Breaking Down The Disconnect Between Home-Based Primary Care Providers, Home Health Agencies


Given their shared goals of closing care gaps, home-based primary care providers should be home health providers’ natural ally. While that has been the case for some organizations, it hasn’t been for others.

Emily Cook, the CEO of Welcome Health — SCAN Group’s home-based primary care medical group — believes that the fragmented nature of the health care sector is making it more difficult for providers to form fruitful relationships.

“We’re all working in our own little silos, and don’t really understand the incentives and challenges of each other,” she told Home Health Care News.

Welcome Health delivers primary care, preventive care, chronic illness management and more in the home. The company infuses the principles of geriatric medicine into its model of primary care, and several of Welcome Health’s physicians are geriatricians.

Welcome Health often finds itself working with home health providers. At least half of the organization’s patients are receiving home health services for a period of time to help resolve a current clinical issue.

Though primary care physicians see home health care as an extension of the care that they deliver, that doesn’t always translate to a harmonious working relationship, according to Cook.

“The nurse or the therapist who has seen the patient in the home doesn’t always try to reach our primary care physicians and strategize,” she said. “If our primary care physicians have any desire from home health that’s different from what we’re getting today, it’s that they would consider our primary care physicians the quarterback and know that we value their work and we want to interact with them.”

At times, establishing referral relationships with home health providers has also been difficult because of the fragmented California home health market.

“We are in LA and Orange County, and we’re expanding to other parts of California,” Cook said. “If there were fewer, bigger players in California, I think it would be easier for us to wrap our systems and our models of care around those home health organizations.”

Differing payment structures has also been a roadblock, as Welcome Health is paid through value-based arrangements and most home health care is covered under Medicare fee for service.

That could change soon, however.

Cook believes there’s still room for improvement with the home health providers her organization has already formed relationships with.


“We need to really devote time to designing how we work together,” she said. “Ultimately, moving away from a referral mindset might build stronger relationships, and lead to better care, in the long-run.

“Rather than simply wanting to secure referrals, ask a different question,” Cook said. “The question is, how can I become a part of your organization’s mission and design.”

Home health struggles in rural America

The home-based primary care provider Homeward has a very specific focus as an organization. Its mission is to re-architect the delivery of health care, particularly in rural communities across the U.S.

“If you’re a rural American, the outcomes experienced are substantially inferior to an urban person,” Homeward President Amar Kendale told HHCN. “We’re talking about a 20% higher mortality rate, as an example. We dug into some of the underlying reasons, one of the reasons that really stood out for us was that there simply aren’t enough providers, there simply isn’t enough capacity.”

On top of this, people living in the U.S. already have less access to effective primary care. Rural communities are hit the hardest, according to Kendale.

“There’s about half as many primary care providers in rural areas as there are in urban areas, and there’s about an eighth as many specialists,” he said. “It’s, in a sense, a double whammy.”

Since Homeward is focused on tackling the care shortage in rural areas, the organization often finds a lack of home health provider availability in the areas it serves.

This has meant that the organization hasn’t been able to collaborate with home health providers as much as it has with, for example, health systems.

In general, home health providers often face difficulties operating in these communities. Workforce retention, limited access to the internet and limited availability of long-term support and services providers all play a role in rural home health care access disparities.

With these encounters between home health and Homeward being few and far between, Kendale believes mutually pushing for stronger technology solutions could be a potential bridge.

“We think about how medications are managed, there isn’t much technology supporting the way people deal with that today,” he said. “When we think about how complex chronic conditions, multiple chronic conditions are managed, there isn’t very much that’s helping people there today. I believe that we are still at the dawn of technology making its way into the routine, patient-focused aspects of health care.”

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