How home care is changing the healthcare landscape.
Older adults often prefer receiving care in familiar surroundings, which enhances their comfort and quality of life. Home health services enable patients to age in place, reducing the need for institutional care, such as nursing homes.
Home health care is also often more affordable than hospital or long-term care facility stays. Providing care at home can reduce hospital readmissions, prevent unnecessary emergency room visits, and decrease overall healthcare costs, making it a more cost-effective option for both patients and the healthcare system.
Home health services allow for more personalized and individualized care. Healthcare providers can spend more time with patients, creating customized treatment plans that are tailored to the individual’s specific needs, preferences, and lifestyle.
For the May issue, Repertoire Magazine spoke to several experts – from distributors to providers – on the current realities of the home care market and what’s in store in the years to come.
To the Point
Henry Schein’s Adam Bries believes the ‘why’ must come before the ‘what’ of home care market solutions.
Adam Bries, vice president and general manager, Home Solutions at Henry Schein, believes U.S. healthcare stakeholders should ask themselves three key questions related to their products and services for the home care market:
- Is there a strong patient preference and benefit?
- Does it lower the overall cost of healthcare?
- Does it improve outcomes and make us a healthier society?
“We have to ask ourselves whether we are solving one of those three things,” Bries said. “We must make sure whatever we’re doing, that it’s for the patient, lowers overall costs and improves outcomes.”
Bries joined Henry Schein a little over 18 months ago to leverage and integrate the Home Solutions division into the company. Henry Schein has made several large investments recently in the home health segment through acquisitions, including Prism Medical Products, Shield Healthcare, Mini Pharmacy, and Acentus.
“We’re looking to build through acquisition and organic growth, and then ultimately leverage Henry Schein’s capabilities in the market in terms of distribution channels to key customers,” said Bries. “Henry Schein has great relationships with health systems and believe that we can help advance support in the continuum of care. As a leading provider of supplies to non-acute businesses, we are well positioned to help with needs in home health, hospice and durable medical equipment businesses.”
Bries discussed the growing home care market with Repertoire Magazine, highlighting some of the main challenges providers face, and technology’s role in enhancing care coordination and recovery at home.
Repertoire: Why is home care an exciting market to be in right now?
Adam Bries: The home health market is one of the fastest-growing markets in healthcare, and it’s no surprise as we continue to see the shift away from an acute care setting or nursing home setting to home-based care. I attribute this to three main factors.
First, patients prefer the convenience to recover and receive long-term care in their homes rather than being in a facility.
Second, it’s more cost-effective to treat patients in their homes, which is why we are seeing an increase in home healthcare. There are more outpatient procedures and hospital-at-home programs that lead to faster transitions from the hospital to home. Insurance plans like Medicare Advantage place significant value in home health. When patients elect for home healthcare vs. other alternatives, it helps save money as well.
Third, there are a lot of studies that show patients actually have better outcomes and results when they’re treated at home, which is critically important.
When you combine these three things – convenience, cost-effective, and better outcomes – I believe that’s what is driving the growth and shift to home health. This is what makes it attractive and why you’ll continue to see the shift to the home over time.
Repertoire: What role is new technology playing in home care’s growth?
Bries: Technology has been an important part of the home healthcare industry for a while, and will continue to be vital in advancing both care coordination and improved overall health. We’ve seen a lot of advancements in terms of electronic medical record (EMR) integrations with home health as it becomes more integrated with an overall health system. Many health systems now own their own home health and hospice. We’re also seeing increases in remote patient monitoring across the industry.
From a medical supply standpoint, we are also seeing technological improvements such as continuous glucose monitors to better manage diabetes and advanced wound care dressings that allow wounds to heal faster. These technological improvements help providers and patients to not only manage their chronic conditions better, but also to enable a quicker and improved recovery from any procedure – all in the comfort of the patient’s home.
The other advancement we hear about a lot is artificial intelligence. It’s a hot topic across healthcare and in many industries, and this will likely play an important role in home health in the future, especially in areas such as documentation processes, workflow processes, and predictive analytics.
Repertoire: What are the biggest challenges facing home care providers in today’s market?
Bries: Staffing seems to commonly rise to the top for many providers in the home care industry. As a supplier and provider of home medical supplies, we continue to look for ways to help ease the burden for our customers, nurses, and care coordinators, so they can focus on the best care for their patients and optimize their time in the field as they travel from home to home.
Additionally, I think growing documentation and authorization requirements are challenges that providers face and can sometimes lead to delays in treatment and/or supplies.
Lastly, is reimbursement pressure. You hear about it all the time, and it continues to be a constant challenge as we’re trying to reduce the cost of healthcare. When you couple the reimbursement pressures with rising costs and staffing, it creates a real challenge for providers and suppliers in the home care industry.
Repertoire: What are the most common conditions or illnesses being treated in the home?
Bries: Home health is a very broad category with many conditions, therapies, and services, but I’ll simplify it into two main categories. First, home healthcare is central to chronic disease management and treatment in the home across all chronic conditions, including heart disease, diabetes, chronic obstructive pulmonary disease (COPD), kidney disease, etc.
Second, home healthcare is vital to post-procedure recovery in the home. This includes ongoing monitoring such as nursing care, physical therapy in the home, DME, and home medical supplies like wound care.
The supplies that Henry Schein’s Home Solutions business provides to patients and providers are critical to both segments. For example, for chronic care management we ensure patients receive their ongoing monthly supplies, support their home recovery after procedures and hospital discharge, and promptly deliver all necessary supplies.
Repertoire: Are we getting better at managing a patient’s care throughout the continuum, even though we’re talking about different providers, settings and services?
Bries: There’s a lot of coordination that must happen across many stakeholders, the hospitals, physicians, home health agencies, insurance companies, and the supply companies. I think we’re continuously getting better. As a supplier and provider for home medical supplies, our role is critical to ensuring patients receive the necessary equipment and supplies at home.
We typically focus on four main areas. One is helping assess the patient’s needs. This involves working closely with the physician and the home health agency to really understand the patient’s medical condition and requirements so they have the right supplies.
