When CEO Randy Klein took over Hometeam about a year ago, he was tasked with leading the private equity-backed home care company into a new era.
The New York-based startup had recently switched from its direct-to-consumer business model to one based on partnering with other agencies and insurers. It also moved from a payment structure based on private pay and Medicaid to one focused almost entirely on Medicare-Medicaid dual eligibles.
Since then, those tweaks have helped Hometeam expand geographically and win new partners, Klein told Home Health Care News, though he declined to share the number of clients and partners the company has.
And while Hometeam is often called a home care disrupter, that’s not the company’s predominant motivation anymore, according to Klein. Rather than disrupt home care, its goal is to supplement it to make that care more effective.
Klein recently connected with HHCN to share Hometeam’s progress and plans for the future, along with his bold Medicare Advantage (MA) predictions and take on recent flexibility for dual eligibles.
You’ll find HHCN’s conversation with Klein below, edited for length and clarity.
HHCN: We haven’t connected with Hometeam in about a year. How has the company grown and changed since then?
Klein: When I last spoke with HHCN for your Disrupt podcast, we were only beginning to speculate about the ability for non-medical home care … to improve outcomes and create value in the delivery system, rather than simply fee-for-service.
Fast forward, and we’ve expanded geographically. We’ve brought on a new health plan. We are working with multiple agencies now trying to help support aides and be an important part of the care delivery system.
We’ve started working directly with consumer-directed or patient-directed independent aides who are still paid for by Medicaid. [We’re] also supporting informal caregivers and self caregivers as well, all through the program we’ve developed.
Can you tell me more about your new partners and how you’ve expanded geographically?
We started working with a health plan in Massachusetts (that I can’t name) that has a large dual-eligible population.
We identified that within their dual-eligible population, they still had the opportunity to reduce potentially avoidable hospitalizations, emergency room visits and other events by better leveraging the care that was already there — the aides that these members had.
We went live with them in January, [and] we’re finding that we have a pretty high rate of member acceptance. We see some good leading indicators that what we’re doing is likely producing results.
It has to do with an approach we’ve been using for years: Understand the client, understand their needs, understand what it takes to keep them safe and in place, and then provide real-time connectivity for the aide back to a supporting clinical team that can facilitate issue identification and resolution pretty much in real-time.
For a representative example, think about a typical frail, elderly dual-eligible member — multiple chronic comorbidities, probably mobility issues, maybe not homebound but something close to it.
In that case, if they have the right set of conditions — which is what we’ve been focusing on: chronic, complex, in the community — they have predictable patterns of care, along with predictable warning signs when things are going wrong.
Anyone in health care knows somebody with congestive heart failure who gains weight is someone you need to pay attention to. They all know how to do stuff like that through biometric monitoring. That’s an important part of it.
We’ve developed a program and process that says, “Alright, Mrs. Jones has this given set of conditions. Let’s make sure she has physicians orders in place and has the appropriate medications in the home or the ability to rapidly get the appropriate medications in the home, so when she starts to gain weight, we can get something to her, and her caregiver can assist her with that, allowing us to avoid the ED for that person.”
There’s actually a whole bunch of stuff we’re doing that caregivers have noticed forever, but we’re putting it to work.
The caregiver is going to be the first person to notice that someone’s not eating as normal, they’re not sleeping as normal, they’re not moving as normal. They’re going to be the first ones to see that there’s broken DME, someone is experiencing behavioral changes or there’s no food in the fridge.
We’ve identified the type of things caregivers can effectively monitor for. We’re not going to ask them a gazillion questions — because then you end up getting bad responses. We only ask them things that are important specifically for the case they’re responsible for.
Then we use that information, bounce it up against someone’s clinical record and say, “Alright, this is important in the context of this specific client’s set of issues.” Then we generate alerts and responses based on that.
Previously, we were only doing that for our agency. We were able to make that process and program now available to other agencies and plans, which allows us to be a lot lighter in terms of scalability and implementation. It also recognizes that in the case of these high-needs, chronic and complex individuals in the community, many of them already have care in place.
Rather than try to disrupt that care, we thought a better way of doing that was trying to make that care more effective.
The last time we connected, Home Team had recently switched to focus almost solely on dual eligibles and some Medicare beneficiaries. Is that still your strategy?
That is still our main strategy, and it is going well. We stood up our first health plan in that model, and we have several other health plans we’re pretty deep in discussions with.
