This fall, our team has spent a lot of time at conferences and on calls with people who care for patients at home: physician and nurse practitioner groups, home health and hospice organizations, palliative care teams, and health systems with house calls programs. The conversations start in different places but tend to end up in the same one. People can see that something big is shifting in home-based care. They're excited about it, and they're a little uneasy about where they fit and whether they're building the momentum they'll need for what's ahead.
One leader we work with put it simply: people sense the opportunity, but they don't know where to start, or even what questions to ask.
Where you sit influences what keeps you up at night
In our conversations, a few groups keep coming up. You may see yourself in one of them.
- Small and independent providers. You bill mostly fee-for-service, maybe with a Medicare Advantage network or two, and you're making the numbers work month to month. The question is whether there's room to keep doing this work, how to position yourself with partners for growth, and how to stem outmigration to larger providers.
- Established home-based primary care groups. You're already thinking about ACOs, Special Needs Plans and risk. The question is whether you'll be chosen as a partner, and on what terms.
- Post-acute providers. Your home health, hospice or palliative teams see the same patients again and again, contingent on someone else's referral. The question is whether staying downstream is enough, whether you can show results on the metrics that matter to physician partners, or whether a medical quarterback could help you move upstream and integrate care across everything you do.
- Academic medical centers. You have a home-based program that works. The question is how to spread it across the enterprise in a way that serves patients well and best supports your system's capacity needs and economics.
- Health systems. You're under pressure on length of stay and readmissions, and the hospital can't fix that alone. The question is how to align your physicians, operations and post-acute partners to support complex patients safely once they're back home.
Different starting points, same bottom line. Organizations that wait to see how things shake out may find the decisions get made without them.
So before the end of the year, we suggest setting aside an hour with your leadership team, or just yourself and a cup of coffee, and working through five questions. They aren't easy, and some may be the ones you've been putting off. That's the point.
Five questions
- Are you getting paid for all the care you already provide? Many home-based providers already do the work behind chronic care management (CCM) or advanced primary care management (APCM) without billing for it. Phone calls, care coordination and medication reviews between visits often go unpaid. Before chasing new revenue, it's worth asking how much you're leaving on the table today.
- If your biggest referral source or payer changed course next year, how long could you keep going? Many home-based care providers rely on one or two key relationships. That works until it doesn't. A new hospital strategy, a plan that narrows its network, or a key contact who moves on can change your outlook overnight.
- If a health plan, ACO or health system in your area were choosing a home-based partner today, would it choose you, and could you show it why? More and more, partners look at hospital use, emergency department visits and total cost of care. Patient stories matter, and they're often why we do this work, but the conversations that lead to contracts tend to turn on data. If you don't know how you show up on those measures, there's a good chance a potential partner already does.
- How well do you really know your market? How many high-needs patients live near you, and how many go without care at home? Who else is serving them? Which payers are growing in your area, and which are fading? Most organizations know their own patients well and their market much less so.
- If you kept doing exactly what you're doing today, where would you be at the end of 2027? Sometimes the honest answer is "fine." Sometimes it's "about where we are now, just more tired." It's worth knowing what's true for you so that you can design your own path.
Sit with the uncomfortable one
If you work through these and one question keeps nagging at you, pay attention to it. That's usually the clearest sign of where to start, and a much better guide than trying to fix everything at once. What's possible for your organization next year depends a lot on facing that question squarely now.
We can help you sort it out
If one or more of these questions is sticking with you, we'd like to learn about that and see if we can help. We have a wide array of resources from those you can use on your own, to time with one of our experts, to taking a closer look at your market through one of our market assessments. To start the conversation, reach out to Heidi Ruhe, Director of Market Growth & Strategic Partnerships, at [email protected].