Last Visit First

Medicare Advantage growth stalled for the first time in a decade. Hospice admissions are growing faster every year. And in some states, patients wait nearly a week after hospital discharge for their first home health visit.

Trella Health CEO Scott Tapp and Senior Consultant of Data & Analytics Carter Bakkum join Tom Maxwell once again, this time to walk through Trella's new Post-Acute Market Intelligence Report: 2026 Edition, live on screen. This year the report is fully interactive, so you can drill into your own state and market instead of relying only on national benchmarks.

We cover why payers are pulling Medicare Advantage out of rural markets like Vermont, what accelerating hospice growth means after the moratorium, the time-to-start-of-care gap that's driving hospital readmissions, and why the TEAM model is a sales opportunity most home health agencies aren't using yet.

We also get a first look at Ask Trella AI, a new tool that answers market questions in plain language: who's gaining and losing share in your market, which physicians refer the most, where you can compete, and much more.

Enjoying the show? Please rate and review Last Visit First on Apple Podcasts and follow us on Spotify. It takes 10 seconds and helps more home health and hospice leaders find these conversations.

Topics covered:

• The new interactive 2026 Post-Acute Market Intelligence Report
• Medicare Advantage penetration stalls at 55.4%
• Payer exits and the rural Medicare Advantage pullback
• Accelerating hospice admissions and length of stay trends
• Time to start of care and its impact on readmissions
• First look at Ask Trella AI

Connect with the guests:

• Scott Tapp
• Carter Bakkum

Chapters:

• 00:00 Welcome: Scott Tapp and Carter Bakkum of Trella Health
• 01:12 What's new in the 2026 Market Intelligence Report
• 04:23 The data behind the report
• 07:10 Medicare Advantage growth stalls
• 08:51 Vermont and the rural MA pullback
• 15:55 What MA shifts mean for providers
• 17:21 Hospice growth is accelerating
• 21:32 Discharge instructions and adherence
• 24:45 Time to start of care by state
• 29:13 The TEAM model and the Indiana opportunity
• 36:21 First look: Ask Trella AI
• 41:07 Who's gaining and losing market share
• 46:45 Where Trella AI is headed
• 53:53 When you can get it and wrap-up

Sponsors:

• Presented by Last Visit First's Premier Sponsor, Trella Health.
• Check out Trella Health's new 2026 Post-Acute Market Intelligence Report here.

Check out Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Element5 Co-founder and CEO Joe Randesi joins Last Visit First once again, with guest host Jennifer Maxwell, Co-Founder and CEO of Maxwell TEC and wife of Tom Maxwell, to talk about how AI agents are automating revenue cycle management and back-office operations for the home health and hospice community. Joe explains Element5's approach to "touchless rate," the percentage of financial and administrative tasks handled entirely without human intervention, and why the company aims for a high touchless rate around 90%, rather than chasing full automation.

Joe also shares his take on why AI adoption, not new technology itself, will be the biggest driver of change in post-acute care over the next few years, and why keeping a human in the loop remains essential even as automation and ambient listening tools continue to advance.

Chapters:

• 0:00 Welcome: Joe Randesi, CEO of Element5
• 0:31 What Element5 Does: Automating RCM & Back Office
• 1:17 Most Successful Moment at the Conference
• 2:36 Why a Human in the Loop Still Matters
• 3:04 Looking Ahead: The Next 3-5 Years of AI Adoption

Connect with Joe: https://www.linkedin.com/in/joerandesi

Connect with Element5: https://www.e5.ai/

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

WellBeam CEO and Co-Founder Amee Devani returns to Last Visit First, this time with guest host Jennifer Maxwell filling in for Tom, to talk about how WellBeam is eliminating one of home health's most outdated workflows: getting physicians to sign care plans and orders. Amee explains how WellBeam brings this process directly into physician EMRs like Epic, Cerner, and eClinicalWorks, mapping everything back into Homecare Homebase, cutting order turnaround from an industry average of 21 days down to as little as half a day.

Amee also shares WellBeam's vision for using AI to surface clinical decline earlier, helping care teams coordinate before a patient crashes rather than after, along with candid reflections on building a healthcare startup as a female founder and balancing entrepreneurship with family life.

Chapters:

• 0:00 Welcome Back: Amee Devani, CEO of WellBeam
• 0:55 What WellBeam Solves: Ending the Fax Machine Workflow
• 1:59 From 21 Days to Half a Day
• 2:29 The Biggest AI Hurdle for Agencies Right Now
• 3:19 Using AI to Predict Decline Before a Crisis
• 4:04 WellBeam's First Users Conference: Key Takeaways
• 5:07 On Being a Female Founder in Healthcare

Connect with WellBeam

Connect with Amee

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

CareXM CEO Si Luo returns to Last Visit First to share how the company's AI triage assistant is changing the way nurses handle patient calls. Si explains how CareXM rolled the tool out to 100% of its internal users, with early external adoption from agencies like Amedisys and LHC, resulting in more than a 25% improvement in the number of triage encounters each nurse can handle.

