New York, Massachusetts and Colorado are pioneering what could become a new trend: age-friendly states. All three received age-friendly state designations from AARP within the past year.
The movement could be good news for home care providers, if it means that states invest more in systems and infrastructure to enable aging in place and community-based services.
Achieving an “age-friendly” designation doesn’t necessarily mean these states are the best place to grow old — but if they keep their word and execute on plans to be more age-friendly, they will be. More than a designation, this is an enrollment program, Danielle Arigoni, director of livable communities at AARP, told Forbes.
“It’s a commitment to growing in an age-friendly way, not a certification that we stamp and then you’re done,” she told the magazine.
New York Governor Andrew Cuomo made that commitment last week. On Nov. 14, he issued an executive order to “improve health and well-being of New Yorkers across the lifespan.”
In addition to a commitment from the governor, which includes assessments and action plans, states requesting an age-friendly designation must also complete an application. New Hampshire, Rhode Island, New Jersey, Tennessee, North Carolina and Oregon may soon follow suit, according to Forbes.
Depending on location, implementation of initiatives looks different, even within states. To best serve older people, different areas within age-friendly states can adopt different policies and programs while drawing on each other for resources and expertise. For example, in Massachusetts, state leaders researched older residents’ wants and needs by conducting listening sessions across the state.
There is no one-size-fits all and that becoming age-friend is partially about combating ageism, Alice Bonner, Secretary of Massachusetts’ Executive Office of Elder Affairs, told Forbes. Broadly, the goal of AARP’s designation program is to get more groups to cater to older people, from recreation to transportation to employment. Now, age-friendly states hope to lead the charge.
“We need to figure out how to care for one another as we get older,” Bonner told the magazine. “This is not about somebody else; a bunch of 90-year-old people over there. This is about you — however old you are — and it’s about us.”
Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find
By Guest Contributor | November 12, 2018
Home Health Care News Perspective: With certain non-skilled in-home care services allowable under the Medicare Advantage program in 2019, the home care industry has made landing partnerships with health plans a top priority. But significant opportunities may not arise until 2020, experts predict. Just 3% of MA plans will next year offer in-home support services such as personal care and housekeeping, according AARP. A new report from Kaiser Health News sheds further light on the topic.
For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.
But the new benefits will not be widely available, and they won’t be easy to find.
Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.
That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.
Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based “Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options.
Even if people sign up for those plans, they won’t all be eligible for all the benefits. Advantage members will need a recommendation from a health care provider in the plan’s network. Then they may need to have a certain chronic health problem, a recent hospitalization or meet other eligibility requirements.
Medicare counselors from California to Maine say key details are not included on the government’s website. In some cases, if insurers offer the new benefits, the plan finder “will indicate ‘yes’ or ‘no,’” said Georgia Gerdes a health care choices specialist at AgeOptions, the Area Agency on Aging in Oak Park, Ill., outside Chicago. That’s hardly enough, she said.
“There is a lot of information on the plan finder, but there is a lot of information missing that requires beneficiaries to do more research,” said Deb McFarland, Medicare services program supervisor at the Southern Maine Agency on Aging.
Nonetheless, officials say the added benefits will help Advantage members prevent costly hospitalizations. Federal approval of additional benefits is “one of the most significant changes made to the Medicare program,” Seema Verma, the head of the Centers for Medicare & Medicaid Services, told an insurers’ meeting last month. She said she expects plans to expand services in coming years.
Medicare Advantage plans, which are an alternative to traditional Medicare, serve 21 million beneficiaries and limit their out-of-pocket expenses. But they also restrict members to a network of doctors, hospitals and other medical providers. They often offer benefits not available in traditional Medicare, such as dental and vision care, hearing aids and gym memberships.
The federal government pays a set amount to the plans to help cover the cost of each member. The Trump administration gave insurers more money to spend on benefits next year — an average pay raise of 3.4 percent, seven times more than the rate of increase in 2018.
Enrollment is underway for Medicare Advantage plans, as well as for people in traditional Medicare who want to buy a policy for drug coverage. The deadline for choosing either type of plan is Dec. 7.
Among the new benefits that some Medicare Advantage plans said they will offer are:
— trips to the pharmacy or fitness center in addition to doctor’s appointments for plan members, depending on where they live or their health conditions
— a monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings
— house calls by doctors or other health care providers, under certain conditions
— a home health care aide for a limited number of hours to help with dressing, eating and other daily activities, possibly including household chores and light housekeeping
However, plans offering these and other services will likely have only some of the options and will have different eligibility criteria and other limitations. The same services likely won’t be available in every county the plan serves.
