“Very few people don’t know someone who has been affected by this,” AlzBetter CEO Gary Skole told Home Health Care News. “People are living longer. If you’re over 85 years old, there’s a nearly 50% chance you’re going to have some form of dementia. There are many people over 85 right now; it’s the fastest growing part of our population.”

Since 1989, AlzBetter, based in Cherry Hill, New Jersey, has provided senior care support to families and health care organizations and recently launched the Dementia 360 program, a model for comprehensive dementia support in health care. The 360 model simplifies the complexities of training in a dementia program so professionals at all levels can deliver care to those living with dementia.

Skole said that although witnessing a patient endure the disease is terrible, its impact extends beyond that.

“How many people can afford to pay for [a family member] to live in a community with around-the-clock care for ten years? We find that people are completely unprepared for this. Even as caregivers, we are unprepared,” Skole said.

Skole said that after 20 years in the home care business, he had a challenging experience with a dementia patient. As a result, his company went through almost a dozen caregivers in two weeks. Finally, the patient’s daughter complained to the referral source about Skole’s agency.

“She complained to the source that we didn’t know what we were doing,” Skole said. “And the reality is, we didn’t, although I didn’t know that at the time. It got me on a path of trying to educate our staff better, and it opened my eyes to how complex dementia is.”

Skole created AlzBetter after facing difficulties in finding suitable training for his caregivers.

“Everything was meant for training nursing home staff because that’s where people ended up,” he said. “I ended up creating material for my company and realized I wasn’t alone. No one else really knows what they’re doing, either. In the private duty world, there are probably 30,000 home care agencies. If you go to 29,900 of these websites, they will all list dementia care as one of their expertise. The reality is that maybe they have a one-hour video that the staff watches, and now they say they’re dementia experts. What I’ve learned is that caring for people living with dementia requires a truly dedicated effort and training.”

Even with dedicated training, Skole discovered gaps when a caregiver was in the moment of caring for a patient.

“We help health care organizations implement a full-blown dementia program,” Skole said. “Our learning management system has a curriculum approved by the Alzheimer’s Association. We’ve developed tools for targeted assessments to identify areas in which people are struggling and teach home health aides how to alleviate that struggle in the moment.”

He provided an example of a caregiver struggling to get a patient to bathe.

“We want the home health aide to have a basic foundational understanding of dementia, but when it comes to [a situation like this], we just need to teach how to get the patient to bathe,” Skole said. “So, we have a five-minute lesson on getting a patient to bathe, and we send the aide a text message or email. There’s nothing they need to download. Now they have the solution at hand.”

Another aspect of the program involves a lifestyle assessment, which allows caregivers to gain insight into the patient’s life prior to the onset of the disease. This helps customize care and restore the patient’s dignity and respect.

“Patients go through retrogenesis; they go back in time,” Skole said. “We had a patient who owned a hardware store. Knowing that, we could give him hardware-related activities to do that made him feel important and occupied his time, but it was something that he knew.”

Skole explained that the program aims to provide home-based care agencies with a unique method for training and implementing an effective dementia program.

“A while back, it was understood that a patient with dementia would end up in a nursing home or a facility of some sort,” Skole said. “With technology and better training, we can keep these people safely at home.”

The post ‘We Didn’t Know What We Were Doing’: Where Home-Based Care Agencies Fall Short In Dementia Care appeared first on Home Health Care News.

“The significance of these investments from two impressive entities further validates WellBe’s commitment to be a payor-agnostic, in-home, full-risk medical group,” WellBe Senior Medical CEO Dr. Jeffrey Kang said in a press release.

Excellus BCBS’ investment follows a partnership announcement in March of this year. As part of that partnership, Rochester-based WellBe will provide care directly to the homes of 30,000 of Excellus BCBS’ most vulnerable Medicare Advantage members in upstate New York. Members who are eligible for this program have high utilization rates, behavioral health needs, risk for readmission and ED visits, a slew of prescriptions and sometimes a combination of the four.

