“Condition focused visits are really giving the member, and the provider who is with them in their home, more dedicated time to do some customized care planning and education about that particular condition,” Dr. Heidi Schwarzwald, chief medical officer of Signify, told Home Health Care News. “At the end of these focused visits, there’s a much more specific care plan around that chronic disease that the member and the rest of their care team can use to really reinforce some of those changes they want to make.”

Signify — a part of CVS Health (NYSE: CVS) — is a home-focused platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs. The company also offers in-home evaluations as part of its model.

Condition focused visits build on Signify’s in-home evaluations by adding a layer of specificity around the care of certain complex conditions.

As part of the initial launch, the company partnered with Aetna – also owned by CVS Health – to pilot diabetes-focused visits for members in Texas and Florida.

“The care plan we leave behind is very diabetes specific,” Schwarzwald said. “It’s also very focused on some of the diagnostic and preventative services that may help manage their diabetes, things like diabetes eye exams in the home to reduce complications from diabetic retinopathy. They also have an opportunity, if they need it, to get an updated hemoglobin A1C, looking at their long-term glucose control. They have an opportunity to screen for chronic kidney disease, a common complication with urine and blood tests.”

Signify decided to begin with diabetes-focused visits because of the prevalence of the chronic disease.

Specifically, the amount of adults diagnosed with diabetes has more than doubled in the last 20 years, according to CDC data.

Currently, almost one-third of the U.S. population over the age of 65 have diabetes.

“We also know it’s an expensive chronic condition in the United States, with one out of every $7 spent in health care going to treat diabetes and diabetes related conditions,” Schwarzwald said. “We felt like diabetes was a strong place to start, where we can make significant changes in that individual member’s care plan, and ultimately in the cost and in the management of this disease.”

Signify is able to determine the best candidates through the company’s in-home assessments.

“We know that our visits are oftentimes great activation points for our members,” Schwarzwald said. “Right after our visits, they tend to see their PCPs more often. So this is another activation point. Perhaps they’re going to make those small changes that can be supported through that care plan by their primary care provider, or even the health plan case management team, to help them really get the most benefit from their diabetic care plan.”

In the future, Signify plans to focus on other complex conditions through its condition focused visits program.

“The other visits that we’re really contemplating now are cognitive health visits, as well as cardiovascular visits,” Schwarzwald said. “We’re thinking about those diseases that are driving much of the morbidity in those over 65. Those are in the planning stages. We do believe this is only the beginning.”

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The Dallas-based Signify is a health care platform that combines technology, analytics and networks to create value-based payment programs, which are highly sought after in today’s health care landscape. The company is CVS Health’s connection to the home, reaching members through millions of in-home visits per year.

Paymon Farazi, the president of Signify Health, recently joined Home Health Care News’ Disrupt podcast to talk about Signify’s direction over a year after the CVS deal was closed, how the company could work with traditional home-based care providers in the future and where Farazi sees Signify – and health care – headed in the near- and long-term future.

Below is that conversation, edited for length and clarity.

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HHCN: Okay Paymon, I’d love to start with an overview of Signify Health for our listeners and readers.

Farazi: Signify Health has a mission that’s pretty common in health care: build trusted relationships that make people healthier. And we have a unique way of doing that.

We basically do in-home health evaluations; we’re going into over 3 million homes in 2024. And the purpose of those visits is to really meet members where they are, do a full, end-to-end assessment of their current health situation, and help them think about what the next steps on their health journey should be.

That’s the core of the product offering; it is free to members. We call and schedule appointments with members across Affordable Care Act plans, Medicaid plans and Medicare Advantage plans across the United States. It’s free to them, completely funded by the health plans, who are our clients.

One of the unique aspects of our company is we have many customers: the members, our customers; the health plans, our customers; the clinicians in the field, I think of them as our customers. I could go on and on. But we have to make all those constituents happy and pleased with that product, which is again at the core an assessment of that person’s health and giving them a path forward for how to take care of themselves better.

What has changed since CVS Health acquired Signify Health?

It’s been great.

The CVS health leadership team deserves a ton of credit for a lot, but two things in particular really stand out to me.

One was they started out by asking us, what other investment can we give you to help you achieve your long-term goals? So they poured a lot of money, a lot of investment into the logistics platform that helps run our whole business, basically putting people into homes across America.

And they put a lot of money into the clinical network.

How do we grow and maintain the very best clinical network in America? That is our aspiration.

And then the second thing was around how they could help us do things like partnerships across pharmacy and retail to bring greater value to our health plan clients.

They were really determined and insistent on us being multipayer business going forward, which we were in the first place. They wanted us to continue to enhance those relationships with other payers, like Humana, like Florida Blue, etcetera.

Overall, we’ve accelerated a lot of things we were focused on before the closing of the deal.

I want to dive into the in-home assessments a little bit further. There’s been a lot of research conducted about Medicare Advantage plans utilizing those, through companies like Signify. Similar to a traditional home health or home care visit, you see things related to a patient’s health journey that you wouldn’t see otherwise. Can you explain, from your perspective, the value of those assessments?

The first thing I would share is that I wish everybody listening could go do a ride along with one of our clinicians. That’s the best way to experience in-home evaluations and the value to the member.

I’ve done dozens of these at this point since I’ve been at Signify. And every single time I do it, I come out of it with this renewed sense of energy and purpose, because it’s so obvious the value that you provide to the member.

