Krista Nelson, CEO of Optum Health, identified a significant opportunity to expand home health services, along with other high-performing care modalities, to deepen the provider’s presence in markets during UnitedHealth’s third-quarter earnings call on Tuesday.

Optum has also expanded its post-acute focus through a payer partnership.

“This year, in partnership with one of our payers, we’ve expanded our ability to manage risk across a post-acute continuum,” Nelson said on the earnings call. “Think from an inpatient hospital stay all the way through SNF and home health.”

Eden Prairie, Minnesota-based Optum is UnitedHealth’s services arm. Optum Health is Optum’s patient-care business, focusing on fully accountable value-based care.

In Q3 2026, Optum served over 120 million patients. Its Q3 revenue rang in at $66.9 billion, down from $69.2 billion year over year.  

In the same quarter, Optum Health’s revenue totaled $22.9 billion, down 10% year over year. UnitedHealth attributed the drop to fewer value-based care patients served in markets where Optum lacked sufficient value-based care presence to sustain clinicians in its Q3 earnings report.

At the same time, UnitedHealth CEO Patrick Conway described the reason for the company’s strong Q3 performance to a continued return to value-based care principles as well as strong clinical programs and operational improvements.

Nelson described strong Q3 performance across clinical programs, including home health, and said it will be durable as the company heads into 2027.  

Alongside home health, UnitedHealthcare President Robert Hunter highlighted hospice, surgery centers, D-SNPs, C-SNP and HMOs as high-performing service lines.

“We’ve seen really strong demand for these products to serve post-acute care risk comprehensively, and we’re also really pleased with the results,” Hunter said. “We’re seeing an improved access to timely care, again, improved access to home health utilization, and I think you’ll see those programs also expand inside 2027.” 

UnitedHealth leadership also described elevated trends in home- and community-based services, while saying that the elevation is moderating slightly.  

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When the Centers for Medicare & Medicaid Services (CMS) enacted an enrollment moratorium on home health providers on May 13, it transformed CommonSpirit Health at Home’s largely de novo-driven growth strategy.

Trisha Crissman, CommonSpirit Health at Home’s president and CEO, said the company’s new five-year growth strategy includes geographical expansion, boosting its market share and pushing patient care farther upstream.

Crissman has served as president and CEO of CommonSpirit Health at Home since September 2024, previously serving as the company’s interim president since 2023. Her prior appointments include vice president and chief operating officer for the home health and hospice division of CommonSpirit.

Based in Loveland, Ohio, CommonSpirit Health at Home is the home-based care arm of the Catholic healthcare organization CommonSpirit. CommonSpirit Health at Home provides home health, hospice, palliative care and home infusion services to over 16,000 patients across 15 states.

A replay of that TALKS episode for HHCN+ members is below, along with a transcript of the conversation. The transcript is lightly edited for style and clarity.

HHCN: What were your priorities for 2026?

Crissman: CommonSpirit Health at Home has significant initiatives in play right now tied to our larger strategic plan.

For us to realize the ROI tied to the implementation of, for example, ambient scribing technology, which we began implementing this past summer, as well as gaining some efficiencies through some referral management platform technology that we also just began implementing that will ease administrative burden tied to the admissions process. These are two huge bodies of work requiring a substantial lift by my teams. I expect that this will continue to be a focus this year from an initiative standpoint.

Additionally, we are laying the groundwork for some emerging strategies that will support our growth plan well into 2030. Those initiatives require a lot of pre-planning, and those are also top priorities for us as we formulate plans around a couple of those key avenues. When I look back on ’26, I will consider it successful if Health at Home continues to grow its EBITDA and our bottom line. This is essential because it provides the resources needed to reinvest in growth and carry out our mission for the larger organization.

To achieve this, we must reduce administrative complexity and realize additional benefits driven through our streamlined centralized function. We’re working on that and driving increased capacity through some of the technology that we’re implementing right now. That will help us have more capacity to care for the people that need our help every day.

Those are our top priorities for the remainder of ’26. I’m optimistic that I’ll look back and recognize that our investments were well worth it and we’ve been successful.

Can you walk us through CommonSpirit Health at Home’s five-year growth strategy?

Crissman: A lot of the five-year growth strategy has been halted because it’s been dominantly de novo-driven and heavily hospice-focused.

However, with the current moratorium in place, we’ve had to re-evaluate opportunities for our growth and expansion until that is lifted. We’ve pivoted. We’ve put on hold some components, but we identified several key growth strategies enabling us to continue to serve more patients in the markets where we already exist.

Our first strategic move is making sure we’re expanding our geographical footprint and increasing market share. That will align with CommonSpirit Health’s coverage and service where they need us to serve our hospital partners.

That’s true for markets where we’re serving CommonSpirit Health, but also for our 15 joint ventures with regional hospital systems, dominantly in the Midwest. Our first strategic move is making sure we’re expanding geography and gaining market share.

The second strategic move is tied to increasing access to care earlier and upstream and in alignment with physician enterprises across CommonSpirit Health. [This involves] establishing proactive early identification of eligibility and transition pathways into home health, hospice, palliative care and doing that upstream in specialty clinics with primary care providers.

We’ll help physicians and practitioners understand and identify eligibility for services earlier and engaging patients with the right level of care at the right time before the next acute exacerbation takes place. This will be particularly powerful for those who may be eligible for hospice when maybe physicians and practitioners possibly have not had advanced goals of care conversations with them and what their hopes and wishes are at the end of life.

A third strategic move is making sure we can drive greater success in value-based care and deliver quantifiable enhancements in clinical quality, patient outcomes and reducing total cost of care across the eight [clinically integrated networks] CINs and shared populations with CommonSpirit Health.

Technology is everywhere and embedded in all of the strategies, and so [we will be] making sure we are accelerating the utilization of some technological solutions. More specifically, we’ll be deploying AI and some digital capabilities to enhance clinician engagement, expand clinical capacity and optimize patient navigation.

There are so many byproducts of doing this well. Empowering our clinical teams with some technology solutions that will make their lives easier and reduce documentation. I’m excited about that. Of course, the admin burden, just to give them the space and the freedom to engage patients and their caregivers without the obstacles of the hardware in front of them that we’ve been hearing complaints about for decades. Then hopefully, we’ll be able to give them an opportunity to connect more deeply with patients as a result.

We’ll pick up the de novo expansion once we hear that CMS lifts the freeze, which will have Health at Home adding about an additional 23 locations through fiscal [year] 2032 in key markets that will support the care continuing for CommonSpirit Health as a whole. Those are the top priorities that will take years.

Did the moratoria change growth goals or just the strategy for growth?

