Home-based care leaders are gaining some gusto. They are at the helm of the organizations that should, theoretically, be the beneficiaries of an overload of demand over the next decade.

In the past, providers have pleaded for a “seat at the table” in the health care continuum. But, to a certain extent, they now hold the cards.

That may not always be evident, particularly in conversations with Medicare Advantage (MA) plans and the Centers for Medicare & Medicaid Services (CMS).

But with the right tools and strategy, providers have the leverage to potentially change the course of those conversations, and also vouch for themselves on much higher ground.

“I think all of us would love to see this industry mature and take hold of the advantage that we’re creating for the U.S. health care system and for Medicare Advantage payers,” Compassus CEO Michael Asselta told me on stage Thursday at Home Health Care News’ FUTURE conference in Nashville. “But there’s a maturation that we all have to undergo to capture that opportunity.”

What home health providers need to do to mature, and what that maturation could lead to, is the topic of this week’s exclusive, members-only HHCN+ Update.

A maturing industry

On the first panel of the FUTURE conference Thursday, the home health leaders on stage stripped themselves of the woe-is-me mentality that can sometimes hamstring the industry.

Asselta – who is relatively new to the industry, having joined Compassus in May – acknowledged the gap between providers and the significant opportunities that could be waiting for them in the near- to long-term future.

One of the first recommendations that he had was building out what he called “wraparound services” in addition to home health care.

“These recurring hospital visits are very expensive,” Asselta said. “Managed care understands this already, and they’re willing to reimburse us. So we have to ask. We have to build and ask. We have to weave things together a little differently for traditional Medicare, and that is providing reimbursable services under our umbrella. That means expanding, it means growing up quite a bit, and that’s sort of a theme we’ve heard, too.”

Based in Brentwood, Tennessee, Compassus provides home health care, home infusion, palliative care and hospice care. It has about 7,000 team members and more than 270 “touch points” across 30 states.

Outside of wraparound services, Axxess CEO John Olajide acknowledged the need for providers to collect and utilize data in a more practical manner.

“You cannot accomplish what you want with the payers – or whoever the stakeholder is – if you don’t have data. And to have data, you need to have the right technology,” Olajide also said on stage. “If there’s not a large data set, there’s not a lot of information to leverage in [those conversations].”

Founded in 2007 and based in Dallas, Axxess is a home health technology company.

Gentiva CEO David Causby offered up an example.

The company’s home-based palliative care business can take a payer’s most at-risk patients, which readmit to the hospital at a 30% clip, and get that number down below 10%, Causby said.

That ability, plus the data, creates leverage.

“For the industry to continue to move forward, … I think you have to scale companies,” Causby also said on stage. “You’ve got to be sophisticated. You’ve got to have a playbook on effective and efficient operations. You’ve got to be innovative. You’ve got to have data.”

Based in Atlanta, Georgia, Gentiva provides palliative care, hospice care and other home-based care services via about 600 locations across 38 states.

“You’ve got to stop being the downstream, waiting for the phone to ring,” Causby continued. “Move up, and truly show the value add. There’s no doubt, over the next 30 to 50 years, this will be the fastest-growing sector in the health care space. For those that are willing to get out there, get after it, do it the right way, be very fundamentally sound in how you operate and take the lead on innovation, technology and analytics – those are the people that will be successful in this space.”

Home-based care providers are in the right business, the right setting. But that alone won’t be enough.

Providers across the home-based care continuum need to take the next step.

“We need to continue to press for a discussion around what leverage we’re bringing to the managed care payer,” Asselta said. “Can we collectively, as an industry, start to say, ‘Hey, look, if I deliver X results, you can hold me accountable for Y. And I don’t know if we’re going to be able to change the narrative until we’re unwilling to take rates that don’t reflect the value that we provide.”

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In the spring, it completed an affiliation process with Trustbridge, which formed the largest nonprofit post-acute provider organization in the state of Florida.

The Clearwater, Florida-based Empath Health offers hospice, home health care, palliative care, grief services, Program of All-Inclusive Care for the Elderly (PACE), adult day services, primary care services and more. It is the parent company of 17 affiliates and two philanthropic foundations.

On its end, West Palm Beach-based Trustbridge offers palliative care, hospice care, support services, pharmacy services and durable medical equipment.