Si also breaks down how the tool works, clinically summarizing calls so triage nurses can stay fully present with patients while the software connects back to protocol for large-scale QA review, and shares what's next for CareXM's integration roadmap alongside Homecare Homebase, including smart scheduling and point-of-care tools.

Chapters:

• 0:00 Welcome Back: Si Luo, CEO of CareXM
• 0:53 What's New at CareXM
• 1:44 The AI Triage Assistant Rollout
• 2:54 What's Next: Aligning with HCHB's Roadmap

Connect with Si

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

QAPIplus Co-Founder and CEO Armine Khudanyan, Co-founder and CTO Lara Koraian, and Chief Growth Officer Jared Robey join Last Visit First, with guest host Jennifer Maxwell filling in for Tom this episode, to talk about how QAPIplus is transforming quality improvement and compliance for home health and hospice organizations.

The team explains how QAPIplus helps agencies operationalize the flood of data coming in from documentation and CMS quality compliance, shifting time and effort away from manual reporting and toward real, measurable performance improvement. They also share their take on the industry's ongoing AI conversation, and why partnership, not competition, between vendors is the key to building a more holistic experience for home health and hospice providers.

Chapters:

• 0:00 Welcome & Guest Host Jennifer Maxwell
• 0:18 Meet the QAPIplus Team
• 0:52 What QAPIplus Does
• 1:32 The Biggest Problem QAPIplus Solves
• 2:59 Why Vendor Partnership Matters More Than Competition
• 4:32 Reflecting on the Conference

Connect with QAPIplus

Connect with Armine

Connect with Lara

Connect with Jared

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Homecare Homebase kicked off its 20th anniversary Users Conference in Orlando, Florida, and Last Visit First was there to capture it. Chief Revenue Officer Hannah Pearson joins host Tom Maxwell to set the stage for this milestone home health and hospice conference, from the keynote and executive track sessions to a jam-packed vendor marketplace with hundreds of home care industry exhibitors.

With nearly 500 attendees and around 50 executives in the room, this year's HCHB Users Conference brought together home health and hospice leaders for education, networking, and a look at what's next for the industry, plus a little fun along the way, including a bourbon and wine night and a glow party at SeaWorld.

Hannah also shares what's ahead for HCHB's Users Conference, including upcoming stops in Washington, D.C., Chicago, and Nashville in the years to come.

Chapters:

• 0:00 Welcome to HCHB's 20th Anniversary Conference
• 0:40 Conference Events & Vendor Marketplace
• 1:30 What's Next: Future Conference Locations

Connect with Hannah: https://www.linkedin.com/in/pearsonhannahm

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

AnewHealth Chief Growth Officer Roman Fry joins Last Visit First to explain how the company's pharmacy care model helps home health agencies manage their most complex, high-medication patients, at no added cost to the agency. Roman breaks down how AnewHealth, the only integrated pharmacy partner with Homecare Homebase, works directly inside the EMR to identify patients with high medication burden, deliver pre-packaged pill strips, and provide virtual pharmacist support, all while reporting a 78 net promoter score among patients.

Roman also shares how referrals work, why speed matters most in the critical first 72 hours after a patient transition, and what's behind AnewHealth's broader portfolio, including Tabula Rasa's leadership in PACE pharmacy and SafeDose's work supporting individuals with intellectual and developmental disabilities.

Chapters:

• 0:00 Welcome: Roman Fry, Chief Growth Officer of AnewHealth
• 1:12 The Pharmacy Model: No Cost to Home Health Agencies
• 2:38 Pill Packs vs. Pill Sorters
• 3:12 The Caregiver Burden AnewHealth Takes Away
• 4:03 What Happens If a Patient Has a Crisis Later
• 4:58 How Nurses Make a Referral
• 6:17 Inside Tabula Rasa & PACE Pharmacy
• 7:16 SafeDose & Serving Dual-Eligible Patients

Connect with AnewHealth

Connect with Roman

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Maxwell TEC COO Jay Duty joins Last Visit First to unpack the biggest themes on the show floor at HCHB's Users Conference, including AI and automation in home health and hospice, ambient listening technology for clinicians, and the industry buzz around the new hospice amendment regulation.