Crissman: The overarching goal is that we need to grow our EBITDA. We know the percentage of patients that we’re not able to serve because of capacity or geography limitations right now. The numbers don’t really change. The budgets have been set. We just have to figure out and be agile with how we’re going to make it happen.

One of the things I love about Health at Home is that we’re really good at pivoting. We’re really good at being flexible and finding a way. The moratoria is not within our control, but what is within our control and focusing there to be architects of our own destiny. I’m proud of my team’s ability to do that quickly.

What might we see with the moratoria?

Crissman: My crystal ball is broken right now on my desk. I wish I could tell you.

I do know CMS made a promise to us at the Alliance Conference that they would give us, obviously, if it’s in writing, they would give a 60-day notice. That notice timeframe has passed if they were going to extend it. I’d like to be optimistic and say, “Well, it must be being lifted.” That’s what I would expect because we haven’t heard.

I never thought it would only be six months. I thought it would likely be extended. I’m on the fence with that. When I get my crystal ball fixed, I’ll tell you what it says.

What is your strategy for expanding value-based care contracts?

Crissman: It starts with ensuring that Health at Home is included in the contracts in each of the markets where they have shared populations. That’s the biggest piece that we’re working on right now: having visibility to being a preferred partner and educating the markets and these CINs around the value that care in the home brings and the impact that we can have on reducing total cost of care.

It sounds really basic, but when you’re an organization the size of CommonSpirit Health, it’s not surprising that there are gaps from where we should be to where we need to be in the future. That’s been elemental, making sure that we’re included in the contract and that we, Health at Home, are educating key stakeholders with each of those CINs.

Has the ability to build those contracts and be included in them changed recently?

Crissman: It’s been pretty consistent. You’d think that it would be automatic, but you push it forward. It’s not necessarily a boulder going up a mountain, but it’s pretty consistent.

Let’s talk about your five-year plan of moving access to care upstream. What does that mean on a practical level?

Crissman: I’m really excited about this because I think it will provide the opportunity for patients to access service when they’re eligible and earlier.

We know that accessing the right level of care at the right time improves overall outcomes, patient satisfaction and quality of life. As far as what it would look like for a patient visiting with a physician or specialty clinic, our vision is that utilizing AI and some technology, some triggers in the EHR, that will flag possible eligibility for either home health or hospice, and that practitioners and physicians would be automatically notified of this eligibility in preparation for maybe an upcoming visit.

Ideally, maybe it would even happen before the patient’s next visit so that we could preemptively encourage a sooner visit with their provider to review their eligibility for that level of care: again, home health, hospice, at the right time, why they qualify.

Then, ultimately, if we’re successful at doing that, preventing the next exacerbation, which obviously would likely result in another hospitalization, which nobody wants.

The vision is that we can positively impact quality outcomes and patient experience by maximizing and leveraging key touchpoints on the patient’s care trajectory.

Doing that earlier and allowing them to have a better quality of life and a much lower likelihood of additional hospitalizations because of the interventions that historically are not provided timely enough. We move from a reactive model, which we have always been, both for home health and hospice, to a proactive engagement of the patient within the care continuum, earlier, more effective — likely to be more receptive because they’re not in the midst of a crisis, and they have time to absorb the reasons why they qualify and how it will benefit them, which all, again, contributes to better outcomes and lower total cost of care. I’m just really excited about this opportunity that we’re working on.

Does moving care upstream help get patients into hospice earlier?

Crissman: It can, it will, it should. Being able to impact access to hospice care for patients who are eligible to receive the benefit and to do so earlier than they currently do, that would bring about such a great end-of-life experience for the patient, for their caregivers. I believe all physicians and practitioners desire that for them as well.

You can imagine being a part of a large healthcare system and serving our hospital partners as the care-in-the-home platform, hospice patients come to us at the end of life way too late and subsequently do not have the ability to benefit from all the ways that this beautiful hospice care benefit can support and enhance someone’s last days of life.

The care teams at Health at Home, we’re so well equipped to have meaningful and powerful goals of care conversations with patients and their loved ones. This can and should be done and will be a part of how Health at Home serves clinics and specialty clinics’ physicians moving forward in the larger health system.

We do this all day long, and we’re good at it. We want to be leaned on to serve physicians and practitioners that way, and of course patients and families. Having the opportunity to be engaged with patients and their loved ones earlier in the disease trajectory, earlier in their treatment, I think it could have really impactful and powerful outcomes.

Do you think there’s an industry-wide trend of organizations moving care upstream?

Crissman: As I look back in the past three decades, we’ve always wanted it to be that way. We haven’t always been successful for lots of different reasons.

I do hope that the AI that’s available to us and how it can be embedded in an EHR that can help us to see earlier, what we don’t normally maybe see in a regular visit or over the course of a year and a half of a patient’s decline, they show up in little tiny changes that we don’t pull the thread together and put a whole story together, but the technology can help us do that.

I would expect that all health systems will be looking at their EHR, and how a patient’s experience and ability to access the right level of care at the right time could be exponentially served by using the data that’s always been there, but we haven’t had an ability to pull on. That’s my hope.

What are the most meaningful problems that you want AI to solve at CommonSpirit Health at Home right now?

Crissman: All of them, but I have to pick and choose.

Our approach to AI and emerging technology solutions must always have consideration and evaluation through the lens of our mission and our values.

We’re very interested in finding solid solutions that will help us be more efficient, drive greater accuracy and be more productive. We have solutions for almost every pain point being thrown at us and coming at us all the time. They’re all very enticing, particularly for reimbursement challenges, workforce shortages and the headwinds of inflation.

I am most excited about the ways that some of the new technology that we’re implementing right now will enable our frontline clinicians to be able to connect more deeply with patients and caregivers that they interact with daily. To give them more time to maybe have deeper conversations. It could drive higher levels of human kindness and opportunities to connect more deeply, I think, relationally in the living rooms and at the kitchen tables [where] our clinicians are sitting with patients and their loved ones.

Technology that enables clinicians to really be the nurse, therapist, social worker or chaplain they dreamed of being, but software and hardware historically has gotten in the way of that. We’ve been listening to that for a long time. If we’re removing those kinds of obstacles with the new technology, such as ambience scribing that we are currently in the midst of implementing, that can be the solution to help create the environment to be successful there.

When you think about mission and culture, always with the patient at the center of everything that we do, the innovation that we seek to embrace has to enable us to be better versions of ourselves tomorrow than we are today.

It has to enable us to live out our mission in more powerful ways. It also has to help us, and this is still important, it has to help us reduce administrative complexity and redundancy and help us be more efficient, care for more patients through our own growth strategies, and without adding additional resources in the future.

