Home-based care providers are operating in an environment of intensified Medicare and Medicaid program integrity oversight and transformational AI technology. The companies that survive and thrive are the ones that adopt AI with disciplined governance, compliance and vendor management.
Companies should respond to the evolving regulatory landscape by conducting internal data reviews and compliance checks, adopting AI tools strategically and practicing diligence with technology vendors, home-based care industry leaders said during a Sept. 10 webinar hosted by Polsinelli.
“Regulators are trying to modernize oversight of a sector that is itself being transformed by technology and by workforce economics,” Jennifer Sheets, CEO of the National Alliance for Care at Home (the Alliance), said in the webinar. “Whether it’s Medicare or Medicaid program integrity, new regulations or requirements or AI governance, the common denominator is that oversight of this sector is intensifying on every front at once.”
The Alliance is a Washington, DC-based advocacy organization representing over two million home health, home care, hospice, Medicaid home- and community-based services and palliative care professionals.
Home-based care providers are already using AI to augment scheduling, documentation and real-time patient monitoring. These technologies will not going away any time soon, said Gregory Leighton, vice chair of privacy and incident response at Polsinelli.
“The goal here isn’t to say ‘No’ and not adopt AI. You’re going to have to. The world’s pushing us all there,” Leighton said.
Based in Kansas City, Missouri, Polsinelli Law Firm specializes in healthcare, including home health and hospice, as well as finance, technology, real estate, private equity and life sciences.
Rather than questioning whether to adopt AI, providers should instead question how to adopt the technology most effectively for their operations, Leighton said. A successful AI strategy must feature at the forefront.
Navigating scrutiny
Home-based care providers should adopt technology strategically in what Leighton calls the “good, better, best” mentality.
“You don’t need to like say, ‘Well we can’t implement AI until we can get a full-blown program out.’ Get a framework down. Get something that works,” Leighton said. “Figure out what your critical use cases are. Assess them. Build compliance and then keep refining and building your program out.”
Companies should also assess whether different types of AI, such as agents, could cause more harm than good. AI models already have inherent risks, including generating incorrect information. Those risks increase “exponentially” when adopting agentic AI, Leighton said.
Agentic AI aims to perform tasks and make decisions that a human could perform, according to the Massachusetts Institute of Technology Sloan.
“If you try to jump right into the agentic pool, you run just a ton of risks because there’s just so much more assessment and, frankly, compliance buildup that usually has to be done around an agentic system,” Leighton said.
He recommends that providers implement non-agentic AI tools before moving to agentic AI.
Since many companies do not build their AI systems in-house, some home-based care providers opt to work with a vendor. However, companies should ensure they do their due diligence before signing a contract, said Angelo Spinola, home health, home care and hospice chair at Polsinelli.
Specifically, providers should understand how a vendor collects and handles their data, the vendor’s security protocols and incident response and whether there are HIPAA concerns with their technology.
“You need to make sure that with your contracts with any vendor, you understand what happens with the data, how it’s processed, what the agreements are [and] that you retain the right to your own data,” Spinola said. “It is extraordinarily important that your security safeguards are in place. That the minimum safeguards are there.”
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