Home Health Executive Forecast for 2019: Obamacare, Consolidation and PDGM

From the introduction of the Patient-Driven Groupings Model (PDGM) to fine-tuning the nine-state Value-Based Purchasing Model (VBPM), 2018 was an important year for home health care at large. Next year will bring its own set of challenges and opportunities — some new and others old.

Home health industry insiders and top executives expect Texas’ recent Obamacare challenge to somewhat complicate 2019. They also anticipate advances in artificial intelligence, continued consolidation and increased demand for home health services.

Below are the predictions of 10 leaders from provider organizations that draw largely from government reimbursement, whether Medicare or Medicaid. See our accompanying Home Care Executive Forecast for a look ahead at the private-pay home care landscape.


The Texas ruling on Obamacare has certainly changed the outlook for 2019 in a big way, but I think home care is well-positioned regardless because of changes on Capitol Hill and voters’ message that health care is a public priority.

First, the 2019 Congressional realignment brings deep support for home care that exists among many on Capitol Hill such as incoming E&C [Energy & Commerce] Chairman Frank Pallone.

Second, America continues to see a growing senior population, an ongoing shift from institutional care, and a stronger preference for patient-centered, integrated care — the very definition of home-based care. These trends come at the same time as the industry continues to both improve value and delivery and garner better engagement with clients and family members.


All three factors combined, we’re looking forward to our sector being an even more impactful player in the public policy arena and that supportive decision-makers will be in a prime position to prioritize health care in the home setting. — Dave Totaro, chief government affairs officer, Bayada Home Health Care; chair, Partnership for Medicaid Home-Based Care (PMHC)

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In 2019, we have positive rates in both home health and hospice, so I think it’s going to be a very good year. But a lot of that momentum and those savings are going to be applied toward PDGM prep — because that’s a whole new care model. It’s the first time we’ve had a change in the care model in 20 years. That’s where people in our industry are going to be focused. Anybody who doesn’t prep for this properly will be screwed. — Paul Kusserow, president and CEO, Amedisys

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In 2019, home health will … prepare for the most significant change in reimbursement since the inception of the Prospective Payment System. Patient Driven Groupings Model takes effect in 2020, but this year, certified agencies should align their resources and focus their agencies on effective, efficient care delivery. For the non-certified segments of our business and hospice, we can expect seniors will continue to desire staying in their homes. Shorter lengths of stay in the acute settings will be advantageous to all segments of home care. Quality outcomes will remain a differentiator among providers in 2019. — Jane Hinton, RN, CFE, VP, franchise operational solutions, Interim HealthCare

With unemployment rates at record lows, I anticipate that in 2019 there will be an influx of companies offering fully integrated artificial intelligence (AI) models and solutions. The use of data analytics in the full recruitment cycle will be leveraged in ways that we’ve never seen before. The integration of AI to improve operational effectives in sourcing, recruitment, and selection will become more common place and will provide candidates a more personalized and engaging experience. The use of AI and predictive data will ultimately lead to better, quality hires and a reduction in turnover for organizations. — Sonya Hinds, chief administrative officer, Interim HealthCare

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2019 will be another year of consolidation and progression of the home health industry, involving expedited trends to better understand and manage large chronically ill patient populations. At Elara Caring, we believe that chronically ill seniors are best managed over a longitudinal timeline involving years, not days. To best aggregate long-term data and create meaningful clinical interventions, we have continued to align programs and large caches of data, in order to better understand this population.

For example, our fall risk assessment and intervention program reduced 30-day all cause re-hospitalization rates to 7.5% when compared to national average of 20% and 28% among chronically ill patients. This correlation will be a large part of the value proposition for Elara Caring in 2019 and for all providers as they seek to better align with the interests of scaled MCOs, large capitated health plans, integrated health care delivery systems and CMS.

