Thus far in 2026, the home-based care industry has been rocked by regulatory shifts, an enrollment moratorium, Medicaid uncertainties from the One Big Beautiful Bill Act (OBBBA) and rapid technological advancements.

Choice Health at Home Founder and CEO David Jackson knows how these changes impact the home-based industry. Choice serves 15,000 patients across its home care, hospice and personal home care service lines and is approaching half a billion dollars in revenue.

Choice recently expanded into Florida and the Pacific Northwest through acquisitions, and Jackson said the provider aims to continue scaling in the Southern United States.

Jackson hinted that the provider may be entering a new geography: “Go West, young man,” he said on the latest episode of HHCN+ TALKS. Jackson also laid out how technology allows integration across its three service lines in ways that were not possible a few years before, and how he thinks avoiding Medicare Advantage is “foolish.”

A replay of that TALKS episode for HHCN+ members is below, along with a transcript of the conversation. The transcript is lightly edited for style and clarity.

HHCN: How would you characterize the year so far for Choice Health at Home?

Jackson: 2026 has been a great year, really, probably from the home health sector of our business.  

We’ve talked about the silver tsunami for years, but we’ve seen 20%, 25%, 30% organic same-store growth rates for a sustained period of time.

When we think about the first half of 2026, in terms of our home health segment, we’re really where we anticipated being late in the year. That’s been a real pleasant surprise when you think about volumes. Additionally, we anticipated the proposed ruling. This was something we were really pleased to see. It feels like advocacy and just people’s awareness of where the patient wants to be, as we try to take care of the Greatest Generation, is starting to be reflected in policy. We were excited about where that was. There’s still some trepidation there. I know we’re going to talk about that. Excited for where the business is.

I think the third thing that really is becoming very apparent in 2026 is that technology is moving so fast. There will be winners and losers as far as the vendors that provide the resources that we’ll use to take care of patients, but it’s exciting to see the developments. I’ve just been really, really pleased. For so many years in my career, technology was something that nurses may or may not want to be engaged in. They’re like, “Oh, this is EMR.” These are things that people are just really excited about.

From a midpoint perspective — and my chief growth officer, Trina Lanier, always tells me it’s the end of the year when we get to July, we’re going to start planning for ’27. I’m so excited about ’26. Solid volumes, great new technologies and a more optimistic regulatory reimbursement landscape.

Anything to add on the PCS side, hospice side?

Jackson: From both of those segments, the hospice benefit, the launch of the Hope Tool late last year, the implementation of that has gone relatively smoothly for our organization. I know it’s definitely challenging for small providers. I think that the clinician and the advocate in me want both. On a national level, we want to advocate for a lot of observation of how that tool is implemented and the ability for smaller organizations to do that. That’s gone really well. We have seen inside of our own organization some really steady data trends as far as how we care for the chronically ill patient. The new palliative proposal by CMS, as far as the initiative in home health, is exciting as we look at the two segments of care for us because we think that’s really— the idea should be there. Palliative and curative medicine should work hand-in-hand to deliver the optimal solution for every patient. And really allowing both segments to utilize that is important, especially as we contemplate in hospice, ‘how do we manage length of stay? How do we manage the chronically ill patient?’ This potentially gives us a new avenue in our home health segment.

In PCS the One Big Beautiful Bill had somewhat cast a shadow over the Medicaid portion of our business. For those of you that don’t know, our PCS division is also diversified. We’re roughly 55% Medicaid, 45% private pay. We have some diversity that makes things like Medicaid regulation less intimidating.

That being said, there was a really positive ruling in North Carolina yesterday that came out, really positive rate increase. We saw nine-to-one in committee in Arizona, support for a rate increase.

There still is a real considerable threat for rural hospitals. I think the states are recognizing that these are constituents taking care of constituents, and if you don’t enable that home and community-based services in the home, you would threaten your entire budget.

We’ve seen a real positive spin there. I think you can see it in Addus’ results as well, if you think about it on the public scale. In that division, we are very optimistic, given the shadow that loomed over as far as Medicaid changes.