“Our collaborations with WellBe support the health plan’s goals around improving health outcomes and addressing the affordability of health care,” Excellus BCBS President and CEO Jim Reed said in a statement.

WellBe Senior Medical and its affiliated medical groups offer home-based care to patients with complex health challenges, including over 100,000 Medicare Advantage patients in ten states.

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The company, headquartered in North Palm Beach, Florida, will offer primary care, podiatry, wound care, mental health and pain management services directly to patients’ homes.

Horizon Care Services is already a successful home care, care management and senior placement provider in Florida. The mobile visits will be conducted through a different company, but the idea for them came from struggles within Horizon’s home care service line.

“I was using five mobile physician practices,” Horizon Care Services CEO Andrea Albertini told Home Health Care News. “They don’t call you back. Medication is not delivered. Meanwhile, the patient is home with the caregiver. The caregiver has not heard back from the doctor, we have not heard back from the doctor. So, I decided to invest in a mobile physician practice.”

The new company will prioritize ongoing primary and specialty care, monitoring conditions, and addressing issues before they escalate. This ultimately reduces the need for emergency room visits or hospitalizations. By emphasizing proactive health care management, Horizon Care Services aims to enhance the quality of life for its patients while maximizing their independence.

It has already treated 30-35 patients in its first month operating.

“When a patient comes to us, we do everything,” Albertini told HHCN. “We ask, do you have a living will? Do you have a primary care physician? What other physicians do you see? We implement everything the patient needs to be at home with their caregivers.”

Albertini stressed that patients do not require a contract or a prior relationship with the company to access its mobile services. All it takes is one phone call to request a visit.

Horizon Care Services bills Medicare, but offers a private-pay option for added flexibility.

“We triage on the phone with our doctors and dispatch someone to the home if necessary,” she explained. “[Patients] can call in if they have a need, we will coordinate everything to have that delivered to their home. Most of the time, on the same day.”

Albertini said that one of the reasons clients choose Horizon is the continuity of care. 

“Horizon Care Services is known for following up on everything,” she said. “If you are a doctor and you refer a patient, we will call the patient, make the arrangements and reply to let you know that the patient has an appointment and the outcome. I have had that level of customer service with Horizon for 20 years and want to continue doing that with the mobile services.” 

As the home has become the preferential care setting for seniors, home-based care companies have tried to capitalize. Albertini’s expansion into home-based medical care is a good example of that.

Elsewhere, the Minnesota-based Lifespark recently just added an in-home urgent care service line.

The Boston-based companies Best of Care and HouseWorks have also added other non-medical service lines, like move management services and laundry services, respectively.

The post Another Home Care Leader Bets On Primary Care In The Home  appeared first on Home Health Care News.

“Bringing Jeff on board is a huge lift for New Day as we continue to ‘Burn the Ships’

and change the way home health care is delivered,” New Day CEO G. Scott

Herman said in a press statement. “Jeff has an extensive history with our team and is an outstanding leader driven by operational excellence. Jeff is one of the industry’s most thoughtful professionals and his ability to problem solve is unmatched. He is perfect for this endeavor and I am thrilled the organization has evolved to a level we are able to capture his expertise.”

Founded in 2020, New Day has close to 30 locations across Texas, Missouri, Kansas and Illinois. The company offers a variety of home-based care services. New Day serves nearly 120,000 patients annually.

Most recently, Bonham served as senior vice president of home health at Empath Health.

“I am excited to be leading this innovative initiative with this market leading company,”

Bonham said in the statement. “Innovation is a staple of this leadership team, with whom I have a long history and have experienced many market leading successes.”

Welcome Health names new chief growth officer

Welcome Health — SCAN Group’s in-home senior primary care arm — has appointed Jay Bakshi as its new chief growth officer.