The minimum scenario is you’re connecting with a human being and listening to their health care issues. That alone provides tremendous value. And then we go above and beyond that by basically assessing what drugs they’re taking, highlighting questions to ask for their primary care provider. We’re giving them this end-to-end strategy on how to work on their health.

Anecdotally, it just feels amazing to do these visits.

To give you some numbers, our clinicians spend – on average – two to two and a half more time in the home than an appointment in an office setting.

What you can imagine is that extended period of time allows you to do, again, a much more comprehensive visit on health history – where things have been, and where they’re going.

I assume that it is nice to now be in a situation – for Signify and for patients – where patients can easily be connected to other health care services, such as primary care. There’s value in being able to bank on those connections, for all parties involved, no?

That’s exactly right.

Our clinicians are amazing, and all of them want to do something to help that individual. It’s not about just doing the visit and moving on, they want to make sure they’re taking care of themselves. And since we’ve been acquired, we’ve leaned into those kinds of partnerships with our sister companies, whether it be MinuteClinic, or the pharmacy, or Oak Street.

We did this huge program with Oak Street Health last year around finding members a primary care provider. We can get them scheduled for a primary care visit, and make sure that we close that loop. This is a product capability that we’ve built over the last several years, we call it care coordination pathways. Post-visit, how do we get you into the follow-up step, whatever that step might be.

I also imagine the more in-home evaluations you do on behalf of MA, those beget even more visits because entities are realizing the value of them. You’re able to show the results of patients previously visited in the home.

That’s exactly right. Last year, we closed almost 10 million care gaps across all the visits that we did. That certainly helps highlight the value of the visit to our health plan partners, and keeps them wanting us to do more of these things.

It’s about gap identification, but it’s also about a pleasant member experience – have the halo effect around the members. Letting them know that this is what it feels like to be a part of this health plan, to have someone in the home, to be connected to services.

Those things help contribute to potential growth. I will also add to that, while our core and our historical growth has been in Medicare Advantage, we are seeing increasing demand from Affordable Care Act and Medicaid plans.

You’re an Optum veteran, a company very much so in the home-based care game, through LHC Group and potentially through Amedisys here shortly. Humana is in a similar position with CenterWell. CVS Health owns Signify and Oak Street, while Walgreens backs VillageMD and owns CareCentrix. Why do you think this trend has materialized, and how will it change health care moving forward?

It’s a great question, and I think about this a lot.

And I believe we’re building these things because this is what members want.

I spend a lot of time with customers of various stripes, trying to understand what their needs are, where the pain points are, and then how we can help solve those. And one of the more obvious trends in health care over the last few years has been the realization that they don’t want to go into an office setting.

Some people want the visit to come to them.

And it’s all of us noticing this broader trend of how we make things more convenient, and help the person get care in their home rather than forcing them to go to another setting. And I believe that, as this happens at a greater and greater frequency, that the limiter will be around: How can you economically do that?

Because home visits can be more expensive. There’s a whole different apparatus of cost that you have to build in order to schedule 3, 4 or 5 million appointments, and that’s probably the rate limiter. But my hope is that as more and more demand comes from members and patients for these kinds of services, that economic picture will fix itself – and expand the number of services that can be done in the home.

If at all, how do you currently work with home health and home care providers?

We don’t today. But that’s something that is possible through the care coordination pathways product.

There’s nothing limiting us from doing that, other than conversations with our health plan partners and those entities to make sure that that’s turned on. I have had partnership conversations with different home health providers. And we’re starting to explore more of that in the rest of 2024. But nothing that has been sort of finalized at this point. But I would say again – the apparatus is built for it. So the only thing preventing us is making sure we find the right, most sensical partnership.

Where do you want Signify to be in three to five years?

To me, it’s really two things, at least from a product offering perspective. One is to continue to extend that core business. Can we try to do more visits across Medicare Advantage, the Affordable Care Act and Medicaid customers? That’s key.

The second is, can we do more in the home? And I would note two sub-themes under that. We do lots of diagnostic testing in the home, we call it our diagnostic and preventative services or DPS product line. We believe there’s a lot more room to grow in doing testing in the home. We want to do that at a larger scale.

And then the second sub theme under doing more in the home is are there adjacent services we could provide, like caretaking? What else could we send a Signify person in the home to do?

We’re actively in the process of figuring that out, so we can extend more services to our members.

And then, do you have a short- or long-term prediction for health care broadly that you can share with us?

The consumerization of health care will continue to make progress.

Health care companies will be focused on becoming more customer-oriented companies. That will drive us to do more of meeting the consumer where they are, which we believe again, is going to be in the home. They want convenience, they want things to be easier. So, you’ll see more and more of that.

Delivering meds to your doorstep, delivering care in the home. There’s so much more that we can do there. We’re just we’re just scratching the surface.

The post Signify Health President: ‘We’re Just Scratching The Surface’ On What Can Be Done In The Home  appeared first on Home Health Care News.

For this episode of Disrupt, we caught up with Paymon Farazi, the president of Signify Health. During the conversation, Farazi breaks down Signify Health’s near-term and long-term goals as a value- and home-based care enabler.