I have concerns about rural hospitals, and I think home-based care is a possible solution there. You need to be proactively running towards solutions in rural communities. That’s something that’s important for Choice to serve both urban and rural communities, and so I think those concerns will linger.

That being said, I think investment in the PCS Medicaid space may have been unduly subdued because people were like, “Hey, let’s see how these states’ budgets shake out.” You’re starting to see the states make the really informed decision to support their home and community-based services when it comes to support of their constituents.

Do you anticipate a shift in the investment and dealmaking trends there?

Jackson: Choice is going to be very active in PCS. I like PCS. We’re very interested.

Looking to the second half of 2026, what are two or three of the priorities that matter most for Choice? It might be integrating recent acquisitions, building density, entering new markets or something else.

Jackson: My staff would joke that I would say, “Yes.” And that that would be the answer to this as far as what are the priorities.

But, we have actively been integrating the businesses. I think at Choice, what’s exciting as we near that half a billion in revenue marker, the 15,000 patient marker, we are very excited in that we still remain very balanced. Roughly, give or take, 33% in each segment of the business. From a scale perspective, we look forward five years out, and we want to be that business. We love what Health at Home says when they say we’ve taken care of people for 50 years. I’m so proud of them for that, and that’s something that we want to be able to say. That gives you a lot of freedom to build a business when you start thinking about things on that type of scale.

We’ve really been working on our financial backbone from the perspective of how we’re funded and how that strategy will be. We’re really excited about what we’re doing there to fund the next five years and how we’re going to continue to grow the business.

We’ve been focused on integrating the acquisitions that you mentioned. More importantly, we’ve never had the visibility, in my 25-year career, to see that a PCS patient is taking more time and assistance to clothe themselves. That should trigger occupational therapy opportunity for that patient to be taken, for that client of the PCS arm, to be seen and say, “Hey, they’re requiring more assistance. We can help them with our skilled arm.”

The CHF patient, this has been a burgeoning technology over the last 5 to 10 years, where now we can really see the trending to where we know, “Hey, the advance directive’s not in place. We haven’t really worked to educate the power of attorney about the hospice benefit. Let’s ensure that this patient is fully informed about end-of-life care, and that they can make decisions fully informed.”

One of the big goals and focuses for Choice is how can we use these new technologies to really enable our clinicians to empower these patients in their homes to make informed decisions about the resources that they have available to them. As we look at the back half of the year, we’re very proud of what we’ve built. We continue to integrate the newest acquisitions, but it’s more about “How do we take these two really complementary businesses and maximize that?”

My dad’s an oil and gas guy, and if he were sitting right next to me, he’d be like, “I’m not that medical. I’m going to leave that to you, David.” He will say, “Oh, yes, that makes sense. My home care provider and my home health provider should collaborate.”

That’s really a goal that has made sense for a long time, but now technology is opening doors for us.

What was the larger strategic thinking behind pursuing the Cy-Fair Health Care, Alliant Home Health, Palliative and Hospice Care and Senior Nannies Private Care deals?

Jackson: Yeah. What’s interesting about Choice having the three segments is if you really watch us, we typically will do a home health acquisition, and our home health team will be integrating the home health acquisition, and then we’ll do a PCS acquisition.

We had done a hospice acquisition, then we did PCS, and then we did home health. And in a few more months, we’ll add another hospice business.

But our hospice team has largely continued to work on integration during the last year. Versus a single-sector platform where you’re doing several acquisitions, that’s very stressful on your ops team. That’s something that we try to pay attention to. We don’t always execute on that, but we will be very cognizant of, “Is the last acquisition integrated? Do we feel confident? They’re on our EMR, on our financial system, on our human resources support system? Do we have all the overlays? Do we feel like the team is ready to tackle the next challenge?” That’s important to us.

The rationale, when you think about it from that angle, is pretty simple. It’s like, “Hey, give your ops teams time to integrate before you come back behind with another acquisition in the same space.”

It doesn’t always work that way. Oftentimes, home health and hospice businesses are running together. For the most part, they’re more leaned towards one segment or the other.

