17 minute read
Health systems look to expand care delivery services in Hospital-at-Home programs post pandemic
from Repertoire June 22
Bolstering Home Care Models
Health systems look to expand care delivery services in Hospital-at-Home programs post pandemic.
By Daniel Beaird
A recent report from McKinsey & Co. stated that as much as $265 billion worth of care services for Medicare fee-for-
service and Medicare Advantage beneficiaries could shift to the home by 2025, representing a three- to fourfold increase in the cost of care being delivered at home for this population.1 The COVID-19 pandemic accelerated this movement and a significant portion of it came through Hospital-at-Home (HAH) programs, which enable some patients who need acutelevel care to receive it in their homes rather than in a hospital, thus aiming to reduce costs, improve outcomes and enhance the patient experience.
CMS launched the Acute Hospital Care At Home program in November 2020, during the first year of the pandemic. It provided hospitals the flexibility to care for patients in their homes, originally helping relieve facilities of non-COVID patients to assist in tackling the surge of COVID-positive patients. As many HAH programs evolved throughout the pandemic, they shifted to enrolling COVID-positive patients as well to finish their hospitalization at home. Now, COVID-positive patients are enrolled directly from emergency departments.
“One driver to more enrollments is the barrier of obtaining reimbursements for short-term oxygen,” Peter Read, MD, medical director of Des Moines, Iowa-based UnityPoint Health’s hospital-athome program, told AHA’s Advancing Health podcast in February.2 “We worked with our ACO to develop a waiver that allows us to dispense shortterm oxygen to overcome reimbursement.” UnityPoint Health has achieved $900,000 in shared savings from just its hospital-at-home program, and many of its other home-based services were in increased demand due to the pandemic. The Midwestern health system has enrolled over 150 patients in its program and averted over 100 hospitalizations during the pandemic. In January, Baxter International, Global Medical Response (GMR) and Cardinal Health led a $110 million investment round in Boston-based Medically Home, a technology-enabled services company that provides tools to allow medical providers to shift advanced medical care from hospitals to patients’ homes. Mayo Clinic and Kaiser Permanente also contributed. These partnerships and investments are supporting the evolution of flexible hospital capacity toward hospital care at home and utilization is expanding.
Medically Home’s hospital-athome program configures a network of clinical and non-clinical services, medications, equipment and supplies to patients’ homes, enabled by the CESIA Continuum® enterprise
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platform for orchestrating highacuity care in patients’ homes. The model is expected to increase demand for a next-generation clinical workforce that combines centralized care oversight by physicians and nurses in medical command centers with nurses, paramedics and technicians in the field.
“When supporting home health, many hospital systems either have their own or partner with home health agencies, and the same is true with hospice,” Philip Parks, MD, MPH, vice president of healthcare innovation for Cardinal Health atHome Solutions, said. “Our strategic partnership with Medically Home allows us to work indirectly with health systems to enable the future of hospital-at-home.”
“It’s like the ‘Geek Squad’ of healthcare. Patients need at-home providers to come inside, set up the medical equipment and show them how to use it. Patients don’t just want it left on their doorstep – imagine being admitted to a hospital bed… but in your home,” he said.
Parks describes Cardinal Health as a healthcare enabler – the logistics and supply chain behind so many patient experiences at scale in large acute facilities. That same philosophy is also how Cardinal Health at-Home Solutions approaches medical supply distribution for care in the home. It ships medical supplies and over-thecounter products to home medical equipment (HME) providers, home health and hospice agencies (HHA), E-commerce providers and directly to patients’ homes across the U.S.
Much like the partnerships and investments from Cardinal Health, Baxter International and GMR in Medically Home, the healthcare industry as a whole is advocating for more home care options.
– Peter Read, MD, medical director of Des Moines, Iowa-based UnityPoint Health’s hospital-at-home program
Philip Parks
Advanced Care at Home Coalition
UnityPoint Health is part of the Advanced Care at Home Coalition led by a steering committee comprised of the three founding members, including Mayo Clinic, Kaiser Permanente and Medically Home. Its 12 other members is a list of prominent health systems, including Baltimore-based Johns Hopkins Medicine, which was a leader under Bruce Leff, MD, in these programs in the mid-1990s. The coalition has applauded the recent introduction of the Hospital Inpatient Services Modernization Act, which would extend the Acute Care at Home waivers that have allowed expanded delivery of hospital-level care at home for Medicare beneficiaries during the pandemic.
The bipartisan legislation sponsored by Sens. Tom Carper (D-DE) and Tim Scott (R-SC), and Reps. Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR) extends the waivers for two years beyond the duration of the COVID-19 public health emergency and it requires CMS to issue regulations establishing health and safety requirements for Acute Hospital Care at Home programs within one year of the bill’s enactment. It’s supported by more than 100 health organizations and healthcare associations.
