Hosts Elyssa Katz and Dr. Steve Landers explore the evolving landscape of value-based care in the context of the care at home community. With value-based care being one of the most prominent trends shaping healthcare policy, payment models, and provider behavior, this episode dives deep into what it really means, who it benefits, and how it impacts patients and providers alike.

In this compelling conversation, they break down the goals, realities, and challenges of aligning better outcomes with lower costs. Dr. Landers brings a unique lens as both a physician and former healthcare executive, providing behind-the-scenes insight into Medicare Advantage plans, demonstration programs, and risk-based care models. The duo unpacks how these models affect elder care, disability services, and home-based healthcare delivery, offering listeners clarity in an often jargon-heavy conversation.

Key concepts discussed include the nuances between avoidable vs. necessary hospitalizations, the true definition of patient-centered care, and the misalignment between coding systems and real-world outcomes. They examine how care at home providers can be empowered as frontline experts in managing complex patients safely and affordably, but also address the frustrating misfires when working with large managed care organizations.

Dr. Landers recounts his personal experiences with CMS demonstrations like Independence at Home and Primary Care First, and what they reveal about system incentives. Elyssa presses on practical implementation — what does value-based care look like when the rubber hits the road for providers and families?

They explore vital tools for success in these models — from telehealth to triage tools to outcome dashboards — and discuss why communication and risk assessment are foundational. A significant portion of the episode questions whether today’s models reward the right behaviors or merely incentivize better documentation and coding.

The episode ends with a powerful call to action: advocacy. With Medicare Advantage now covering more than 50% of Medicare beneficiaries, both hosts stress that now is the time for care at home providers to demand a seat at the table. The stakes are too high to leave policy conversations to profit-driven entities alone.

Tune in for an accessible, honest, and insightful look at the current state — and future possibilities — of value-based care. Whether you’re a home health provider, policy advocate, or family caregiver, this conversation will leave you more informed and inspired to take action.

Timestamp Topics
[00:00:00] What is Value-Based Care? 
[00:02:00] Medicare & Medicaid Focus
[00:05:00] Lessons from Demonstrations
[00:07:00] Risk Adjustment Challenges
[00:10:00] Tools for Success
[00:12:30] Communicating Value
[00:14:00] Home Care vs. Medicare Advantage
[00:17:00] Hospice & MA Carve-In Debate
[00:23:00] Breaking Down Jargon
[00:33:00] Advocacy and the Future

What happens when federal agencies and policymakers quietly gut the key program supporting recovering or managing conditions at home? In this episode, Dr. Steve Landers and Elyssa Katz unpack the real consequences of proposed payment cuts to the Medicare home health benefit. You’ll learn why home health care is not only preferred by millions of families, but also the most cost effective choice for the American healthcare system—and why reducing funding now will be a disaster later.

Home health aides are the backbone of our aging care system, yet they are too often overlooked. In this deeply moving episode of Who Cares, co-hosts Elyssa Katz and Dr. Steve Landers — physician and CEO of the Alliance — take listeners inside the homes, hearts, and hurdles of America’s most critical care workforce: home health aides.

As our population ages and the demand for care at home surges, the spotlight turns to the individuals providing hands-on, personal care every single day. Bathing, dressing, companionship, feeding, and emotional support — these aren't just tasks, they're life-changing interactions. Dr. Landers shares compelling anecdotes and data, reinforcing why this workforce is vital to the future of aging in America.

With stories ranging from a veteran finally finding peace through the kindness of an aide, to thousands of referrals going unfilled due to workforce shortages, this episode paints a vivid picture of both crisis and opportunity. The conversation dives deep into critical topics like Medicaid reimbursement challenges, workforce housing scarcity, and the severe shortage of younger caregivers entering the field — all while highlighting transformative solutions that could change everything.

From developing training pipelines in high schools and community colleges to reimagining retirement for older adults as second careers in caregiving, Elyssa and Dr. Landers emphasize a path forward grounded in humanity, policy, and purpose. They also touch on nurse delegation laws, the importance of supporting family caregivers, and practical resources like CaringInfo.org to help bridge gaps in home care education.

Listeners will walk away with a newfound appreciation for home care aides and a clearer understanding of the urgent changes needed to support them. If you care about the future of aging in America, this episode is essential listening.

In this compelling episode of Who Cares, hosts Elyssa Katz and Dr. Steve Landers dive deep into the state of hospice care in America, examining how the hospice benefit has evolved and why hospice reform is urgently needed. The conversation kicks off with a focus on two crucial SEO terms—hospice benefit and hospice reform—which are discussed within the first few sentences to maximize search visibility.

They begin by framing hospice as a “national treasure” that’s been a vital part of Medicare since 1982, serving more than 1.7 million Americans each year. But while over half of Medicare beneficiaries receive hospice care, the average length of stay remains alarmingly short—just 18 days. This severely limits the full potential of the benefit.

Dr. Landers describes how hospice is often misunderstood as “giving up care,” when in fact it offers a more holistic, comfort-oriented model. The Medicare hospice benefit was designed to deliver personalized, interdisciplinary support—including nurses, social workers, chaplains, physicians, and even volunteers—to patients at the end of life. But outdated policies and funding models are threatening its effectiveness.

Key issues covered include the stagnant reimbursement rates, the problematic per diem payment structure, and the rising cost of labor that hospice providers can’t keep up with. The conversation also tackles Medicare sequestration, CAP limits, and the growing burnout among hospice workers due to financial and policy constraints.

A major reform opportunity discussed is concurrent care, which would allow patients to receive both hospice and curative treatments at the same time—something proven effective in the Medicare Choices Model. They also advocate for telehealth flexibility, extending bereavement support, and adapting care models for special populations like dementia patients, who often fall through eligibility cracks.

