Making the best site of care decision means combining thorough documentation, communication across hospitals, skilled nursing facilities (SNFs) and home-based care providers, as well as outcomes data, patient preferences, caregiver support and coordination of services, industry experts said during a PAYER Summit in June.

“Site of care transitions are incredibly complex,” Arun Dahiya, principal of SNF innovation and advancement strategy at OneHome, said on a panel. “We can all agree — patients prefer to recover at home, but that’s not always an option. That’s where us working collectively, especially as SNF operators, to ensure a responsible discharge.” 

Miramar, Florida-based OneHome works with health plans to coordinate home-based healthcare, medical equipment and infusions through a coordinated provider network.

OneHome uses a data-driven approach to determine where a patient should receive care, whether at home or elsewhere. OneHome will then work to enable providers to enter risk-based arrangements based on their size and current healthcare interoperability.

Making the decision also goes beyond data. Brandi Cunagin, vice president of case management at Signature HealthCARE, utilizes the “Friday night test.”

The “Friday night test” consists of a simple question, Cunagin said: “If I send a patient home on Friday at 4 p.m., am I comfortable that they’re going to have everything they need and not return to the hospital before Monday morning?”

Louisville, Kentucky-based Signature HealthCARE provides home health, assisted living and other services.

The question often simplifies complex situations, Cunagin said, but it still helps determine whether the patient has access to critical care needs, such as support, medications, home health scheduling and transportation.

“If we would just keep things very simple and basic, we can really cover all of the bases for the patient,” Cunagin said.

Despite these measures, not all patients can be discharged to the optimal place, Dahiya noted. As a result, healthcare providers and coordinators must work within the patient’s circumstances to find the best path forward.

“We’ve discharged members to their cars because we couldn’t get in their way of wanting to get out of the SNF in the first place,” Dahiya said. “It’s our job to respect the patient, to come up with creative solutions, touch points. Maybe they are housing unstable, but we also check in on them. We find the community partners that are willing to be with them, offer those solutions.”

For home health providers, helping to determine the best site of care for a patient means improving documentation and educating staff on the best documentation practices, Cunagin noted.

Dahiya echoed the importance of thorough documentation, adding that providers should come prepared to show outcomes data and margin and spread between standard Patient-Driven Groupings Model (PDGM) rates.

“That’s where we could be valuable partners in a renegotiation if your outcomes data is superior to your peers, like we will send a referral volume your way,” Dahiya said.

The post Site Of Care Decisions: How Referral Partners Weigh Home Health, SNFs  appeared first on Home Health Care News.

For founder and president Jon Siegel, having a real person answer phone calls 24/7, 365 days a year instead of turning to virtual assistants is one key element of operating a business poised for future growth.

“You can’t run a concierge service and not know your clients,” Siegel said. “For us, I think it’s exciting that a lot of people don’t know how to do this this way, and they don’t have the sophistication that we have.”

Based in Phoenix, the Perfect Companion is a private-pay, concierge-level home care provider operating in Arizona, Ohio and Tennessee. The Perfect Companion ranked No. 3,142 on the 2026 Inc. 5000 list, reporting 96% growth over three years.

The company’s client base, meanwhile, is unlikely to meaningfully grow in the near future. The Perfect Companion has never served more than 50 to 100 clients, Siegel said, but they retain each client for “a lot longer than people may think.”

Siegel has approached growth “methodically,” so as not to disrupt quality of care. He said he aims to grow client hours at an annual rate of 20% to 30%, which he said ensures sustainability.  

The company’s operating model divides frontline workers into three categories: companions, caregivers and hospice care. From there, the company matches caregiver skill sets and personality with the client’s individual needs and personality.

The matching process involves a comprehensive clinical care assessment, performed by a nurse, social worker or consulting medical doctor. The matching process also includes consideration of psychosocial factors, Siegel said.

The company’s luxury-style model of care, which Siegel compared to the Ritz-Carlton, depends on paying its caregivers a living wage, he said.

“We charge more than anybody, but we don’t apologize for that,” he said. “But we pay our caregivers a living wage. So the retention of our caregivers is better than anybody else probably in the industry, because we keep the people who work for us. We pay them every week. We pay them a wage they can live on.”

The post The Perfect Companion Pursues Methodical Growth In Luxury Home Care  appeared first on Home Health Care News.