For example, next year an estimated 150,000 Humana Medicare Advantage members in Texas and South Florida — two of the 43 states Humana serves — who cannot be left alone at home will be able to get a free in-home personal care aide for up to 42 hours a year, so that their regular caregiver can get a break. And more than half of the members in Cigna-HealthSpring Advantage plans will have access to free transportation services in all but five of the 16 states and the District of Columbia where the company sells coverage.
To find these supplemental benefits, seniors can use the online plan finder. After they enter their ZIP code and get a list of plans available locally, they can click on a plan name. That will take them to another page that offers more details about coverage, including a tab for health and drug plan benefits. That page might say whether the new services are offered.
But often the website will simply indicate that specific benefits are available — and perhaps not name them — and advise consumers to contact the plan for more information. A Medicare spokesperson confirmed that there is currently not an indicator on the plan finder for plans offering these expanded health-related supplemental benefits.
In addition to extra benefits, other variables should be considered when choosing an Advantage plan, such as which health care providers and pharmacies participate in a plan’s network, which drugs are covered and the costs.
Where available, several insurers say the new services will be free with no increase in monthly premiums.
“We certainly believe that all of the ancillary benefits we provide will help keep our members healthy, which is good for them, and it’s good for us in the long run,” said Steve Warner, head of the Medicare Advantage product team at UnitedHealthcare, which insures about 5 million seniors or 1 in 4 Medicare Advantage members.
Insurers are betting that services will eventually pay for themselves.
Dawn Maroney, consumer president at Alignment Healthcare, which serves eight counties in Southern California, said it’s much cheaper to give an air conditioner to someone with congestive heart failure to keep that patient healthy than to pay for more expensive medical treatment.
But if the new benefits are such a good idea, they should be available to the majority of older adults in traditional Medicare, said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy
How Home Care Could Be Re-Shaped if Walmart Acquires Humana
By Tim Mullaney | April 1, 2018
In the midst of acquiring a stake in the largest home health provider in the nation, insurance giant Humana (NYSE: HUM) might also be in early stage talks to itself be acquired by retail behemoth Walmart (NYSE: WMT). The combination of Humana and Walmart, though far from certain, would potentially be a game-changer for home care and the overall health care delivery and payment system for U.S. seniors.
On Thursday, The Wall Street Journal was the first to report that Louisville, Kentucky-based Humana and Bentonville, Arkansas-based Walmart are negotiating, citing an unnamed source familiar with the matter. Details remain scarce, but subsequent reporting from Bloomberg indicated that Walmart and Humana have been discussing a “wide range of options,” and that at this point, an outright combination is not likely.
Still, the rumors were enough to send Humana’s stock surging, with shares jumping from $263.21 on Thursday morning to $268.83 mid-day Friday, bringing the company’s market capitalization to around $41 billion. Walmart was up 1.48% on Friday afternoon, trading at $88.97 a share.
Humana had not responded to requests for comment as of press time. Walmart does not comment on rumors or speculation, the company stated in an email to Home Health Care News.
The Walmart rumors began swirling on the same day that shareholders of Louisville-based Kindred Healthcare (NYSE: KND) began casting votes to approve or reject a proposed deal with Humana. In that $4.1 billion transaction, first announced in late December, Humana would acquire a 40% stake in Kindred at Home, the largest U.S. home health provider. Two private equity firms would acquire the other 60%, but Humana would have the chance to fully take over Kindred at Home over time. The shareholder voting is scheduled to close on April 5.
Walmart could be interested in tying up with Humana as a defensive move against Amazon, its fierce retail rival.
Though known primarily for its e-commerce platform, Amazon has been making inroads into health care recently. It is teaming up with JP Morgan Chase and Berkshire Hathaway on a new venture that will seemingly manage insurance benefits for the companies’ roughly 1.5 million employees, although the exact nature of the three-way partnership has not yet been clearly defined.
In addition, Amazon has been active in the pharmacy space, leading to chatter that it might be interested in acquiring a pharmacy benefit management (PBM) company.
Acquiring Humana would hypothetically be a way for Walmart to answer both these plays by Amazon.
Humana is “by far the largest PBM” that realistically could be acquired at the moment, Bloomberg reported. Other major pharmacies such as CVS and Express Scripts are already in the midst of mega-mergers with insurers Aetna and Cigna, respectively. Walmart and Humana have partnered on some prescription plans, under which Humana beneficiaries can pay as little as $1 for medications picked up at Walmart locations.
Furthermore, owning one of the largest U.S. insurers would be a way for Walmart to internally manage the benefits of its own 1.5 million employees.