At Choice, we think about the C-level is really working for the segments, and then the segments have leads. At the C-level, our job is to facilitate interaction between the organizations. That allows us to do things like executive coaching, sales integration, planning, versus using one C-level to run all three. That’s one of the reasons I think we’re having success at this scale.

Any hints you can give us about the hospice deal you said is coming up?

Jackson: Well, I would just say, “Go West. Go West, young man.”

It’s exciting. We’ll continue to be in the South, but it gives us some substantial overlay and just some really good people, so we’re excited about it.

What made Florida the right next market? What does success in the South look like over the next few years?

Jackson: A few things. We quietly also moved into Washington, so we have a new office in Seattle. I’ll be out there at the end of the week. As we think about Florida specifically, we have Arizona, Texas and Florida. We have, over the last five years, been really focused on the Southwest. We continue to be very confident about our ability to grow the business in the Southwestern United States.

Phoenix, Maricopa County, is the size of a state when it comes to population. Harris County in Texas, DFW, these are 4 to 5 million population areas, MSAs. When you think about Choice and the success that we’ve had over the last five years, Florida is another state very similar to Texas and Arizona: a burgeoning group of geriatric patients. We’re excited to take care of them.

With that acquisition, we felt like, as we become a more national provider, having these three pillar states of Texas, Arizona and Florida, if you look at the growth and the population in those three states versus the broader country, that’s very simple math to say, “Hey, this is a great place to be.”

We also always are excited about new people to join our organization. Specifically, the team there, very motivated and solid vision for what we want to build at Choice. Taking care of people for decades at a time is something that resonated with them. As we mapped our culture, like, “Hey, this is good footing to jump in the state.”

Now, we’ll continue to work our way across the South. We’re excited about the Pacific Northwest, specifically, and I mentioned Seattle, Washington, because we feel like the cultures of our Denver offices, Salt Lake City, Boise, Idaho, in the future, and Seattle, they’re very similar clinician cultures.

As a physical therapist, I’m very cognizant of clinical culture by region. And so, “Can we build regions that have similar clinical cultures as we try to take care of people?” That’s important.

How do you balance breadth versus depth in terms of building density and entering new markets?

Jackson: When we think about the two, we want to have density. When you look at what Choice builds, we typically will look at roughly $80 million revenue in Greater Harris County in Houston, Texas. Similar story in Maricopa County in Phoenix. Denver, Colorado, is about a third of that and continuing to grow.

When we get around these large urban markets, we want to use them like hubs to a wagon wheel. We want to be large businesses in these urban MSAs, because that’s going to enable us to do satellite offices out into the rural markets and be successful. That’s one of the challenges in healthcare. If you look at some of the bigger, more successful hospital systems, they have these large, really attractive MSAs from just a financial profile. You can use them as hubs to serve the rural markets.

While we are starting to stretch across the map, we’re very focused on creating density. If you look at what we did in Florida over the course of a few months, we went well up over 2,000 total patients under care between the organizations that we put together. They overlap each other in a way that we can optimize operations, give us really good footing. We see Florida as having multiple MSAs that have that type of potential.

What tells you that the if a potential acquisition is really a fit for Choice?

Jackson: We have five cultural pillars at Choice. Patient-centered care. We want to be compliant. We are professionals. We always raise our hand like people get paychecks every other Friday. That’s important. We’re pros, but more importantly, we carry ourselves like professionals. We have processes and best practices that we adhere to. We want to be empathetic, meaning that smiles are free. We want to have a good time when we’re coming to work.

Finally, we want to develop people personally, personal development. That’s a little different than self-improvement, because a really good RN case manager may say, “Hey, David, I want to be a really good RN case manager. That’s what I want to be. I’m not interested in professional promotion.” The next question is, “Well, what do you want?” “I want more time with my family.” “Well, you haven’t taken a PTO day in a year and a half. Maybe we should mandate some three-day weekends, and you’re going to start spending more time with your family.” Or, “Maybe you want to read more books. Let’s find out what you’re going to read.” Those are our pillars.

Our mission is to enhance the life of every patient that we serve through the pursuit of excellent healthcare. Really, what we’re trying to gauge is, can we map our cultural pillars with things that they’ve said to their staff? Are these people really about that pursuit?