Since completion of the affiliation process, the company has focused on integration, synergistic opportunities and determining how best to deliver care to the communities it serves.

One of the people at the helm of this transition is Tarrah Lowry, Empath Health’s chief operating officer and Trustbridge’s interim president. Home Health Care News recently caught up with her at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference in Las Vegas.

During the conversation, Lowry provided an update on integration efforts, industry challenges and how the combined companies are now better equipped to take on these pain points.

HHCN: We are at NAHC FMC, so I have to ask, what are the biggest financial or operational challenges for home health providers right now? How are these pain points impacting Empath Health specifically?

Lowry: One of the things, being in Florida, is that pre-claim review has just been extended. That just adds more work and time to all of our claims before they go out. Just getting paid by everyone that you’re contracted with is huge, and then also just the auditing processes that go on.

How is Empath Health navigating these challenges?

One of the things that has been wonderful is we’ve brought together all of the different organizations that have come together as Empath health, so we’ve got a lot of talent. We’re really picking from all of the organizations where someone has a lot of experience with billing, and we have wonderful financial staff that are looking through things and keeping us going.

What impact has the completion of the Empath Health, Trustbridge affiliation process had on the company? What has that experience been like?

Anytime organizations come together, you’re merging cultures. I think that one of the greatest assets is the culture at Empath Health, and the one at Trustbridge, really merge well together.

Culturally, we’re a great fit for one another, and we’ve got a lot of talent on both sides. Being able to bring everyone together has been wonderful. Anytime you bring organizations together, there’s always growing pains of getting everyone on the same systems, adopting the same policies and procedures, all those things that are kind of done in the background. There is a lot of work that most of the colleagues, probably, don’t see happening. But it’s been a very positive experience so far.

Where are the biggest opportunities for collaboration between the Empath side and the Trustbridge side?

Trustbridge was a very large hospice and palliative care provider on the east coast of Florida, but that was all of the service lines that were being offered. Empath Health has the whole care scope of all different types of services. Trustbridge was super excited to be able to learn more about those types of things and bring some of those into our markets.

We were selected to be a part of the GUIDE Model program with CMMI. We have a whole team that’s working on getting that going, and figuring out which areas that we serve would be the best to start that in. There’s so many people that are living with dementia, and they have a lot of needs. We’re very excited that CMMI has come up with this program.

Talking about the affiliation process leads me to ask: What’s Empath Health’s appetite for M&A these days? Is the company open to pursuing deals, and if so, what are you looking for in terms of acquisition targets?

We’re looking at the full life care continuum, and we’re trying to see what the needs are of all of these patients. So we’re very open to new business partners and new ideas.

A good example would be, we have PACE programs. We are now doing the GUIDE Model program. We are just starting a partnership for I-SNP. We’re really looking at how we can best care for people where they are, and at the level of care that they need during that time.

We would be open to expansions, but it’s really based on what the needs are in the communities we serve. We’re not wanting to just grow, just to grow. We’re really trying to be thoughtful of which communities need our services. We’re not necessarily setting out to be the biggest — but we do want to be the best.

Looking ahead, what are going to be the biggest financial drivers at Empath Health over the next few years?

For home health, we are being very deliberate in our growth and the communities that need our services. Empath Health is a four star home health provider, and we’re very proud of that. We have a lot of opportunities to partner in different communities with some of the hospitals, they’ve asked us to be their preferred provider. There’s a lot of activity going on, but we’re trying to be very deliberate.

What are some of your goals for the rest of the year?

We are just right on the heels of the merger with Trustbridge, so our biggest goal is still integration — integrating our cultures, integrating our colleagues, so that everyone feels a part of Empath Health.

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“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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“We’re in the Medicare-certified home health business, and we’re in the private-duty business, and we’ve had palliative care for a very long time,” she told Home Health Care News. “But what we’ve been working on at Alivia is a more comprehensive solution.”

Jacksonville, Florida-based Alivia Care provides home health care, hospice care, personal care, palliative care, advanced care planning and Program of All-Inclusive Care for the Elderly (PACE) services across Northern Florida and Southern Georgia.

At Alivia Care @ Home, a more comprehensive solution means patients having the opportunity to take part in a goals of care discussion, while simultaneously receiving care.

“We really wanted to develop something where we could begin to assess, while delivering excellent home health care, if it’s time to perhaps do a goals of care discussion, and bring in our palliative team,” Ponder-Stansel said. “Whether or not the person ever wants hospice, or needs anything more from palliative care, it’s an opportunity to hear more about the stage of their illness, ask some questions and get some good information.”

The main impetus behind the program was the company’s discovery that roughly 55% of patients who are receiving Medicare-certified home health are also going to be hospice appropriate within a year, according to Ponder-Stansel.

The idea behind Alivia Care @ Home is that there is no wrong door for patients to enter.

“We may interact with them at different stages of their illness, or in different ways,” Ponder-Stansel said. “Each service stands on its own, but then for patients who really need more of a progressive system, more help, they can be put together in a way that meets the patient’s needs differently, than just say, episodic care for home health, which we do too. This is just a novel way to put them together in a manner that follows the patient and really meets a gap in care right now.”

Currently, each service has its own revenue stream, but Ponder-Stansel says that Alivia Care @ Home was designed with future value-based care goals in mind.

“If we’re in that space, where we’re working with an existing ACO to help take over the management of their high needs patients — because that’s something that a lot of the general track, REACH ACOs struggle with — then this is the exact kind of solution that would be able to not only get excellent outcomes for the patient, but also help you with any-value based or risk-based reimbursement,” she said. “Because you’re avoiding events and costs that really don’t improve the patient outcomes through this care navigation.”

Ultimately, Ponder-Stansel believes that there’s an opportunity for home health providers, that also have hospice under their belt, to train their home health staff on what progressive illness looks like.

“I think all of us along the continuum are focused very much on preventing readmissions, and really helping patients not have to go back to the hospital,” she said. “If we’re just doing episodic care, and just thinking transactionally, we may miss the fact that somebody we’re caring for is at the stage where they do need some help understanding they have another choice, and how to find that resource. I just think it’s a great opportunity for some great training.”

The post With Eyes Set On Value-Based Care Success, Alivia Care Introduces Alivia Care @ Home appeared first on Home Health Care News.

Part of that conversation with hospital and health system partners includes convincing case managers that patients will be better suited at home.

“The longer a patient lays in a hospital bed, I’m convinced that it catches on fire,” Choice Health at Home CEO David Jackson said at the Hospice News/Palliative Care News Palliative Care Conference in Tampa, Florida. “Our mission is the pursuit of excellent health care in the home. Our value prop to hospitals when promoting palliative care is, ‘We want to continue these difficult conversations in a less stressful environment.’”

The Tyler, Texas-based Choice Health at Home is a home health, hospice, rehabilitation and home care services provider that operates mainly in Texas, as well as Louisiana and Oklahoma.

Showing value to health systems and hospital partners at the top of the health care ecosystem has been a main focus for Jackson and his staff as they continue to build out the fill care-at-home continuum.

Choice Health at Home is in a position to have those conversations with referral partners and has the bandwidth to make the transition to the home more manageable.

“If you discharge out into our organization, these are the things that will happen,” Jackson explained. “We will strive to integrate a nurse practitioner group that can actually go out and have a controlled conversation for four or five hours with the family. An MSW is going to engage and continue to continue to try to provide additional resources for this complex patient. We want to be an extender and that’s a value prop that we can provide because the systems — in most cases — don’t have the resources to do that part of discharge.”

Once referral partners understand what at-home palliative care can bring to the table and what the comprehensive care plan looks like, doors open, Jackson said.

Another key value prop that palliative care offers is as a bridge in the continuum of care. It’s always patient-specific and when done correctly, meets patients where they are.

“Palliative care is not a one-size-fits-all type of service,” Kaiser Permanente Senior Director of Hospice and Palliative Care Gina Andres said. “But it does meet the needs of patients wherever they’re at in that continuum. We really focus on giving the right care at the right time in the right place.”

Kaiser is one of the largest health systems and medical groups in the country. Its health plans cover over 13 million people across eight states.

Its home-based care network is made up of about 26 agencies, including companies like LHC Group, Bayada Home Health Care and Pavilion Medical Home Care & Staffing.

Some patients will need palliative care services in a traditional setting. Others will use it strictly as a bridge to hospice, Andres said.

However, it can also be used with a more innovative approach in addressing the gaps that exist in the care continuum.

“I think there’ll always be a need for inpatient palliative care,” Andres said. “But if we touch the patient in outpatient palliative care and we’re giving them education and information and support, it prepares them as they go down the line in their serious illness and need care at home.”

It can also be a lifeline for both patients and caregivers who are going through a new and oftentimes confusing process.

“For the caregiver and the patient, palliative care is such a gift,” Andres said. “There are so many patients that are not ready for hospice, either physically or emotionally or for whatever reason. The number one thing we see with patients and families is a lack of caregiver support and a lack of knowledge. There’s nothing like palliative care for these patients because if they don’t have palliative care, they fall through the cracks. And then what happens? They wind up with unnecessary hospital stays.”

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Their experiences underscore the importance of finding advocates within partner organizations and embracing patient-centered models.

While the journey towards palliative care integration may be slow for some, its transformative impact on patient experience and efficiency is becoming increasingly evident.

“It’s easier to remain in your own silo,” Tiffany Hughes, COO PalliCare Inc., said at the Hospice News/Palliative Care News Palliative Care Conference in Tampa, Florida. “I saw that [mindset] coming from hospice where it’s the perfect model of care because you control everything. When you start adding in different elements and add more hands into the pot, it gets more complicated.”

Providers who are integrating more models of care into their operations are showing that – in general – the juice is worth the squeeze.

PalliCare Inc. is a Texas-headquartered palliative care provider. In order to integrate successfully, Hughes has found that finding a partner who is willing to advocate for that new service line is key.

“Having a champion in what you’re doing is so important for us,” Hughes said. “We partner with physician groups and we’ve found that having an advocate within that health group has been really beneficial. Having a collaborative approach but having a leader in that group that can advocate for palliative care and really push this along has helped us in the decision-making process.”

By integrating palliative care, home health providers can enhance their care models to focus more on the patient and cater to more of their needs.

When Alex Binder – vice president of Parker Advanced Care Institute – was first introduced to palliative care, he didn’t know it had a specific name.

“I went on some house calls with a colleague and I was involved in some of the training to try to bring people up to speed,” Binder said. “What I saw was this comprehensive, holistic, highly communicative medicine. I just assumed that’s what medicine was. If you’re taking care of an elderly homebound patient you have this certain level of communication, you ask them questions and you develop a care plan that’s in sync with their needs.”

Parker Advanced Care collaborates with physician practices for a comprehensive home-based primary care program while also running a specialized consultative palliative practice. The company also offers palliative care training to clinicians across all its service areas.

While experts like Hughes and Binder are more familiar with palliative care integration, it has taken others longer to get on board. That includes everyone from health system executives, to nurses, to patients.

However, when they finally do get on board, people seem to catch on rather quickly.

“We have nurse practitioners that come from totally different backgrounds that have embraced palliative care,” Hughes said. “Because what palliative care is is what they’re missing in their clinic or their hospital where they have said it feels like patients are put in the system like cattle. It’s beneficial to the patient when they are more of an advocate for their care instead of being stuck in this health care hamster wheel.”

Patient-centered palliative care is also an accountability tool that can be used when focusing on the entire care continuum, Binder said.

“If you’re being held accountable for the total cost of care, you need to know where your patient is, when they went to the hospital, etc.,” Binder said. “As difficult as it is and as radical of a concept as accountability and ownership of the patient. It’s me saying, ‘I will take ownership of that patient, I will make sure that their care is appropriate in all these settings and I will be held accountable for those outcomes that quality and those costs.’ I think that’s a really efficient business model.”

The post The Benefits Of Integrating Palliative Care Into Home-Based Care Programs appeared first on Home Health Care News.

As more care expands into the home, a pharmacist’s role in that village is only going to get more necessary.

“Hospitals typically provide patients with a medication reconciliation sheet upon discharge, but there’s often a discrepancy between the medications listed on this sheet and what the patient is actually taking,” Mary McPherson, professor and executive director of the advanced post-graduate education in palliative care program at the University of Maryland School of Pharmacy, told Home Health Care News. “This gap can lead to errors in the medication regimen when patients transition to home care. To address this issue, it’s crucial for home care providers to conduct thorough medication reconciliation upon admission and to follow up within a week to ensure accuracy.”

Ensuring accurate medication management in home care involves more than just reviewing a client’s reconciliation sheet, McPherson said. It requires asking probing questions to uncover any overlooked or omitted medications and conducting a comprehensive medication review with patients.

Involving pharmacists as part of the care coordination team in home care is a valuable addition, and something more providers should consider, McPherson believes.

That’s especially the case as patients continue to be more complex and receive more acute levels of care in the home.

“I think one of the biggest issues is polypharmacy,” McPherson said. “Which is essentially when someone routinely takes five or more medications a day. Some patients are taking up to 25 medications daily, often in multiple doses. It’s impossible to keep them all straight. The more medications a patient has, the higher the risk of an adverse effect or a drug interaction. Whether it’s a home care or hospice patient, it’s really important to have goal-concordant prescribing.”

In other words, the prescribing should be aligned with a patient’s goals.

Pharmacists can also identify drug-related problems that frequently arise in home care settings.

These problems include drug use without indication, inappropriate drug selection, need for additional drug therapy, overdose, underdose and adverse effects, among others. Pharmacists play a key educational role in the care continuum and should be utilized to the best of their abilities.

“The pharmacist is the most readily accessed health care provider of all because you can walk into the pharmacy and it’s free,” McPherson said. “The pharmacist has the most face-to-face time with patients, families and caregivers. I think pharmacists have a huge role to play in educating people.”

Involving pharmacists in the care team can also provide valuable support through their availability for questions, participation in team meetings and helping with staff education and patient materials.

These practices can improve medication management and reduce the risk of errors during transitions of care in home settings, McPherson said.

“Overall, there’s a significant need for education and support for patients, families and caregivers to navigate the complexities of medication management and ensure the best possible outcomes,” McPherson said. “I do think it’s important that home care agencies, hospice agencies and other post-acute providers should always have a pharmacist in the loop.”

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That’s according to a recent study conducted by the West Health Research Institute of Blue Shield of California.

“Home-based palliative care is a powerful tool to improve the care of seriously ill members who struggle to have their health care needs met in the doctor’s office,” Jenelle Hallock, senior manager of growth and health solutions at Blue Shield of California, told Home Health Care News in an email. “The care is not only aimed at managing a member’s symptoms, but also provides emotional support and addresses social needs that can interfere with the ability of a member to access services. High-quality home-based palliative care shows promise in reducing hospital and emergency department utilization.”

Palliative care, generally, is specialized medical care focused on providing relief from the symptoms, pain and stress of a serious illness. Many home health agencies offer palliative care services, but they typically have been hard to manage financially. With the emergence of value-based care, that is beginning to change, however.

Amedisys Inc. (Nasdaq: AMED), AccentCare and Gentiva are just a few of the larger home health agencies offering palliative care in the home.

The objective of the study was to assess whether acute health care utilization and costs decreased after members were enrolled in the health plan’s HBPC program.

By using claims data for over 2,000 patients between 2017 and 2019, Hallock and her team were able to find that members enrolled in the HBPC program had fewer visits to the emergency department and fewer total hospitalizations during the study period compared to before the program started.

Additionally, the cost of care per member, per month was lower during the study period compared to before the program began — $2,746 after the study and $3,996 before.

Beyond hospitalization rates and total cost of care, the difference in mortality between the two groups came close to reaching statistical significance. There was a slight trend that indicated patients lived a longer life in the HBPC group, but the difference was not statistically significant, Hallock said.

The study’s authors did point out some limitations of the research. For instance, the study did not measure health care utilization and costs during the last six months of life — a period when costs typically rise. This limits the study’s ability to analyze potential cost savings associated with palliative care.

“There is a trend toward greater utilization and cost reduction for members in home-based palliative care, but further research is needed to fine tune the intervention and determine if this trend will become statistically significant,” Kim Bower, medical director at Blue Shield of California, said in an email. “There are also some indications from the study that home-based palliative care may extend a member’s life, but this also requires more research to understand the true impact.”

If palliative care were found to extend life, Bower added, it would reinforce that this type of care is “not only patient centered, but also truly improves quality.”

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As the demand for home care grows, so do the industry’s largest providers. In particular, franchises are expanding rapidly across the country, adjusting operations slightly along the way.

BrightStar Care and Griswold Home Care are two examples of that growth. Both companies earned spots on Franchise Times’ annual ranking of the largest franchise systems in the country.

This year, BrightStar Care signed almost 40 franchise deals, and 17 owners expanded into 28 new territories across the U.S.

“It’s a year where we welcomed a lot of new franchisees on board, but we’ve seen a lot of our existing owners expand,” Pete First, chief development officer at BrightStar Care, told Home Health Care News. “That’s a strong testament to the brand and to where things are going in the future.”

Chicago-based BrightStar Care is a provider of home care and supplemental staffing. The organization has more than 380 locations nationwide. It also has a senior living portfolio.

On its end, Griswold Home Care saw 12 franchise sales in 2023, and expanded into five new territories.

“We’ve exceeded our goals in network same-store sales and year-over-year growth,” Griswold CEO Michael Slupecki told HHCN. “We look at growth in two different ways, the top line, with the network as a whole. We also look at the percentage of the network that grew year-over-year versus the percentage of the network that had a decline year over year. We were happy to have exceeded our goals.”

The Blue Bell, Pennsylvania-based Griswold provides home care services in 30 states. The company has more than 160 locations.

More than half of Griswold’s new franchise sales have been in the state of California. It’s a market that is considered both fruitful and challenging due to its wage and hour laws, according to Slupecki.

“It’s the sixth or seventh largest economy in the world, and there’s certainly a vast population of seniors that need our services,” he said. “We can’t just shy away from business climates that are challenging. We just have to figure it out, and be there for our clients.”

In general, the regulatory climate and senior population are factors that weigh heavily on Griswold’s decision to pursue expansion in a specific market.

Additionally, the company has seen the value in focusing on what are known as “secondary markets.”

“We prefer a secondary market over what some people call a primary market,” Slupecki said. “We see a lot of saturation in the major metropolitan areas, so focusing on smaller markets is appealing to us.”

For BrightStar Care, its entrance into new markets has been the result of research and strategic planning.

“We look at the demographics and where the demand is,” First said. “We have key markets and key states, like Washington State, that we’re looking to expand into. We also take a network strategy approach – [we look at] franchise development, look at the open markets, and we also work with our national accounts team, and we work with our operations team.”

BrightStar Care’s growth coincides with its focus on clinical outcomes data.

“It has allowed us to really prove the outcomes of what we’re able to do, and that continues to attract interest from not only consumers, but other payer sources from national accounts,” First said. “Being able to provide some of these clinical studies that we’ve done has given us an advantage, and our franchisees an advantage, because we can actually prove what we’re doing. That’s provided a lot of opportunity for growth.”

At Griswold, much of the focus has been on rebranding to embrace innovation.

“We felt like our other former brand was a little bit dated,” Slupecki said. “How could we talk about being a forward-thinking innovative company, when you look at the brand and it looks a little bit dated?”

In particular, Griswold has increased focus on things like caregiver engagement utilities and client monitoring technologies.

More broadly, Slupecki also believes that the company has “a different level of energy” in recent years. This has translated into a slightly more hands-on approach with the company’s franchise owners.

“Every franchise is an independently-owned and operated business, so each franchise could have something that’s specific and unique to them that’s either helping them grow or holding them back,” he said. “Our operations team is really problem solving, and helping them optimize their business.”

In addition to its franchise locations, BrightStar Care also has a number of company-owned locations. These locations continue to be a vital tool when it comes to testing new technologies, marketing strategies, payer sources and more.

One example of this is BrightStar Care’s ability to test automation and AI.

“We’ve been able to integrate and test some of those features, which are going to provide great benefit for new franchisees, whether they have one location, or they have multiple locations,” First said. “It’s about being able to streamline and become more efficient with some of the day-to-day tasks.”

BrightStar Care still sees some key markets in both the Northeast and the Midwest.

“Even though Brightstar care has been around for 20 years, we still have territories that are available and open where we know that providing new franchisees into that market will be a definite asset to the community,” First said.

Ultimately, Griswold is looking to continue raising the bar at its organization.

“Resetting the expectations around care and delivery of services — making sure we’re all aligned in what we’re trying to do – is critical,” Slupecki said.

The post ‘Can’t Shy Away From Challenging Business Climates’: Griswold, BrightStar Care Share Top 2024 Priorities appeared first on Home Health Care News.

The latest use of that name is through the newly established Gentiva, which is a home-based care provider formed out of the divested assets of what used to be Kindred at Home.

When Humana Inc. (NYSE: HUM) completed its acquisition of Kindred at Home – now CenterWell Home Health – it divested the personal care and hospice assets to the private equity firm Clayton, Dubilier & Rice. That formed the standalone company Gentiva, which is led by former Kindred at Home CEO David Causby.

The new company has an end-of-life focus, and it is also leveraging palliative care – a service line that’s beneficial, but hard to make work – as a differentiator.

After officially forming last summer, Gentiva’s first splash as a standalone company was agreeing to acquire ProMedica’s Heartland home health and hospice assets for $710 million. That deal would increase Gentiva’s hospice census by 9,000 patients – from 27,000 to 36,000.

Now that Gentiva has solidified its brand and footprint, Causby wants to build out its palliative care footprint further.

After years of research focused on what a patient’s life was like in between home health care and hospice, Gentiva found a window of opportunity.

“One of the things that we’re really trying to build out is an advanced palliative care model,” Causby said during Home Health Care News’ FUTURE conference last month. “Palliative care is very difficult today. It’s built on the physician Part B schedule. It’s a loss leader. There’s just not very good reimbursement. But we personally feel that’s one of the greatest needs. One of the biggest spends in the health care system today are those patients that sit in that middle bucket that don’t qualify for home health and don’t qualify for hospice. That’s really where palliative should sit.”

The company is looking to fill that patient care gap first and expects the reimbursement to eventually follow.

Under Gentiva’s Advanced Illness Model (AIM) — or as Causby calls it, “palliative on steroids” — a nurse practitioner goes out once or twice per month to see a patient.

In doing so, that practitioner tries to help maintain the patient’s care needs in order to keep them living at home, independently.

“This next reiteration that we’re building is way more comprehensive,” Causby said. “It involves case managers, nurses and aide work. We’re going on a PMPM basis arrangement and a risk-sharing basis to where we can take these patients during that five-year journey and provide services. We believe that we have the data, and the partners we’re working with believe that there’s no doubt that, over that five-year journey between home health and hospice, we’ll be able to majorly impact those patients to ensure that they have decreased re-hospitalizations, … and we’ll help the payers in managing those patients.”

In theory, a robust palliative care model can act as a feeder system into hospice, too.

“We really think there are a ton of these patients who are getting identified way too late into the hospice journey,” Causby said. “If we’re able to get upstream, manage these patients, cut costs to the health care system, improve quality of care and then appropriately help identify when the right time is for them and their families to transition, it takes the burden off physicians and families who have just been hit with hospice.”

The cost of doing business

The company has the value proposition and the scale.

Still, there’s risk in deploying the kind of capital Gentiva is and hoping to find success with Medicare Advantage plans.

“We’re spending a tremendous amount of capital in order to prove this out,” Causby said. “The first thing we have to do is to go and ensure that we develop the program and the product. We need to try to get the best pricing that we can in order to be able to demonstrate this. We also have to run enough volume through the organization to be able to show that we’re able to reduce these re-hospitalizations and hit these other benchmarks.”

Gentiva has between 400 and 500 patients enrolled in the palliative care program today and is enrolling 30 to 50 new patients per week. By the end of 2024, Causby hopes the program will have 10,000 patients.

Then, the company will be able to sit down with MA plans and have benchmark data to prove the program’s value.

“We’ll be able to monitor and track those patients over a period of time and then look at that subset of patients that are in that program against the general average of patients that are not,” Causby said. “You should be able to determine the cost savings associated with it. When you have that, you’ll get the attention of payers.”

Looking ahead, Gentiva plans to add more tuck-in acquisitions where necessary.

Causby believes the market dynamics are still very strong for a company with the size and scale of Gentiva.

“We believe we have competitive advantages with organic growth and taking market share,” Causby said. “But this AIM business that we’re building is probably where I’m going to spend the majority of my time. I really believe that this will be a game changer.”

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