“Walmart has an opportunity to leverage their own massive employee health care needs to beat Amazon to the punch of re-imagining health care first for employees and eventually for consumers,” Brittain Ladd told Home Health Care News. Ladd is an independent consultant who specializes in digital, operations and supply chain management, and he previously focused on these areas in jobs with Amazon and accounting/advisory firm Deloitte.
Home care is a piece of the puzzle
These potential moves by Amazon and now Walmart have put home care providers—both Medicare-certified and private-duty agencies—on alert.
Most obviously, an outright acquisition of Humana would make Walmart a de facto home health provider, assuming that Humana’s acquisition of Kindred at Home is completed as planned. Jarring as it might be to think of Walmart as a home health company, lines are already being blurred between insurance, retail and home care.
For example, CVS and Aetna are joining forces, with one goal being to transform CVS pharmacies into one-stop shops where seniors could buy a greeting card, pick up a prescription, and receive health care services—helping them to manage chronic conditions, avoid hospitalizations, and improve the bottom line for Aetna’s large Medicare Advantage business.
Walmart and Humana could execute a version of this model on an even larger scale. Humana is the second-largest Medicare Advantage provider in the nation, behind only UnitedHealthcare. And Walmart is the largest retailer in the world, with $485 billion in annual sales, according to the Forbes Global 2000 rankings for 2017. CVS ranked as the second-largest retailer on the list, with about $178 billion in sales.
“The reason why I recommended [in a piece last June] that Walmart acquire a health insurer is because of the fact 90% of Americans live within 10 miles of a Walmart store,” Ladd told HHCN. “Acquiring Humana provides Walmart with an imperative to greatly expand their pharmacy, clinics, health care, and insurance capabilities within their stores to give seniors and others easier access to a provider capable of meeting the majority of their health care needs.”
In the long run, Walmart has the potential to be a huge driving force not only for transforming home care but the whole senior care ecosystem, he believes. He painted a picture of Walmart fulfilling Meals on Wheels deliveries from its stores, offering house cleaning, and doing on-demand wellness and welfare checks of seniors living at home. Already, tech-forward home care startup Honor has opened storefronts inside some Texas Walmarts.
Walmart could eventually even acquire nursing homes or develop its own alternative to nursing homes, powered by its supply chain, technology platforms, and health care services, Ladd postulated.
Home care providers and industry stakeholders have already been envisioning this type of large-scale disruption, in light of Amazon’s recent moves.
If Amazon were to leverage its retail services, technologies, and customer support to enable aging-in-place, it could theoretically reduce the need for traditional caregivers, posing a threat to established providers. On the other hand, Amazon is already boosting home care in certain ways—its voice-activated technologies like Echo are proving valuable in supporting in-home care, for example. And its experiment with Chase and Berkshire Hathaway could lead to more in-home care, if the three corporate giants try to lower costs by covering services delivered at home rather than inpatient settings.
Similarly, though home care providers might tremble at the thought of Walmart becoming a direct competitor, transforming retail stores into robust health care hubs is not necessarily bad for the industry, if it enables more seniors to live at home for longer periods of time. The trend can be seen as a “validation of the home health pitch,” which is that the volume of patients will increase in the coming years as more people will be able to age in place, Brian Tanquilut, analyst with investment bank Jefferies, told HHCN after the Aetna-CVS deal was announced in December.
Of course, Walmart acquiring Humana is far from certain, no matter how compelling the arguments might be. And there are drawbacks and obstacles as well.
Operationally, Walmart would be expanding outside its core competencies in retail. Financially, the price tag on Humana could run to $50 billion, but Walmart ended 2017 with only $6.76 billion in cash on hand, the WSJ reported. If Walmart were to issue stock rather than take on debt for the acquisition, the Walton family’s ownership stake likely would drop below 50%, which could be an impediment. There would be inevitable regulatory hurdles to clear as well.
Even if this particular deal does not go through, the writing appears to be on the wall that home health and private duty providers need more scale and sophistication than ever before, both to compete against and potentially partner with the massive corporate entities taking an interest in the sector.It’s a point recently made by several CEOs of home health companies, including AccentCare CEO Stephan Rodgers, and is one reason for consolidation in the space. As Kindred’s shareholders were casting their votes on the Humana deal, two other heavy hitters—Lafayette, Louisiana-based LHC Group (Nasdaq: LHCG) and Louisville-based Almost Family (Nasdaq: AFAM)—on April 1 closed on a merger that will create the second-largest home health provider in the nation.
Medicaid Bill Would Prevent Spousal Impoverishment as Route to Home Care Coverage
House lawmakers have taken a step toward extending crucial — but expiring — financial protections to seniors receiving long-term care in home or community settings. They did so with backing from more than a dozen health care and provider organizations.