Second, and a big part, is navigating their health insurance. It’s a complex process, so we help patients, caregivers and providers by understanding their health benefits, what’s covered, what’s not covered, and what authorizations we need. We also make sure we have good compliance and documentation to prevent any delays.
Third, there’s constant coordination that must happen with providers. We help in communication with the hospital discharge planners, physicians, and home health agencies to verify prescriptions and supply needs, all have a smooth transition.
Last, time is of the essence. When you’re looking at that coordination of care and who is handing what off to whom, we must ensure supplies are delivered on time, provide ongoing support and assistance to patients, address any supply issues, and finally address reorders and ongoing adjustments that they may need for their supplies. By doing this efficiently, we can help streamline the discharge process, reduce hospital readmissions and empower patients to manage their conditions effectively in their home.
Repertoire: For reps calling on these accounts, are there unique parts of their discussions that vary from traditional physician office clients?
Bries: While we provide a variety of ongoing supplies, our business is service- and patient-focused. We value providing the best level of service. Providing the best patient and provider experience is crucial to our success because very little of our business is contracted. We must earn our customers’ trust and deliver the best-in-class offering every single day. Since it’s a patient-focused business, it’s not all about the price. In a lot of cases, it’s about providing the best quality support to patients and providers.
Repertoire: How do you see the market evolving?
Bries: We’ll continue to see the shift toward home-based care, just as we have over the past decade or so. And we’ll probably continue to see consolidation in the industry as well.
New technologies and technological advancements will help us continue to evolve in how we assess the overall health of an individual.
As we evolve, it’s important that we connect all the dots – behavioral health, social determinants of health, eating and living habits, chronic conditions, etc. I’m optimistic that we’ll continue to see improved outcomes and improved health of individuals in society, and hopefully this can all be done at a lower overall cost.
Home Care and Technology
How promising innovations will help improve personalized health management in the years to come.
Technology is reshaping home health care by revolutionizing services, enhancing patient experience and expanding accessibility, all while empowering individuals to manage their health comfortably from home, said Perry Bernocchi, EVP and CEO, Patient Direct, Owens & Minor.
ByramConnect™, powered by the Welldoc App®, exemplifies this transformation by restructuring care for individuals living with diabetes and other related chronic diseases, Bernocchi said. The more information input by the user, the more help the app can provide.
Byram Healthcare, part of the Owens & Minor family, recently launched ByramConnect, a personalized digital health program powered by the Welldoc App.
Bernocchi discussed the benefits of the digital health platform with Repertoire Magazine.
Repertoire: What specific data sources does ByramConnect integrate with to provide a holistic view of a patient’s health?
Perry Bernocchi: Armed with the Welldoc Advanced AI-engine, the app connects and correlates between six dimensions of health, which informs personalized guidance and digital coaching:
1. Symptoms
2. Nutrition
3. Medications
4. Individual Generated Health & Lab Data
5. Psycho-Social
6. Activity and sleep.
Additionally, the app allows individuals to connect to their vital health data across more than 400 devices and data sources, including fitness trackers, blood glucose meters, continuous glucose monitors and weight scales – allowing for highly personalized insights and recommendations tailored to everyone’s unique health needs.
By leveraging this data, ByramConnect, powered by the Welldoc App, offers truly personalized health management. It empowers patients with a customized approach to understanding and managing their diabetes and other chronic conditions and ensuring the incorporation of lab and pharmaceutical medication data – providing patients with total autonomy and on their path to better health.
Repertoire: Can you elaborate on how the AI-driven digital coaching works to personalize the experience for each user?
Bernocchi: Personalization is key when supporting patients living with chronic disease – like diabetes – especially as everyone has different lifestyle factors that can impact their journey. Welldoc’s proprietary AI excels by correlating insights across the broad spectrum of health data, surpassing the capabilities of other solutions. Its dynamic, adaptive AI models, powered by evidence-based guidelines and our proprietary language learning model (LLM), deliver personalized insights and coaching within established regulatory guidelines. These models fuel advancements in predictive capabilities, supporting improved health outcomes across multiple conditions and driving a shift towards proactive, prevention-focused healthcare. Furthermore, Welldoc continues to advance AI through the integration of advanced sensor technologies.
As we continue to empower individuals to gain more sophisticated insights and guidance beyond what is available via traditional data sets, ByramConnect, powered by the Welldoc App, works to seamlessly integrate into a patient’s daily routine, offering support and guidance tailored to their unique health needs and lifestyle.
This is successful through five key factors:
- Personalized Medication Management: The AI-driven coaching tracks and organizes a patient’s medication schedule, sending reminders to ensure adherence. It also monitors for potential side effects, utilizing data from past experiences to alert users and informs healthcare providers with alternative recommendations.
- Actionable Health Insights: By analyzing data trends and patterns from various health metrics (such as glucose levels, blood pressure, activity levels, etc.), the AI generates actionable insights. These insights help patients understand their current health status, highlighting areas of concern and offering strategies to address them effectively.
- Guidance on Healthy Eating Habits: The platform provides custom dietary recommendations based on individual nutritional needs and dietary restrictions. It considers preferences, medical conditions and lifestyle to suggest meals and snacks that support overall health, promote balanced nutrition and align with personal goals.
- Reinforcement of Mental Well-being: Recognizing the integral connection between mental and physical health, the AI-driven coaching emphasizes the importance of mental well-being. It tracks mood patterns, sleep quality, and anxiety levels – offering suggestions to improve mental health.
- Holistic Support and Feedback: The AI adapts continuously, learning from ongoing interactions with the user to enhance its recommendations. It offers encouragement and feedback, celebrating milestones and motivating patients to stay committed to their health goals. This holistic approach ensures that patients receive comprehensive support that addresses all aspects of their wellbeing.
Repertoire: How does the ByramConnect platform measure success in managing chronic conditions like diabetes and hypertension?
Bernocchi: ByramConnect, powered by the Welldoc App, measures success through member engagement, member feedback and overall health outcome improvements over time. While success for users ranges based on personalized goals, specific areas we’re seeing initial results include A1C improvement, weight loss and blood pressure reduction.