CommonSpirit Health at Home is also really focused on how these technological solutions will help us with our retention efforts. Candidates today, in general, are becoming extremely tech-savvy and sophisticated. They have an expectation that organizations like Health at Home, that if they choose to be a part of that, those organizations are utilizing the newest, latest and greatest technology as solutions to help them have an overall better experience — no matter their role. Of course, when you’re a field clinician in home health, hospice or palliative care, the administrative burden of documentation and the time that it has always been one of the top complaints from our staff. Even back to the days of paper at the bedside.

Being able to offer the latest technology as a part of our operational platform and culture, to me, that’s going to be really attractive to candidates. I’m banking on that. Not just attracting them, but retaining them. That’s extremely important for us to be successful in our ministry.

In the recruitment process, does CommonSpirit discuss the type of technology candidates will be using?

Crissman: Yes. We’re telling the story of a day in the life of each of the interdisciplinary team members and how that technology is being used in their role to make it simple for them to understand. We’re using that in advertising, our website and certainly as a part of what we’ll send to an interested candidate when they apply for certain positions.

It’s here to stay, and it’s not going away. It’s an expectation to all our staff that we embrace it for the good it can bring us.

You talked about the ambient scribing technology. How are you using that technology? Where are you with the implementation process?

Crissman: We began implementing ambient scribing early this past summer. We are 100% implemented for home health, just beginning for hospice.

Everyone’s really excited about it when we explain what it can do for clinicians and our team members. I thought originally that we would have 1,000% embrace, and that this is the best thing since sliced bread, and that we would have really quick adoption. Well, that hasn’t been the case.

We do have a small portion of our employees that are hesitant around using AI and ambient scribing for various reasons. We have some that are slower to adopt in the ways that we educate and redevelop our teams around having conversational assessment dialogue versus using the tablet, clicking and doing a narrative maybe later or copying — all the things that have historically been a part of how we documented on our current EHR without ambient scribing.

It hasn’t been as smooth as I want. The change management piece, we underestimated. It doesn’t mean we won’t get to where we’re going because we always do. It’s just a little bit slower of an adoption timeline than we expected.

I have anecdotal stories of clinicians that came back day one and said, “I can’t believe that I’m done. I get to go to my son’s baseball game.” That’s really powerful to me. I want all of our team members to experience that, and I know that they will. That’s where we stand today.

How do accelerate AI utilization?

Crissman: I happened to have looked at our action plan this morning. I liked a couple of components where we’re going to tap super users. We’re going to turn them into zealots for us and embrace those who may be slower, hesitant or resistant to adoption, and then do co-visits together so it may dispel what might be threatening to a nurse or therapist who is not using it.

Let’s partner folks up with those who are really seeing how it changes their life. I’m going to put a lot of weight on that. I think it’s brilliant.

I also think continuing to explain why we are doing this will help individuals understand. The reality is, likely, a couple of years from now, all providers will be utilizing ambient scribing. We can’t afford not to with workforce shortages.

It’s not like individuals who want to be in this industry — and I hope more decide to join us to care for people where they want to be cared for in their own home — are going to be able to find somewhere that isn’t going to use some level of this technology.

Is there another technology you want to highlight?

Crissman: We have our hands full right now with the ambient scribing, and then we also are implementing referral management AI. Right now, those are the bites of the elephant that we’re taking off.

There are some other components that, when I look at technology, it has to be through, again, the lens of how are we going to grow? We need to grow our EBITDA, and that means we need more efficient processes and less administrative complexity. It means we need more capacity so that we can see more patients with the same workforce that we currently have.

I’m confident the technologies we have moved forward with this year will help us accomplish all that together. I don’t have anything else in the hopper. I’m sure that we’ll be looking, once we’re successful with these two components, for what the next opportunity is for us to be more efficient and lean into technology to serve the outcomes we’re looking to improve on.

It sounds like the admission technology would help serve both patient need and increasing efficiency.

Crissman: It does. Not just reducing the clunkiness and time of the referral-to-admission process, which is way too long, but it removes subjectivity around, “Should I say yes to this referral? Can I take this patient? Can I admit this patient?”

It’s automated. In my mind, we say yes, and we figure it out. Because these patients need our help.

It’s amazing what does go into the discernment currently around whether we accept a referral. We’re better than that. We have to move beyond it. We have to figure out how to admit the patients that need our help every day. That’s being a good partner to our hospital system and our joint ventures.

Again, there’s a lot of change management and taking that off an agency’s autonomy and having it be automated, but we’ll get there.

Are you in the implementation phase for the admissions AI or pilot? What part are you at right now?

Crissman: We’re entering phase two on Tuesday next week. Maybe 15% of my agencies are on it. We’ll be rolling this out and complete by end of December.

How is it important for providers to make sure that tech enhances patient care rather than replacing it?

Crissman: This is in my roots as a hospice chaplain. How we frame the opportunity that AI offers our clinicians to be more authentic and to make more authentic human connections in the day-to-day practice of caring for patients in their own home.

That’s really vitally important, as well as defining what success looks like upfront. For example, in the ambient scribing piece, we’re retraining clinicians to engage in conversational assessment and dialogue with their patients, which is very different from tablet charting during a visit.

We’re going to maximize the accuracy and the effectiveness of ambient listening. Alongside that, more importantly, we are framing up and leveraging AI as an empathy enabler. Our clinicians are maximizing the opportunity to become more enhanced and advanced compassionate healers, to embrace this newfound time to maybe slow down, maybe listen more deeply and to provide more personalized care and support during their visit.

Defining success has KPIs tied to whether we are efficient and accurate, but we have to define success also related to this enhanced, accelerated human kindness. That will include improved patient experience. This is the piece that I’m really excited about, this deeper, more meaningful clinician connection to their “why” and their purpose. Why did they want to get into this work in the first place?

This has to be a part of the rationale and the business case for utilizing AI for our clinicians, and to ensure the technology we use helps humanize the care we provide, not just make us more efficient.

On a leadership level, does that look like having conversations with clinicians, listening throughout and after the implementation process?

Crissman: Yes. I would say asking really good questions of our clinicians for them to articulate what has changed, what’s different. Can you make that tangible? How does it feel when you go home at night, when you have no more documentation to do? How does it feel sitting on the living room couch with your patient now, and you don’t have a tablet in front of you that’s maybe been an obstacle?

Let’s get our people talking about the difference that it makes, and then lean on that and leverage it.

Health at Home obviously has the unique position of being under the broader CommonSpirit Health system. What opportunities do you see to leverage that?