Jay breaks down the fast-approaching hospice amendment deadline, the challenge of getting signed amendments back from patients within five days of start of care, and why traditional tools like DocuSign may not be a realistic fix. He also shares what's happening at Maxwell TEC right now, from rising M&A activity in home health and hospice to the growing adoption of their nanaCONNECT platform for automating patient communication, intake, and bereavement outreach.

Chapters:

• 0:00 Welcome & Why Jay's at the Conference
• 0:23 Top Themes: People, Process & Technology
• 0:47 AI, Automation & Ambient Listening for Clinicians
• 1:32 The New Hospice Amendment Deadline
• 2:42 The DocuSign Problem: Getting Signatures from Patients
• 3:02 What's New at Maxwell TEC: M&A Trends
• 3:13 nanaCONNECT & Automating Patient Communication
• 4:05 Who's at the Conference with Jay

Connect with Maxwell TEC

Connect with Jay

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Mosai CEO Elliott Wood joins Last Visit First once again to talk AI, software, and where home-based care technology is headed next. Eighteen months after the merger of Forcura and Medalogix into Mosai, Elliott shares how the company is reimagining software delivery from the ground up, from consolidating cluttered multi-screen clinician workflows into a single AI-assisted interface, to using AI agents to gather information and surface decisions for clinicians rather than requiring them to dig for it themselves.

Elliott and Tom also dig into how AI is transforming software development speed itself, cutting build timelines from weeks to hours, and what that means for the future of home health and hospice technology more broadly.

Chapters:

• 0:00 An Update from Mosai
• 0:08 What Is Mosai? Forcura + Medalogix
• 1:23 Conference Buzz: Reset & Realign Keynote
• 2:43 18 Months Into the Merger
• 2:59 AI's Impact on Software's Future
• 3:59 From Multiple Screens to One AI-Assisted View
• 6:01 Speed to Software: Building Faster with AI
• 7:18 A Golf Scoring App Built with Claude
• 9:32 Software People Want to Use, Not Have To

Connect with Mosai

Connect with Elliott

Sponsors:

• Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

• Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

For nearly five decades, Bill Dombi has shaped almost every major law, regulation, and legal battle behind home health and hospice care in America. As former President and CEO of the National Association for Home Care & Hospice (NAHC) and now senior counsel at Arnall Golden Gregory, Bill has argued in front of Congress, CMS, and the courts to protect access to care at home.

In this episode, Bill sits down with Tom Maxwell to reveal the untold history of the industry, including the landmark Duggan v. Bowen lawsuit that rewrote Medicare home health coverage, the last-minute decision that almost kept home health out of Medicare entirely, and the uphill battle to create the Medicare Hospice Benefit in 1983.

Topics covered:

• The origin story of Medicare home health coverage
• Duggan v. Bowen and the fight to expand home health eligibility
• Creating the Medicare Hospice Benefit
• Operation Restore Trust and hospice fraud today
• Medicare Advantage's impact on home health and hospice providers
• The future of value-based care
• AI's role in clinical and operational efficiency
• Advice for the next generation of home care and hospice leaders

About the guest:

• William "Bill" Dombi served as President and CEO of the National Association for Home Care & Hospice (NAHC) from 2018 until its merger with NHPCO, forming the National Alliance for Care at Home. Prior to that, he spent decades as NAHC's Vice President for Law. He was lead counsel in landmark litigation expanding Medicare home health coverage and helped shape the Medicare Hospice Benefit. He now serves as senior counsel at Arnall Golden Gregory LLP and sits on the board of advisors for New Day Healthcare.

Connect with Bill:

• LinkedIn
• Email

Chapters:

• 0:00 Welcome Bill Dombi to the show
• 1:44 What first drew Bill to home care advocacy
• 4:05 Bill's proudest career accomplishments
• 9:08 Bill Dombi outside of Washington
• 11:09 The patient story that defines his mission
• 12:43 Sponsor Break
• 13:42 The hardest battle: creating the hospice benefit
• 18:49 What almost happened: home health nearly left out of Medicare
• 21:31 Why healthcare fraud keeps happening
• 23:41 Sponsor Break
• 24:55 The biggest threat to home health: stagnation
• 28:09 Is hospice at a crossroads?
• 35:24 Medicare Advantage: is it really an advantage?
• 42:32 Where AI actually helps in home-based care
• 48:41 If Bill could rewrite one regulation
• 52:53 Sponsor Break
• 54:45 Einstein the hospice therapy dog
• 56:11 How Bill stayed optimistic for 50 years
• 59:35 What Bill is doing today
• 1:04:37 How to reach Bill Dombi

Check out Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Sponsors:

• Premier Sponsor: Homecare Homebase
• Premier Sponsor: Trella Health
• Maxwell TEC
• IntellaTriage