It’s a neat part of the market to work on because, by definition, you’re talking about folks who have needs and the right payer construct — Medicare and Medicaid — making it achievable to use home- and community-based services to improve outcomes.
We’re just starting to look at doing this for people with Medicare only — people with Medicare Advantage plans. We see that there’s an opportunity there with MA plans that are looking at ways to use home- and community-based services through the benefit flexibility that was recently offered.
For the time being, our main focus is on dual-eligibles.
Speaking of dual-eligibles, CMS recently announced plans to expand coverage options for that population. What’s your reaction to that?
I clapped. I think I posted about it, too.
Only like 10% of duals are actually in organized care delivery. Being dual is actually a social condition, not a medical one. It means that you are low income and either disabled or elderly.
It has nothing to do with your medical care, but it makes you many times more likely to experience adverse medical outcomes. It does not need to be that way.
With the moves CMS is making right now, I would anticipate that in the not too distant future, you’re going to start to see growth in the fully integrated dual-eligible plans. You’re also going to see provider groups that are taking risks or creating synthetic dual-eligible plans.
Going back to Medicare Advantage and the new flexibility — what plans does Hometeam have there?
I still think it’s really early days on that.
There was limited uptake of the benefit last year, and what did come out was pretty light. The reason for that is many-fold: rate adequacy, concerns about adverse selection, questions about whether or not it’s actually going to have the anticipated results.
I expect it’s going to be another year or so before we really see that benefit take off because health plans are cautious.
That being said, we’re looking at the rules around what CMS put out there, which is that they’re looking for an extended benefit that will produce improved outcomes for its recipients. It has to have something that has a medical improvement aspect to it as well, and we’re very much positioning ourselves to support that. We look at the major opportunities there as falling into a couple of buckets.
Care transitions make a ton of sense. The other is for high utilizers — people who are cycling in and out of the hospital or who are at end-of-life on Medicare.
For that subset of the population, I could see a plan deciding they’re going to offer an extended home care benefit that goes above and beyond the Medicare regulations for skilled home care and allows for some degree of personal care to keep those folks from cycling back in.
Previously, you told us that the Hometeam of the future will be a technology and data-enabled provider of in-home care supports and services. What sort of tech and data projects are you working on?
We’re ingesting all sorts of health plan and delivery system data. We’re working with claims, pharmacy data [and more]. This allows us to automatically build member profiles and use them to anticipate the type of things we should be watching for.
We’ve gotten much more precise in identifying which members are likely to have a need that is unmet in the community.
One of the things we’re doing that’s pretty unique and valuable is marrying up the traditional home-based functional time-and-task type information with the medical claims [and] pharmacy data, where those two really have not spent time mingling together.
Hometeam is often grouped with Honor and now-defunct HomeHero as a venture-backed home care disruptor. What are your thoughts on those comparisons and disruption in home care in general?
Each company has found its own way.
Obviously, HomeHero is not around anymore in its present form. I’ve heard that they’ve considered reconstituting.
I wish [Honor] well. They’ve chosen a path that makes a ton of sense for the type of business they’re trying to enable.
What Honor, HomeHero and HomeTeam was trying to do at the outset — it’s needed.
We need better aide placements. We need a better way of connecting with people with community-based care. And disruption takes time.
There’s a strong need for disruption in home care, otherwise I would not have moved here. But it’s a very difficult business to achieve disruption in for a lot of reasons.
That being said, I believe with the moves that have happened from CMS, in the market and around value-based contracting, the time is now more than it was four or five years ago for this to happen.
What other industry trends are you keeping your eyes on?
Social determinants. It’s really important — and it’s buzzy, but it’s buzzy for a reason.
It’s great that people are starting to think about health behaviors, anxieties, insecurities, loneliness [and] real things that affect people’s ability to thrive.
Looking forward, what’s next for Hometeam? Can we expect any strategy shifts or big changes in the future?
I don’t think so. I say that at all peril that statement could create for myself.
We’re doing what we said we were going to do when I got here a year ago. We’ve been doing it, and we’re going to continue to do it. I like the results that we’re seeing.
There’s just so much work to be done here that what makes sense for us is to continue moving at this issue of improving outcomes through supporting caregivers in the home.
*Editor’s note: HHCN spoke with Klein before fellow home care disruptor HomeHero was acquired by Family Directed, giving the once-defunct start-up new life.