In general, to financially qualify for Medicaid long-term services and supports (LTSS), an individual has to meet certain low-income and asset requirements. Marriage often complicates those eligibility requirements, however, potentially putting husbands or wives in the position to “spend down” or bankrupt themselves to secure care support for their partner.
Medicaid is currently the primary payer for long-term care services and supports in the U.S. health care system.
As of August 2018, more than 73 million individuals combined were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), according to federal Medicaid data. More than 66 million individuals were enrolled in Medicaid, while about 6.5 million were enrolled in CHIP.
To prevent self-induced bankruptcy for the purpose of continuing a spouse’s Medicaid eligibility, Congress created spousal impoverishment rules in the late 1980s.
Originally, the rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, according to the Kaiser Family Foundation. States, though, were also given the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA) changed that stipulation, mandating that the spousal impoverishment rules treat Medicaid HCBS and institutional care equally. That provision is set to expire at the end of December, meaning individual states would once again become the decision-makers when it comes to spousal impoverishment in home care.
In 2018, all 50 states were applying the spousal impoverishment rules to HCBS waivers, according to Kaiser Family Foundation. Five states — Arkansas, Illinois, Maine, Minnesota and New Hampshire — plan to stop applying the spousal impoverishment rules to some or all of their HCBS waivers if Section 2404 expires at the end of 2018.
With support from LeadingAge, the National PACE Association, the National Council on Aging and several other groups, U.S. Reps. Debbie Dingell (D-Mich.) and Fred Upton (R-Mich.) on Friday introduced the Protecting Married Seniors from Impoverishment Act.
If passed, the bipartisan piece of legislation would permanently extend spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting.
“Our long-term care system is broken,” Rep. Dingell said in a statement. “Seniors and their families already face too many challenges when navigating long-term care, and they should not have to get divorced or go broke just to be eligible for the care they need.”
While it is unclear how much Congressional support the Protecting Married Senior from Impoverishment Act will ultimately draw, the fact that most states plan to continue protections on an optional basis is encouraging, LeadingAge President and CEO Katie Smith Sloan said in a statement provided to Home Health Care News.
“As a national organization, LeadingAge has consistently supported federal law establishing protections against spousal impoverishment,” Sloan said. “We support the legislation to extend the current protection.”
Washington, D.C.-based LeadingAge is an industry association that represents more than 6,000 not-for-profit senior care providers. If the Dingell-Upton bill fails, LeadingAge members in states that do not plan to continue impoverishment protections will likely be impacted negatively, Sloan said.
The National Academy of Elder Law Attorneys, Inc., the National Association for Home Care & Hospice and AARP are among the groups that have lobbied on issues including “spousal impoverishment” in the past two years, an HHCN review of lobbying records found.
A bill previously introduced in the House in 2017 — H.R. 181 — also sought to change Medicaid eligibility requirements pertaining to spousal relationships.
Specifically, the bill sought to amend Medicaid to count as available income, for purposes of determining the Medicaid eligibility of an institutionalized individual, portions of certain annuity income made in the name of the individual’s spouse.
The bill was last forwarded from the House Energy and Commerce Subcommittee on Health to the full committee by a 19-13 vote.
You’ve probably heard about the many amazing ways that taking a Coenzyme Q10 supplement can benefit your health, from increased energy and mental clarity to significantly improved heart health. In fact, the effects of CoQ10 are so well established that it has become one of the most popular supplements, and many doctors, even conservative ones, are starting to recommend it.
However, what many people don’t realize—even some doctors—is the important link between CoQ10 and many pharmaceutical drugs, especially cholesterol lowering statins that leave many older Americans feeling tired, sluggish and achy.
CoQ10 Is Fuel for Your Heart
Your heart beats about 100,000 times a day to get its job done and is fueled by CoQ10, which is why so many scientific studies have shown that it confers powerful support for your entire cardiovascular system. When your heart has the high levels of CoQ10 it needs, it works like a charm. You see, your mitochondria (the cells’ energy factories) need CoQ10 to generate ATP energy to keep your heart cells functioning and healthy.
But when levels get too low, your heart strains to do its job, and ultimately your entire body suffers.
Suboptimal heart function can play a role in a variety of health problems that plague us as we get older. That’s why taking the right CoQ10 can play a major role in making sure your body has the cellular energy you need to maintain a strong, healthy heart to live an active, healthy lifestyle as you age.
By Age 50, Your CoQ10 Levels May Be in Decline
According to leading experts on the cutting edge of natural health, it’s critical to supplement with CoQ10 as you age. After the age of 30, natural levels of CoQ10 begin to diminish. By the age of 50, this depletion of CoQ10 continues to accelerate and by age 70, your natural CoQ10 levels may be 50% lower than they were when you were a young adult!
