Boston, MA – May 3, 2017 – FHS SeniorCare Payment Solutions® and Ankota® announced today their partnership that will integrate FHS’ third party billing solutions with Ankota’s home care agency management Software-as-a-Service platform. The integration will deliver a complete, end-to-end solution for agency management, billing and revenue cycle to the private duty home care market.[Distinctive features of both companies’  product lines are described in this article, along with details on the value this partnership may bring to the healthcare at home industry.]


Ankota—an innovative home care management software solution provider—and FHS—an industry-leading revenue cycle management company— believe that home care providers are better served when their needs for agency management, billing and revenue cycle solutions are seamlessly integrated. FHS’ and Ankota’s missions are aligned with the common goal of simplifying front and back office processes so that home care agencies can be more efficient and profitable.

Ankota enables Next Generation Home Care Management and enables agencies to delivery care efficiently but also with the compliance and transparency that is being mandated throughout the industry. The solution delivers robust functionality including: online client intake, scheduling, care plans, caregiver tracking via telephony and mobile/GPS, point-of-care documentation, a family mobile application, care transitions and remote patient monitoring.

The integration gives agencies access to FHS’ network of more than 300 third party payers and to FHS’ billing expertise. This tightly integrated solution will help agencies to streamline billing with long-term care insurance, Veterans Administration, workers’ compensation and additional payers, as well as to increase cash collection rates and reduce accounts receivable days outstanding.

“We are excited to partner with FHS and incorporate their robust revenue cycle management capabilities with our next generation home care management platform.  This is another example of how Ankota seeks to open new opportunities for our customers to attract new referral sources, enhance their revenue stream and increase their efficiency,” said Ken Accardi, CEO, Ankota.

With the influx of clients with third party benefits entering the home care market, agencies need a trusted partner that can help manage the complex revenue cycle. FHS delivers third party billing solutions to help agencies add new revenue streams, diversify their payer mix and decrease their time to collect cash. FHS is the only company with 30 years’ experience billing more than 300 non-medical third party payers including: long-term care insurance, the Veterans Administration, Medicaid Waiver programs, workers’ compensation, non-profit organizations and more.

“Private duty home care has expanded beyond just a private pay business, which has increased the administrative complexity for agencies trying to manage billing rules and accounts receivable with multiple entities,” says Matt Capell, chief executive officer of FHS. “Our partnership with Ankota provides an end-to-end solution that enables agencies to operate more efficiently, optimize revenue and focus on delivering quality care.”

About FHS
FHS SeniorCare Payment Solutions® provides revenue cycle management solutions to the non-medical, long-term care industry. FHS offers a robust portfolio of services that streamline revenue collection and simplify financial operations including: third party eligibility, claims processing, payment processing and collections. FHS provides financial advocacy to care recipients, helps them understand third party benefits and other payment options, collects from responsible parties and remits cash to long-term care providers.


About Ankota
Ankota™ enables the next generation of home care, understanding the rapid growth of the elderly population and the shifts to managed care and population health. The highly customizable software offers full home care agency and Electronic Visit Verification (EVV) management including telephony, GPS, fixed number generator fobs, biometric authentication and verification schema. It manages people, payers and programs via configurable business rule sets and supports optimized delivery of care in homes, readmission reduction, individualized plans of care and cost controls. Sophisticated scheduling algorithms support managing non-skilled and professional workers in post-acute markets that include AAA’s, Medicaid, DME, therapy staffing, infusion and phlebotomy.  Foresight Care™, an innovative remote patient monitoring service and patient engagement platform, helps avoid hospital readmissions at the lowest possible cost.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


By Tim Rowan, Editor & Publisher of the Home Care Technology Report

There are many opinions circulating this week about the alternative to the Affordable Care Act that the Republican-controlled House of Representatives passed on a 217-213 vote. Rather than hastily cobble together an analysis of our own, we have gathered the official statements of several national organizations that will be most affected in the unlikely event the House bill passes unchanged through the Senate. [Rowan compiles the views on the American Health Care Act of representatives of many national healthcare organizations, including the National Association for Home Care and Hospice; the Visiting Nurse Associations of America; AARP; America’s Essential Hospitals; American Medical Association; American Nurses Association; and Joe Baker, President of the Medicare Rights Center.


National Association for Home Care and Hospice

March 8, 2017

The Republican majority in the U.S. House of Representatives released their official Affordable Care Act (ACA) repeal and replace legislation, the American Health Care Act (AHCA) and on first glance it appears to be a mixed bag for home health and hospice.

The new legislation will be marked up by two different committees — Ways and Means and Energy and Commerce on Wednesday morning. Controversially, the AHCA has not been scored by the Congressional Budget Office (CBO) yet, meaning legislators do not know how many people this measure will cover, how much it will cost, or the impact it will have on the Medicare Hospital Insurance Trust Fund, better known as Medicare Part A. Below we outline, the good, the bad, and the yet-to-be determined pieces of the American Health Care Act.

Of immediate concern to the Home Care and Hospice community is the repeal of a six percent incentive payment for Home and Community Based Services (HCBS) under the Medicaid program. Simply put, this rebalances the ratio of federal to state responsibility for Medicaid HCBS with the federal government picking up an additional 6%. The intent of this bonus was to drive states to encourage rebalancing of care from institutional settings to home and community environments. This incentive was made available under the ACA. Since its enactment eight states have taken advantage; California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington. An additional five states, Alaska, Arkansas, Colorado, Minnesota, and Wisconsin have applied or are considering accepting the bonus payment.

