How PathWell Went From Tech Company to Growing Home Health Provider

PathWell started as a technology company with the goal to help other operators with back-end issues.

When COVID-19 hit, everything changed. The Connecticut-based company, at the direction of co-founder and CEO Raman Brar, decided to change the direction of the company to become a provider itself.

Over the past two years, PathWell has grown into a multi-state provider through organic expansion and acquisitions. Brar entered into home health care after spending most of his career in private equity, and now is focused on doubling down on a busy and financially successful 2021.

Home Health Care News caught up with Brar to talk about the company’s switch, its growth plans, the incoming Home Health Value-Based Purchasing (HHVBP) Modell and the future of home health care.

Highlights from the conversation are below, edited for length and clarity.

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HHCN: Can you explain why PathWell made the shift to become a provider at the onset of COVID-19?

Brar: That was the beginning of our journey in many ways. But historically, as a team, we were focused on being a solution provider to the broader in-home care space. As COVID hit, we saw an opportunity to really eat our dog food — for lack of a better term — just because we saw what the industry needed and we decided to focus on being in the operations ourselves. Then we got started with our one acquisition of a home health care agency in Southern Connecticut in Fairfield County.

Once you made that switch, how were you able to grow the company into what it is today?

One area of focus, using the lowest hanging fruit mentality, was streamlining the backend operations: recruiting, human resources, finance, revenue cycle management, compliance and OASIS review.

That really allowed our clinicians to focus on growth, accepting referrals and concentrating on proper case management. And that really allowed us to focus on delivering quality care that supports growth.

What are PathWell’s growth goals for the near-term future?

That’s a two-pronged answer for us.

We’re an acquisition platform, but that’s certainly secondary. The primary goal always is to grow organically in our existing markets. Right now, we’re in Southern Connecticut and Northeastern West Virginia, and those are both contiguous markets. We’re really focused on executing our backend operations and really letting the clinicians, the sales team and the tech team focus on growing the census.

A lot of the acquisitions PathWell has made seem to be borderless when it comes to the geographical footprint. Is that a conscious decision?

There’s a density angle to it and then there’s a payer-driven play. From a density perspective, any market we’re in, we’re squarely focused on growing that market. We’re building relationships with our referral partners, getting as many clinicians as we can in the dense region and then serving the patients and capturing market share. We’ll continue to look at smaller acquisitions in our existing markets.

Looking outside of our existing markets, we approach that from a payer angle. Medicare Advantage is taking share from Medicare, so we are very cognizant of being the first mover in working with the payers. We’re looking at the payer universe, scanning and seeing, ‘What is UnitedHealthcare’s approach? What’s Humana thinking? What is Blue Cross Blue Shield doing? Etna, Kaiser?’

Then we’re forming our view in terms of how they are looking at home health care as a way of providing service to the patients, and how we can fit into that.

We’re early on in that journey and we think everybody will be talking about that a lot more in the coming years.

The last time we chatted you mentioned the number of really important hires for PathWell that helped you drive growth. How did those hires contribute?

We’re lucky to have a really good team. We’re a curious bunch who love technology and are passionate about growth. My partner Andrew Quinn oversees the operations, including finance. His role is to ensure that clinicians are focused on what they do best and that’s taking care of the patients.

Kelly Federle joined us in early 2021 and is a lifelong home health care nurse and passionate about the space. Her role, if I had to define it as one goal, is to prevent hospitalizations. She oversees all clinical operations, so she and Andrew work very closely together.

We hired a director of finance and director of human resources, which are both key as we focus on recruiting and HR compliance, especially as we grow in new states that have different regulations.

Shifting gears a little bit towards labor and staffing, what is PathWell doing to address issues when it comes to workforce issues?

Like anybody else, we saw a pretty tough market from a recruiting perspective and from an overall labor dynamics perspective with the Omicron wave. But those things will happen. We pride ourselves on using the best-in-class tools that exist in the marketplace.

Short of any regulatory changes that politicians need to work on by unlocking the supply of clinicians, there’s not much you can do in terms of the existing supply. We’re looking at the issue like any sales organization, right? We’re trying to sell the clinicians to come work with us, working on conversion, and then – finally – retention.

We use modalities like texting, email and social media as a form of outreach. We’re not waiting for people to come to us, we’re reaching out to them and selling our value proposition. We’re selling them on working with PathWell versus a national carrier – where they might feel like a small cog in a wheel. That has worked out for us.

We’re a big family, so keeping existing employees engaged, creating a work culture where we know our nurses, our therapists and catering to their needs is important. If they need flexibility with times or geography, we work around them.

What is PathWell doing to prepare for HHVBP?

That’s obviously at the very top of mind because the total performance score is what’s going to drive the penalties or the bonuses with HHVBP. It’s really a function of three things: your OASIS documentation, HCAP scores and the claims data.

Looking at those three things, we’re already very good, as I mentioned, in our backend team on the OASIS front. There’s ongoing education on HHVBP that’ll impact the quality scores and reimbursements. We’re really focused on data and measurement. If you’re not benchmarking things properly and analyzing the data, you’re going to struggle under the new payment model.

We’re also focused on being precise in measurements and clinical answers to the OASIS questions. We’re always revisiting our orientation process and adding more, ongoing learning. Unlike a lot of other agencies, we use our backend QA team to work closely with the clinicians for ongoing training.

On the claims front, it’s all about reducing hospitalizations after the patient has been discharged. We already had some dedicated programs that focused on that, and we’re adding more and communicating that to the physicians or referral partners.

Aside from HHVBP, what are other regulatory topics that may be on your radar as we get closer to 2023?

Broadly speaking, I think Medicare Advantage taking market share is certainly top of mind. What does that mean from a regulation perspective? One of the things I know HHCN has covered is patients maintaining access to care. That might be hindered as Medicare Advantage takes over the market share, right?

Obviously the OIG report that was published was pretty critical of the MA plans, so we’re looking at that space closely. How do the rules of engagement change from an MA plan’s perspective in terms of reimbursements?

Given PathWell’s background as an agency that both provides care and helps others provide care, what do you think most needs to be changed in the industry to make the experience better for providers and patients?

We think our strength is in bringing the best tools, processes and technology-centric operating models to the table. Ultimately, that allows the clinicians to do what they do best: take care of patients and reduce hospitalizations.

Outside of that, there’s only so much you can do when addressing the labor supply. We need more nurses, more therapists. The industry needs to find a solution to that. Whether that’s immigration policy reform, specialty visas or more budget allocation for training and bringing people into those fields. Those are areas we’re pretty focused on, and seeing what big moves are being made.

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