Listen to this episode of Disrupt to learn:

– How at-home care can drive value for retailers like CVS, as well as payers

– How Signify coordinates care for all of its health care partners

– What the future of the company looks like under the CVS umbrella

– And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

The post Disrupt Podcast: Paymon Farazi, President, Signify Health appeared first on Home Health Care News.

Thanks to impactful, large-scale transactions over the last decade, the collective face of home-based care has changed forever.

Traditional providers in both home health care and personal home care have merged. Payers became involved in the home-based care space like never before. Of late, retailers have too.

But it’s often easy to forget how the current landscape became what it is.

Below, Home Health Care News takes a look at some of the most important and impactful deals in home-based care over the last decade – deals that explain, in part, where the home health and home care industries are today.

‘Big time’ provider deals

This past decade’s first blockbuster remained one of the most impactful throughout the last 10 years.

In 2014, April Anthony’s Encompass Home Health & Hospice was acquired by HealthSouth Corporation for $750 million. HealthSouth took a swing at home health and hospice, merging an in-patient facility business with a post-acute care business.

Four years later, HealthSouth would rebrand completely, taking on the home health and hospice entity’s name. Encompass Health Corp. (NYSE: EHC) still exists today, but is again without post-acute care capabilities.

The HealthSouth-Encompass deal is like a few other deals in home health care, in that it set off a domino effect and a winding life cycle of a home health entity.

Anthony left Encompass Health in 2021, and after her home health and hospice company operated as a segment within the larger organization for nearly a decade, Encompass Home Health & Hospice was spun off into its own public company: Enhabit Inc. (NYSE: EHAB).

That happened in 2022, and two years later, Enhabit may land in the hands of a different owner after it concludes its own strategic review. Anthony now runs VitalCaring, which is backed by her, The Vistria Group and Nautic Partners.

Over the decade, larger health care organizations like Encompass Health have also bundled up services, and also unbundled them.

For instance, Brookdale Senior Living (NYSE: BKD) had one of the largest home health footprints for a long time. After COVID-19 woes, however, it offloaded that to a health system eager to get into home health care: HCA Healthcare (NYSE: HCA). LHC Group would later acquire some of the assets jointly owned by Brookdale and HCA Healthcare.

Ascension Health, too, teamed up with TowerBrook to buy the home health and hospice provider Compassus in 2019.

A theme that has been a mainstay, and will likely remain a mainstay, is health systems changing course on their strategic planning – and deciding whether to own home health care themselves or focus on core operations and partner with home health care instead.

“You’re seeing a lot of these facility-based providers divesting or spinning off assets,” Chaz Bauer, director at Fifth Third Securities, told Home Health Care News. “They realize they have fundamentally two different businesses. They’re very related and intertwined. But fundamentally, you have these facility-based businesses that are very centralized models, very capital intensive. Whereas home-based care businesses, they’re very decentralized; they’re very capital-light. Part of the motivation there – in unbundling – is they can unlock value for their shareholders by splitting those businesses.”

But then there’s the M&A that has come from within the home health sector itself.

For instance, “the merger of equals” that turned LHC Group into a true home-based care powerhouse.

In late 2017, LHC Group agreed to merge with Almost Family in a $2.4 billion transaction. A straight line can be drawn from that deal to UnitedHealth Group’s (NYSE: UNH) acquisition of LHC Group, which was finalized in 2023.

LHC Group and Almost Family’s merger is not an anomaly, either. Not long after, Great Lakes Caring, National Home Health Care and Jordan Health Services combined in a three-way merger to create another one of the largest home health companies in the U.S.: Elara Caring.

That deal was powered by the PE firms Blue Wolf Capital Partners and Kelso & Company.

PE money in home-based care has turned a lot of sizable providers into powerhouses. The aforementioned PE firms – Blue Wolf, Kelso, Vistria and Nautic – have all played a part in that, in the transactions mentioned already and otherwise.

That will also continue, particularly as some of the holding periods of the largest companies turn over. There’s also a chance, however, that PE firms direct more attention to other parts of home-based care – like personal care – given the uncertainty surrounding home health payment rates.

In home care, Vistria and Centerbridge Partners uplifted Help at Home, turning it into one of the largest providers of home- and community-based services (HCBS) in the country.

Waud Capital recently acquired the large home care franchise Senior Helpers. Wellspring Capital Management acquired Interim HealthCare’s parent company Caring Brands International in 2021. Last September, The Halifax Group acquired Comfort Keepers from Sodexo.

PE has always been involved in home care. Bain Capital’s 2018 creation of Arosa, one of the largest non-franchised home care companies in the country, is one past example.

In the future, it’ll be interesting to see if PE will drive more large-scale, impactful deals like it has in home health care over the last decade.

Payers enter the fold

Any commentary on the biggest deals in home-based care over the last decade needs to note increased payer involvement.

Enter Humana Inc. (NYSE: HUM).

When people think of the company’s home-based care investments, most go straight to its takeover of Kindred at Home.

But let’s take a step out of the last decade, just for a second.

In 2011, Humana acquired the home-based care provider SeniorBridge, which was doing just $72 million in annual revenue at the time. When that deal was announced, it was not exactly frontpage news. But one could argue that kickstarted a chain of investments that changed the M&A landscape in home-based care forever.