Of benefit to home health agencies (HHAs) is the repeal of the employer mandate to provide health insurance to employees. This will be accomplished by reducing the penalty for non-compliance to zero. The legislative language is written so as to provide retroactive effect from the mandate. The entirety of calendar year 2016 will be exempted from the mandate. The National Association for Home Care and Hospice (NAHC) has long disagreed with the employer mandate as the added expense to HHAs goes uncompensated by Medicare and Medicaid payments. In private pay situations, the added expense can make home care unaffordable in some cases, pushing patients towards Medicaid institutional care settings instead.

As expected, House Republican leadership included a provision to cap the federal share of Medicaid. They seek to achieve this through “Per Capita Caps.” As we’ve written before, this model provides a predetermined amount of funding allowable to each individual eligible for Medicaid in a given state. The amount will be based on 2016 figures and will be adjusted yearly according to the Consumer Price Index for Medical costs (CPI-Medical). This is expected to result in reduced federal share of Medicaid funding. In turn, states will take on the additional responsibility, and will then be forced to either find alternative revenue sources or limit benefits made available. NAHC is concerned that home care and hospice services as a benefit could be lost in this model.

Due to the added flexibility Per Capita Caps entail, states may favor or disfavor home care services. Each state would have the freedom to define what is and is not covered under Medicaid, and the parameters around program operations. This would potentially include beneficiary cost-sharing responsibility. Further, states could be handicapped in expanding home care options, as rates are tied to 2016 funding figures. However, with the caps, states may find a need to be more efficient in their spending. This could lead to support for home care as a more cost effective solution to nursing home care and as a way to transition patients out of inpatient care with reduced risk on re-admission.

Other notable changes include:

  • Increased age-rating ratio. Under the ACA, insurance plans could not charge older persons more than 3 times that of a younger person. A 3:1 ratio. The AHCA would increase that to a 5:1 ratio.
  • Repeals the individual mandate under the ACA. In place of this, Insurance companies will be allowed to charge an additional 30% to beneficiaries that had a lapse in coverage greater than 63 days. This extra 30% would be allowable for up to one year.
  • In place of subsidies, the AHCA will provide refundable tax credits based on age and income to those who do not receive insurance coverage from their employer.
  • Under this legislation, Medicaid Expansion will be rolled back by 2020.

This is only an early look at a large piece of legislation that will affect millions of Americans nationwide. NAHC will continue to review, study, and analyze the impact the AHCA could have on the home care and hospice industry. As always we will keep you up to date with notable events and developments related to health care reform.


Visiting Nurse Associations of America

The U.S. House of Representatives approved the American Health Care Act (AHCA) today by a vote of 217 to 213. Last minute amendments to the bill persuaded enough members of the House Freedom Caucus (a collective of conservative members of the Republican Party) and House Tuesday Group (a collective of more moderate Republicans) to vote in favor of the legislation.

These passed amendments that are now part of the AHCA are:

The McSally Amendment:
Representative Martha McSally (R-AZ) introduced an amendment that would eliminate the exemption from Congressional members and their staffs from provisions within the American Health Care Act.

The Upton Amendment:
Representative Fred Upton (R-MI) introduced an amendment targeting $8 billion from 2018-2023 to help subsidize the insurance costs of individuals with pre-existing conditions. Organizations such as Consumers Union, the Kaiser Family Foundation, and the American Medical Association all agree that $8 billion is insufficient to cover this need.

In late April, the MacArthur Amendment was released to update parts of the AHCA and bridge the gap between conservative and moderate Republicans.

The MacArthur Amendment:
reinstates essential health benefits (EHBs) as the federal standard;

  • maintains the prohibition on denying coverage due to preexisting medical conditions and discrimination based on gender;
  • guarantees the issue of coverage to all applicants and renewability of coverage;
  • allows for coverage of dependents on parents’ plan up to age 26; and
  • maintains Community Rating Rules,
  • provides an optional waiver for states to bypass the EHB standard and certain Community Rating Rules.


As VNAA previously alerted members, the AHCA would repeal key portions of the Affordable Care Act and make dramatic changes to the Medicaid program. Please note, the legislation does not repeal either the home health payment rate rebasing or the face to face certification requirement. VNAA has carefully monitored this debate to ensure continued accessibility and affordability of home-based care. VNAA remains concerned that AHCA takes a step backwards for vulnerable and home-based care patients. VNAA opposes further passage of the AHCA.


VNAA will continue to monitor and engage in this debate. This House-approved legislation faces considerable challenges in the Senate, setting up negotiations to develop a compromise bill to pass both chambers. As always, VNAA’s goal is to ensure access and affordability to high-quality home care.



The American Health Care Act (AHCA) would permit discrimination against people with preexisting health conditions, substantially increase insurance premiums for older adults, result in millions of people losing coverage, and worsen the fiscal health of Medicare.

The bill would also cut Medicaid funding, which millions of low-income seniors as well as children and adults with disabilities rely on, by more than $800 billion over 10 years.

The AHCA has been condemned by leading consumer and health groups, including AARP and physician and hospital organizations.

“AARP is deeply disappointed in today’s vote by the House to pass this deeply flawed health bill,” said AARP Executive Vice President Nancy LeaMond. “The bill will put an age tax on us, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with preexisting conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

Pulled from House consideration in March when it lacked sufficient votes for passage, the legislation found new life through an amendment permitting states to request waivers that would allow insurers to charge higher premiums to people with preexisting conditions. That would be a dramatic departure from the protections of current law. Twenty-five million people ages 50-64 have a preexisting condition and would face much higher premiums — thousands of dollars a year — that in many cases would be unaffordable.

While supporters of the bill maintained that people with preexisting conditions could be cared for through high-risk pools, an analysis by AARP’s Public Policy Institute found that premiums in such pools could reach unaffordable levels — as much as $25,700 a year in 2019. In the past, high-risk pools have put such an onerous financial burden on states that insurance benefits were scaled back and enrollment in them was capped.