“We are excited to have Jay in this role as he brings extensive experience in partnering with payers in value-based arrangements to bring innovative solutions to the members they serve,” Welcome Health CEO Emily Cook said in a press statement. “Welcome Health has established a growing presence in Southern California, and we look forward to bringing our unique, high-touch primary care model to additional health plans and seniors across the nation.”

SCAN Group, a nonprofit organization focused on helping older adults age in place, launched Welcome Health in 2021.

As chief growth officer, Bakshi will be in charge of growth, market expansion, payer business development and contracting, account management and patient acquisition and retention.

“Welcome Health’s physicians and interdisciplinary teams holistically and expertly serve seniors where and when they need it, creating new access and improved quality of care,” Bakshi said in a statement. “I proudly make the Welcome Health mission my own — to eliminate the health obstacles preventing seniors from achieving what matters most.”

Previously, Bakshi served as finance lead for the state-sponsored businesses at Healthfirst, one of New York’s largest health insurance plans.

BoldAge PACE promotes Dr. Glenn Meyers to CMO

BoldAge PACE, a provider of Program of All-Inclusive Care for the Elderly, has promoted Dr. Glenn Meyers to the position of chief medical officer.

“Dr. Meyers has been an invaluable member of BoldAge’s team,” BoldAge Pace CEO Mary Austin said in a press statement. “His experience and compassion have allowed us to help older adults live a meaningful independent life at home, with grace and dignity.”

Prior to the promotion, Meyers served as senior medical director at BoldAge PACE. One of his chief accomplishments has been standardizing the organization’s clinical operation.

As CMO, he will be in charge of implementing his model across BoldAge PACE’s sites in California, Florida, Illinois, Indiana, Kentucky, Ohio and South Carolina.

“I am honored to join a leadership team that puts people first,” Meyers said in the statement. “BoldAge PACE is a values-driven organization that exceeds expectations by providing more to our participants than I ever saw during my time in Medicare Advantage. Our participants rely on us to meet their needs, and we proudly fulfill that promise every day.”

Home Care Alliance of Massachusetts Board of Directors appoints new chair

Renee McInnes has been appointed to chair of the Home Care Alliance of Massachusetts Board of Directors. McInnes currently serves as CEO of NVNA and Hospice.

The Home Care Alliance of Massachusetts is a nonprofit trade association comprised of home care agencies.

Prior to her appointment, McInnes served on the board as vice president. She will lead the board’s vision and strategic policy.

“It is an incredible honor to take on the role of Chair of the Board of Directors,” McInnes said in a press release. “What the Home Care Alliance of Massachusetts does each day to promote access to care is extraordinary. I look forward to working together with the executive team as we advocate for patients and families in our state amidst the current health care challenges.”

Axxess names new chief operating officer

Axxess has named Tom Codd its chief operating officer.

In his new role, Codd will take the helm of the company’s global operations and will be responsible for driving continued growth.

“Tom joined Axxess two years ago as our first chief people officer and has done exceptional work growing our talent and ensuring we maintain our award-winning culture as we expand,” John Olajide, founder and CEO of Axxess, said in a press release. “His extensive leadership experience and years managing global activities has been invaluable to our growth. As he transitions into his new role, we are excited about the continued positive impact he will have on our ambitious plans.”

Axxess is a home-based care technology company that provides agencies with cloud-based software solutions. The Dallas-based company works with over 9,000 organizations that serve more than 5 million patients around the world.

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K2 HealthVentures and other existing investors – such as Rubicon Founders, Valtruis, HLM Capital and Oak HC/FT – also participated in the round.

HarmonyCares will use the money to expand to additional geographies and develop new technology to “drive clinical outcomes and patient satisfaction at scale.” The Troy, Michigan-based company is already in 15 states and cares for over 70,000 patients under Medicare Advantage (MA) plans and Medicare Accountable Care Organization (ACO) programs.

It provides in-home primary care, as well as home health care, hospice care, palliative care, radiology and laboratory services. Its physician-led care teams include nurse care managers, social workers, pharmacists and 24-7 on-call support.

