This article is sponsored by Homecare Homebase. This article is based on a Home Health Care News discussion with Luke Rutledge, President at Homecare Homebase, Bud Langham, advisor and former EVP of Enhabit Home Health & Hospice, and Dan Deak, Founder and CEO At Home Halo Franchising. The discussion took place on September 16th, 2025 during the HHCN FUTURE Conference. The article below has been edited for length and clarity.

Home Health Care News (HHCN): It’s been a busy year—from the proposed 2026 Home Health Rule to the passage of the One Big Beautiful Bill Act to the proposed DOL caregiver exemption. I’d love to know, in your view, which 2025 change—or proposed change—has been the most impactful for your organization and the industry, and why?

Bud Langham: Good morning, everyone. It has to be the proposed rule. A cut of that magnitude is deeply disruptive to the industry for a variety of reasons. It’s not just about margin—it’s about patient access. There’s no debate there. That’s the issue we’ve got to figure out.

Perfect. Luke, would you like to go next?

Luke Rutledge: Sure. Homecare Homebase works with about 47% of the market, so we hear perspectives from across the industry. I agree with Bud—the proposed Home Health rule is the most impactful. It’s essentially a 9% cut, adjusted down to 6.4%.

Everyone’s still reeling because CMS insists their methodology is correct, but the behavioral adjustment data doesn’t support their projections. Agencies are asking, “How do I cut 6.4% from my budget?”

If you’re a $100 million company, that’s $6.4 million off your P&L—just gone. The proposed rule comes out around July 4th, then there’s the comment period and advocacy work. By Halloween, the final rule solidifies, and then we at Homecare Homebase have to update the software in a matter of months.

The challenge this year is helping agencies find ways to absorb that 6.4% reduction efficiently.

Thank you. Dan?

Dan Deak: For our company, Home Halo, we’re a non-medical home care franchise, so the proposed caregiver exemption rule could have the biggest impact on us. I’m taking a “wait and see” approach.

I entered the industry just as that exemption was being phased out, so I never experienced it firsthand. But with today’s much higher demand for care—and ongoing caregiver shortages—it’s concerning. Will this rule make things worse? I’m curious to see how the market adapts and how we’ll need to respond.

It’s definitely been a divisive topic in the industry. Interesting to hear how you’re approaching it.

Deak: Absolutely.

Langham: Morgan, can I double-click on that question?

Please do.

Langham: I don’t want to sound all doom and gloom. There are also positive disruptions coming. The administration’s current focus on health technology, innovation, patient-facing applications, and interoperable networks is promising.

There are real opportunities for early adopters to change how we deliver care. One initiative I love is Kill the Clipboard. If you haven’t read about it, you should—it’s exciting.

So yes, there are major challenges, but also real opportunities ahead.

Thank you for the silver lining—I appreciate that. Speaking of innovation and technology, there’s so much happening right now—from remote patient monitoring to AI-assisted scheduling. Which technologies do you think will most transform the industry? Luke, let’s start with you.

Rutledge: I’d say AI-driven tools, for sure. Right now, everyone’s chasing ambient listening and automated scribing to reduce clinician documentation burden. But at a deeper level, what agencies really want is data automation—eliminating redundant data entry across roles.

Second, I’d highlight capacity logistics. It’s incredibly complex to match a patient’s unique clinical needs with a skilled clinician who has availability—especially with limited workforce supply. We’re seeing admission rates as low as 60%, meaning many patients go without care. AI can help optimize those logistics in powerful ways.

Bud, would you like to take that one?

Langham: Yes—it’s definitely AI that will transform the industry. But we have to be careful not to create more work for people with these tools. Burnout is already a huge issue.

At a recent conference, a physician told me, “Stop giving us more work. Take it somewhere else.” That stuck with me. Innovation has to increase efficiency and reduce friction—especially in the back office—so we can focus on care.

If we do this right, AI can create an incredible experience for clinicians, patients, families, and providers alike. Efficiency matters, but experience is everything. Without that, it’s all for nothing.

Dan, how about on your end?

Deak: I completely agree—AI will have the biggest impact across all our businesses. I started experimenting with ChatGPT and Claude last year to understand what they could and couldn’t do.

Lately, I’ve focused on how AI can simplify workflows and make our employees more efficient—not replace them, but empower them. One of the biggest bottlenecks in home care is scheduling, and I think AI will massively improve that.

If we can schedule more efficiently, we’ll retain more caregivers, which means retaining more clients. That’s where growth happens.