Repertoire: How does the platform assist in managing medications like GLP-1, and what are the key benefits for patients?
Bernocchi: Managing diabetes and other chronic diseases is a lifestyle change, inclusive of a variety of different factors. We wanted to provide users with a simple and easy way to manage their medications alongside other changes, such as nutrition and fitness, to support their health journey.
The program supports a member’s holistic weight loss journey whether or not they are using GLP-1 medications for obesity. Neither Byram Healthcare nor Welldoc are a prescriber. However, we support GLP-1 usage by educating, coaching and creating a seamless user experience to help members track their medication adherence, side effects, protein intake, muscle retention and other metrics related to overall weight management.
A few of the key benefits for patients include:
- Enhanced Responsiveness: Continuous monitoring to help patients and healthcare providers quickly address issues as they occur – to optimize patient care.
- Optimized Treatment Outcomes: Tailored nutrition support and adherence tracking contribute to more effective management of diabetes, maximizing the benefits of GLP-1 medications.
- Comprehensive Health Support: The holistic approach ensures that all aspects of a patient’s health, including diet, medication, and general well-being, are managed effectively.
Where Healthcare’s Future Will Reside
Why Supreme Medical’s Colton Mason believes the home will continue to be the major catalyst for growth within the healthcare industry.
The home health market continues to grow at a rapid pace year over year. At their 2024 Summit, Vizient projected a 22% growth rate for Home Health Care over the next 10 years. Coupled with their growth projection for telehealth (+25%), we are looking at the demand for care received in the home almost doubling within the next decade.
This is a stark contrast to markets like skilled nursing facilities and urgent care clinics, which are projecting declines in care volumes, said Colton Mason senior vice president, Supreme Medical. The reason for this is simple.
“I could spout data points outlining the costs savings that home care delivers to payers or recite statistics that show the drastic reduction of infection rates when you receive care in your home versus being in a facility surrounded by sick people, but the fact of the matter is, all of that is irrelevant,” he said. “Regardless of costs, reimbursement rates, or even outcomes, people want to be at home – surrounded by their loved ones, their pets, and their things. It’s where they want to receive care, recover from surgery, and have end of life.
“Dorothy got it right 85 years ago with five simple words – there’s no place like home,” Mason continued. “And that is why the home will continue to be the major catalyst for growth within the healthcare industry.”
Repertoire Magazine asked Mason to share his insights as an independent specialty distributor serving the home health market.
Repertoire: How do you see the home medical equipment market evolving over the next five to ten years?
Mason: The HME market is projected to grow over 50% by 2031. Why? Because 10,000 Americans turn 65 every day and these folks are going to need products to help them walk, stand, sit, and remain active and independent as they grow older. The main evolution in this key segment of the home care market has been the unseating of Medicare and Medicaid as the major payer for goods and services. As of this year, out-of-pocket payments represent the largest revenue stream within the home medical equipment payer mix – accounting for nearly 50% of the share of payments – more than Medicare and Medicaid combined!
How many of us have become caregivers for a family member in recent years? More and more, you see this rising trend of adult children taking care of their aging parents at home. And when Mom and Dad need a walker, a wheelchair, or hospital bed – they’re not filling out insurance paperwork anymore. They’re pulling out their credit cards and going shopping for what they need. The manufacturers and distributors within the healthcare industry that understand this and work to deliver the best products at the best price to this new class of trade will be the winners of the next decade.
Repertoire: What challenges do providers face in providing quality care at home?
Mason: One word – Staffing. Over the past two years, it is estimated that between 10% to 25% of care that was being delivered in hospitals, outpatient clinics, physician offices, skilled nursing facilities, and urgent care has shifted to care delivered at home. To put it frankly – there are simply not enough nurses, therapists, delivery technicians, or caregivers available to meet this increasing demand. Thankfully, the home care workforce is projected to be the fastest growing profession and add almost 1 million new jobs by 2031.
As an industry, we must coalesce to capture the attention of kids in high school as well as upcoming college graduates and educate them on the opportunities that exist to them in healthcare outside of the four walls of a hospital.
Repertoire: What are the most common conditions or services managed in home care?
Mason: As a home care distributor, Supreme Medical serves the needs of thousands of individuals managing chronic conditions at home. The Research Institute for Home Care reported in their most recent chartbook that 45% of all Medicare home health users have five or more chronic conditions. This data underscores the important role that home health plays in protecting and caring for our most vulnerable seniors. Thanks to quality home health services, these at-risk vulnerable patients can remain in their homes and receive necessary skilled nursing and therapy services, while avoiding unnecessary inpatient care and hospital stays.
Whether it’s supplying bandages and dressings for those suffering from a wound, adult diapers and urological supplies for those dealing with incontinence, or oxygen concentrators to help those diagnosed with COPD to breathe easier – home care providers continually step up to the plate to meet the needs of our chronically ill population.
Over 3 million patients annually are now receiving home infusion therapy, with the top modality being enteral nutrition – a product category that continues to innovate. Long gone are the days of formula for old people. Based on consumer demand, these products have been enhanced to contain peptides, real foods, and organic plant-based nutrients to help provide nourishment to seniors and children who require a feeding tube. Pain Management products are also a top category, ranging from a brace to support someone suffering from back pain or compression socks to help improve circulation and reduce foot and leg swelling due to diabetes.
As you can see, basically any chronic condition can now be managed from the comfort of your home.
A North Star for Home Care
Cardinal Health’s Rob Schlissberg believes finding tomorrow’s home care advancements will only happen if U.S. healthcare stakeholders continue to let patient preference be their guide.
When you think about why home care is growing in popularity, there are certainly a lot of demographic and technology related factors, said Rob Schlissberg, president, Cardinal Health at-Home Solutions. “But really it comes down to this – people like it.”
It also takes significant cost out of the system. And in many cases, outcomes are proving to be better, Schlissberg said.
Technology has helped enhance the care provided in the home, whether it’s remote patient monitoring or diagnostic devices that can connect to a smartphone.
