A couple months ago (yes, behind on posting), Dr. Pippa Shulman and I co-led the final session of the Health Evolution Roundtable on Integrated Home-Based Care, a group we've convened for four years with co-chairs Dr. Hal Paz and Dr. Mona Siddiqui (and co-chairs emeriti Dr. Patrick Conway and Dr. Jaewon Ryu). 

As this work folds into Health Evolution’s new Executive Forum, we used our time to ask: compared to four years ago, are we actually better off?

Five threads ran through it all:

Payment reform: The gap between what home-based care proves clinically and what gets reimbursed hasn't closed. But there are bright spots: high-performing MA/D-SNP value-based partnerships, strong ACO performance, PACE growth, and supportive CMMI experimentation.

Technology & AI: Tech has evolved from nice-to-have to full care-orchestration infrastructure. But it's only worth it if we can measure what it produces, especially for value-based providers underwriting these investments. And, for complex patients, hybrid models are a bare minimum—AI and RPM have a role to play, but these patients will require engagement from in-home and virtual providers armed with new tools and data to expand their reach.

Workforce: Staffing has diversified to include a range of provider types, and formerly facility-based providers often get a second wind in home-based models. However, retention is hard-won. And we still haven't solved for unpaid family caregivers carrying enormous weight without support, a gap that doesn't get enough airtime relative to how much it matters.

Partnerships: No longer just a growth tactic. Increasingly foundational, as payers, health systems, at-risk primary care groups, and senior living facilities seek partners to help care for complex patients at home.

Access: The throughline across every year: care's future is outside the hospital and the clinic. Reaching rural and underserved urban communities will take creativity and hybrid models.

The gaps don't close on their own. They close because leaders across government, payer, provider, and investor seats keep showing up for candid conversations, the kind where you talk about what went wrong as much as what went right.

At ConcertoCare, we are fortunate to partner with some of the country’s leading health plans to ensure that seniors and other adults who have complex health conditions receive the kind and of high-quality care that any of us would want for ourselves, our families, and our friends.

Mostly, this was a chance to say thank you to the Fellows who've shaped how an industry thinks about care beyond the hospital and clinic. Special thanks to Sade Taylor and the entire Health Evolution team.

Onward, beyond the four walls, together.