We all know that as we age, our bodies do not perform as well in certain areas. But in many of these cases, there’s little we can do about it. That’s why I get so excited about CoQ10. It’s one tool that enables us to fight back against aging, and provide our bodies with a nourishing antioxidant that it is struggling to produce!
However, age isn’t the only factor that accelerates the loss of CoQ10. You may be shocked to learn that one of the worst culprits is pharmaceutical drugs, especially statins.
Statins and Other Drugs Can Quickly Deplete CoQ10 Levels
If you are taking a cholesterol-lowering statin drug such as Lipitor®, Zocor®, Crestor® or Pravachol, then you’re probably trying your best to stay on top of your cardiovascular health. However, I have important news to share with you today.
While statins aren’t for everyone (due to some well-established side effects), there is a hidden side effect that is not detailed on the warning label. And your doctors, in their rush to see the next patient, may have simply neglected to warn you, or even worse don’t even know about it in the first place.
It is widely known that statins severely deplete your body’s natural levels of CoQ10, which can be very dangerous. A Columbia University study found that within 30 days, your levels of CoQ10 can be decreased by half.
Statin drugs aren’t the only culprit. In fact, there is a long list of pharmaceutical drugs that rob your body of CoQ10. And since nearly 50% of American adults take at least one prescription drug daily, it’s more important than ever to supplement with CoQ10 so you can be sure your body has the necessary levels needed for proper cellular energy function and a strong cardiovascular system.
Why You Need the Right CoQ10?
I can tell you firsthand that once you start taking the right kind of CoQ10, you’ll know it without a shred of doubt.
You’ll experience a noticeable boost in your energy levels as you feed your mitochondria the fuel they crave. This increased energy production will, in turn, improve your heart health since an active, healthy heart has such high energy demands. And the benefits don’t stop there. CoQ10 may in fact support both optimal brain and skin health.
As I explained above, the older you get, the more likely you are to have reduced levels of CoQ10. This is why I recommend a high-quality CoQ10 supplement to help slow the signs of aging. But please don’t grab the first CoQ10 bottle you see on the shelf believing it will provide these incredible health benefits.
6 Benefits of CoQ10
Improves Cardiovascular FunctionCoQ10 can support your heart as you age, keeping it pumping strong while supporting normal blood pressure and reducing LDL cholesterol oxidation.
Boosts Energy and StaminaCoQ10 fuels the energy-producing mitochondria found in every cell in your body.
Supports Cognitive FunctionCoQ10 keeps brain cells healthy, while supporting mental energy and clarity.
Fights Free-Radical DamageCoQ10 is a powerful antioxidant that helps reduce oxidative stress to fight harmful free radicals.
Supports Healthy Vision and HearingCoQ10 protects the delicate tissues of your eyes and ears from free radical damage.
Improves Oral HealthResearch has shown that CoQ10 keep the cells of your mouth and gums healthy.
It’s been confirmed time and time again that CoQ10 is amazingly safe and well tolerated by the human body. There appears to be no toxicity whatsoever, even at very high levels, and it has virtually no side effects.
The Supplement Industry’s DIRTY Little Secret
You can find CoQ10 supplements virtually everywhere. And unfortunately, most people are tricked into thinking all CoQ10 is the same. But there’s a dirty little secret that they won’t tell you on the label. Most of the major studies supporting the benefits of CoQ10 have been conducted with natural CoQ10. But many supplements are made with synthetic CoQ10.
Worse yet, guess what synthetic CoQ10 is synthesized from? Believe it or not, tobacco leaves are the primary source! This synthetic junk is called the “cis” form, and there is absolutely no good data out there proving its effectiveness or safety. I don’t know about you, but I don’t want to put anything in my body that’s used to make cigarettes.
You might be surprised, but 100% natural CoQ10, known as the “trans” form, is usually no more expensive than synthetic CoQ10—you just need to know how to look for it. It’s easy if you follow my simple “cheat sheet.”
How to “Read Between the Lines”
Discount brands, such as those found in drugstores or big-box retailers, take advantage of labeling requirement loopholes, and do a great job hiding the source of their CoQ10. Don’t fall victim to their cost-cutting.
Here’s my foolproof guide that will prevent you from being scammed:
Look for the words “trans-form” on the label. Trans-form CoQ10 is identical to the CoQ10 produced naturally within the body, and if you read the studies on CoQ10 like I have, you’ll notice that most research is conducted using trans-form CoQ10.
Also check to see if the CoQ10 is made using a natural fermentation process, which yields by far the most natural form. This is a patented process used by only the most reputable, higher quality producers of CoQ10.