To win over holdouts on the bill, the House leadership included an amendment adding $8 billion over five years for high-risk pools, an amount representing a very small fraction of what would be required.

Under the bill, states could also obtain waivers allowing insurers to sidestep coverage for critical benefits such as emergency services, hospitalization, prescription drug coverage, mental health services, chronic disease management and preventive care.

The controversy over how to treat people with preexisting conditions was only one objection raised by consumer groups about the AHCA. The bill would impose an “age tax” through the combined effect of allowing insurers to charge older adults five times what other consumers pay for the same insurance and reducing tax credits that help older adults pay for their insurance coverage. The result of these two big changes would be an increase in annual premiums of up to $13,000, according to the Congressional Budget Office (CBO).

Compounding this problem, insurers in states receiving a federal waiver would be allowed to charge older adults even more than five times what others pay for coverage. Current law limits the premiums for older consumers to three times what younger adults are charged.

The CBO found in March that the legislation would lead to a loss of coverage for 24 million Americans over the next decade. The House leadership plunged ahead with Thursday’s vote even though the CBO has yet to analyze the recent changes. The result was that members of Congress voted on legislation without knowing how many people would be affected and how much their premiums would be.

The AHCA wouldn’t affect only people 50 to 64 years old. The bill would also worsen the fiscal outlook for Medicare by reducing the program’s revenue. It would hasten Medicare’s insolvency by several years and weaken its ability to pay for future services for those who rely on the program to help cover their health care costs.AARP vowed to hold every member of Congress who voted for the bill accountable by letting its nearly 38 million members know how their elected representatives voted.


America’s Essential Hospitals
Statement on House Passage of the American Health Care Act

Statement attributable to:
Bruce Siegel, MD, MPH
President and CEO

WASHINGTON – The House voted today to take health care coverage away from tens of millions of Americans, reduce benefits and increase costs for millions more – including the sick – and gut a program that has been a lifeline for vulnerable people for more than 50 years.

This is not reform. This is legislation that will take us back to a time when working individuals and families were forced to choose between health care coverage and life’s other necessities. In fact, it will leave us in a worse place than before the law it seeks to replace, the Affordable Care Act.

The hospitals and health systems that care for disadvantaged Americans, essential hospitals, meet their mission across all states and localities – blue and red, urban and rural. But the draconian cuts to Medicaid and soaring levels of uncompensated care this bill would create put that mission in jeopardy. If this bill becomes law, it will put all communities at risk of losing access to basic care and vital services, including trauma care and disaster response.

It is particularly telling that an overwhelming majority of Americans oppose this legislation and no major stakeholder group supports it. The Senate must heed those warning signs and stop this damaging legislation. The solutions we need to fix the shortcomings of the ACA demand a more deliberative process that brings all stakeholders, including our hospitals, to the table.

With a measured approach, we can preserve access to affordable health care and protect struggling Americans from the massive loss of coverage that almost certainly will occur under the AHCA. We offer our members’ experience and expertise to achieve those goals.

About America’s Essential Hospitals
America’s Essential Hospitals is the leading association and champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. Since 1981, America’s Essential Hospitals has initiated, advanced, and preserved programs and policies that help these hospitals ensure access to care. We support members with advocacy, policy development, research, and education.

Our nearly 300 members are vital to their communities, providing primary care through trauma care, disaster response, health professional training, research, public health programs, and other services. They innovate and adapt to lead the broader health care community toward more effective and efficient care.


American Medical Association
President Andrew W. Gurman, M.D., released the following statement today after the U.S. House of Representatives passed the American Health Care Act:

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question. Action is needed, however, to improve the current health care insurance system. The AMA urges the Senate and the Administration to work with physician, patient, hospital and other provider groups to craft bipartisan solutions so all American families can access affordable and meaningful coverage, while preserving the safety net for vulnerable populations.”


American Nurses Association
“In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on. These changes in no way will improve care for the American people,” the organization wrote in a letter March letter.

The group’s president tweeted on Thursday, calling the bill “worse than before.”


Joe Baker, President of the Medicare Rights Center

New York, NY—The American Health Care Act (AHCA) undercuts our core mission and violates our driving principles — to ensure older adults and people with disabilities are assured access to affordable, high-quality health care. This bill was written in the dark of night and rushed to the floor for a vote without anyone knowing how much it will cost or how many people it will affect.

The American people deserve better than Congress playing fast and loose with their health care, but it’s the substance of the AHCA that alarms us most of all. The AHCA would yank coverage out from under 24 million Americans, end Medicaid as we know it, weaken protections for people with pre-existing conditions, impose an unaffordable “age tax” on older Americans, and undermine the Medicare guarantee. The AHCA puts access to affordable health care at risk for every older adult, person with a disability, and American family, especially as our society ages and becomes increasingly reliant on Medicare and Medicaid.

We are undaunted by today’s vote, and we will continue to fight the AHCA’s passage. We ask the U.S. Senate to start from scratch and to seek consensus on health care reforms that protect and strengthen affordable access to care for American families, and we urge President Trump keep his campaign promise not to cut Medicare and Medicaid.

For more information on the Medicare program and proposals under consideration by Congress to change it, visit the Medicare Rights Center’s “Protect and Strengthen” webpage at




By Tim Rowan, editor & publisher of Home Care Technology Report

On your last visit to a restaurant on a busy Saturday night, did the hostess hand you one of those pagers that lights up like a tiny UFO to let you know your table is ready? Or did she ask for your cell number?