Technology should help staff by reducing administrative friction, giving frontline caregivers better access to relevant client information and facilitating the credible data providers need to showcase value-based care outcomes, according to industry leaders in an August FUTURE conference panel.

Case in point, Caring Senior Service developed its proprietary technology platform, Tendio, to streamline scheduling, billing, payroll, human resources and marketing for franchisees. The investment has helped the company manage its operational and growth demands, CEO Jeff Salter said.

“For us, the most significant [use case] has been reducing friction — really working to allow our teams to do the work that they need to do efficiently, effectively — and that’s been a lot of investment in our own proprietary software to manage end-to-end,” Salter told Home Health Care News at FUTURE. 

San Antonio-based Caring Senior Service provides home care, hospice and other healthcare services across 23 states.

AI and real-time information tools also offer providers ways to identify operational pain points and develop solutions more quickly, noted Dan Deak, CEO of Home Halo. In June, Home Halo partnered with Sensi.ai, an AI-powered remote patient monitoring platform designed to improve safety and improve care responses.

AI can help organizations innovate and adapt in real time, while better use of data can help providers identify meaningful trends and demonstrate value-based outcomes to payers, according to Deak. 

“They don’t want to just hear from us that, ‘Hey, we can reduce unnecessary rehospitalizations,’” Deak said at the conference. “They want to see the data.”

Based in Greenwood Village, Colorado, Home Halo is a home care company serving older adults and veterans in eight states.

Helping humans

Technology’s purpose isn’t to replace caregivers or simply cut costs, the panelists said. The goal is to reduce and streamline the administrative burden on staff.

“If you focus on the caregiver experience, then you’re going to have a good outcome with the client,” Salter said.

Reducing the time caregivers spend reviewing a patient record is one way to boost efficiency, said Tammy Tenton, vice president of clinical and compliance at Avid Health at Home.

“It’s very nice to have someone be able to quickly get a synopsis of that patient … they’re able to see exactly what’s going on — when was their last hospitalization, their medications — very quickly, so that when they go in, they can make the appropriate interventions,” Tenton told HHCN.

Chicago-based Avid Health at Home is an older adult home care provider serving five states.

Identifying and responding to changing needs is crucial for caregivers entering homes of patients with complex conditions, Tenton added. Using technology to glean data allows caregivers to provide more coordinated, tailored responses to care needs.

“Rising acuity doesn’t necessarily mean asking staff to do more of the same,” Tenton said. “It means the sickest clients get measurably more attention by design, and certainly not by whoever happens to notice.”

Salter also said the technology can give caregivers who are new to the organization a fast and thorough briefing of years’ worth of data. Caring Senior Service often sees caregivers who are new to the organization and thus new to clients. Therefore, providing them with thorough client information as quickly as possible is “important,” he said.

Overall, the best business case for home care companies is to use technology to scale operations, support value-based care and reduce administrative burdens on caregivers and staff, the panelists indicated.

“Home care, specifically, for us as an industry, is the very last to adopt [new technologies],” Salter said. “There’s so many people who are going to need care, and if we don’t become better, we won’t be able to meet that challenge.”

The post How Caring Senior Service, Home Halo And Avid Health at Home Are Using Technology To Transform Care appeared first on Home Health Care News.

I’m coming to you live from HHCN’s FUTURE conference, where I’m having the pleasure of connecting with HHCN+ members, readers, and a slew of industry experts and leaders.

I’m currently tucked away at an out-of-the way table to bring you a few key insights from the event. I’m still processing my thoughts and the information I’m gathering from panels, new introductions and casual hallway conversations, so I’ll be back with more formal thoughts soon.

For now, I want to share two quick, striking takeaways from Day 1 at FUTURE.

So far, panel conversations have covered insights into the playbooks of CEOs who have newly stepped into their roles, personal home care companies that HHCN is tracking as providers to watch, and how the federal government’s increasingly intense focus on program integrity is impacting home health and home care providers, among others.

From panel discussions and casual conversations, I’ve been struck by how interrelated the home-based care industry is with the home medical equipment (HME) industry, and what we can learn from each other. I was also struck by a broader lesson: Providers can innovate in all kinds of ways, but they have to be dedicated first and foremost to building strong infrastructure and operational discipline.

In this week’s exclusive, members-only HHCN+ Update, I’ll share these two takeaways from day one at FUTURE:

— Lessons for overlapping industries

— The requirements for home-based care infrastructure and discipline

Overlapping industries

One of the most impactful takeaways from a panel I moderated about fraud, program integrity and compliance is how much the home-based care industry can learn from the HME industry.