Additionally, I predict we’ll see increasing expansion in the behavioral health space, as more and more patients seek long-term mental health support in the home. The Elara Caring Behavioral Health Business continues to treat about 40% of patients for opioid addiction, with every payer and public program looking for support and answers. Elara Caring will expand this program over the next several years. Movement toward these consolidated continuums is crucial and will continue over the coming year. — G. Scott Herman, CEO, Elara Caring

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In 2019, patients and families will propel growth in home health programs as they discover and seek integrated virtual care for themselves and/or for their loved ones. Growing awareness about these virtual home health tools is already leading to more requests for our integrated virtual care program, Home Care Connect — a program now used by more than 16,000 patients. We expect to see this trend continue as people request virtual care for their home care needs. Being able to access an effective two-way video virtual visit using a tablet means patients are empowered to improve safety, avoid preventable ER visits and hospitalizations, and enjoy greater independence. Erin Denholm, president and CEO, Trinity Health At Home

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In 2019, the home health industry will continue to shift its focus from delivering services to a focus on improving health:

— Our industry will invest in care delivery models that focus on meeting the needs of a growing population of seniors who are challenged with increasingly complex medical, behavioral and environmental challenges.

— The care models will have a more holistic focus that looks beyond medical needs to include social determinants of health: Do they have enough to eat; can they afford medication and safe and reliable housing; do they have social supports and meaningful, fulfilling relationships; are there transportation challenges we can address; what behavioral health challenges are impacting their ability to manage their medical challenges?

— Reflecting on the cumbersome processes home care clinicians face, our industry will identify technologies that empower them spend more time getting to know and caring for their patients and less time searching for and documenting information about them, what we call ‘practicing at the top of their licenses.’

— Care models will shift toward preventative care with an increased use of data and predictive analytics to help us intervene before patients have adverse events such as hospitalizations.

Today, there’s a real opportunity for payers and providers to more closely collaborate to usher in a paradigm shift in the way home health is utilized and to have a more profound positive impact on the lives the patients we serve. — Kirk Allen, PT, MSHA, president, Humana At Home

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What we see happening across the health care industry is a move toward a multi-disciplinary approach to population health and coordinated care management, with patient needs at the center and care delivery in the home. This shift to integrated, comprehensive care management in the home and coordination between home care and major providers and payer is undoubtedly the new frontier — we’ve looked at it this way at VNSNY for a while now and are already starting to see amazing progress as we unleash our clinical and care management teams to work across our own provider and payer business. These efforts improve the ability to manage care in complex patient populations, and allow home care organizations to leverage innovative technologies, care models and sophisticated data analytics.

The goal is always providing efficient, effective, and timely patient- and family-centered care in a value-based environment. — Dan Savitt, EVP and chief financial officer, Visiting Nurse Service of New York (VNSNY)

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With a divided congress and the 2020 election cycle approaching, I predict we will largely have a reprieve from entitlement reform debate in 2019. Hopefully, this will also open the door to more innovative policy initiatives coming from CMMI [Center for Medicare and Medicaid Innovation] and the Dual Office.

I would also predict the recent ACA ruling to be overturned. As far as the home care industry goes, I would expect more of the same, continued consolidation of providers and movement to performance/value-based contracting. A number of important managed care states have had changes in the executive mansion which could lead to greater innovation and advancement of care coordination efforts in LTSS and physical health. — Darby Anderson, EVP and chief development officer, Addus HomeCare

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As we enter the new year, it is self-evident as well as reinforced across multiple channels that demand in the home health care industry will continue to increase. National health care expenditures continue to increase as our country’s aging and chronic disease population grows. This requires more resources and innovative solutions in the home and community that put the person at the center of connected and integrated care.

In 2018, industry experts successfully predicted that the rising costs and evolving health care landscape would prompt companies to re-evaluate their care platforms, creating consolidation and synergistic partnerships.

I believe that three things will drive our industry in 2019: First, companies with scale to work across large geographical areas through several lines of complementary services will continue to find themselves more attractive to partners, payers and Medicare. Second, focus will continue to shift toward providing more comprehensive, ‘surround sound’ care solutions through clinical, non-clinical and ancillary services (like pharmacy, telehealth, etc.) to not only provide streamlined integrated care, but also lower available costs. And third, companies that can offer geographic scale and leverage required clinical, people and technology (analytics) investments and capabilities, but also provide service at a localized level, will be the preferred model to follow in the future in all things, focusing on people and quality with better tools and insights. — Jon Rousseau, president and CEO, BrightSpring Health Services

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