Restaurants are one of the last businesses where pager companies have been able to sell their 20th-Century technology but even that market is drying up as texting becomes ubiquitous. Healthcare, however, has just leapfrogged the pager era and gone straight to replacing waiting rooms with smart phone apps and texts. Meet Jellyfish Health, headquartered in Panama City, Florida and led by serial entrepreneur Dave Dyell.

Possibly the worst experience in all of healthcare is the Emergency Department waiting room. In many cities, if you are not delivered by ambulance with a life-threatening injury, you may spend six hours or more surrounded by people with every category of contagious disease. Worse than the risk to your health is the realization that the only reason you need to wait there is so that you are within earshot when your name is called. Why is there not an app for that?

“Why are hospitals not as enlightened as restaurants?” Dyell wondered two years ago. “What if patients could sign in virtually and wait at home until a text notified them their turn was imminent?” Of that wondering was born a scheduling optimization and communication system Dyell describes as “the ability to remotely get in line.”

Jellyfish Health is in Florida, where demographics are futuristic, graying is ahead of the U.S. average, and healthcare costs are higher. The company started testing its system locally before marketing it to other population centers. During those tests, Dyell reports, patient satisfaction rose as wait times shrank. Today, it is in use at major medical centers from coast to coast.

“Not only can people wait at home when they need to use the ED instead of a family physician, for whatever reason, but the app also gives them better options,” Dyell said. “They can see on the app that the wait time at an Urgent Care center, which might be closer to them, is one hour while the ED wait time is four or five hours. When they choose the better alternative, they are better off and their insurer, whether public or private, pays a lot less for the same care.” The app even works for regularly scheduled primary care physician appointments, Dyell added.

Additional information and an online demo are available at
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.

SAN DIEGOApril 25, 2017ResMed (NYSE: RMD) today unveiled its AirMini™, the world’s smallest CPAP machine – a game-changer for people with sleep apnea.

Designed for travel, AirMini packs ResMed’s clinically proven CPAP (continuous positive airway pressure) technology along with its comfort and ease-of-use features into a sleek, portable, pocket-sized device ideal for traveling. The AirMini is available with ResMed’s proprietary AutoSet™ functionality as well as an innovative, built-in humidification system for patient comfort.

AirMini weighs a mere 0.66 pounds (300 grams) and measures just 5.4 x 3.3 x 2 in (13.6 x 8.4 x 5.2 cm). “The ResMed AirMini has redefined CPAP therapy – providing patients with peace of mind, knowing they can easily get ResMed-quality therapy wherever they are,” said Mick Farrell, ResMed CEO. “CPAP is now more portable and accessible than ever before. I have been traveling all over the world with a prototype of the AirMini system, using AutoSet, humidification, and an AirFit™ P10 pillows mask, and it has changed my travel life. I am so excited to see that this technology is now available to many millions of sleep apnea patients.” [Details are provided about results of a CPAP technology’s  users’ use (or not) of CPAP technology when traveling. Features of the AirMini™ product are noted in the closing paragraphs of this short article, followed by details on the new product’s worldwide availability.]

In a recent survey, 65% of CPAP users said device size is the #1 reason they don’t take their CPAP every time
they travel, breaking the cycle of adherence and exposing themselves to sleep apnea’s chronic effects: they
stop breathing repeatedly throughout the night, unconsciously transitioning between moments of sleep,
suffocation, and jolts of awakening to resume breathing. This may cause dangerous levels of daytime fatigue
and raise the risk of developing other fatal conditions like type 2 diabetes and heart failure.

AirMini’s comfort and ease-of-use features are ideal for patients and for home medical equipment providers
who will benefit from the device as a growth driver for their business:

  • A phone app (iOS and Android) for patients to change comfort settings and track their own nightly
    usage data, a practice that’s shown to increase compliance and health outcomes
  • Portable and convenient waterless humidification to maximize comfort, capturing a patient’s exhaled
    heat and moisture with a HumidX™ humidifier in the mask tube and redelivering it to them
  • Compatibility with ResMed’s AirFit N20 nasal and F20 full face masks, easy for home medical
    equipment providers to fit on a wide range of patients (an unprecedented 99 and 97 percent of patients, respectively) as well as a special AirMini version of the award-winning AirFit P10 nasal pillows mask.

CPAP users in the United States can contact their home medical equipment provider to place an order for the
AirMini. ResMed will begin taking preorders on May 3, 2017, and AirMini will begin shipping by May 31. The
technology will also be available in Australia, Canada, Denmark, Finland, Germany, New Zealand, Spain and
the United Kingdom.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


By Tim Rowan, Editor & Publisher of Home Care Technology Report

For a Medicare-certified home health agency, falling out of regulatory compliance regarding timeliness of claim submission is a constant threat. When the agency is at fault, remedies might be available through improved operational procedures. When the cause of the delay is completely out of agency control, there is no remedy, only frustration. [Various means of addressing delays in submitting HHA documents to CMS are noted–e.g., via US mail and fax. Rowan introduces the “Client Sidekick” — the newest entry in the growing field of electronic physician portals.  He also provides details on its developer Ziad Kassaband on 2 HHAs in which it was beta tested,  Some of its capabilities are noted as are payment options by HHA and hospice providers.] (more…)

By Tim Rowan, Editor & Publisher of Home Care Technology Report

In the middle of a busy 3-day conference, VNAA CEO Tracey Moorhead took time to speak with Home Care Technology Report editor Tim Rowan for a few minutes to unpack the meaning of her April 19 announcement of the formation of “ElevatingHOME,” a member-driven national association, which she will serve as President and CEO. Her answer to our first question cannot be expressed in writing as emphatically as it was stated.