It’s really about the pursuit, because we’re going to make mistakes. People are going to make mistakes. They may say, “Oh, my goodness, my financials are a mess.” Are you working hard towards taking care of this group of patients? Do you want to improve? That’s really what we’re looking for. It’s, “How does that map?”

Now, I will say, family-run businesses, nurse-run businesses, typically, we like them. There’s a mission there, typically, a passion around it. Oftentimes, from a professionalism perspective, they had to create some margin for sustainability. Margins about sustainable healthcare. Those things are very attractive to us: businesses that have been around for some time.

What is the most important quality in a potential acquisition?

Jackson: Number one will be the patient-centric care and compliance. Compliance will kill a deal. It’s dead before it starts. We start with the compliance overview at Choice. We will have seen some financials, but we don’t do any financial diligence until after the compliance review. That is the imperative, is that patients are cared for in a compliant fashion. Really important in 2026.

Then we’ll move into the financial piece. As far as what’s most important, my message to people who are looking to sell their agency is you need to meet with accountants and be in GAAP accrual. You need to know what your agency is doing financially.

This is founder-to-founder telling people that. That’s just really important.

What we find a lot of times is that they have financial discipline around just understanding their financials. It may not be perfect, but they’re accurate. Then their documentation will be accurate. It’s very often the same thing.

Compliance is the imperative. So many of us are clinicians that found these businesses, and the idea around having an accountant is just so foreign to us. I have never regretted hiring a good financial person. Every FT we add is just more visibility and enables us to take care of more patients.

I think from an importance perspective, it’s, number one, compliance and patient-centric care. Number two, as a seller, you should know what your business is doing. Finally, are they magnets in their community to more patients? Are they the type of people that people send patients to?

Has your approach to M&A changed as Choice has become larger and more complex?

Jackson: I think we’re at 53 deals, including 24 since 2020. They’re all sizes, all shapes. For those of you that don’t know the story, it was three credit cards, a handful of people that trusted me to come to work at Choice back in 2007. We’ve definitely done the single license acquisition, up to much larger, multi-state deals. We learned something with every one of them.

The one thing that I always strongly encourage is, as a founder, you want your business to mean something. You want to stand behind the mission. You want to have built it on a pillar, on a foundation. We did a lot of work and really defined both the mission statement, the pillars, how we would map them.

That was the first real evolution of our M&A process. It’s like, “Hey, if we can’t get there, if we can’t get to this mission, if we can’t map that out, this may not be a good fit for us.”

The other thing that I’ve learned over the years is, if someone builds a business to sell it, it is not nearly as good as the nurse-founded home health agency where she had to take care of her patients, feed her family, do all those different things. That does create sustainable healthcare because they have to have those dollars in order to continue to be in business. As an evolution, it’s really those pillars, pursuit of the mission.

We’ve landed out in Florida. We’re going to pursue across the South. We think about the Pacific Northwest. As Choice becomes a more national platform, you will see us adhere to those two geographies as we build out. We have our Southwestern platform. We’ll be very disciplined around the Pacific Northwest and the South, Southeast as we build that out. The bigger you get, you’ll have these temptations to jump out into a different place and not follow the map that you’re running with. From a management perspective, that’s very difficult.

What are your growth goals in the next year or two?

Jackson: We’re going to build out the Southern geography. We are very excited about the Pacific Northwest.

Our goal over the next five years is to double our footprint in the Southwest and then achieve really what we achieved, over the last five years in the Southwest, in the Southeast and Pacific Northwest. Now, the volumes will be slightly smaller in the Pacific Northwest, but from that angle, we feel like we can become one of the six or seven largest post-acute care businesses in the home over the next five years. We can achieve density in those geographies and work towards our mission of a continuum.

The caveat to that would be we are going to continue to be focused on being a three-legged stool. While certain sectors tend to be hotter in M&A, we’re going to be disciplined around, like, “Hey, let’s stay balanced. Let’s try to achieve all three service lines in every service territory,” and that’s difficult sometimes with CONs, but we’re going to actively pursue that.

What should integrated care actually feel like for the patient and the family?

