Tomorrow Health – one of the more prominent home-based care startups – has launched a new product that aims to cut through the complexity of offering care in the home.
With home- and community-based services (HCBS) booming across the country, the company wants to make the delivery of those services more seamless while reducing costs, improving care and increasing access.
“It’s a recognition of the unique complexities that are faced by both Medicaid MCOs as well as care coordinators – and ultimately patients and their caregivers – in navigating home-based care,” Tomorrow Health CEO and co-founder Vijay Kedar told Home Health Care News. “This is something that we have worked to develop over the last year in partnership with a range of stakeholders to ultimately be able to deploy and deliver a product that is really tailor-made and suited to support some of these key stakeholders in the Medicaid space.”
Backed by BOND, Andreessen Horowitz, Obvious Ventures and others, Tomorrow Health was founded in 2018. The company has raised $92.5 million in funding to date. It partners with health plans, home medical equipment suppliers, providers and health systems to enable care in the home.
Tomorrow Health’s new feature will help Medicaid managed care organizations with care coordination, interoperability and real-time access to the right patient information. It will give MCO care coordinators fuller visibility, “resulting in high-quality patient outcomes,” according to the company.
Among those areas where fuller visibility is paramount: referring provider details, product category estimated delivery dates, confirmed delivery dates and cancellation reasons, among others, according to the company.
“One of the things that we realized is, while the home-based care ecosystem is fragmented and there’s challenge across the board, Medicaid MCOs and members face a differentiated set of complexities that comes from differentiated benefit designs that can vary based on state coverage guidelines,” Kedar said.
State-by-state variance is a major paint point for plans, and a pain point Tomorrow Health has been working on solving since its inception.
“Having really sussed out that initial challenge and pain point with several of our partners about a year ago, we really began breaking ground on this new extension of the platform,” Kedar continued.
Tomorrow Health’s partners are those stakeholders in HCBS delivery. There is a litany of parties involved – whether within one organization or throughout multiple – that are ultimately responsible for a patient receiving, or not receiving, home-based care.
The Medicaid waiting lists for HCBS are long, especially so in certain states. Simplifying the process via this technology, Kedar believes, will allow for more patients to receive HCBS, but also for HCBS beneficiaries to receive their promised care on time and in accordance with what has been prescribed.
“Oftentimes, the array of stakeholders involved in this process is not well coordinated,” Kedar said. “And what we’ve in the Medicaid space is there’s a higher incident rate of patients who have a documented need for home-based care not actually receiving it. When we break down why, it’s often coordination across this breadth of stakeholders, as well as that navigation across the more complex benefits and coverage guidelines.”
Home-based care is also a lever that payers can pull to leverage value-based care across their networks.
But that value-based care is only an idea if home-based care is not actually being delivered in a timely or appropriate fashion. While risk-based and value-based care is more prevalent in the Medicare Advantage (MA) space at this point, Medicaid MCOs are also considering how to become more value-based over time.
The rising demand for home-based care and the payers’ desire to become more value-based are undoubtedly tailwinds for an organization like Tomorrow Health.
“We are seeing significant demand at both the national and regional levels from Medicaid MCOs and diversified health plans toward this effort and toward providing greater coordination for home-based care,” Kedar said. “We expect this to grow – in terms of the members we’re able to afford – between three to 5 times over the next two to three years.”
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