Bryony Winn became the CEO of Pennsauken-based Bayada Home Health Care in March after a career at two big Blue Cross health insurers and at the consulting firm McKinsey & Co.
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Those experiences, she says, prepared her to take the reins at one of the nation’s largest home health companies at a time when Bayada is wants to increase the intensity of its home care offerings — and get insurers to pay for it.
“Hospitals are full,” and patients want to be at home, said Winn in an interview this month at Bayada’s headquarters in Pennsauken.
The company, whose founder Mark Baiada converted it to a nonprofit in 2019, operates in 22 states and five additional countries, employs 44,000 people, and had $2.2 billion in revenue last year.
Winn, Bayada’s first non-family CEO, grew up in Zimbabwe and went to college in South Africa. “Being around so many challenges and so much opportunity every day in the developing world, I always had a sense that I wanted to do things that made lives healthier,” she said.
When she came to the United States in 2009 to work as a consultant in Chicago, it struck her how specialized and disconnected healthcare is here. “In the developing world, there’s not enough trained people, so it’s a much more connected system around patients and humans,” she said.
The Inquirer spoke with Winn about the importance of taking care of people at home as the nation’s healthcare providers come under increasing financial strain. Questions and answers have been lightly edited for length and clarity.
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How did your jobs at McKinsey and at Blue Cross of North Carolina and Elevance Health prepare you to lead one of the nation’s largest home healthcare companies?
I learned a lot about the U.S. healthcare system and became more and more convinced that this lack of connection was driving unsustainable cost, and I still think it’s driving unsustainable cost. Pre-COVID, I used to say affordability is the greatest healthcare crisis of our time. Then COVID really was for a while, and I think we’re back to that now. The quality of care here is amazing if you have a really rare form of cancer. I’d prefer for it to be treated in some of the amazing institutions here than anywhere else in the world. But if you are just a typical person, and especially an aging person here with two or three chronic conditions, you are pushed from pillar to post across a system who doesn’t ever see you as a human being.
What do you think you can accomplish at Bayada, which was founded more than 50 years ago, to address that connectivity issue?
What I can bring to it is really understanding the place of home health in the entire healthcare ecosystem. This is the place where clients and patients want to be; they want to be in their homes. And so the question I’m asking is not what are the kinds of conditions that should be addressed at home, but rather flip that on its head and say, what are the kinds of capabilities you need in the home to be able to address things for clients who want to be there?
What’s happening now that makes it so important to solve this problem?
For two decades in healthcare, we’ve been talking about people aging into Medicare. Ten thousand people a day aging into Medicare. Now 10,000 people a day are 20 years older. They’re aging into 85 every day. Because it’s not a change in insurance, it doesn’t generate the same conversation. But it’s a huge change in health status. We now have all of these seniors with two or three chronic conditions, and with a decent chunk of life expectancy still. The delivery system really needs to shift in how we care for these folks.
What has to change?
One thing that’s needed is a collection of multiple services in the home. Very rarely do you need just skilled nursing. You need skilled nursing and a home health aide and potentially wound care. That requires care management, a much more connected ecosystem, versus what is today much more a siloed set of services. The second thing is we just need more intense care at home. We have done this quite successfully, and we’re doing it even more now around NICU babies [in partnership with Children’s Hospital of Philadelphia and insurers Highmark and Independence Blue Cross].
Do you see Bayada playing a broader role in health systems’ hospital at home programs?
I do. We can serve higher-intensity patients at home with more complex care needs, and we do a lot of this today. We’re just not really paid for it, or it’s not the service that we’re meant to provide. So it’s really, how can we more sustainably do this high-intensity work at home? That’s a shift for us. Our clients want it. Wound care at home is hard. It’s one of the biggest reasons for readmission back into the hospital after post-acute discharge. How we can build really strong clinically evidence-based wound care capabilities is one of the big pieces that we’re looking at in this elderly population.
Providing more intensive care has higher costs. How do you convince insurers to pay more, especially given the prevalence of Medicare and Medicaid in home health?
There is not a ton of wiggle room, but this is where my background helps. I’ve worked on the payer side for a long time. They truly care about affordability and quality as well, and so it’s really working together to say how does what we need for our caregivers, clinicians, and ultimately clients map with what you can afford, and how do we build this together? I’m not sure home health has ever had those conversations as intently as we need to have them now. It’s a very fragmented industry. Hospitals have been having these more strategic conversations with health insurers for decades.