In healthcare debate, home care deserves attention

Providers tend to 'high utilizers' in lower cost settings

THROUGHOUT THE COVID-19 pandemic, home healthcare providers played a critical role in taking the pressure off hospitals and an overwhelmed healthcare system, enabling patients to be taken care of and remain stable at home. Home healthcare clinicians were an essential lifeline to patients across the Commonwealth – many of whom had limited resources prior to the onset of the pandemic; that problem was only further exacerbated during the last two years.

Over the last few years, some of the programs that patients relied upon for social support were closed or working at significantly reduced capacities due to mandatory stay-at-home orders and social distancing. Many home healthcare providers made significant investments in staffing, PPE, and new technology to fill that gap to ensure that their patients remained safe and well cared for in the community.

At the start of the crisis, Gov. Charlie Baker issued orders that insurers and state health plans must cover all clinically appropriate telehealth services at the same rate as in-person care. MassHealth also issued a temporary rate increase that enabled providers to secure the additional protective equipment and supplies required to treat symptomatic patients or those exhibiting coronavirus-like symptoms.

These measures were critical as they provided a safety net of adequate care for all patients, including a population that is often overlooked – complex and vulnerable patients with comorbid physical and behavioral illnesses. This patient population is the most underserved in the country, and it was the impetus for my decision to establish and create a new type of home health company 20 years ago.

These patients are considered “high utilizers.” Although they comprise approximately 5 percent of the population, they account for more than 50 percent of all costs across the healthcare continuum. Home healthcare organizations add value to the healthcare continuum by providing equitable and critically needed care to this patient population in the lowest cost care environment – the home. From insulin injections and wound care to therapeutic supervision and assistance with solving issues related to social determinants of health, home-based care delivers positive outcomes for vulnerable patients who were already living with mental health issues and limited support systems prior to the pandemic.

While COVID-19 cases continue to decline in Massachusetts, home care providers will be treating our most vulnerable patients or those with coronavirus-related complications for years to come. Further, home healthcare agencies are poised to play a critical role in responding to a pandemic-fueled mental health crisis throughout the state. Home health agencies across the country are already seeing an unprecedented increase in requests for behavioral health services in the home settings for the chronically ill or seniors.

Once again, home healthcare providers are being asked to shoulder the burden of another crisis – while trying to keep pace with hiring demands in a challenging market along with rising costs due to inflation, sky-high gas prices, and supply chain issues that complicate delivery of quality care when traveling from home to home. To compound this issue, overall MassHealth reimbursement rates – especially for skilled services such as nursing, physical, and occupational therapy – haven’t been permanently increased since 2007.

As a result, many home healthcare providers often end up having to discharge patients because they cannot effectively serve certain geographic markets – typically low-income and congested gateway cities. Failure to bring rates up to speed would not only hurt home healthcare agencies and care workers, but also these vulnerable patients who are already living at the edges of society. When these patients can’t receive home care, their quality of life declines significantly and health outcomes decline, resulting in increased costs for our healthcare system. These marginalized patients deserve equitable access to home health care to ensure better outcomes and to lower the cost of care.

The Baker administration recently called on health care providers and insurers to increase spending on primary care and mental and behavioral health by 30 percent over three years – an investment of $1.4 billion. The governor’s legislation also establishes a special line of funding for providers who serve people on MassHealth. Notably, both  House Speaker Ron Mariano and Senate President Karen Spilka have made strong commitments to take up mental health legislation this session.

I applaud these commitments, but It’s imperative that any mental health legislation include measures to support home healthcare. It’s time for the Commonwealth to step up just as devoted home care workers always have – throughout the pandemic and beyond – by providing a reimbursement rate structure that sufficiently meets the needs of providers to serve all patients with quality care. Without this, the state could see a mass exodus of skilled care workers and providers from the MassHealth program.

Meet the Author

Joseph P. McDonough

CEO and founder, Innovive Health
The upshot is the increasing demand for home-based care provides a unique window of opportunity to invest in home care providers and services, which will translate into better access, continuity of care, and patient outcomes. We must take this opportunity to look comprehensively at how to achieve a more sustainable system across the healthcare continuum.

Right now, the state has access to stimulus money  that has yet to be fully allocated. In addition to any proposed legislation, we call on the Baker administration and the Legislature to expedite the release of these funds to our healthcare system, which includes home-based care. Policy and regulations must change to keep up with this new reality to ensure that we continue to develop truly innovative care models that improve patient outcomes in an equitable fashion by addressing social determinants while reducing costs and burdens across the entire healthcare system.

Joseph P. McDonough is the CEO and founder of Innovive Health in Medford.