Tracey Moorhead

HCTR: Now that your nearly two-year planning has come to fruition and Elevating Home has been introduced, the first question on everyone’s mind has to be what your vision is. You put attendees at today’s National Leadership Conference through an exercise to brainstorm their own vision but certainly you must have one of your own for what ElevatingHOME should become and what its initial activities should be.

Moorhead: “No, I don’t! It’s not about me. It’s about having a member-driven organization. From the first day the VNAA board talked about this in June, 2015, they talked about the term “member-value organization,” an organization that provides value to the members and is responsive to their needs, and that has been at the core of their mission to develop this organization. The way we are thinking of it now is that not only will it be member-driven, with all of the decisions coming from the members, but that it will be board-managed. The board will be the true leaders. The board will be making decisions.

It was the board that made a conscious decision that we did not want to launch ElevatingHOME with a fully formed strategic plan. If we had done that, it would have been complete anathema to what we were saying about being member-driven and board-managed. We want to engage people, to hear what potential members want to focus on. The first thing we want to do is listen to the industry, engage people, have them decide what to do first. [More details are provided in this article about the board of directors’-led strategic planning initiatives of Elevating Home, which Moorhead notes is exactly how initiatives at VNAA have been followed through with. She explains: “For the VNAA board, it was critical to have them driving this, to have them making those decisions, to have them in charge of every aspect of creating ElevatingHOME, and that is exactly the way we did it. We won’t be successful unless it is a collaborative effort.” She noes, too, that ElevatingHOME’s first member organization is the Council of State Association, which, she notes, ElevatingHOME will work closely with as allies.  She says: “The board and I will continue to speak at their state meetings to get the word out and engage them in the process.”  The prominence of the home as the center of healthcare is the position envisioned for ElevatingHOME.]

HCTR: So, you will be a coordinator as much as a CEO, implementing what they tell you to do.

Moorhead: Absolutely, and frankly that’s the way it has worked at VNAA. Our strategic planning initiatives, the management of our strategic plan, the management of our initiatives, have always been led by our board of directors. I think that, in order to ensure that your board is engaged, your board is supportive and that they are telling their colleagues about the value they find in this new organization, you have to understand why you’re doing something. For the VNAA board, it was critical to have them driving this, to have them making those decisions, to have them in charge of every aspect of creating ElevatingHOME, and that is exactly the way we did it. We won’t be successful unless it is a collaborative effort.

HCTR: How will you get started? You will have to build a membership base first.

Moorhead: Our first member organization is already with us. Having the Council of State Associations as our first member was critical to the board, so we were thrilled that they voted unanimously to join ElevatingHOMEand we will work closely with them as allies. The board and I will continue to speak at their state meetings to get the word out and engage them in the process.

HCTR: And that message is?

Moorhead: For me, the most important message is that we are taking an entirely different approach. We do not want to be a reactive industry organization; we want to be an industry organization that is envisioning a better position for Healthcare at Home. We want to talk about and develop a model for the home as the center of healthcare; the home in support of primary care; the home in support of the patient managing chronic illness; the home in coordination with the hospital.

We want to underscore the value of the home to all provider partners who diagnose and treat patients. We are not looking to usurp physicians or hospitals in any way; we are looking to demonstrate our value as a critical partner as opposed to an afterthought. We want to change the way they think about home-based care, and the services home health, hospice, palliative care can provide.

HCTR: How will you execute?

Moorhead: Following the messaging is the engagement part, which is deeply important and complementary. It starts with the development of a model through engagement with members in all 50 states. Bob Fazzi and the rest of the board have put together a Strategic Action Initiative, an engagement process over the next three months to invite leaders from agencies in all 50 states to provide input to us about how this model will look and work. We want to hear about case studies from innovative programs, pilots, other agency self-funded initiatives that have allowed them to change the way care is delivered in the home.

We are very excited about this. We strongly believe that engaging agencies in this way, working through state associations, will help demonstrate to them the value proposition. If we can take their small pilots that have proven value and blow them up into a bigger program and incorporate them into a broader model, they are going to see value; they are going to feel heard; they are going to be involved in the direction of a new organization.

HCTR: This is starting right away?

Moorhead: The goal is to have the strategic plan completed through that process by the beginning of October.

HCTR: Actually, the Council of States is the second member of ElevatingHOME, correct? The VNAA is the first member, with a few of its board members also serving on the new board. Are VNAA member agencies asking what their status will be under ElevatingHOME?

Moorhead: There will be a two-part strategic planning effort. Now that we have created ElevatingHOME to lead the industry, services such as education, advocacy and quality improvement training, which are applicable to both for-profit and non-profit agencies, hospices and palliative care providers, will move up to be services from ElevatingHOME. The VNAA, as a subsidiary, will provide services that are specific to the unique needs of non-profits. We have broadly defined those as training, leadership skills, and fundraising. During the startup, I will continue to hold the title of president and CEO of the VNAA for now.

HCTR: When you sketched out this idea at the Homecare 100 meeting in February, before the name “ElevatingHOME” was chosen, you said your research had turned up as many as 14 different national associations for home-based care providers. There are going to be questions about how you will relate to other organizations.

Moorhead: While 14 is certainly too many, there is no one organization that could serve every need. Many of these organization were formed out of agency frustration that their needs were not being met by any other national association. If ElevatingHOMEbecomes what we know it can become and meets those missing needs, perhaps not all 14 need to continue to exist. The ones that do continue, the ones with unique services for the needs of their unique members, we want to partner with them.

I know there are questions. “It’s another new organization. What does that mean? How is it going to impact me?” The only way to answer those questions is for ElevatingHOME to be a consistent, transparent leader for this industry, and by having folks on the founding board be the key messengers of that. Those are the folks who are going to be leading the charge to engage their colleagues in other organizations.