The last factor is reimbursement. The industry is seeing an increased level of support when it comes to payor reimbursement for care that’s provided inside the home. For example, hospital-at-home programs provide true acute-level care in the home, and today, are covered under Medicare through the Acute Hospital Care at Home waiver, which is awaiting Congressional renewal this spring.
As a result of these advancements, there are new home care providers popping up constantly. “New ones are starting, but there’s also a lot of consolidation happening,” Schlissberg told Repertoire Magazine. “It’s a fast-moving industry sector. You have different types of companies across the healthcare continuum that are acquiring various home care companies or acquiring different elements of that ecosystem.”
In the following discussion, Schlissberg provided more insights into the emerging home care market.
Repertoire: How is technology changing the way home care is provided?
Schlissberg: For me, it starts not necessarily with new technologies, but current technologies that are able to work together. Can our operating system talk to a hospital’s operating system, then talk to a home care agency’s operating system? It’s that connectivity that creates an ecosystem that when a patient is “remote” in their home, everybody is viewing the same information and able to provide the right care. That is the most critical thing.
For us specifically, we’ve invested a fair amount in technology around our distribution capabilities so we can more quickly and efficiently get patients the critical medical supplies they need, delivered directly to their homes. Our customers are durable medical equipment providers and home care agencies – and they may not have the infrastructure in place to deliver medical supplies that their caregivers and patients need. It’s too costly – and that’s where we come in.
We have nearly a dozen buildings around the country, some fully automated with robotics and technology to get medical supplies directly to people’s homes in a very timely fashion. Our customers only need to worry about doing what they do best – caring for a patient. So, we believe deeply in investing in the type of technology that is specific to our type of distribution. We only do small medical supplies – not giant pallets. We don’t deliver to hospitals or health systems. We are only focused on getting medical supplies onto the doorstep of somebody’s home. That focus helps us design the best possible systems and network to be great at that.
Repertoire: So, boxes instead of pallets?
Schlissberg: Yes. We focus on small medical supplies that can fit into small, shippable boxes. Others in the durable medical equipment space may do bent metal or larger equipment – like wheelchairs. We are only focused on medical supplies that help treat chronic conditions. Diabetes, for example, is a key focus area for us and one we know will continue to grow.
So, in our distribution centers, we pack medical supplies directly into a box that’s either going to show up at the home of a patient or, sometimes, at a home health agency.
We have been on a multi-year transformation journey with our nationwide distribution network. This transformation is really focused on two things: Expanding our space and capacity so we can support industry growth and bringing in key automation technologies that help us get packages out the door and to patients faster. In the last couple of years, we opened two brand-new distribution centers – one in Grove City, Ohio, and one in Greenville, South Carolina. This summer, we will open a new facility in Fort Worth, Texas, which will consolidate two existing buildings into one, larger space. We continue to add space, capacity and technology to our network for direct-to-home distribution. I’m proud to say that because of our efficient and strategic locations throughout the country, we are able to deliver products to a large majority of the U.S. population in 24 hours, and that’s really the goal. The rest of Cardinal Health operates in a different distribution network – so, the at-Home Solutions business is incredibly unique to the rest of the enterprise.
Repertoire: That must be exciting to have that kind of national reach.
Schlissberg: It is. In the vast majority of the country, you can order from us mid- to late-afternoon and it’ll be there the next day, which is fantastic. Many of the things that we do are quality-of-life type products. If it doesn’t show up on time, accurately, and with the right product in the box, it could change somebody’s life. So, it’s something culturally we stress across our entire business, but specifically in our distribution centers. We want people to know that they are putting something in a box for a human being, and not just stacking boxes on top of each other, putting them on a pallet and shrink wrapping them.
Repertoire: The providers, in turn, would have to trust you at a higher level; it’s no longer just the supplies coming to them, it’s supplies coming to their patients.
Schlissberg: That’s right. When we set out to transform how we think about distribution and how we think about our distribution network, the patient at the end of the shipment is always coming first. We’re committed to doing everything we can to provide the best possible patient and customer experience, priority one.
Second, we must do this in a way that creates a great employee experience, because we can’t deliver that great customer experience if our employees don’t buy in and don’t have that same mission.
Third, how do we get supplies to patients in the most productive way possible? How do we continue to take cost out of the system? The patient’s needs are at the core of everything we do. Yes, that healthcare provider is effectively trusting us that we will deliver on their behalf to the best possible degree. And we are currently running at historically high service levels, fill rates and quality metrics. We couldn’t be more pleased with the team on the distribution side.
Repertoire: What are some of the most common conditions or illnesses being treated in the home?
Schlissberg: On the durable medical equipment (DME) side of our business, some of those conditions include diabetes, ostomy, urology, nutritional feeding, continence, respiratory (COPD), and sleep apnea (such as OSA). We carry a broad spectrum of products – because, for example, in the Cardinal Health at-Home side of our business, our primary customers are classified as DME providers. No two DME providers look the same. There are a lot of specializations. So, you might be a smaller pediatric nutritional formula focused provider in Greenville, South Carolina. That might be all you do. And then on the other side of the country, there might be a provider solely focused on respiratory conditions and patients diagnosed with COPD. Even though they’re all classified as the same type of provider from a Centers from Medicare & Medicaid Services (CMS) perspective, what they do is all very different.
Now, the hospital-at-home leg of our business, called Velocare™, is focused on the supply chain and logistics side of providing high acuity care in the home. This is serving a much different customer base that we normally serve within our Cardinal Health at-Home and Edgepark businesses, which are focused on the DME space. Our customers here are health systems across the country. In this care model, hospital-at-home patients are typically admitted for acute conditions like pneumonia or COPD, COVID-19, stroke, or a urinary tract infection, for example. As the supply chain and logistics provider of our customer’s hospital-at-home programs, we bring in all the supplies a patient would need to be treated inside the home, including remote monitoring technology, medically approved meals, medical gases waste disposal, and more. We also provide troubleshooting, courier services and more throughout a patient’s home-hospital stay. When a patient is admitted to a hospital-at-home program, we are able to get to their home and set up their hospital room in as little as two hours. We see these programs as the future of healthcare delivery – it’s really exciting to be able to be a part of this evolving model of care.
