How Medicare Advantage, Labor, AI Will Shape Home-Based Care In 2024

Home Health Care News recently spoke with 15 home-based care leaders for our annual “Executive Forecast” articles, which we published at the end of last year.

Those executives’ responses covered a wide range of topics, and were surprisingly and refreshingly diverse. But, in the end, a few themes emerged.

In part, these answers helped form our home care and home health trend predictions, released last week and this week, respectively.

But the specific executive perspectives are worth revisiting.

In this week’s exclusive, members-only HHCN+ Update, I analyze the executive outlooks and offer key takeaways, including:

– An impending upheaval of the traditional home health business model

– The supply and demand labor issue

– An Increase in efforts related to AI and other future-facing technologies

Coming to grips with Medicare Advantage penetration

In HHCN’s home health trends piece, we wrote about the evaporating home health fee-for-service business model.

Even Amedisys Inc. (Nasdaq: AMED), which is likely to be a part of one of the largest payer organizations in the country soon, is adjusting operations with Medicare Advantage (MA) in mind.

Amedisys CEO Richard Ashworth is particularly focused on his company – and the industry at large – coming to the table with better data to demonstrate value in 2024.

“Data and analytics to drive the value proposition will be an important focus for 2024,” he told HHCN. “It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.”

Ashworth sees data and analytics as integral to negotiations with payers. But he also believes that home health providers can boost their value by coordinating care, or being a liaison to other services such as personal care, housekeeping and rides, among others.

“I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024,” he said. “The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity.”

New Day Healthcare CEO G. Scott Herman, who is running one of the more quickly growing home health providers in the country, believes that home health providers are considerably behind in adjusting to take care of a home health population that is skewing more and more toward MA over traditional Medicare.

It’s one of the reasons New Day is operating a remote home health model in Texas.

The visits are in person, but the company does not have brick-and-mortar locations tied to a certain area. That is in order to keep overhead costs down.

“What our company is doing is, we’re focused on understanding exactly how those Medicare Advantage payers work, building models that support them that are remote and that are driven with data and analytics through our ‘Carelytics’ system,” Herman told HHCN. “Models where we can sit down and understand how to work with patients longitudinally, do cross referrals internally and then take the business that those payers really need to take in markets where they’re struggling with providers.”

Home health leaders may not agree on the best way to achieve sustainability in a world more dominated by MA. But they are reaching a near-consensus on the fact that providers do need to adjust operations to survive, and that continued MA penetration is both a threat and a reality.

“2024 is the year for tomorrow’s home care provider to build plans on how to thrive — not just survive — with Medicare Advantage,” Frontpoint Health CEO Brent Korte told HHCN. “The home health industry is going to see disruption in 2024 and subsequent years. It’s an exciting time to be part of this industry.”

Labor difficulties

Accurate Home Care CEO Bill English quipped at Aging Media Network’s Continuum conference that, if 200 nurses showed up in his parking lot tomorrow, he’d hire them on the spot without conducting interviews.

Though there’s been some investment in home health nursing platforms by companies like LHC Group and BrightStar Care, there’s still a severe nursing shortage. On top of that, home health care tends to be a more difficult sector to recruit nurses to.

“There are plenty of challenges on the horizon, but America needs more nurses,” English told HCHN. “It will take another 5 to 10 years for supply to meet demand.”

That supply and demand will result in increased costs for home health providers yet again, Intrepid USA CEO John Kunysz added.

“I believe 2024 will include continued scarcity of labor and pressure to increase labor wage rates across the board — particularly for patient-facing team members,” he said.

That’s where the Centers for Medicare & Medicaid Services’ (CMS) rate cuts really hurt.

Providers are having to pay more for nurses than ever. Rate increases from CMS – or MA plans, for that matter – are not keeping pace.

That leaves the industry in a precarious position. Home health leaders are left to scramble for ways to become more efficient with the same amount of nurses and caregivers.

“We can find better use of technology and virtual care models to create at least a 30% increase in labor productivity for our existing labor resources,” Kunysz continued. “The supply isn’t increasing, so you have to drive labor efficiencies and productivity through technology that also reduces the burden on clinicians.”

Integrating AI

Slimmer margins and labor challenges will all but force providers to consider utilizing AI and other technologies in 2024.

They won’t be able to put the cart before the horse, however. AI tools will be rendered useless if there’s not enough quality data to be inputted into those tools.

VNS Health CEO Dan Savitt believes a heavier reliance on those sorts of tools will be table stakes in the future.

“The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies,” he said.

In looking for that 30% increase in productivity, Kunysz and Intrepid are also looking at AI as a potential solution.

“We’re finding ways to integrate AI into our clinical documentation processes to reduce the variability of the documentation quality and reduce the time burden on clinicians,” Kunysz said.

Home care providers are also looking to integrate AI to solve similar challenges.

The cost of delivering home care has skyrocketed. Agencies either have to raise the billing rates – pricing a group of clients out in the meantime – or find better ways to keep the cost of care down.

Reducing caregiver turnover, for instance, is one way to keep costs down.

“There are a range of ways AI can be applied to caregiver recruitment and retention,” Griswold CEO Michael Slupecki told HHCN. “From writing job postings, to chatting initially with applicants, to scheduling interviews, AI can eliminate several time-consuming steps in the hiring process. Once onboarded, AI can drive ongoing caregiver engagement to measure job satisfaction, provide rewards, give recognition, and even assign training.”

On the client side, providers also see AI as a tool to deliver better care.

“Increased capacity for predictive modeling through AI will empower home care leaders to enhance service offerings to improve the quality of care, patient health, comfort and independence,” Emma Dickison, the CEO and president of Home Helpers, told HHCN.

Slupecki added that predictive analytics driven by data and AI can aid in fall mitigation, UTI detection, medication adherence and other areas.

“AI technologies are changing and improving faster than we can implement and will impact the future of home care indefinitely,” he said.