Gentiva Believes It Can Turn ‘Loss Leader’ Palliative Care Into ‘Game Changer’

“Gentiva” is a familiar name in the home-based care space.

The latest use of that name is through the newly established Gentiva, which is a home-based care provider formed out of the divested assets of what used to be Kindred at Home.

When Humana Inc. (NYSE: HUM) completed its acquisition of Kindred at Home – now CenterWell Home Health – it divested the personal care and hospice assets to the private equity firm Clayton, Dubilier & Rice. That formed the standalone company Gentiva, which is led by former Kindred at Home CEO David Causby.


The new company has an end-of-life focus, and it is also leveraging palliative care – a service line that’s beneficial, but hard to make work – as a differentiator.

After officially forming last summer, Gentiva’s first splash as a standalone company was agreeing to acquire ProMedica’s Heartland home health and hospice assets for $710 million. That deal would increase Gentiva’s hospice census by 9,000 patients – from 27,000 to 36,000.

Now that Gentiva has solidified its brand and footprint, Causby wants to build out its palliative care footprint further.


After years of research focused on what a patient’s life was like in between home health care and hospice, Gentiva found a window of opportunity.

“One of the things that we’re really trying to build out is an advanced palliative care model,” Causby said during Home Health Care News’ FUTURE conference last month. “Palliative care is very difficult today. It’s built on the physician Part B schedule. It’s a loss leader. There’s just not very good reimbursement. But we personally feel that’s one of the greatest needs. One of the biggest spends in the health care system today are those patients that sit in that middle bucket that don’t qualify for home health and don’t qualify for hospice. That’s really where palliative should sit.”

The company is looking to fill that patient care gap first and expects the reimbursement to eventually follow.

Under Gentiva’s Advanced Illness Model (AIM) — or as Causby calls it, “palliative on steroids” — a nurse practitioner goes out once or twice per month to see a patient.

In doing so, that practitioner tries to help maintain the patient’s care needs in order to keep them living at home, independently.

“This next reiteration that we’re building is way more comprehensive,” Causby said. “It involves case managers, nurses and aide work. We’re going on a PMPM basis arrangement and a risk-sharing basis to where we can take these patients during that five-year journey and provide services. We believe that we have the data, and the partners we’re working with believe that there’s no doubt that, over that five-year journey between home health and hospice, we’ll be able to majorly impact those patients to ensure that they have decreased re-hospitalizations, … and we’ll help the payers in managing those patients.”

In theory, a robust palliative care model can act as a feeder system into hospice, too.

“We really think there are a ton of these patients who are getting identified way too late into the hospice journey,” Causby said. “If we’re able to get upstream, manage these patients, cut costs to the health care system, improve quality of care and then appropriately help identify when the right time is for them and their families to transition, it takes the burden off physicians and families who have just been hit with hospice.”

The cost of doing business

The company has the value proposition and the scale.

Still, there’s risk in deploying the kind of capital Gentiva is and hoping to find success with Medicare Advantage plans.

“We’re spending a tremendous amount of capital in order to prove this out,” Causby said. “The first thing we have to do is to go and ensure that we develop the program and the product. We need to try to get the best pricing that we can in order to be able to demonstrate this. We also have to run enough volume through the organization to be able to show that we’re able to reduce these re-hospitalizations and hit these other benchmarks.”

Gentiva has between 400 and 500 patients enrolled in the palliative care program today and is enrolling 30 to 50 new patients per week. By the end of 2024, Causby hopes the program will have 10,000 patients.

Then, the company will be able to sit down with MA plans and have benchmark data to prove the program’s value.

“We’ll be able to monitor and track those patients over a period of time and then look at that subset of patients that are in that program against the general average of patients that are not,” Causby said. “You should be able to determine the cost savings associated with it. When you have that, you’ll get the attention of payers.”

Looking ahead, Gentiva plans to add more tuck-in acquisitions where necessary.

Causby believes the market dynamics are still very strong for a company with the size and scale of Gentiva.

“We believe we have competitive advantages with organic growth and taking market share,” Causby said. “But this AIM business that we’re building is probably where I’m going to spend the majority of my time. I really believe that this will be a game changer.”

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