Startups, Payer-Provider Hybrids Believe They Can Bring New-Age Thinking To Home-Based Care

Home-based care startups and large payer-provider hybrid companies are not alike in many ways. One way in which they are similar, though, is their belief that they can drive care in the home forward.

That’s one takeaway from a recent panel discussion that took place at the 2023 HLTH conference.

A company like Humana Inc. (NYSE: HUM), for instance, is in a unique position. Humana is a health insurance company that operates one of the largest Medicare Advantage plans in the U.S.


It is also a provider organization through its CenterWell arm, which includes home health care, pharmacy and primary care services.

Operating as both payer and provider has allowed Humana to lean into value-based care, according to Dr. Andrew Agwunobi, the president of Humana’s home solutions business.

“When you have the payer and the provider together, you’re also able to invest in the clinical value-based side of it, for example, to decrease hospitalizations,” he said during the panel discussion. “You’re able to invest in that and actually see the benefit from a total cost of care reduction, on the payer side of it.”


Integration and alignment has been a key focus at Humana when it comes to leveraging all of these pieces of the puzzle.

“We have the largest senior focused value-based primary care,” Agwunobi said. “We have CenterWell, the largest home health provider and we have a very sizable pharmacy with mail order, so integrating those as well, [and] … with the payment methodology, with the providers, you start to get a powerful solution for the patients.”

In general, value-based care allows health care organizations to be preventative, as opposed to reactive, Erin Denholm, chief nursing officer at DispatchHealth, noted.

“Our health care system is very reactive,” she said. “When you are talking about population health risk management, which can go with value-based payments, I think that it allows positive outcomes to occur, but there’s ownership.”

Originally launched as an in-home urgent care startup, Denver-based DispatchHealth delivers higher-acuity care, including hospital-level care, in the home. The company operates across 30 states in the U.S.

Denholm believes that DispatchHealth’s position as an ecosystem disrupter has led to better outcomes because of its “blank canvas” approach.

“To have a blank canvas, and actually design a system around an individual’s home without the encumbrance of capital, of brick and mortar, of ancillary businesses … allows the ability to rapidly innovate, fail, learn fast, tweak and modify, which is what DispatchHealth has done,” she said.

Similarly, Agwunobi pointed out that stepping outside of the traditional way of delivering care has led to innovation, and, in turn, better outcomes.

“I always like to think about freestanding ambulatory surgery centers,” he said. “That wasn’t developed by hospitals, and I ran hospitals for many years. People used to think ‘Well, why would anyone think of having surgery outside of a hospital?’ But it was intrapreneurial physicians that said, ‘No, this can be done. It provides the same outcomes, better customer service, better parking, you name it.’ The rest is history.”

There’s also a huge opportunity for home-based care providers to double down on this kind of thinking, according to Dr. Francesca Rinaldo, senior vice president of clinical product and innovation at the digital health company Sharecare.

“You always hear people talking about the home as the last mile of health care, but it’s really the place that’s the most important in people’s lives, and really where they want to be,” she said. “In terms of disruption, if we start thinking about the home as the first mile of health care … we can be incredibly disruptive, and it’s a win-win.”

Companies featured in this article:

, ,