Policy Opportunities To Expand Home-Based Care For People With Complex Health Needs

Home-based care is an important and undertapped modality for providing care to millions of people in the United States who are unable to access or have difficulty obtaining care. This type of care is especially important for individuals with complex medical conditions requiring more specialized care and management. Interest in providing care in the home setting has accelerated during the COVID-19 public-health emergency (PHE) as policy makers, providers, and payers quickly pivoted to support care outside of facility settings, such as telehealth or in-person care delivered at home.

However, the home setting remains unevenly used and underutilized. Despite evidence indicating overwhelming patient preference for home-based care, the majority of the seven million Americans eligible for home-based care do not receive these services due to provider shortages, coverage barriers, and payment challenges. This mismatch between the demand for home-based care services and the current level of home-based care provided disproportionately affects individuals residing in communities that are economically and socially marginalized. This gap was exacerbated by the PHE and will become more pressing as the US population ages.

At present, there is a unique policy window to address the gap in care by leveraging administrative interest (such as the Centers for Medicare and Medicaid Services’ (CMS’s) refreshed strategic vision) and legislative momentum to expand home-based care at the federal and state levels. In this article, we assess near-term policy opportunities and provide strategic recommendations for policy makers seeking to expand home-based care for patients with complex needs. Through interviews with leading experts, policy makers, payers, and providers, we developed technical policy recommendations that can improve home-based care through value-based payment (VBP) models implemented by the Center for Medicare and Medicaid Innovation (the Innovation Center), traditional Medicare, Medicare Advantage, and Medicaid programs. This article synthesizes our findings and provides a high-level overview of immediate policy options to strengthen home-based care models.

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