New Hometeam CEO Leads Dual-Eligible Business Plan

New York-based home care startup company Hometeam has named Randy Klein as its new CEO. Klein takes the helm just several weeks after former CEO and founder Josh Bruno stepped down.

The leadership change comes after Hometeam, which provides services in New York and New Jersey and has raised more than $43 million in investment capital, recently switched its business model from a payment structure based on private-pay home care and Medicaid reimbursement, to nearly a sole focus on Medicare-Medicaid dual eligibles and some Medicare beneficiaries.

Home Health Care News previously reported that the company’s new focus was on the Medicaid population. The company began accepting Medicaid in New York City in 2016.


“[These are] the oldest, frailest members of society,” Klein told Home Health Care News on Thursday, in describing the company’s current patient population. “That also means [its] the greatest opportunity to help, where there is the most waste. We are focusing on that component.”

Prior to joining Hometeam just nine days ago, Klein was senior vice president of partner development for Remedy Partners, the largest bundled payment administrator in the country. He has roughly 20 years of experience in the health care industry, including being responsible for the oversight, administration and coordination of Medicare Advantage operations with the Visiting Nurse Service of New York (VNSNY), one of the nation’s largest not-for-profit community-based health care organizations.

Dual eligibles strategy


Klein’s appointment marks an important step for Hometeam, signifying its strategic and aggressive pursuit of the dual eligibles market. However, the company has not strayed entirely from its roots.

“Hometeam of the future will be a technology and data-enabled provider of in-home care supports and services focused on people, duals, who are aging in place,” Klein said.

Dual-eligible beneficiaries are those who qualify for both Medicare and Medicaid benefits. There are nearly 10 million dual eligibles in the nation, according to Klein.

“The immediate vision we have is there’s a unique opportunity in the market where Medicare and Medicaid combined—duals—have created an actual payment stream for frail, primarily eligible individuals to receive the services they nee to be safe at home,” Klein said. “[This is a] really important innovation in payment. It used to be you had to get sick to get care, which you then got in a spin cycle of getting readmitted, losing support, and getting readmitted.”

This group of patients may not be suffering from an acute episode or need skilled care, but without health management, they will likely end up in the hospital, he said. This population often has complex and high-cost care, and are very likely to benefit from higher levels of coordinated care. Since the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has also taken aim at these enrollees to integrate care, improve quality and control costs.

“Dual [eligible payment rates], and MA in particular, have now recognized that personal care is important for preventative care,” Klein said. “Disease suffering may not be disease at all. You can be healthy and a frail person and at a high risk of hospital readmission because you are frail. …It only becomes an acute care when it’s unmanaged.”

Hometeam’s  pivot away from the private-pay space raised some eyebrows at first, given the company’s headline-making funding.

Other venture-backed home care startups that aimed to disrupt the home care space with their tech-forward approach have also faced scrutiny as they have transitioned their business models. San Francisco-based Honor, which has raised $65 million, has increasingly focused on a partnership business model that formalizes relationships with other health care providers. The now-defunct HomeHero also pivoted its model before closing in 2017.

Managed care opportunity

With its clear direction, Hometeam plans to accelerate its integration into the broader health care system.

It will do so “very simply, by working with managed care organizations,” Klein said. “What that does is give us the ability to work with networks, physicians, certified agencies and skilled nursing facilities (SNFs). Because of what we are doing, we have the ability to work with other players in the delivery system. We’re not limiting ourselves to managed care companies.”

However, Hometeam is not working with vertically integrated systems today; rather it’s sticking to the ER and hospital side.

“The hospital and ER portion is what we’re trying to control through the personal care efforts,” he said.

Hometeam is currently involved in a partnership with a New York health system to take care of dual-eligible beneficiaries and provide personal care and home health care services, Klein said. The arrangement includes the agency’s fee-for-service base rate and a “value-based component” on top of it.

The company will also look to expand in the Medicare Advantage (MA) landscape. CMS recently included non-skilled in-home supports as a supplemental benefit for MA in 2019, opening the door for personal care providers to integrate into these plans. Special Needs Plans (SNPs) for dual eligibles, which are a form of MA plan and provide a managed care option for those with specialized needs, will also be one of Hometeam’s “target markets,” Klein said.

While Hometeam is no longer accepting new private-pay clients, its website still includes an inquiry page for services. The website will be updated, according to Klein, though Hometeam is still providing private pay care to its legacy clients who began care prior to the decision to go all-in on duals and Medicare.

Written by Amy Baxter

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