Creating a Home Health Care Virtuous Cycle to Improve Clinical Access and Maximize Reimbursement

The demand for home health care has risen dramatically in recent years, with demand often exceeding capacity—even forcing agencies to turn away referrals.¹ At the same time, clinician turnover remains high, heavy backfilling of roles is required, and payment models are changing. Home health agencies have an ongoing need to recruit, onboard, and retain nurses in an attempt to solve this gap in clinical capacity.

There are two additional problems at play, with the first being increased demographic demand:

According to data from the U.S. Census Bureau, the number of people aged 65 and older in the United States has grown to approximately 59.3 million in 2025.² Every day 10,000 more people turn 65 and qualify for Medicare,³ and by 2030, every member of the Baby Boomer generation will qualify for Medicare. That means Medicare spending is expected to more than double over the next decade due to increased enrollment and health care costs. Complicating these factors is that more patients each year simply prefer to receive care in the comfort of their own homes.⁴

The second issue is clinical access.

• 11,000 new nurses enter home health each year to help keep up with the rising demand.

• Home care nurse turnover has increased by more than 12 percent over the past two years.⁵

• Approximately 118,000 nurses need onboarding each year to solve this growing problem.

• Increased numbers of higher acuity patients with complex conditions are now being referred to home health rather than inpatient care.⁶

This all adds up to more competition between agencies for a smaller field of nurses seeking jobs. Because of the rush to boost capacity in the short term, many of these new nurses will wind up receiving training created for other settings. Without their agency providing evidence-based education, nurses often feel pressure to turn to substandard or unvetted sources like YouTube, leading to a knowledge gap that can have serious consequences for patients. Complicating matters are the new reimbursement models introduced over the past decade that have shifted the industry to value-based care.

For all of these reasons, a holistic home health ecosystem has become critical to success; otherwise, agencies run the risk of falling into the home health vicious cycle.

The Home Health Vicious Cycle

Picture this scenario: Agency A has been experiencing high demand for the past several years, but they're having trouble keeping up with clinical capacity. Hiring new nurses in a competitive market has been challenging, and the nurses they already have are showing the telltale signs of burnout. Referral rejections are high, and morale is low. The decision is made to rush new nurse onboarding to boost clinical capacity in the short term and lower the rejection rate.

Lets see how that might play out:

 

 

So how could this have been avoided? Lets look at another agency that took a different approach and achieved the home health virtuous cycle.

The Home Health Virtuous Cycle

Agency B is experiencing the same unprecedented clinical demand affecting the entire home health industry. But they've found a superior training solution, one that offers excellent onboarding training, remediation training, and on-the-go clinical procedure education that they can utilize anywhere, even in the field.

 

 

Not only have they had a banner year in improving patient outcomes and satisfaction, the higher reimbursement rates they've earned now allow them to reinvest in patient care and staff, creating a virtuous cycle that can continue year over year. Staff are more satisfied, reducing burnout and improving patient outcomes. This makes Agency B a much more attractive place to work when hiring nurses in a competitive field, giving them an advantage when finding the best talent. Staff satisfaction is improved, clinical competency is high, the patients are receiving the best possible care, and the agency continues to thrive.

 

How Medbridge Can Help

Traditional pen-and-paper onboarding isn't enough to keep up with the rapid changes to home health that have occurred over the past few years. You need an entire digital ecosystem to support your growing clinical capacity needs. Medbridge’s In-Home Essentials provides a comprehensive solution that addresses all of these challenges, allowing home health agencies to support nurses along their entire career path. From onboarding to career advancement, our solution allows nurses to quickly master necessary home health skills, access high quality training on the go, and learn advanced skills to provide even patients with the most complex needs the best care possible. Medbridge is already providing these solutions to top home health agencies around the country. 

Medbridge Skills 

Gain more visibility into staff readiness with a digital solution that simplifies skill acquisition, evaluation, and documentation training. Medbridge Skills help you meet audit requirements, and ensure your staff are trained on your organization's unique approach to care delivery, specialties, and protocols. Our simplified digital platform gives preceptors effective tools for properly reviewing, correcting, and signing off on key skills more efficiently, with the ability to bulk review assessments in as little as one click.

The Medbridge Clinical Procedure Manual

The Clinical Procedure Manual provides clinicians with a single, reliable source of truth to ensure consistent and accurate care delivery. With tablet-ready, easily searchable procedures approved by an expert review board, the Clinical Procedure Manual helps empower clinicians at the point of care and reduce variability in clinical practices through standardized protocols.

Education Tools

Interactive educational content engages learners more deeply by providing hands-on, visually rich experiences that promote better knowledge retention. For clinicians, this means access to interactive training modules, case-based learning, and real-time assessments that align with HHVBP metrics such as functional improvements and patient satisfaction. These tools, which are part of the Medbridge Home Health & Hospice Solution, help standardize practices across teams, ensuring consistency in care delivery and accurate data collection for performance reporting.

The Medbridge Patient Engagement Solution

Keep patients activated, inspired, and on track between home visits with easy-to-assign exercises and educational modules. By integrating interactive training content and patient-focused solutions into their workflows, home health agencies can enhance both staff preparedness and patient involvement, directly impacting the metrics that matter most.

Conclusion

The home health industry is facing an inflection point, with agencies simultaneously staring down record demand and also monumental challenges. By adopting an ecosystem model, agencies have the opportunity to come out of this crisis moment stronger than ever, staff satisfaction improves, patients receive the best possible care, and your agency continues to thrive. How each agency decides to proceed will determine whether they'll be treading water while caught in a vicious cycle, or riding the virtuous cycle to the benefit of their staff and the patients they serve. For more information on how Medbridge can help, request a demo.

_References

_{1. https://homehealthcarenews.com/2023/08/amid-historically-high-rejection-rates-heres-how-home-health-providers-are-maintaining-positive-referral-relationships/}

_{2. https://www.consumeraffairs.com/homeowners/elderly-population-by-state.html}

_{3. https://www.hhs.gov/aging/index.html}

_{4. https://www.mckinsey.com/industries/healthcare/our-insights/from-facility-to-home-how-healthcare-could-shift-by-2025}

_{5. https://homehealthcarenews.com/2024/07/home-cares-industry-wide-turnover-rate-reaches-nearly-80/}

_{6. https://www.mckinsey.com/industries/healthcare/our-insights/from-facility-to-home-how-healthcare-could-shift-by-2025}