Q&A: Regence’s Vince Porter on home-based care and how end of PHE could affect service-related waivers

Regence Health Policy Center Director Vince Porter has worked on several key pieces of legislation including the creation of Oregon’s Prescription Drug Price Transparency Program and the Sustainable Health Care Cost Containment Program since he began working at Regence in 2017. Prior to his tenure at Regence, Porter was the Jobs and Economy Policy Advisor to Oregon Govs. John Kitzhaber and Kate Brown.

Regence saw its home-based care services expand after CMS approved Acute Hospital Care at Home waivers for hospitals in Washington, Oregon, Idaho, and Utah in November 2020 at the height of the COVID-19 pandemic. Porter discusses the benefits of home-based care services and what the upcoming end of the public health emergency (PHE) could mean for Regence and other organizations in this Q&A.

 

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State of Reform: What are some of the key benefits home-based care offers patients from Regence’s perspective?

“Vince Porter: Delivering care to the home has been a part of our health care system for more than 100 years, it’s just that it was [previously] called a house call. But over time most care moved to established hospitals and other institutions.

While acute hospital care will always be an essential pillar to our health care system, moving some care back to the home is more possible than ever and we believe the evidence is showing that this movement is offering more affordable solutions with equal or better health outcomes.

During the COVID-19 emergency our entire health system was stretched to the limit and there was an urgent need for innovation and new models. Thankfully new care models and digital technologies had been in the works for several years and were at the ready when the pandemic hit. For some cancer patients who would rather receive care in their home, the model can be more convenient and personalized for the patient.

Policymakers often talk about advancing policies that keep people out of the emergency room. As entities like Dispatch Health expand and improve delivering acute care to the home, we can keep our emergency rooms from being overcrowded and offer savings to patients.”

SOR: In Regence’s service area within Washington, Oregon, Utah, and Idaho, 9 hospitals have received Acute Hospital Care at Home waivers since the PHE began. What could the end of the PHE mean for home-based care?

“VP: Declaration of a PHE allowed the federal government a significant degree of flexibility to waive or modify certain requirements such as insurance costs and coverage, telehealth expansion, access to COVID-19 testing, vaccines, and treatments under FDA emergency use authorization. The end of the PHE could also mean the end of a reversal of innovations realized through these flexibilities without thoughtful analysis of the data obtained during this process.

Letting these programs expire, specifically Hospital at Home waivers, at this juncture would set everyone back a few years on research, data analysis, and process improvements. This is a pivotal moment and key opportunity that could help move the ball closer to a quality, community-based health care system that improves access and decreases costs for patients.”

SOR: Why is it important for these waivers to be extended?

“VP: We have only begun to understand the benefits of providing various levels of care in the home and there needs to be more opportunity for more innovation. The Huntsman at Home program at the Huntsman Institute in Utah is one example of a model demonstrating affordable and positive outcomes that have only scratched the surface on what is possible by providing cancer care in the home. 

Extending the waivers will allow for others to improve and innovate their models and begin to develop best practices and standards of care in these settings. It would allow federal and state regulators to go deeper into the data and demonstrated outcomes coming out of the waiver program. Once a more thorough analysis is completed, necessary policies can be introduced and implemented to further advance the care-at-home model.”

SOR: What does the future of home-based care look like for Regence?

“VP: We envision our members will have the ability to access the right care in the right place at the right time, and the new care models delivering care to the home will be essential to meet this expectation.

Any at-home model must be affordable and deliver the same, if not better, health outcomes but we believe there is already evidence that the best models deliver on both. It will be important to communicate with our members so they know what tools are in front of them, but we are confident that when our members know what they can access affordably, they will engage and improve their health care experience.”

This interview was edited for clarity and length.