We will focus on individual agency membership and let agencies decide what associations to join. I believe every agency should join any state or national association that provides value. If that is one or three or seven, then they should be members of those organizations because every organization is not going to offer the same suite of services. For example, we are not going to be involved with private duty; we are not going to do state level services. We will help coordinate services, we will help states with advocacy but we will not try to provide every possible service. So I can see value in agencies wanting to be members of ElevatingHOME and another association but it is entirely up to them. We will endeavor to be the best value add for these agencies.

We have spoken with many other organizations, all that are willing to speak with us, about becoming part of ElevatingHOME. We are willing to talk with all of them about this. I have briefed all of them. We have been very transparent about what we are going to offer, our status, our purpose. I’m on some of their boards. As we understand some of the challenges these organizations have, we might be working closely together in both the short and long term. At the end of the day are we not stronger together?

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


SAN FRANCISCO, CA — April 19, 2017 —ClearCare, the San Francisco-based provider of a SaaS and mobile software platform for home care agencies, today announced the acquisition of HomeTrak, a pioneer in private duty home care software solutions. [Details about this acquisition and the two companies’ principals’ positive response to this partnership are provided in this short news release.]

We spoke with Geoff Nudd, ClearCare’s founder and CEO. He told us the combined team of product developers and support personnel will make both companies stronger. “We are going to keep the HomeTrak team intact in order to support the 1,000 users of their complete portfolio of software products,” he said. “And we are going to be able to incorporate some of their great ideas into the ClearCare product.”

“We’re thrilled to welcome HomeTrak to the ClearCare family,” Nudd said in the official company news release. “The strength of both companies is our shared passion for understanding and solving business and operations problems for home care agencies so they can focus on the core job of providing the best possible care for seniors and families.”

According to Alex Kapetyn, co-founder of HomeTrak, ClearCare is an ideal partner for his team and customers. “We share the same commitment to our customers and dedication to innovate and make the delivery of low cost, home-based care easier. Given ClearCare’s proven track record of innovation and customer support, HomeTrak’s customers are in great hands.”

“Our number one priority is ensuring customers see no disruption from this acquisition,” Nudd added. “Furthermore, our acquisition of HomeTrak extends ClearCare’s skilled nursing capabilities as well as customer support resources for all of our combined home care agency customers.”

Nudd also told us that the combined company will continue under the ClearCare brand. Together, the customer count will reach 4,000 home care agencies.

“We have eight of the ten largest agencies in our customer base,” he added. “Many of those large customers have Canadian branches so, with HomeTrak’s office in Sarnia, Canada and its customers there, we have one more reason why our two companies are compatible.” HomeTrak is headquartered in SanDiego and ClearCare in San Francisco.

HomeTrak’s products support scheduling, billing & payroll, HR, relationship management and reporting.

Asked whether this acquisition would be the last one for a while, Mr. Nudd referred us to that last article we wrote about his company, ClearCare Accepts $60 Million Investment From Battery Ventures (8/24/2016).

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


San Diego, California April 19 — The Visiting Nurse Associations of America (VNAA) announced the launch of ElevatingHOME, a new 501(c)6 organization that brings together America’s home-based care providers to advocate for high-quality, affordable home care. ElevatingHOME will unify the myriad voices of home-based health care and reposition   as the center of health care delivery.

Industry leaders say the need for a consolidated organization to advocate for home-based care is acute. With 10,000 Baby Boomers enrolling in Medicare daily, this segment of the health care industry is expected to grow more than 70 percent in the next three years—from approximately $80 billion today to $137 billion by 2020. When surveyed, 87 percent of America’s seniors say they want to stay in their own home as they age and would prefer to receive medical care at home when possible. [Many comments about the need for and value of home healthcare are noted in this article. Extensive details about the origins of  are also provided, along with information about the leaders of of ElevatingHOME’s board of directors and its senior  entities. Details about of ElevatingHOME’s focuses on advancing home-based care as the central and critical component of health care delivery are delineated near the conclusion of this article.]

“Most patients—seniors, but others too—prefer to receive medical care at home when possible, but the current health care delivery system design is organized around costly and sometimes unnecessary hospital stays,” said Joseph Scopelliti, President and CEO, VNA Health System of Shamokin, Pennsylvania and Chair, ElevatingHOME Board of Directors. “When people can receive the care they need in their own homes, amidst familiar surroundings with family and friends nearby, they often have better health outcomes at lower costs.”

Introduced at this week’s National Leadership Conference in San Diego, ElevatingHOME will represent both non-profit and for-profit home-based care providers. The Council of State Home Care Associations will also join ElevatingHOME as a founding member.

“The Council of State Home Care Associations, which has a long history of working collaboratively with many national organizations committed to advancing home health care, is very excited to work in partnership with ElevatingHOME by virtue of the unanimous vote of our Executive Committee,” said Tim Rogers, Chairman, Council of State Home Care Associations and President and CEO of the Association for Home and Hospice Care of North Carolina and the South Carolina Home Care and Hospice Association. 

ElevatingHOME will be led by a Board of Directors consisting of leaders representing both for-profit and non-profit home-based care agencies. In addition to Mr. Scopelliti, other founding members of the Board of Directors include: J. Mark Baiada, Founder and President, BAYADA Home Health Care, Susan Brouillette, MBA, MPH, CEO, Alacare Home Health and Hospice, Erin Denholm, RN, MSN, RWJENF, President and CEO, Trinity Health at Home, Norene Mostkoff, MBA, President and CEO, Visiting Nurse Health System, Marcia Reissig, RN, MS, CEO, Sutter Care at Home, and Bob Fazzi, EdD, Founder and Managing Partner, Fazzi Associates. Tracey Moorhead, President and CEO of VNAA, has been appointed President and CEO of ElevatingHOME.

