Maribel Health CEO on Trends in Home-Based Care Model Adoption

Maribel Health designs and operate home-based clinical care models to help expand total health system capacity. Adam Groff, M.D., M.B.A., the company’s CEO, spoke with Healthcare Innovation about the growth of home-based care, the recent merger between two hospital-at-home vendors, and the short-term extension of the acute hospital-at-home waiver by Congress.

In 2023, Maribel announced a partnership with St. Louis-based Mercy, one of the 25 largest U.S. health systems, to co-develop care-at-home programs, including Mercy Hospital@Home. Maribel Health offers clinical workflows, operating capacity, training, automation, and technology to clinical teams to provide care outside hospitals or clinics.

Healthcare Innovation: Before we talk about Maribel and the hospital-at-home space, could you talk a little bit about your background as a physician entrepreneur? 

Groff: I’m still a hospitalist at Dartmouth Hitchcock. But I got started in the home-based care space with Bayada, in southern New Jersey. I helped start their hospice work and home-based primary care. I helped start a company called Go Health, which does urgent care joint ventures with health systems; WellBe, which does PACE programs; and a company called Better Life Partners, which does substance use disorder treatment in the icommunity. Maribel is the most recent one. It’s kind of at the intersection of everything I’ve done.

HCI: And you co-founded Maribel  with Dr. Ronald Paulus, correct? 

Groff: Yes, he did a quality technology company that ended up going public, and then was bought by Premier, the GPO informatics company. Then he was the first chief innovation officer in the United States at Geisinger. Then he went to Mission Health in Ashville, N.C. and was the CEO there. Then he was an executive in residence at General Catalyst, and with General Catalyst we launched the company together.

HCI: I have written quite a bit about the acute hospital-at-home space, but it seems like that is just one of the areas of innovation in the home-based care space. There are models around SNF-at-home, for instance. Are some of those waiting for the reimbursement models to develop? 

Groff: It depends on how you define the model. Hospital at home is in many ways a very generic term. Every organization defines it a little bit differently. The acute hospital care-at home waiver is one flavor of that. But health systems that have bought or built or done joint ventures in home health and hospice have post-acute models where they’re doing home infusion. They have remote patient monitoring. So we are really looking at it as a spectrum of care. Many organizations have home-based primary care inside of their primary care practices. 

In fee for service, there are a limited number of options, but RPM and telehealth and hospice are reimbursed. Infusions is another one that people have been leaning into. On the value-based side, if you’ve got a shared risk contract, there can be a lot of rationale for home-based care in order to reduce ED or inpatient days.

HCI: Well, zeroing in on the acute hospital-at-home space, can you talk about some challenges that the health systems face when they’re trying to scale them up?

Groff: I think there are three main things that we hear a lot about. The first is just having the right knowledge on how the program works, operationalizing it, the jobs to be done and the technology. So there’s a lot of just getting up to speed. Another part is related to the workforce, and making sure that there’s efficiency and data transparency. Whether that’s using an EHR like Epic, or using supplemental technology, it helps with the logistics and coordination in this unique model. A third piece is once they have the right technology and other systems in place, it’s growth and scaling. 

HCI: And as they grow, they have to deal with more logistical complexity and more workflow orchestration, right?

Groff: Yes. We call it care orchestration. It’s a lot harder in a distributed model, where patients are at home and you’ve got things that are moving around. It’s not all in one location. Focusing on the people, the assets and the information in the distributed environment requires a new way of operationalizing systems. I would say the EHRs are not designed necessarily for this kind of care orchestration. Secure chat is how the care managers, care navigators and discharge planners orchestrate this.  A lot of programs will use Microsoft Teams, and then it’s a lot of Excel spreadsheets and Post-It notes and whiteboards.

HCI: We just saw a merger between two of the larger players in the market, DispatchHealth and Medically Home. Are there some things that make sense about that merger, and maybe some challenges they will face coming together? 

Groff: I think it’s very positive for the industry to bring them together. Dispatch and Medically Home have been pioneers in the space. There are a lot of complementary capabilities that they bring to bear. Dispatch has historically been more an urgent care type service in the home, particularly partnering with Medicare Advantage plans. Medically Home has been really focused on inpatient level of care through the waiver program, and they’ve had some overlap, but bringing them together does round out the spectrum. So you’ve got services expansion between the two. You’ve got probably a wider payer mix. You’ve got a scale right across many different health systems across the country.

HCI: But are there also some challenges for them? 

Groff: Well there are both internal and external challenges. Mergers are always difficult. Blending teams and cultures is always challenging. Then there are the broader external market dynamics. The number one thing that’s front-of-mind is helping existing hospital-at-home programs grow, and making sure that there’s regulatory support when it comes to the waiver. I think everybody’s struggling with the same issue.

HCI: Congress just extended the waiver, but only for six months. Does that add to the uncertainty for health systems that haven’t created programs yet? 

Groff: If you’re on the fence and trying to decide if this is the thing that you want to do to solve your capacity issues, I do think that the uncertainty in the extensions gives people some pause. But what we’ve been hearing is that more organizations are taking a higher-level strategic look at what are the different capabilities and opportunities to solve the crux of the problem, which is almost always focused on capacity. Whether that is inpatient capacity, ED capacity, the throughput issues that lots of folks are having with getting people out in the home and community, and the inevitable march toward value-based care and how they can manage quality or total cost of care. Hospital at home is one potential solution in that. 

Given the waiver uncertainty, what we’re hearing is let’s go up another layer and really understand how we should think about this and where we should deploy resources. Some folks are still going down the hospital-at-home path, because it’s really a chassis in certain aspects for addressing the spectrum. What we would argue is that it needs to be a broad, strategic approach to using home- and community-based care to unlock capacity.

HCI: Are there still things that still need to be researched about quality compared to care in the hospital setting, or reimbursement levels for CMS?

Groff: I think it makes a lot of sense that for CMS to ask the questions around what is the right clinical model and intensity. I think it’s a fair and open question to ask what kind of flexibility could be baked into the clinical model, and then what kind of flexibility could be baked into the reimbursement model. I think that it’s fair to say that that is not settled, because it’s really much more about the operating model, and you want to have a very safe and effective operating model that works both in the traditional fee-for-service world as well as for organizations moving toward value and risk. So there’s an awful lot of opportunity to hone and optimize, or at least provide the flexibility so that we can learn more about what works.