Home-Based Care Still an ‘Undertapped’ Resource for Seniors with Complex Health Needs

Policymakers should focus on home-based care services and payment model improvements in order to address the unique needs of people with complex health issues.

That’s according to a new analysis published by Health Affairs, which took a closer look at the opportunities to improve and expand home-based care through value-based payment (VBP).

Experts at the Margolis Center for Health Policy at Duke University in Washington, D.C., argue there should be four key areas of focus to ensure home-based care is folded more regularly into the broader health care system:

– Adapting existing VBP models to better support the nuances of home-based care

– Ensuring these models are accessible to small, independent care providers with limited resources

– Modifying technical components of existing models to account for the unique needs of individuals receiving home-based care

– Strengthening the home-based care infrastructure by leveraging initial and ongoing flexibilities introduced during the COVID-19 public health emergency (PHE)

The majority of the 7 million Americans eligible for home-based care do not receive these services. Now is the time to address that issue, the analysis states.

During the PHE, there has been some legislative momentum to expand home-based care at the federal and state levels.

The analysis states that fee-for-service-based payment arrangements “are ill-suited to achieve” the four goals proposed. Thus, adjusting to VBP from fee for service will be crucial, it maintains.

“Providers operating under fee for service are often undercompensated for travel time, not reimbursed for many home-based services and face additional administrative burdens from billing and coding practices,” the authors wrote. “Since revenue in fee for service is determined by the volume of patients seen, providers have less financial support to conduct home visits, given that home-based care providers travel up to two hours a day to deliver care and therefore see fewer patients compared to office-based providers.”

VBP models afford flexibility and accountability where fee-for-service payments can’t. The analysis suggests that it would also be beneficial to develop a “sub-track” within existing population-based VBP models that can be customized for people with complex health and social needs.

For instance, if patients need additional resources beyond those provided in general population-based models, those patients can transition between the sub-track and the larger population-based model as their medical and functional requirements evolve over time.

Investing in technology and care coordination for smaller, independent care providers will also lay the foundation for more sustainable, long-term opportunities for home-based care. While facility-based providers have received government money to update their electronic medical record systems, home-based care providers have never been lent similar support.

A key to financially supporting potential policy changes, however, is investing in the home-based care workforce.

The Biden administration’s Build Back Better Plan initially included $400 billion for home-based care services. The money would have gone to low-wage workers as well as an effort to reduce Medicaid waiting lists for home-based care.

The $400 billion eventually got sliced down to $150 billion, and then, of course, Build Back Better ended up failing to complete its trip through Washington, D.C.

States have likewise tried to address the home-based care workforce crisis by raising wages for workers. For instance, the Fair Pay for Home Care Act in New York would significantly increase wages for home- and community-based care workers in the state, while also mandating corresponding provider reimbursement hikes.

Overall, the authors of the piece argue that the home setting remains unevenly used and underutilized. And finding specific ways to change that should be an immediate priority for health care policymakers.

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