“By extending these flexibilities, Congress will create a predictable pathway for medical professionals to fully realize advances in the care delivery system that enable patients to be treated with safe, equitable, person-centered care in the comfort of their own homes,” said Stephen Parodi, MD, executive vice president of The Permanente Federation at Kaiser Permanente, which has provided hospital-level care at home to more than 1,100 patients.
“We adapted to COVID-19 by developing pathways to deliver the COVID-19 vaccine to those unable to obtain one through traditional pathways,” added Dr. Read. “We are also testing patients for COVID-19 who are unable to leave their homes. In the future, we would like to begin administering monoclonal antibody treatment at home for those COVID-positive patients at high risk for complications.”
Mount Sinai’s model
New York-based Mount Sinai Health System was awarded a Center for Medicare and Medicaid Innovation
(CMMI) award in 2014 to launch its hospitalization-at-home program, building upon its home-based primary care program for homebound patients in Manhattan, N.Y.
“I had always been frustrated as a primary care physician in someone’s home where I knew the patient had pneumonia and needed an IV and antibiotic, but because of all the rules, regulations and prior authorizations, I couldn’t treat them with IV antibiotics at home very easily,” said Linda DeCherrie, MD, clinical director of Mount Sinai at Home, told the AHA.3
When Mount Sinai received the project grant from CMMI, the patients they took care of were Medicare fee-for-service patients for three years of the grant. After that, it had to pivot to Medicare Advantage plans, commercial and managed Medicaid. It formed a joint venture with Nashville, Tenn.-based Contessa Health in 2017 for the ability to negotiate with various insurance plans for bundle payments. Contessa Health aids its provider partners in addressing these challenges in the new standard of care.
Negotiation challenges are some of the biggest barriers for these programs starting up around the country, according to Dr. DeCherrie, but Mount Sinai’s program has been very successful and popular with patients.
“I don’t think we had a single patient decline joining the program,” said Dr. DeCherrie. “People were wanting to get out of the hospital, especially during the height of the pandemic with a no visitor policy. They wanted to go home as soon as they could.”
The New York health system launched the second part of its program during the pandemic and called it Completing Hospitalization-atHome. This was aimed at patients who had been in the hospital, even as a COVID-positive patient in the ICU but were on a healing trajectory.
Some of the state of emergency waivers allowed Mount Sinai to implement the program. They had it up and running within two weeks of the issued state of emergency. It began with non-COVID patients, but eventually extended to COVID-positive patients.
“The pandemic has shined a light on what needs to evolve and modernize in healthcare,” Parks said. “Taking COVID-19 tests in our homes, for example, is an expectation now. Patients’ behaviors have changed and that makes it easier for adoption of new procedures – saving them time and money.”
“The question is ‘can we create something that the customer wants to use in-person’ and it creates value for them and their experience,” Parks explained. “Milestones are based on asking patients what they would like to have happen in their hospital at home experience. We can make those things happen, test them and find ways to scale them to the broader marketplace.”
Parks says it’s still early in the adoption phase, but it’s a different world of expectations from only two to three years ago, and that’s a silver lining from the pandemic. “The broader idea is the continuum of care and how people want to experience health and wellbeing, potentially getting care in the comfort of their own homes,” he said. “And generationally, we have a group of younger people that can’t imagine doing it the old way.”
1. From facility to home: How healthcare could shift by 2025 2. Hospitals at Home with UnityPoint Health 3. Members in Action: Mount Sinai Health System
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By Pete Mercer
Shannon Bream’s Journey in American Media
The host of Fox News @ Night shares insights on news gathering, team building, and content creation with Repertoire.
Developing a plan for your career is a wise decision in just about every
respect, but it doesn’t mean that the plan is going to come out exactly as you initially thought. You might have gone to school for one thing and ended up in an entirely different field for work. It’s all about the journey, something that Fox News anchor Shannon Bream understands very well.
Bream, author and host of Fox News @ Night, recently sat down with Repertoire publisher Scott Adams to discuss the journey and changes of her career, leadership, and content in the realm of journalism.
Building her career
Bream attended Liberty University, where she graduated with a business management degree. While she loved the program, Bream was interested in politics, specifically the intersection of law and politics. After graduating, she went home to Tallahassee to attend Florida State Law School, and even practiced law for a few years after that.
“I had always had an interest in news from very early on. Staying up all night, watching election returns when I was 8 years old, and my parents always said, ‘This doesn’t concern you, you can’t vote. Go to bed.’ I just loved knowing what was going on in the world. But when I was at Liberty, I studied business because I couldn’t really figure out what I was going to do.”