“There is an urgent need to expand access to longitudinal care, particularly as many patients across the U.S. are already struggling to get the care they need,” HarmonyCares CEO Matthew Chance said in a statement. “This latest investment enables us to double-down on our commitment to expand access to value-based care for patients with complex clinical and social needs and who often have limited access to care, resources, or even family nearby.”

General Catalyst has invested in a wide range of health care companies over the years, including Homeward Health, another home-based primary care provider.

“Health care today lacks a platform at scale that comprehensively delivers services to our most complex patients in the convenience of their home,” General Catalyst Managing Director Chris Bischoff said in a statement. “HarmonyCares is well on this journey and actively manages our most vulnerable patients in an economic model where incentives are aligned. We are excited to welcome Matt and the broader HarmonyCares team to our Health Assurance ecosystem.”

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BrightSpring President and CEO Jon Rousseau discussed it as part of the company’s broader strategy at the Goldman Sachs 45th Annual Global Healthcare Conference Monday.

“Our playbook — which has been successful really now for over the last seven years — has been to drive volume growth, operational excellence, and then accretive acquisitions,” he said during the discussion. “On the volume side, we participate in very large growing markets, and so we like to focus on markets, on the provider side, that are growing at 6% to 8%.”

Based in Louisville, BrightSpring delivers care to patients in the home and in the community. The company focuses on complex populations, offering primary care, home- and community-based services, pharmacy services and rehab services to over 400,000 consumers throughout 50 states.

Rousseau called the three main pillars — volume growth, operational efficiency and accretive acquisitions — of BrightSpring’s overall strategy a “winning formula.”

What’s more, BrightSpring is looking to layer another growth strategy on top of the areas Rousseau outlined, and that is the company’s ability to provide value-based care. Home-based primary care will play a role in this effort.

“We have pharmacy, provider services and home-based primary care,” Rousseau said. “We are seeing about 400,000 people a day between our pharmacy and home health patients. That is just a tremendous amount of access to patients that are available to us, if we can serve them under our primary care, and serve them in a more attractive payer model. That’s a potentially really unique opportunity that we have into the future as well.”

On the M&A side, the company continues to prioritize proprietary deals.

“We tend to be a company that a lot of local owners want to sell to for the long term and be a part of our story for the long term,” Rousseau said. “A lot of our deals are proprietary, and then we bring our operational prowess and our scale, and our synergies to bear. We’ve typically been able to cut our acquisition multiple by about 50% to 100%. We usually get things onboarded within about 30 days, and the synergies come very quickly.”

Over the past five years, the company has completed nearly 60 transactions.

“Our acquisition strategy is to achieve three objectives,” Rousseau said. “Number one, to deepen and expand geographically. A good example would be, on the provider side, there are some CON states where you can’t participate without a Certificate Of Need. Number two, continuing to have a mix of our complementary services in each market and, and having those integrated care capabilities. Number three, just continuing to drive broad-based growth in the organization. There’s so much fragmentation in our markets and we can leverage our scale to a great extent by focusing on small transactions that fit those three.”

Ultimately, Rousseau believes that there’s an endless opportunity to complete accretive tuck-in acquisitions in the markets that BrightSpring operates in.

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In the first quarter, BrightSpring saw some mixed impact on EBITDA margin as a result of the company’s growing specialty oncology business. However, Jon Rousseau, president and CEO of BrightSpring, believes that the company is now in a stable position. He expects to see the margin go up throughout the rest of the year.

One of the factors behind this is BrightSpring’s home- and community-based services (HCBS).

“[In] home and community, we’re very focused on a number of procurement and operational initiatives as well, [and] we see about at least a point or 2% margin opportunity in those businesses over the next year or two,” Rousseau said Thursday during a discussion at the Leerink Partners Healthcare Crossroads Conference.

Based in Louisville, BrightSpring delivers care to patients in the home and in the community. The company focuses on complex populations, offering primary care, home- and community-based services, pharmacy services and rehab services to over 400,000 consumers throughout 50 states.

