Congress extended the Acute Hospital Care at Home waiver for a third time earlier this year. For some, this signaled an ongoing interest in expanding home-based care options, but for others, the short extension brought cause for concern. I’ve been in the room with many health system leaders who are nervous about the waiver’s future and what it might mean for the industry as a whole.
From these conversations and my firsthand experience as a physician and operator, the future of home-based care hinges not on a single delivery model, such as “hospital at home,” but rather on a broader, more strategic transformation. Demographic trends, patient preferences, the cost of care, capacity constraints and technological advancements demand rapid evolution in home-based care. However, the results from home-based care efforts have often been underwhelming for health systems and payers.
To achieve its promise, home-based care can no longer be treated as a set of siloed service offerings and instead must demonstrate a solid return on investment (ROI). It needs to develop into a dynamic capability set that allows health systems and payers to extend their reach, improve outcomes and operate more efficiently. To do so, it requires care models that are custom, tech-forward, flexible and high value, regardless of what tomorrow’s regulations, payment models or patient needs may bring.
We refer to this idea of care that happens outside the walls of a hospital or ambulatory clinic as “distributed care.” Whether we’re talking about acute programs like hospital-at-home, long-term home and nursing homecare, traditional post-acute care or patient-directed chronic care, these all fall under the umbrella of distributed care. Their differences become less important when we zoom out to what truly matters: being a strategic set of capabilities that expands capacity, drives financial performance and delivers excellent care for health systems and payers. Hospital-at-home certainly has its place in this context, but it is only one lever to pull in creating value.
So, what does it take for home-based care organizations to be recognized as indispensable partners? In my view, it comes down to building and delivering three core capabilities:
- Medical Management Layer: First and foremost, successful home-based care providers must integrate a robust medical management capability that operates on top of and with existing programs. They need to create a clinical infrastructure that can coordinate with health systems and at-risk provider groups within payer networks. These teams should be able to provide oversight, manage complex patients and ensure safety and quality across care settings.
By embedding medical expertise into home-based care, organizations gain the credibility and clinical rigor needed to collaborate with discharge planners and care management teams. This is what transforms home-based care from a supportive service into a critical extension of the health system or payer’s core clinical operations. - Patient & Workforce Experience: Next, patient experience must be both technologically enabled and human-centered. Home-based care has the advantage of meeting people where they live, but that alone isn’t enough. The best programs cultivate a patient experience so seamless, accessible and reassuring that patients turn to them first when issues arise. People—the workforce that delivers care in the field and those who support people in the office on phones—are the primary drivers of this experience. This requires investing in platforms that support continuous communication, care coordination and workforce augmentation to help the field staff do their jobs better. Done correctly, it allows for more growth, lower operating expenses, higher productivity and better outcomes. Exceptional experience isn't a luxury. It’s a critical differentiator in retaining patients and workforce while creating the ROI that matters.
- Value-Aligned Contracting: Finally, none of this works without smart payment design. Home-based care needs contracts that align with the strategic goals of their partners, be they health systems or payers. That means going beyond traditional fee-for-service arrangements and augmenting them with alternative payment models. For example, if a home health agency wants to participate in strategic capacity creation and quality initiatives with an at-risk health system, it may require a new contract that doesn’t yet exist. These contracts must recognize the capacity creation, cost savings and quality improvements home-based care can deliver—and ensure that providers share in the upside they help create.
This doesn’t mean every agency needs to start absorbing high levels of risk overnight. But they do need the ability to structure agreements that reflect their contributions to expanding service access and total cost of care.to support therapy and progress throughout treatment. This data can be integrated quickly from the program into the patient’s record. Each clinician saved valuable hours per week—a meaningful benefit to clinicians and patients.
Preparing for an Uncertain Future
As we look ahead, especially toward the potential expiration of the Acute Hospital Care at Home waiver in September, the real question we should be asking is how home health agencies can prepare for uncertainty. Regulatory changes, policy shifts and macroeconomic pressures are givens. Success lies in resilience.
The answer is not to chase every new model or waiver. Instead, home-based organizations should focus on developing the capabilities that will matter no matter what: medical management, patient engagement and value-based contracting. These are the foundations that will allow them to thrive in a wide range of future scenarios and be a critical component of the distributed care ecosystem.
The agencies that succeed will be the pragmatic organizations that combine culture with advanced technology that is both elegant and powerful. They’ll be the ones that build trusted relationships with health systems and payers by delivering value reliably—be it clinical, operational or financial.