Repertoire: Tell us about your journey into this space. When did you start working in home care specifically, and what’s interested you about this part of the industry?
Schlissberg: I got into the home-care focused part of the business about a decade ago – I worked in this space for a while, then went to a different part of Cardinal Health. A few years ago, I was honored to be asked to come back into at-Home Solutions to lead the entire business in totality. When I originally joined the at-Home Solutions business, the thing that most interested me was the customer base – not just that they are focused on caring for patients in the home, but that many of them are small, family-owned businesses. It’s incredibly rewarding to get to work with that type of customer. It’s not just that they’re home care type, but small businesses.
I started my career at Cardinal Health in what we would call the retail independent pharmacy side of the business. So, the “Rob’s Pharmacies,” not the major retail pharmacies. What I grew to love about that part of the business was what we did as a big company really impacted them every day. With these small businesses, we can really drive value and help them in turn care for the patient to a greater degree.
As I learned more about the value of home care, I experienced family members going into it. I could see firsthand how home care is a valuable part of our healthcare system.
The third element would be it’s hard to coordinate real quality care in a simplified, easy to access and user-friendly way. And that’s a great spot to be as a business leader. It’s a great spot to be in amid a challenging industry. Because you can, again, add value. We like to say we’re trying to simplify and empower quality care in the home. That’s our north star.
Repertoire: How different are conversations for territory managers calling on home health service providers versus today’s physician offices, and even IDNs?
Schlissberg: For a sales leader out in the field, you’re going to talk to somebody who’s usually a business owner. They may have a clinical background. Maybe they went to business school, maybe they grew up in a business and rose through the ranks, but they’re not the CEO of a large IDN. You get to talk to the people that are really affecting the business every day and have real, value-driven conversations.
It’s important to find somebody who embraces that as a rep. Someone who takes pride in the value which we can provide. We’re not just a vendor; we become an extension of healthcare. They trust us with the care of their customer, their patient. If you don’t take pride in doing that, it will be a difficult job.
Repertoire: What keeps home health care providers up at night?
Schlissberg: For that true home health agency (those providing nursing care in the home), I think they would all say labor. More broadly though, most would say reimbursement is something that keeps them up at night. There’s uncertainty right now. Home care providers want to know there will be fair reimbursement so they can continue to provide the type of care that they know is important.
Specifically, on the DME side of the business, there’s a lot of administrative burden to not just take an order and ship, but take an order, verify insurance, process the order, make sure the prescription and medical necessity is there – all those important steps along the journey. It’s a difficult and complicated thing to do.
In certain areas though, I give CMS a lot of credit. There have been many improvements in access to care, deregulation and reduction of administrative burden.
Transitional Care Program Shows Promise
Ochsner Health’s Acute Care at Home™ program has achieved some “significant” early outcomes, the IDN says.
Ochsner Health launched the Acute Care at Home™ program at Ochsner Medical Center – New Orleans in March of 2024 to enhance patient outcomes, streamline ED operational flow and observation unit throughput, shorten the length of stay, reduce unnecessary hospital utilization, and decrease readmissions. To accomplish these goals, the New Orleans-based hospital partnered with myLaurel, a home-based acute and transitional care company tailored to the needs of frail, elderly, and complex patients.
Late last year, Ochsner Health revealed “significant early outcomes,” preventing either initial admission or 15-day readmissions for 92% of patients referred to the program from the emergency department and observation units.
As a result of the partnership, providers can discharge eligible patients from the ED and observation units with myLaurel’s at-home services, avoiding an observation stay or inpatient admission. This approach results in over 1,000 bed days saved and has the potential to allow for 200+ new admissions. Patients are seen the same or next day at home by a virtual physician leading an in-home care team, ensuring continuity of IV medications, managing point-of-care labs, treating symptoms, providing in-home education about treatment plans, and performing medication reconciliation.
For patients to qualify, several eligibility criteria must be satisfied:
- Value based payer with Ochsner
- Discharging to a home / home-like dispo (ALF, Group home, Medical Shelter)
- Live within Ochsner service radius.
Clinical criteria includes:
- ED program. Prevention of admission for a low acuity, stable problem.
- Readmission program. Have an Epic assigned HIGH readmission risk score and / or preceding 30-day admission.
Remote check-ins with a registered nurse are conducted for seven days, during which care plans are communicated with the Ochsner team and the patient’s primary care physician to coordinate treatment and reduce care gaps. Monitoring patients in the home allows myLaurel to closely track symptoms, even those unrelated to their ED visit, effectively avoiding unnecessary hospital utilization.
“This is not a home health program,” noted Dr. Logan Davies, medical director of hospital access and throughput, Ochsner Medical Center – New Orleans. “This is a transitional care program within home provider visits providing post ED and post hospital care.”
The program has improved care by durably moving care closer to the patient, reducing ED and hospital visits for those enrolled by 33% and 38%, respectively, Dr. Davies said.
All outcomes are monitored and measured for weekly reports. Quarterly reviews exist between Ochsner and myLaurel. KPIs include utilization (ED, observation, admissions), quality / safety (patient safety events, mortality), patient / provider engagement / satisfaction, and financial.
During the program patients and caregivers are the beneficiaries of a 24/7 staffed hotline for any clinical questions or concerns.
Patient and family decision making is key, Dr. Davies said. “Enrollment is never forced upon patients and as a requirement patients must agree to enrollment,” she said. Ochsner provides in-home education and training to patients and caregivers including medication reconciliation, falls prevention, and disease specific education.
Meeting the Demand
With an influx of patients and continued labor challenges, home health providers will need their distributor partners and the solutions they provide now more than ever.
The team at TwinMed sees two divergent trends happening that will affect the home care market for years to come. First, there is a “gray tsunami” of aging Baby Boomers coming that will want and need care in the home.
But the question is, will home health providers have enough nurses and staff to properly care for them?
