What exactly encompasses the "Home Healthcare" industry?

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November 12, 2021

by a searcher from Loyola University of Chicago in Chicago, IL, USA

I know this traditionally involves in-home senior care, and other services/care that occur in a patient's home? But given the COVID-19 environment, do other services now become "home care?" Many checkups, "doctor visits," therapy/counseling sessions were done over Zoom, and many may even remain in this format.

If the patient receives any form of care, while physically in their home, does this in turn make the service/care/product a type of "home care?"

Seems like an expanding industry, or at least one that intertwines with other healthcare sectors.

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Reply by a searcher
from Towson University in Portland, OR, USA
Home health in the past was mostly nursing and ancillary services billed under medicare part A. Usually with consolidated billing for combined services. The companies are agencies that get leads by way of referrals. They dispatch providers and manage their credentials and regulatory compliance. Part A reimburses higher than part B, so it makes the logistics tenable.

There's a lot of flavors of home health now...Medicare part B is also in the mix...some companies partner with insurance payers and some don't. There's a lot of home health that is cash pay too...but at least in my market, cash pay services is like <2% of spend.

For the most part...home health is still only reimbursed by insurance for "homebound" Medicare patients. It's super hard to get commercial insurance to accept home health services for folks that can be seen in person. There are some exceptions, but it usually happens at-scale when the company has control of a network of providers or a patient population...at that point they collectively bargain with the insurance company and the rules change.

Telemedicine and digital health get lumped into home health sometimes, but they're different. Most wouldn't fit into the CMS distinction of "home health". The platforms themselves are somewhat of commodities, but there are telemed companies who have improved patient experience by abstracting away a lot of the admin crap (auths, intake forms, etc.). They can sell a medical product/service and connect customers to a doctor to get those services. Covid accelerated this adoption because of regulation changes...it's a frothy space, but still super fluid and changing rapidly.
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Reply by a searcher
from Johns Hopkins University in Washington, DC, USA
Govt. reimbursement represents a lion's share of home heath, but private pay and long-term care insurance also represent a percentage of the market depending on where you are looking to establish a business/franchise. I would recommend looking at the language on home health care in the upcoming reconciliation package for adjustments to reimbursement models as well as the industry reports in IBIS World offered through Searchfunder which provide a great general overview.
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