Crissman: I remember, early in my career, reflecting on what it would be like to be a part of a larger health system. I salivate around the referral stream and all the resources that would come. There are pros and cons to all different types of relationships. It is really wonderful to be a part of the larger CommonSpirit Health ecosystem that provides a unique opportunity for Health at Home to understand more deeply the pain points of the larger organization, and to ensure that we’re providing solutions for the gaps between where we are today and what’s possible.

Having access to, whether it’s IT or HR or strategy or business development, a standalone provider would never be able to for example, have bots created to be a part of a national IT department, we wouldn’t be able to afford to develop that on our own. We benefit greatly from being a part of a larger health system.

At the same time, you’re a part of a large health system, and you have lots of people that want to weigh in on your business, and there’s bureaucracy, and things take a long time. It’s all give-and-take, but we benefit greatly from being a part of a larger perspective and system resources that are available to us right now.

What’s the big change that you’re hoping for patients to see out of all of this? What’s the core outcome you’re looking for?

Crissman: I’ve mentioned clinician connection to their “why.” I will just lean on that again. Attraction and retention.

I also am hopeful that maybe technology will help us more broadly take better care of patients. Maybe that’s where predictive analytics come in around anticipating clinical decline, preventing adverse events and making more personalized care plan. Home health problems don’t start as a code blue. They start as micro trends. They go unnoticed until a patient winds up in the ER.

We’re inundated with information. From medication changes, supply requests, standard documentation, this clinical early warning system that parses the noise to a nurse [and describes] based on the last three visits that this patient’s baseline is shifting. Because some of this stuff just happens in the gaps between our visits. It’s happening in the day-to-day life of patients. It’s happening in the social determinants of health, all those little things.

It would be really nice if our clinicians could have access to that information to be impactful and have interventions before their patients hit a threshold of a crisis.

That might be something that I would look forward to having in their hands. Something that solves for the gaps between the visits. Helping us be better versions of ourselves tomorrow, which translates to our patients [being] happier. Our patients have a better quality of life. The story that patients tell can ooze with loyalty to the larger CommonSpirit Health organization, and that they would never consider having a provider other than the one that’s caring for them right now.

That’s how I would translate the outcomes that I’m hoping that we’re all going to be experiencing through these changes that we’re making.

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The new program will offer in-home primary care and palliative care, among other services. Dartmouth Health plans to grow the program over time, Dr. Nathan Goldstein, chair of Dartmouth Health’s department of medicine and co-CEO of Dartmouth Health at Home, told Home Health Care News in an email.

The Dartmouth Health at Home program will launch in January 2027 as a pilot, serving 10 to 20 patients. The organizations plan to grow the program over the next several years to serve over 1,000 patients and their families annually, according to Goldstein. At full scale, the program will employ approximately 30 clinicians and staff.

“The programs will all start locally, so we can adapt and refine the programs based on the feedback of the patients and caregivers that we serve,” Goldstein said. “Then, over time, we will expand the program across New Hampshire and Vermont, with the ultimate goal of serving all patients who receive care from Dartmouth Health.”

The Dartmouth Health at Home program is intended to revolutionize rural healthcare by expanding care access, improving patient outcomes and supporting patients and their families through a safe and effective shift of care from hospitals and ambulatory care settings to the home setting.

“One of the things that is revolutionary about Dartmouth Health at Home is bringing a range of coordinated services to patients in their homes rather than patients coming to one of our facilities for services,” Goldstein told HHCN’s sister publication, HealthLeaders. 

The program will also establish the Family Caregiver Institute at Dartmouth Health to provide family caregivers with services, education, support and access to home care aids.

Additionally, the program will use the expertise at the medical school’s Dartmouth Institute for Health Policy & Clinical Practice to study what works in home-based medical services and how those services can lower costs for health systems, patients and payers. 

To boost access to care, the Dartmouth Health at Home program will be designed to provide medical services in the home for patients who struggle to get to medical appointments, Goldstein said. For example, older frail adults often rely on family members to take them to medical appointments and providing services in the home will avoid the difficulty that family members face in taking time off from work to take a loved one to a doctor’s office.

The Dartmouth Health at Home program should improve patient outcomes and care quality in several ways, according to Goldstein.

By seeing patients in their home on a timely basis, the program’s clinicians should be able to diagnose and treat medical conditions before illnesses progress to acute stages. When clinicians visit patients in their homes, they can see whether patients are taking their medications, whether they have food in their refrigerator, whether the home is clean and whether there are fall hazards.

Dartmouth Health at Home is expected to reduce cost of care, particularly if clinicians can diagnose and treat medical conditions earlier, which will avoid costly emergency room visits and hospitalizations, Goldstein said. The program should also reduce costs by improving medication management.

Shifting care to the home effectively and safely 

In shifting care from the hospital or ambulatory care setting to the home setting effectively and safely, interdisciplinary care teams are crucial, according to Goldstein.

“With Dartmouth Health at Home, we will have interdisciplinary care teams that include physicians, advanced practice providers, social workers and home health aides,” Goldstein said. “We will not be having a single provider at a single point in time. We will have an entire team of professionals to serve patients and their families.”

The interdisciplinary care teams will meet at least weekly to review the care of patients in their homes, which should ensure that home-based care services are effective, Goldstein said.

To make sure Dartmouth Health at Home patients are safe, the program will offer home safety assessments for patients as well as 24/7 phone support for patients and their families, Goldstein said.

Achieving financial sustainability and developing national model 

The Dartmouth Institute for Health Policy & Clinical Practice will help to ensure that the Dartmouth Health at Home program is financially sustainable, according to Goldstein. 

“The institute will examine how we can create home-based services programs, the costs of home-based services programs, how much revenue will be generated and the expected financial margin,” Goldstein said.

While the $20 million gift from Dartmouth alumnus Richard “Dick” Levy is enough to begin the program, it will not sustain the Dartmouth Health at Home program financially over the long term. 

“One of the goals is to make sure the home-based services that we offer will be attractive to private and government payers,” Goldstein says.

Dartmouth Health expects the program will eventually be adopted in rural areas across the country. 

“When we look at the intersection of rural health and home care, we think that Dartmouth Health and the Geisel School of Medicine at Dartmouth can be national leaders,” Goldstein said. “We think the programs we are building can be disseminated across the country.”

Advice for CMOs and other senior leaders 

For CMOs and other senior leaders at health systems considering adoption of programs like Dartmouth Health at Home, the first step is to select patients for participation intentionally, according to Goldstein.

“You should identify the patients who need home-based care services and can benefit from these services, then ensure that you have the right financial model to make home-based care services sustainable,” Goldstein said.

Another starting point is piloting home-based services before scaling them. For Dartmouth Health at Home, one pilot features a physician who will lead the primary care at-home service. 

