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Last week, home care leaders Chris Gerard, Michael Slupecki and Mike Trigilio joined our Home Health Care News Executive Outlook On An Industry In Transformation webinar. I had the chance to connect with these leaders — from TheKey, Griswold Home Care and HouseWorks — about the ways they’re leaning into growth opportunities, combating the industry’s toughest challenges, and so much more.
Through the course of the wide-ranging panel discussion, three topics — the rise of homegrown technology platforms, evolving payer mix strategies and the ripple effects of shifting policies— stood out to me more than others. The insights I gleaned from talking to Slupecki, Trigilio and Gerard are indicative of the direction the industry is heading.
Providers are no longer just adopting tech, they’re building it. Proprietary tools are helping home care companies streamline operations, drive outcomes and scale. Current payer mix strategies are largely stabilized, but they aren’t static. While companies are doubling down when they find a strategy that works, they stay inquisitive about diversification, including the Centers for Medicare and Medicaid Services’ (CMS) Guiding an Improved Dementia Experience (GUIDE) model.
While providers work to improve operations, policy shifts are prompting concern and advocacy and providers are ramping up engagement in visa reform efforts and adjusting operations.
In this week’s exclusive, members-only HHCN+ Update, I highlight the webinar discussion and return to other industry voices to further explore the themes that emerged in this conversation. I also offer my takeaways, including:
— Providers aren’t only relying on technology vendors. Instead, they are building their own tech platforms.
— Home care companies are, largely, sticking with their current payer mixes, but this hasn’t stopped them from eyeing diversification opportunities.
— Policy shifts and immigration concerns remain top of mind for home care leaders.
Building proprietary tech
When I spoke with the panel, Trigilio, the CEO of Houseworks, was quick to describe his company as a “tech-based shop.”
“We have used technology for the last 20-plus years in personal care,” he said. “Historically, personal care margins and lack of scale have, effectively, pushed the development of new key technology backwards. We’ve always been behind as an industry.”
Seeking to get ahead,, HouseWorks rolled out its proprietary “Payor HUB” platform last year, a tech platform designed to strengthen its relationships with payers by sharing hospitalization alerts, start-of-care notifications, compliance metrics, EVV and other important data points.
Trigilio explained that its HUB allowed Houseworks to operate more easily across various Medicaid state programs. This is crucial since Medicaid makes up the majority of the company’s payer mix. Operating a business that primarily relies on Medicaid can be challenging, as the program varies from state to state.
“The joke is, if you’ve seen one Medicaid state, you’ve seen one Medicaid state,” Trigilio said. “The HUB basically translates all the states into an operating model that anyone can kind of drive.”
Backed by InTandem Capital, HouseWorks is a Greater Boston-based home care company that also provides meal delivery, adult day and laundry services. It delivers services across Massachusetts, Connecticut, Maine, New Hampshire, New York, Pennsylvania and Tennessee. The company serves 30,000 clients and 20,000 caregivers.
Houseworks isn’t the only home-based care company that has created its own tech platforms. New Day Healthcare, for example, developed its own platform, Carelytics. The system integrates data from patient records, payer systems and electronic medical records (EMRs).
“We aggregate this data to reassess patients, allowing us to gain insights not only during our interactions but also while they are at home,” G. Scott Herman, founder and CEO of New Day, previously told HHCN.
With Carelytics, New Day wants to have the ability to intake data from any source, according to Herman. At the start of the year, he told HHCN that the company monitors 200,000 patients on a daily basis.
Apricot, a tech platform that leverages generative AI, was created by Accentra Home Health and Hospice CEO Trent Smith and has been adopted by Elara Caring and Choice Health at Home. The latter uses the AI tool to help manage Outcome and Assessment Information Set (OASIS).
In my view, we are seeing more providers develop their own tech because it allows them to tailor these platforms to fit their hyper-specific needs. When a webinar attendee asked Trigilio why Houseworks chose to go this route, rather than sticking with tech vendors already in the market, he explained.
“Owning and developing your own internal systems gives us the ultimate flexibility going state to state, so we have chosen to go down that path, but we don’t solve it all internally,” he said.
Indeed, Trigilio noted that the company still works with outside vendors in addition to having its own platform in place.
Payer mixes remain consistent
At the top of the webinar, the first question I asked Gerard, Slupecki and Trigilio is what the current payer mix is at their respective companies. I also asked them if they see this changing in the near future.
As previously mentioned, Houseworks’ payer mix is predominantly Medicaid. Specifically, the business is 90% Medicaid and 10% private pay.
Trigilio explained that Houseworks was built systematically to provide complex care in a Medicaid environment.
“We have really been transforming this business over the last four years to service that Medicaid population, and we believe we’re going to keep doing that and doing it very well,” he said.
That said, Houseworks has also been making moves to “rebalance” the business. This means expanding its private pay business in areas where the company has a Medicaid presence.
“We have continued to … build out some new de novos around our private-pay model, similar to what Griswold and TheKey are doing in other areas of the country,” Trigilio said.
On its end, TheKey operates a 100% private pay business.
“I don’t really see our payer mix changing,” TheKey CEO Gerard said during the discussion. “It’s a little bit more of a complement of services that we’re expanding. We provide the skilled nursing services and care management in a handful of our markets, but we’ve been aggressively looking to expand both of those.”
