M&Y Care has earned the 2019 SHPBestTM “Premier Performer” Patient Satisfaction Award 

M&Y Care has earned the 2019 SHPBestTM “Premier Performer” Patient Satisfaction Award 

M&Y Care has earned the 2019 SHPBestTM “Premier Performer” Patient Satisfaction Award 

 M&Y Care has been recognized by Strategic Healthcare Programs (SHP) as a “Premier Performer” for achieving an overall patient satisfaction score that ranked in the top 5% of all eligible SHP clients for the 2019 calendar year.

The annual SHPBest™ award program was created to acknowledge home health agencies that consistently provide high quality service to their patients. The 2019 award recipients were determined by reviewing and ranking the overall satisfaction score for more than 3,000 home health providers. With the largest HHCAHPS benchmark in the nation, SHP is in a unique position to identify and recognize organizations that have made patient satisfaction a priority and have been rewarded for their efforts with high marks on the HHCAHPS survey.

“SHP is proud to present the SHPBest awards to our top-performing customers. We commend these organizations for their continuous focus on delivering the highest quality of care to their patients”, said Rob Paulsson, President of SHP.


COVID-19 Patient: VA Telehealth “Saved My Life”

COVID-19 Patient: VA Telehealth “Saved My Life”

The infection began with a dry cough that Michael Novielli couldn’t shake.
He soon developed fatigue, aches and a low fever.
As a 71-year-old with underlying health conditions, living on Long Island near the American epicenter of the COVID-19 outbreak, Novielli wasn’t taking any chances. So as his symptoms worsened, he went to the hospital, where he was diagnosed with COVID-19.

“I had never felt this sick my whole life,” he said.

Novielli spent four days in the hospital before he was sent back home. “I was going to wait it out,” he said. “I thought I could get rid of it at home.”

As a precaution, Novielli’s VA providers placed him on a telehealth program to monitor his symptoms at home. Once his recovery took a turn for the worse, Novielli says the VA telehealth program saved his life.

“The Best Move I Ever Made”

Michael Novielli served as a U.S. Marine during the late 1960s. He developed chronic lymphocytic leukemia after exposure to Agent Orange in Vietnam. Later in life, he was also diagnosed with diabetes.

Novielli’s care team at the VA Medical Center in Northport, New York, first suggested Remote Patient Monitoring – Home Telehealth (RPM-HT) about five years ago. They gave Novielli a blood pressure monitor that he could use at home to keep track of his health.

“It was the best move I ever made,” said Novielli. “For me, my blood pressure is very important, and using telehealth, they are able to monitor that from home.”

After being hospitalized with COVID-19, Novielli was happy to use RPM-HT to track his recovery once he returned home on April 3. Through the COVID-19 RPM-HT program, Novielli began sharing his temperature, oxygen levels, and heart rate every day with the VA telehealth team at the Northport VAMC.

On April 22, more than two weeks after Novielli was discharged from the hospital, Marjorie Rogers, a registered nurse with 14 years’ experience with VA, noticed something unusual in Novielli’s symptoms. Although his temperature and oxygen levels were normal, Novielli’s heart rate was elevated.

Rogers called Novielli immediately. “She said, ‘Your heart rate is up. Something’s definitely wrong. Go to emergency right away,’” Novielli said.

When Novielli arrived back at the hospital, doctors found that COVID-19 had caused fluid to build up in his lungs. Novielli had developed pneumonia.

This time, Novielli was in the hospital for almost two weeks. He was on oxygen and antibiotics, felt weak and tired, and lost 40 pounds. But after 13 days, he said, “The monster had left me.”

“Marjorie saved my life,” said Novielli. “If I wasn’t on the telehealth, I would have stayed home with the pneumonia, and who knows what would have happened.” 

Using Telehealth To Stop the Spread

For VA providers like Marjorie Rogers, RPM-HT has been an important tool in fighting the spread of COVID-19 at the Northport VA.

“Because it’s a new disease, there is so much we don’t understand about it and that we’re learning,” Rogers said. “Through telehealth, we are keeping our Veterans safe from exposure. They’re not going into the VA facilities if they don’t have to, since we’re able to monitor them in their homes.”

Alisa Tribley, a registered nurse who is the Northport telehealth coordinator, said that telehealth has grown to meet the needs of Veterans with COVID-19. She said that at the peak of the local outbreak, over 140 Veterans were enrolled on Northport’s RPM-HT COVID-19 protocol.

