Welcome to Beyond the Hospital: Voices in Advanced Care at Home, an interview series hosted by Chi-Cheng Huang, MD, Chief Medical Officer, and David Zimmerman, Chief Operating Officer at Inbound Health. Each episode features top voices in home-based healthcare who share the latest trends, innovations, and personal stories shaping the future of care delivery.

In this episode, we welcome Krista Drobac, Partner at Sirona Strategies, Executive Director of Moving Health Home, and a longtime policy leader and advocate for care in the home. Drawing on her decades of experience shaping federal healthcare policy, Krista discusses the challenges and triumphs surrounding the push for hospital-at-home and highlights how coalitions, health systems, and industry partners each play a critical role in driving change for the future of care delivery.

Dave Zimmerman: To kick us off, I’d love to hear about your background. What motivates you to stay in the public policy space?

Krista Drobac: It’s gotten a lot harder to get things done, but I still feel like we can. This is my 30th year in Washington. I came right after college, because you can accomplish a lot here. I worked on Capitol Hill, I worked at the Centers for Medicare & Medicaid Services (CMS), I led the Health Division for the National Governors Association––all to try and change a little piece of the world. While there’s a lot going on in the news, there are still people on the ground doing good things.

DZ: Throughout your time on the Hill, how have things changed in terms of what it takes to get policy enacted?

KD: When it started, it was all about making deals. Now, you have to have a coalition. As I tell people, you need to find your fellow travelers and go in as a group. It’s hard for one company or one organization to change things; that’s why we reach out to patient groups, provider groups, and business groups across the spectrum, so we go in together to say, “This impacts all of us and we need a change.” It really does take a village nowadays. It also takes more evidence. People want to know: Will this policy work? Is it going to raise costs? How will it impact patients? It’s less about knowing the right people, and more about having the story and the people around you to make an impact.

DZ: Is that part of the origin behind Moving Health Home?

KD: I’ve always been a big believer in coalitions. I started out in telemedicine. And if you think about it, one company isn’t going to be able to do the lift that’s necessary to, for instance, permit telemedicine and Medicare in perpetuity. We launched the Alliance for Connected Care in 2013 with the goal of securing coverage for telehealth services in Medicare. In 2020, we felt like it was finally going to happen. We’d already worked with the first Trump administration to remove the statutory barrier for remote monitoring, and we felt like telehealth was next. But then we thought, well, what happens if we get telehealth and remote monitoring? It still doesn’t create an in-home benefit. All you’re doing is paying for the tools––you’re not creating the care model.

So, we started Moving Health Home to extend hospital-at-home and raise awareness around all the things that can be done if we change the care models. For instance, how can we ensure that we don’t need a nurse in the home 24/7 for an SNF-at-home benefit? Patients and caregivers want to be home. There’s better care, more resilience, better mental health, no hospital-acquired infections––so many good things. I hope care-at-home becomes the future.

DZ: I’m biased, but I couldn’t agree more. What’s the temperature in Washington around home-based care?

KD: It’s always part of the conversation. The challenge is creating the right policy window. There are always a few major issues dominating the healthcare landscape, and it takes a significant amount of effort to break through the noise. But we’ve got a real crisis underway, and it takes groups like ours to keep pushing for attention, action, and solutions.

I do think it’s possible—we just need to seize every opening. For example, the $50 billion Rural Health Transformation Fund passed by Congress in the One Big Beautiful Bill (OBBB) mentioned care-at-home, as did the Physician Technical Advisory Committee to CMS. Any time Congress or a committee recognizes home-based care, we have to jump on it, amplify it, and make sure it’s heard. That’s how we build momentum and get people excited about this work.

DZ: Compared to the Biden administration, how have you seen interest in this space change under the second Trump administration?

KD: The difference has been striking. The team he has at CMS is deeply interested in tech-enabled care—things like remote monitoring, wearables, and tools that can measure blood pressure and other critical health indicators. They recognize the capacity challenges we’re facing with an aging population, so in that sense, we’re in a better position, but at the same time, we’re worse off with a secretary whose main focus is wellness and prevention. He talks a lot about chronic disease, which is important, but our emphasis is more on tertiary care, not prevention.  

DZ: A lot of people are eager to see what happens with the extension of the hospital-at-home bill. Where do things stand now, and how do you expect to see this play out over the next few months?

KD: The challenge is that hospital-at-home is tied up with the year-end funding package, which has become the norm. Thirty years ago, we’d pass standalone bills—and something like this, which doesn’t cost money, could go through unanimous consent and pass without a vote. Today, almost everything is subject to a vote, and bills are often bundled into larger packages. Lawmakers use larger vehicles, such as the debt ceiling or year-end funding, to attach priorities and secure votes, which makes it harder to move something like hospital-at-home on its own.

