Johns Hopkins Home Care Group is attached to one of the top health systems and educational institutions in the country. It’s often a place where health care breakthroughs take place and new home-based care ideas are formed.
And yet it still deals with pain points that are all too familiar to most home-based care agencies across the country: staffing woes, rate cuts and inflation.
Yet even with those challenges, it’s up to Mary Gibbons Myers – the president and CEO of Johns Hopkins Home Care Group – to stay on the cutting edge of things.
In total, Johns Hopkins Health System’s Home & Community-Based Services division has 1,600 employees who provide care services to about 170,000 patients a year.
Home Health Care News caught up with Myers in Las Vegas at the National Association for Home Care and Hospice’s Financial Management Conference in July.
Highlights from that conversation are below, edited for length and clarity.
How has home-based care advanced over the past few years, from your perspective?
I do think that COVID really helped give home care value and recognition, because we stepped up. As far as in health care, in general, the idea of what can be done in the home was really highlighted.
When physician groups were doing everything remote, they were looking for us to go in to be their eyes and ears. When people needed to be tested, it was us going into the homes and doing the testing.
When people were starting to desaturate, after a couple of days of being discharged from the hospital, we created remote patient monitoring programs. When we couldn’t get into skilled nursing facilities, we were bringing people home and taking care of them at a much higher level.
The other thing that happened during COVID is an increased number of hospital-at-home [programs] were created. I think the concept of leaving the hospitals and coming home was propelled during that time.
Do you think that’s transferring over the workers at all? Some providers have reported that if they’re doing hospital-level care at home, their workers actually liked that better than what they were doing previously in brick-and-mortar institutions.
What we have is the data on employees that work within the home. We didn’t have data on people that don’t work in the home and why. Now we are working with a group called Transcend, who is doing some research to find out what would interest those health care workers who are actively working outside the home-based setting. We want to find out if they would be interested, what their age groups are, what their concerns might be.
We’ve got some preliminary data, and then the group will be getting together, reviewing that data and finding out how we can use that data to help create a plan to really improve and propel forward the image of home-based care.
What is the biggest issue plaguing your operations right now?
Across all lines of business it’s workforce. We have a greater demand for our services than what we can provide. On top of that, the workforce is demanding much higher compensation, and reimbursement is not adequate to meet these needs.
In terms of other types of at-home care – for example primary care, palliative care, oncology, hospital at home – what are you most excited about?
My biggest thing is to keep care in the home. I believe that all goes together. If you can do acute care in the home, you can do SNF care in the home. That’s what I’m the most excited about. I believe Hopkins will have that by the end of this fiscal year.
Would your organization be doing this under the Acute Hospital Care at Home waiver, or on your own?
Maryland is different. The waiver really doesn’t help us because we’re something called an all-payer state. Yes, we’ll be doing it under the waiver, but the payment structure will be very different.
What are the biggest barriers to having a successful hospital-at-home program?
In Maryland, the biggest barrier is reimbursement. In the other states, it’s about building capacity. In Maryland, we’re not looking to build capacity, we’re really looking to decrease the cost of care by moving patients out of the hospital and into the home setting, and not backfilling them in the higher-cost centers.
Is there a popular opinion that you have a different perspective on?
People are really worried about Medicare Advantage. I do agree that the reimbursement has to be looked at differently, but I also believe we have the opportunity to demonstrate our value and get into more member per month type of contracting with plans versus fee-for-service. I also think they have the flexibility to reimburse for more novel programs, such as remote patient monitoring.
We’re actually working with our Medicare Advantage program now for them to compensate for remote patient monitoring of congestive heart failure patients. The idea is to keep them out of the hospitals, and decrease total cost of care.
With Medicare proposing this rate cut, does this open the door for Medicare Advantage to have an opportunity to work with more home health providers?
It could be, but Medicare Advantage always tries to make their rates lower. Medicare Advantage is not the optimal payment structure either.
If the proposed rule ends up being the final rule, what will Johns Hopkins have to change to become more efficient, or to survive?
We would try to come up with novel programs to knock away that middleman. We would truly partner with the different payers to be their coordinator of care.
What are you the most excited about, when it comes to day in and day out of your job, and things you see that are going on in the industry?
That people are starting to demand to have home care. Once a consumer demands it, everything else starts to fall in place.
The one real return on investment that we have seen is through home-based primary care. We need to take that model and apply it to all our other lines of business to demonstrate that return. Once we showed our payers that return on investment, they wanted to use us more, and for us to grow it.
The other opportunity I think we have is with SNFs. I think if patients could be provided care in the home instead of having to go to a SNF, they would.
HHCN Reporter Joyce Famakinwa also contributed to this article.
Companies featured in this article:
