On a Tuesday earnings call, Walgreens CEO Tim Wenworth – who took over as the company’s chief leader in October of last year – said the company would be “reorienting” its business to focus on retail pharmacy.

“WBA is reorienting to its legacy strength as a retail pharmacy-led company,” Wentworth said. “This reorientation allows us to leverage our key strategic assets of consumer trust, convenience and relevance. Our position of trust stems from the millions of face-to-face interactions our consumers have with our pharmacy personnel every day, and we will continue to take actions now – and for the long term – to be the first choice for retail pharmacy and health services. Having earned our consumers’ trust – indeed, our reason to exist – we also want to be accessible and convenient, but we need to be appropriately sized.”

Wentworth said that of Walgreens’ over 8,000 stores, around 6,000 are profitable. With that in mind, and in order to be “appropriately sized,” the company is closing a majority of the stores that are not profitable.

That is part of an effort to balance its budget sheet, too. Its reorientation to retail pharmacy follows a strategic review of assets, which took place earlier this year after Wentworth took the helm.

Walgreens has poured over $6 billion into the home- and community-focused primary care provider VillageMD, but has recently reduced the latter’s physical footprint. VillageMD is a part of Walgreens’ U.S. Healthcare segment, which also includes the post-acute care platform CareCentrix.

While health care services and the U.S. Healthcare segment were emphasized as priorities moving forward in 2021 and 2022, Walgreens now appears to be moving away from that – for the most part.

“We believe our reorientation to retail pharmacy has a bright future,” Wentworth said. “We’re engaging in a multi-year program with a long-term goal of an appropriately sized and well positioned fleet of stores, and an industry-leading customer experience in both retail and pharmacy across consumer channels. And we continue to believe that the adjacent strategic businesses in which we’ve invested can incrementally contribute to value creation over the longer term.”

Wentworth also called VillageMD “not a crucial part of the business moving forward.”

Walgreens’ peer, CVS Health (NYSE: CVS), has also experienced financial turbulence of late, after heavily investing in health care services over the last few years. While Walgreens has VillageMD and CareCentrix, CVS Health has Oak Street Health and the home-focused, value-based care platform Signify Health.

Overall, the strategic decision to focus more on health care services after the height of the COVID-19 pandemic has not gone smoothly for either company.

“Many of our actions across this turnaround will take time, but I am confident that we have the right team, the right focus and the right strategy,” Wentworth said.

Overall, Walgreens’ fourth quarter sales increased 6% year over year to $37.5 billion. Fourth quarter operating losses, however, totaled $978 million.

The post Walgreens To Close 1,200 Stores, ‘Reorient’ Business Away From Health Care Services appeared first on Home Health Care News.

Broadly, the company captures detailed observations from caregivers in real time to identify client needs and predict unforeseen events.

The care coordination program depends on caregivers submitting weekly observations and reporting any changes in client conditions.

Community health workers (CHWs) also conduct a self-reported health assessment using the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs screening tool. This tool includes 24 questions about the home environment and access to eligible benefits and services. These questions help identify issues such as housing instability, food insecurity, transportation challenges, financial strain, safety concerns and lifestyle factors that can affect a client’s ability to achieve long-term health goals.

“We’re uniquely positioned, using the millions of hours we spend with our clients, to connect home care to health care through our innovative care coordination management programs and services supported by our value-based care philosophy,” Julie McCarter, president of care coordination at Help at Home, told Home Health Care News. “Through the launch of our health care coordination strategies that build on our longitudinal caregiver-client relationships, we’re addressing access to care, health-related social needs and unmet client health needs, advancing care as we improve quality and cost outcomes.”

The Chicago-based Help at Home is one of the largest home care providers in the country. It provides home- and community-based services (HCBS) via over 200 locations across 11 states.

In its first year, the program made one million observations and carried out 4,000 proactive interventions that had an impact on the health care system. These interventions included scheduling pulmonology appointments when there was a decline in breathing and mobility, activating mental health resources when there were signs of agitation or mood changes and connecting individuals with food resources when food insecurities were identified. The results of these interventions included a 31% decrease in emergency room visits, a 37% decrease in inpatient admissions compared to the previous year, and a 51% improvement in depression, among other positive outcomes, according to McCarter.

“Our caregivers serve as an extra set of eyes and ears in the home, and through the program, they can digitally capture physical, behavioral and environmental observations,” McCarter said. “Clinical teams can assess, act and prevent avoidable health events in real time to avoid unnecessary hospitalization or institutionalization.”

McCarter mentioned that the clinical care team supporting caregivers includes CHWs. These CHWs typically reside within the community they serve and share the same ethnicity, language, socioeconomic status and life experiences as the client population, allowing for the formation of trusting, organic relationships.

“The results of caregiver tools and care teams engaging populations with high-tech, high-touch wraparound clinical efforts are proving to reduce emergency room visits, inpatient utilization, close preventative gaps in care, increase primary care and optimize health care benefits and services,” McCarter explained.

Furthermore, Help at Home reports that caregivers involved in the care coordination program have higher net promoter scores, demonstrating the program’s ability to improve caregiver satisfaction and retention, making them feel valued and motivated.

“Caregiving can be a difficult job, so we are attentive to the caregiver and work to elevate the caregiver role by providing a village of support through care coordination clinical care teams,” McCarter said. “We’ve seen this lead to greater caregiver satisfaction scores and tenure. Not only does the program support client health and wellbeing, but it also focuses on identifying and supporting the caregivers’ needs. Through the program and that understanding, we’ve found that nearly 50% of caregivers expressed that having a better understanding of their clients’ conditions or needs and how they can be a part of the solution helps them to alleviate their worry and stress.”

Building on the strength of the company’s foundation, core service offerings and long-term relationships, McCarter said that the company is expanding its efforts. Caregivers now have a deeper understanding of a client’s overall health journey and how they can improve the quality of life for underserved populations who wish to age in place.

“We’re energized by the program’s results thus far and are continuing our journey to build on learnings and successes,” she said. “As we move to 2025, we’re excited about embarking on a broader clinical care delivery journey that furthers the value we can provide to our partners, clients and caregivers with value-based care and wraparound support programs to drive quality outcomes and total cost of care opportunities – further connecting health care to home care.”

The post Help at Home’s Care Coordination Program Prevents Hospitalizations, Increases Caregiver Satisfaction appeared first on Home Health Care News.

Based in Dallas, VitalCaring provides home health and hospice care to patients in the Southern U.S., covering Texas, Oklahoma, Louisiana, Mississippi, Alabama and Florida.

Constant Therapy is a digital health company. Its technology enhances the effectiveness of cognitive, speech and language therapy while also increasing access to and reducing the cost of these therapies, according to the company.

The Constant Therapy app uses AI technology to offer personalized exercises that aid in rebuilding cognitive and speech function for individuals recovering from stroke or traumatic brain injury, as well as those living with aphasia, dementia or other neurological conditions. A team of neuroscientists at Boston University developed the app.

“The pilot program was launched to harness the power of technology to elevate the quality of in-home therapy and alleviate the burden on families and caregivers of patients with cognitive disorders,” Janice Riggins, VitalCaring’s chief clinical officer, told Home Health Care News. “The initiative was driven by several key objectives, including enhancing cognitive abilities to improve physical functioning, enabling patients to age in place more effectively, collecting data to support medical necessity and tailor interventions more precisely, and expediting the patient’s journey toward regaining independence safely within their homes.”

The pilot took place from October 2023 to May 2024 and involved 52 patients aged 54 to 92. The patients had various primary diagnoses, including cerebral infarction, brain tumors, dementia (including Alzheimer’s disease), Parkinson’s disease, encephalitis, encephalopathy and mild cognitive impairment (MCI). Patient performance was assessed using the Montreal Cognitive Assessment/MoCA and the Saint Louis University Mental Status/SLUMS cognitive screening.

The program included various exercises to improve auditory and visual memory, reading comprehension, speech, attention, problem-solving and visuospatial processing.

“While the primary goal for patients with chronic diseases is often to maintain cognitive function or slow its decline, we observed more gains in functional cognition, and caregivers reported more social and physical activity gains than anticipated,” Riggins said.

Patients in the program showed statistically significant cognitive improvements, including improvement by at least one cognitive level and achievement of normal cognitive function by discharge, according to Riggins.

“Success in the program required both the patient and caregiver to demonstrate a willingness and ability to comply with the recommended regimen,” she said. “Ideally, patients had access to a device compatible with the app to maximize results during and beyond therapy visits, ensuring continued progress post-discharge.”

Patients’ ability to independently access Constant Therapy’s therapeutic exercises at home has proven valuable to clinician-supervised therapy, Riggins noted. The VitalCaring Cognitive Care pilot program aimed to determine how additional therapy tools could speed up recovery and maximize cognitive functioning for VitalCaring patients with dementia-related diseases and those recovering from stroke or other brain injuries. On average, each patient in the pilot could access an additional 11 hours of digital therapy independently.

“This program equips our clinicians with an additional resource to complement their skilled interventions, maximizing patient success,” Riggins said. “It enables us to support our patients longer in their goal to age in place.”

Following the pilot, VitalCaring plans to explore more opportunities to expand this initiative across its network.

“We’ve already begun training clinicians throughout our organization and are committed to providing this valuable resource to all patients who can benefit from it,” she said.

The post VitalCaring Pilot Program Shows Promising Results For Cognitively Impaired Patients  appeared first on Home Health Care News.

Having a unique business model is a strength, but it also means dedicating time to explain how the company operates and its overall value add. It’s a position Klein has often found himself in.

“I used to have a boss that referred to that as an ‘evangelical sale,’ because you actually have to evangelize what you’re doing,” he told Home Health Care News on the latest episode of the Disrupt podcast. “People don’t know what it is at first.”

New York-based Vesta Healthcare is a specialized medical group for individuals receiving home-based care services. The company oversees, coordinates and supervises care in the home. It recently raised $65 million in a Series C funding round.

At the center of all of this is the belief that caregivers are an integral part of health care. HHCN recently caught up with Klein, who went into detail on this topic. During the conversation, Klein also talked about where sees home-based care business opportunities and how the company has been able to expand so rapidly.

Below is that conversation, edited for length and clarity.

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HHCN: For the listeners that are unfamiliar with Vesta Healthcare, can you go into detail about your company’s business model and how it works with home care providers?

Klein: We are a specialized medical group for people with long-term home care. We have a highly-integrated network of non-medical providers, particularly personal care agencies, but other provider types as well. We get referred patients from the community and other providers the way that anybody would get referred, and then we work with the agencies that are servicing those folks to integrate the [people] who are providing that care, and their service coordinators and what have you, into the care that’s actually being delivered.

It’s a unique model that allows us to take the insights and access that people in the home have and convert it into actionable events for medical care delivery, in a way that the medical side of the house can reimburse for. I think it’s very effective in engaging the home in terms of improving quality of care.

Let’s take a step back, can you share with listeners what your health care background is, particularly on the home-based care side?

I grew up in a home care family. My dad worked for a health plan. My mom is a social worker. My grandparents worked in health care as well. Health care is kind of in the blood.

I ended up starting my health care career working for a company in New York called Visiting Nurse Service of New York (reporters note: The company is now VNS Health). It’s one of the oldest and largest nonprofit home care companies around.

I had the very weird entry point of implementing an episodic reimbursement program for home care, Medicare, PPS — that I’m sure many people here know. I really started my health care career from the standpoint of value-based home care. Over the past 20 years, I’ve had the ability to work on this from a variety of perspectives. I’ve been an operator of a plan. I’ve been a vendor that’s focused on in-home assessments and care management. I’ve done episodes of care payments, but all of it has been really around this idea that the home is a very important, overlooked and disconnected setting of care. If you can engage the people that are there, as part of the delivery system, you can actually create better outcomes, as well as reduce cost and improve satisfaction.

I’ll give you one quick anecdote. When I was working at VNS, I was on a project for one of their executives. I had the ability to actually go out and do a whole bunch of home care visits studying what happened in the home. I remember being absolutely blown away by what these nurses and aides were doing. I came back, a naive 20 something, talking to my boss about how great all this stuff was, and what a difference it must have made. His comment was something to the effect of, ‘wouldn’t it be great if?’

What came from that was the idea that, ‘Oh, wait a second, this part of the system actually isn’t being used properly.’ Later on, I had another person there refer to home care as the caboose of health care. That’s been one of the things that I’ve spent a lot of time thinking about and working on ever since.

Caregivers — whether informal family caregivers or ones with agencies — are such big pieces of Vesta Healthcare’s puzzle. Why is that so?

They’re the ones that have the most access and positions of trust. We got into this with the idea of making health care better, and there’s been a tremendous amount of investment and innovation in the system.

This caboose part of it — if you look from a dollar spend perspective and a population spend perspective, it’s actually a very large caboose. It’s kind of gigantic. It makes up a huge percentage of state Medicaid budgets. If you look at people who are older adults with functional limitations, the likelihood that you end up on Medicaid. You look at the size of the workforce, you’re talking about millions of paid aides, tens of millions of caregivers, it dwarfs almost anything else, but it really doesn’t get a lot of focus. We built a company, and a program, around the idea that the enormous resource — which I’ve come to call the dark matter of the health care system — we can do good things if we engage it. That’s why it’s the center.

Your company recently raised $65 million in funding. Can you walk listeners through Vesta Healthcare’s funding history, and what this latest round of funding will enable the company to accomplish?

Vesta Healthcare was founded in 2019 and we were founded out of a prior company.

What we did was we raised our initial round of capital from some of the original investors. That would be what you would consider round A. That was really designed to get us proof of concept. Can we demonstrate that we have a business that folks are interested in working with? We did that, and then shortly thereafter, we ended up doing our B round. That was really designed to help us scale, because we had some demonstration that what we were doing was working. The B round was designed to get us to a point where we had essentially unit economics. We knew that our business was working, economically, so it would be viable in the long term.

We hit some pretty rough market conditions over the past few years. The health care innovation landscape has been a very tough place to actually access capital in, and I’m really fortunate to have great investors and partners that have helped us along this journey, and we were able to grow and scale during that time. Then earlier this year, we were able to raise our C round, which is a growth round that’s designed to help us digest all the opportunities that we’ve been developing over these past few years, so we’ve been growing very rapidly. You may have seen that we were on the Inc. 5000 for the fastest growing companies, almost 1,000% growth over the past three years. We have more than that lined up over the next few years.

Growth is expensive. You have to hire, you have to invest. We’ve expanded our footprint geographically. We’ve expanded the programming that we can support. In addition to our present models, there’s a new one called GUIDE coming out that we’re going to participate in. There’s other value-based, aligned programs that we participate in. All that requires investment.

What this round of investment is going to do is twofold. We use debt to help finance some acquisitions that helped us catalyze our growth, so it retires that older debt. The equity portion of it is primary equity that we’re using to grow the company to the next stage.

Let’s talk a little bit about Vesta Healthcare’s expansion. In 2021, the company was in five states, and now it’s in 21 states. How have you expanded so rapidly, and where do you want to go next?

We’re seeing patients in 12 states, and we have 21 we can see patients in. What we’re doing is basically following our referral patterns. We don’t ever enter a state without there being someone that’s bringing us into the state.

The nature of our business is that you’ve got imperfect overlap between payers and providers. We work with home care agencies that cover multiple states. We start with them in one state, and they want to expand with us. We go to the next state with them. When we get to the next state with them, we have to get to scale, so we apply for network participation. I’m really proud that we’re in network with over 100 health plans at this point in time. Then we use the ability to be in that state with a partner as a catalyst to recruit other partners to work with us, which then does the same thing again. It brings us into new geographies, and we repeat it all over. We’re just following where the growth is taking us, and that’s been the reason why it’s happening so quickly.

What are some of the growth barriers that you’re seeing in the market? More importantly, how is Vesta Healthcare navigating these challenges?

First and foremost, for a company like ours, the biggest barrier to growth is understanding what we are. If you go and talk to most participants in the system, they probably say, ‘Hey, we already do care management in some form or another,’ and they do. There’s lots of care management out there. If we’re a different form of current care management, or we’re not care management at all, then what are we?

One of the things we’ve had to learn how to do over the past few years is tell our story, which is why I told it the way I did. We’re a specialized medical group for people with long-term home care. We oversee and coordinate and supervise care in the home, and we engage the aides and caregivers as part of that. When you start to frame it in that sense, many payers will recognize that they don’t have a provider or network that’s doing this. Many providers will recognize that they would benefit from this. This is something that could help them improve their own businesses and improve their own quality. That’s the first part, I used to have a boss that referred to that as an ‘evangelical sale’ because you actually have to evangelize what you’re doing. People don’t know what it is at first.

The second part of it is just the inertia of the delivery system. If you’ve ever tried to get a contract with a payer, get in network, get anything through that stuff, it just takes a long time. We come in through the front door in most places. There’s nothing fast about it. We have to get in network. We have to get credentialed. You have to recruit credentialed providers. You have to get to scale. All of that takes a long time and a lot of resources. Which comes back to having great partners. But once it’s in, it also tends to be pretty durable.

Where are you seeing key home-based care business opportunities right now?

I think that the future of care in the home is in the earliest innings right now. The ability for technology to rapidly upskill and scale what can happen, the ability of better information flow will enable much more personalized approaches that do a much better job of using the home setting as an actual setting of care. Payment models have to continue to innovate to support that.

If I were looking at ways to continue to expand what folks do, I would be looking at how to get skilled agencies to the top of their license, how to move end-of-life care into the home on a greater basis, how to upskill the non-skilled, to get them to the top of their ability levels. I would be looking at virtual models that can augment home-based models, so you can get greater scale out of them. I would be looking at personalized approaches for management of medications. I would be looking at ways to really simplify getting things like DME into the home.

I think there’s so many different places here where, in the home, you can do things that will ultimately be higher quality and lower cost. Behind that, I think there’s also a ton of back-end stuff right now. There is a lot of administrative burden that happens around home-based care. As the system gets smarter on this and understands what it’s doing, it will be able to eliminate a lot of the paperwork and back and forth that, frankly, exists because of the complexity of the system, but doesn’t add any value.

As CEO, what goals do you have for the near-term future?

I want us to clearly demonstrate the value that integrated care in the home creates.

There’s still too much evangelizing happening around this. I’ve met some folks who are innovating around similar models, and I cheer for them. We have to get to a place where the notion that care in the home that’s not integrated is an anathema. That you would always expect that care in the home is going to be part of just care in general.

Secondly, to make sure that the business that we’re running is sustainable. I run a business. I have to make sure that what I’m doing works economically. I have to be really careful as we grow, that we don’t take on too much. I have to be really careful that we continue to perform well. The second part, as a CEO, is to run a great company. I would say the third part of it is to make sure that I am a very valuable partner.

If I’m not a valuable partner, I’m going to lose my partners. I need to make sure that the folks that I’m working with on the provider and the payer side are experiencing the value that we set out to create for them, and in my mind, that does extend all the way to the caregivers. Whether you’re a family member, or an aide in this system, I believe there should be a material difference to being supported by someone like us, where you feel greater access, greater support, greater control, greater participation.

The post How Vesta Healthcare Raised Over $60M To ‘Integrate’ Personal Home Care appeared first on Home Health Care News.

The biggest retailers were zealous in their pursuit of home-based health care initiatives. But there’s little evidence to suggest that pursuit has been successful, at least thus far.

This week, CVS Health (NYSE: CVS) announced that it was laying off 2,900 workers. Simultaneously, reports surfaced of Glenview Capital – a significant shareholder in the company – emerging as an activist investor.

Reuters then reported that CVS Health is exploring a potential breakup of its business. CVS Health has multiple segments, including retail, pharmacy, insurance through Aetna and health care services.

Health care services is where the company took a stab at home-based health care for the first time. In addition to acquiring the community- and senior-focused primary care provider Oak Street Health for over $10 billion last year, it also acquired the home-focused value-based care platform Signify Health for $8 billion.

“CVS’ management team and Board of Directors are continually exploring ways to create shareholder value,” a CVS spokesperson told Reuters. “We remain focused on driving performance and delivering high quality healthcare products and services enabled by our unmatched scale and integrated model.”

For payers, investors and retailers alike, home-based care looked like a worthwhile frontier to explore during the pandemic. For retailers like CVS Health and Walgreens Boots Alliance (Nasdaq: WBA) specifically, their success administering the COVID-19 vaccine to Americans gave them hope that community-based health care would be a somewhat smooth path forward.

That has not been the case, for Walgreens, CVS Health, or a slew of others.

In this week’s exclusive, members-only HHCN+ Update, I revisit the plight of retailers delving into home-based care, and consider who will be the beneficiaries of health care moving to the home.

Support in the home

The overarching idea is simple. The United States has an aging population, and more seniors than ever want to receive their health care in the home.

Plus, home-based health care tends to be cheaper than facility-based care. Traditional personal care services enable seniors to age in place and prevent further health problems related to activities of daily living struggles. Home health care ensures smooth transitions home from the hospital, keeping patients out of more costly brick-and-mortar settings.

Other home-based care is becoming popular too. Home-based care for younger Americans. Skilled nursing facility care in the home (SNF at Home). Hospital-at-home care. Primary care at home. Oncology care at home. Kidney care at home. In-home health assessments and evaluations.

Broadly, these types of care are more consumer-focused, a departure from the care that forced Americans to uproot their lives for a day, week or even months to receive the health care they needed.

For the sake of designation, I refer to Medicare-certified home health care and personal care services – through Medicaid, private pay or the VA – as “traditional” home-based care services.

As more non-traditional at-home care has proliferated, there was some sense of concern from traditional providers that more cash-strapped entities could disrupt two long standing industries.

That still could be the case, as home health and home care providers tend to be – on average – behind the curve on technology and future-facing business practices.

But in the last quarter of 2024, that disruption doesn’t seem any closer than it did in 2019.

Walmart (NYSE: WMT), which wanted to “support people aging in their homes,” has largely ditched its health care services plan. Amazon launched Amazon Care – which had an at-home care component – and then did away with it shortly thereafter. Best Buy (NYSE: BBY) is still mostly smooth sailing, but it intended from the start to be a technology partner more than anything.

Then there’s CVS Health and Walgreens, which both made massive bets – strategically and monetarily – on health care services.

Both began to shrink their retail footprints, hoping to become more health care providers than corner stores.

Walgreens invested over $6 billion in VillageMD, another home- and community-focused primary care provider. It also acquired CareCentrix, a post-acute technology company. An affiliate of the company was also a significant backer of BrightSpring Health Services (Nasdaq: BTSG), one of the largest home-based care providers in the country.

But then, earlier this year, CEO Tim Wentworth announced that the company would be undergoing a “strategic review of its assets.”

“We are now meaningfully looking at the entire portfolio of assets that we have to ensure that everything we have is going to drive the growth that we aspire to deliver,” he said at the time.

The company shuttered 160 VillageMD locations after aggressively expanding in years prior.

The investment firm KKR also acquired Walgreens’ remaining shares in BrightSpring.

Both CVS and Walgreens have had multiple leaders look over their health care divisions over a short period of time.

While CVS owns Oak Street Health and Signify Health – a similar portfolio to Walgreens’ backing of VillageMD and CareCentrix – it also purchased Aetna for $70 billion back in 2018.

Aetna’s leader was also recently ousted by CVS Health.

While Glenview Capital – the rumored activist investor – said it was not pushing for a breakup of the company, other news outlets reported that CVS’ board has already discussed that option.

Not long ago, CVS Health was considered a potential buyer for some of the remaining standalone home health companies. It had an obvious interest in home-based care, and also owned Aetna. Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH), two of Aetna’s top competitors, own home health assets of their own.

“I think, over time, we’ll look at what other assets [we need],” CVS Health CEO Karen Lynch said in 2023. “As you think longer-term, around the corner, there might be additional opportunities in the home.”

Now that idea appears to be off the table.

Walgreens and CVS Health both wanted to become health care services players, and they are. Thus far, though, they’ve stumbled. They are not yet successful players, nor successful home-based care players.

What it all means

Legacy home-based care providers love the industries they’re in, and they know there’s plenty of future opportunity.

But they also know all the challenges that come along with reaching that opportunity: staffing woes; the delicate intimacy of providing care in the home; turbulent payment environments; and the barriers to growth and scale.

There are over 10,000 home health agencies in the U.S., while there are more than 30,000 home care agencies, according to best estimates.

Consolidation has been projected for more than a decade, but has never come in a significant way.

Payers like Humana and UnitedHealth Group own two of the largest home health companies in the country in CenterWell Home Health and LHC Group. But that still only grants them access to a small slice of the home health pie.

For instance, after UnitedHealth Group acquired LHC Group, it then agreed to purchase Amedisys Inc. (Nasdaq: AMED), another one of the top home health providers. But even with both agencies under its belt, the company will likely have less than 10% of market share in the industry.

There is more startup activity in home health care and home care than ever. A couple of those businesses may have a shot at disrupting.

But, for now, the large health care companies taking a shot at home-based care have failed to make waves.

That could be because of their size, or because of the complexities that come with delivering good home-based care.

Either way, for now, most of the opportunity that lies ahead still remains for the taking. And the legacy operators have as good of a chance as anyone to capitalize.

The post Health Care Giants Are Falling Short Of Home-Based Care Disruption appeared first on Home Health Care News.

The collaboration between BrightStar Care and Medically Home is one example of this.

“More care is moving into the home, and higher acuity care is moving into the home,” Shelly Sun Berkowitz, founder and executive chairwoman of BrightStar Care, said during a panel discussion at Home Health Care News’ FUTURE conference in August. “I think that’s exciting, but home care providers that have been more on the non-medical side need to start thinking about how they transform and move into higher levels of acuity. I think that’s where a lot of the opportunity is going to be.”

Chicagoland-based BrightStar Care offers personal home care, as well as supplemental staffing and home health care. It has over 400 franchise locations across the U.S.

On its end, Boston-based Medically Home partners with organizations to help them deliver hospital-at-home services, as well as emergency department services in the home. The company coordinates in-home visits, sets up the proper technology and equipment, and pulls together all of the necessary resources.

Medically Home and BrightStar Care have been partners since 2018. At the time, the former was in “startup mode” and was attracted to BrightStar Care’s approach.

“BrightStar came in with this entrepreneurial approach to our work together,” Dr. Pippa Shulman, chief medical officer at Medically Home, said during the discussion. “It was immediately, ‘How can we solve the problem that you have, and not be constrained by our idea of what home care medicine looks like?’ It was really future thinking. Now, we’ve both grown. We’re both different organizations, and we’ve really committed to partner together, and when we need new nursing services, BrightStar is our primary partner going forward.”

Shulman is a hospital-at-home pioneer, and previously told HHCN that “the tipping point is coming” in relation to that type of care in the U.S.

In 2023, BrightStar Care expanded its higher-acuity care services by rolling out primary in-home clinician and transport services in Arizona.

“We’re a franchise organization, so we went and bought back several of our franchisees, made a multi-million dollar investment in Arizona to own the territory, control the territory,” Sun said. “We believed hospital at home would be so important for the growth of our brand and the transformation of health care in our country. We wanted to make sure we could spend the money, get the vehicles right, meet all the expectations of a great partner, but we felt like that’d be difficult to do, if we were relying just on a franchisee.”

Sun noted that this strategy allowed the company to work out the kinks before pulling in franchise owners.

“It’s a great way for us to be able to take a company-owned marketplace, spend our capital – not a franchisee’s capital – and figure it out, get the bumps out, and then once it’s ready, roll it out to our network,” she said. “I think we learned a lot together, built a great program there … and continue to make lots of impact for our franchisees across the country. As a good franchisor, I don’t want the franchisees having to spend their hard earned capital figuring it out. I have a much greater capacity to do that as a franchisor.”

Since then, BrightStar Care — in partnership with Medically Home — has expanded this effort.

In April, the company rolled out these services in California and New Jersey, and they’re offering this care in six states.

Ultimately, Shulman believes that the home should be the center of health care in the future.

“I’m not saying we don’t need hospitals,” she said. “We do, but we need ICUs, and surgery centers and a place for traumas [patients] to go. Almost everything else we can do at home.”

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CVS Health leaders reportedly met with Glenview Capital – the rumored activist investor – on Monday to discuss ways to “improve operations,” according to The Wall Street Journal.

Year over year, CVS stock is down close to 10%. Year to date, however, the retail giant’s stock is down over 20%.

The company also announced Monday that it would be laying off 2,900 workers, with most of those being corporate positions.

In the wake of COVID-19, CVS Health began to switch its business strategy, as did its peer, Walgreens Boots Alliance (Nasdaq: WBA).

Both companies decided to dive further into health care services, partly because of the success they had as vaccine administrators during the pandemic. CVS Health acquired the primary care provider Oak Street Health last year, as well as the home-focused value-based care platform Signify Health. In total, those acquisitions cost CVS $18 billion.

Those businesses help make up CVS Health’s health care services arm, which is dubbed CVS Healthspire.

On its most recent earnings call, CVS President and CEO Karen Lynch reaffirmed commitment to that segment moving forward.

“We are committed to delivering value every day to our clients and our members,” Lynch said. “In our health care delivery business, we are driving meaningful progress connecting patients to health services across all of our channels, primary and acute care, health services in the home, and clinical programs.”

CVS Health also owns Aetna, one of the largest insurers in the country. Aetna President Brian Kane was removed from his post last month, after less than a year on the job.

As of Monday, it wasn’t clear what Glenview Capital would be urging CVS Health to do moving forward. The company is a New York-based hedge fund.

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Hospital at Home (HaH) is a sustainable, innovative and next-generation health care model. From the physician’s perspective, it offers person-centered medical care and keeps patients out of the hospital, away from possible complications and on to better outcomes. However, there are still plenty of challenges for providers to work through.

“People love to have inpatient or acute level care in the comfort of their own home,” Dr. Adam Groff, co-founder of Maribel Health, told Home Health Care News. “The data suggests that for populations studied in multiple areas, [HaH] is a safe service with high-quality care, low readmission rates, low escalation rates, low infection rates and, bottom line, patients love it.”

Maribel Health, based in Hanover, New Hampshire, designs, builds and operates advanced clinical care models in the home and community to expand health system capacity and improve patient access.

While it seems like a win for patients and caregivers, the model has seen growing pains.

“One challenge is clarifying the distinction between HaH care and other in-home health care services like home health or skilled nursing facility (SNF) care,” Heather O’Sullivan, president of Mass General Brigham Home Hospital, told HHCN. 

Based in Boston, Mass General Brigham Home Hospital provides comprehensive home-based care, including chronic, urgent and acute care, directly to patients in their homes.

The structure and implementation of HaH care vary depending on the hospital’s needs, capacity and patient population. Some organizations run the program out of the emergency department and admit eligible patients to their homes. In contrast, others rely on community paramedics or specialty clinics to refer patients to the program.

“While the use of paramedics in health care is not new, the pandemic accelerated the scaling of this workforce to support home-based acute care,” O’Sullivan said. “By incorporating paramedics into the HaH model, we address workforce shortages while enabling health care professionals to practice at the full scope of their licensure. This expansion not only meets the complex needs of our patients, but also ensures that we are using our workforce to its optimal potential.”

The HaH model was introduced at Johns Hopkins in 1995 and was used to manage and treat older patients who refused hospital stays or were at higher risk of hospital-acquired infections.

Early trials of the model found the total cost of at-home care was 32% less than traditional hospital care, the length of stay was one-third shorter and the incidence of complications was dramatically lower.

“HaH can reduce hospital overcrowding and provide care that aligns with patient preferences,” O’Sullivan said. “As health care systems increasingly focus on strategic sustainability amidst a rapidly evolving health care ecosystem, scaling HaH presents a unique opportunity to meet growing patient demand while improving clinical outcomes and satisfaction.”

Though the structure of these programs varies, many commonalities exist. They are well-suited for medium-acuity patients needing hospital-level care, but stable enough for safe monitoring from their homes. They are also suitable for patients with conditions requiring defined treatment protocols, such as pneumonia, congestive heart failure, chronic obstructive pulmonary disease (COPD) or diabetes.

“One of the greatest advantages of this model is that it allows clinicians to enter patient’s homes, offering insights into social and environmental factors that may impact health – insights often missed in a traditional hospital setting,” O’Sullivan said. “This holistic view enables more tailored care.”

The Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver during the pandemic, which created a payment system for HaH through Medicare. Now, the model is popular enough that providers are operating within that waiver – which has been extended to the end of 2024 – but also outside of it.

Launching a program

Novant Health New Hanover Regional Medical Center in Wilmington, North Carolina, began enrolling patients in its HaH program in March. The program is in its early stages and is growing.

“To date, the Novant Health New Hanover Regional Medical Center (NH NHRMC) program has cared for approximately 70 acute patients in their home,” Christy Spivey, senior director of nursing, told HHCN. “Patient experience has been overwhelmingly positive, reaching satisfaction scores of 100%.”

According to Spivey, there have been no unexpected returns to the hospital, and readmission rates are either within or better than those of similar hospitalized patients. Based on the number of patients served at home, NH NHRMC has saved almost 300 in-hospital physical bed days, creating the capacity to keep higher acuity patients in those beds.

“Our health care providers have found great satisfaction in meeting the patient’s needs creatively, allowing the patient to heal in their home environment,” Spivey said. “Often, they find that providing health education is better received by the patient when they are at home. They can also include family members in the plan of care and education, which supports the patients. And the ease of access to the patient via technology makes it easy to see patients from wherever the provider is located.”

Spivey went on to say that patients benefit for many of the same reasons.

“First, they can heal in the comfort of their home, with loved ones, and even pets,” she explained. “They can easily reach a [nurse] or physician by touching a button on a screen if they have a question. Specially trained community paramedics and a physical therapist come to their homes to administer care and therapies, where the approach is tailored to their unique needs.”

Core tenets of the Novant Health program support optimal nighttime sleep, medically ordered meals, and optimized mobility, all tailored to the patient’s unique needs. Pharmacists, case managers, and other care team members can also visit the patient virtually to teach and support the patient’s care plan.

According to Spivey, nationally reported outcomes consistently show patients in these programs have higher satisfaction and lower readmission rates than similar patients who receive care inside the hospital.

Overcoming challenges

To be eligible for the Acute Hospital Care at Home program, patients must meet clinical and social criteria established by CMS. The program has 78 approved diagnoses, including pneumonia, COPD and urinary tract infections.

On Sept. 18, the U.S. House Energy & Commerce Committee approved a bill extending necessary flexibilities to benefit telehealth and hospital-at-home providers.

The Telehealth Modernization Act of 2024 would grant two-year extensions to various telehealth flexibilities implemented during the COVID-19 pandemic. These include continued payment for virtually furnished care services, eliminating in-person or geographic requirements for telehealth providers and supporting audio-only telehealth. These flexibilities are set to expire at the end of this year.

The act would also extend the hospital-at-home waiver by an additional five years. Again, for now, the waiver program is expected to expire at year end.

While the HaH model offers numerous benefits, it also comes with challenges. Significant barriers and limitations exist, including payment reimbursement issues, physician and patient resistance, patient safety concerns and implementation hurdles.

“The single biggest challenge is the looming end of the CMS Hospital Care at Home waiver,” Dr. Stephen Dorner, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, told HHCN. “We need congressional action to extend the waiver and maintain federal support for this incredible care delivery model.”

Regarding challenges to care delivery itself, Dorner said that all health care providers are working to overcome them.

“The first is culture change,” he said. “This is not how people are used to providing or receiving acute hospital-level care, and it takes a lot of time and effort to educate and facilitate buy-in. Then, once people understand the phenomenal quality benefits associated with HaH care and agree to undertake it, the logistical challenges of delivering that care take hold. Orchestrating the complexities of home-based acute care delivery – staff, supplies, patients, equipment, medications, food – can be daunting. Finally, there is a burgeoning market for solutions to these challenges that is waiting on certainty from federal regulators that the waiver will remain in place before activating.”

Most private payers do not cover hospital-level care in the home. Hospitals have had some success with Medicare Advantage (MA) plans and Veteran Affairs (VA), but health systems with insurance plans have a similar opportunity to cover HaH care.

“It’s important for providers to write and call their senators and representatives to let them know they want their support for the continuation of the Acute Hospital Care at Home Waiver,” Dorner said. “When you look at the traditional health care landscape, the growing demand for access, and the ever-longer wait times for care, it’s clear that the status quo is unsustainable. We need new solutions to deliver better care, and HaH is our greatest promise to realize a better future in care delivery.”

The benefits of HaH for patients

Nancy Foster, vice president for quality and patient safety at the American Hospital Association (AHA), told HHCN that she believes people would be surprised at the costs of HaH programs, and the overall benefits.

“We’ve looked at various studies,” she said. “They are comparable to the brick-and-mortar hospital, partly because we use staff time differently. We have staff traveling to the patient and so forth. We need technologies that you might not have to use in the hospital, but that assist with bi-directional communication. So, there are different costs, but the totals are similar.”

Dr. Ronald Paulus, co-founder of Maribel Health, agreed and provided more background.

“The literature is pretty clear that when your emergency department is congested, there’s significant harm that accrues to patients, including excess mortality,” Paulus told HHCN. “So, anything that improves the throughput of my emergency department and inpatient floors is a good thing from a safety perspective. But it is also good from an economic perspective. If you look at how HaH has been studied, it’s been shown to reduce direct costs by just under 40%. It’s at least 20 times more capital efficient, and when the program is run effectively, it can generate double digit EBIDTA margins.”

Standing up a HaH program requires logistical and technical work, which requires time, staff and budget. Some hospitals have partnered with companies that can provide the technology, manage logistics or provide care coordination to facilitate the implementation of a HaH program.

According to O’Sullivan, to support the growth of this model, organizations must continue to focus on expanding the health care workforce and address gaps in education.

“This includes initiatives like industry and academic partnerships to create new career opportunities for students and the innovative use of a broad professional team in the home hospital model,” she said. “We are working closely with educational institutions to address gaps in standardized curricula, ensuring that the future health care workforce is well-prepared to meet the new and undefined demands of this growing model.”

Before the pandemic, there was skepticism that the quality of care provided at home would be as good as in the hospital. This could be changing. As patients are reluctant to go to the hospital and telehealth capacity is growing, HaH care is becoming a more desirable option for providers and patients.

“Growth can be achieved by demonstrating the success of HaH models, advocating for legislative support and continuing to innovate in care delivery,” O’Sullivan said. “At Mass General Brigham, we’ve reached 70 beds in our Home Hospital program. Our pilot program has evolved into a core service, delivering high-quality, patient-centered care at home. Research has consistently shown that patients and caregivers prefer this model due to its proven outcomes and an overall positive experience for all involved.”

Spivey said that overcoming barriers and limitations is an ongoing internal and external process, and that growth depends on the customer’s voice.

“As more people hear about the program, they ask their physicians if they can be included, which will provide more momentum,” she said. “We provide internal education and presentations to physicians, nurses and other team members. Case managers have worked to integrate screening processes into daily patient rounds. Screening protocols for the team have been honed to support more rapid identification of patients, including optimizing the electronic medical record to create patient lists based on inclusion criteria. Also, including family in the initial discussion about the program is critical. If the patient or family is uncomfortable with care in the home, they can decline participation. For those who consent to participate, it is clear that if they become uncomfortable while receiving care in the home, the team will work with them to address the issue or bring the patient back to the hospital, if necessary.”

Dorner said the most significant opportunities for HaH are better patient care, job satisfaction and value.

“We know that the quality of HaH exceeds traditional brick-and-mortar hospital care for the patients who can safely receive care at home,” he said. “We also know that clinicians who join HaH, either as part of a diversified traditional clinical portfolio or as their full-time job, report increased job satisfaction. Some of these clinicians, who otherwise would have left health care at the end of the pandemic, have found the clinical care of HaH to provide more fulfilling, deeper connections to patients, which is why many of us joined health care in the first place. All in all, there’s better value associated with HaH care, and delivering greater value at a greater scale presents a spectacular opportunity for health care across the United States.”

According to O’Sullivan, there is immense potential for health care system transformation using the HaH model.

“HaH can reduce hospital overcrowding and provide care that aligns with patient preferences. As health care systems increasingly focus on strategic sustainability amidst a rapidly evolving health care ecosystem, scaling HaH presents a unique opportunity to meet growing patient demand while improving clinical outcomes and satisfaction,” she said.

Dorner added that there’s a clear upside to investing in the growth of this care delivery model, given the long-term regulatory and financial certainty that will increase patient awareness of the HaH model’s benefits, as well as the hospital’s willingness to break out of the mold and do something innovative.

“Increasingly, we will see improvements to equipment becoming more modular, portable and interconnected,” he said. “We’ll see software solutions to care orchestration to make moving equipment and services across a broader geography seamless. Eventually, this will be the primary method of caring for many conditions that require hospitalization today, and society will greatly benefit from it.”

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In the meantime, Canopy – a manufacturer of wearable safety technology for health care workers – has announced an expansion of its platform to help with those plans and to keep home-based caregivers safe.

Specifically, the company has launched Canopy Go, which is geared toward direct care workers visiting client or patient homes. 

Founded in 2019 and based in Palo Alto, California, Canopy designs technology to maintain the safety and security of health care workers.

“For the last five years, we have focused primarily on protecting staff inside the four walls of a hospital,” Canopy Founder and CEO Shan Sinha told Home Health Care News. “Canopy Protect works with a complete package of hardware and software that we deploy as part of an end-to-end service that includes all the work required to roll this program out to all staff.”

According to Sinha, the company is expanding rapidly. In the last four and a half years, it has grown to protect 200,000 people nationwide.

“We’ve learned, in working with our customers, that there is a huge amount of anxiety when caregivers go outside the four walls of an organization,” Sinha said. “People feel disconnected when entering environments where they have little to no control and are out of their organization’s security range.”.

Finding a need to expand outside the confines of the hospital building, the company introduced Canopy Go for home care workers.

“Canopy Go is a set of capabilities built on top of the Canopy Protect platform and deployed at a scale that gives home care workers a way to use a wearable button to gain access to support if they encounter a dangerous situation,” Sinha said.

Pressing the safety button puts caregivers in touch with a network of dispatchers who connect them to local law enforcement and facilitate a coordinated response with organization security.

“With a click of the button, the staff member’s ID and exact GPS location are discretely shared with the security team, enabling timely and effective intervention,” he explained.

Sinha sees an indirect benefit of caregiver retention for those using technology like Canopy Go.

“It becomes a strategic tool for leaders to invest in their workforce and to use in recruiting efforts,” he said. “It’s a symbol of all the ways that health care organizations are protecting and supporting staff and gives them a reason to believe in the organization they work for.”

Further, Sinha sees wearable technology as enhancing patient care by reassuring caregivers that their organization is always in contact and monitoring their safety and security.

“Wearable safety is almost like another level of personal protective equipment (PPE),” Sinha said. “Every health care worker will wear something like this in the future. Individuals will show up to work with much less anxiety that they might encounter an incident, and by reducing this stress, they can focus on caring for their patient.”

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“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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