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Home-Based Care Can Help Turn Around CMS’ Investment Portfolio, Former Administrator Says

Administrator Seema Verma
 

Former U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma is bullish on a lot.

Speaking at the Home Care 100 conference Tuesday, she expressed enthusiasm for a new era of data-tracking and technology, as well as value-based care, Medicare Advantage and hospital at home.

Most noteworthy to the attendees, however, was her validation of the idea that the home setting was the next frontier in the U.S. health care system.

“I think this is the shift to the home, right?” Verma said. “This is the turning point. While it kind of had gone on before, COVID really accelerated [that shift]. At the same time, there’s a lot of new technology that’s out there that’s enabling it, whether it’s telehealth, whether it’s remote care. And I think that there’s an understanding and appreciation for what the potential for going out into the home is.”

Verma shared an anecdote from a company she now works with, saying a home visit from that company enabled a woman who had been on insulin for 20 years to finally wean off it.

She spoke on a panel with Bill Miller, the CEO of WellSky, another company that Verma advises as a board member.

What Verma was less bullish on was the passage of the Build Back Better Act, or even a “skinner” version of it. Build Back Better is relevant to home-based care providers because it initially included $400 billion – then $150 billion – for home- and community-based services.

“I will say that for both parties, Republicans and Democrats, there is a lot of interest in the space,” Verma said. “There’s the recognition, especially with the problems that are happening in nursing homes, that we need viable alternatives for people – and home-based care could be that.”

While both parties recognize to some extent the value of bringing more care into the home, especially with the Medicare trust fund projected to “run out by 2026,” they will likely disagree with each other on Build Back Better’s role.

“Now we’ve talked about having that skinnier, smaller version, and that [may] include, in terms of what’s left, some home- and community-based services [funding] in there,” Verma said. “That would require some offsets, though, such as using drug pricing there and trying to fix our pricing. And that’s obviously more complicated.”

The other aspect that makes the outlook of Build Back Better dire is time, Verma said.

Based on the priorities in Washington, D.C., it’s unlikely something will get done before May. And then, in the summertime, election season will be in full swing, which would be another barrier to passage.

Verma looks forward – and back

The former administrator served during a time arguably unlike any other in the history of the country. It was also a unique time to oversee home health specifically, which underwent a payment overhaul with the Patient-Driven Groupings Model (PDGM).

Additionally, home-based care saw other regulations come into play, such as the Review Choice Demonstration (RCD) for Medicare providers and electronic visit verification (EVV) for Medicaid providers.

The Home Health Value-Based Purchasing (HHVBP) Model was also pushed forward and viewed as one of the rare Center for Medicare & Medicaid Innovation (CMMI) projects worth pursuing further.

“We did an assessment [of the CMMI portfolio]. It was very dismal,” Verma said. “If you were an investor and looked at this portfolio, it probably would’ve been the worst portfolio you’ve ever seen. The vast majority of the models are losers. I don’t mean to disparage all the hard work that’s going on behind the scenes, but if you looked at it in terms of quality and costs, they weren’t achieving those – only four or five had done well.”

Verma was able to view those models in that light once CMS got its hands on more data, she said. And it was part of the reason why she believed more needed to be done to enhance value-based care.

In the same vein, data is also needed to continue advancing the role that home-based care providers play on the health care continuum, she said.

“Where I think services can be expanded will be … in the context of value-based care,” Verma said. “The fear for legislators is, every time they look at something like community-based care to get scored, in terms of the actual costs, they’re not able to look at the offset.”

The offset of how much less money would be spent overall, in other words, would be justification for investing more in value-based and home-based care.

Another one of the models that came to fruition under the Trump administration and Verma’s tenure was the Acute Hospital Care at Home waiver, which was created near the onset of the public health emergency.

As of Feb. 3, there were 91 health systems and 201 hospitals participating in the waiver in 34 states.

“I think we are shifting as a country, and I think there’s going to be more investment in hospital at home, which has been a successful program with CMS,” Verma said. “And I think also, given concerns of beds and capacity, there’s going to be more of a push to add more care [in the home].”

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