Experts believe home-based care can play three critical roles in a redesigned health care delivery system: partnering with primary care; providing post-acute and acute care at home; and partnering with home and community-based long-term care providers. “Home-based care is carefully designed to provide care that people of all ages need – from wellness visits and chronic disease management to palliative, advanced illness and hospice care – and it is generally provided at lower costs than similar care provided in a medical institution,” said Moorhead. “Not only can home-based care services substitute for higher-cost hospital care, it can also ensure that patients who have been hospitalized do not wind up back in the hospital soon after being discharged.”

As an example, New Jersey-based BAYADA Home Health Care has focused on training its staff and creating system-wide best practices to reduce unnecessary hospitalizations and improve patient outcomes around heart failure. The provider has seen an 85.9 percent decrease in hospitalizations after 30 days and significant patient outcomes in better ambulation, reduced dyspnea, and reductions in pain that restricts activity.

In the months ahead, ElevatingHOME will focus on advancing home-based care as the central and critical component of health care delivery by:

  • Demonstrating the role of home-based care in meeting patients’ health care needs at home;
  • Developing and disseminating best practices for home-based care;
  • Establishing a high standard of operational integrity;
  • Elevating the level of public, private, foundation, academic and legislative support for the patients and families served;
  • Advancing financial models to support a robust home-based care industry while delivering value along the broader health care continuum.

About ElevatingHOME

Launched in 2017, ElevatingHOME is a 501(c)6 organization established to advance and strengthen the home-based care industry.  Representing home-based care providers including home health, palliative care and hospice, ElevatingHOME aims to advance cost-effective, high-quality, patient-centered health care that starts at home.

About The Visiting Nurse Associations of America (VNAA)

VNAA is a national organization that supports, promotes and advocates for mission-driven providers of home health, hospice and palliative care. VNAA’s members provide cost-effective and compassionate home health and hospice care to the nation’s most vulnerable individuals, particularly the elderly and individuals with disabilities.


by Audrey Kinsella, Telehealth Reporter, Home Care Technology Report

The “Transitions Advanced Illness Management Program” is a pre-hospice, at-home, pallative care program developed at San Diego’s Sharp Health Care in 2007. It was developed to help avoid urgent care visits and hospitalizations by persons living with advanced COPD, CHF, dementia, and other progressive diseases.

Transitions patients have access around the clock to a team of nurses and social workers familiar with each patient’s history and needs. To date, 2,013 patients have been cared for, by phone or in-person care, as needed.[Details are provided about the care team’s aims to avoid emergency room visits and  hospital readmissions and its success in doing so. Details are also provided about the Transitions program’s funding sources. Other pre=hospice programs nd their funding sources are noted near the conclusion of this article.]

Reducing costs by avoiding emergency room care and hospital readmissions is a main Transitions goal but not the only one. According to Dan Hoefer, MD, CMO of Sharp Health Care’s outpatient palliative care program, and co-pioneer of the Transitions program with Suzi Johnson, RN, VP of Sharp’s Hospice Care, a hospitalization for a patient nearing hospice placement can be debilitating. That is why succor as well as advice and medical assistance are delivered by Transitions’ team staff patients’ own homes.

According to Dr. Hoefer, “At this point in the patient’s life, you should be bringing healthcare to the patient — not the other way around.” 1

Talk to them
A team of Sharp Health Care nurses and social workers open each new case in the patient’s home, bringing customized care as well as comforting conversation. Helping patients better manage their symptoms and their family’s concerns is calming for the patient and helps keep their family members out of “panic” mode. This serves to avoid knee-jerk reactions when the patient’s pain becomes severe or some other temporary crisis would otherwise lead them to call 911.

Physicians on the team
While “Transitions” teams always include a patient’s physician, the program’s early stages were not without skepticism from some Sharp Health Care Doctors. At least one neurologist was quite uneasy and skeptical  about a teamwork approach for his own patients. However, according to one case study, he did eventually refer some of his patients to the program.

The study reports that, after assigning one of his advanced dementia patients, “he quickly realized that the extra support for his patient and his family meant fewer panicked calls and Emergency Department trips. He quickly became a “Transitions” supporter.” 2

Sharp Hospice initially funded “Transitions” with a $180,000 grant. Patients targeted early on were those living with advanced heart failure but the program later shifted its reach to patients with other chronic conditions. Lengths of stay vary, as do dispositions after discharge. Some patients stay for 7-8 months, some stay for several years. Some stabilize and are discharged to standard home healthcare without palliative care; others transition directly to Sharp’s Hospice.

Ongoing funding is supported by shared savings with Medicare Managed Care payer partners. Sharp Health Care, a not-for-profit entity, receives a fixed amount of money per member per month and can assume for itself monies it does not spend on hospital stays and other costly medical interventions.

“Transitions” one of many experiments in palliative care
Anna Gorman, in “Pre-Hospice Saves Money By Keeping People at Home Near End of Life,” says that pressure has mounted in recent years to continue moving away from traditional payment systems. She notes that pre-hospice programs are influenced by the Affordable Care Act, with its rules that reward quality rather than quantity of care.

One example is Sutter Health’s “Advanced Illness Management” program, known as AIM.4 Another is managed by the University of Southern California and Blue Shield of California. This program recently received a $5 million grant to provide and study outpatient care. Gormand also suggests that private healthcare insurers, hospitals, and hospice organizations may also consider underwriting pre-hospice programs.