Rousseau also highlighted home-based primary care’s potential as a margin driver for BrightSpring.

“If we’re able to, ultimately, scale home based primary care — that’s a higher margin business too,” he said.

Overall, BrightSpring’s provider business has been a double-digit growth segment for the company. Rousseau called this characteristic of the broad based growth BrightSpring is seeing across the company.

“Home health and hospice grew near 10% in Q1, rehab grew well into the double-digits,” he said. “Community living and personal care — those are more Medicaid businesses, which have just been very steady for us, really good cash flow businesses. [It’s a] very nice mix of businesses, serving people in the home, on the provider side.”

Going forward, Rousseau identified home health, hospice and rehab as the main areas where BrightSpring expects to see the most outsized growth.

“We’re very optimistic that those businesses will continue to grow into the double digits for the long-term,” he said.

During the discussion, Rousseau also explained what he saw as the synergies between BrightSpring’s provider business and its pharmacy business.

“Most of our provider patients all get their pharmacy from our organization, so that’s a very meaningful synergy right there,” he said.

In 2023, a study published in the Journal of American Medical Directors Association found a 73% reduction in hospitalization for individuals who were receiving both home health care, and medication management from BrightSpring.

“I think that just shows the benefit of when people can address both their home health needs and their pharmacy needs,” Rousseau said. “Medication issues are one of the top two reasons why people go to the hospital … so addressing the pharmacy side of a patient who is high-risk is one of the No. 1 ways you can keep them out of the hospital and drive savings.”

Ultimately, BrightSpring sees the ability to drive home health referrals from its pharmacy customer base as a big future opportunity. Home-based primary care will also play a role in this as well, according to Rousseau.

“We’re putting care management resources to that and really the build out of our third pillar of home-based primary care was focused on driving more coordinated care, and driving more of these integrated care cross referrals,” he said.

The post BrightSpring Health Services Views Home-Based Care As The Key To Margin Uptick appeared first on Home Health Care News.

Both entities believe that joining forces will allow the combined organization to improve access to home-based care services, while also expanding services.

Ennoble Care provides hospice, palliative care and home-based primary care throughout the Northeastern U.S.

On its end, Clare Medical is a home-based primary care provider that operates throughout New Jersey.

Home-based primary care is at the center of both organizations’ care delivery models. This was one of the main reasons behind the merger, Kush Das, CEO of Ennoble Care, told Home Health Care News.

“We do the same kind of work for our patients, which is home-based primary care work,” he said. “It’s just really nice to find a fit, in terms of how we approach and deliver care, as well as the cultural fit. I got to know Ron and Deb, who run Clare, and we share a lot of the same values, so it made a lot of sense.”

The merger gives Ennoble Care full coverage across the New Jersey market.

“We cover all of the counties, and we cover them relatively densely,” Das said. “When a patient calls us, we’ll be able to see them a lot faster. It’s very different to serve certain parts of the more rural areas in New Jersey versus the more urban areas. Combined, our footprint is fully comprehensive. When someone calls us now in New Jersey, we will be able to serve them, which was the goal.”

The combination of the two organizations also means the patients will have access to a wider array of home-based care services. This is especially important because Ennoble Care often serves patients that have difficulties leaving the home.

“Our patients are often homebound, they often have trouble getting around,” Das said. “We’re providing the kind of access that makes care as seamless as possible, which lowers the barriers to entry to seeking the kind of primary care that’s needed. We know that in the U.S. the wait time to see a primary care doctor is sometimes months long. That’s the thing that we also are trying to fix — the quickness of care delivery.”

Upon completion of the merger, Ron Lipstein, CEO of Clare, and Deborah Scott, director of operations of Clare, will lead the Company’s regional housecall operations. Das and the current Ennoble leadership team will continue to lead the broader company across service lines

“We are excited to join forces with Ennoble to form what we believe will be the leading in-home primary care provider in New Jersey,” Lipstein said in a press statement. “Together, we will leverage our combined expertise to meet the evolving needs of our patients and ensure that every patient receives the highest standard of care.”

