As home-based care demand continues to increase, several leaders are thinking about the unique growth trajectories at their companies.

At Impact Healthcare, growth has been achieved by not overextending. In recent years, the company has seen 35% year-over-year growth, except for in 2020.

“When I think about our growth trajectory, it’s making sure that we stay true to who we are,” Steve Burningham said during a panel discussion at Home Health Care News’ FUTURE conference. “In my experience, there is one of two things going on, if things aren’t going well. It’s either there’s a lack of clarity … or you have the wrong people in the wrong seats. It’s a kind of blocking and tackling that sometimes when you get in the hyper-growth mode, you can lose track of.”

San Francisco-based Impact Healthcare is a home-based care provider that offers a variety of services including home health, hospice, home care and remote patient monitoring. The company operates in Arizona, California, Utah and Oregon.

About 30% or 40% of Impact Healthcare’s growth has been inorganic, according to Burningham.

However, the company has taken a step back from M&A more recently.

“The last several years have been so crazy that we haven’t been able to compete, because we’re not backed by a bunch of money,” Burningham said. “We have backed away from that, and have really focused on the density.”

Patient-driven growth

For CareRing Health, growth has largely been driven by patient needs.

“What does this thing that we’re talking about mean to the patient,” CareRing Health CEO Steve Guenther said during the panel discussion. “Our patients are in a progression from chronic illness through pre-acute, post-acute care, palliative care, end-of-life care, and so what do our patients need us to do for them?”

CareRing Health’s services lines includes primary care, home health care, personal care and hospice. The company operates in Pennsylvania, Delaware, Ohio, Virginia, Maryland and the District of Columbia.

Recently, CareRing Health brought its services to Philadelphia through its health hub.

“We’re seeing some really interesting results in metropolitan Philadelphia,” Guenther said. “We’re 30 days now — having all four of our service capabilities in the same building. We’re building out a showcase in West Philly, another showcase up in another neighborhood. Our goal is, ultimately, to have six of those in the metro Philly region, and really just bring an entirely different patient experience into those neighborhoods.”

The company also has its sight set on growing through M&A. This means acquiring home and community-based care services (HCBS) organizations of size in targeted areas across the country, and specifically Ohio, Virginia, Massachusetts, Illinois and Michigan.

Guenther noted that these markets were business-friendly states for providers.

During the conversation, Guenther and Burningham also touched on the Medicare Advantage (MA) and managed Medicaid environment that providers are experiencing.

Guenther believes that managed Medicaid plans have been more open to home-based care, especially when compared to MA plans.

“You don’t have to talk them into home health services or home care services, they get it immediately, and they’re more reasonable in terms of rate setting,” he said. “Medicare will pay you $3,000 an episode, and the managed care organizations want you to do it for $1,200 bucks. Frankly, if you don’t want it, they’ll get somebody else to do it.”

On its end, Impact Healthcare is at 35% traditional Medicare, but the rest is managed care. Finding the right regional plans to form relationships with have been key for the company.

“We have some kind of key providers that we really settle up next to on that,” Burningham said. “I think the biggest difference for us is really trying to create some regional density. I think this idea of saying, ‘Hey, we have an office here, and an office there, an office kind of all over,’ is really getting tougher. For us, when we can have that density, we can go to a place like Kaiser and say, ‘Look, you don’t need to contract with all these different providers. We can match your territory.’”

Ultimately, Burningham believes that the best general growth strategy has been remembering to stay disciplined.

“From the highest level, I’d say it’s really about what we are capable of doing and keeping that in mind,” he said. “If you’re like me, and I think maybe a lot of us are, there’s kind of a dopamine hit that comes from the next phase of growth. We’re focused on growth, but sometimes that isn’t the right decision. Being disciplined about it is something that we continue to think about.”