The episode takes a hard look at fraud too, noting how bad actors threaten the system’s credibility. But the hosts warn against using a sledgehammer approach, emphasizing that most providers are delivering high-quality care. “Use a scalpel, not a sledgehammer,” becomes a recurring refrain.By the end, listeners will understand that hospice reform must be careful and constructive. Cutting corners on reimbursement or overburdening providers with audits could do more harm than good. Instead, smart reforms can reduce costs while improving outcomes for both patients and caregivers.

Whether you're a policymaker, healthcare worker, or simply someone who wants to ensure dignity at the end of life, this episode offers a powerful look at what’s working—and what’s not—in American hospice care.

AI is making its way into home care—helping improve efficiency, predict falls, assist caregivers, and even provide companionship. But is this the future of better care, or are we heading toward a system that replaces the human touch with algorithms?

Today, we’re breaking it all down. We’ll separate fact from fiction, hear from experts on AI’s real impact in home care, and put AI to the test in some high-stakes scenarios.

Nurses in home care are the cornerstone of patient well-being and recovery—and yet, amid a growing nursing workforce shortage, the pressures on them are intensifying. In this episode of Who Cares, the official podcast of the National Alliance for Care at Home, hosts Elyssa Katz and Dr. Steve Landers shine a light on the challenges and triumphs of today’s nursing professionals.From the first moment, Dr. Landers is clear that nurses are the beating heart of the home-based care system. Whether it’s wound care, managing infusion pumps, symptom tracking, or supporting families through the end of life, nurses play a multifaceted, invaluable, and often underappreciated role in keeping patients safe and comfortable at home.But the story doesn’t stop there.This episode explores the diverse nursing roles across hospice, home health, and home care, including how nurses lead care planning, collaborate virtually with other providers, and operate with significant autonomy—something rarely found in traditional healthcare settings. And while that autonomy offers professional freedom and fulfillment, it also comes with demands for broad clinical expertise and strong decision-making.Dr. Landers also addresses a growing crisis: the nursing workforce shortage. With over 65,000 qualified nursing school applicants turned away in 2023 due to limited faculty and resources, the system is strained at every level. He calls for urgent investment in accelerated education programs, nurse residencies in home care, and better faculty recruitment to ensure the next generation of nurses is supported and trained.There’s also a human side to the conversation. Nurses aren’t just clinicians—they are connectors. They walk into people’s homes, earn their trust, and provide comfort in some of life’s hardest moments. From witnessing a nurse-led COVID care model that kept patients safe at home to celebrating real-life leadership stories in the field, this episode paints a vivid, moving picture of what nursing in home care looks like.Listeners will leave with a renewed appreciation for the power, complexity, and heart of nursing—especially in home care—and will understand why addressing the nursing workforce shortage is not just a policy issue, but a national imperative.Tune in for a thoughtful, solution-oriented conversation that highlights what’s working, what’s broken, and what’s next for nurses in home care.

The aging population is transforming healthcare in America—and the aging population isn't just a future concern, it's a present-day crisis. In this inaugural episode of Who Cares, hosts Elyssa Katz and Dr. Steven Landers confront the reality that our systems aren't ready for what's already happening. With demographic projections showing a tripling of the 85+ age group by 2060, it's clear that business-as-usual in healthcare won’t work.

Dr. Landers, a nationally recognized leader in geriatric and home-based care, shares compelling data that shows why focusing solely on those 65 and older misses the real urgency. He and Elyssa Katz explore the surge in unmet needs—especially when one-third of hospital referrals for home health go unfulfilled. This gap has life-or-death consequences, increases readmissions, and places enormous pressure on family caregivers and our already strained hospital systems.

The conversation underscores how the aging population is changing everything—from Medicare and Medicaid financing to hospital capacity, emergency room backups, and workforce shortages. Elyssa and Dr. Landers cite recent losses from prominent hospital systems and expose the bottlenecks created by the lack of available post-acute care options.

Listeners will learn about the Four M’s of Age-Friendly Health Systems—Mobility, Mentation, Medication, and What Matters Most—and how these principles can create better outcomes and more meaningful care experiences. With heart and humanity, the hosts emphasize that improving care isn’t just about systems; it’s about deeply personal moments.

Elyssa opens up about the final six months she spent with her father under hospice care, illustrating how care at home transformed not only his quality of life, but her family’s ability to create lasting memories. Dr. Landers also shares personal stories from his thousands of house calls, where seeing patients in their environments revealed issues that would have gone unnoticed in clinical settings—from safety hazards to malnutrition caused by undiagnosed vision loss.

The episode wraps with a deep dive into the Home Health Value-Based Purchasing Model, which has successfully saved Medicare hundreds of millions of dollars by aligning provider incentives with outcomes. This model is proof that care at home can deliver higher-quality outcomes at a lower cost—what the hosts call a “win-win-win” for patients, providers, and the system at large.

Whether you’re a policymaker, healthcare professional, caregiver, or simply someone concerned about aging with dignity, this episode lays the groundwork for the critical conversations ahead. Elyssa Katz and Dr. Steven Landers bring data, empathy, and clarity to the challenges and opportunities of aging in America.

Join the movement. Care at home is the future.

Who Cares is the podcast dedicated to informing, inspiring, and empowering the care at home community. Hosted by the National Alliance for Care at Home, we bring expert insights, meaningful conversations, and advocacy for person-centered healthcare to the forefront.

As the leading authority in home-based care, we invite dialogue and spark transformative discussions that shape the future of care across America. From hospice and home health to personal and palliative care, we explore the challenges, innovations, and human stories driving this essential industry.

Care at home will impact us all. Let’s shape the future together.