I learned this because of one special element about FUTURE this year: It’s the first year we have officially combined the event with our sister publication, HME Business, to cover the worlds of home-based care and home medical equipment all in one event. That crossover became especially relevant in this conversation, as panelists drew parallels between the enforcement pressures facing HME providers, home health agencies and Medicaid-supported home care providers.

On the fraud-focused panel, we brought together Katie Wehri, vice president of regulatory affairs and quality and compliance at the National Alliance for Care at Home; Brian Holzer, CEO of Freedom Senior Services; and Gayle Devin, CEO of Home Care Delivered.

Hours before our speakers stepped on the main stage, CMS announced that the six-month temporary moratorium on accepting new Medicare durable medical equipment (DME) supplier enrollment applications expired as of Aug. 27, 2026.

Industry experts have previously told HHCN that the DME moratorium could give home health leaders insight into the future of the home health moratorium.  

The home health moratorium was announced as a six-month moratorium, with room for CMS to extend it in six-month increments. Hillary Loeffler, the vice president of policy and regulatory affairs at the Alliance, previously told HHCN that if CMS extended the DME moratorium, it could signal that the home health moratorium would also be extended.

The announcement of the DME moratorium’s expiration does not translate into an immediate sigh of relief for the home health industry, but it isn’t a bad sign. The expiration has both positive and negative elements for the DME industry, Devin said.

On one hand, it opens the door for compliant suppliers to expand. On the other, she said, it could give competitive bidding efforts a “green light,” potentially accelerating a process that suppliers worry could further limit provider participation and patient access. 

At the same time, the conversation was not an argument against fraud enforcement. In fact, all three panelists emphasized that legitimate providers should welcome more precise scrutiny of bad actors. The issue is whether enforcement can distinguish intentional fraud from isolated errors or operational shortcomings.

For now, I’ve seen firsthand that the home health and home care industries can look to the DME sector for insights into what an intense fraud crackdown can look like, as well as possible cues for what could happen next for the home health industry.

Home care requiring infrastructure, discipline

Panelists across the event are discussing exciting innovations, plans for growth, and the latest industry trends and transformational forces. What has also become clear is that providers require a backbone of quality, compliance and the frontline worker’s experience. This theme came up across multiple panels.

For Avid Health at Home, that means being intentional about how it integrates providers after an acquisition. Tammy Tenton, vice president of clinical and compliance at Avid Health at Home, described the importance of first verifying “ground truth” through data-quality audits, rather than assuming that an acquired organization’s existing processes will translate seamlessly to a larger platform. From there, the company can standardize systems, survey readiness and clinical processes.

Tenton described verifying “ground truth” through data-quality audits when integrating new acquisitions, rather than assuming existing processes will translate seamlessly to a larger platform,

Brian Holzer, CEO of Freedom Senior Services, described his approach to growth building a house: If you build the first floor correctly, you can add on to it later without the whole thing falling apart.

Building that strong foundation includes a strong focus on the clinical and compliance. Stacie Bratcher, CEO of LiveWell Partners, echoed that discipline is about clinical capacity as much as systems. She talked about building density in LiveWell’s markets so clinicians can be more effective and so the company can meet higher-acuity needs, rather than growing for growth’s sake.

Whether the topic was acquisitions, franchising or new technology, one of the clearest messages was that the industry’s next phase will reward organizations that can move fast while prioritizing discipline and why home-based care matters in the first place.

The post Why Home-Based Care’s Operational Backbone Matters More Than Ever appeared first on Home Health Care News.

Commenters broadly praised the proposed rule change, while also urging the Centers for Medicare & Medicaid Services (CMS) to appreciate the true costs of home-based care, to provide clearer safeguards for legitimate home health during fraud enforcement actions and to ensure the rule does not restrict access to home-based care for medically complex patients.

On July 1, CMS proposed a rule that would increase home health aggregate payments by 2.4%, including a 2.1% payment update and 0.3% increase for the Fixed Dollar Loss ratio. The total proposed pay increase would rise to $420 million for home health services, a marking a departure from the payment cuts included in the last several years of rulemaking.

The public comment period will close at the end of the day on Aug. 31 to submit comments. Over 250 comments have been submitted as of the time of this story’s publication. Home Health Care News featured standout statements from five letters to CMS.

