The Chicago area-based Home Centered Care Institute (HCCI) is developing new educational resources to help hospices and other providers move into the home-based primary care space. Hospices will likely have to step into some form of a primary care role as they seek to capitalize on emerging value-based payment models such as Medicare Advantage or direct contracting.

As hospices seek new ways to engage patients further upstream, a rising number are diversifying their services to include home-based primary care, along with palliative care and other services. Evidence indicates that these primary care programs carry substantial benefits for patients and families and can have a significant positive impact on a hospice’s bottom line.

Among the new HCCI resources is a series of videos depicting what a primary care house call looks like. Portions of these videos will be made available to the public as well as put to use in HCCI’s education programs.

“The initial purpose is to use elements of the video in one of our online courses. Our initial video really shows that there are different elements of assessing patients in home-based primary care. In addition, we use a simulation video in our workshops,” said Melissa Singleton, HCCI’s chief learning officer. “We have people who are newer to home-based primary care to help them see what one house call might look like. We also have been working with a number of residency and other provider training programs.”

HCCI is a national non-profit organization focused on advancing home-based primary care to ensure that medically complex and homebound patients have access to high-quality care in their homes.

Engaging patients earlier in the course of their illnesses, reducing high-acuity utilization and offering a seamless continuum of care will be key considerations for hospices as they become more involved in value-based care. The Center for Medicare & Medicaid Innovation’s (CMMI) direct contracting program launched April 1. Participating hospices are gearing up to take total responsibility for a patient’s care potentially long before they enter the last six months of life.

Direct contracting includes three payment model options that are designed to help the U.S. Centers for Medicare & Medicaid Services (CMS) and health care providers reduce the cost of care and improve quality. The models incorporate lessons learned from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage.

Within the direct contracting models, providers bear 100% of the risk associated with eligible patients for the global option or 50% risk with the professional option. Contracted agencies would have to choose between a Total Care Capitation option or a Primary Care Capitation option. This would be a capitated, risk-adjusted monthly payment for enhanced primary care services equal to 7% of the total cost of care.

To produce its new video resources, HCCI hired actors, a real-life father and daughter, as well as a film crew. The organization also rented a house in which to film. The clinician in the video is portrayed by Paul Chiang, M.D., senior medical and practice advisor at the Home Centered Care Institute (HCCI) and medical director for a suburban Chicago practice, Northwestern Medicine HomeCare Physicians (HCP).

“The video goes through the process from the very beginning of a provider pulling up to a patient’s home, to meeting the caregiver at the door, and going through all of the steps of patient assessment,” Singleton told Hospice News. “It shows the interactions with the caregiver, and the importance of really treating that dyad. The family and caregivers are always part of that equation.”

Taking on a primary care role may require some retooling for hospice providers. If a provider takes primary responsibility for an ill population it opens more opportunities from a payment perspective, but it also requires a cultural decision that they are going to manage a patient population over time, possibly the last 10 years of life. That level of change requires resources, and among the first investments a hospice should make is in personnel.

Clinical staff must understand how to manage patients with serious illness across health care settings, and business staff must know how to operate and bill for primary care programs. Negotiation with payers to develop value-based contracts is also an essential skill that hospices must develop in order to be successful.

Another key factor is that the COVID-19 pandemic has boosted demand for health care delivered in the home. More health services gravitated towards the home setting during the outbreak, due to concerns about spreading the virus or losing access to loved ones due to facilities’ visitor restrictions.

The pandemic also drove up interest in telehealth, which providers can successfully leverage to enhance home-based care.

“Throughout COVID, there’s been so much talk about telemedicine. We see how it helps to provide better, more consistent care,” HCCI President Julie Sacks told Hospice News. “It doesn’t 100% replace home visits, but there’s a certain relationship that is built between a provider and their patient that’s very special in this model of care.”