Startup Homeward is now a B Corp-certified company as it doubles down on its focus to improve rural health and expand its services to more patients.
Homeward was founded in 2022 as a public benefit corporation that focuses on value-based contracts with health plans in rural markets.
"We recognize that in order to solve the rural healthcare crisis, we had to connect our mission and our business objectives," Jennifer Schneider, M.D., Homeward co-founder and CEO, said in an interview.
As the company deepens its relationships with payers in Michigan and Minnesota to serve wider populations, achieving B Corp certification alongside its existing public benefit corporation status reinforces Homeward's commitment to the rural communities it works in, said Schneider, a health tech veteran and former Livongo executive.
"As a public benefit corporation, it gives us the right governance structure to ensure that we're consistently making progress on our mission. The B Corp certification indicates the impact that we're making in the markets that we serve," she said.
Public benefit corporations are for-profit entities created specifically to pursue a public benefit. There are a number of healthcare companies that have been established as PBCs, including Aledade, Mark Cuban Cost Plus Drugs, Osmind and Homeward, among others.
B Corp Certification is a designation by the nonprofit B Lab that a business is meeting high standards of verified performance, accountability and transparency on factors from employee benefits and charitable giving to supply chain practices and input materials.
The process of B Corp certification is rigorous. Companies that hope to achieve certification are subject to the third-party B Impact Assessment of its societal impact, from workers and customers to the environment. According to B Labs' database, there are 41 healthcare or healthcare-related B Corp-certified companies globally. Of these 41 companies, Homeward and Indigenous Pact, a tribal healthcare consulting firm, are the only companies that are both B Corp-certified and public benefit corporations.
"This recognition emphasizes our fundamental belief that solving the rural healthcare crisis requires great businesses that are driven by purpose, focused on community partnership, and empower employees to thrive," Schneider said. "We believe everyone should be able to achieve their best health, no matter where they live, and this certification is further evidence of our dedication to that vision.”
Homeward's B Corp certification status comes as the startup builds on its payer partnerships to focus on improving population health across entire counties.
Schneider reunited with other Livongo alums to tackle rural healthcare and official launched Homeward at the ViVE 2022 digital health conference with an initial $20 million investment from General Catalyst.
Five months later, Homeward secured $50 million in series B funding and inked its first value-based care partnership with Priority Health to provide medical care to Medicare Advantage members in rural Michigan.
A year after launching, the startup expanded into its second state in partnership with Blue Cross and Blue Shield of Minnesota. Through that collaboration, Blue Cross Medicare Advantage members residing in 24 Minnesota counties outside of the Twin Cities metropolitan area will have access to Homeward’s services such as in-home visits, community-based visits and telehealth.
While the company's initial contracts in Michigan and Minnesota focused on enrolling patients one by one as a value-based care provider, Homeward is evolving to target population health at a county level, executives said.
Beginning this year, Homeward inked expanded relationships with Blue Cross and Blue Shield of Minnesota and Priority Health. The company now manages clinical and financial outcomes for nearly 25,000 Medicare beneficiaries across 10 Minnesota counties and an additional close to 3,000 Medicare beneficiaries across three Michigan counties, Homeward exclusively shard with Fierce Healthcare.
Homeward delivers a hybrid model of technology and services to increase access to primary care and specialty services. The company employs a multidisciplinary care team, available both virtually and on the ground via mobile care units, with in-home remote monitoring that keeps patients connected to their care teams. These teams conduct physical exams, perform diagnostic tests and integrate with regional health systems, local physicians and specialists to provide care coordination, referring members to local in-person services as needed, Homeward executives said.
Homeward takes accountability for outcomes and cost of care, which allows the company to deploy services and technology in ways that wouldn’t be possible in a traditional fee-for-service model, according to Schneider.
The company has reported high member satisfaction ratings of 90%, according to Schneider.
"It speaks to both a combination of the need in the ecosystem as well as the service. Because of those great results, our health plan partners started asking us if we could take accountability for larger populations. So, we moved to a world in which we contract at the county level. So with a payer, they'll give us all of their Medicare Advantage lives in a particular rural county," she said.
In conjunction with these new agreements, the company launched Homeward Navigation to support local healthcare providers and health systems in providing value-based care.
"Homeward Navigation is really this idea around, 'Can we help manage the whole population?' We want to leverage our technology assets to wrap around the existing providers, the existing community resources and allow people to navigate as well as bringing in our own clinical services to augment, supplement and complement, not replace," she said. "There's no provider abrasion from the payer standpoint. We make the providers more successful and we provide services where there's not enough services."
There are many healthcare disparities facing rural communities, and it's a sizable problem. About 60 million people, or 1 in 5 Americans, live in rural America. In the U.S., 80% of rural counties lack a sufficient number of primary care providers, according to the National Rural Health Association’s policy institute.
"Ten percent of all rural counties have zero health care provider. Most rural counties may have some resources but they may not be the highest quality because those providers are overworked," Schneider noted.
She notes that improving rural healthcare is "personal" for her as she grew up in the small town of Winona, Minnesota. She was diagnosed with Type 1 diabetes at a young age and experienced firsthand the lack of primary and specialty care that millions of families across rural America deal with every day.
"This is my family; these are my aunts and uncles that we're in Minnesota taking care of," she said.
The company has seen rapid growth in just two years with more than 28,000 covered lives in counties in Minnesota and Michigan. By comparison, Iora Health, a value-based primary care group established in 2020, had 38,000 Medicare patients at the time of its acquisition by One Medical.
"The evolution of our business also continues to incentivize us to improve outcomes in rural geographies at a very exaggerated and differential scale of the number of lives that we're responsible for," Schneider said.
Social and community impact standards
Homeward's B Corp certification ties in with its ongoing evolution to addressing population health across rural geographies.
In order to earn certification, a company must demonstrate high social and environmental performance by achieving a B Impact Assessment score of 80 or above and passing B Labs' risk review. The B Impact Assessment examines a company's impact on their workers, community, environment and customers.
Companies aiming for B Corp status also must make a legal commitment by changing their corporate governance structure to be accountable to all stakeholders, not just shareholders, and achieve benefit corporation status, which Homeward already achieved.
These companies also must exhibit transparency by allowing information about their performance measured against B Labs' standards to be publicly available.
Homeward executives said the company earned B Corp certification due to a number of factors including its impact to members by connecting them to high-quality local clinical and nonclinical resources and addressing social determinants of health.
Homeward strives to hire employees, support local suppliers and provide charitable donations within the rural communities it serves. In addition, 100% of Homeward Health employees are paid a living wage, receive equity grants, are eligible to participate in a retirement plan match program and are offered a comprehensive benefits package including health coverage.
Homeward also has made a commitment to hiring a diverse workforce, with more than 30% of employees identifying as racial or ethnic minorities and over half of all employees and managers identifying as women.