“With RPM-HT, we are monitoring mild symptoms that can be managed at home and recognizing if Veterans reach the point where they should go for in-person care,” Tribley said.

Making a difference

Some of the Veterans in Northport are using telehealth for the first time. Tribley said that while it is an adjustment for some, many are appreciative of the added care.

“Veterans are very grateful that they have a health care team member watching over them and being in touch with them on a daily basis,” said Tribley. “It’s very rewarding knowing that you’re making that difference for them.”

Rogers said that she felt honored when Novielli called her to thank her for intervening on his behalf.

“I really felt that his story was a testament to all the VA telehealth coordinators nationwide,” she said. “To hear him say that really gave me a sense of pride that we’re contributing to Veterans health — that we’re helping them stay alive.”

Novielli says he is thankful for all the care he received from the VA telehealth team and at the hospital. When he finally overcame the pneumonia, the health care workers on his floor applauded as he left the hospital. “It’s nice to have people like that take care of you — people who really care,” he said.

Novielli is still being monitored by RPM-HT – but his cough is finally gone, he is off oxygen, and he’s starting to go on walks with his physical therapist. He said that once a COVID-19 vaccine is developed, he wants to visit Europe and go on a cruise with his fiancé.

Novielli said he hopes that his experience encourages his fellow Veterans to take COVID-19 seriously and take advantage of VA telehealth resources.

“Going through something like this makes you feel for other people who weren’t as fortunate,” Novielli said. “I hope it encourages people to take more care, and to have a better outlook on life.”

Taken from Official Blog of the U.S. Department of Veterans Affairs
Posted on Monday, June 22, 2020 9:30 am


Medicare Advantage Expert Anne Tumlinson: It Looks Really Good for Home Care Right Now

Medicare Advantage Expert Anne Tumlinson: It Looks Really Good for Home Care Right Now

Home care agencies have been trying to figure out how to partner with Medicare Advantage (MA) plans since the Centers for Medicare & Medicaid Services (CMS) announced the possibility back in 2018.

Anne Tumlinson, CEO of ATI Advisory, has the answers. She’s an expert on the economics of aging, a panelist at the upcoming Home Health Care News Virtual MA Summit and the latest guest on HHCN’s Disrupt podcast.

In our newest episode of Disrupt, Tumlinson breaks down the MA opportunities for home care providers by the numbers — from the number of plans offering in-home benefits to the financial considerations driving MA decisionmakers. Additionally, she briefs agencies on how the coronavirus is rocking the industry, what providers should say when pitching to plans and why home care’s future in MA is looking especially bright.

To hear that conversation and others, you can subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Tumlinson will dive even deeper into the financial considerations guiding MA decision makers at the Virtual MA Summit, which runs June 24 through 26. You can register here.

Until then, you can catch portions of HHCN’s conversation with Tumlinson below, edited for length and clarity.

HHCN: While many home care agencies want to work with MA plans, only a few are. In 2019, about 3% of MA plans offered in-home support services. Your team released some new data for 2020, pre-coronavirus, but what does that figure look like today?

Tumlinson: Today, there are 223 plans offering the new supplemental benefit in-home support services. That’s the category referring to in-home personal care services.

That is an increase over the previous year, which was only about 80. So the good news is we’re definitely seeing an increase from 2019, when these benefits could first be offered.

At the same time, this is also the first year plans could offer a whole new set of benefits much more focused on social-support needs. They’re called Special Supplemental Benefits for the Chronically Ill (SSBCI). It’s a category that lets plans offer benefits not related to health care at all — food, produce, meal, pest control, transportation, social-needs benefits.

Between the non-medical primarily health-related benefits and new non-medical services, we have 619 plans that are doing one and/or the other. That’s not a high percentage of the about 3,000 or 3,500 plans, but the fact that there are 619 plans doing this at all, to me, is like a small miracle.

Are all of those plans working with home care providers to offer those services?

It varies tremendously.

We’re definitely seeing the approach where somebody in the health plan has reached out specifically to a home care provider in their market — or two or three — to say: “Hey, we want to offer this benefit. Are you guys equipped to deliver it, and can we start to talk about what that relationship would look like?”

It might be a regional plan, like Geisinger or SCAN Health Plan. They want to work with regional local providers with whom they can build long-lasting relationships and can be collaborative to their approach to collecting data and information.

