Julie SacksThe Home Centered Care Institute named Julie Sacks as its president and COO on March 3, 2021. Sacks will expand on work she started as COO and use 20 years of experience to help HCCI continue to increase the awareness and availability of home-based primary care. 

What is your vision for HCCI?

When I think of our vision, I think of what we often say at HCCI, which is that the future of healthcare is in the home. We are working to realize that vision through four key strategies: education, consulting, research, and advocacy. We have already done significant awareness-building around the importance of home-based primary care, but there is much still to do. With HCCI’s dedicated staff, consultants, and faculty, we can make great strides in increasing the availability of home-based care.

Our research shows that the demand for home-based primary care far outweighs the supply. Patients want and need this care, but not enough providers deliver it. We are looking at how we can add to that supply through workforce development and by encouraging practices, investors, and payers to get behind it. My overarching goal is to improve equity by improving access to high-quality care delivered in the home.

What is the biggest opportunity and challenge for home-based primary care?

One of the biggest opportunities is the shift from a fee-for-service model to value-based care. Home-based primary care providers can ultimately improve patient outcomes and save money by engaging in value-based payment arrangements. For example, The Center for Medicare & Medicaid Innovation demonstration projects like Independence at Home have been highly successful. And there are others coming that could also benefit home-based primary care providers.

As far as challenges, one of the most common is smaller practices wanting to provide this type of care but not having adequate patient volume to qualify for value-based payment arrangements with the large health plans. We are now seeing these smaller providers come together to form consortiums to get the patient volume required. They also need the capital, typically an investment up-front, and the necessary  infrastructure. The good news is that we are seeing private equity come into the space in a big way. With that additional capital comes more opportunity.

What role is HCCI playing when it comes to how home-based primary care providers are compensated and how the care is delivered? 

HCCI is skilled at supporting providers and practices regardless of their payment structure or practice model. We are helping a lot of home-based primary care providers transition from a fee-for-service model to a value-based care one, but we provide guidance and assistance on both sides of that fence. For practices that are still primarily reliant on fee-for-service revenue, HCCI guides them on how to ensure fair and accurate reimbursement for the complex and comprehensive services they provide including things like Chronic Care Management (CCM), Transitional Care Management (TCM), and Remote Patient Monitoring (RPM). We have a practice management and certified coding/auditing specialist on our team that can help practices optimize their billing model.

For practices making the transition to value-based care, HCCI can help providers and practices enhance their Hierarchical Condition Category (HCC) coding to accurately reflect the complexity of their patient population. We also help practices understand and prepare for the new Alternative Payment Model (APM) opportunities.

HCCI’s curriculum also includes a focus on clinical best practices as well as practice management and operations. Many physicians become operational leaders of their practices but were not typically trained for that. They were trained to be clinicians. HCCI fills that knowledge gap by educating them on how to be successful and sustainable from the operations side. We also offer consulting solutions to help them build and grow their practices.

What do you think the biggest shift will be for home-based care in the next five to 10 years?

Ideally, the fact that home-based primary care exists will no longer be a surprise to anyone. Today, when I tell people what I do for a living, some of them, especially those not in the healthcare field, say, “I didn’t know house calls were still ‘a thing’!”

But with telemedicine and technology so much can be done in, and from, the home, and it’s frequently the  way people prefer to receive care. What I see happening in the next decade is home-based primary care becoming much more integrated into the overall continuum of care and becoming a regular part of the conversation. The same way the public thinks of hospice at the end of life, people will begin to think about home-based primary care as soon as someone is homebound, home-limited, or frail enough that they should not be going out of the house to get care. It will be viewed as the natural and automatic way to take care of people as they age.

Are there changes to home-based primary care brought about by COVID-19 that are here to stay or that need to be here to stay?

Nothing will replace the relationship developed between a home-based primary care provider, their patient and the caregivers and other family members. That being said, there are also ways to manage some of the more routine care through telehealth and telemedicine – that will improve care and reduce costs. As we saw with the pandemic and some of the changes from the Centers for Medicare & Medicaid Services, telehealth was made more readily available. We believe many of those changes should, and will, remain in place.

What must happen for the expansion of home-based primary care?

First, CMS’ changes to its telehealth approach, made during the pandemic, must be made permanent to allow for more uptake. Two, the role of nurse practitioners must be expanded.

Nurse practitioners (NPs) are currently the largest, and fastest growing, segment of the HBPC workforce, and their holistic, person-centered approach to care is an ideal fit for home-based primary care.  The challenge is that the level of authority NPs have varies by state.  For example, some states allow NPs to sign home-health orders and others do not. We need to both raise and level the “playing field” at the same time. Nurse practitioners should be able to practice at the top of their license across all states to permanently prescribe and certify for additional medical equipment and hospice care.

Physician Assistants (PAs) are also a tremendous asset to the field of home-based primary care.  In fact, the American Academy of Physician Assistants recently passed a resolution showing support for home-centered care at its highest levels. AAPA’s commitment to advocating for home-based care will increase affordability and patient access to care, and encourage more PAs to engage in home-centered care.

How can providers prepare for a future where home-based primary care is a popular option for patients?

Providers can start by simply identifying patients they have not seen in a long time to determine if a house call is appropriate and beneficial. The first question to ask is why haven’t you seen the patient? Is it because they are in and out of the hospital? Can you hire a nurse practitioner to see some of these patients at home?

Once these questions are answered, providers can build some of the foundational things like the infrastructure to start monitoring health outcomes. In all, a home-based primary care service line complements the provider’s other service lines.

Providers who share HCCI’s vision of a future − that takes medical care to those would otherwise have difficulty accessing it − can help build that future.