“Patients who have difficulty seeing this physician in her office will be enrolled in the primary care at home program,” Goldstein said. “The pilot will test the needs of patients and the operational needs of the program, then the program will be scaled based on what we learn.”

Christopher Cheney, CMO editor at HealthLeaders, contributed reporting to this story.  

MK Manoylov, senior reporter at Home Health Care News, contributed reporting to this story.

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The study, which will analyze data on home health and skilled nursing facility (SNF) payments, will examine patient selection and coding practices that could inflate payments without corresponding increases in patient complexity, according to a Friday MedPAC meeting.

“This work is exploratory, but there have been concerns about patient selection in home health,” MedPAC analyst Evan Christman said in the presentation.

MedPAC is a nonpartisan agency to the legislative branch that advises Congress on Medicare.

At the time of PDGM’s implementation, some industry insiders suggested that PDGM would lead to disruptive cash flow pressures, while others said the model would not be as disruptive as other changes to the home health payment landscape.

CMS’ proposed CY2027 Medicare home health payment rule included a 3% temporary adjustment, tied to the agency’s effort to recoup what it considers PDGM-related overpayments. The home health community broadly decried the temporary adjustment.

MedPAC analysts will consider 2020 revisions to thee health payment systems which eliminated therapy-based incentives, as MedPAC had recommended, with the new systems relying more on patient characteristics to determine payment levels, Christman said.

Now is an opportune time to evaluate the payment system, with several years of data accumulated and providers having had time to adjust, Christman said. The probability of someone using home health in the last cycle has not changed significantly in 2023 compared to 2019, he added.

Still, Christman said that some home health stakeholders believe that the system favors post-hospital patients over community-admitted patients.

The study will examine patient selection to determine whether high-profit and low-profit case mix groups are distributed unevenly across providers, MedPAC analyst Carol Carter said. Carter dded that uneven distribution could arise from market characteristics or provider capabilities.

Analysts will also examine whether coding changes reflect genuine shifts in patient complexity or if documentation practices raised payments without a true change in underlying complexity, Carter said. For cases with a prior hospital stay, researchers intend to compare SNF and home health coding patterns against how the same cases were coded during the preceding hospitalization.

The researchers will then compare how coding has changed for patient assessment items used to create payments with those not used for payments. The difference could indicate changes in coding practices, Carter said.

The use of AI in coding and revenue cycle management emerged as a related concern. Commissioner Kenny Kan warned that providers may already be leveraging AI tools to drive up coding intensity or report patient complexity beyond what patient conditions warrant.

“I worry that many health systems and providers are way ahead of health plans in using AI to augment inappropriate coding intensity or reported patient complexity to optimize revenue cycle management,” Kan said. “This is likely inflationary for overall cost of healthcare long term.”

MedPAC plans to begin presenting results in fall of 2027.

The post MedPAC Launches PDGM Study Analyzing Home Health Payment Accuracy  appeared first on Home Health Care News.

The fund includes three fall prevention programs totaling $27.8 million over three years. The money is earmarked to expand proven programs, strengthen relationships between healthcare providers and community organizations, and help states and local organizations prevent falls in older adults.

The named recipients include two providers that directly provide or support care in the home: Central Maine Area Agency on Aging, which offers adult day services and personal support through its Bridges program, plus meals and caregiver support, and Partners In Care Foundation, which provides care management, in-home assessments, care-transition support and community-based health programs.

The other award recipients are:

— Health Research, Inc.

— Maryland Department of Health

— CHPcommunity, Inc. dba Iowa Community HUB

— AgeOptions, Inc.

— Texas A&M University

— Partners In Care Foundation

— Central Maine Area Agency on Aging

— The Oasis Institute

Each recipient will receive $1,940,162, subject to fund availability, according to HHS.

“A fall can change an older American’s life in an instant, and we can prevent many of these injuries,” HHS Secretary Robert F. Kennedy, Jr. said in a statement. “These investments will reduce injuries and healthcare costs while helping more Americans remain safely in their homes and communities.”

The awards will expand two programs: the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, which aims to help healthcare providers screen for, assess and address fall risk, and Stepping On, a community falls prevention program that helps older adults improve strength and balance and address fall-related risks.

Home-based care providers have rolled out training programs and technology models specifically aimed at preventing falls and reducing hospitalizations.

For example, Bayada Home Health Care launched the Enhanced Quality of Care Model (EQoC) in 2025. The model assessed clients’ risk levels for falls and other incidents, allowing caregivers to intervene faster. The program improves outcomes and can foster more successful negotiations with payers, Matthew Kroll, Bayada’s practice president of personal care services, previously told Home Health Care News.

Bayada provides home health, home care, hospice and behavioral health care services in 23 states and internationally.

Delray Beach, Florida-based TheKey, which provides home care in 100 markets across U.S., Canada and Australia, has launched a mandatory training program designed to reduce falls.

“[The training involves] how you support a client in their home and perform safe transfers that not only help reduce any form of injury for our caregivers, but also it’s building their confidence, strengthening their skill sets, building new skills. That’s all promoting safety for our clients,” Mansi Mehta, vice president of human resource operations, previously told HHCN. 

Falls among older adults lead to approximately 4.5 million emergency department visits and 1.4 million hospitalizations each year, according to the CDC.

The post HHS Launches $27.8M Initiative To Reduce Older Adult Falls appeared first on Home Health Care News.

Colorado’s Medicaid program has moved to terminate its provider agreement with home care provider FreedomCare of Colorado. 

The provider went from receiving about $1 million in Medicaid payments last year to nearly $22 million so far this year, according to the Colorado Sun. That spending increase drew scrutiny, but the grounds cited for termination center on alleged operational failures and risks to clients.

My reporting found that the Colorado Department of Health Care Policy and Financing identified what it described as a pattern of abuse, according to the termination letter sent to FreedomCare. The state alleged failures in oversight and care delivery affecting more than 700 members across 17 counties. 

FreedomCare disputes the state’s action and obtained a preliminary injunction allowing it to continue serving existing clients pending further proceedings, according to the Sun. The company did not respond to my request for comment by the time of publication. 

Regardless of the outcome of the court case, we can dive into the information and see what it says about how states are approaching Medicaid home care program integrity.

In this week’s exclusive, members-only HHCN+ Update, I’ll use the FreedomCare example to discuss program integrity and enforcement, offering analysis and key takeaways, including: 

— The allegations behind Colorado’s termination action

— How Colorado’s enforcement approach compares with Ohio’s

— What providers should know heading into 2027

Inside the FreedomCare case 

On Sept. 16, the Colorado Department of Health Care Policy and Financing sent a letter alerting FreedomCare that its agreement with the state’s Medicaid program would be terminated. 