***

Cornerstone VNA strongly supports CMS’ exploration of a home health-specific wage index and urges the agency to develop a methodology that reflects the actual cost of delivering home health services in community-based settings. The current hospital-based wage index fails to capture the economic realities facing home health agencies and, for Cornerstone VNA, suppresses reimbursement in our highest volume service area at a time when costs are rising at three to five times the rate of reimbursement increases.

— Jennifer Ufkin, president and CEO, Cornerstone VNA 

***

Axxess supports CMS’s objectives. Our principal recommendation is that CMS increasingly treat interoperable, auditable healthcare technology as infrastructure for achieving those objectives.

[…] Axxess encourages CMS to consider not only whether a requirement is substantively appropriate, but also whether the requirement can be operationalized through modern digital systems without imposing unnecessary administrative burden on clinicians.

One of the most significant ‘downdraft’ effects providers expect over the next several years will be the expansion of a data-driven regulatory enforcement. Federal regulators increasingly use sophisticated data analysis tools to identify providers they believe may present compliance or fraud risk. This includes predictive analytics, billing trend reviews, ownership tracking and comparisons of utilization patterns between agencies. As a result, organizations with inconsistent operational practices, incomplete clinical documentation, unusual visit utilization patterns or weak oversight processes may attract regulatory attention even when there is no intentional fraud involved.

— John Olajide, founder and CEO of Axxess

***

While we recognize that the 2.4% proposed payment adjustment is, when compared to previous years, a positive development, it nonetheless does not fully keep pace with current labor and operating cost pressures, which are keenly felt by providers after years of payment cuts. Compounding this fact is the CMS’s proposal to both continue with temporary recoupments and to maintain the permanent behavioral adjustments based on Calendar Year (CY) 2020-22 data. We’ve long maintained that the latter warrant a reexamination, and we continue to do so. Our comment letter will outline the specific methodological factors deserving greater focus.

In addition to that, we will also address the proposed rule’s significant expansion of CMS’s enrollment denial, revocation, reporting and related enforcement authorities for all Medicare providers, along with the simultaneous removal of or omission of objective standards and procedural safeguards. The result could be severe and far-reaching enrollment consequences for legitimate providers based on technical errors, the conduct of third parties and staff outside their control, or broadly defined associations rather than intentional or egregious misconduct.

Targeted program integrity measures are the answer, not a blanket approach. We will urge the agency not to finalize this rule as proposed.

— Katie Smith Sloan, president and CEO, LeadingAge

***

I write on behalf of co-op.care, a worker- and family-owned home care cooperative based in Boulder, Colorado. We are an early-stage, pre-revenue organization building home care in which the caregivers who deliver the care are worker-owners, and in which every visit is verified three ways: that it happened, who delivered it, and — the part usually left out — whether it actually helped the person. We are not a large agency, and we do not write to defend a payment line. We write because this rule asks two questions at once, and we think there is a single answer to both.

The rule tries to expand access and protect integrity at the same time. The proposed rule seeks comment on promoting community-based palliative care through the existing home health benefit, and simultaneously proposes far-reaching program-integrity measures — expanded enrollment revocation and denial authority, retroactive revocations — alongside a temporary behavioral adjustment to recoup prior overpayments. These goals ordinarily pull against each other: broadening access invites the fraud that integrity measures then restrict, and blunt integrity measures deter honest providers along with dishonest ones.

— Blaine Warkentine, founder, co-op.care

***

The beneficiaries at the center of the dementia dyad are clinically complex, socially complex, and dependent on a family caregiver — and a substantial share are dually eligible for Medicare and Medicaid, reflecting their intensive long-term services and supports needs. This rule can make home-based, caregiver-inclusive care more accessible for them, or it can quietly price it out. We urge CMS to make caregiver training and caregiver-burden assessment explicit, covered skilled care in the palliative BPM examples, including a dementia-specific example; ensure any new wage index reflects the full home-based workforce; protect access for ADRD and dual-eligible episodes as the temporary adjustment and LUPA thresholds take effect; build caregiver-facing, function-focused, dual-stratified quality measurement into the HH QRP and HHVBP alignment; and apply the new geographic-density revocation authority with safeguards so it targets fraud clusters rather than legitimate community-based providers serving high-need dual-eligible markets. 