Seek out a supplement that contains piperine, an extract of black pepper. One problem with CoQ10 is that it’s not always well absorbed within the body. However, research shows that piperine significantly increases CoQ10 absorption by up to 30%!
Finally, make sure it is manufactured in an FDA-inspected facility here in the U.S. Who needs CoQ10 bottled overseas in facilities of questionable integrity? It’s just not worth the risk.
CoQ10 May Be the Solution Your Doctor Overlooked
I’ve read hundreds of CoQ10 studies from around the world, and it’s been confirmed time and time again that CoQ10 is amazingly safe and well tolerated by the human body. There appears to be no toxicity whatsoever, even at very high levels, and it has virtually no side effects.[6,7] Also, it doesn’t make you jittery or upset your stomach, and it doesn’t conflict with any other medications or supplements.
What it does is nothing short of a health miracle:
Energizes your heart and keeps it pumping strong
Supports brain health and mental clarity
Increases cellular energy and effectively combats fatigue
Fights off harmful free radicals that accumulate in your body
Surging Functional Impairment Costs Could Mean Big Business for Home Care
By Robert Holly | November 12, 2018
Functional impairment is, perhaps, far more costly to the U.S. health care system than previously thought.
Functional impairment is broadly defined as a condition or status that interferes with one or more basic life activities, such as bathing, eating or dressing. To help carry out these activities, individuals living with functional impairments often turn to home care providers and personal care aides.
Roughly 39.5 million adults have some degree of difficulty when it comes to physical functioning, according to the U.S. Centers for Disease Control and Prevention. Of adults aged 75 and over, nearly 11% need assistance with personal care specifically.
Medicare beneficiaries with both multiple chronic conditions and functional impairments are twice as expensive to the Medicare program than individuals who have multiple chronic conditions alone, new data from Anne Tumlinson Innovations (ATI) has found. The findings suggest that the Centers for Medicare & Medicaid Services — and even Medicare Advantage (MA) plans — will fail to reduce health care spending if they don’t prioritize functional ability
“This data analysis shows that the population most likely to be receiving long-term services and supports — that is, people who have difficulty with basic life activities — are the ones who are also using the most health care,” Anne Tumlinson, ATI CEO and founder, told Home Health Care News.” Health plans need help identifying this population, assessing them and determining which interventions will have the greatest impact on costs and outcomes.”
In general, home care agencies are in the best position to care for individuals with functional impairments and multiple chronic conditions, Tumlinson said. It’s a value proposition that many home care agency leaders have touted in the past — and one that traditional home health providers have been widely pursing as well.
ATI is a Washington, D.C.-based research and advisory services firm that specializes in businesses, communities and public programs focus on older, frail adults.
“The very reason someone needs to hire a home care provider is the very same reason that person is using a lot of health care,” Tumlinson said.
Medicare spends, on average, half as much annually on beneficiaries with multiple chronic conditions as the program does on individuals who dually have multiple chronic conditions and functional impairment, according to the ATI data. Comparatively, that ends up being about $11,600 annually compared to nearly $27,000.
Additionally, health care utilization and spending also increases as the level of functional impairment increases, ATI data suggest. Indeed, individuals with the highest level of need — people who require help with two or more activities of daily living — use inpatient hospital services much more frequently, with Medicare spending nearly three times as much on them as the overall Medicare population.
“In-home care, together with care coordination, support for family caregivers and the involvement of primary care providers can make a big difference in reducing functional decline, avoiding unnecessary hospitalizations and addressing the underlying chronic conditions,” Tumlinson said.
To tackle these spending trends, functional ability should be included in the eligibility criteria for non-medical supplemental benefits available under the CHRONIC Care Act of 2018, ATI maintains. Among its provisions, the CHRONIC Care Ac gives MA plans more flexibility to target non-medical benefits to eligible Medicare beneficiaries.
CMS announced in April that non-skilled in-home care services will — for the first time — be allowed as supplemental benefits in MA plans starting next year.
Previous research has highlighted the cost of functional impairment as well.
A 2017 study published in the Journal of the American Geriatrics Society, for example, determined that functional impairment is associated with greater Medicare costs for post-acute care and may be an unmeasured but important marker of long-term costs that cuts across conditions. In the study, researchers found that the most severely impaired participants cost 77% more than those with no impairment.
Considering costs attributable to co-morbidities, only three conditions were more expensive than severe functional impairment, according to the 2017 study: lymphoma, metastatic cancer and paralysis.