Another model we see [is from] some of the larger insurance companies like Humana (NYSE: HUM), Anthem (NYSE: ANTM) and WellCare (NYSE: WCG).

Some [larger plans] haven’t done anything, really. They just put these benefits in their benefit package, and they haven’t really built out a contracted network yet. It’s still a really immature set of relationships where there’s a lot of floundering around.

Model No. 3 is where there’s an intermediary that’s serving kind of like an aggregator. We have a relationship with a company called healthAlign. A couple health plans have contracted with them to essentially find all of the different home care providers and aggregate them in one platform to play the go-between role in terms of contracting and things like that.

That’s my favorite kind of model.

How has the coronavirus shaken up the MA industry?

It’s a little hard to say right now.

Many MA plans are in this very weird position where their costs are way down for medical care because doctors’ offices and everything else has been closed. They’re kind of sitting there with the pot of money they’re supposed to be spending that they haven’t been able to spend.

Secondly, they’ve been given this incredibly broad flexibility from CMS around these supplemental or non-medical benefits, which previously only a handful of them had been offering as formal benefits.

But now CMS is saying: “If you need to change that in the middle of the year, which is normally not allowed, [you can]. We get it. You did your benefit packages way back before anybody knew what COVID-19 was, and now you’ve got a bunch of people stuck at home, who need things like meals, groceries and in-home support services. We’re going to allow you health plans to make those changes in your benefit packages … so that you can meet your member needs and redirect the resources.”

But the third thing is there’s an enormous amount of uncertainty, so it’s really hard, especially for larger plans, from a financial standpoint, to say, “Let’s start buying in-home support services.”

They don’t know if three or four months from now there’s going to be this huge pent-up demand for all these elective procedures. So there’s some hesitation on their part to jump in with both feet and start paying for things that they haven’t been paying for before.

My opinion is given how long we expect this pandemic to dramatically affect our lives, it’s going to dramatically change the way that MA plans and health care, in general, are delivered — and these flexibilities will be more and more deployed.

It looks really good for home care right now. That is the bottom line.

I know there’s not a lot of data on those mid-year MA flexibilities, but this essentially means that MA plans could be adding new home care benefits right and left right now, right?

That’s right.

This all sounds really good for home care, but I don’t want to sound flippant because I know there are a lot of challenges to delivering home care as a result of the virus. But I think there will be a need.

What other recommendations would you have for providers looking to get involved with MA plans?

You’ve got to attack this in a variety of ways.

Look at the local health plans. Who in your market is a real leader at a community level? It could be a hospital, a health system, a physician group.

I always give the example of Geisinger or SCAN Health Plan. They’re a little bit less bureaucratic, and they’re a lot more focused on meeting the needs of [the] community.

Those are going to be the organizations that are more receptive to working with you. There’s fewer people to deal with, and you can find the decisionmakers and get in front of them.

If you’re part of a national organization, … think about, at your corporate level or at a regional level, what is going to be your strategy or your approach?

You’ve got power in numbers. You’ve got a quasi-network. How do you organize yourself in a way that gives you something to take to those conversations?

Finally, you have to have something to say about who you are when you make that approach, really making sure that you understand what is valuable to these health plans. “How can we as an agency be helpful in delivering [these services]?” And what are the benefits to you in offering them?

On the flip side, what are MA decisionmakers taking into account when they’re creating plans?

It’s a long process in deciding what’s going to go into a benefit package. We’re in June 2020, … and their [plan] decisions are all made for 2021.

In a month or two, if they haven’t already, [plans] are going to start thinking about what’s going to go into their packages for 2022.

How much extra money are they going to have under their bids and how are they going to divide that up? A lot of it goes into what other plans are doing in that market and how they can be competitive.

At the end of the day, what Medicare Advantage plans really want to do is be very, very competitive on enrollment. That’s No. 1. “How can we structure our benefit package to be attractive, both in terms of attracting new members and retaining current members?”

And then, “How can we do this in a way that doesn’t … increase spending in any way, shape or form above and beyond what we estimate it will?” They want to feel comfortable that they know what they’re doing when they price [supplemental benefits].

Finally, they care a lot about what we call coding — information that can help their care managers manage their population better. And then also, you know, what kind of information can help in the coding that they need to get paid well by CMS.

Finances are obviously an important part of the equation. We’ve heard from some providers working with MA plans that the payments they’re getting aren’t always great.

That’s exactly right.

[Imagine] for illustrative purposes every health plan getting $1,000 per member, per month.