“SeniorBridge fills a growing market need and is consistent with Humana’s focus on delivering clinical care for seniors in their homes,” Michael B. McCallister, Humana’s chairman and CEO at the time, said in a statement. “Acquiring SeniorBridge will immediately expand Humana’s existing clinical capabilities with the addition of SeniorBridge’s national network of 1,500 care managers. The company does a terrific job of reducing hospital readmissions and emergency-room utilization, all while helping seniors achieve lifelong well-being.”

Humana’s home-based care thesis was already there, but the SeniorBridge deal was likely the deal that set the stage for what eventually became CenterWell.

“The deal was a game changer. I was initially surprised by the size of the transaction. It was pretty small by Humana standards,” Mertz Taggart Managing Partner Cory Mertz told HHCN. “It didn’t take long for Humana to tout the savings SeniorBridge created for their membership, saving it billions of dollars within the first couple years of the deal, by keeping their members at home and out of the hospital.”

Nearly 13 years later, Humana is one of the largest home health providers in the country through CenterWell Home Health.

The company, with the help of the PE firms TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS), acquired and merged Kindred at Home and Curo Health Services. Yet another home health and hospice powerhouse was formed, this time under the watch of one of the largest payers in the country.

In 2021, Humana opted to take over a remaining 60% of the enterprise (it had previously owned 40%), which was worth over $8 billion at the time.

In 2022, it divested the hospice and home care operations of Kindred to Clayton, Dubilier & Rice (CD&R). Those divested assets became what is now known as Gentiva, led by David Causby, the former CEO of Kindred at Home.

The home health assets Humana held onto are now under CenterWell Home Health. CenterWell, overall, includes primary care, pharmacy and home health services.

In 2024, most large payers – namely the ones with large MA memberships – have some sort of home-based care capabilities. That was not the case when Humana acquired SeniorBridge way back when.

“This has been an ongoing development, and it’s really just vertical integration,” Bauer said. “The thought is: why not get into that downstream, and then be able to more directly control those costs and quality outcomes on the payer side?”

The other heavily involved payer is the only one that has a leg up on Humana in MA: UnitedHealth Group.

UnitedHealth Group’s Optum already had a variety of health care provider assets, but it decided to make its first big home-based care splash early in 2022 when it announced the $5.4 billion acquisition of LHC Group.

While payers liked the thought of vertical integration, large providers like LHC Group were also recognizing an existential threat to home health business: MA penetration. More MA beneficiaries meant fewer traditional Medicare beneficiaries, which meant a less sturdy financial leg to stand on.

UnitedHealth Group further cemented its interest not long after, when it made a $3.3 billion all-cash offer for Amedisys. That deal was agreed to in June of 2023, but is still pending.

Though UnitedHealth Group may have to divest some Amedisys assets to finalize the deal, the company will most likely have the largest home health market share when that deal closes. Estimates suggest Optum will have about 10% of the U.S. home health market under its belt.

Not only are payers now involved in the home health industry, but they are also creating scale.

“You can make an argument that Optum acquiring LHC group, and now Amedisys, is a scale transaction, like ones we’ve seen before,” Bauer said. “Because it puts together two of the largest providers to make an industry leader.”

New kids on the block

Like payers before them, another group of companies is now firmly involved in home-based care investment: retailers.

In fact, they’re so invested, they may not be labeled as just retailers five to 10 years from now.

CVS Health (NYSE: CVS) has a new health care services segment dubbed CVS Healthspire. Walgreens Boots Alliance (Nasdaq: WBA) has the same with its U.S. Healthcare segment.

Both of those segments are arguably the future of their respective parent organizations. And both include home-based care services.

Payers and retailers have different business models, but tend to want the same thing: pharmacy, primary care and home-based care services.

In 2020, Walgreens made an over $1 billion investment in VillageMD, a home- and community-focused primary care provider. After subsequent investments, it has backed VillageMD with over $6 billion.

After that, Walgreens found its next health care services asset in the health-at-home solutions platform CareCentrix. Though he is no longer in the position, CareCentrix’s former CEO, John Driscoll, was the initial leader of Walgreens new U.S. Healthcare segment.

“We continue to see strong results and potential for growth from our partnership with CareCentrix. Our full acquisition further accelerates our transformation to become a consumer-centric health care company, leveraging innovative platforms that extend our capabilities into fast-growing segments of health care,” former Walgreens CEO Roz Brewer said at the time. “CareCentrix is key to offering services to our patients at every stage of the care continuum, and to driving long-term, sustainable growth as part of our U.S. Healthcare strategy.”

Not to be outdone, CVS Health agreed to acquire the home- and value-based care enabler Signify Health in 2022 for $8 billion. Shortly after that, it got its primary care provider, too, with the over $10 billion acquisition of Oak Street Health.

While none of these assets are traditional home health or home care assets, this retailer involvement represents a seismic change in U.S. health care – and home-based care is a major part of it.

These companies could go after more assets in the future, or they could become major partners for those traditional providers.

Honorable mentions

It’s impossible to highlight every deal, but there are some that don’t fit perfectly into “themes” that are still worth mentioning.

The home care technology company Honor acquired the home care franchise brand Home Instead in 2021, for instance. In lieu of strictly partnering with providers to see its vision through, Honor opted to purchase Home Instead to speed up the process. The jury is still out on that deal, however.

Prior to agreeing to become a part of Optum, Amedisys also made plenty of deals that turned it into a multi-billion-dollar business.

It acquired the hospital-at-home platform Contessa Health in 2021 for $250 million.

