The home health industry has long organized its business model around episodic, clinician-driven visits, but that traditional framework may struggle to solve a mounting chronic disease crisis, according to industry veteran Paul Kusserow.

The industry must evolve beyond a traditional, visit-based clinical model into one that mixes skilled care with family caregiver support, technology and value-based accountability, Kusserow, CEO and executive chairman of Careforth and chairman of Elara Caring, said during HHCN’s FUTURE conference in August.

“That’s going to be a combination of skilled care and unskilled care,” Kusserow said. “Understanding how important ADLs and social determinants are if you’re going to do elongated care of people longer term, and if you’re going to take risk on it.”

Kusserow has spent decades in leadership roles in the home-based care and broader healthcare industries. From 2014 to 2025, Kusserow served as the CEO and chairman of Amedisys until UnitedHealth (NYSE: UNH) acquired it in a $3.3 billion deal that closed in August 2025. He stepped into the CEO role at Careforth in June and joined Elara Caring’s board in August.

Kusserow is also the executive chairman of Unified Women’s Healthcare and sits on the board of directors of the in-home health assessment and care management services company Matrix Medical Network.

Boston-based Careforth provides payment, resources and support for home-based caregivers across nine states. Elara Caring, based in Dallas, provides skilled home health, hospice, behavioral health and personal home care across 18 states.

A more sustainable caregiving-payment model will be necessary as home-based care takes on a larger role in supporting an aging population, Kusserow said. The number of family caregivers is growing rapidly, Kusserow said, adding that estimated unpaid caregiver labor represents roughly $600 billion in care yearly.

AARP’s latest estimate suggests that family caregivers of adults provided an economic value of $1.01 trillion in adult caregiving in 2024. The report found that an estimated 59 million family caregivers helped an adult family member, neighbor or friend with daily activities during the year. Of these, 63% provided care each month.

Careforth’s model acts as an example of how providers can support an expanding caregiving population, Kusserow said. The company not only offers compensation for family caregivers but also offers training, technology, clinical backup and other support.

Rather than relying solely on clinician visits, providers should build models that incorporate family members, friends, personal care workers and community resources to handle non-clinical needs, Kusserow said.

In addition to providing better benefits and compensation for caregivers, Kusserow suggested that providers must offer services for higher-acuity needs and build specialized, disease-specific care models.

“Chronic illness demands care in the home,” Kusserow said.

Individuals will live for years with their diseases, making it economically unfeasible for recurring hospitalizations to occur for health plans or government payers, he said. That dynamic creates an opening for home-based care providers to keep patients at home while managing their conditions and avoiding unnecessary institutional care.

Providers will need to move up the “acuity chain” and learn how to care with disease-specific individuals, but the learning process will help make providing value-based care much easier, Kusserow added.

The transition will require providers to view clinical services as one component of a broader, longer-term care model, Kusserow said. Supporting ADLs, addressing social determinants of health and equipping family caregivers will be imperative for companies aiming to provide long-term care for medically complex patients.

“There’s the next version of home health, which I’m very excited about,” Kusserow said.

Caregivers and technology

Providing the best infrastructure for caregivers will lead to the best outcomes for home-based care, Kusserow said.

“Why aren’t we using all the resources at hand?” Kusserow said. “Why aren’t we using the people [who] love these people, training them how to do things right and having them do everything but the clinical?”

Kusserow said Careforth identifies family members or others in the home of a person receiving a Medicaid waiver and trains and pays them to serve as caregivers, offering $50 a day for 24/7 care. The company provides resources, support and breaks.

“We’re keeping people at home,” Kusserow said. “We’re training people how to take care of those people in the home, and we’re building in that community.”

Data collection and technology will also help lead to the next phase of home-based care, Kusserow said. For instance, if a patient has congestive heart failure, the company will be able to provide better care if it has collected information on 10,000 other people with the condition and knows the risks and best courses of action for the condition.

Technology can also allow caregivers to build better continuity with their patients, foster predictability and collect crucial individualized data.

“You can figure out when someone’s doing okay, when you need to be involved, when you don’t,” Kusserow said.