Ennoble Care has added five states to its home-based primary care footprint, extending its reach into Florida, Kentucky, Ohio, Mississippi and Texas in September.

The expansion aligns with the Ennoble’s larger mission of eliminating primary care deserts for older adults in the United States, the company’s CEO Kush Das told Home Health Care News.

“Our goal was to go contiguous growth from east to west and slightly down to the south, and especially prioritizing markets where there’s just a ton of seniors that just need the help in the home, which is what we can uniquely provide,” Das said.

Hackensack, New Jersey-based Ennoble Care provides in-home primary care within 16 states.

Ennoble targeted Texas and Florida for expansion for multiple reasons, Das said.

“Texas and Florida, especially, were on our list for a long time,” Das said. “You have tremendously growing senior populations — folks that are getting frailer and frailer over time, [and] there’s a bunch of healthcare deserts in those areas that are unable to serve those patients well.”  

Beyond tackling care deserts, Ennoble’s recent expansion was driven by momentum and finding good partners within new states.

Georgia is a home market for Ennoble Care, and the company could more easily expand into neighboring Alabama. The most recent Mississippi expansion arose from an opportunistic acquisition rather than simple geographic proximity. 

“Mississippi, we got into because we found a great practice there that needed some support in terms of back-office infrastructure to open great care,” Das said. “That was one of our acquisitions that’s now got onto our platform, [and it] is doing a fantastic job.” 

Ennoble’s geographic expansion encountered operational hurdles, however. With every new state Ennoble entered, the company onboarded new health plan networks.

“The longest pole in the tent for us is always getting into the network and credentialing,” Das said.

He added that the process can prove even more difficult when some payers do not distinguish between home-based and office-based primary care when determining network adequacy.

“That’s been the hardest thing — educating the insurance plans in each of these states that they need to cover us, because, otherwise, these patients that they have [assumed] risk on are going to end up back in hospital,” Das said.  

Still, Das believes that hard work pays off. Ennoble Care sees hospitalizations drop by more than 50% among patients who have been under its care for over two years, Das said.

“Home health agencies play a tremendous role in that [reduction] as well, in terms of the immediate 45 days or so after hospitalization to prevent the readmission,” Das said. “Our goal is to also bring home health and into that longitudinal relationship.”

Future growth plans

Das estimates there are 7 million Americans who need home-based primary care, though only one in seven of those people receive it.

Since Ennoble serves about 50,000 patients already, that means the company has big plans to meet those care demands. Though the company does not plan to expand its service lines, Ennoble intends to start a Medicare Advantage plan that includes a chronic special needs plan, such as for diabetes care and certain kinds of chronic management care, in a few of its markets.  

“We’re not trying to be competing with massive payers here. That’s not our goal. Our goal is to have the ability to provide a tailored benefit for our patients that specifically need certain kinds of care in the home,” Das said. “It’s like a very niche health plan approach that’s primarily for the patients that we’re serving.”

Ennoble is also broadening participation in accountable care organization (ACO) models, with plans to enter two models next year on a state-by-state basis. The company currently participates in ACO Realizing Equity, Access and Community Health (REACH), and it will shift to the Medicare Shared Savings Program (MSSP) and Long-term Enhanced ACO Design (LEAD) model, depending on geography, once ACO REACH sunsets at the end of 2026. 

In the next year, Ennoble intends to expand into another 10 or so states. That growth will likely come through a mix of entering new states adjacent to existing markets and acquiring house call practices that need additional support, Das said.  

“The goal of our company is twofold. It’s No. 1 to be the best services business for home-based primary care,” Das said. “No. 2, to thoughtfully take on risk and build a care management network that actually provides savings for the system and savings for the patient.”