It acquired Compassionate Care for $340 million in 2018, and AseraCare Hospice in 2020 for $235 million. Those two deals significantly bolstered its hospice arm.

Modivcare (Nasdaq: MODV) entered into the personal care game in a real way with its $575 million acquisition of Simplura Health Group in 2020 and its $340 million deal for CareFinders Total Care in 2021.

BrightSpring and PhaMerica completed a merger in 2019 that eventually led to today’s BrightSpring Health Services (Nasdaq: BTSG), which is now a public home-based care company.

Finally, Aveanna (Nasdaq: AVAH) – formerly a pediatric provider – entered into the home-based senior care world with its $345 million acquisition of Comfort Care Home Health in 2021 and its acquisition of Accredited Home Care for about $200 million later that year.

Addus Homecare Corporation (Nasdaq: ADUS) has executed several high-profile transactions of its own, most recently acquiring Tennessee Quality Care in a $106 million deal.

The post The Most Game-Changing Home-Based Care Blockbusters Of The Last Decade appeared first on Home Health Care News.

One of the reasons Signify Health is focused on heart arrhythmias is because of how common it is among the population the company serves.

“Heart arrhythmias are something that increase as people age,” Dr. Heidi Schwarzwald, chief medical officer at Signify Health Home and Community Services, told Home Health Care News. “Over [age] 65, 5% of people in the United States may have a heart arrhythmia. As you get to 75 or 80, that increases to 10% of people. Of course with our Medicare Advantage population, that involves a large part of that population. Of those people who have heart arrhythmias, we know anywhere between 1.2 and 1.5 million are actually undiagnosed.”

Dallas-based Signify is a value-based platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs. The company also offers in-home evaluations as part of its model.

People who have heart arrhythmias often deal with symptoms like chest pain, rapid and irregular heartbeat and shortness of breath.

Schwarzwald noted that most people are not diagnosed with a heart arrhythmia until they have a complication from it, such as a stroke or heart failure.

“We feel very strongly that being able to bring this service into the home allows us to assist the medical community with early diagnosis of heart arrhythmias, where you can have treatment and avoid those horrible complications,” she said. “That really fits with our philosophy of our diagnostic and preventative services. We’re trying to help with earlier diagnosis of diseases that can be treated. You can prevent worsening complications, as well as remove barriers to access to care.”

Schwarzwald explained that testing for heart arrhythmias typically involves having an appointment with one’s primary care provider, and then being referred to a cardiology clinic. At the clinic, the person has a Holter monitor placed on them, and then they must return to have the device taken off. Then there’s another visit with the cardiologist to receive the test results.

Signify Health’s new offering truncates this process by bringing the device into the home.

“It could easily be applied by our clinician, who can answer any questions that the member may have,” Schwarzwald said. “The member can take it off themselves. It looks kind of like a giant band aid with a device on top of it. It’s fairly easy to place and to wear. Then the member can send it to the cardiologist, and if they find anything they call the member and their [primary care provider] directly. We’re removing multiple different steps that generally are needed for this type of diagnostic.”

The new offering is also a way to curb costs incurred by traditional monitoring methods.

“There are often costs for Medicare members with seeing a specialist, and we’ve eliminated all of those costs, as well as just the cost to the member of time and effort,” Schwarzwald said.

Ultimately, Signify Health hopes to raise awareness about heart arrhythmias.

“We want our Medicare Advantage members to live the healthiest life they can to stay in their homes, to be able to participate in their communities,” Schwarzwald said. “By early diagnosis of these heart arrhythmias and early treatment, we hope to extend that meaningful and fruitful time for them.”

The post Signify Health Expands At-Home Care Offerings appeared first on Home Health Care News.

Home-based care providers avoiding the shift to value-based care are running out of time and excuses.

The Centers for Medicare & Medicaid Services (CMS) wants 100% of traditional Medicare beneficiaries and the “vast majority of Medicaid beneficiaries” in accountable care relationships by 2030.

Home health providers are already under the Home Health Value-Based Purchasing (HHVBP) Model, which is, by definition, a value-based care model.

Plus, the share of Medicare Advantage (MA) beneficiaries is increasing, while the share of traditional Medicare beneficiaries is declining. MA plans pay less for home-based care services, and value-based arrangements may be the best way for providers to achieve healthy financial relationships with those plans.

Even if providers are not capable of moving fully toward value-based care on their own, there are plenty of partners that can help them get there. They’re not just health plans.

There are value-based payment enablers, risk-bearing delivery organizations and hybrids of the two that can be leveraged by providers.

Healthcare Management Administrators (HMA) recently released a 70-page report on the current value-based care landscape. CMS also recently unveiled a value-based care spotlight webpage to aid providers.

This week’s exclusive, members-only HHCN+ Update pulls from those new resources, as well as recent conversations with home-based care leaders, to paint a picture of what value-based care currently looks like from a home-based care provider perspective.

Value-based care entities

When regulators point toward and acknowledge a trend they’ll be following over the next decade, the private sector generally listens closely.

As value-based care has gone from a pie-in-the-sky term with no real meaning behind it to something legitimate, more opportunities have arisen for providers interested in moving further toward value.

“At the start of the movement, value-based arrangements primarily involved traditional providers and payers engaging in relatively straight-forward and limited contractual arrangements,” HMA’s report read. “In recent years, the industry has expanded organically to include a broader ecosystem of risk-bearing care delivery organizations and provider enablement entities with capabilities and business models aligned with the functions and aims of accountable care.”

