At-Home Healthcare After COVID-19

With the rapid spread of COVID-19, at-home healthcare became more important than ever. But how were healthcare providers able to pivot to provide adequate care to patients who were already struggling to manage their chronic health conditions? GLG’s Frank Fox spoke with former GLG Social Impact Fellow and CHW Cares Founder Manmeet Kaur to learn more about the home care industry before COVID-19, how companies like CHW Cares adapted to meet the increased demand, and the challenges these companies are still working to address.

Could you give us an overview of the CHW Cares business model and where the company stands today?

I started what was then called City Health Works as a health coaching business 10 years ago, hiring and training people from the community that we served. We began in East Harlem and Central Harlem, hiring folks without a high level of prior training or credentials. We developed an intensive training system around motivational interviewing, which was how we hoped our employees would be able to relate to and motivate people regarding their health, particularly because we were focused on chronic conditions. We would then build their chronic disease health managements skills, grounded in evidence-based guidelines.

Sometimes I joke that what we established may not have been very innovative because of those evidence-based guidelines for good chronic condition management, which should be ongoing and heavily involve the patient. But realistically, we thought, how would these patients manage this on their own, without someone with these management skills involved?

So, we built training programs around people from the community, and then a clinical supervisory layer of dietitians who would work with the corresponding doctor’s office, communicating back and forth. We partnered with clinics like Mount Sinai or Federally Qualified Health Centers in New York City, as well as with clinics in Albany, that would send us patients who had persistent poor clinical control of their chronic conditions.

Overall, we achieved a net promoter score of 90, reduced total cost of care by 30% in relation to controls, and our conversion rates were between 50% and 75% of enrolling patients.

When COVID began, we had just converted from nonprofit to for-profit and had adapted the business model to become a provider instead of a service that we would try to sell to value-based providers in the wake of the pandemic. We evolved into an integrated provider, with an MSO-PC structure, acquiring a large practice of about 14,000 patients in New York City and partnering with a value-based payer.

What care gaps were you seeking to fill in the primary care space or home health space when you founded CHW Cares?

I was interested in creating a business to develop a new type of worker category that could generate high value and create an opportunity for low-income folks. Over time, I realized that I was building a care-delivery system around a gap: chronic condition management for rising-risk patients, or folks who are not in active crisis. Nothing as serious as severe mental illness or uncontrolled or poorly controlled drug abuse, but the largest segment of our population that has health burdens, people with chronic conditions who need more attention.

It turned out that there is a lot of misinterpretation when a patient is overwhelmed, stressed, or doesn’t have strong health literacy skills. We wanted to enable the patient to better understand and manage their chronic conditions, like diabetes, by using a nonclinical workforce that’s integrated into the patient’s primary care team, that will visit the patient at home to provide a relaxed, comfortable setting as opposed to in a hospital or clinic.

Has the healthcare landscape for companies like CHW Cares changed significantly over time, or do those care gaps still exist?

That gap is still tremendous. There has been an extraordinary increase in interest in digital health for a long time, but I’m struck by the overemphasis on that versus in-person care for sicker, older adults, who need the most healthcare.

Companies are beginning to recognize that a digital-only approach causes a lack of patient engagement. I don’t think that enough companies are working to integrate the best of technology with human capital and logistics well enough to bring care into the home, but I do think the interest is growing.

CHW Cares works with insurers on value-based contracts. What challenges do you face that might still exist in the market today?

When we acquired a practice, they were fee-for-service. We had the intention of moving these patients from that format into value-based and formed a partnership with a health plan. We initially faced, as an outsider, a challenge in this plan’s ability to market and win the trust of patients. The plans that this payer brought in were strong compared with what the patients had, but the patients had such loyalty to the brands and health plans they were already familiar with, so this went nowhere.

Additionally, this brand’s sales pitch seemed almost too good to be true. I think that, to scale many of these solutions, existing health plans need to play a larger role in changing contract structures and develop that sophistication.

We also saw that although there were a lot of strong features with this value-based plan, you can’t simply shortcut core functionality. If you don’t fully meet a patient’s expectations, you’ve already lost them.

Overall, the power of legacy brands, both on the provider and payer side, plays a large part in patient decision-making because that brand recognition and inherent trust is already there.

With increasing attention and improved reimbursement for at-home care, where do you foresee the future of home health services?

With the data that’s been collected since COVID began, we can see that there was a huge burst of digital and the telehealth service, but it tapered off. Over time, as we become more accustomed to doing more at-home, the demand will continue growing. It will likely be a hybrid. Companies that figure out the right mix of logistics and human capital and training and recognize how to integrate with existing healthcare providers and payers will find success and add value into patients’ lives.

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About Manmeet Kaur

Manmeet founded City Health Works (CHW) in 2012 to extend the reach of primary care into the home by building a neighborhood-based, technology-enabled health coaching service. CHW’s chronic care coaching solution has been externally validated to deliver a 4:1 ROI and significant clinical improvements among vulnerable seniors. In 2021, Manmeet relaunched the company as CHW Cares, a value-based provider that served 14,000 patients annually in Washington Heights, New York. In late 2022, Manmeet sold the medical operation of CHW Cares to Oak Street Health (NYSE OSH).

Before launching CHW, Kaur worked with community health workforce initiatives in South Africa, India, and New York City. Her work emphasizes the link between fostering high-quality service operations and high-quality jobs to elevate livelihoods and health.

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This healthcare article is adapted from the GLG Teleconference “Care Delivery Systems.” If you would like access to the transcript for this event or would like to speak with healthcare experts like Manmeet Kaur or any of our approximately 1 million industry experts, contact us.