For some background on the company: FreedomCare operates in 15 states, including Colorado. The company helps eligible Medicaid recipients choose their own in-home caregiver and ensures that the caregiver gets paid through the Medicaid program. FreedomCare manages enrollment, payroll, training and compliance while the person receiving care directs their own care plan. The company completed its initial licensing and certification surveys in May 2022.

Paid family caregiving has become part of the broader debate over Medicaid program integrity. RFK and Dr. Oz have specifically called them out as rife with fraud or as services that family members have historically provided for free. Home care advocates have responded critically to such portrayals, saying they diminish the work of direct care workers and imply that family members should give up their jobs to care for their loved ones. For additional context, Ohio lawmakers have considered, then removed, a provision that would have banned Medicaid payments to family caregivers after advocates pushed back.

The timeline for FreedomCare’s alleged violations starts in April of 2025, when Colorado officials attempted to conduct a survey inspection of the agency. According to the state, the agency reported that its owner was out of the country and no backup administrator was available. This led the state to call it a failure to complete the survey due to lack of compliance.  

FreedomCare then submitted a plan of correction regarding the regulatory compliance violations, which the Colorado Department of Public Health and Environment accepted in May 2025. But when officials revisited the agency to conduct survey inspections in October 2025, the owner was again reportedly unavailable and no backup administrator was present.

When officials successfully completed the survey between July and August 2026, they found 27 deficiency tags. The survey also resulted in nine immediate-jeopardy calls requiring immediate correction. According to the termination letter, officials found significant and widespread noncompliance. If you’re into the specifics, here are the details:

“Specifically, your agency failed to investigate, document, and resolve complaints; failed to implement an effective complaint process; failed to have alternate or back-up staff available when scheduled caregivers were unable to provide services; failed to complete required skills validations for staff; failed to conduct caregiver background checks; and failure to maintain care plans and documentation,” the letter read.

The letter also said that agency oversight conducted from outside Colorado and, at times, outside the United States was a particular concern because adequate systems and staffing were not in place to ensure members’ needs were met. In addition, the state said the agency had very limited Colorado-based staff and did not appear to have sufficient local staffing for in-person oversight or backup care when a regular caregiver was unavailable.

“Rather than effectively coordinating alternative coverage or otherwise ensuring members’ identified care needs were addressed, multiple members were placed on hold and did not receive needed services,” the letter read. “This resulted in circumstances of neglect and demonstrated a significant failure to ensure continuity and coordination of care that is required.”

Colorado told FreedomCare that the agency was no longer approved to accept new Medicaid clients and would not reimburse services rendered to them. It said it would continue to pay for covered services for existing clients for up to 60 days after the letter was sent.

FreedomCare has offered a different account of its response. According to the Sun, the company said it corrected the findings and sent a team of 36 people, including 13 registered nurses, to Colorado to address the deficiencies. Its attorney also argued that regulators did not return to verify the remediation.

The company argued that transferring its clients would disrupt care for hundreds of vulnerable people. A preliminary injunction allowed it to continue serving existing clients pending further proceedings, and the Sun reported that an administrative hearing was scheduled for Oct. 29–30.

The state alleges that FreedomCare’s operations put members at risk, while the company argues that forcing a transition would itself threaten continuity of care. The injunction does not settle the underlying dispute over the deficiencies or whether the company’s corrections were sufficient.

The bigger picture

Colorado’s move to terminate FreedomCare’s Medicaid provider agreement adds another layer to the state-level enforcement push reshaping home-based care.  

Another state Medicaid enforcement news item came in June, when Ohio’s Medicaid program suspended payments to 49 home health providers whose billing patterns triggered potential fraud concerns.

In both Ohio and Colorado, financial indicators drew attention. Ohio used billing-pattern analysis to identify providers for review, while FreedomCare’s jump from about $1 million to nearly $22 million in Medicaid payments drew state scrutiny. 

There are differences here. Ohio flagged potentially suspicious billing patterns, while Colorado saw a substantial spending increase. Additionally, Ohio interrupted payments while reviewing providers, while Colorado sought to end a provider’s participation in the program.

Financial indicators drew attention in both states, but Colorado’s case shows that enforcement grounds can extend beyond billing concerns. The termination letter cites regulatory noncompliance and alleged care-delivery, oversight and safety breakdowns —not an adjudicated finding of billing fraud.

In my earlier Ohio coverage, I focused on the shift away from “pay-and-chase” and toward efforts to prevent questionable payments in the first place. Colorado adds another dimension: Program integrity also involves whether an agency can demonstrate that members receive the services they need and that required safeguards are functioning.

That does not mean Ohio and Colorado are following an identical playbook. They are using different tools to address different concerns. But both cases illustrate how an enforcement action can threaten a provider’s revenue or continued participation before the underlying dispute reaches a final resolution.

Colorado’s budget pressure is also relevant. The Sun reported that the state faces a $1.6 billion shortfall, driven largely by Medicaid spending. That helps explain the stakes around Medicaid expenditures, but it does not establish that the termination was budget-driven. The stated grounds remain regulatory noncompliance and member safety.

For providers, the takeaway is broader than “watch your billing.” Accurate claims and evidence of service delivery matter, but so do complaint handling, caregiver screening, backup coverage and the ability to demonstrate that corrective actions have actually been implemented.

Program integrity outlook

The FreedomCare example is a potential enforcement signal, not evidence that specific regulatory changes are coming. The practical takeaway is that providers need demonstrable backup coverage, accessible leadership, completed screening and skills validation, functioning complaint investigations and current care records. 

Regardless of how the court case turns out, it’s also a reminder that an accepted plan is not the same as evidence that deficiencies were fixed and stayed fixed.

I’ll be watching the administrative outcome of this case to see how regulators weigh remediation, repeated noncompliance and continuity of care. Looking into 2027, providers should walk away knowing that their response to scrutiny needs to show what changed in practice — not just what they promised to change.

Providers should also understand the enforcement tools available in their own states. Ohio’s payment suspensions and Colorado’s termination action carry different consequences and procedural requirements. Knowing how to respond, what documentation is needed and which appeal deadlines apply is part of being prepared.

The other issue to watch in 2027 is how states protect access when they restrict a provider’s operations. Enforcement cannot be assessed solely by the number of providers suspended or the dollars withheld. It also matters whether affected members can transition to another agency without losing necessary services.

That is not an argument against enforcement. In Colorado, the state alleges that members were already going without needed care. But it all serves as a reminder that protecting Medicaid’s integrity and preserving access to care have to go hand in hand. Heading into 2027, providers should be prepared to demonstrate that their safeguards work in practice.

