The telehealth boom has made one thing clear: The era of health care provided exclusively within the confines of a clinic or hospital is over.
In the hopes of making the shift to virtual care more permanent, Washington, D.C.-based lobbying firm Sirona Strategies formed a coalition earlier this month called Moving Health Home. The organization’s 10 members include virtual-first care company Amazon Care, hospital chains Ascension and Intermountain Health, and risk-based senior care group Landmark Health. Together, they plan to advocate for a suite of policy changes that would widen access to at-home care — and allow providers to be reimbursed more readily for those services.
Sirona, whose role in the coalition was previously unreported, primarily lobbies federal health agencies and has also worked with health care companies including Aledade and Magellan Health. The firm recently convened the 10 members of Moving Health Home and will lead the group’s work on the hill, Nick Loporcaro, chief executive officer of founding coalition member Landmark Health, told STAT.
The companies within the Moving Health Home coalition have a wide range of business models and operating principles. Dispatch Health, a small health care startup whose operations are concentrated in Denver, Colo., and Amwell, a sprawling national telehealth company serving over 240 health systems, are both members.
Despite its membership’s varied business models, the group is united in a core belief, said Loporcaro: “We all agree that more and more care is going to be directed to the home.”
STAT spoke with Loporcaro and Chris Johnson, Landmark’s vice president and head of corporate development, about the coalition’s priorities and future plans. This interview has been edited and condensed for length and clarity.
How did this coalition come together?
Nick Loporcaro: Sirona are the conveners of this coalition. And for us, in the last few months, we’ve been very active in going across the proverbial aisle in talking to people with similar care models from an M&A or partnering perspective. That served as the catalyst on our side.
Chris Johnson: Covid shed a light on the challenges a lot of patients have faced accessing care. I think people tend to think of “home health” as physical therapy or episodic nursing or just telehealth. We think there’s a whole bunch of things in between. The system we have today, where patients have to go to a medical facility to receive care, maybe that isn’t the best way to keep them in their communities living healthy lives. So it felt like a good opportunity to rebrand what health care in the home looks like.
How do the members of the coalition support one another’s goals?
N.L.: At times we think of ourselves as competitors, and at times we think of ourselves as partners. Overall, we’re looking for policy changes that enable more primary care services to be delivered at home. We’re all aligned on that proverbial north star. There is a lot of room for a lot of players to deliver these kinds of services. There’s a ton of opportunity here for everybody.
What does designating the home as a clinical site of care mean to Landmark and to the coalition?
N.L.: Our model involves sending a team into the home and being there at high frequency. We could be in someone’s home 16-20 times a year for an hour-plus for each visit. We’re going into the kitchen, going into the fridge, looking for fall hazards, looking for mold, looking at everything to keep that person healthy and in the home environment. And while our model is expensive on the surface, one avoided emergency room visit or hospital admission could pay for most of our expenses. In the meantime, you’ve given better quality of care. That’s what we consider health care at home.
C.J.: As a coalition, the policies we want to pursue have to do with ensuring that the payment models enable that, and that there aren’t barriers to using a model that isn’t just clinic-based medicine. What we do feels less efficient and more expensive on the surface, but with the right payment structure we think we generate more value.
Tell me more about the policy changes the coalition is pursuing?
C.J.: We hope to expand the range of services that can be covered in the home, including what you can bill for. Historically, a lot of the limited policies were based on wanting to avoid fraud. But that’s a double-edged sword: You’re also preventing innovation that brings convenience to patients. And we also hope to retain flexibilities for home-based care. For example, we’d like to see CMS extend the Hospital Without Walls program it rolled out at the start of the pandemic. (The program allows hospitals to transfer patients to outside facilities while still receiving hospital payments under Medicare, and permits providers to supply some forms of care, such as therapy, in patients’ homes.)
N.L.: The minute we started leveraging telehealth in our visits, the first thing we heard was, “That should be cheaper.” We want to keep those higher-touch capabilities so we can keep people at home versus sending them to an emergency room.
The protections granted by HIPAA, the health data privacy law written in 1996, essentially end at the doors of a clinic or hospital. How are you thinking about protecting patients’ health data when they are receiving care outside the traditional health care setting?
C.J.: It’s an interesting question. Our mental model is that we consider the patient’s home the site of care. When our providers are in the home, we operate the same in terms of HIPAA and privacy as you would in a clinic. We think of the patient’s home as the clinical site of care and our providers document their care in the same way they would as if they were in a clinical office.
What kinds of evidence do you analyze when it comes to comparing the effectiveness of at-home versus in-clinic services?
N.L.: At Landmark, we’ve invested a lot in our data scientist group and we’re getting interesting results that look at the reduction in admits and emergency room visits. Our chief medical officer, Dr. Michael Le, also noticed recently that our patients are living six to nine months longer on our programs than not, and we believe they are living with a better quality of life as well. That’s something we plan to study further.
C.J.: When we look at the reduction in hospitalizations, we see that across the 17 states where we operate, it’s a 20-25% reduction. And we believe that’s primarily through managing chronic disease. With conditions like chronic obstructive pulmonary disease and heart failure, for example, by being more proactive, we’re able to get in front of those conditions so they don’t lead to hospitalization.