Frail Older Adults Not Getting the In-Home Health Care They Need
By Robert Holly | November 15, 2018
A huge gap exists between the need for home-based medical care and what is actually being provided to frail older adults, especially in rural areas, a new study has found. There also appear to be significant disparities in access to home-based care between male and female patients as well.
The study was published in the Journal of the American Geriatrics Society.
“Most homebound seniors have not received medical care at home,” Nengliang “Aaron” Yao, one of the study’s authors and an assistant professor at the University of Virginia School of Medicine, said in a statement. “More medical house call programs are needed.”
To further evaluate the use of home-based medical care in frail patient populations, Yao and researchers from Johns Hopkins University, the University of California, San Francisco, and the Home Centered Care Institute analyzed scores of Medicare claims from 2011 to 2014. To single out frail Medicare beneficiaries, the team of researchers “scored” patients based on the number and severity of their health impairments
About 7% of the Medicare patients included in the researchers’ analysis were considered “frail.”
Throughout the health care community, frailty is generally seen as something linked to exhaustion, weigh loss, low activity, slow gait speed and weak grip strength.
Among the frail older adults identified in the study, less than 10% received medical care at home in 2011. While there was a slight uptick in home-based care use from 2011 to 2014, the vast majority of frail Medicare beneficiaries still did not receive medical care at home.
“Most of us agree that the bedrock of clinical care is human connection,” Yao said. “Visiting the sick at home re-humanizes care for frail patients.”
Health care in rural areas
Access to home health care in America’s rural communities, in particular, has long been an issue. Policymakers have tried to address the challenge through rural add-on payments, which give home health agencies operating in sparsely populated and remote counties a slight financial boost.
During their study, researchers found that only 2% to 4% of rural Medicare recipients received home-based medical care, with rural residents 78% less likely to receive home-based care than Americans living in the most metropolitan of counties.
U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma touted the agency’s commitment to rural health care in a statement released on Thursday — National Rural Health Day.
“Approximately 60 million people live in rural areas — including millions of Medicare and Medicaid beneficiaries,” Verma said. “We at CMS recognize the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured people.”
Michigan, Florida and Arizona had the highest percentages of Medicare beneficiaries who received home-based medical care between 2011 and 2014, according to the study. Vermont, Idaho, Wyoming, Iowa, Louisiana, Arkansas, South Dakota, Mississippi and North Dakota had the lowest percentages.
In 2014, many deaths among rural Americans were preventable, including those from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke, according to the U.S. Centers for Disease Control and Prevention.
In-home physical therapy (PT) helps knee replacement patients recover more successfully, with six to nine PT visits being a generally optimal level of treatment.
That’s according to research findings from the University of Colorado School of Medicine, recently published in the Journal of Bone and Joint Surgery. A team of physical therapists analyzed Medicare home health claims for patients who received total knee arthroplasty in 2012 and subsequently had in-home rehabilitation.
The review involved nearly 6,000 Medicare beneficiaries.
Individuals who received fewer than five home health visits from a physical therapist had more problems in resuming activities of daily living, the researchers found.
The results of this study have implications for a bundled payment model known as Comprehensive Care for Joint Replacement (CJR). In this program — mandatory in certain markets identified by the Centers for Medicare & Medicaid Services (CMS) — hospitals are responsible for managing costs for a full 90-day care episode for orthopedic patients, including their surgery and post-acute rehab.
Because therapy is more costly to provide in inpatient settings such as skilled nursing facilities (SNFs), CJR hospitals are incentivized to route more patients directly home after surgery.
However, if these patients do not receive appropriate levels of at-home PT, they could be at higher risk of a re-hospitalization — and being readmitted to the hospital drastically drives up the episodic cost of care.
Generally, patients in rural areas and who have other complex medical conditions receive fewer home health visits, the researchers found.
“Our study may help care providers prescribe more optimal dosages of at-home physical therapy for these patients who are discharged,” said lead author Jason R. Falvey, Ph.D., in a post on the CU School of Medicine website. “ … The risks of not providing the appropriate level home health care may result in higher overall health care costs in the long term.”
Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019.
“Although there have been many strides in adopting and using virtual care and telehealth within the past year, there is considerable opportunity for the home health industry to more fully embrace the power and value of this technology,” Horner said. “Barriers include the fear of a new technology being disruptive to current workflows, lack of an IT infrastructure which can support patients’ evolving digital health habits, and reimbursement policies.”
In October, CMS proposed a rule that would give MA plans more flexibility to offer government-funded telehealth benefits to all enrollees, regardless of whether they live in rural or urban areas. In addition to eliminating the market restriction, CMS’ proposal would also allow MA enrollees to receive telehealth services from home, rather than requiring them to go to a clinic, SNF or other health care facility.