“We’ve seen a huge struggle for home health and hospice agencies in retaining employees, specifically nurses,” said TwinMed’s Billy Bindel. “There’s a nursing shortage, but we’re also seeing a huge influx of nurses either stepping away from the profession or going into sales roles, such as working for manufacturers. That’s hurt our customer base being able to service their patients … Every customer I speak with either has nurses with overwhelming schedules, or they don’t have enough staff to care for the increase in patients. It’s definitely been a big struggle.”
Repertoire Magazine asked Bindel, VP Hospice Sales, and Scott Williams, Senior VP Alternate Sites, TwinMed and President of the GroveMed division of TwinMed, about how the market is evolving and what home health and hospice providers need from their distribution partners.
Repertoire: What are some unique things about servicing your customers in extended care that may differ from other traditional med/surg relationships?
Scott Williams: First, you’re shipping product directly to the patient’s home, which brings up a multitude of different challenges from delivery, freight, shipping, to set-up once the product is there, etc.
Billy Bindel: Smaller orders, smaller volumes, more shipping costs, just like Scott said. In addition you have delivery challenges with product being shipped directly to these patients and their caregivers. We sell in the lowest unit of measure which can be more costly and labor intensive.
Repertoire: How do you see the market evolving in the next 5 to 10 years?
Bindel: Technology is going to play a big part in the coming years. We’ve seen AI start to get involved and implemented within the EMRs. And that’s a big piece for the next step, where nurses can save time and have more visits.
Take into consideration that a home health nurse or hospice nurse, if they have a caseload of 15 patients, they could be making 30 visits in a week and could be driving a few hundred miles. So, having AI involved and being able to chart faster, or see a patient on a screen, could be a lot more beneficial for the hospice/home health agency, as well as the nurse’s time.
Repertoire: Of home agencies that are doing home care well, are there any common themes or best practices that you see?
Bindel: Culture and training. I have a customer whose company culture is amazing, and they’re growing. They’re rocking and rolling. Their nurses and staff love who they work for. You can tell the company cares. They care about the patients, and they care about the families. They provide phenomenal patient care. And I think that company culture goes a long way.
Repertoire: Are big health systems and local home health agencies doing a better job of coordinating care for the patient who may move between those entities?
Williams: There is a transition taking place. Everybody is aware that the care is going to the house. So, they’re all trying to find a path there, to build a sustainable revenue stream as they go forward.
I believe the volume of businesses – it’s close to a $300 billion business today – is expected to grow by 30% to 40% over the next five to 10 years. So, the home is going to be a giant source of where the volume and revenue is going to come from.
But, how does a hospital transition? How does a doctor’s office transition? How does a private insurer transition? I think we’re all trying to figure that out right now. I’m not sure anybody has the right answer. Even nursing homes are looking at whether there is a path for them to get into home care.
Hospitals, obviously, are buying home care offices. Home care and hospice companies are all expanding and growing their businesses. The average hospice or home care business is probably 100 patients across the country. Then you have the Goliaths and everything in between.
So, I think we’re all in a great mixing bowl trying to figure it out.
Bindel: I’ve got some prior experience working for a company involved with IDNs. I can tell you that hospitals and IDNs don’t want to lose sight of that patient. They would love to have that patient from time of birth all the way through time of death.
I do feel that the IDNs struggle with end-of-life care and hospice services, it’s a different philosophy of care they often aren’t familiar with.
Williams: Billy, to your point, there are so many volunteer people involved in the hospice side, that they don’t see a revenue path to build that out on the IDN side.
Bindel: It’s two completely different animals. And that’s one thing that sets TwinMed apart from our competition. We have 100% focus on the non-acute care business, the full extended care market. We understand the extended care market. It is completely different than the IDNs, and completely different than the acute care market. It’s end of life care, home care, home health.
Repertoire: Are home health agencies feeling the reimbursement squeeze?
Williams: I think everybody is feeling the squeeze. They got a little bump in rates last year. But the labor cost keeps going up. The cost to retain employees keeps going up. You’ve got product costs that keep going up. Freight that keeps going up. And now you have tariffs coming potentially.
Medicare/Medicaid is half of the reimbursement in this marketplace. Private pay is probably another quarter, and then random stuff to round it out. We are going to have to do something about it from a legislative and regulatory standpoint to increase the reimbursement rate.
Repertoire: What else is important to understand about the home health market?
Bindel: Over the last 20 or so years, the market has come a long way in educating the public on the benefits of home health and hospice. The government is finally understanding that a patient in home health and hospice or palliative care is much less costly than a patient who is readmitted to the hospital.
That’s a big development over the last dozen years or so. We’re making progress and seeing the public understand more of what home health and hospice can provide. Twenty years ago, you hear the terms home health and hospice, and people would think, “I can’t afford that.” But Medicare, Medicaid, and private insurance cover it. It’s definitely a lot less costly than a hospital admission or being readmitted to a hospital. So I think that’s been a big push, and somewhat successful.
But there is a lot more we have to do. Educating the public is important, and continuing to push what benefits people have, and how they can take advantage of those benefits.
At the end of the day, do people really want to go to the hospital or urgent care? People want to be comfortable in their own home with their family and friends at their side while receiving consistent care by a clinician. The technology that’s available adds a lot of advantages to care in the home, from patients being able to connect quickly via video calls to clinicians being able to order supplies with their mobile device.
That wasn’t something that we could do 20 years ago, we’ve come a long way and there’s even more opportunity to use technology.
Keeping Pace
To continue providing optimal care in the home, reimbursement rates must match market realities, says one national association.
HME suppliers and manufacturers are a critical part of the healthcare continuum, especially given the large and growing population who are especially dependent on home-based care, according to AAHomecare, a national association that represents providers and manufacturers of home medical equipment and services.
In the U.S., more than 70 million Americans have one or more disabilities. In addition, more than 51 million people are over the age of 65 and are eligible for Medicare, which provides reimbursement for home medical equipment and supplies. Every day, an additional 10,000 individuals in the U.S. reach the age of 65.