Jackson: How that should feel is more seamless. It happens in the single sectors too. Your nurse and your therapist need to communicate. It’s very difficult on a patient when they feel like they have to explain themselves multiple times.

Again, some of this is theory, some of this is holy grail. And again, our mission at Choice is the pursuit. We are going to pursue this. I’m not saying this is the perfect thing. Ideally, your provider— in PCS, the provider often, what we find, doesn’t know what’s available to their client in full. We want to strive to educate our providers so that they’re more informed, so that the provider who’s gained the trust of the client can say, “Hey, I’ve been working with you getting in and out of the bathtub, and you’re starting to have a really difficult time.” Or, “You came home from the doctor with all these new meds. I see all these new meds. Maybe we could have a nurse come in here and do education with us and talk to us about these meds.” How rewarding is that to that client?

And then the nurse that’s caring for them in the home health realm, that sees the CHF patient, and she’s seen them two or three times over the last year, episodes of care, where they’ve gone in and out of the hospital. That nurse is challenged to be like, “Hey, we really struggled to maintain you in the home. We really need to start talking about advanced directives. Can I talk to visit with your son about your disease process?” Not because you need to choose hospitals, but because you need to be fully informed about the availability of it. There’s better ways to manage your breathing. I know it’s very difficult, and the palliative care specialist may be able to help you with your breathing more than I can, more than we can currently on curative.”

It should feel more concise, more coordinated and there should be a better result. That is what we’re pursuing.

How do you get the providers to be able to know what to say and what is available? Is that continuing education, or what do you do there?

Jackson: It’s continuing education. The other exciting thing is we’re gaining more visibility, and you’re also seeing some of these tools, real-time, cue the provider that, “Hey, this is available.” Where we want to go with it in PCS is where we can automate more that we’ve seen, more of that success in home health and hospice, where we have centralized hubs.

In our bridge between home health and hospice, or the utilization of palliative and primary care on top of our home health, we’ve seen that better coordinated because nurses and therapists often, as they’re dealing in curative care, are active in that. They may not look outside of that at times. Different nurses have their different capabilities. Therapists have different capabilities. We have a separate team and software overlay where that team can call into a branch in Muskogee, Oklahoma, and say, “Hey, we’ve seen these five patients, and here’s their trending, and let’s talk about it in IDT. They’re Zoomed into IDT or Google Meet. We’re having the conversation about that patient,” and the nurse is like, “Oh, okay, yes, I’m seeing the trend that you’re seeing.” They’ll give them education, and they’ll be like, “Hey, do you want us to set up this call with the family? How can we do that?”

That’s how we’re trying to attack that at Choice. It’s continuing education, but then also remote oversight with these new tools.

What’s the most important thing to get right in terms of the connection between the service lines?

Jackson: The most important thing is to be excellent at your service provision.

You’ll see, at times over the last 20 years, different groups that would be really good home health providers, and maybe they would struggle with hospice or vice versa, or they didn’t really actively pursue PCS development across the full demographic. You’d see whole organizations where they would skew to singular service lines.

My job as chief executive officer is really about my org chart and finding people who are outstanding at the individual service lines. That’s the number one component is if you are delivering home health service, you need to strive to be excellent at that. Same in hospice, same in PCS. How can we pursue excellence in that line?

As an organization, it’s putting the collaborative pieces together that make it easier to work with these specialists in the sectors. That’s really what I would say is it’s not so much about the collaboration, it’s about being really good at what you do. If you are treating the full patient as a physical therapist treating a hip fracture, that is an 85-year-old female hip fracture, the odds of success on the curative side are low. If you are being excellent, if you’re pursuing excellence there, you’re going to say, ”Hey, I should have the social worker come in while I’m working on all these exercises, because I know that palliative medicine can really benefit in pain control and planning.” That’s just good medicine.

That’s why I was excited about the CMS initiative in the home health side, because it’s going to cause people to think more broadly about the use of palliative medicine and the collaborative treatment approach to patients.

The organization should work on that coordination layer. The individual clinicians need to be excellent at what they do, and you need to pursue being an excellent home health and excellent hospice and excellent PCS.

Why has personal home care become such a key part of the continuum?

