Homeward CEO Jennifer Schneider, M.D., in a recent interview with Fierce Healthcare.

Remote Care

Homeward Debuts With $20M for Rural Care

Sometimes no disruption is the best disruption, which is why Homeward is launching with $20M in funding to rearchitect rural healthcare with a full-risk hybrid model that augments local providers as opposed to replacing them. 

At the helm of the new startup is ex-Livongo president Jennifer Schneider, MD, who is aiming to bolster access to both primary and specialty care services in less populated areas, like her hometown of Winona, Minnesota.

• Homeward overcomes traditional barriers to rural care by combining a multidisciplinary care team, available virtually or in-person via mobile units, with cellular-based remote monitoring that doesn’t require a broadband connection.

• Under Homeward’s model, which will focus initially on cardiology, a typical patient journey will involve proactive measures with RPM tools to detect heart problems, a visit from a mobile care unit to diagnose issues, and virtual visits for ongoing treatment.  

• The company’s confidence in its model is seen in its commitment to becoming the first comprehensive provider to take on full risk in rural markets, giving it ownership of the economic benefits of delivering high-quality care at a lower cost.

• To avoid displacing local primary care physicians and specialists, Homeward will work with regional Medicare Advantage plans to refer members to nearby facilities when appropriate, ensuring timely care while also reducing unnecessary hospital admissions.

The Takeaway

While the value-based model isn’t a new concept, its application towards the 60M Americans living in rural communities has been limited due to challenges with poor broadband and specialist availability. Telehealth as a standalone solution hasn’t been the remedy to these disparities, but Homeward’s cellular RPM devices and mobile care units could bridge the gap that other methods have failed to cross.

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The Wire

• Telehealth Flexibilities: As part of 2022’s $1.5T omnibus spending package, Congress recently approved a five-month extension to post-pandemic telehealth flexibilities through September 14th. The 2,741 page law allows Medicare to continue covering remote services, while postponing the requirement that patients seeking virtual mental health services must have an in-person consultation prior to telehealth visits. The legislation also broadens telehealth reimbursement to occupational therapists, physical therapists, and speech-language pathologists, which could greatly improve access to these services if a more permanent telehealth extension is ratified.

• Is Pricier Healthcare Worth It? A new study from the National Bureau of Economic Research found that US hospitals with higher costs of care have lower overall mortality rates, with a 35% mortality reduction between hospitals in the 20th and 80th cost percentiles. However, the reduction was driven by hospitals in competitive markets where consumers have alternatives, and receiving care from pricier hospitals in less competitive markets where competition isn’t geographically feasible (reportedly 69% of all hospitals) has no detectable effect on mortality.

• Swift Ray 1: Digital wound care company Swift Medical unveiled its new Swift Ray 1 imaging device that attaches to smartphone cameras to let patients capture beneath-the-skin clinical data that previously would have required an in-person visit. The Swift Ray 1 uses long-wave infrared, ultraviolet, and enhanced RGB imaging technology to detect signs of improper healing such as infections and perfusion, then integrates the data with Swift Medical’s wider platform that automates wound care workflows.

• Clinicians Want Virtual Options: Wheel’s recent survey of nearly 400 doctors and nurses found that although clinicians are losing passion (58%) and have considered quitting (58%), they’re also optimistic about virtual care. Nearly two-thirds of respondents said they prefer virtual or hybrid work, and 63% said they believe virtual primary care will be more common than in-person care within five years (33% said 10 years). To reach this point, respondents believe there’s still a lot of work to be done, with half of respondents reporting a need for more virtual care training and 40% stating that advancements in remote patient monitoring will be critical.

• Current Health Chronic Care: Less than half a year after getting acquired by Best Buy, Current Health is adding new features to its remote care platform to better support patients with chronic conditions. Current Health now offers compatibility with more remote monitoring devices (such as those that manage hypertension, asthma, COPD, CHF, and diabetes), a new dashboard to view enrolled individuals across conditions, and more smartphone communication tools to drive engagement (automated nudges, daily surveys, messaging).

• Measuring Discrimination: An investigation into hospital Yelp reviews revealed that they can be effective for measuring discrimination in healthcare, a statistic that’s hard to track with traditional performance metrics. The JAMA study found 182 reviews across 100 randomly selected acute care hospitals in the US from 2011-2020 that described at least one instance of discrimination, with 48.9% being clinician to patient discrimination and 36.3% described as discrimination directed from the patient to a clinician. The researchers call for further work correlating these qualitative reports with quantitative measures of inequities to help address medical discrimination as a patient safety issue.

• Top EHR Vendors: Definitive Healthcare reported that the top inpatient EHR vendors by market share in 2021 were Epic (34%), Cerner (24%), and MEDITECH (15%, down 13 percentage points since 2009). EHR adoption in U.S. hospitals is at 96% (up from about 72% in 2011), and 80% of rural hospitals now use at least a basic EHR system. Although the EHR landscape continues to consolidate around the leaders, the increase in adoption among rural hospitals has carved a niche for smaller vendors willing to focus on their unique needs, such as Netsmart and Athenahealth.

• Bloom App: Digital musculoskeletal care company SWORD Health recently unveiled Bloom, a sensor-based therapy solution that will provide at-home care for women with pelvic disorders like postpartum pain. Bloom first matches members with a pelvic health specialist before starting them on a customized exercise program using an app-enabled pelvic sensor that measures the pressure and stamina of the pelvic floor. The sensor-based digital solution is coupled with clinical guidance via telehealth, making Bloom the only fully remote solution for personalized pelvic healthcare.

• Missed Screenings: The latest survey from the Prevent Cancer Foundation found Americans are continuing to miss routine doctor’s appointments, with half of US adults postponing or canceling in-person medical appointments or cancer screening in the second half of 2021. Respondents’ top reason for missing appointments was an effort to limit COVID exposure, but 45% are not planning to make up the missed screenings, which could lead to a wave of late cancer detection without a focused effort to address the screening backlog.

• Info Blocking Numbers: The ONC released its first information blocking claims report, which revealed 274 possible claims of information blocking made on its online portal since April 2021. Claims most often came from patients who were seeking access to their electronic health information (176 claims) and were either charged to see them or faced unnecessary delays. Although both of these are explicitly forbidden in the 21st Century Cures Act, surveys following the law’s implementation showed that there’s still widespread confusion on what information blocking actually entails.