“Without the support of the home medical equipment sector, this population segment would require more care in costlier settings, such as hospitals, short-term nursing facilities, and in long-term care facilities,” AAHomecare said. HME allows individuals to stay in their homes longer and remain active in their communities.
In an interview with Repertoire Magazine, AAHomecare provided insights into market trends and regulatory issues that suppliers and providers must navigate.
Repertoire: Please tell us about some of the key initiatives of AAHomecare. What are some wins from 2024 and what are your priorities for 2025?
Maintaining strong patient access to high quality equipment and care is a top priority for AAHomecare and the HME community, and much of our legislative, regulatory, and payer relations work is in support of that overarching goal. A major part of maintaining strong patient access is ensuring that reimbursement rates from Medicare, state Medicaid programs, and private insurers keep up with rising product and material costs. Since a large portion of HME products are provided under fixed rates by Medicare and other payers, suppliers can’t just charge their customers more when product or operating costs (like gas prices, which impact suppliers’ delivery costs) go up. It’s a constant effort to make sure that reimbursement rates match the market realities for HME suppliers.
Another top priority that impacts patient access is making sure that payers don’t implement burdensome authorizations and coverage restrictions for critically needed products. For patients with ALS or other severe respiratory issues, being forced to try a less effective respiratory assistance device instead of a ventilator that was prescribed by their doctor can be a distressing or devastating experience.
Over the last three years, we’ve helped boost reimbursement rates or prevent cuts to Medicare and other state and federal payers by about $4.5 billion, while also expanding coverage for mobility assistance devices and streamlining regulations related to several HME product categories.
Repertoire: What are the top challenges/issues for the HME community in today’s marketplace?
Securing sustainable reimbursement rates, making sure insurers allow patient choice and wide network access to their beneficiaries, and fighting burdensome regulations and authorization processes.
Repertoire: How has the HME industry changed over the last 5 years (post-pandemic)?
The biggest change has been the migration from Fee-for-Service (FFS) Medicare to Managed Care/ Medicare Advantage (MA). This had had traditionally been closer to 30% MA vs. 70% FFS, but now MA closer to 52% verse 48% FFS.
Utilization management and prior authorization challenges are greater in the MA space. Post-pandemic we have seen some payment changes for acute care at home become permanent like oxygen coverage and a greater acceptance of telehealth.
Repertoire: Why is payment reform needed? What is the situation like now for HME providers?
Medicare reimbursement policy has not kept up with the cost environment that suppliers operate in. One salient issue is that Medicare implemented a highly flawed bidding process for major HME product categories more than a decade ago, but allowed low-ball bidders to influence the results without having to fulfill their bids. That drove prices down artificially.
We worked with Congress to ensure that CMS implemented reforms to the bidding process that drove non-serious bidders out of the process and utilized a better methodology to determine bid results. But when we finally had a rebid under the new rules in 2019, CMS rejected the results because they “did not achieve expected savings.” So, Medicare rates are based on results from the old, flawed program that was last re-bid in 2015, and have only enjoyed annual inflation-based increases that don’t take into account the flawed bidding methodology originally used or reflect the much higher cost increases in the medical sector over the last 10 years.
Since bidding program rates went into effect on a widespread basis in 2013, the total number of separate HME company locations serving Medicare beneficiaries has been reduced by 38% – even as the senior patient population that especially depends on HME grows rapidly.
Medicare rates – and rates from the other payer segments that are influenced by Medicare rates – are simply not reflective of the cost structure our industry operates under.
Repertoire: How do you foresee home care changing over the next decade?
There’s tremendous opportunities ahead for HME suppliers to take advantage of technology advances that will allow more patients to remain at home, including remote-monitoring and telehealth. Stronger adoption of ePrescribing platforms by HME suppliers and clinicians can improve workflows, cut down on paperwork errors or missing information that requires additional follow-ups, reduce overall admin costs, speed up reimbursements, and prevent errors that may impact patients.
As overall healthcare costs rise and the share of older Americans continues to grow, HME can help meet the challenge with cost-effective, clinically proven, and patient-preferred care at home.
HME product examples
The HME industry directly serves millions of Americans who use HME products and related services, as well as helping the families and caregivers who also support them. Some examples of HME products include:
- Home oxygen equipment, ventilators, and respiratory therapy
- Sleep therapy technologies such as CPAP devices
- Mobility assistive technologies, including power and manual wheelchairs
- Diabetes therapy and related supplies
- Urological and ostomy supplies
- Home hospital beds
Integrating Home-based Services
Compassus, a provider of home-based healthcare services, announces joint venture with Providence to advance patient-centered at-home care.
As post-acute healthcare evolves, both patients and caregivers have begun to shift toward favoring high-quality, home-based care over institutional settings. Once a patient is discharged from an acute-care hospital setting, it may be necessary for some of those patients with ongoing conditions to receive further, advanced post-acute care within a long-term acute care hospital (LTACH), skilled nursing facility, or to receive home-based care.
Studies have repeatedly shown that patients and caregivers strongly prefer at-home care, as opposed to other types of post-acute care, according to Kathy Winn, senior vice president, chief marketing and communications Officer for Compassus.
“In addition to patient preference, factors driving increased demand for home-based care include our aging population, hospital length-of-stay pressures, and new payment models, such as CMS’ new Transforming Episode Accountability Model, or TEAM, (an alternative, episode-based CMS payment model),” according to Winn.
Providence, a nonprofit health system serving the Western U.S., and Compassus, a national provider of integrated home-based care services, recently announced the first phase of a joint venture for home health, hospice and community-based palliative care in three states – Alaska, Texas and Washington. Operations in Oregon and California are expected to be finalized in the coming months, pending anticipated regulatory reviews and approvals.
Under the first phase of the agreement, Compassus will manage operations for the joint venture, which includes six home health locations in Alaska and Washington, and five hospice and palliative care locations in Alaska, Texas and Washington. The new entity will operate under the name Providence at Home with Compassus except in Lubbock, Texas, where the hospice program will be known as Covenant Health at Home with Compassus.
