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Kaiser Permanente is one of the largest health systems and health plans in the entire U.S. And while home-based care has always been a part of the system’s integrated model, it now has its own division, “Care at Home,” underneath the massive brand’s umbrella.
Angel Vargas has been enlisted to lead the budding enterprise in its largest market — the Southern Pacific. He believes that home-based care will be the reason why people are choosing Kaiser Permanente in the future.
“In two or three years, I see Care at Home being the distinguisher for Kaiser Permanente, just as cardiology would be a distinguisher for Mayo Clinic,” Vargas, the VP of Care at Home at Kaiser Permanente, told Home Health Care News. “We want our market – Southern California and Hawaii – to be known for its home care. We want patients saying, ‘I want to join Kaiser Permanente because they are invested in the home setting.’ That’s my goal – and our senior leaders’ goal – for this space. And we’re going to do it. I can’t wait.”
Based in Oakland, California, Kaiser Permanente currently serves 12.5 million members from 727 locations in eight states and the District of Columbia. Its network includes 38 hospitals, and its growing home-based care division currently cares for a census of about 5,300 patients just in the Pacific Southwest.
Vargas himself learned about the ins and the outs of the home health industry as a young man looking for any sort of job. He took one working the computers for a home health agency in Chicago in the early 2000s and eventually began directing a small agency a few years down the line.
After a long career in the U.S. Air Force Medical Service – which included a fellowship at Kaiser Permanente – he returned to home health care. Just as he rose through the ranks in the military as a medical service corps officer, he eventually worked his way up to a position where Kaiser felt comfortable making him the head of Care at Home.
“I credit my current role to the leadership and systems experience I gained while in the military,” he said. “But I also had significant tactical home health experience that provided me strong fundamentals to lean on. It may have seemed my career trajectory has been fast, but without the leaders I had and that home care experience, I would not have had the wherewithal to serve in my current position.”
Somewhere between 90% and 95% of the home health patients in Care at Home right now are Medicare Advantage patients, all within Kaiser’s health plan network, as are the hospital-at-home patients that Vargas’ team works with.
The hospice patients, however, tend to be fee-for-service Medicare beneficiaries. Care at Home also has a home palliative care program.
The hospital-at-home program is one point of growth for the division. Kaiser itself just became one of the founding members of the Advanced Care at Home Coalition, which is a group of health care providers that will vie for favorable hospital-at-home legislation post pandemic.
In fact, hospital-at-home is likely one of the reasons why Care at Home became a core priority under Kaiser in the first place.
“Our market has nine home health agencies,” Vargas said. “And the best way to move to the needs of the market and the needs of a patient is to have one coherent shift, as opposed to nine different shifts. So what we decided to do is just create our own service line within the integrated care delivery model.”
That shift helped immensely during COVID-19, when Kaiser cared for thousands of patients in the home.
“So we became a service line out of necessity, and now we all move together,” Vargas said. “We couldn’t afford having as much variation. And we’re still rooting out some of that variation. But now we’re preparing for growth in the space, because that’s what we intend to do – grow.”
Kaiser’s future in home care
COVID-19 acted as an accelerant to Kaiser’s at-home ambitions. And it also forced the organization to think differently.
“Were we perfect? No,” Vargas said. “But did we serve as many patients as we could safely and creatively? Absolutely.”
Still, Vargas and his team believe they can grow much larger than where they’re at now. And they believe that when it’s all said and done, and the consolidation finally comes in the home health industry, Kaiser will be one of the larger home-based care players around.
“It’s something that I think about a lot, and I think smaller home health agencies will struggle in the next 10 years,” Vargas said. “Very few middle home health agencies are going to survive the merger-and-acquisition rush that’s going to happen once the federal regulations are changed, especially with Choose Home.”
He believes the same goes for hospice, which is the reason that the M&A market is so hot right now and why a moratorium on hospices in California has been enacted.
In order for home health to keep growing as a main site of care, two things need to happen, he said: New talent needs to be recruited to the industry, and regulation needs to taper in the U.S.
“I once heard that we’re regulated almost as much as a nuclear power plant in the home care space,” Vargas said. “I think that is hindering innovation. And Medicare should adapt the changing patient needs.”
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