As health systems double down on hospital at home, tech retailers retreat and the federal government proposes a 6.4% payment decrease, home health organizations are facing a new wave of industry pressures.
“Hospital at home isn’t dying, it’s just shedding its tech tourism phase,” Michael Maniaci, MD, chief clinical officer of advanced care at home for Rochester, Minn.-based Mayo Clinic, told Becker’s. “What’s left are the true builders: health systems, digital clinical leaders and care-at-home architects who know how to deliver complex care outside four walls.”
Fifty years after opening its doors in Philadelphia, Moorestown, N.J.-based Bayada Home Health Care’s footprint now spans across 22 states and six countries. Appointed CEO in 2017, David Baiada led the company’s transition into a nonprofit organization in 2019.
Mr. Baiada spoke with Becker’s about the lessons his organization has learned over its 50-year history and how it is preparing for the future.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Reflecting on Bayada’s 50-year anniversary, what has been the most transformative lesson you’ve learned about scaling home healthcare?
David Baiada: The most transformative lesson I’ve learned is that meaningful scale in home healthcare only happens when operational discipline is deeply aligned with our core cultural values: compassion, excellence and reliability. Over the past 50 years, we’ve grown from a single office in 1975 into a global organization serving tens of thousands of clients. We’ve seen that simply expanding infrastructure and systems isn’t enough.
True sustainable growth has to stay rooted in human connection and purpose. In fact, the bigger and broader our reach becomes, the more intentional we need to be about reinforcing our mission-driven foundation. At Bayada, we’ve learned firsthand that operational scale, anchored in our cultural commitments, is what enables us to deliver meaningful, lasting impact.
Another key to long-term success has been our advocacy through Hearts for Home Care, the grassroots movement we launched by transitioning our government affairs office into a broader, more inclusive platform. Hearts for Home Care unites employees, clients, families and the larger home care community, to raise awareness and influence public policy on behalf of home care. By giving our stakeholders and the entire industry a collective voice, we’ve been able to advocate more effectively for the needs of clients and employees, something that’s become especially critical as we continue navigating fluctuating reimbursement rates and ongoing threats to Medicaid.
Q: The home health landscape is rapidly evolving with new payment models, technologies and patient expectations. What trends are you most focused on today that you believe will define the future of home healthcare?
DB: We’re closely tracking three critical trends shaping home health care: evolving payment models, the integration of advanced technology and AI, and rapidly changing workforce expectations. First, new reimbursement structures, particularly Medicare Advantage and state budget pressures, are pushing providers to clearly demonstrate value, including improved outcomes, client satisfaction and cost efficiency. Second, AI and automation present enormous opportunities to enhance clinical productivity, streamline documentation and scheduling, and allow caregivers to focus more deeply on personalized client care. Third, the modern workforce increasingly prioritizes flexibility, career growth and meaningful employment.
Providers need to prepare by investing strategically in scalable, technology-enabled care delivery systems that uphold our fundamental commitments to client-centered care. At Bayada, we refer to this next strategic phase as “The Scale Years,” which means leveraging technology to balance human compassion and operational efficiency. The future demands both, and that’s exactly how we intend to lead.
Q: As you look to the next 50 years of home healthcare, what one key issue is the healthcare industry overlooking or underestimating right now?
DB: The healthcare industry is facing a profound crisis of transformation. Aging baby boomers are driving unprecedented demand just as our system is already strained, with limited capacity, tight resources and declining reimbursements. Compassionate care, the very heart of healthcare, is under enormous pressure at the exact moment clients value it most.
Home-based care offers a powerful answer. It provides compassionate, personalized care in the settings clients prefer and often at a lower cost. Yet despite its importance, this indispensable part of the healthcare continuum receives some of the smallest levels of financial support and reimbursement.
For too long, home care providers have worked within the constraints of existing programs. But it’s time to think and act differently. We need to embrace broader, more holistic solutions to meet client-centered challenges, stepping beyond conventional boundaries, unlocking funding, creating new services and staying rooted in compassion and purpose for the well-being of clients and their families.
We also need to advocate more boldly. Federal budget decisions continue to put home care at risk, with programs like Medicaid-funded services still considered “optional” despite being cost-effective and overwhelmingly preferred by clients. Ensuring policymakers truly understand the value of home-based care — and the consequences of underfunding it — is critical to protecting and expanding access for the growing number of people who depend on it.