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“We’re like the advocate and navigator … when you’re building a home, you’ve got plumbers, you’ve got electricians, you’ve got masons. You’re not an expert, so you hire a general contractor to figure all that out. We can fill that role for the consumer,” WellBe Senior Medical CEO Jeff Kang explained during the latest episode of HHCN+ TALKS.

Kang is the former CMO of the Centers for Medicare & Medicaid Services (CMS). Since his time with the agency, he’s worked with payers and providers. Now, he’s bridging the gap between the two with WellBe.

The Chicago-based WellBe offers home-based medical care services to patients who are facing multiple complex health challenges. It is backed by the private equity firm Chicago Pacific Founders.

Kang sat down with HHCN to talk about the current state of home-based care, what providers can do to enhance their value proposition and much more. Highlights from the conversation are included below. View the episode here.

HHCN: I would love to talk about your background, because I think it’s a pretty unique one. Could you take us back to your days at CMS, and even before that?

Kang: 40 years ago I was a geriatrician up in Boston, and actually did home visits before anyone ever knew what a home visit was. For about 10 years, I was running a group practice, doing that, caring for people in nursing homes, in the home etc.

Then, as you said, I went to CMS. I was the first and longest-serving chief medical officer at CMS. I actually was responsible for the conditions of participation, so we regulated the home health agencies.

From there I went to Cigna for about nine years, so I certainly understand the health insurance side. I was their chief medical officer.

Then I went to Walgreens, where I ran all their clinics. They had about 800 clinics around the country. I learned about consumer health and consumerism from a retailer.

Then I went to ChenMed, a private medical group that takes care of the elderly patients and they deliberately locate their clinics in low income areas. Now, I’m CEO of WellBe Senior Medical, which we’ll get into. I’ve seen health care from the retailer’s perspective. I’ve seen it from a health insurance perspective. I’ve seen it from a federal perspective. I’ve seen it from the provider perspective, certainly in the home.

How do you think home-based care, in general, has changed since your time at CMS? Obviously, COVID accelerated things, but where have things changed and where have things stayed the same?

I was at CMS from 1995 to 2002. Let’s go by segment or sector.

Home health agencies existed then, and it was covered by Medicare. I think the big difference between then and now was the implementation of OASIS, we actually did the rules for that. It basically changed home health from a fee-for-service per-diem model into a bundled or capitated model, similar to a hospital DRG episode. I think that was a big change for home health agencies.

When I look at home care, or personal care, that largely hasn’t changed. The issue there has been, who’s going to pay for it? The big difference, probably, in the last maybe 10 to 15 years is that Medicaid, state agencies, have actually started paying for it, as part of an effort to keep people out of nursing homes and in the home. You can get personal care assistance in many states, not all states. The goal there is to provide those personal care services to keep people out of nursing homes.

Durable medical equipment in the home is largely unchanged. Home infusion has changed a fair amount because there are more drugs that can be delivered at home. Otherwise, from a reimbursement perspective, it hasn’t really changed that much.

Hospice in the home has not particularly changed that much. There have been some variations around cost qualifications, how to get into hospice and how long you’ve been in hospital, but in general, not much. That’s from a traditional Medicare perspective.

There has been an increasing amount of efforts by Medicare Advantage plans to step up and provide what they’re calling transitions of care programs, or post-acute care programs. Basically, following the hospitalization if someone doesn’t qualify for skilled home health, but they still need some transitions of care support. The last big change, which is fairly recent – let’s call it the WellBe Senior Medical model – is primary care or longitudinal care in the home. It’s difficult to do in Medicare fee-for-service. It can be done, but I think that’s largely accelerated by Medicare Advantage plans.

A long time ago, home-based primary care was the norm. Then for a while it went away because it was more viable if 15 or 20 patients came into one place, as opposed to you going to all of the patients. What made that viable again, as a business model?

