4 Quotes Illuminating At-Home Care CEOs’ 2025 Strategies

To sustain margins while meeting growing demand, against a backdrop of payment pressure, at-home care leaders must find ways to operate more efficiently while expanding access and improving outcomes. Top executives have varying approaches to managing their operations and pressing issues.

For Jennifer Webster, the CEO of DispatchHealth, demonstrating outcomes is top of mind when forging value-based reimbursement agreements. For Jason Growe, CEO of LiveWell Partners, being a referrer’s “first second choice” is imperative to ensuring the organization stays in a referrer’s mix. For others, renegotiating Medicare Advantage (MA) rates and expanding service lines are key to managing in the current operating environment.

Below are four quotes that I believe capture some of the top trends, challenges and opportunities that were top of mind for executives at Home Health Care News’ Capital+ Strategy event, along with some analysis unpacking these statements.

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“We are just trying to negotiate with the Medicare Advantage plan so that we can accept as many patients as possible. A lot of the MA plans, as everybody in this room knows, don’t pay rates that even cover our direct cost per visit, much less the corporate overhead. Exploring different new payment models with those MA plans is how we’re trying to expand access. We’ve had to walk away from a number of plans because we’re in two states and we don’t have the national scope to leverage them with anything that’s workable for us.”

– David Lester, CEO, ProHealth Home Health & Hospice

The MA market expanded to reach 54% of the eligible Medicare population in 2024. While MA penetration has grown, rates have continued to scrape the ground, and home health providers are often forced to subsidize the treatment of MA patients with margins from traditional Medicare patients. 

Additionally, research shows that home health utilization is lower among MA beneficiaries compared to traditional Medicare enrollees.

ProHealth is in good company when it comes to struggling with MA rates, seeking to negotiate alternative arrangements and having to, at times, walk away from plans. The company also faces a problem unsurprising for companies without an expansive national footprint – a lack of leverage for negotiations.

Birmingham, Alabama-based ProHealth is a home health, hospice and skilled nursing facility operator, averaging about 1,200 patients each month.

All these factors together contribute to an environment where providers are likely to either innovate, such as through new payment models, as Lester suggested, or walk away, which Lester has also done.

Other providers have walked away from MA plans due to low rates that persist without raises and other issues, like pre-authorization terms. Knowing when to walk away from a plan is a critical strategic consideration, which the CEO of the LTM Group, David Kerns, considers a process of “zeroing in” rather than walking away. 

“You don’t have to be everything to everybody,” Kerns previously told HHCN. “A lot of times, if you focus on everything, it’s hard to focus on anything. A lot of providers think, well, I have to be in a contract with everybody and do everything. That’s not necessarily true. Instead, focus on your best payer partnerships, and do something really spectacular with them.”

Some providers who walk away from MA plans can return to the negotiating table and forge more sustainable agreements later. But others, like ProHealth, may struggle to strike favorable deals due to less leverage. 

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“You have to be able to demonstrate that to the folks that are paying for that care every day, through those value-based arrangements, or through the data and through the evidence that says, ‘Look, this patient’s first inclination is to go to the emergency room, and we kept them out of the emergency room,’ or ‘We shortened their hospitals stay,’ or ‘We were able to keep them from readmitting at this huge value to to both both payer partners, value-based providers, as well as health systems.”’

– Jennifer Webster, CEO, DispatchHealth

As operators face pressures from MA, workforce shortages and regulatory challenges, having a body of evidence to demonstrate the value of an organization’s home-based services is of utmost importance.

Payers and health systems must see an “undeniable” ROI, Webster said. For DispatchHealth, this includes boasting a high Net Promoter Score (NPS) and compelling testimonials.

Denver, Colorado-based DispatchHealth provides in-home medical care for people with serious health issues and has treated over 1.2 million people in over 20 U.S. states. In March, the company announced a merger with Medically Home, which it closed last week. 

DispatchHealth’s average patient is 74 years old with eight comorbidities, and 50% of those patients have been hospitalized or gone to the emergency room in the last six months. For these high-cost, high-complexity patients, home-based care saves money, allows the patient to stay more comfortable and allows providers to better address social determinants of health, according to Webster.

Simply providing these benefits to health systems or payer partners is insufficient, however. Care providers must be able to demonstrate the meaningful savings associated with providing care in the home to negotiate better rates or forge new reimbursement agreements.

Identifying health plans’ pain points and demonstrating that the provider can address those issues is a critical component in negotiating higher rates, according to Brent Nash, chief development officer at Elara Caring.