That said, we’re in a strong position. Last year, despite the chaos, we still managed to secure a spot in the second funding bill, even if only for a short-term extension. And we’ve gained a new set of champions in Congress, which is a real testament to the advocacy in this space. We now have a five-year extension bill with broad support, and over 120 organizations have signed onto a letter urging Congress to act. Since it doesn’t cost anything, we have a good score and strong champions. It’s possible Senate leadership will decide to resolve this with a full five-year extension, just to get it off the table. Or they could tie it to the same timeline as telehealth, which faces a similar situation. Either way, we’re confident there will be an extension—it’s just a matter of how long.

DZ: Tell us about the work you’re leading around SNF-at-home. 

KD: Hospital-at-home really paved the way for showing what care in the home can do, and SNF-at-home is the natural next step. Right now, we have a hospital discharge crisis—patients are stuck in ERs because they can’t get a hospital bed, and those beds are tied up because people can’t get into a SNF. It’s exactly the kind of bottleneck you see dramatized on shows like “The Pitt”.

SNF-at-home helps relieve that capacity problem. There are so many good things about sending someone home. Patients and caregivers really want it, providers get to see the home environment, people can rehab in their own home and get back into their own routines—it’s a win all around. [H2] The barriers are statutory: the law requires 24/7 on-site nursing and physical infrastructure, the same two requirements we waived for hospital-at-home. What we’re advocating for is a five-year demonstration project that would enable patients to return home while we collect robust data on length of stay, readmissions, infections, and outcomes.

And because it’s a statutory barrier, we need the legislation. Republicans are very supportive, and some Democrats are too, but others question whether we need another post-acute option instead of fixing SNFs or home health. That’s the hurdle. But once there’s broader bipartisan agreement, I think this will move forward. Everyone recognizes the capacity crisis we’re facing; we just need to get more decision-makers on board.

DZ: Beyond that issue of alignment, what other barriers could potentially get in the way of launching this kind of demonstration project? 

KD: There’s always some opposition. I don’t think the SNF industry will love this—though some will, especially those that also own home health agencies, since they’d be well positioned to provide a SNF-at-home benefit. So, the industry may be somewhat divided. Whenever you introduce a new model, certain groups will feel that it disrupts their position, while others see it as an opportunity. The key is building a coalition big enough to withstand opposition from other industry groups.

DZ: What guidance or hope do you have for these coalitions given the landscape? What key role should they be playing at this point in the process?

KD: The Alliance for Connected Care has already had some big wins. In 2018, we successfully convinced CMS Administrator Seema Verma to unbundle the CCM codes from the remote monitoring code. That created two separate payments and marked the first time remote monitoring was reimbursed. After that, the AMA created three new codes that are also paid for—another huge win.

More recently, in the OBBB, the Alliance secured permanent coverage for telehealth within the deductible for people on high-deductible health plans and HSAs. That means employers can now offer discounted or even free telehealth before a deductible is met, and that was a really big win. Looking ahead, the key wins for Moving Health Home would be five-year demonstrations for both hospital-at-home and SNF-at-home, and ultimately, a bundled payment for primary care delivered in the home. To get there, coalitions need to keep raising the profile of care in the home, proving the use cases, gathering data, expanding the tent, and keeping up a steady drumbeat of advocacy.

DZ: How can health systems, provider groups, and third parties like Inbound Health play a key role in shaping that voice and moving the industry forward?

KD: The biggest thing is to make time to get involved. Whether that’s joining a coalition, talking to your member of Congress, or reaching out to folks like me, even something small can make a difference. One reason groups like ours exist is that hospital systems are often consumed with big-ticket issues that carry major financial implications. Their government affairs teams don’t always have the bandwidth to dig into more niche issues like care-at-home or telehealth. That’s why systems like Intermountain, Ascension, MedStar, and Johns Hopkins join our groups; they know these are critical priorities that may not get the same level of attention elsewhere.

So, my advice is to talk to your government affairs teams and let them know this matters. Even if it’s not the issue that will cost your hospital millions, it’s important for the future of care delivery. Ask them to get involved. The only way we’re going to get this done is if we have a lot of people at the table.

DZ: After 30 years in the space, what keeps you motivated in the fight to advance policy?

KD: I’m a policy nerd. I get jazzed when I see models that work. And there are people on Capitol Hill and in the administration who respond to research, data, and real-world results, and are interested in trying what’s working. That keeps me motivated.

I don’t necessarily expect sweeping reform of the entire system anytime soon, but if we can launch pilots based on proven approaches, and then gradually expand and scale them, real change will follow. Over time, people will start asking, “Why isn’t everyone in an ACO? Why aren’t we all in risk-sharing arrangements?” That’s how progress works; you just have to chip away at it.

My hope is to lay the groundwork now so the next generation can finish the job.