If you look at Medicare fee-for-service reimbursement, in order to economically make home-based primary care work, back then, you would have to do maybe 12 visits a day. This is a little difficult with the drive times and everything.

Under current Medicare rules, you might be able to get around eight to 10 visits a day because now Medicare’s starting to pay for care coordination visits and post-hospitalization visits. The big difference for WellBe is that we are only doing four to five patient visits a day. That’s because the patients who are really sick, they really need it.

The big difference is the introduction of a value-based model. We are not actually dependent on fee-for-service billing. We are, essentially, both the provider and the payer. We’re economically responsible for the hospital bills, the radiology bills, the specialist bills. That’s a value-based model or a full risk model. We can make it work because we’re prepared to spend the time with the patient and keep them healthy and out of the hospital. We make money by keeping people healthy and out of the hospital. It’s completely flipped. In the fee-for-service world, you make money by just seeing as many patients as you can a day, but that’s not necessarily good for the patient.

When you’re in a value-based care model, you’re not worried about increasing utilization too much, because you’re doing it for the patient. You’re not worried about overutilization or underutilization.

It’s interesting, people do get a little more worried about underutilization. A lot of health policy experts will estimate anywhere from 40% to 60% of the care that’s occurring in this country is either unnecessary, avoidable or due to error. We’re really not at risk of doing too little care. From our perspective, the goal is to provide as much primary care as possible for the avoidance of multiple emergency room visits, multiple hospitalizations.

Last time we spoke, you wanted WellBe to be the general contractor of home-based care. Can you explain what you meant by that?

From a consumer’s perspective, there’s skilled home health, there’s home care, DME, home infusion, hospice, Meals on Wheels. It’s a plethora of things. The challenge, from a customer’s perspective, is how to orchestrate and organize. Many of these things actually need a doctor’s order. For personal care, you need a functional assessment from a physician to qualify.

In many ways, groups like WellBe are essentially that physician, nurse practitioner, quarterback. I use the word general contractor. We’re like the advocate and navigator, out of all of those things that can be done in the home. When you’re building a home, you’ve got plumbers, you’ve got electricians, you’ve got masons. You’re not an expert, so you hire a general contractor to figure all that out. We can fill that role for the consumer.

Joining with primary care providers, whether it be regular primary care or home-based primary care, seems like an option for home health providers to start dipping their toes into risk.

I think that’s correct, but I will just say it’s going to take a while.

In Ohio, for example, we have 30,000 members or so. From a home health agency’s perspective, that’s just a really small drop in the bucket of the available lives, or members, that they’re trying to serve. I don’t think, right now, we’re large enough to have a really exclusive arrangement and make it worthwhile for a home health agency.

I think there is an opportunity for home health agencies to get in this value-based world. There’s this concept in value-based care of an episode. When you think about it under the Oasis, payment, that’s an episode of care, post-hospitalization. One of the potential outcomes of that episode of care is if you do a really good job, you can actually lower hospital readmission rates. I do think there are opportunities for home health agencies to basically say, if we can lower your hospital readmission rates, let’s actually gain share in some of those savings. I think there are home health agencies that are beginning to move in that direction.

What do providers get wrong sometimes about the way payers think?

I’m not sure they get it wrong. I think it’s a little more of trying to figure out how to best kind of talk in their language. It’s trying to figure out the outcome that the payers really care about. From a home health agency perspective, they care about readmission rates and lowering that, so that’s an opportunity.

From a personal care standpoint, there’s been a lot of progress here because the payer there for a lot of this is Medicaid. They care about keeping people out of a nursing home. If you’re going to work with the Medicaid payer, you’d say your nursing home rate admission rate is Y. We start serving the patients and can reduce that by 10%. Is there an opportunity then for [the home care provider] to share in some of those savings?

It’s more about figuring out what the payers really care about and then helping them solve that problem.

