Home Care Margins: Sustainability & Growth Strategies
Home-based care providers grapple with reimbursement challenges reshaping their financial landscape. Rising labor costs, the expansion of Medicare Advantage, and stagnant reimbursement rates demand strategic adaptation for survival and growth. News Directory 3 explores how providers can fortify their margins. Discover essential strategies like precise cost reporting,fostering robust payer relationships,and optimizing operational efficiencies. Industry leaders emphasize the shift toward episodic contracts and the critical importance of a strong clinical team. Advocacy groups push for crucial policy changes to address reimbursement inadequacies, while a focus on network adequacy within Medicare Advantage is paramount. How are these challenges reshaping the future of home-based health, and what innovative solutions are on the horizon? Discover what’s next …
Home-based Care Providers Navigate Reimbursement Challenges
updated June 03, 2025
Home-based care providers are facing increasing pressure on their financial margins. Industry leaders say that precise cost reporting, strong payer relationships, and efficient operations are crucial for overcoming these challenges amid rising labor costs, the growth of Medicare Advantage (MA), and stagnant customary medicare reimbursement rates.
Jason Growe, CEO of LiveWell Partners, emphasized the importance of a strong clinical team delivering high-quality care. LiveWell Partners, based in St. Louis, operates in several Midwest cities.
Growe said that LiveWell focuses on securing a favorable payer mix, aiming for a balance between traditional Medicare, private episodic contracts, and per-visit rates. He noted a possible shift toward episodic contracts due to the evolution of Medicare Advantage.
Joe Shannon, vice president of business development at HomeCentris Healthcare, said his organization has found success with local and regional MA plans, particularly in private duty personal care, by building strong relationships with referrers and payers.
HomeCentris Healthcare, based in Owings Mills, Md., offers various home-based care services.
The National Alliance for Care at Home (the Alliance) is advocating for policy changes with CMS and Congress. Scott Levy, chief government affairs officer, said the Alliance aims to broaden policymakers’ understanding of margin and profit beyond Medicare fee-for-service.
Levy added that the Alliance is working with MA plans to understand contracting elements and highlighted the lack of network adequacy for home health in Medicare Advantage.
he also noted the importance of accurate cost reports, as advisory bodies like MedPAC rely on this data to set reimbursement rates.
“We have a fine focus as it relates to protecting margins on our operations,” Growe said.
“we’re trying to change that narrative so they understand that our members who are providers treat all Medicare beneficiaries, irrespective of whether it’s a Medicare fee-for-service or Medicare Advantage,” Levy said.
What’s next
Home-based care providers will likely continue to refine their strategies for navigating the complex reimbursement landscape, focusing on building strong relationships with payers, improving operational efficiencies, and advocating for policy changes that support lasting margins.