Jackson: Again, I’m a physical therapist, and I think about things clinically. My journey from a rehab company into home health, learning about hospice, was literally like a few personal experiences with my family. I see this physician talking about palliative care at a congestive heart failure conference, and I’m just like, ”Oh, this is awesome. This is what I need to treat these patients.”

If you can get a patient a hot meal, they will be more successful. Patients call the ER because they can’t get in and out of the bathroom, or they’ve fallen in the bathroom. Their ability to get to and from the primary care physician’s office and get to their visit, which is not a skilled service, it is more indicative of where they’ll go back to the hospital than any of the other care that they receive. It’s wild. Social determinants of care impact the medical outcome.

If you look at skilled occupancy, it’s almost frightening how fast the beds are filling up post-COVID and how difficult and complex it is to build new facilities. There’s a real bed occupancy issue that we’re going to have over time, and just a sheer cost.

If you look at PCS, there’s the sheer medical benefit of ”Hey, we can provide these services that enable patients to be in their home.” There’s the cost of it, which is much less expensive than inpatient facilities. And then there’s just the occupancy problem that we’re going to be facing over the next decade. I like all of that. The physical therapist in me is like, ”If we get a hot meal, we’re going to be better at executing on our physical therapy home exercise program.”

What’s your overall read of the Medicare home health proposed rule in terms of reimbursement? Does it meaningfully change the outlook for providers?

Jackson: Definitely, it is less draconian than what we’ve seen over the last several years. We’re excited about the way the narrative is changing as far as the aggregate payment increase.

The temporary adjustments, we’re hoping for some resolution on that. I recognize that they’re trying to spread that out. We’re hoping to see resolution on that because, again, here at Choice, and I think for so many organizations across the country, we really think about things in a longer horizon. Resolution gives you a lot more visibility, like, ”Hey, when is this going to stop?”

At Choice, we anticipate that being 2028. We think that we should start seeing these positive aggregate payment increases potentially pull back on the temporary adjustments.

The other thing, the elephant in the room, is Medicare Advantage plans. There is some pressure there, but we continue to see patients that should receive services at a certain rate that have Medicare Advantage plans that they don’t receive those services. It’s very strange to me that a physical therapist in the field or a nurse in the field, that we’re having a disagreement about a singular nursing visit, and almost chronically they have less visits than traditional Medicare patients because of the payment form, the pay-per-visit form versus episodic.

We’re having these disagreements with clinicians in the field as they try to advocate for their patients. MA plans are basically saying, “Hey, you’re not right. They don’t need another additional visit.” Resolution around Medicare Advantage and more regulation about how these persons are entitled to certain benefits are more of a focus area for us at Choice. We do think the rule, obviously, better than what we’ve seen historically, and we think we’ll continue to see resolution there, which makes it a great place for investment.

What is your Medicare Advantage thesis?

Jackson: The simplest thing is we want to match the market. We want to serve the markets we serve. If it’s 50% Medicare Advantage penetration, we want to strive to be 50% Medicare Advantage penetration. We think it is somewhat foolish to stick your head in the sand and say, “Hey, we’re just not going to treat those patients.” We are going to continue to work to have contracts that reward the level of care that we provide. Our philosophy is, “Match the market.”

What’s the practical impact of the proposed Medicare home health payment rule?

Jackson: The practical aspect of it for large providers is we will navigate this rule very well, very effectively. The concern for me, again, with the temporary adjustments is access. Small providers, their ability to navigate the rule will not be the same as the large providers. They’re working and providing really good care. The advocate in me is just like, “We provide really valuable services. We continue to be looked at in a silo.”

I like where we’re going with this. I am appreciative that we’re starting to see the aggregate payment increases, anticipate drawbacks to the temporary adjustments. As far as real impact for Choice, the palliative component, we historically have— because we have the three service lines, we believe palliative medicine and curative medicine should work hand in hand. I had a clinical instructor when I was a young physical therapist that used to tell me to go in and open up the blinds with these little ladies in the hospital because they were experiencing depression, and that was palliative care. You walk around and start talking to them about their grandkids, and all of a sudden, they’ll sit up on the side of the bed. That was palliative medicine applied in a curative setting.