Delray, Florida-based TheKey provides home care, care management, memory care and specialized care services in 60 markets across 100 locations throughout the U.S., Canada and Australia. The company serves 13,000 clients annually and employs 10,000 caregivers.
Like TheKey, Griswold mostly operates in the private pay space. The company is roughly 90% private pay, “with a sprinkling of lots of other different payers in our mix depending on opportunistic options,” CEO Slupecki said.
The Blue Bell, Pennsylvania-based Griswold provides home care services in roughly 30 states. The company has more than 150 locations.
While private pay will continue to make up the bulk of Griswold’s business, this hasn’t stopped the company from embracing other payers.
Currently, veterans assistance (VA) is the company’s fastest-growing segment.
“There’s a great opportunity there because so many veterans are unaware of the care services that they have available,” Slupecki said.
Griswold is also getting involved with the GUIDE Model. CMS launched the GUIDE Model last year with the goal of improving dementia care.
As I mentioned in a previous HHCN+ Update, the GUIDE Model cracks open the door for home care providers to get involved in the Medicare program in a larger way.
While the payer mixes at TheKey, Houseworks and Griswold have mostly remained consistent, the companies’ willingness to diversify when necessary and experiment with payer mix shows that providers aren’t rigid and can recalibrate depending on industry headwinds and the current needs of their business.
I think that this talking point from Slupecki best illustrates this attitude.
“I don’t see a big change in the payer mix, but I think long-term we are concerned about the cost of care, so we’re really trying to up our game, if you will, and be a more hospitalization-focused and outcome-focused company, as we move forward to make sure the folks that need our care are getting the best care possible, and we also position ourselves as great partners to the skilled home health side,” he said.
Policy shifts and immigration
Home care leaders aren’t just focused on perfecting their payer mix and building tech platforms to help advance their business. A number of policy shifts and immigration-related concerns have come to the forefront.
“We all know that if you’ve been in health care for a while, the regulatory landscape is always evolving and changing,” Gerard said. “There’s a new challenge every day.”
For some providers, these changes include the companionship exemption.
Earlier this month, the U.S. Department of Labor proposed reinstating the companionship exemption. If passed, this would make workers who provide companionship services exempt from federal minimum wage and overtime rules. Many in the home care industry consider it a “win” for providers.
“The intention of the Obama administration, when the exemption was eliminated, was to boost pay to caregivers by making them eligible for overtime,” Slupecki said. “Unfortunately, very few clients can afford to pay overtime, so caregivers willing to work more than 40 hours in a week were forced to work for multiple agencies, and all of that work without earning overtime pay. We see this as a positive for caregiver retention, and a positive for client satisfaction.”
Slupecki also stated that he doesn’t believe this change will negatively impact caregivers.
“It really provides tremendous flexibility as we move forward, and it really shouldn’t hurt the caregivers that are looking for additional hours, if they’re able to accomplish that with one client at one agency, versus multiple clients at multiple agencies,” he said.
The Trump administration’s aggressive mass deportation policies will also impact the industry, but in a less positive way, according to industry experts. Houseworks has already begun to see the impact across various states.
“We believe our exposure is somewhere around 5% of our workforce,” Trigilio said. “We are working daily with a number of these individuals, trying to ensure that their eligibility remains intact, or if they can essentially go through our onboarding process again. If not managed, obviously, this is a really tough thing for this industry. The workforce is everything we have. That said, we have to operate within the set guidelines that have been given.”
In May, I gave an overview of some of the actions being taken by the Trump administration, including signing an executive order that “expands the use of expedited removal,” the suspension of the refugee admissions program and the end of temporary protected status.
At the time, Dr. Steffie Woolhandler, a professor of public health at Hunter College, explained how this uniquely impacts the home-based care industry.
“[Immigrants] play a major role as doctors, as nurses, but particularly in long-term care like nursing home care or home care,” she previously told me. “If Trump follows through on his plans for mass deportations, there’s going to be major shortages of health care workers, and that’s going to compromise access to care and the quality of care for Americans.”
From my perspective, providers and industry advocates aren’t just waiting for these shortages to happen. They are doing everything in their power to respond.
The Home Care Association of America (HCAOA) has thrown its support behind EB-3 visa reform. Senior Helpers CEO Peter Ross, as a member of the Healthcare Leadership Council, has advocated for the repurposing of unused immigrant visas to expedite health care workers’ entries into the U.S.
Right at Home CEO Margaret Haynes also recently spoke about the importance of immigration pathways on an episode of HHCN’s Disrupt podcast.
“[We are focused on] how can we make it easier for caregivers to come into the country, and so we’re asking caregiving to be added to schedule A, where nurses and some other key professions are being listed, so that it can be easier to bring in some quality caregivers to supplement this caregiver shortage that we know is happening today and will continue to be exacerbated in the future,” she said.
Trigilio explained that Houseworks has focused its efforts on identifying “hot spots, ” or in other words, the markets that will be impacted most by these immigration polices.
Likewise, Gerard noted that there are specific geographies where TheKey’s business will be most affected by these polices, but so far it hasn’t been consequential.
In the coming months, I plan to closely monitor how the proactive measures being taken by home-based care providers and industry advocates materialize. While I believe these measures have the potential to slightly move the needle, the impact of the Trump administration’s policies will be a devastating blow — further limiting access to care.