“If you go in there and you just say, ‘I want more money,’ they’re probably going to just laugh you out of the room,” Nash previously told HHCN. “You need to say, ‘I want to help you. What’s your pain point? Are you worried about readmission or ED diversion?’”

Home-based care companies that have invested in robust data collection systems have found significant cost savings that can be leveraged at negotiating tables. BrightStar Care, for example, launched a new data system and conducted an analysis of its personal care business. The company reported average savings of $13,000 per person across 30 different conditions and an average of $30,000 in savings for patients with heart failure. 

Telling health systems and payer partners a compelling story through data is more key than ever in a tough operating and negotiating environment, and can lead to new value-based reimbursement arrangements.

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“We decided that we need to have some meaningful differentiation in the agency in order to grow and scale, and for that reason, we chose Alzheimer’s, dementia, Parkinson’s care. … What we were looking for there is stability in our patient, our client, census and building long hours over time. … We have an ideal client profile, and if a condition has a patient population that doesn’t meet that, we won’t [specialize in that condition].”

– Ralph Laughton, CEO, Heart, Body & Mind Home Care

Home-based care providers are increasingly seeking to diversify their lines, creating specialty services to differentiate their businesses and attract clients. Choosing which conditions to specialize in requires strategic consideration.

For Heart, Body & Mind Home Care, for example, determining which service lines would suit the business model required consideration of the company’s “ideal client profile,” which includes at least a nine-month length of care. Laughton decided to specialize in Alzheimer’s, dementia and Parkinson’s care because people with these conditions typically have their disease for 15 to 20 years, begin requiring some amount of home care after about four to seven years and then eventually need longer-hour or full-time home care. These patients provide stability in Heart, Body & Mind Home Care’s patient census and help build long hours over time, Laughton said.

Fort Myers, Florida-based Heart, Body & Mind Home Care offers personal care, companion care and hospital discharge services throughout Florida.

The provider offers some care outside of its ideal profile, including hospice support. This helps support patient volume, Laughton said.

Still, Heart, Body & Mind Home Care avoids moving into specializations far from its ideal client. Cosmetic surgery is common in Southwest Florida, and some agencies have a high volume of patients recovering from these procedures. Heart, Body & Mind Home Care avoids treating these patients, as well as joint replacement patients, because they are short-term clients.

Other providers also take careful consideration when launching new service lines. VNS Health created a product development team and released an analytics tool as part of a “very calculated” approach to product launches.

As providers face tightening margins and mounting competition, developing new service lines is becoming essential — and choosing the right ones may make all the difference.

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“A lot of our hospital systems have their own home health and hospice providers. We respect that. That’s fine, but there’s also a recognition that they can’t meet all the demand coming out of their facilities. For a long time, we have said that we want to be your first second choice. … If we’re able to deliver the quality care, if we’re highly responsive when we get a referral on a Friday afternoon, and we’re okay being payer flexible, maybe not agnostic, but flexible and delivering quality care consistently and a great patient experience consistently to those people, it’s going to unlock doors over time.”

– Jason Growe, CEO, LiveWell Partners

Building strong referral relationships is crucial for home health providers seeking to expand their scale. For Growe, being the home health and hospice provider of choice for health systems sometimes means playing the long game.

St. Louis-based LiveWell Partners is a home health and hospice provider operating in St. Louis, Kansas City, Wichita, Kansas, Detroit and Cincinnati.

Playing the long game means being willing partners with health systems that offer their own home health and hospice programs, knowing that patient demand is likely to outpace their capabilities. That’s where a home health provider can step in.

Demand for home health services is increasing, but research shows that providers’ acceptance rates are only at 34.5%, creating a bottleneck of patients in the health care system. 

Home health organizations want to take more patients, according to Tim Ashe, chief clinical officer at WellSky, but several factors lead to constraints on the number of referrals a provider can accept.

“The 34.5% acceptance rate is really indicative of home health organizations wanting to take those referrals, but in many instances, they are constrained either by supply, availability, capacity in general, or the ability to take on particular payers,” Ashe previously told HHCN.

To become a referrer’s “first second choice,” the provider must deliver quality care promptly. This involves deploying the right level of clinician at the right time, Growe said.

While maintaining quality is critical, managing costs is crucial to continue operating, Growe said. Cost savings include leveraging paraprofessionals when possible and managing supply costs. Keeping costs down is how, in the short term, the industry will survive.