It’s worth noting that most home health providers have been making shifts toward value, particularly after the implementation of the Patient-Driven Grouping Model (PDGM), which de-incentivizes volume.

But it’s also worth noting that providers were entrenched in the fee-for-volume cycle for a long time. Whether they would admit it or not, undoing those habits is an ongoing chore.

Luckily, they don’t have to do it all on their own.

HMA identified three different types of entities worth paying attention to in the current value-based care landscape, for instance:

– Value-based payment enablers: “Entities that partner with providers to help them in the transition to value; share responsibility for the cost and quality outcomes; does not own provider asset.”

One example given by HMA here was Caravan Health, which was acquired by Signify Health in 2022. Signify Health is an at-home care solutions enabler owned by CVS Health (NYSE: CVS). It is not a traditional home health provider itself, but does partner with home health providers.

“We talked a lot through this journey about home health,” CVS Health CFO Shawn Guertin said after the Signify acquisition, also in 2022. “And the value-based care capabilities that this brings us is where a lot of the power is, I think, for the long haul. I’m very excited about the opportunity that Caravan could provide us for the future.”

– Risk-bearing delivery organizations: “Entities designed to deliver value-based care from the outset and assume accountability for the cost and quality outcomes of patient populations.”

Oak Street Health, which is now also owned by CVS Health, is one of these risk-bearing delivery organizations. It’s clear what CVS Health is trying to do from a strategic perspective.

Another entity mentioned is CenterWell, the provider organization owned by Humana (NYSE: HUM). CenterWell has three pillars currently: pharmacy, primary care and home health.

Over the next few years, CenterWell President Dr. Sanjay Shetty wants home health care to play an even larger role in the entity’s overall value-based care goals.

“I think the intent, with our pivot into value-based models for the home, is to first prove [things out],” Shetty told me this week. “We are making those investments within the business and within the clinical model, in order to change the way we’re doing things – to orient the teams on the ground towards the outcome. We’re still probably in the early days of that journey, but it’s been exciting.”

– Hybrids: “Entities that own risk-bearing delivery assets and offer VBP enablement services to external providers.”

A prime hybrid, which HHCN has covered extensively, is VillageMD. A primary care provider with a home- and community-based focus, VillageMD is backed by Walgreens Boots Alliance (Nasdaq: WBA). The latter has put up over $6 billion behind the former’s business.

“Home-based care is just going to become even more important,” Dr. Clive Fields, VillageMD’s co-founder and CMO, told Home Health Care News in 2021. “With the use of technology, teams and analytics, we think we can drive the same kinds of results for people who previously just may not have that access, either because of where they lived or because of the transportation that was available to them.”

Where providers stand

Some providers are taking on risk without a partner, through a Program of All-Inclusive Care for the Elderly (PACE), for instance. Some are partnering with PACE programs, too.

Other home-based care providers are partnering with health plans in value-based arrangements, though historically those have been on a more limited basis.

Home-based health care is lower-cost care, and also drives desirable outcomes when delivered correctly. Therefore, the aforementioned three types of value-based entities could all use home-based care providers. At the same time, the providers would also benefit from engaging with organizations already set up to deliver legitimate value- and risk-based care.

The first step is generally a cultural change, which is something I noted in last week’s update as well.

“I think the first relationship that you must establish – and this sounds a little hokey – is a pretty good internal harmony with your employee base, your stakeholders, your board, your governance, structure, whatever that might be,” Chapters Health System Andrew Molosky told me last month. “Because nothing will waylay an organization faster than when you have people viewing the priorities differently.”

CMS’ spotlight on value-based care reaffirms their commitment to the 2030 initiative, but it also proves just how behind many providers still are.

The webpage goes over some of the basics of value-based care – why it matters and how it can be achieved.

“CMS just launched a new Value-Based Care Spotlight page that explains in plain language what we mean by value-based care,” CMS Deputy Administrator and Director Liz Fowler said in a statement. “How it supports patients and providers, and why value-based care is important.”

Even if most home-based care providers are behind, value-based care will have to wait.

Time is of the essence, but health plans, patients and risk-enabled providers need home-based health care to truly provide the value-based care CMS wants.

“As with other healthcare organizations, entities in this segment are expanding their in-home care capabilities to support patients and caregivers in low-cost, convenient settings and a growing cohort of home-based innovators is emerging, each with slightly different approaches to optimizing in-home care,” the HMA report read.

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Signify — CVS Health’s acquired value-based care platform — conducted 649,000 in-home evaluations for multi-payer Medicare Advantage partners in the fourth quarter of 2023, marking a 20% increase from the previous year.

“Among our Aetna customers, we are broadening our addressable market, utilizing Signify’s strong capabilities and other products — including individual exchange and Medicaid,” Karen Lynch, president and CEO of CVS Health, said during a Wednesday Q4 2023 earnings call. “We will be expanding these capabilities with other clients and will deliver value by engaging consumers and their health across multiple channels.”

CVS Health originally completed its $8 billion acquisition of Signify Health — a value-based platform that offers at-home health risk assessments, among other services — in March 2023.

The company then closed on its $10.6 billion deal to purchase primary care provider Oak Street Health in May.

