The U.S. healthcare system has moved rapidly away from hospitals, nursing homes, and inpatient facilities over the past year. As a result, home care organizations have received more attention and resources. A trend that is expected to continue into 2021.
However, according to John Driscoll, CEO of CareCentrix, this is not fully guaranteed.
Hospitals and institutional facilities – sometimes viewed as “the empire” of the health universe to borrow from “Star Wars” – have a lot of clout in Washington, DC. Once the COVID-19 pandemic is over, this empire may want to strike back.
CareCentrix, headquartered in Hartford, Connecticut, is a health-at-home solutions company that manages the care of 26 million members across a network of more than 8,000 locations in over 25 states. While CareCentrix currently has annual sales of around $ 2 billion, the PE-backed company is aiming for even greater growth in the coming year.
On our latest installment of Disrupt, Home Health Care News caught up with Driscoll to learn about the move to home care, CareCentrix’s growth plans, and other healthcare trends for 2021. The highlights from HHCN’s conversation with Driscoll are listed below for length and clarity.
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HHCN: How does CareCentrix fit into this shift towards home care that we’ve seen?
Driscoll: CareCentrix is a leading provider of healthcare plans that help patients heal and age at home. We have a broad portfolio of home health, DME and infusion networks. We have doctors, nurses, and other health professionals across the country.
Today we serve Medicare, Medicaid, and commercial populations. We’re starting to work mostly with health plans. There are the dollars. We are increasingly working in palliative care and in our post-acute risk business in Medicare and Medicaid with hospitals and doctors who bear the risk themselves. We use technology and analytics for all of the things that patients need to manage after discharge. Our ultimate goal is to enable healthier days at home.
I think for all of us who are committed and interested in home care, we are only in the second inning of what we can achieve.
It feels like the “relocation is coming home” conversation is over. That shift has taken place and now the point is to accelerate what can be done at home.
I think that’s absolutely true. We did some research last year. We were shocked to see that nearly 75% of all patients prefer to relax at home. Another 70% would like their follow-up appointments and check-ins to be with their doctors and nurses at home. There has certainly been a profound change.
Frankly, consumers have put up with a lot of nonsense about waiting times and scheduling in the past. They have put up with a lot because they have to go to hospitals and nursing homes, which are becoming more and more dangerous. This risk was clearly illustrated using the COVID-19 statistics. However, hospitalization is one of the leading causes of death in America. The combination of technology and telemedicine will enable an expansion of the number of things that can be done digitally and personally at home.
You touched on this briefly a second ago: is palliative care something you can do with the takeover of turn-key health?
I agree. Turnkey is only an untouched good. It was the best palliative and end-of-life care provider that really focused on making sure people could get more of these services at home and in the community. We were lucky enough to be able to acquire turnkey last year. We are now integrating the business so that there is a seamless suite of services for patients whether they are recovering from hospital, trying not to go to a nursing home, getting rehab at home, whether they are having trouble with of pain therapy. We are very happy about this advantage.
What does CareCentrix expect in the next 12 months?
We are trying to capitalize on this unique tectonic shift for providers and patients by expanding the possibilities of what can happen at home. We’re expanding it by investing in remote patient monitoring. We take more risks when we avoid the hospital and nursing home. We’re working with health plans to deliver more services. I think we are in a golden age for people who want to thrive and stay independent.
One of the things that deeply depress health care is that it deactivates, and in some cases infantilizes, the patient or family. With my own 87 year old mom, staying in control of her care even when we have access to some great doctors is a real challenge. We can show that it’s not only cost saving or safer at home. We can show that the home can also promote independence and a sense of “control over your life”, which also leads to better health outcomes by promoting accountability.
At CareCentrix, we aim to develop more plans for Medicare, Medicaid, and advertising over the next 12 months. You will see a significant shift in our post-acute services to Medicaid and Medicare. You will also see that we offer modular options. As hospitals and doctors move into direct contracts and hospitals increasingly start converting their service panel fees into managing care, we will provide services so they have more home care options.
We have seen many changes in the world of home care. This includes, for example, the new CMS foregoing the hospital at home. What else can you see on the pike in 2021?
We see a digitization and miniaturization of monitoring devices and evaluation devices. We are seeing a dramatic decrease in the cost of remote patient monitoring technology, with more bandwidth and information being fed back into systems. I think there is accelerated intelligence provided at home by home care. Providers will use it and gain more insight into what goes on with patients after discharge.
We’ll focus more on social determinants of health, although I don’t love that phrase.
That is a sentence we write in many of our stories these days. I agree that it’s a bit mouthful and too technical. It seems like we should just say, “Anything that is important to a person’s health.”
Realistically, everything matters that healthcare has not been willing to pay for in the past. I mean, that’s really the only reason we came up with a complicated name like “social determinants of health” – so someone can find a way to pay for it.
At CareCentrix we offer transports where these were not available. We have integrated people into gastronomy. We made sure that we deal with the problems of social behavior. We use pharmacists to actually carry out this pharmacy coordination. We didn’t do it because there was a new reimbursement mechanism. It was one of the most important ways we can help people heal and thrive at home. I think “social determinants of health” is a phrase that only an economist or accounting person would want.
Let’s stay with this topic of payment for a second. Last time we spoke, we were talking about how payers want home care more than ever. You realize the value. You are ready to pay for it. How did you see that at CareCentrix?
Back to our researchWe found that almost 90% of health insurers want more home care. But almost the same crowd said they didn’t feel ready to do it themselves. They want partners because they’re not exactly sure how to get there.
It’s an incredible opportunity for people like CareCentrix, for some of our competitors, for demanding home health authorities, for doctors who want to expand their practices to the home. Health plans are looking for partners. And these partnerships are not offered outside of the traditional “transactional after-transactional” function. There has to be an integration agent to take the risk out of the health plan so you can control the dollars to move more of them home. There needs to be an entity like CareCentrix that can provide this care traffic control. We spent $ 10 million to $ 20 million building analytics engines – and we’re still investing in them so we can predict what will happen next and then feed that information back to vendors or members and maintainers.
The big advantage is that everyone wants home care from a health plan perspective, but the plans don’t know how to get there.
What do you think will be the next major source of disruption to home health and home care? More PE or VC money in the room? Someone like Amazon or Google who is moving into home health care more aggressively?
Well, I think the nontraditional providers will be causing disruption. I don’t think that new solutions come from established companies. There are lots of great things going on in hospitals, nursing homes, rehab facilities, what you have, but there is still too much care ingrained in those facilities. We have to look for the interferers elsewhere.
I think from a VC perspective there is a lot of interest in things like monitoring patients remotely and wiring the flow of information back home. PE can be a positive force. We had good PE partners at CareCentrix. You have seen some other great investments in trying to rotate or expand some of the current players.
Real disruption is caused by this deepening web of information available to us and everyone else. We’re all wired up. We’ll get more insight into what’s going on at home than we have in the hospital today. Imagine.
Has there been a development or trend in the past year that you think will eventually run out? Or normal again?
You never want to bet against the institutional healthcare empire. I mean the reason healthcare costs are rising every year, the reason we have the most expensive healthcare system in the world with some of the worst performing is because the incumbents are really good at fighting for their position. So “the Empire” will strike back. No question about it, you will see hospitals and doctors pulling people back into hospitals, nursing homes, and doctor’s offices. There is a strong economic incentive for them.
At the same time, patients and families want better care. They want different care. They want alternatives. You also see the bipartisan, aggressive support for value-based care. You can see this especially in end-stage kidney disease (ESRD), for example. As the Empire strikes back, I think there will continue to be a natural departure from these more expensive attitudes.
