Compassus CEO: To ‘Grow Up,’ Home Health Industry Needs To Become Accountable

Compassus – one of the largest home-based care organizations in the U.S. – takes a unique path to growth. Of late, the company has formed new joint ventures with prominent health systems.

Those JVs come with advantages.

“I think that’s a differentiator for us,” Compassus CEO Mike Asselta recently told me. “It’s something that’s really important, our strategy is being aligned with a health system partner.”

Based in Brentwood, Tennessee, Compassus provides a wide range of home-based care services, including home health care, home infusion, palliative care, hospice care and home-based high-acuity care. It has more than 270 touchpoints across 30 states.

Specifically, it has recently finalized JVs with Providence, Bon Secours Mercy Health and OhioHealth.

On Asselta’s end, he is a newcomer to home-based care. He was named the CEO of Compassus in May, after serving in leadership roles at companies like Fresenius Medical Care North America, Quest Diagnostics (NYSE: DGX) and SelectQuote Senior.

With his feet underneath him now, though, Asselta is ready to solidify a growth strategy for the company that will usher it into a new era.

For this week’s Thanksgiving edition of the members-only, exclusive HHCN+ Update, I dive into the future of Compassus and home-based care with Asselta. The conversation has been edited for length and clarity.

Q&A with Compassus CEO Mike Asselta

Donlan: Mike, I think a good place to start is Compassus’ partnerships with health systems. Why are those such a big part of the company’s strategy?

Asselta: For Compassus, I think that’s a differentiator for us. It’s something that’s really important, our strategy is being aligned with a health system partner.

We’ve been aligned with Ascension, for instance, for a long time. We’ve learned a lot there. That started out as a home health and home infusion partnership. And of course, we serve them with hospice as well.

In our more recent partnerships with Bon Secours Mercy Health and OhioHealth, we also have home health and hospice. This is a core part of our strategy.

We think that our alignment with health systems gives us a different and maybe a little bit more interesting view, I think, of what the opportunity is with home health, hospice and palliative care.

And there will be more. If I was guessing from my perch, I would suggest to you that there will be more. So this is indeed a strategy that Compassus is pressing into.

And what is the specific advantage to having these partnerships?

As Compassus is growing its home health footprint across the U.S., we’re gaining assets with these joint ventures. So as we come together with the hospital systems we mentioned, we’re generally gaining programs, we’re enlarging our footprint. We’re getting more assets and more programs and people on the ground to serve. So don’t forget that point.

The other thing is, we’re getting terrific branding in the market for us to go out and address the community. There are a lot of health systems in these catchment areas with our joint ventures that don’t have their own home health or hospice assets at large, right? So it gives us an opportunity to take our joint venture and market to the communities as well with a direct, terrific brand name.

Our partnerships are generally also with nonprofit, faith-based organizations that share our mission, vision and values, right? So we’re distinguishing ourselves by saying, “Yes, we align closely with a nonprofit, faith-based system that has a mission to care for people.” That is unique.

It’s coming to the market with a really big validation that Compassus means what it says when we talk about our mission, vision and values – enough so that our community joint venture partner has chosen to work with us. That’s a pretty important litmus test. So we’re getting a lot of benefits, I think, between the assets, the opportunity to address the community, the validation of our mission, vision and values. These are terrific starting points for any health care company that wants to compete in virtually any health care space.

One comment you made at HHCN’s FUTURE event, which I thought was interesting, was that there needs to be a maturation process in the home health industry in order to capitalize off of some of the opportunities that are out there, specifically in Medicare Advantage (MA). How can providers begin to take that next step?

I’m reflecting on sort of a broad experience, I didn’t necessarily grow up in home-based care. But I see this market as highly fragmented. In a lot of cases, the home-based care isn’t accountable. It doesn’t mean that we don’t care deeply about the outcomes for patients, just that the industry hasn’t matured to have accountable relationships.

Certainly, there’s accountability to CMS for quality and those sorts of things. But when you think about the direct referrer, how accountable has home-based care been for outcomes and as a good partner for the referrers? I think in that respect, the fragmented market has a lot of opportunity to grow up and take accountability for results, not just quality outcomes, but timely initiation of care, being available and having capacity to address the demand that’s out there.

Being able to initiate hospice care earlier, for instance, with the average hospice patient arriving … between 20 and 30 days on hospice as the average. We know that most patients would benefit from being in hospice much, much earlier. Let’s just say, nominally, six months. And during that six months, avoiding one, two, three or four hospital visits or emergency room visits.

So if we want to grow up as an industry, I think we have to be accountable. And I think the vehicle for that is being able to invest in value-based relationships. Yes, with payers, but also with providers who are referrers, who need a value-based partner that helps them with length of stay, that helps avoid readmissions, that helps deliver outcomes.

I think there’s a huge opportunity there.

When you joined the home health industry, were you surprised by the disparity between payment in MA and traditional Medicare? And are you willing to walk away from major health plans that don’t reimburse adequately for services?

On the differences in reimbursement, no, I think you see that in other health care sectors too. I wasn’t surprised by that.

In regards to the second question, if our goal is to provide accountable care and be a good partner for our health systems, I would prefer to have a value-based relationship, yes, with a payer. Traditional Medicare is making that potentially possible for all of us to generate in 2026 with the TEAM Model.

When you go back to Medicare Advantage, would I prefer to have our quality recognized and reimbursed through a quality-based relationship, or value-based relationship? Yes. And that’s what we need to drive for. Whether or not we will walk away from an undesirable rate really comes down to how undesirable that rate is. Even if it doesn’t have a value-based care component, we may participate in that network at relatively unattractive rates because it’s a good service to our hospital partner. Remember, think about how Compassus is generally oriented toward helping the health system have an effective partner.

On the other hand, there are rates that we just won’t accept, and we just grin and bear it. We’re not going to be in that Medicare Advantage network, because the reimbursement is not sustainable. We walk away from those contracts, or we never enter them in the first place.

What other payment models – whether CMS-driven or otherwise – have piqued your interest?

This evolution of the TEAM Model that suddenly came into focus, for me, it’s like, “Wow, this is CMMI’s thinking around post-acute.”

And I think our partners are starting to realize that they need an accountable post-acute partner. The TEAM model excites me greatly, because it gives us insight into how CMMI is thinking about the utilization of home health and considering a procedure as an episode of care. This should be music to our ears in our industry now, but that means we need to step up to the plate and find ways to be great partners in an environment where there’s meaningful risk on the table.

And we have a meaningful opportunity to manage that risk, deliver the outcomes and also avoid the financial penalties that come with what hospitals might be facing. So yeah, I’m really thrilled about TEAM.

The idea of SNF-at-Home care exploded during the pandemic, then subsided a little bit as we exited the pandemic. Are you still excited about the prospects of that model?

We’re very bullish on it. We have a handful of clients now that directly pay us to manage a patient at home that could otherwise be in a skilled nursing facility. And what does that mean? That means building on our home health service. We have to provide biometric monitoring. We have to provide DME. We have to provide support from physicians – some virtual physicians, some nurse practitioner visits. We have to provide a whole bunch of wraparound services to be able to really deliver a bona fide SNF-at-Home experience. It’s not just home health. There are a whole bunch of additional services we need to bring to bear.

We’ve built that out at a relatively small scale based on our current clients, but to your point, I’m very bullish on the recognition that some patients that are being referred to a skilled nursing facility could recover at home in a SNF-at-Home concept at a much lower cost, at a preferred site of care and with the potential for better outcomes.