely recommended vaccine and is no longer presented in a special "call out" box as in previous years. This, in a sense, helps 'normalize' this vaccine and sends a powerful message to both healthcare providers and the general public that everyone ages 6 months and older should stay up to date with recommended COVID-19 vaccines (including a booster, when eligible), just as they would with any other routinely recommended vaccine," Dr. Neil Murthy and Dr. A. Patricia Wodi said in a statement.

However, including Covid-19 vaccines on the routine schedule does not mean vaccination will be required by schools. School-entry vaccination requirements are determined by state or local jurisdictions, and not by CDC.

The new recommendations also add the use of PCV15, a pneumococcal conjugate vaccine used to treat bacterial infection recently approved for use in children. Either PCV13 or the higher valent PCV15 may now be used based on the specific pediatric population.

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More Payers Leaning Into High-Acuity, At-Home Care Could Be ‘Game Changer’

Home Health Care News | By Andrew Donlan 

Hospital-at-home care had a breakthrough moment in the U.S. after the onset of COVID-19.

At the end of 2022, the $1.66 trillion omnibus spending bill made sure that the financial setup that helped get hospital-at-home programs off the the ground during the pandemic would not go away once the public health emergency ended.

But the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver is now just one part of the larger shift to high-acuity home-based care. While that funding mechanism remains, organizations are also finding new ways to fund hospital at home – and new models to bring into the home.

Medically Home – one of the early adopters of a business model tailored around enabling hospital-level care in the home – recently unveiled its “ED in Home” model, which is meant to bring emergency department care into a patient’s home.

“Our primary focus is to build the core chassis to decentralize care,” Medically Home CEO Rami Karjian told Home Health Care News. “So, what you’re seeing here with ED in Home is a natural extension of that primary focus to decentralized care to another use case.”

The Boston-based Medically Home partners with health plans, health systems and other providers to enable hospital-level care in the home, namely through coordinating in-home clinician visits and supplying the necessary technology, medication and equipment.

Its financial backers include the Mayo Clinic, Kaiser Permanente, Baxter International Inc. (NYSE: BAX), Global Medical Response and Cardinal Health Inc. (NYSE: CAH).

The ED in Home program was officially announced in January, though thousands of patients had already been cared for underneath it at that point. While it’s live in Massachusetts, Medically Home is actively working on bringing it to other states across the country, though Karjian declined to name specific ones at this point.

“Adding ED at Home is another use case, and it’s particularly powerful today, because of the access challenges that COVID exposed,” Karjian said. “Patients don’t want to go to the hospital, they don’t want to be in the hospital, they’re finding it harder and harder to get to a hospital. This brings the hospital front door to them in a way that inpatient care alone couldn’t.”

More payers getting involved

CMS and the Acute Hospital Care at Home waiver were the primary drivers of health systems delving into hospital at home in 2020 and 2021. But the model is no longer a niche service offering.

Because of home-based care’s ability to drive down costs, there’s an increasing amount of payers and providers willing to engage.

“The commercial payers are really starting to accelerate the rollout and adoption of this,” Karjian said. “We’ve had a number of the commercial payers in a number of states come to us and just say, ‘How can we work together, along with the health systems, to accelerate this and maybe even provide some of the funding that would allow this to progress?’ So, that’s very exciting.”

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Despite Hardball Tactics With Home Health Providers, MA Plans Have High Gross Margins

Home Health Care News | By Patrick Filbin
 
Insurers are reporting much higher gross margins per enrollee in the Medicare Advantage (MA) market than in other health insurance markets, according to a new Kaiser Family Foundation analysis.
 
At the same time, many Medicare Advantage plans continue to play hardball with home health providers by rationing utilization and offering low rates.
 
The KFF analysis took a look at financial data in four insurer markets: Medicare Advantage, Medicaid managed care, individual (non-group) and fully insured group.
 
In 2021, MA insurers reported gross margins averaging $1,730 per enrollee. That was at least double the margins reported by insurers in the individual/non-group market ($745), the fully insured group/employer market ($689) and the Medicaid managed care market ($768). Source: KFF
 
There is still some margin pressure for MA plans, as the Centers for Medicare & Medicaid Services (CMS) is looking to increase oversight of them and claw back overpayments in the near-term future.
 
While MA pays almost the same as traditional Medicare in a hospital setting, for instance, skilled nursing facilities and home health agencies are often paid far less by MA for services.
 
“Medicare Advantage plans have both higher average costs and higher premiums (largely paid by the federal government) because Medicare covers an older, sicker population,” KFF reported. “While Medicare Advantage insurers spend a similar share of their premiums on benefits as other insurers in other markets, the gross margins — which include profits and administrative costs — of Medicare Advantage plans tend to be higher.”

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