Let’s just call that the benchmark right now. Then the plan says, “Hey, I think we can do this for $900 per member per month.”

CMS says: “That’s awesome. Of that difference of $100, you get to take $50 of it and do whatever you want with it.”

Not anything, but all that fun stuff that’s going to help you attract enrollees like lowering the cost of the plan premium, lowering out of pocket costs, offering supplemental benefits.

This is not a lot of money relative to the rest of the spend. Within that, they have to prioritize. This is very hypothetical right now, but there’s really a small amount of dollars available designated for the category that we’re talking about.

In many ways, this opportunity [for home care providers] is more strategic and symbolic than it is financially a big win.

The actuaries have to price the risk. They think, “Hey, how about if we pay $4 for every 15 minutes.” They don’t really know what they’re doing, so the rates are not great. Not always, but in many instances.

The last thing I’ll say about all this is that the policy environment is very fluid right now. This is an election year. We have a huge pandemic going on. Nursing homes are under fire. Medicare’s never been more flexible.

Going into next year maybe, there are going to be some proposals on the table to make the pot of money available for home care from public paying sources bigger because there’s a recognition that people really do need these services to stay home and to stay out of nursing homes.

Overall I’m hopeful that will go up. That’s why it’s so important to strategically position yourself with these payers now.

By Bailey Bryant | June 17, 2020
Source: Home Health Care News


Long-Term Care Decision-Makers More Likely to Choose Home Care in COVID-19 Aftermath.

Long-Term Care Decision-Makers More Likely to Choose Home Care in COVID-19 Aftermath.

The Value of Home Health Care

The Value of Home Health Care

For the first time in our modern history, staying at home has become a “new” normal. And with more than 1.5 million Americans now infected with COVID-19, never before in our lifetime has accessing care in a person’s home been so important.

Smartly, our federal and state policymakers quickly expanded reimbursement for telehealth and removed barriers that have now allowed more providers to care for patients virtually via video and phone, eliminating the risk of COVID-19 exposure during provider visits. But not all care can be provided through telehealth – and we would be shortsighted to not also address the growing need for home-based care.

Long before the COVID-19 emergency, health care policy experts have increasingly recognized the value of home-based health care. A recent AARP survey found that three in four adults 50 years and older would prefer to age in their homes and communities. And a growing body of evidence suggests it is less expensive to deliver care in the home. Indeed, for years we’ve seen hospitalized patients more quickly returning to their homes and communities to heal and recover safely, reducing costs for themselves and the health care system.

Home-based care addresses some of the negative health effects of social isolation and loneliness, which drive poorer health outcomes that annually cost billions of excess health care dollars. According to one study, those experiencing loneliness and social isolation had a more than 60 percent higher risk of developing dementia and a fourfold increase in hospital readmission rates within a year of discharge.

Despite its demonstrated value, our country has yet to fully integrate the support needed for home-based care. Instead, we have a collage of different reimbursement frameworks across state, federal, and private payers.

Traditionally, Medicare has paid only for home caregivers in very limited circumstances. But we’re now seeing small and promising changes. The Medicare Advantage program, for example, now allows plans to offer non-medical care services in the home as supplemental benefits. These benefits can include day care services, in-home support services including meals and support for caregivers.

We have also seen a surge of technologies to enable home-based care. From those receiving home infusion therapies, to home dialysis, to remote patient monitoring, the private sector has stepped up to meet the needs of those wanting to or needing to receive care at home.

Now is the time to expand on these promising changes with a more comprehensive approach to paying for home-based care delivery. With more thoughtful integration of caregiving services and improved care coordination across care settings, including the home, such models can drive down health care costs for patients and the system overall.

Whether caring for those impacted by our current public health crisis, or those who are medically homebound, or those who simply choose to age in place, policymakers should think beyond essential medical services and consider the non-medical drivers of health that are often as essential to good health outcomes. For example, many individuals needing to stay at home are ill-equipped to carry out their own basic needs. Daily tasks — such as getting in and out of a chair or bed, moving about the house, shopping and preparing meals, taking medications properly, bathing and dressing, and cleaning and laundry — can be a struggle for the elderly and those with serious health conditions.

Fortunately, we have millions of home health nurses and caregivers working on the front lines to care for vulnerable adults who should safely remain in their homes during this pandemic and beyond.