— Genevieve Caruncho-Simpson, co-founder and CEO, Dyad Health

The post Home Health Industry Comments On Proposed CMS Rule, Lauding Rate Hike, Urging Caution  appeared first on Home Health Care News.

State Medicaid programs could consider these value-based arrangements over exclusive cuts or benefit reductions, said industry leaders speaking at Home Health Care News’ PAYER Summit in June.

“Everyone right now should be a little concerned. The sky is not falling, but it’s definitely a lot cloudier than it’s been in a long time,” Allison Rizer, chief growth and innovation officer at ATI Advisory, said on the panel.

ATI Advisory is a healthcare research and advisory firm based in Washington, DC.

Those who are dually eligible for Medicare and Medicaid are typically among the most vulnerable within our populations, said Scott Leitz, vice president in the Health Care Programs department at the University of Chicago’s National Opinion Research Center (NORC).

While individuals dually eligible for Medicare and Medicaid typically have greater needs, economic downturns can end up reducing access to some of the services they require, Rizer added.

“Historically this is what we’ve seen when the economy has a downturn, every state has pulled back on home and community-based services,” Rizer said.

Downturns cause states to squeeze health plans and push new requirements on them, which then impacts how providers offer care, Rizer explained.

“I wouldn’t necessarily expect to see ongoing heavy rate cuts into the future,” Leitz said. “What I would likely expect to see is a greater degree of emphasis on this value proposition.”

That shift could mean providers showcasing how HCBS helps keep clients at home through value-based care. Richard Keller, CEO of PurposeCare, says that is already central to the company’s operating model.

PurposeCare is a Chicago-based company providing home health and personal care services across Indiana, Illinois, Ohio and Michigan.

“From a strategy perspective, what we do is already value-based care,” Keller said. “Our entire business model is based on what the client wants — and, quite frankly, what the payer wants, which is to keep [patients] at home. For us, that also happens to just be good business.”

The post CMS Emerges As Value-Based Care’s New Engine appeared first on Home Health Care News.

In an increasingly data-driven world, data and metrics are essential for home-based care companies to track growth and success, as well as potential areas of concern.  

Home Health Care News asked five executives for their thoughts on the most essential metrics to watch within their organizations.

For the CEO of Team Select Home Care, the most-watched metric comes down to patient volume.

“It sounds overly simple,” Fred Johnson, president and CEO, told HHCN. “If we don’t have the volume first, we can’t have any margin. … This is the kind of business where if you’re not growing, you’re dying.”

Phoenix-based Team Select Home Care provides pediatric and adult private duty nursing, long-term home-based clinical care and family-centered support programs in 16 states.

Patient census is also one of the most critical metrics for Christopher Rinn, CEO of VNA Health Group.

“I look at our daily census in all of our programs, and that means you know that that’s an indicator to me on how we’re delivering on our mission,” Rinn said. “How many people are we helping? How many people are depending on us? And everything flows down from there.”

The Visiting Nurse Association Health Group (VNA Health Group) is a nonprofit provider of home and community-based care in New Jersey. The organization provides home health, hospice, palliative care and private-pay personal care services, among other offerings.

Volume alone does not capture the quality of care delivered — or whether that care is helping patients avoid more costly settings.

Hospitalization rates came up for several polled leaders. Johnson remarked that hospitalization rates are his second most-watched metric. This statistic can demonstrate the value of Team Select’s care to payers, with which the company has risk-based contracts.

“I’ve been obsessively reviewing our 30-day hospitalization rate and our average length of stay,” Johnson said. “This can open up a whole new way of contracting with payers and doing business where we’ll take that risk on, betting on ourselves to keep those children out of the hospital.”

Hospitalizations are also top of mind for Deka Dike, founder and CEO of Omatochi. Part of the need to track hospitalizations stems from the Dublin, California-based company’s geographic location.

“We have frequent fires, and we have a lot of people [who] keep going back into the hospital, and when they do, that means it’s not safe for them to be by themselves,” Dike told HHCN.

One of the goals of California’s Medicaid program is to reduce hospitalizations among older adults, she added, so when hospitalizations are reduced, Omatochi is doing its job.

Omatochi provides technology-integrated personal home care to Medicaid beneficiaries in California. 

In addition to patient- and client-focused metrics, leaders are focused on metrics related to their frontline workers. Jon Siegel, founder and CEO of the Perfect Companion, most closely monitors retention among clients and caregivers. Home care providers must be proactive about their clients, he said, and anticipate their needs before they ask.

