‘Sick-Care Silos,’ Medicare Advantage and Market Exits: Home Care CEOs Look Ahead to 2020

Once considered an afterthought, non-medical, in-home care took on newfound importance in 2019. Many home care CEOs predict that momentum will continue in 2020, especially as risk-based arrangements among providers become more common.

Medicare Advantage and outcomes-related health data are also positioned to play leading roles in home care next year, industry leaders believe. The same holds true for technology that assists with workforce challenges.

Below are 2020 predictions from 14 home care CEOs and C-suite executives. Home Health Care News highlighted home health predictions in a story published Dec. 11.

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The biggest factors that shape 2020 will be the confidence and will of owners/operators to own the longitudinal client experience within true value-based and global-risk contracting. Home care will start to redefine how and where service is delivered — and all the trends are pointing to home care leading the full client experience through medical and social support. Companies that take the lead now will be major winners as home care becomes the nexus of health care as we know it.

Those that stand on the status quo still may win economically but will not truly make a significant long-term difference to assist seniors, families and communities to realize what it means to “age magnificently!” Home and community service providers cannot allow the perverse, acute, reactive, sick-care silos to continue to “quadruple miss.”

The industry will change in 2020 by consolidation and partnerships of both services and data. Best-in-service providers will be forming continuum partnerships to round out their delivery system for those populations they are at risk for. Data consolidation and use of information across the client journey will change the industry significantly.

Going from fee-for-service and reactive care to getting compensated for wellness, behavioral change and value will require integration of claims data, medical records, as well as whole-person, first-party discovery to meet seniors and families where they are in their health and life journey.

— Joel Theisen, CEO of Lifesprk and Homespire

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Size and scale will become increasingly important and lead to increased industry consolidation due to a variety of factors. They include pressure to increase caregivers’ wages due to rising minimum wage, low unemployment and the overall shortage of caregivers. Factors also include increased regulatory costs, increased competition for clients and increased competition for quality caregivers.

There will also be increased competition for corporate talent with entrepreneurial skills mixed with a big dose of mission.

In 2020, companies will introduce more specialized, evidenced-based dementia care services — where families better understand the progression of the disease. Technology will be “table stakes,” meaning companies who take tech seriously must upskill their caregivers to use it effectively. Finally, companies will source caregiver talent from new labor pools.

— Andrea Cohen, founder and CEO of HouseWorks

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Outcome data will play a critical role for home care in partnership with payers and providers in 2020. Those home care companies that track and provide this data in an easy-to-see format will have the best opportunities.

Technology will finally start to impact how home care is delivered with telehealth, virtual care, hospital-at-home models and other devices. Each of these will help to supplement the care offered by home care and allow for clients to stay out of the hospital and ER.

I’m most excited about the rise of group care and how it will further impact and compliment home care in 2020. Expanding available group care options will lessen the caregiving burden for families that can’t afford to provide around-the-clock care and further enrich seniors’ quality of life.

What am I most worried about? According to the Bureau of Labor Statistics, 1.3 million caregivers will need to be hired by 2026. Failure to find staffing solutions for this in 2020 and future years may force families to place loved ones into facilities sooner than desired.

— Peter Ross, co-founder and CEO of Senior Helpers

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2020 should bring about a quieting of the buzz about Medicare Advantage plans, as home care providers face the reality of less-than-desirable contracts. Democrats [in addition to] Mayor Pete Buttigieg will put forth generous plans related to long-term care programs, which will sadly become a low-priority item on Nov. 4, 2020.

I forgot to mention, Duke will win its 6th national championship.

— Arosa+LivHOME CEO Ari Medoff

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What will be the biggest factors that shape home care in 2020? Employment. There is no substitute for truly exceptional caregivers. In order to be competitive, home care companies are going to have to develop recruitment, retention and recognition programs that differentiate their company from the others.

How do I see the industry changing in 2020? The need for home care will continue to increase. The competition in the industry will continue to increase. Tight labor markets will make margins tight for many, perhaps forcing consolidation within individual markets or at a national level.