These workers are the foot soldiers who perform tasks such as shopping, meal preparation and assisting with mobility and personal care. Well-trained caregivers and nurses, sensitive to the time and place where patients actually live, can more readily identify and address issues that can exacerbate a person’s chronic, complex illness that may not otherwise be visible in a single visit to a traditional health care setting.

As we face record unemployment, federal, state and local policymakers should consider how best to utilize this untapped resource both now and in the future. With the appropriate testing, training, and reimbursement, individuals can have a choice in where they age and receive care.

While keeping people safe and healthy in their homes has always been appealing, now it is imperative. For our most vulnerable individuals — the elderly and those with chronic health conditions – home-based care can save their lives.

By Tom Daschle & Bill Frist   |   June 3, 2020
Health Disparities are a Symptom of Broader Social and Economic Inequities:

Health Disparities are a Symptom of Broader Social and Economic Inequities:

The COVID-19 pandemic and killing of George Floyd along with other recent deaths of African American people at the hands of police have laid bare stark structural and systemic racial inequities and their impacts on the health and well-being of individuals and communities. While these events have brought health and health care disparities into sharp focus for the media and public, they are not new. These longstanding and persistent health disparities are symptoms of broader social and economic challenges that are rooted in structural and systemic barriers across sectors — including housing, education, employment, and the justice system — as well as underlying racism and discrimination. Amid this difficult time for our nation, the increased recognition and understanding of disparities could provide a catalyst for the challenging work required to address them.

Despite being recognized and documented for many years, disparities in health and health care have persisted and in some cases widened over time. Our analysis finds that Black and American Indian or Alaska Native (AIAN) individuals continue to fare worse compared to White individuals across most examined measures of health status, including physical and mental health status; birth risks; infant mortality rates; HIV and AIDS diagnosis and death rates; and prevalence of and death rates due to certain chronic conditions (Figure 1). For example, the infant mortality rate for Black and AIAN individuals is roughly two times higher than the rate for White individuals. Black teens and adults have an over eight times higher HIV diagnosis rate and a nearly ten times higher AIDS diagnosis rate compared to their White counterparts; the HIV and AIDS diagnosis rates for Hispanic teens and adults are more than three times higher compared to the rates for those who are White.

Figure 1: Number of Measures for which Group Fared Better, the Same or Worse Compared to Whites

The disparate impacts of the COVID-19 pandemic on people of color mirror and compound these broader underlying racial/ethnic disparities in health. Data across states show that, in the majority of states reporting data, Black people account for a higher share of COVID-19-related deaths and cases compared to their share of the population. Similarly, Hispanic individuals make up a higher share of confirmed cases relative to their share of the population in most states reporting data, and there have been striking disproportionate impacts for American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander people in some states. The resulting economic crisis has also had an unequal effect on people of color.

Health disparities, including disparities related to COVID-19, are symptoms of broader underlying social and economic inequities that reflect structural and systemic barriers and biases across sectors. Though health care is essential to health, it is a relatively weak health determinant. Research shows that social determinants of health—the conditions in which people are born, grow, live, work and age—are primary drivers of health. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care (Figure 2). For example, children born to parents who have not completed high school are more likely to live in an environment that poses barriers to health such as lack of safety, exposed garbage, and substandard housing. They also are less likely to have access to sidewalks, parks or playgrounds, recreation centers, or a library. Further, evidence shows that stress negatively affects health across the lifespan and that environmental factors may have multi-generational impacts.

Figure 2: Social and Economic Factors Drive Health Outcomes

The heightened focus on and understanding of disparities can serve as a catalyst for the challenging work required to address them. Steps can be taken within the health care system that would help address health disparities. For example, actions to expand health coverage, such as adoption of the Medicaid expansion to low-income adults in the 14 states that have not yet expanded; increasing accessibility to health care providers; increasing access to linguistically and culturally appropriate care; and diversifying the health care workforce could help reduce health disparities. However, efforts to address health disparities also require cross-sector approaches beyond health care to affect the broader social and economic factors driving health. For example, actions to increase access to healthy food options and improve food security; improve affordability and quality of housing; enhance educational opportunities; improve built environments and provide more green spaces and recreational opportunities; and increase financial security and economic opportunity may all positively affect health and reduce health disparities. Beyond these factors, any effort would be woefully incomplete if it does not also recognize and address racism and discrimination and long histories of stress and trauma affecting the health of individuals and communities and how they shape our systems and policies. Such efforts are challenging and complex and require strong leadership, community engagement, resources, and cross-sector collaboration to achieve progress forward.

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