On a personal note, I’m even using AI more for research—I find myself going to ChatGPT or Claude instead of Google. It’s a new way to learn and gain insight.

Rutledge: I’ll piggyback on that. Same here—I’ve basically ditched Chrome and Internet Explorer.

The next generation of apps—agentic, generative AI—will do things like, “Schedule Bud for Tuesday and Thursday for three weeks,” and it’ll just happen automatically. That’s the kind of automation we’ll see across intake, scheduling, and documentation. The future is here.

Perfect, thank you. Let’s talk about Medicare Advantage. Bud, can you describe its current impact and how providers should be responding to its growth?

Langham: It’s been challenging—and increasingly so as more market share moves to MA. Providers are in a tough spot.

You have to be willing to say no to contracts that don’t make sense, which is incredibly difficult when everyone’s striving for growth. But if a contract doesn’t allow you to provide quality care and positive outcomes, you can’t take it.

Staffing shortages remain one of the biggest threats to home-based care. Many providers are using strategies like improved benefits or education pipelines, but can these really offset workforce shortages long-term? If not, what else needs to happen? Dan, let’s start with you.

Deak: When 10,000–12,000 people are turning 65 every day, it’s hard to imagine ever fully keeping up from a workforce standpoint. We need to rethink our care delivery model—how can we serve more seniors with the resources we already have?

For many agencies, the main problem isn’t recruiting—it’s retention. Caregivers often leave not for 50 cents more an hour, but because they’re not getting enough hours, or the hours they want. Better scheduling can fix that.

If we focus on smarter scheduling with AI, we’ll retain both caregivers and clients.

Luke, how about you?

Rutledge: On the recruiting side, technology can now flag early warning signs of turnover—like missed visits or delayed documentation. AI can predict when a clinician is at risk of quitting, giving leaders a chance to intervene early.

We also have to make home care more appealing by catching up technologically. Hospitals offer scribing and digital tools that make clinicians’ lives easier. Home care needs to do the same to stay competitive and retain talent.

Bud, what’s your perspective on staffing?

Langham: We can’t recruit our way out of this. We need to delight our clinicians—to make their work experience joyful and supported.

I often ask happy nurses in hospitals, “Why are you smiling?” They always say the same thing: support. They have technology, teamwork, and immediate backup.

Our nurses and therapists, by contrast, are often isolated—miles from help. That’s why I’m so excited about this wave of innovation. Technology can bring that same support and connection to the field.

Now, with slimmer margins, how should providers decide when to invest in new technology?

Rutledge: Great question. Every organization has more problems than time, so start with your top three. Know your KPIs and focus on what will truly move the needle.

Next, assess your ability to drive adoption—change management is real, and cultural readiness matters. Then, when choosing a vendor, look for a true partner, not just a software seller.

We’re also seeing creative partnerships—like risk-based models where vendors pilot solutions until results are proven. That kind of collaboration will move the industry forward.

Dan or Bud, would you like to weigh in on balancing innovation and margins?

Deak: Sure. For me, it’s about ROI. If I can see a clear return—whether that’s retaining caregivers longer, improving client satisfaction, or helping franchisees succeed—I’ll invest.

Langham: It has to reduce cost, improve outcomes, and enhance experience—those are the three measures. Be strategic: identify what you need, focus your efforts, and pilot aggressively. Fail fast, fail forward, and keep innovating.

Perfect. With the rise of value-based and risk-based care, how are savvy organizations adjusting reimbursement strategies? Bud, can you start us off?

Langham: Sure. The key to lowering overall healthcare costs is embracing risk and regulatory reform. That’s our future.

To succeed, you need strong data and technology muscles. Like physical training, you can’t build them overnight—you have to start now.

Efficiency, data literacy, and forecasting ability are essential to thrive under value-based models.

Luke, your take on value-based care and risk-based contracting?

Rutledge: Bud nailed it. From a tech standpoint, it’s about using data to mitigate risk for high-risk patients and to understand contract value and cost to serve.

More agencies are now saying no to low-value contracts, which is smart. Knowing what the payer values—like RAF scores or HEDIS measures—helps you negotiate better terms and position yourself for success.

Dan?

Deak: From a payer and reimbursement standpoint, diversification is key. Don’t put all your eggs in Medicaid or VA—have a balanced mix.

Also, we need better data sharing to drive more adoption of home care benefits in Medicare Advantage. Right now, we can’t show outcomes effectively enough to convince payers. They want data, not promises. If we can deliver that, adoption will grow.

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