Do you have a prediction for the next five years for the home-based care space at large?

Lots of new entrants coming in, which is good. I think everyone deserves a WellBe-like model whether we’re delivering it or someone else is delivering it. I think there are many of our fellow companies that are also going into Medicare fee-for-service, but they’re doing it through the ACO REACH program. That makes a ton of sense. We’ve decided not to do that, but at some point we may come around to that. I do think applying this model to adult Medicaid, in particular the long term-care population, makes a ton of sense.

The post WellBe Senior Medical CEO On Demonstrating Value To Payers In The Home appeared first on Home Health Care News.

Case in point, Patina Health has a specific strategy when it comes to delivering at-home primary care. Targeting and taking care of adults 65 and older is at the core of Patina Health’s mission as they try to take advantage of the opportunities in the post-acute space as traditional health care systems struggle to meet the needs of this population.

“To be blunt, health care is not age-friendly,” Patina Health Chief Health Officer Dr. Neil Patel told Home Health Care News. “Health care is built for all ages. Society is not age-friendly. We forget about how needs are different. We forget about the values and preferences that people earn after eight decades of life, and how those values and preferences actually make for very different decisions than what the textbook might suggest.”

Patina Health is a Philadelphia, Pennsylvania-based home-focused primary care medical practice.

Patel reiterated the approach his company takes by catering to what he says is best and most convenient for the patient — care in the home.

“Older patients will get better care when they lead their own care, when they’re seen and heard for their own wisdom and preferences,” Patel said. “The place where they’re most likely to produce that data, for me, is in the home. At home, patients are better leaders of their own care plan.”

This “pivotal moment” for primary care coincides with a paradigm shift towards home-based care. Traditionally esteemed for its value, primary care’s practical application has faced economic challenges, leading to its decline, Patel said.

However, in tandem with evolving medical trends like value-based care and heightened patient-centricity, the importance of primary care — particularly in the home setting — is being rediscovered.

“On one hand you have this universally-lauded thing that the best of us have been able to do for a long time,” Patel said. “And it’s old fashioned. The idea of a house call was the only way medicine was done. At the same time, there’s this trend that Patina is a part of where we’re realizing that model was never meant to go away. We can do it and we can do it better, and we can do it differently.”

A main driver of Patina Health’s success in recent years are the partnerships it has cultivated — from United Healthcare and Cigna (NYSE: CI) to Aetna and Independence Blue Cross in Philadelphia.

At-home primary care patients need things from different sources, Patel said, and building a strong throughline from health system to patient has been a key focus over the last few years as more care moves to the home.

“Primary care, to me, is your partner in understanding your own health and well-being,” Patel said. “Where you want it to go and how to get it there. I can do a lot for you. I can prescribe your antibiotic, I can do your refills, but I can also curate your referral when you need something. I can refer you to a specialist in medicine or to a marriage counselor, or I can connect you with a transportation benefit. We see ourselves as being that curator to the patient to help them connect with all the partnerships they need — both internally and externally.”

Building the trust of payers is another crucial aspect of increasing access to care for patients. While negotiating with payers, Patina Health has also found success in eliminating financial barriers to access like copays, particularly in Medicare Advantage plans, as a way to be more accommodating to patients.

By partnering with payers, Patel ensures that financial considerations do not hinder patient access to care, leading to happier and healthier patients, he indicated.

Patel also argues that accessible primary care enables providers like Patina Health to engage in ongoing conversations with patients, adjust treatment plans as needed and deepen trust, ultimately leading to better outcomes.

Trust is the currency Patel and his team negotiate with, he told HHCN.

“It turns out that one of the biggest gatekeepers to access is the payer,” Patina said. “When I have a successful relationship with a payer, that gives patients access to me and it allows me to practice my craft. Money is a part of that. There’s no access if you can’t afford it. The resistance to get rid of the copay for primary care has melted away over the last 15 years so I think the world has caught up and realized that primary care is just so valuable. It certainly pays for itself.”

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