Shannon Bream’s Journey in American Media
This interest in news pushed Bream to pursue an internship at a local TV station in Tampa, but she could only do the internship for college credit. She went to USF in Tampa where she took a course in news writing, giving her a foot in the door with the internship. Bream would shadow reporters, producers, and photographers to learn about the industry and take copious notes. She would often offer to buy dinner for the other person to further pick their brain.
Bream said, “I remember one photographer said to me, ‘No, I don’t want you to buy me dinner. I want, when someone comes to shadow you, for you to do the same thing. Just pay it forward.’ I’ve always remembered that. We all have opportunities in our careers to help other people.”
Eventually, she took a risk and quit her job as a lawyer to pursue a career in media. By “stepping out in faith,” Bream got her first on-air job, working from 2:00 a.m. to 11:00 a.m. She continued to do things like answer phones, make coffee, work the teleprompter, and write scripts for the morning anchors.
After a change in management, Bream was told that she was never going to make it in the industry and to go back to law. She hunkered down and eventually got a job offer in Charlotte, North Carolina at WBTV. From there, she continued to develop her career before landing at Fox News in 2007.
What leadership should look like
Bream’s long relationship with Fox News has not only afforded her great success, but it has also given her the opportunity to work with the leadership within her organization, as well as interview incredible female leaders for her show. Because of women like Barbara Walters and Diane Sawyer, Bream never had the thought that she couldn’t go into broadcasting because she’s a woman. They had already broken through that wall.
Now, Bream has the opportunity to carry that torch for the next generation of female leaders. She says, “I feel like a lot of the strong leaders I know are very confident, but not arrogant. Because that’s different. Confident in whatever their mission they or their organization has. They believe in it and have a passion for it.”
However, being in leadership doesn’t cure anyone of missing the mark. Thinking about some of the strongest leaders Bream has worked with, she said, “They have confidence, but a lot of humility too. They are willing to listen to people with different viewpoints who can give them good advice, and maybe save some headaches. For me, I don’t want people to just tell me every idea I have is great and wonderful.”
Bream also finds significant value in taking counsel from other people, especially when it’s people she works
Shannon Bream’s Journey in American Media
with. Her team works with her every day to build the structure and the content for Fox News @ Night, all coming from different backgrounds, age groups, ideas, and viewpoints. This diversity gives her team the opportunity to A/B test the content of the show, improving on the foundation of Fox News @ Night with different perspectives and ideas.
“I think being humble enough to listen to people and take their advice is huge. The willingness to always learn will make you stronger in any area that you’re willing to invest time in. I will say, there’s never been a perfect show that we’ve done. It’s live TV, something is going to be flubbed. The important thing is to admit that and leverage it into making yourself and your team better.”
Building content
Bream’s team at Fox New @ Night works together to put out daily content in the form of a news show. For @ Night, Bream’s team consists of an executive producer, senior producers, segment producers, a copywriter, and someone who books the guests. “I think if you try to pretend like you’re doing everything yourself, first of all, that’s going to blow up in your face. No one should be that arrogant. We all have teams to us get everything done.”
Not only does it take a team of multiple people to produce the content for Fox News @ Night, but the entire network has a vast team of local and global correspondents to cover the news from all over the world. Even now, there are teams of reporters in the Ukraine covering
the war, relaying critical and often time-sensitive information back to Bream and her domestic team of reporters, producers, and writers.
Building content is all about understanding the needs and wants of your audience. If you are producing or publishing content that your audience isn’t interested in, they will find someone else who will. Capturing the eyes and the attention of the audience is the biggest obstacle for major news organizations like Fox News.
At Fox News, Bream and her colleagues are trying to push the most up-to-date, accurate information around the clock. Bream says that Fox Nation, the official streaming service of Fox News, works because they really understand their audience. “We know what our viewers are interested in and what they’re going to connect with. And we want to feed them content that they feel like they’re not getting anywhere else. That we value them as a viewer, as a customer.”
To hear the full interview, visit repertoiremag.com.
The Mothers and Daughters of the Bible Speak: Lessons on Faith from Nine Biblical Families
“Have faith” is a phrase we hear all the time. But what does it actually look like to live it out?
In The Mothers and Daughters of the Bible Speak, Shannon Bream examines the lives of biblical women to see how God’s plans can turn our worlds upside down. She tells the story of Jochebed, a mother who took enormous risks to protect her son, Moses, from Pharaoh. Could Jochebed have imagined that God’s actual design for her son involved flight into exile and danger? And yet this was all part of the master plan to deliver Israel from slavery. Another biblical mother, Rebekah, made terrible choices in an attempt to ensure her son’s place in history. And a daughter, Michal, struggled to keep her faithless father, Saul, from sin, while battling pride in herself.
The Mothers and Daughters of the Bible Speak shows that faith is more often a twisting road than a straight line. Yet, as the stories of biblical families attest, at the end of these journeys lies greater peace and joy than we could ever imagine.
Available on Amazon and other book retailers.