If implemented, the proposed changes would go into effect for the 2020 plan year. In part, CMS is proposing the changes, according to the agency, because the Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” as part of government-funded “basic benefits.”
Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019.
“Expanded access and coverage for virtual care will benefit the entire health care ecosystem,” Horner said. “The use of technology to allow visiting nurses and home health providers to deliver care remotely will optimize productivity by turning ‘drive time’ to ‘patient time,’ while also helping agency owners and administrators better hire, train and retain talent.”
‘A step in the right direction’
Spun out of Stratus Video’s telehealth division at the beginning of 2018, Synzi is an example of the impact telehealth can have on home health providers’ operations. Synzi’s tech platform uses a combination of video, email and secure messaging tools to help home health providers stay in touch with patients.
Trilogy Home Healthcare, a Florida-based home health company with roughly 3,000 patients and about 700 employees, began using Synzi in June across a handful of its locations.
“The feedback we have received from referral sources has been very positive,” Trilogy CEO Dale Clift told HHCN. “The accounts that are using the Synzi platform appreciate that we are being proactive in case managing our shared patients.”
Trilogy is not yet able to quantify how telehealth has improved its operations, Clift said, but promising findings have been reported in a number of past pilot programs.
One telehealth home health pilot program in Colorado, for example, reported a 62% reduction in 30-day re-hospitalizations related to congestive heart failure, chronic obstructive pulmonary failure and diabetes. Over a 60-day episode of care, emergency department use also fell sharply, as did nurse home visits and costs of care.
“Anytime CMS approves and reimburses for additional services that will enable the patient to get better comprehensive care and engages them in their own outcomes is a step in the right direction,” Clift said. “Right now, telehealth is an incurred cost and an investment by the agency. I think with the current landscape, one needs to be a ‘big picture’ and forward-thinking type of agency in order to validate the return on investment.”
The proposal — Question 1 — would have provided free, home-based care to adults over the age of 65 and individuals with disabilities. To do so, the universal home care program would have taxed high-income households, though critics of the proposal have argued others would have been affected as well.
Nearly 362,000 Mainers voted in opposition to Question 1 on Tuesday, with fewer than 215,000 state residents supporting the initiative. That breakdown put more than six out of every 10 voters in Maine against the tax-funded universal home care proposal, a first-of-its-kind measure that has served as an interesting case study for future home care plans across the United States.
The Home Care and Hospice Alliance of Maine, The Maine Chamber of Commerce, Spectrum Health Care Partners and Maine Hospital Association are among the organizations that rallied against Question 1.
The Maine Hospital Association stood against the universal home care proposal for several outlined reasons, including questions regarding federal labor and health privacy laws. Additionally, any universal home care program implemented in Maine should first go through Maine’s legislative branch, the association also argued.
“Question 1 was a flawed proposal and Maine voters agreed,” Jeffrey Austin, vice president of government affairs and communications for Maine Hospital Association, told Home Health Care News. “We believe the Legislature is well suited to review the issue of long-term care and craft solutions that build on what’s working in Maine.”
About 27,000 Maine residents would have been eligible for the universal home care program, according to a University of Southern Maine Muskie School of Public Service analysis using 2016 population figures. In 2016, slightly more than 5,6000 people in Maine were already accessing publicly-funded community-based long-term services and supports.
Groups supporting Question 1 included The Alliance for Retired Americans and Caring Across Generations. Maine People’s Alliance, a grassroots organization that focuses on a variety of issues, created and spearheaded efforts to pass the universal home care initiative.
“We are incredibly proud of the hundreds of volunteers who placed universal home care on the ballot and who fought so hard to make forward progress against some daunting headwinds in this campaign,” Yes on One Campaign Manager Ben Chin said in a statement provided to HHCN. “We’re also proud to have put Maine’s home care crisis front and center in the public debate.”
The percentage of Americans age 65 and older is increasing on a national level — but even faster in Maine.
From 2000 to 2032, the percent of Americans age 65 and older is projected to almost double from 12% to 20%, according to U.S. Census data and University of Southern Maine projections. In comparison, nearly 30% of Maine’s population will be age 65 and older by 2032.
“Seniors are being forced from their homes every day,” Chin said. “We take politicians across the state at their words that they are now committed to taking real action. We’ll be turning our full attention to the legislature to make sure that they do.”
Although only a small portion of older adults have a disability at any one time, the rate of disability increases with age, according to University of Southern Maine. About 9% of people age 18 to 34 have a disability in Maine, while 50% of those over 75 have a disability.
While a full-fledged universal home care program would have been a first for the country, some states have already taken action to at least partially fund home care programs beyond traditional payment streams