Specialist
Former executive at Heal
Agenda
- Recent developments in the home healthcare industry and updated COVID-19 impact
- Margin trends in home-call business and segment’s fee-for-service long-term sustainability
- Regulatory dynamics and scrutiny into risk adjustment coding
- Competitive positioning of major players such as Signify Health (NYSE: SGFY), DispatchHealth, Patina and Optum Care
- 2022 outlook – consolidation trends from fragmentation and potential aggregation
Questions
1.
What are the most important trends and developments you’ve been following in the home healthcare services market over the past year or so?
2.
You mentioned the uptick of seniors seeking to age in place. Could you quantify this potential tailwind for home healthcare providers longer term?
3.
What are your thoughts on the Office of the Inspector General report published in September 2020, alleging unethical Medicare Advantage billing practices, as well as increasing regulatory scrutiny around the in-home evaluation process? What has been the fallout from this report and how are you assessing general regulatory oversight around home healthcare?
4.
Could you outline the differentiation among the prominent business models of home healthcare delivery, such as urgent care, primary care and extended care? Who are the major players within each segment? Are there any you’re more bullish on around revenue model or growth opportunity?
5.
How is telemedicine adoption and utilisation trending for home healthcare visits? How is this changing the modality and operational model of the traditional house call, given your previous commentary?
6.
How much of a risk is commoditisation in the legacy house-call service line? To what extent is it translating into downward pricing pressure on the top line for major players?
7.
Could you outline the general unit economics and gross margins for home healthcare players, appreciating this may vary substantially by business model and geographic region?
8.
What are typical reimbursement rates in fee-for-service primary care across commercial, Medicare, and Medicaid, appreciating this will vary by state?
9.
How widely adopted are value-based care arrangements in home healthcare, considering primary care, urgent care, extended and so on? What inning are we in the shift from fee-for-service to value-based care, especially considering the latter’s more attractive unit economics?
10.
How efficient are physicians in terms of visits per hour, appreciating this will vary substantially based on visit type and geographic location?
11.
There have been substantial staffing shortages industry-wide in healthcare. What labour issues would you note in home healthcare for physicians, nurse practitioners, home health aides and other staff? What operational challenges have these shortages presented?
12.
What wage increases have there been to retain staff? How detrimental could these be to players’ bottom lines?
13.
What operational levers can be pulled to preserve margins in home healthcare? Are companies using flexible staffing models or technological innovation to change the care model and lower costs? Do you consider the home care model somewhat of a dying business line, at least in fee-for-service?
14.
What’s your overview of the new Medicare Direct Contracting and Primary Care First patient-driven groupings model? How could this impact the home healthcare market over the near term? What’s important to understand about this development?
15.
What tech innovations are being utilised to better manage cost of care? Would you highlight any players that are ahead of the curve on tech innovation?
16.
Which regions or states do you think represent the most opportunity for home healthcare players to expand further into, considering patient population or market saturation?
17.
Do you think it’s better to try to dominate one major geography or acquire more of a national scale without the same penetration depth?
18.
How are you assessing the financial opportunity in the direct-to-employer channel? What are some keys to penetrating this demographic?
19.
How do you assess the home healthcare competitive landscape? Could you compare names such as Dispatch, Signify Health, Heal and Optum in terms of business model differentiation and market share?
20.
How much of an advantage do you think Optum enjoys from its robust scale and the synergies it can leverage from the UnitedHealth-Optum conglomerate?
21.
What are your thoughts on upstart, Patina Health, who plans to launch a home healthcare service with an unnamed Medicare Advantage?
22.
How are companies approaching customer acquisition efforts? What makes for a successful patient recruitment strategy?
23.
How are you expecting consolidation to play out over the next 12-18 months? Could margin deterioration in legacy house-calls and overall fragmentation lead to increasing aggregation?
24.
Could large payers become increasingly acquisitive? Do you think any particular names might be attractive acquisition targets?
25.
Is there anything else we haven’t discussed regarding the US home healthcare market that is especially important to highlight?
