How Home Health is Still Forming its ‘Universe’

Home health care advocates have identified a “tipping point” for the industry, and many groups are pushing for home- and community-based services to become more centralized within the broader health care system.

As home-based services adapt to to the ongoing changes in health care, where home health falls on the provider spectrum is still to be determined.

Home Health Care News sat down with Mark Heaney, Principal at DTRT Health Advisors and former president and CEO of Addus HomeCare (Nasdaq: ADUS), to discuss his take on the biggest opportunities for the home health care industry and why managed care could become the center of the health care “universe.”


What’s the biggest opportunity for home care, and what’s the biggest challenge?

The opportunity remains to manage change and how providers configure themselves for survival as there will be continued and accelerated consolidation. The payer is increasingly becoming managed care, and managed care is a different buyer than anything the industry has had to serve. It’s so big.

Every action has an opposite and equal reaction, so I choose not to look at the challenge, but to look at the opportunity. One of the first opportunities is survival. Large and small providers can survive, but the larger have a better chance of survival. The smaller have an opportunity to survive, you just have to be willing to accept that the world is changing, and change with it, unless you’re going to stand on that shore and stop the tide.


Industry groups have called this year a “tipping point” for the industry. Do you agree?

I don’t think we are at a tipping point. It depends on the definition, but every year we meet and we talk about the world. It’s the same world. Every year we talk about five years from now. One year, we went back and looked at it five years ago and it was all the same.

I agree. I hear we are at the tipping point year after year.

I think that those are words we use. We have to use words to describe things. The home health care industry is, for all intents and purposes, 30 or 40 years old. The health system is constantly changing. It’s evolving to what’s it’s going to be.

It’s like the universe—with heat and gas. Then galaxies began to form. We’re only at the heat and gas stage [in home health]. We’re forming. Within that you’re going to see—my heavens! Space used to be gas and heat! And now there are globules, appearing! Later we will say, My heavens to Betsy—there is more than one of them, and some are really big and burning! So, that’s where we are. We have to evaluate change and be flexible, because it is an evolving, maturing organism.

Do you see it maturing in the right direction?

Yes, I think that—and this is heresy here—I’m a citizen first. And I think that health care should treat every person. It’s a basic right. And we don’t have it. Health care is a precious resource of people and money. It’s everyone’s communal responsibility to preserve the resources as much as possible so we can all enjoy it. The best way to do that is to actually manage care. Not to deny it, but to manage it. I think we can and we should.

I believe in managed care. We say the words like they are just words, but if we say them slowly and think about what they are, that’s what we need to do.

What is the missing data or research that is not pushing home care further into the center of the delivery system or health care universe?

That’s a good question, a massive question. Back to the universe. We need to measure, but what do we want to measure? Do we want to measure heat? Matter? Space between matter? Light and dark?

What we lack is a standard data set. We don’t have a Dewey Decimal System for what constitutes data. Let’s organize the data, identify the data we need, and then we can flow into it. We aren’t even near that point.

What is the role of technology in propelling home care toward these bigger goals?

I think that tech is an enabler. It’s not primary; it’s secondary as the enabler. What we are doing is taking a very sick person who used to be inside of four walls (a hospital) and moving them far and trying to manage them. And they are still just as sick. A person after a hip replacement is still just as sick on day two as they were on day two 30 years ago. We didn’t make them less sick. So how do you manage the risk from afar?

You need a human being to do that. We’ve got to talk to them. Then the effort is supported by technology. I believe mobile tech is a means for case management extension. It is the tech that allows the extension.

The most important thing is that the human being is there, not that they have technology. If I throw the phone into the house, it won’t help the person too much. But if I send an aide in there or a nurse in with the mobile phone, we can do more. It’s an enabler and will be for a long time. Its evolving even faster than everything else.

Is the focus on the importance of the human element—the nurse, the aide, the caregiver—is it keeping up with the acceleration of technology? If home care is still about human services, is that focus keeping up with the tech?

No. The reason that’s a great question is because a few years ago, I realized something. This is also heresy, but the most important person isn’t the patient. The most important person is the individual that is helping the patient, because the patient wants help. We all want the patient to be helped. So, the most important part of that equation is the human being who provides the help, the care.

If we focused on that, the patient would benefit so greatly, if we had great employees feeling great about what they are doing, with technology and tools, with support, encouragement, training. What the patient cares most about, the caregiver that comes and helps, the patients would feel so much better and get a better outcome. I think the patient wants us to focus on the caregiver. I had this epiphany—I’m running around thinking the patient is the most important thing, and they are not. It’s what the patient wants is the most important thing.

Written by Amy Baxter

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