The post What Colorado’s Move To Terminate A Home Care Provider Signals For Medicaid Enforcement  appeared first on Home Health Care News.

The move, which will go into effect Nov. 2, 2026, aims to better inform providers and suppliers about issues and trends affecting home health, hospice and other healthcare sectors. CMS will require MACs to post quarterly results from the Targeted Probe and Educate (TPE) program, intended to reduce claim denials and appeals.

Added transparency will ultimately improve payment accuracy, according to LeadingAge, because providers can see the sources and causes of errors. The added visibility will also help advocates identify differences between MACs, the organization said, allowing them to work with providers when oversight actions appear to be inconsistent with regulations.

“Overall, we think that this is great first move and look forward to continuing discussions with CMS and its contractors and advancing recommendations for other actions that’ll result in more targeted and transparent oversight,” LeadingAge Vice President of Policy and Government Affairs Mollie Gurian told Home Health Care News.  

Washington, DC-based LeadingAge is an advocacy organization representing over 5,300 nonprofit aging services organizations, including home-based care providers.

The change follows industry feedback to CMS that quarterly results keep providers informed, according to the agency’s Sept. 30 filing. The requirement aims to ensure publication consistency across Medicare contractors. 

“Requiring Medicare Administrative Contractors to post quarterly TPE results on their websites is a welcome step toward greater transparency,” the National Alliance for Care at Home (the Alliance) told HHCN.  

The Alliance, based in Alexandria, Virginia, is an advocacy organization representing over two million professionals in home health, home care, hospice and other healthcare fields.

Under the new rule, contractors must publish the most common denial reasons for each TPE priority area, listing the top three where applicable. The requirement applies to contractors overseeing home health and hospice claims, among other sectors. Reporting additional denial reasons beyond those three is optional, although CMS encouraged contractors to include them when useful to providers and suppliers.

The update changes contractors’ reporting obligations, not Medicare coverage.

Visibility to common denial reasons helps providers detect and correct errors before they become compliance issues, the Alliance said.

LeadingAge has previously called for greater transparency into claims information. Such visibility would improve payment accuracy since providers better understand where errors occur and why, Gurian previously wrote in a March letter to CMS Administrator Dr. Mehmet Oz.

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EBITDA alone no longer defines a home-based care company’s worth, and sellers do not always leave after deals, industry experts said at Home Health Care News’ FUTURE conference panel. Instead, the focus has shifted to sustainable organic growth and buyer-seller partnerships after acquisitions.

For prospective sellers, that means demonstrating more than strong earnings.

“If you’re showing organic growth and infrastructure, and that you’re building your team, your value’s going with it,” said Dustin Distefano, chief operating officer of franchise operations of A Place At Home.

Omaha, Nebraska-based A Place At Home provides non-medical in-home care, care coordination, Alzheimer’s and dementia services and other healthcare offerings across 22 states.

EBITDA can look good on paper, but it does not necessarily show organic growth, Distefano said. He encourages A Place At Home operators to demonstrate real, sustained growth rather than settle into a comfortable plateau.

“I’ve used this new M&A organic growth model to say, ‘You guys are showing staleness, your value’s going down in my book,’” Distefano said.

In Aveanna Healthcare Holdings (Nasdaq: AVAH) CEO Jeff Shaner’s view, slower growth, powered by strong clinical outcomes, is preferable to chasing faster growth without the same commitment to quality.

Financial outcomes correlate with strong clinical results, Shaner said at FUTURE, which is why he looks for businesses built on a long-term commitment to clinical excellence rather than short-term financial wins.

“I would personally take a slightly lower-growing business [if it’s] a better-quality business than a faster-growing business that I don’t think has the same lift to quality,” Shaner said.

Aveanna Healthcare, based in Atlanta, provides home healthcare, hospice services, private duty nursing and medical solutions within 39 states. The company closed on its $175.5 million acquisition of Family First Homecare in June, growing its footprint by 27 locations spread across seven states.

Leadership and culture also influence whether a buyer sees a business as ready for its next phase of growth, said Bill Mixon, executive partner at Waud Capital. As investors become more selective and prioritize alignment with their firm’s investment thesis, demonstrating long-term growth — and effective leadership to foster it — matters more than ever, Mixon said.

“If you go into a management presentation and the team is just not cohesive, and there’s no sense of the culture, it’s hard to get to the rest of the conversation,” Mixon said. “You immediately have to start talking about, well, what are we going to do to make sure that we have the right leadership team in this business?”

Chicago-based Waud Capital Partners is a private equity firm that has completed more than 480 investments since its founding in 1993.

A shifting buyer-seller relationship

As valuation philosophies shift, so too are post-deal relationships. Historically, a sale often meant the seller collected the proceeds and stepped away, Shaner said. Now, buyers are increasingly keeping the acquired companies’ executives on board as operating partners.

Aveanna aims to make sellers equity owners and leaders in the acquired operations, giving them a continuing stake in the business’s performance.

“Although you’re trying to optimize or maximize absolute value down to the last penny, you’re also sitting in the boardroom the next time the board meets, and you talk about the success of the company,” Shaner said. “We want this to be a win-win for both of us.”

Distefano is one example of a co-founder staying on the leadership team after an acquisition. A Place At Home was acquired by European home care giant Dovida in February. Distefano, co-founder of A Place At Home, was named COO following the deal’s close.

That approach extends to A Place At Home’s joint venture strategy: Franchise owners can retain minority ownership stakes and continue as general managers, making a sale a transition rather than a complete exit.

The post Home-Based Care Deals No Longer End At The Closing Table  appeared first on Home Health Care News.

Providers need to demonstrate reliable access, quality outcomes and a willingness to work with plans on an ongoing basis — increasingly through timely performance data and regular communication, industry experts said during PAYER Summit in June.

“I often see providers, they get that contract, and then there’s no communication back and forth between the two sides,” said Chris Cycak-Dyos, director of strategic network operations at Helion. “I think that’s where providers often fail.”

Pittsburgh-based Helion is a healthcare technology and services provider augmenting home- and community-based care through technology solutions, data and reporting and subject matter expert consulting.

To strengthen their position within payer networks, providers should shift from managing care on a visit-by-visit basis to managing the full episode of care to strengthen their position within payer networks, Cycak-Dyos said. The approach can benefit both providers and patients or health plan members by centering care management on the broader course of treatment rather than individual visits.

Providers also need to bring their own performance data to payer conversations, Cycak-Dyos said. Providers and payers both struggle with obtaining timely, high-quality data, noting that claims data can be six months behind. Still, providers should establish their baseline performance and understand both operational measures and patient outcomes, then bring their data to payer conversations.