“I’m always thinking, ‘How do I anticipate our clients’ needs, our caregivers’ needs?’” Siegel told HHCN. “I want to show them that I’m thinking about them.”

Based in Phoenix, the Perfect Companion is a luxury concierge in-home care provider operating in Arizona, Ohio and Tennessee.

A holistic view

While certain metrics may take top priority, leaders also emphasized the importance of a holistic view of a home-based care organization.

A single metric can sometimes fail to tell the whole story, according to VNA Health Group’s chief operating officer and chief financial officer, Kevin Rogers. For instance, a frontline worker may be scheduled for six to seven visits a day for five days and appear to be busy. But some of those visits may be shortened or canceled, making the schedule appear to be a full caseload when it is actually a short one.

Leaders cannot look at one metric in a vacuum, he said.

Among the group of metrics Rogers keeps top of mind are productivity, admissions and the number of visits per episode per period.

“All these things go in the mixing bowl, and when one goes up, that’s not maybe a major concern, but when two or three of them are triggering in the wrong direction, what are you going to do about it?” he said.

The post The Most Important Metrics Home-Based Care Leaders Track appeared first on Home Health Care News.

Home health and hospice dealmaking could spike not only in volume, but also in valuation, according to a recent report from the Braff Group.

“From an M&A perspective, the second quarter of 2026 has set the table for a strong period of dealmaking in home health and hospice over the next 12 months,” the report’s authors wrote.

Pittsburgh, Pennsylvania-based Braff Group is an M&A advisory firm for home health, hospice and other healthcare sectors.

The Braff Group’s report analyzed data collected from the first half of 2026. The firm’s annualized first-half data point to 134 transactions across certified home health, hospice, private duty and Medicaid categories in 2026, an increase of 12.6% compared to 119 in 2025.

On an annualized basis through the second quarter, certified home health was on pace for 48 deals in 2026 — up 41% compared to 2025. Hospice dealmaking was on pace for 44 deals, an increase of 57%, while the volume of private duty and Medicaid deals were set to decline by 10% and 42%, respectively.

Improved payment predictability from the Centers for Medicare & Medicaid Services (CMS) after months of uncertainty could partly explain the increase in dealmaking.

“After a devastating proposed rule issued by CMS last year that initially floated a Medicare home health cut of 6.4% (the final rule was a somewhat more palatable cut of 1.3%), the proposed rule issued in July for 2027 recommended an increase of 2.4%,” the report’s authors wrote. “The upshot is that many industry insiders believe that CMS may have concluded that it has finally battered home health enough, paving the way for greater payment predictability.”

This, combined with the six-month moratorium on new home health and hospice provider enrollment, which the report said many believe will be extended in November and could extend through the remainder of the Trump administration, makes it “no surprise” that dealmaking is trending upwards after four consecutive years of declines, according to the report.

Healthcare services dealmaking overall is on track to surpass pre-pandemic transaction numbers, according to the report.

Home infusions and specialty pharmacy dealmaking is on pace to surpass its 2025 total by 32% and to reach the highest level in over a decade.

Rising demand for lower-cost care settings and accelerated hospital discharges have driven the increase in home infusions over the past few years, experts previously told Home Health Care News.

This year’s projected healthcare dealmaking follows weaker-than-expected M&A volume in 2025. Despite improved inflation rates and minimized workforce challenges, the Braff Group’s Managing Director Kris Novak said tariffs, interest rate cuts and other headwinds tempered home health dealmaking in 2025.

The post Home Health M&A Activity Rises As Proposed Rule, Provider Moratorium Shape Market  appeared first on Home Health Care News.

Health systems and payers are increasingly steering patients to agencies that can prove quality ratings, low hospitalization rates, fast acceptance, broad payer coverage and complex-case capability, industry leaders recently said in a Home Health Care News webinar. Home health and home care providers and both investing in technology to capture these metrics.

In decades past, the main driver of a referral was a positive relationship, something along the lines of “I like them, so I’ll refer them,” said Matt Haglund, senior vice president of business development for Aveanna Healthcare.

Now, those relationships have “dwindled” because of a stronger preference for high ratings, the ability to take multiple insurances and lower hospital readmission rates, Hagland explained.