With both Signify and Oak Street, CVS Health continues to drive success in its health care delivery business, Lynch said. Oak Street – a risk-bearing senior care primary organization – ended 2023 with 202,000 at-risk lives, an increase of 27% year-over-year.

Through January, the number of Aetna members enrolled in Oak Street clinics doubled.

Total revenues increased to $93.8 billion, up 11.9% year over year. For its health services arms, revenue came in at $49.1 billion, up 12.3% year over year.

This increase was driven by factors like changes in drug mix, growth in specialty pharmacy, brand price hikes, and the acquisitions of Oak Street Health and Signify Health. However, changes in pharmacy client pricing partially offset these gains.

Thomas Cowhey, EVP and CFO of CVS Health, said the company is encouraged by the performance and growth of its health care delivery assets

Signify posted a revenue growth of 39% in the quarter compared to last year. Oak Street ended the quarter with 204 centers — an increase of 35 centers compared to 2023.

“We continue to expect to add 50 to 60 centers in 2024,” Cowhey said on the call. “Oak Street also significantly increased revenue in the quarter, growing 36% compared to the same quarter last year.”

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However, participation in value-based arrangements should not be the be-all and end-all.

“I would argue it’s relatively easier to get providers to sign up for value-based care arrangements than it is to ensure they’re successful within those arrangements,” Joel Haugen, senior vice president of product management at Signify Health, said last week during a webinar hosted by Signify and Rise Health.

Dallas-based Signify Health — a part of CVS Health (NYSE: CVS) — is a value-based platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs.

The company’s home and community services division also conducts millions of in-home evaluations per year.

According to Signify, around 35% of all MA members are involved in some kind of alternative payment model. That — coupled with the fact that CMS continues to drive strong incentives to push providers into risk-based arrangements — is an indicator that provider participants in those models “must have skin in the game,” Haugen said.

In order to do that, providers and health plans will need to work more closely together.

One of the ways to do this is to leverage an enabler or a risk-bearing entity that specializes in the success of these partnerships, Haugen suggested.

“Each health plan may have varying levels of quality incentives,” he said. “They may have various levels of PMPM payments, different levels of maturation on analytics and the impact of those care management program collaborations. Is there an opportunity to think beyond just a single health plan partnership? These enablers can support the aggregation of all risks on behalf of not just one provider organization, but multiple in a community or region.”

Enablers can also reduce or eliminate downside risk for risk-averse providers, while also accelerating cash incentives, Haugen said.

How Signify leverages the home

According to Signify, 29% of Medicare members return to their primary care physician (PCP) within 30 days after their in-home health evaluation.

Although these in-home evaluations shouldn’t be seen as substitutes for a visit with a PCP, they can lead to crucial findings in a member’s health journey.

“It does, in fact, support those relationships and helps drive patients to primary care,” Denise Graeber, senior vice president of product management at Signify Health, said during the webinar. “When we think about in-home evaluations, they have historically been targeted at Medicare Advantage members. The need and the value of in-home evaluations is continuing to grow.”

There is a substantial opportunity for providers and health plans to collaborate in order to reach some of the more “hidden” members that have specific needs.

For instance, Graeber pointed out that 11% of Medicare beneficiaries don’t have a PCP and 19% have a transportation need.

“That’s why referrals coming out of in-home evaluations are so critical,” she said. “That’s where we can connect immediately to emergency care, but also to help with care coordination. Whether it’s back to a primary care physician, a specialist, a care gap closure or a testing follow-up appointment.”

In-home visits can also lead to home-based care referrals, whether to personal home care providers or Medicare-certified home health providers.
“The value of the in-home visit is unlike your more traditional visit with a doctor in the health care setting,” Graeber said. “There are things that you see and hear at someone’s dining room table or on their couch that don’t get anywhere else. You really start to understand, on a deeper level, things like medication adherence, hazards around the home and other barriers that might exist that are impacting mobility and — therefore — overall health.”

At Signify, the integration following in-home visits is already showing promising results.

In a recent case study, Signify reached back out to members after an in-home visit. Of those that Signify contacted, 20% of members were interested in learning more about Signify Health.

Of those members, 50% scheduled an appointment during their first call with the provider partner.

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Home-based care organizations continue to evolve. As they do, they’re becoming more pre-acute and embracing preventative care.

Traditionally, providers step in after an acute event has already occurred. This has slowly begun to shift, as providers realize that if they are already in the home, they can prevent some of these events or outcomes.

Signify Health, a part of CVS Health (NYSE: CVS), exemplifies this shift.

“What we do is pre-acute, we do not specifically target members after acute scenarios,” Denise Graeber, senior vice president of product management at Signify Health, told Home Health Care News. “That doesn’t mean it doesn’t happen, that we actually have a visit after an acute event, but the purpose of our visit is not to address any specific condition. The purpose is to really be holistic and complete in the evaluation, and to help prevent acute incidents.”

Dallas-based Signify is a value-based platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs. The company’s home and community services division conducts millions of in-home evaluations per year.

The company spends anywhere from 45 minutes to an hour in a member’s home doing a full assessment of their health — a medication review, prior history check, a physical examination, coverage of social determinants of health and in-home diagnostics and labs, Graeber noted.