Emma Dickison, president and CEO of Home Helpers Home Care

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In 2020, we will see a significant uptick in the amount of care, both acute and sub-acute, being provided in the home — care that would have been traditionally provided in a facility. More importantly, we will see non-traditional payers for these services, namely facilities themselves. CMS star ratings are becoming increasingly important to both hospitals and skilled nursing facilities, so if home care providers can help facilities lower readmissions and increase patient satisfaction, we will continue to see facilities partner with us. However, home care providers will have to demonstrate capabilities with hard numbers.

— Georgetown Home Care CEO John Bradshaw

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The oldest boomer turns 74 next year. We are just at the beginning of this aging tsunami. This growth will force our industry to quickly adapt and scale to serve demand while maintaining quality and standards. And it must be done so one of our most vulnerable populations isn’t put at risk.

Our industry must continue to evolve to ensure we provide quality care that is accessible for older adults, while also providing a positive employment experience. This means supporting our professional caregivers holistically, from compensation and flexibility, to professional development and ongoing emotional support.

While I’ve seen much of industry embrace technological innovations in the last few years, I think the types of technology that will truly succeed in our industry in 2020 are those that integrate more seamlessly into seniors’ lives. Older adults don’t want to feel monitored – as if they are being watched every time they walk out to the mailbox. Successful technology in 2020 will have to serve the seniors, rather than just the caregivers.

— Home Instead Senior Care CEO Jeff Huber

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In private home care, the biggest factors will be labor and benefits. As unemployment remains low, the need for quality care will increase. Since other industries can offer better benefits for the entry-level labor market, the home care industry needs to make bold changes to provide better perks for its workers. Yes, it will add to the already burdened cost in home care, but something needs to be done to attract the best workers.

There will be more consolidation of home care companies, with smaller companies being bought out or going out of business. Regulations and enforcement, especially involving labor, has already affected the mom-and-pop shops. Care management, on some level, will also increasingly be part of larger home care companies’ service mix.

— AMR Care Group CEO Anne Markowitz Recht

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Roughly 10,000 baby boomers reach retirement age every day. Current retirement savings plans for many no longer can keep pace with longer life spans we are achieving. I believe that home care is and will continue to be the most logical choice from a financial and personal preference perspective for those that desire to age at home. As a result, health plans and other health professionals will also continue to view home care as a more appropriate level of care — having a positive impact in reducing U.S. health care spend.

The other factor that I believe will continue to shape and expand home care is the rising demand of the 11 million Americans in the sandwich generation trying to care for dependents and parents. Increasingly, this is being recognized by employers as a leading stressor negatively impacting the health and productivity of their workforce.

Continued research is clear that social isolation is having a far greater impact on older adults’ health status than previously understood. Companion services — so often provided through home care — will continue to be a highly sought after service.

We will continue to see interest in home care by third-party entities such as back-up care programs, Medicare and health plans, in general. However, this focus will require additional scrutiny of the home care industry bringing. We’ll need to raise expectations and accountability around quality performance measures and data safeguards, including HIPAA compliance.

— SYNERGY Homecare CEO Peter Tourian

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The continued constraints on the labor pool and the impact on home care affordability will lead to more home care agencies offering shorter, less extended care shifts, making it more challenging to maintain extended care for clients. As home care costs increase, more people will opt to transition into living communities if extended care is required, making it increasingly challenging to rely on long shifts.

More home care agencies will look to differentiate their offerings in order to stay competitive in the marketplace. The providers that do the best job with their workforce and that keep their caregivers happy and connected to their mission are going to win the game in the end. There’s just too many alternative options now for caregivers to pursue if they don’t get enough hours and feel they can potentially get something better somewhere else.

