An excerpt from Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.

Carmella Mason has been a caregiver since her husband, Frank, had a heart attack fifty years ago. They were in their 80s when we spoke. Frank likely owes his survival to her efforts. When he developed diabetes, circulatory complications necessitated the amputation of a big toe in 2022. Things did not go well. He underwent more surgeries and faced losing additional parts of his feet and perhaps lower legs.

One bright spot in the couple’s medical odyssey, beyond supportive children and good neighbors near their New Jersey home, was one great doctor—and a few they’d like to forget—and a relatively new company called SENAHealth that was able to provide Frank hospital-level care in their home. Medicare covered their care, thanks to new programs unknown to most people.

“If it wasn’t for them, I don’t know what we would have done,” she told me. “When this first happened, I didn’t know what I was going to do. And thank God, we have a good primary physician, and he just started everything for us. And it was great, because I was a wreck, and we didn’t know how bad it was going to be.

“When SENAHealth tells you they are available 24/7 they mean it,” said Carmella, who goes by the nickname Carmie. “Immediately, they handled everything. They would make the appointments. Or someone would come to the house and draw blood. I hadn’t known they were going to do all of that. But it was wonderful. And they weren’t just concerned about Frank. It was nice that they were concerned about me, too, as the caregiver. Because I was here all the time and it’s a full-time job.”

“SENAHealth took over the management and coordination of our doctors, nurses, and other care,” Frank said in an email. “Besides the professionalism SENAHealth care workers exhibited, their compassion and kindness will never be forgotten.”

Success is relative at the Masons’ ages. Frank may be on his fourth pacemaker by now, Carmie said in a later email. “It was a stressful time when we were told that his heart muscle is ‘shot.’ So, send up good thoughts for us that all will work out well and, remember, we can only live in the moment. Forget the past moment(s) and don’t look to future moment(s). Just concentrate on the present moment because that is when we’re alive.”

The Masons’ story illustrates the reasons that led Dr. Anthony Webbe to found SENAHealth in 2019. At the time, there was no mechanism to be paid for health care that falls under the broad umbrella of “hospital at home” treatment.

Webbe prefers to call it “healing at home,” in part because the company’s care services are broader than those provided in a hospital. The definition of home is also broader. “We meet people where they are.”

“The home can be someone’s apartment, it can be someone’s home in the community, it can be an independent living or assisted living community, it can be a nursing home or even a group home,” he said in an interview. “We do a lot of work in group homes for people with intellectual disabilities, bringing care to them in their home.”

Dr. Webbe was an internist before moving into hospital administration. “House calls have always been my personal favorite since I was a medical student in South Philadelphia,” he explained. “What drives me personally is helping people age in place, I have aging parents, myself. And around when the pandemic started, I was looking to start something on my own.”

America can provide great health care, he said. “Unfortunately, there’s still a lot of challenges that we have helping people navigate the common things like pneumonia and diabetes and congestive heart failure. And there’s a lot of struggles there for people.”

We wanted to show others in health care that we can take care of really sick people, he said. “At the core of what we do is provide technology-enabled services that include a 24/7, 365-day command center” to manage patient care and help people navigate the system. The company’s business clients include insurance plans, health systems, and medical practices.

As you’ll read later, the pandemic spurred emergency rules that permitted SENAHealth to also be paid for its work with Medicare beneficiaries. Once again, the mundane topic of payment mechanisms turns out to be a crucial requirement for changing U.S. health care.

Care moves ahead to the past

Before the hospitalization of America, health care was delivered in the home. It was where people received care and where they died. The rise of institutional health care and health insurance payment systems helped end the era of physician house calls and home-based care. People went to hospital emergency rooms if they had serious medical issues. They died in hospitals or nursing homes, not at home.

No more. To mangle the words of Marty McFly and Doc Brown in Back to the Future, health care is hurtling ahead to the past. The aging of America has fostered an “aging in place” culture. This often includes first-floor bedrooms that help people stay in their homes and receive medical care.

When the pandemic arrived, it compressed twenty years or so of home care transition into one or two. Hospitals were overwhelmed with highly contagious patients. They often filled all available beds, hallways, and lounges. CMS moved with unusual speed to change its rules and permit acute care to be moved from hospitals into the American home. Along the way, the U.S. health system passed the tipping point for home-based care. In this way, it has begun to resemble the home-based care that has long been available in other countries.

Telehealth and technology-enhanced home care became staples during the pandemic. New companies entered this space and helped turn U.S. health care into a venture capital arms race. Well-funded start-up companies are reinventing ways of providing and receiving care.

Entrants include companies that will dispatch emergency room teams to your home, bypassing hospitals and urgent care centers. Kidney dialysis machines can be placed in the home, along with people to operate them. Ditto for cancer treatments and other infusion therapies. New home-based treatments are being added to the list.

Hospitals are not simply watching these new services bypass their facilities. Many have decided they need to lead the charge by sending emergency room and hospitalized patients back to their homes, where they get the kinds of acute care once available only within a hospital.

Philip Moeller is a journalist and author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.