“A lot has changed, and it’s much more metric-driven,” Haglund said. “Being the solution for a hospital system [is key] because, in many cases, they’re not coming to you and saying, ‘Hey, here’s my traditional Medicare.’ They’re saying, ‘I have these three managed care payers, and nobody else will accept them.’”

Aveanna Healthcare, based in Atlanta, Georgia, provides home health, hospice and private-duty nursing services across 39 states.

Hospital systems use these metric-driven results to rank providers for these referrals, Haglund added. Hospital systems are narrowing their referral networks based on star ratings and readmission metrics, while on the Medicare side, electronic portals rank providers by how quickly they accept referrals and the types they accept.

“Relationships matter on the payer front as well, but that only gets you so far,” Haglund said. “The biggest change that I see that we see is being able to generate a high-quality outcome because that is what is generating the cost savings for these payers and certainly freeing up these beds in the hospitals.”

These metrics aim to drive value-based care, which is a main objective for the Centers for Medicare & Medicaid Services (CMS), Hagland noted.

“CMS has done a great job kind of putting that line in the sand to be able to move forward into more value-based care,” Hagland said. “Essentially, they’ve funded rate increases from one provider to another: Your metrics exceed the benchmark, and we will reward you and pay you more for those services because you’re able to keep those patients out of the hospital.”

Improving metric-based outcomes requires tracking data — but getting that information can be difficult for non-medical home care providers, said Dan Deak, founder and CEO of Home Halo.

Greenwood Village, Colorado-based Home Halo provides in-home care for older adults and veterans across eight states.

“Historically, the non-medical home care space has been absolutely terrible at tracking data. We just didn’t,” Deak said. “But the healthcare landscape is radically changing, and companies have been upping their game and doing more with the data.”

He said that, for the past six months, Home Halo has focused on capturing its own data to propel these insights. The firm even invested in custom-made tools to help analyze its information, Deak explained.

Meanwhile, Aveanna uses Trella Health, a healthcare intelligence platform, to bolster business opportunities within its locations, Hagland said.

However, technology is just the first step in helping home-based care providers compete for narrowing referrals. Companies need to effectively interpret their data to secure their spot, Deak noted.

“The data needs to be able to tell a story,” Deak said. “If you just have data just sitting there, it’s just numbers, it doesn’t do you any good.”

The post Metrics Are The New Referral Currency In Home-Based Care  appeared first on Home Health Care News.

Prior authorization denial rates varied widely among the largest insurers in 2025, according to a recent study by KFF.

“Health insurers use prior authorization to reduce the use of low-value or unnecessary care, and in the complex and fragmented U.S. health care system is one of the primary tools used to restrain costs,” the study’s authors wrote. “Nevertheless, this practice may result in delays or denials in receiving necessary care, as well as administrative burdens for patients and providers.”

San Francisco, California-based KFF is an independent health policy organization that researches Medicare, Medicaid and other health policy issues.

KFF analyzed publicly available prior authorization metrics for calendar year 2025 from 14 insurers. The data covered 25 million Medicare Advantage enrollees, 35 million Medicaid managed care organization enrollees and nearly 11 million federally facilitated ACA Marketplace enrollees.

Among the six largest Medicare Advantage insurers included in the analysis, standard-request denial rates ranged from 5% at Elevance to 17% at UnitedHealth Group. Expedited-request denial rates varied from 3% at Elevance to 13% at Centene.

Prior authorization denials are rarely appealed, the study found, but appeals are often successful. Among the insurers in KFF’s analysis, 67% of appealed standard-request denials were overturned in Medicare Advantage, compared with 47% in Medicaid managed care and 43% in the federally facilitated ACA Marketplace.

Because the metrics were aggregated across medical items and services, the data do not show which service categories — including home health services — had the highest prior authorization denial rates.

Prior authorization denials can impede the transition from hospital to home-based care settings. Medicare Advantage plans typically authorize initial home health visits and require additional approvals before patients obtain services — a process that can take more than a week, an expert previously told Home Health Care News. That waiting period can cause patients to forgo or pay out of pocket for home-based care, as well as disrupt care continuity or cause delays.

Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), has promoted efforts to digitize and streamline prior authorization requests, citing estimates that the process costs providers nearly $34,000 and 700 administrative hours per provider annually. In May, he instituted a Jan. 1, 2027, deadline for CMS-regulated payers to integrate electronic prior authorization interfaces.

The post Medicare Advantage Plans Denied 12% Of Prior Authorization Requests In 2025  appeared first on Home Health Care News.