The momentum has been fueled, Gormand notes, by a movement to shift away from traditional payment systems and instead tap into models encouraged by the ACA. The current climate of uncertainty under the Republican threat to do away with the ACA, of course, may discourage additional experimentation. Demonstrated savings may or may not result in funding for transitional palliative care programs to continue if and when healthcare regulations undergo a transition of their own.
1 “‘Pre-Hospice’ Saves Money By Keeping People at Home Near End of Life

3 California Healthline:



Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at or 828-230-0895.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


by Tim Rowan, Editor and Publisher

Talks have been continuing for a number of years about what can best be described as concern over the image of the U.S. healthcare segment we call Healthcare at Home. Specifically, there is concern over how that segment is represented before Congress, regulatory agencies, and the press, and how to help the entire segment by improving its image.

The segment, of course, includes medical and non-medical in-home care, hospice, palliative care and homemaker services across the full spectrum of public and private payers.[Rowan presents an overview  of recurring but informal discussions about need for the healthcare at home industry to change its public image and for the industry to present a unified voice  for healthcare at home issues. Early  beginnings of the developing organization ElevatingHOME are noted as is the need for such a representative body to address the needs and concerns of the healthcare at home industry.Earliest players in thie new organizatiuon are identified near the end of this article, and include: utter Care at Home, the VNA Health System of Shamokin, Pennsylvania, Fazzi Associates, and the Council of State Associations.]

These conversations of which I speak are not official talks. They are not high-level summits at publicized seminars — though they often take place during state and national conferences — nor are they heard from stages over microphones. No, these are talks held in hotel lobbies and restaurants, attended by small groups of industry leaders, individuals with names you would recognize, CEOs and corporate board members of some of the largest and most influential Healthcare at Home providers in the nation, and, occasionally, a reporter.

There was one exception. The same concerns that were being shared in after-hours meetings burst out in a public form just once in this writer’s experience. The occasion was the Homecare 100 closing general session, February 2016, in Austin, Texas. It was an open discussion, guided by a moderator, who clearly had no idea what was coming.

In the midst of a familiar group conversation about what our industry needs and where it is going, with no prompting from the moderator, the discussion took an unexpected turn. One by one, and with no apparent pre-planning, individuals stood and asked what everyone wanted to do about “the sad state of our representation in front of Congress and MedPAC and CMS.” The first to say it out loud was buoyed by nods and murmurs and several other supportive comments from peers that “something needs to be done.”

Those industry leaders who had met at a restaurant table just the night before caught each other’s eyes across the crowded room as if to confirm that their surprise was mutual. None of those leaders were the ones standing up and complaining. Every comment came from someone who had never said it out loud before. C-level executives from both large provider agencies and their supporting technology vendors are the only ones invited to Homecare 100 and they were the ones who changed the direction of that 2016 conversation.

Fast-forward one year. Essentially the same people are assembled in Florida for Homecare 100 2017. VNAA President and CEO Tracey Moorhead addresses the room, from the stage this time, about findings from research she had conducted since last year’s meeting. “I identified 14 separate organizations that speak to Congress and CMS on behalf of Healthcare at Home,” she said. “It is no wonder Representatives and Senators from both sides of the aisle ask us – and they do – why we cannot speak to them with one unified voice.” The solution she hinted at that day is the one she formally announced on another stage 3,000 miles away this Wednesday afternoon.

To have an impact, to ever hope to lobby Congress and MedPAC and dialog with CMS as one unified industry voice, ElevatingHOME needs to attract members. Three clues say that it will.

First is the collection of spontaneous comments at Homecare 100 2016, described above, combined with the resounding applause following Ms. Moorhead’s hints of a new association during Homecare 100 2017.

Second is the new board’s commitment to transparency and a member-driven agenda. They underscored that commitment by inserting language about fiscal transparency and forbidding nepotism into their by-laws.

Third is the impressive list of charter board members and member organizations, most of which had canceled their memberships in the leading national association years ago, putting their resources behind two separate efforts, the Association for Home Health Quality and Innovation, with an educational mission, and the Partnership for Quality Home Health, an advocacy group.

Helping to launch ElevatingHOME are Bayada Home Health, Alacare, Trinity Health at Home, Sutter Care at Home, the VNA Health System of Shamokin, Pennsylvania, Fazzi Associates, and the Council of State Associations, which itself was formed over ten years ago out of dissatisfaction with the NAHC-controlled Forum of State Association Directors. Each of these organizations has lent an executive to the new board; Bob Fazzi will coordinate early strategic planning efforts.

The goal to unify the industry is lofty and will not be achieved in a year, maybe not in five. But it is possible. You will know if it is coming true if you see for-profit providers exercising the same option non-profit providers have always had, to wit, to join either NAHC or the VNAA or both. Many for-profit providers have already joined ElevatingHOME and certainly many more will, as soon as they see its value and compare it to the value of their current membership.

No one has ever expressed a single negative comment – at least not within this writer’s earshot – of the quality of the legal and clinical consultations NAHC provides to its members. On the contrary, what is usually heard is that access to these services is the only reason they maintain their membership, in spite of any negative opinions they may have.

While we admire the patient-centered, industry-promoting altruism of the new organization’s board and CEO, and wish that all national associations mentioned transparency and nepotism in their by-laws, we know that these next six months are critical. They will have to demonstrate not only altruism and transparency but the ability to replace the educational, advocacy, and consultative services to members that for-profit providers considering switching allegiance would be giving up.

Perhaps a miracle will happen and ElevatingHOME will work cooperatively with every other national association. The last thing a struggling industry needs is internal rivalry. As Tracey Moorhead said to me this week, “At the end of the day, are we not stronger together?”

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.