“Showing that you have an understanding of your own data just really sets you apart from others,” Cycak-Dyos said.

Matt Lippitt, vice president and division director of Bayada Home Health Care, said that data creation, collection and analysis are crucial in the home-based care industry.

“The beginning of a payer relationship is really the data sharing…and understanding what the expectations of the relationship,” Lippitt said.

Founded in 1975, Pennsauken Township, New Jersey-based Bayada Home Health Care provides adult and pediatric home health, personal care, hospice, private duty nursing, companion care and other services across 20 states.  

Payers are looking for providers that can demonstrate quality improvement, dependable access and reliability, Lippitt said. Data helps Bayada show payers how it is performing against those measures and whether it is on track to meet shared goals.

Bringing in clinicians and teams

Provider organizations can also benefit from bringing clinical teams into contract discussions, Cycak-Dyos said. This practice helps leadership understand what the contract requires and address potential issues ahead of time.

“Having their clinical teams and their resident teams in the same room discussing contract clauses, rather than learning that through denials, is such an important proactive step,” Cycak-Dyos said.

Justin Meara, senior vice president of managed care at Ignite Medical Resorts, similarly emphasized the importance of maintaining regular communication with MA plans after signing a contract.

Park Ridge, Illinois-based Ignite Medical Resorts provides skilled nursing services, orthopedic rehabilitation, palliative care and other services across seven states.

When one of Ignite’s facilities in Texas faced friction with a payer, Ignite set up weekly meetings with a group of senior leaders to listen to the payer’s concerns, Meara said. The approach demonstrated Ignite’s commitment to quickly addressing issues, he said

“You just need to show that senior leadership wants to be involved, to communicate and to make sure that we have a great partnership, as we’re both working towards the same goals,” Meara said.

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Team Select Home Care bet $6 million on an unproven concept: that proprietary predictive AI, trained on more than a decade of patient records, could catch subtle clinical decline and keep medically fragile patients out of the hospital. Now, the provider is reporting measurable results — and using them to reshape how it negotiates with payers.

With the machine learning platform, called CareSight AI, now expanded to cover 100% of its patient census, Team Select is betting that its hospital-avoidance data can unlock additional value-based contracts. Between April and August 2026, hospitalization rates among Team Select’s patients dropped 14.9% year over year, according to company data shared with Home Health Care News.

“I knew that if we could do this, not only would it be a long-lasting competitive advantage … [it] would significantly decrease those hospitalizations even further,” President and CEO Fred Johnson said. “It just makes the world a better place.”

Phoenix-based Team Select Home Care serves the medically complex pediatric population and seniors in the home, operating in 16 states. Private equity firm Court Square Capital Partners invested in the company in 2023.

Team Select launched CareSight in 2025, using over a decade’s worth of Team Select patient data. The tool monitors up to eight vital signs in real time, along with nurse notes and changes in condition. The technology can flag subtle trends that clinicians might otherwise miss, Johnson said.

The company first launched the tool specifically for respiratory patients. The initial model could not cover all diagnoses, Johnson said, so the company evaluated which disease types or comorbidities accounted for the most hospitalizations to identify a starting point. Leadership chose respiratory patients because Team Select excels at high-acuity care, the CEO said.

Expanding CareSight

The technology caused hospitalization rates for those patients to plummet, he said, so Team Select turned to cardiac patients. While the respiratory model required three years to develop, the cardiac-specific platform required only six months, because the company had already cleansed its backlog of data and learned from CareSight’s first iteration.

With the cardiac model, 65% of Team Select’s patients were covered by one of the two CareSight models. To expand that number, Team Select launched an infection detection model. The company’s data showed that infections were a significant source of unnecessary hospitalizations, so Team Select developed a model to address that risk. This development period required only 90 days, Johnson said.

Now, 100% of the company’s patients are covered by at least one of the three models.

Developing the platform also changed how Team Select approached alerts. At first, the technology was overly cautious, Johnson said, and generated too many false positives. For instance, the technology would flag that a patient’s respiratory rate was outside standard parameters, even if that reading was normal for that specific patient. Adding a second, patient-specific model allowed the platform to check alerts against each patient’s historical baseline, reducing false positives, which could burden clinicians with unnecessary alerts.

Data to back up the technology

Johnson shared five months’ worth of outcome data with HHCN, comparing April through August 2026 with the same period in 2025.

With the three CareSight platforms now in place, Team Select’s hospitalization rate has dropped 14.9% year over year. That improvement builds on what Johnson said was already a low hospitalization rate compared to the industry average.

Prior to launching CareSight, a seven-state Medicaid claims study commissioned by Team Select found that its monthly 30-day hospitalization rate was 3% to 8%, he said, compared to an industry average of 10% to 20% per month.

The technology keeps children safe at home and out of the hospital, Johnson said, but also serves as a competitive differentiator.

“The reality is that most of our competitors aren’t on one EMR,” the CEO said. “They don’t always integrate all of their acquisitions, and they don’t have a data strategy that goes back more than a decade, as we did. So I saw the opportunity and the worth of the risk to take because I’m pretty confident that none of our competitors could copy this anytime soon.”

The technology is changing how the provider works with payers, too. Over time, with CareSight on board, Team Select expects to win more contracts and continue expanding its value-based contracting, Johnson said.

This is especially essential when fee-for-service rate increases are harder to come by, he said.

“When a payer says, ‘We got budget problems, I don’t have any money to give you a rate increase,’ we can say, ‘Fine. We’ll earn it. We will put our money where our mouth is, and we will do a value-based contract where the only way we can get a rate increase for more money is by delivering on hospitalization reduction and total cost of care reduction.'”

The company is also redeveloping payer scorecards, which would allow payers to see Net Promoter Scores, hospitalization and emergency department visit ratios for their specific patients, and compare that data to the industry average.

“All those things can create a stronger company and a stronger marketplace,” he said. “In a marketplace where the companies that are driving the necessary outcomes are rewarded, I view this tool as a long-term way to increase the bar in this industry.”

Team Select is not stopping its expansion of CareSight. The company is currently building its fourth model, focused on diabetic patients. Moving forward, Team Select will continue targeting body systems or comorbidities in descending order of cost of care and frequency of hospitalization.

Moving forward, Team Select will continue targeting the body systems or comorbidities associated with the highest costs of care and the most frequent hospitalizations.

By continually expanding CareSight, Team Select plans to keep investing in a tool that Johnson said improves as it processes more data, while focusing on the patients with the highest costs of care for payers.

The post Team Select Scales AI Platform To Full Census, Reports 15% Drop In Hospitalizations appeared first on Home Health Care News.