Obviously, that’s a pretty elementary approach to it, but there’s more advanced things that we can do, so that’s exciting.

How do you view this enrollment moratorium?

Jackson: I’ll start with the good thing. We need to block bad actors, and that’s important. I think we do so many good things. When you look at the total spend, our dollars decrease total Medicare spending. They just do. In both hospice and home health. Let’s get rid of the bad actors. Additionally, the enrollment process and how states and the federal government deal with that, it definitely can be improved. I probably have had my fingerprints taken 15 times this year.

To me, there are some things that could be maybe moved forward from a technology perspective. This is a great time for them to look at that and say, “How do we bring this into the 21st century? What’s the opportunity there?” I absolutely understand what they’re trying to do because it’s probably like all these new enrollments, you’ve got renewals, we’re trying to stop fraud in certain pockets of the country. I think we need to do that, bring it forward.

Now, the American entrepreneur in me, this type of rule doesn’t really slow down big businesses, because we will come in and we’ll buy license numbers, buy established businesses. We’re going to look at compliance right out of the gate. That’s how we’re going to build our business. The nurse in a small town that wants to open up a home health, this inhibits them.

Again, like a licensed nurse who’s been providing care in the local hospital system or with a big established home health that wants to open their own business. It’s been background checked. They should be able to open. This is the United States. They should be able to go out there and open up the business and take care of people. Those nurses are really important and therapists are really important to the industry.

That’s how I feel about it from the challenge perspective. That does impede certain rural markets, development of new agencies in rural markets, where it’s harder for big businesses to execute. That’s one of my fears is that would slow that down. My first license, that’s how it happened. That’s near and dear to me.

Does the moratorium impact anything on the operational side? Are you adding maybe more compliance dollars?

Jackson: I always welcome the ‘walk-in door and make sure we’re seeing patients’ audits because that’s what’s happening in Choice locations. If you go around the country, that’s what’s happening in the vast, vast, vast majority of these operations, is people taking care of patients.

I do think it’s important from an education-to-the-public perspective, compliance around documentation, thoroughness, how we’re documenting. There are a lot of new AI tools that we’re using where we can audit all our CTIs. We can look at everything that our nurses are doing from a documentation perspective around homebound status. We can automate so much — at Choice, in both hospice and home health, we’ve gone to 100% pre-claim review because we can automate so much of it. We can use tools that allow us to scrub and walk in and see a dashboard with 1,000 patients on it and see… It used to have to be random samples with a human being, which was really hard. Now, those human beings are enabled with these new scrubbers to find issues and educate clinicians.

Educating clinicians about the best practice and documentation is a little different than persons with license mills in Los Angeles or those type of areas where we’re seeing the hotbeds of that type of fraud. It’s just a different thing. We don’t have to worry about that at Choice because we do know we’re actively seeing patients, and so many of the organizations are.

The new investments in tech are going to continue to be there. We’ll use it because we want to provide the best level of care. I do anticipate dollars being put into that by organizations across the country.

Where has tech in the last two or three years made the most difference at Choice, and where’s one place where you’re looking to use tech in a new way?

Jackson: Over the last, really, I would say five years, automation and bots were probably the more prevalent technology. We usually have these LLMs where you can assist clinicians from the field at this rapid rate around documentation. It was really about back office.

One of the things we used to say earlier, back in the early 2020s, was we wanted people to practice at the top of their license. A nurse taking a social security number from here and putting it over here, back when you used socials, or the patient data moving from this system to this system, that seemed like a really low use of their license. We would want to create automation to move information from here to here. That was the biggest influence over the last five years was just automation of moving data from this portal to this portal.

That makes a lot of sense because we don’t have enough RNs and LPNs. By we, I mean the planet. It’s important that they not be just executing clerical data. As much as we can do that, that was what you were seeing.

The other thing was around insurance portals, and how do we manage submission for revenue cycle. That has been historically, the most prominent technology was automation in bots on that side of it. Now you’re starting to see smart automation where it can make decisions about this patient should go up in this territory because Nurse Jenny needs more patients than Nurse Dave. We’re seeing that type of smart automation happen.