“Last year, a provider came to [a member’s] home and identified something when listening to her heart that sounded like a potential concern,” she said. “We suggested the member follow up with her PCP. She went in and found that she actually did have an issue with her bowels that was extremely concerning, both important and acute. [In-home evaluations] are just another check to help get ahead of acute situations and prevent other health conditions.”

Signify is able to collect data in the home that becomes a bridge to eliminate information gaps for their member’s PCP.

At-home interventions

As a company, MedArrive’s core focus is emergency department (ED) diversion and hospital admission reduction. This means pushing back against the ER as the first primary source of care.

The Dallas-based company works with health plans to enable home-based care and virtual care, utilizing non-traditional workers on the way, such as emergency medical services (EMS) professionals. The company focuses almost exclusively on Medicaid and dual-eligible populations.

More recently, MedArrive moved into the cardiology at-home space, through a partnership with Heartbeat Health, a tech-enabled virtual cardiology company. The collaboration will allow the company to deliver medication titration, symptom assessments and other at-home services.

Even with a focus on preventative care, MedArrive CEO Dan Trigub is quick to clarify that the company isn’t operating in the on-demand care space, and that health care is a lot more than just one acute episode.

“For us to really lower the total cost of care and have a material impact on health outcomes, we want to see these people over an extended window of time,” he told HHCN. “Our case management social work team is really helping to address health literacy, getting better durable medical equipment and helping with transportation.”

Trigub thinks that vulnerable populations will be the ones to benefit most from at-home care companies adapting more features of pre-acute care.

“For more vulnerable populations who don’t have anybody coming to see them and who, unfortunately, use the ER as their primary care source of care, there’s a huge impact from doing pre-acute visits, building relationships and extending care into the home of these populations,” he said.

Whether more at-home care organizations will become more pre-acute in nature will depend on if the company has the size and capacity to potentially pull it off, Alivia Care CEO Susan Ponder-Stansel told HHCN.

“In our case, we have hospice, we have PACE, we have some other lines of service that very much complement one another and are part of a continuum, but if you’re a standalone home health … it might not be something that you really have the resources or interest to do,” she said. “A lot of it depends, too, on the payment source.”

In other words, providers working strictly under the Medicare umbrella may have a tougher time pulling this off.

Alivia Care is primarily a provider of home health, hospice and palliative care services. The company operates across 32 counties in North Florida and Southeast Georgia.

“If you’re working in a value-based environment where you’re either working with a Medicare Advantage plan, or you’re part of a system or medical provider group that has at-risk lives, that’s where I think the opportunity is going to come for preventative, proactive care of the patient rather than, letting things progress to the point where you’re basically cleaning up after an incident that perhaps could have been either avoided or moved fairly far into the future,” Ponder-Stansel said.

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Karen Lynch – CVS Health’s CEO – outlined that vision at the Morgan Stanley’s 21st Global Healthcare Conference Tuesday.

“As we step back and as we looked at all of our businesses, what we said was we needed to extend into other areas for growth,” Lynch said. “And we said we needed to build out national provider capabilities either through primary care or in the home.”

The company has done so in both areas, through its $8 billion purchase of the at-home and value-based care enabler Signify Health and its $10 billion purchase of the primary care provider Oak Street Health.

Those investments represent a complete shift in CVS Health’s business model, which has led to speed bumps.

In August, the company announced that it cut 5,000 jobs, or 1.6% of its overall workforce.

But, in the minds of CVS Health leaders, the strategic shift is necessary. The company wants to capitalize off of the shift to value-based care in the U.S., and believe it’s set up perfectly to do so.

“Oak Street Health and Signify, I would argue, are the two premier value-based care providers in Medicare today,” Lynch said. “Signify is a home health risk assessment company that is in three million homes annually. It has the power to unlock additional health services and has an interlocking connection with Oak Street Health. There’s value between the two businesses.”

In addition to connecting Oak Street Health and Signify Health together, CVS Health also wants to connect both with its pharmacy business.

“When we’re looking at Oak Street, we’ve been using our retail pharmacies to engage people when they don’t have a primary care physician,” Lynch continued. “Signify Health, when they’re in the home, and [a patient doesn’t] have primary care, we’re recommending Oak Street. … The results so far are promising and encouraging. There are two things that matter when you think about unlocking the value of those two businesses, one is membership and the second is lowering overall acquisition cost.”

Walgreens Boots Alliance (Nasdaq: WBA) is making the same connections with the primary care provider VillageMD, the at-home care technology platform CareCentrix and its own pharmacy business.

Walgreens has a U.S. Healthcare services segment now, which is led by CareCentrix’s former CEO, John Driscoll.

CVS Health is following a similar path, and announced last week that its CFO, Shawn Guertin, will be in charge of health care services moving forward.

“We always were going to have to have someone lead our health services division,” Lynch said. “I’m very excited that Shawn will be taking over the leadership role, which means Oak Street and Signify will report to Shawn, and he will be responsible for unlocking the long-term value, the revenue and earnings power of those businesses.”

CVS Health can believe in the value of unlocking at-home care and primary care, but it also needs those investments to pay off financially sooner rather than later.

Guertin will be tasked with that challenge moving forward.

“The health services strategy is really about accomplishing two objectives,” Guertin said. “One is to create more accretive earnings growth from year to year. But also, over time, to fundamentally change the growth rates inherent in this company as we build a new business that has more attractive long-term growth characteristics than the enterprise. That’s the big challenge, financially.”

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