The Next Frontiers for Home-Based Care Operators

Right now, there are three sections of home-based care that I see as core components to the concept: home health, hospice and personal care.

There are companies that offer one, two or all three services in some spots. But there’s a growing group of home-based care providers that are hellbent on building out the “three legs of the stool” in all the markets they serve.

With most hospice operators, palliative care also often tags along. In home health care, many providers see at-home palliative care as a logical service to offer, but monetizing it in a meaningful way has been anything but easy.

Hold that thought.

The job of any leader in this space – whether he or she is in a home-based care organization specifically, or in private equity, venture capital or a health system – is to predict what’s coming next.

In part, it’s a writer’s job too. And while I don’t have a crystal ball, I do have enough research and conversations (with people a lot smarter than I) under my belt to play prognosticator for a day.

Many correctly predicted the hospital-at-home wave, for instance, even prior to the pandemic. Others saw hospice as an emerging service line decades ago.

More types of care are being brought to the homefront, and the question I’ll try to answer below is: What’s next?

Where we are

None of this is to say the hospital-at-home trend is already over. On the contrary, it’s still in its infancy here in the U.S. Over the next five years, plenty of more providers will get involved in pilots that aim to shift hospital-level care into the home.

SNF at home, which I would consider synonymous with the idea of shifting higher-acuity care into the home, in general, was an idea that gained traction because of the pandemic, whereas hospital at home was already being explored.

So while hospital-at-home and SNF-at-home models are still finding their footing, they are here. It would not be a reach for anyone to dub those models as “the next frontier” for home-based care.

For instance, in a recent survey conducted by Home Health Care News and Homecare Homebase, responses from nearly 400 home-based care operators showed hospital-at-home and SNF-at-home models were the top care models providers were pursuing in 2022.

Where we’re going

The figure above can be viewed in two ways: that the smallest percentage-grabbing care models are relatively irrelevant or that they are the next trends and thus in the “innovators” stage of adoption, based on Everett Rogers’ “Diffusion of Innovations” theory.

Whereas hospital-at-home and SNF-at-home models are gaining higher “Q Scores” and becoming more feasible from an operational standpoint by the day, care types such as oncology care at home and pediatric care at home are relatively unexplored.

But even before the data from the HHCN-Homecare Homebase survey was released, I was beginning to believe those two care types, in particular, would be emerging frontiers in home-based care.

A private equity executive also told me recently that those were the two specific areas his firm was looking at moving forward.

The University of Utah’s Huntsman Cancer Institute’s Huntsman at Home program is a prime example of what at-home cancer care could be and has long been one of the only examples of it in practice.

When I wrote about the prospects of the model back in 2020, even experts believed wide-scale adoption was still years away.

“You can’t bring a radiation machine to somebody’s house to do proton therapy, you just can’t,” Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told me at the time. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”

But things are starting to change. Cancer care was – severely and sadly – delayed, put off and interrupted during the pandemic. It led providers to start thinking more about delivering care to patients in the home, even if in a some-here-some-there fashion.

Slowly, work is being put in to make it more of a reality. And the technology issues that Cannady was once worried about – reasonably so – are waning.

In July, the Children’s Oncology Group teamed up with Signify Health (NYSE: SGFY) to bring cancer care into the home, specifically for children – a hybrid between two of the frontiers we’re discussing.

“I really do think we’re going to see more cancer care in the home, and I think it’s part of a larger trend, where more and more specific disease categories will see additional home-based resources brought to bear for their patient populations,” Marc Rothman, the CMO of Signify, told me.

Then, in late January, Reimagine Care – a startup in-home cancer care enabler – announced that it had raised $25 million in a Series A.

“We think the level of capital that we raised – and the quality of the investors – would suggest that there is a strong belief … that now is the time for this to happen,” Reimagine’s CEO and co-founder Aaron Gerber told me.

Reimagine also polled health care executives before its Series A and found that close to 70% of them agreed that home-centered oncology care is gaining traction and represents a “real opportunity for growth.”

Pediatric care is in a similar stage, though it has always been feasible, unlike in-home cancer care.

While large providers such as Aveanna Healthcare Holdings (Nasdaq: AVAH) found a way to succeed with pediatric care in the home, few others have on a large scale. Mainly, that has to do with a difficult reimbursement landscape and, frankly, a lack of providers.

“My opinion on this particular issue is that it is a national problem — not just a local one,” Emily Wiechmann, the owner of the in-home pediatrics company First Day Homecare, told me last year. “There are just universally not enough home health providers in the private-duty nursing space to meet the demand of the medically complex infants and children.”

As the policy tailwinds continue to blow at home-based care providers’ backs, this is an area where many home health and home care providers could more seamlessly step in. They could do so without investing heavily in new technologies or partnerships that would be necessary to make something like in-home cancer care doable.

What else is out there

Palliative care is offered by a great deal of home health and hospice providers, but hasn’t yet been completely capitalized on. In part, that’s because there’s no real palliative care benefit, though that could eventually change.

“A growing body of clinical and economic research indicates that palliative care has the potential to generate substantial cost savings, with some estimates reaching into the hundreds of billions of dollars within the next two decades if access were to expand,” my colleague, Jim Parker, wrote in a recent Hospice News op-ed.

In the interim, it’s a good way to complete the continuum of service offerings for providers.

At-home kidney care also can not go without mention. In February, the value-based, home-focused kidney care company Somatus announced that it has raised more than $325 million in oversubscribed Series E financing.

Meanwhile, Monogram Health – a kidney care management company – recently raised $160 million in its Series B. CVS Health (NYSE: CVS) has also done considerable work to move kidney care into the home.

Finally, there’s also opportunities in home-based care generally to elevate the industry. Grabbing the aforementioned tailwinds and using them to lift the entire industry up on stilts – to gain that larger seat at the table – could yield great bottom-line results.

Nick Loporcaro, a senior operating partner at The Vistria Group, filled me in on this concept last week.

“One area that intrigues me is home health benefit management,” he told me. “You think about other models that exist in health care like management services organizations (MSOs), or similar organizations like that, that can help the industry get better organized and elevate it … that is really interesting to me.”