The most exciting thing is the augmentation around documentation and the ability to aid and assist nursing staff, therapy staff, physicians, MSWs with their actual documentation. I graduated from physical therapy school in 2004, and I had previously been in the ERs and things of that nature. Documentation in the EMR has always been the thing that makes us happy. I’m joking. This is a big joke for anybody who’s listening. It’s like this interface between us and the patient. The more we can drop that down and open up the dialogue between the clinician and the patient, the better. I’m just incredibly bullish around the new technologies that do that for nurses and therapists.

Is there anywhere that you would not want to use tech?

Jackson: I don’t know if there’s an area where I would say, “Let’s not use it.” I think there are areas where I want to be more careful. I don’t want it necessarily choosing treatment plans for patients. I want it giving suggestions based on, “Here’s the outcomes when you use this treatment approach with this type of patient. Here’s the things you need to watch for when they have this medication and the things you need to educate on.” I want that to be prompted. I think we need to be careful as far as how we use it in application of treatment plans and make sure the human in the loop is who is engaged, the physician, the nurse, the therapist.

I also just think when you think about ambient listening, there are definitely some legal hurdles we need to make sure. As these technologies come out, they’re moving so fast. You have to be concerned around HIPAA, and then also, do we have authorization for the son who’s walking through the room saying something? Have we seen their consent sign? What do we do to protect our patients and our employees as we launch these new technologies? I think it’s just more about caution and proper vetting.

Where are the most credible opportunities to take on risk today? What needs to change for more of those arrangements to be possible?

Jackson: I think, obviously, as the country looks at value-based care on a national level and home health, it’s really about visibility to data and the health information exchanges, which are still very primitive. I was in a call right before this one, and we were just talking about a few different states where we were like, “We’ve got 80% of hospitals participating here. We’ve got this level of participation from post-acute providers.”

You are blind-spotted to certain utilization, and so that needs to improve. We’ve been consciously working on that in so many different communities across the United States. It’s how do we consolidate the health information exchange so I can see if a patient that’s been a patient at Choice Home Health or on our PCS services is going to the hospital, but they go to this one system where we can’t see them— we don’t even know they’re utilizing that service. Or they’re in an ALF, and they’re going to the ER at night, and we’re not being notified? We’re seeing ER utilization there? It’s just about being able to see more of the data. That needs to improve for us to really take steps forward.

We are getting to a more significant size in several MSAs where we have more capability. That is impactful. Your ability to care for patients across that full post-acute care continuum enables you more. And then consistency in contracting. Are we aligned with, say, a payer on their goals and the patient’s goals? We just have to work on the contract structure.

I think as data integrity and the ability to move it continues to rapidly improve, we’re on the precipice of having much more capability. 15 years ago, it was just a buzzword.

When you say “on the precipice,” what does that mean from a time perspective?

Jackson: In the United States, every four years, we have to consider administrative changes and where people are going with that for Medicare. When you think about the payers, I think the payers are more and more proactive. Obviously, you see Optum’s investment in Amedisys and LHC Group. The CenterWell play. You see how insurance companies are seeing some value there. As an industry, we need to show them how we can dramatically lower costs.

What will separate the home-based care winners from the rest over the next three to five years in the industry, and where do you want Choice to be in that future?

Jackson: Yeah, I think the winners are going to embrace these new technologies that enable the clinicians. They need to be thinking about the clinicians. There is no shortage in demand. Period. We are in an industry where there is no shortage in the number of patients. There are some complexities around execution.

So, as you think about investment in the space, it’s so exciting because in very few industries is there so much demand. Execution is where we need to focus. The organizations that really say, these are the key technologies, there’ll be winners and losers in technology. There are so many players out there, it’s very exciting. But we have to really vet them, see how it’s being applied to our clinicians. I think that’s where the winners are going to be.

Choice wants to be at the forefront of that. We want to fast-forward, and we want all three segments in five years to be the size of our business today. With that balance, we think we can better serve communities. We want to embrace technology so that we can be an asset. If your mom wants to stay at home, say, “Hey, Choice Health at Home.”