Inside 2 Emerging Risk-Based Home Care Models

In order to become less dependent on fee-for-service business, home health providers have begun to take on more risk.

That has led to an emergence of risk-based home care models, many of which have given providers room to partake in upside and downside risk.

Resilient Healthcare has used that trend to its advantage.


Resilient is a Plano, Texas-based home-centered management services organization that works with home health providers on hospital-at-home and care management services.

“Yes, we know that when we take on risk, we’re putting ourselves in a position that we might end up losing, but we’re creating opportunities so that we can actually move health care at home forward,” Resilient CEO Jackleen Samuel said during a presentation last month at the Home Care 100 conference.

Samuel identified two key areas where health care providers can take on risk, reduce costs and increase the quality of care. These areas are chronic care management and preventative care.


At Resilient, its focus is on high-acuity, high-utilization patients.

“We’ve created a digital platform to be able to provide virtual care for patients, so that we could recreate that hospital setting,” Samuel said. “We really started to manage care in their homes, in a multidisciplinary manner.”

Partnerships have been the lifeblood of Resilient, according to Samuel.

“When we go and contract with payers, we say, ‘We want to take on risk, and we want to be rewarded for being able to reduce your costs, keep patients home, remove them from the ER and avoid hospitalizations,’” she said. “Then we know there are companies — home health agencies, non-skilled home care providers — who can really help drive that value when we’ve worked together. Rather than recreating the wheel, we took the approach of partnering and building a virtual network that allows us to take on this risk, and then share that risk with our partners.”

Resilient has two kinds of contracts: upstream and downstream. Its upstream contracts are with hospitals, health systems, payers, ACOs and corporations. Its downstream contracts are with its “boots on the ground” partners. That includes home health providers, personal care agencies, virtual clinicians and paramedics.

The company’s virtual platform, Taxi, connects all of its partners.

Whenever Resilient decides to contract on risk, the company focuses on five benchmarks: rehospitalizations, overall cost of care, medication adherence, physical and mental health scores and behavior.

“These are the things that we felt we can definitely change,” Samuel said.

Homeward’s risk-based initiatives

Homeward is building a new model for a major pain point in the home-based care industry — providing care in rural communities.

“The real impetus behind our company is the realization that by virtue of nothing other than just happening to live in a rural county across the United States, there are individuals that are at significantly higher risk of poor health outcomes,” Stephanie Gutendorf, senior vice president of market strategy and development at Homeward, said during a presentation at the conference.

Homeward is a tech-enabled home-based primary care provider. Its partnership with the Medicare Advantage (MA) plan Priority Health is one way it’s leveraging risk.

“[We are] essentially taking the Legos that exist today and putting them together in a different format, under a different business model,” Gutendorf said. “[One] that allows us to then bring care back to folks living in rural communities. That, for us, looks like going into the home.”

The company has a team of clinicians that work in care pods. Those clinicians deliver care through its mobile clinics and local partner locations.

“There is a segment of the population in the Medicare area that really needs this, and without getting this, they’re not going to get the care that they need,” Carrie Kincaid, senior vice president of market development at Priority Health, said. “Literally driving these big, beautiful purple, mobile clinics and vans up to their homes can make all the difference for them.”

Looking ahead, Homeward is open to partnerships with home-based care organizations that will help them scale.

“We’re going to bring in partners that can help with things like acute home health issues, Or, hospice care is another great example where we partner significantly,” Gutendorf said. “We’ll continue to see that grow and expand.”

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