opportunities
A new openness to funding home health and health-related social needs creates new opportunities in care.
SDOH, healthcare in the home, and value-based care are changing the care experience
Addressing the social determinants of health (SDOH) as a central pillar of quality care continues to become more and more mainstream. SDOH is increasingly braiding with other critical trends in the healthcare industry, like healthcare at home, value-based care, and more tech-forward innovation (e.g., personalized health AI). Together, this is giving rise to a new imagination on how to meet individuals’ healthcare needs, and it’s creating urgency to find more effective and efficient ways to meet those needs. For example, there are clear linkages between SDOH and the provision of healthcare at home. With 80%+ of older adults wanting to age in their home, innovators are creating new models for an increasing scope of care that can happen at home (up to 30% of what’s traditionally considered inpatient care).
The health system is walking the SDOH walk
This is the future, and we have evidence it works. For instance, in 2024, the Centers for Medicare & Medicaid Services (CMS) approved Section 1115 waivers for states including Delaware, New Jersey, and Washington that enable the provision of services like housing supports and nutritional assistance to Medicaid beneficiaries. States like California, Connecticut, Hawaii, Illinois, New Mexico, Pennsylvania, Rhode Island, and Vermont had pending requests in 2024 to implement similar SDOH-focused initiatives. Medicare Advantage plans have increasingly incorporated services that address Social Determinants of Health (SDOH) to enhance overall health outcomes. For example, SCAN Health launched myPlace Health an integrated care delivery organization to provide personalized care to older adults that enables them to remain in their homes and communities.
Who is talking about this
Elana Berkowitz Springbank
Jake Rothstein Upside
Michael Skaff Sequoia Senior Living
Home health and recognizing/paying family caregivers could have some tailwinds in this new administration, as well as possible Medicare Advantage supplemental spend being able to go towards more preventative / holistic care.
Elana Berkowitz
Co-Founder and Managing Partner
springbank
We're experiencing strong momentum in the Managed Medicaid market, with increasing interest from CMS and state Medicaid agencies in integrating health-related social needs. Payment mechanisms to support these initiatives are becoming more defined, which is a positive step forward. Additionally, housing remains one of the most pressing and unsolved challenges in this space, and there’s a clear push to identify effective solutions for this critical need.
Jake Rothstein
Founder and CEO
Upside
Medicaid waivers are proof that the government is willing to redirect Medicaid funds into alternative funding contexts. This will be a tailwind for home-based care, allowing new technologies to support people in staying safe in their homes for longer.
Michael Skaff
Chief Information Officer
SEQUOIA SENIOR LIVING
challenges
Healthcare payers grapple with cost and labor pressures to economize.
The pressure continues on care delivery
The core service delivery of our healthcare system as we classically know it is under immense pressure. Collectively, we have not recovered from the emotional and physical tolls of the pandemic, which strained the labor force, drove up the cost of delivering care, and drove up the need to address deferred healthcare issues. We’re also older than we’ve ever been. By 2034, those 65 and older are projected to outnumber children under 18 for the first time in U.S. history. Premiums feel too high to consumers, wages feel too low to the healthcare workforce, and margins feel too low for all health services organizations–and it all demands more precision in care delivery.
New models are emerging
Something must give, or perhaps more likely, everyone must give. Payers will need to form new partnerships to manage costly care upstream (e.g., Maryland joining the federal AHEAD model to manage care costs upstream). Providers will need to reimagine care delivery models (e.g., Pine Park Health provides holistic in-home care directly within senior care communities). Innovators will need to find ways to create new value from integrated data (e.g., Waymark coordinates Medicaid care across Community health workers, therapists, pharmacists, pharmacy technicians). We should look for other systemic answers, too; lest we forget, whereas there’s a shortage of professional caregivers, there are over 53 million unpaid family caregivers waiting to be equipped with new tools to care for their loved ones and compensation for their work.
Who is talking about this
Chris Waugh Sutter Health
Jessie Wild Sneller Clover Health
Julie Wroblewski Magnify Ventures
Maria Thomas Sunday Health
Sharon Cilione COMCAST
There is too much disease burden and not enough provider capacity to meet the need. That holds back healthcare’s ability to go upstream on the prevention side.
Chris Waugh
VP, Chief Design and Innovation Officer
sutter health
There are increasing network costs across different domains of healthcare – hospitals, pharmaceuticals, specialists, etc. These systemic pressures necessitate a fundamental overhaul, and innovative models show the potential of integrated, technology-driven care. The key is scalability, transforming these innovations into broad solutions for a more efficient and equitable healthcare system.
Jessie Wild Sneller
VP and Chief of Staff
clover health
Over the past year, the financial strain on healthcare systems, particularly due to inflation and rising labor costs, has worsened significantly. The economic pressures from rising operational costs (especially in senior care and home healthcare) were exacerbated by the broader economic slowdown and supply chain disruptions. This has led to increased pressure on health plans to reduce spending, while still managing high levels of demand.
Julie Wroblewski
Co-Founder and Managing Director
Magnify Ventures
Our healthcare system is experiencing a significant shortage of providers, driven by factors such as an aging population, provider burnout, and an insufficient pipeline of new healthcare workers. As demand for care rises while the supply of providers struggles to keep up, financial pressures on the system are likely to increase due to higher labor costs, increased patient wait times, and greater reliance on expensive temporary staffing solutions.
Maria Thomas
Co-Founder and CEO
Sunday Health
The wrong things are incentivized when it comes to health. It’s more transactional than holistic because that’s what has been done historically and how payors and providers are set up to run. How can you efficiently and effectively turn things around to be patient centric with all of the innovation that’s happening in the space?
Sharon Cilione
VP, Emerging Products
comcast