— IndeCare CEO Alan Fisher

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Positive outcomes and strategic alliances should be the theme for home care providers in 2020, which will be a year that organizations managing Medicare Advantage Plans, as well as other organizations, more fully utilize and invest in home care providers to support the end result of better outcomes for the clients.  Home care providers that can execute care plans that result in better outcomes and can strike alliances with the organizations that are prepared to pay for that care and those positive outcomes, will be better positioned to grow their home care businesses exponentially.  Of course, in order to execute superior care plans, it will be necessary for the home care providers to excel in the recruitment, hiring, training and retention of the best caregivers, which obviously continues to be a declining labor pool relative to the increasing demand for care and a highly competitive environment.  

— Jake Brown, president and CEO of Always Best Care Senior Services

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Legislators from both sides of the aisle across the country will create new bills that create financial incentives [and] tax savings to help offset the cost of in-home care. More formalized caregiver training programs from the private, not-for-profit and government sectors will come to fruition. Immigration requirements for professional caregivers will be loosened.

At least one VC-backed, fast-growth company will close or sell due to previously hidden bottom-line losses. First-year data showing ROI on Medicare Advantage utilization of non-medical care will influence other plans’ participation in 2021.

— Gavin Ward, regional director of strategy and partnerships for 24 Hour Home Care

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We will be innovative to find and keep the best caregivers. Reimbursement models for other parts of the health care continuum will impact home care: PDGM and PDPM, which impacts skilled nursing facilities. With PDGM, home health providers will be altering their service models to where home care may be able to help supplement savings and improve outcomes where reimbursement is otherwise tying their hands.

Then there’s Medicare Advantage. With more programs offering support services, we’ll get more data about costs and outcomes, which will help us refine the benefit. This will create opportunities for partnerships (between insurers and providers, for example). We’re seeing some MCOs exploring how to offer the benefits themselves, with Humana and Kindred at Home being examples.

Jennifer Tucker, COO of Homewatch CareGivers

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Technology is going to play a huge role in 2020, particularly in the monitoring area to help reduce the cost of care, increase transparency, and form a bridge between non- medical home care and health care. Monitoring technologies that are safe and secure will help streamline the volume of information about a patient [or] client’s care, and they have the potential for improved care coordination as we move towards more person-centered care.

With the continued caregiver shortage, there will be more focus on reducing caregiver turnover rates and improving how caregivers are recruited and retained. Independent home care agency owners will have to take a harder look at pay, benefits, and career paths in order to attract and keep the best caregivers.

With more people looking at value-based care, and with Medicare Advantage coming into play, we’ll have to start looking at mixed payer pools. While there’s still a lot of unknowns about the impact of Medicare Advantage, it will open the door to mixed, multiple payer sources.

— TheraCare CEO Greg McCarthy

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Over the last year or so, there seems to be an increase in the number of “pilots” where home care has a significant role. Whether these pilots involve Medicare Advantage plans or involve working with hospitals and health systems to lower readmission rates, this is a relatively new development for home care. In fact, Right at Home alone currently has eight to 10 pilots underway with MA plans or similar.

Over the course of 2020, we will start to see the results of all of these pilots. If they show what we all expect — that home care can have a very significant impact on client outcomes and decrease costs — then they’ll impact 2020 and many years after. We anticipate that the drive toward value-based care and more focus on social determinants will change the way providers deliver care and develop partnerships

In-home providers have to be able to be better at swimming in the lanes of our partners — meaning, can we talk the same language around shared goals and outcomes? By understanding the overlap in value proposition, we can develop a service delivery model that is truly about the “WHOLE” person.

This industry is getting more complex by the day. Access to data isn’t a “nice-to-have,” it’s a must-have and is bordering on just becoming table stakes in today’s environment. We are focused on continually raising our own sophistication levels in all aspects of what we do. There is a little bit of “survival of the fittest.” For home health agencies, it is about how well they adapt to PDGM and other regulatory changes, and for in-home care, it is about how we manage a larger population of clients with a smaller population of professional caregivers. There are only a couple ways you can do that: technology and/or creating an environment and career that a professional caregiver doesn’t want to leave. As a provider in that space, you have to determine whether you want to tackle that hurdle or broaden your value proposition to where the hurdle no longer exists.

— Brian Petranick, president and CEO of Right at Home

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