“Compassus offers a continuum of integrated home-based services,” said Winn. “We provide high-quality care and manage patients’ advanced illnesses in partnership with hospitals and long-term care partners whether they need medical care during recovery from a serious illness, in-home IV therapy or end-of-life care.”
A nuanced healthcare delivery model
Home health services include skilled nursing, therapy services, personalized care assistance, and other specialized treatment in the comfort of a patient’s home.
According to the National Library of Medicine survey “Preferences for Post Acute Care at Home vs Facilities,” respondents stated that they were willing to pay an extra $51.81 per day for at-home care ($58.08 for patients and $45.54 for their caregivers) compared with staying in a shared room at a skilled nursing facility (SNF). Survey respondents’ prior experience with post-acute care was associated with an increased willingness to pay for home-based options.
“Within the Compassus care home delivery model, we’ve developed 16 evidence-based management programs for the most frequently seen medical conditions, which include balance problems, chronic obstructive pulmonary disease, congestive heart failure, dementia, diabetes, orthopedic rehabilitation, pneumonia and stroke,” said Winn.
These programs allow Compassus to provide personalized care to fit each patient’s specific health needs. Compassus also partners with health systems to provide advanced care management to improve care and clinical outcomes for patients with serious illness.
For certain patients, home healthcare allows for a more tailored and patient-specific approach to treatment, the familiarity and comfort of home, reduced obstacles to gaining access to and traveling to receive care, and has the potential to reduce institutional care costs, according to The National Library of Medicine.
“Home is the preferred site of care for many patients because of its convenience, and it’s less expensive and just as effective as care received in a hospital or other facility setting. Patients treated at home are also significantly less likely to be readmitted to the hospital,” said Winn. “Our advanced care management partners experience total cost of care reductions in the last year of life through increased access to high-quality hospice care and reductions in unnecessary emergency department visits, skilled nursing facility utilization and inpatient stays.”
The growth of home healthcare
CMS projects home health care will grow faster than other health sectors through at least 2032. In 2022 alone, home health spending increased by approximately 6%, according to a previous CMS report.
“Compassus is growing to help meet the projected needs of the home health sector,” said Winn. “Today, over 7,000 Compassus teammates provide care from more than 280 touchpoints across 32 states in partnership with hospitals and long-term care partners. We partner with leading health care systems that include Ascension, Bon Secours Mercy Health, OhioHealth and Providence, and view the home-based care a patient receives as fundamental to the overall care continuum to improve patient experience and lower overall costs of care.”
Winn says that Compassus’ multi-disciplinary teams complement in-home visits with telehealth technologies that offer a glimpse into the social determinants of health physicians use to address and support patients’ overall physical, emotional, spiritual and environmental well-being.
“Remote patient monitoring technology helps physicians recognize potential medication conflicts, changes in symptoms or patient condition, or the need for medical stabilization to avert a health crisis and unnecessary ED visit,” said Winn.
“We use data and analytics to provide better advanced illness management, making sure patients receive the right care in the right place at the right time so we can make a meaningful impact on their health, safety and quality of life,” said Winn. “We also make strategic technological investments that alleviate administrative burdens so our team members can spend more time serving patients and less time on paperwork.”
The Compassus “Care for Who I am” culture reflects its unique care delivery model, which focuses on each person as an individual. Compassus’ brand promise, according to their website, is written in the first person (“I” rather than “you”) because it is guided by the patient’s perspective. The three domains of its Care Delivery Model are:
- Who I Am – Emphasizing patient quality of life
- How I Feel – Comfort, including total pain management and symptom management
- What I Need – Safety, including the right medications at the right time and patient safety and autonomy
“The word “integrated” is key to our model because of our focus on seamless transitions of care from the hospital to the at-home setting,” said Winn. “Patient comfort, safety and quality of life are the cornerstones of our care delivery model. Improving outcomes for our patients is at the foundation of the care we provide.”
Home as a Place of Healing
For many patients, the environment can play a key role in their healing process, says AdventHealth.
Research shows that being in a familiar environment and surrounded by family can help in the healing process for many people, said Maura Nazario, vice president of clinical operations for AdventHealth home based services.
“By bringing the same whole-person care found in our hospitals to your home, we can offer our patients a more comfortable and personalized healing experience increasing the patient’s autonomy.”
AdventHealth’s Hospital at Home program enables patients who would have required an inpatient stay at the facility to receive care at home instead. All the services that would be provided in the hospital are provided in the patient’s home. This includes things like nursing care, physical and respiratory therapy, and more.
Outside of the Hospital at Home program, AdventHealth also has an extensive home health program that includes skilled nursing, physical therapy, home infusions, speech therapy and home health aides, Nazario said.
AdventHealth can provide services in the home for conditions like congestive heart failure, COPD exacerbations, uncontrolled diabetes, along with people needing IV antibiotics for conditions like skin and bone infections, and more can all be treated at home with a higher level of patient satisfaction.
Patients who have a qualifying condition can work with their hospital-based care team to determine if Hospital at Home is right for them. The care team will also help determine if the patient’s home environment is appropriate for this level of care.
“Through technology, patients can interact with their physician and patients’ electronic medical records are updated in real time, just like they would be in the hospital,” Nazario said.
Patients accepted into the program are provided with a computer tablet for video visits with their nurses and physicians, a telephone that connects directly to their care team, a personal emergency response bracelet, vital signs monitoring devices and a backup power supply. They are monitored 24/7 through a virtual command center.
Nazario said family support is important for many patients to heal at home and educational resources are provided to both patients and their families. “It’s important to note that care is being provided by trained healthcare providers,” Nazario said. “Family members are not asked to perform tasks that professional clinicians would provide. Having a caregiver or family member is not required and every patient is assessed on their particular condition and needs.”
If there is an emergency, the AdventHealth Hospital at Home team will immediately contact paramedics. Patients can also reach their care team in real time with the push of a button.
Patient satisfaction is already showing positive feedback from the patient and families, Nazario said. “Length of stay has also been positive. As we progress through adding patients to this model, we will have more outcomes to share.”