Impromptu House Calls Turned This Company into a Venture-Funded, Nationwide In-Home Care Provider 15 Years Later

When Dr. Todd Stivland was a practicing physician, he was finding it hard to connect to his patients, whether they were in assisted living, group homes or their own homes. He felt like they weren’t getting the care they needed, so he started going to them on home visits.

Eventually, those home visits became so popular that Stivland left his practice and started his own company, Bluestone Physician Services. Since then, he’s taken that hands-on approach to over 20,000 patients.

Now, the company has received a significant strategic investment to further its capabilities and growth.

“I just found house visits to work much better, and I ended up getting so many requests for them that I left my clinical practice and founded Bluestone,” Stivland told Home Health Care News. “The idea was to create a model for chronic disease management, focusing on where the patients lived and what resources they had, and service them there instead of making them come to where we were in the ivory tower.”

Momentum has picked up behind the Bluestone model over the past 15 years. Today, it has grown to the point where the group has over 100 provider locations that provide care in assisted living facilities, group homes and patients’ own homes in Minnesota, Wisconsin, Florida and Virginia.

Overall, the company has about 500 employees, including primary care physicians, nurse practitioners, physician assistants and care coordination staff.

Based in Minnesota, Bluestone was independent until it became a portfolio company of WindRose Health Investors in April. Now, it has obtained an investment from the Blue Venture Fund (BVF), which is a collaborative fund between Blue Cross Blue Shield, the Blue Cross Blue Shield Association and Sandbox.

“We are thrilled to support the Bluestone team as their care model, outcomes and growth strategy squarely align with our focus areas at BVF, and where we add value as a partner,” Andrew Boyd, the VP of the Blue Venture Fund, said in a press release. “We believe Bluestone is innovating the delivery of care management to an extremely fragile population and is well positioned to succeed as the shift to value-based care continues to accelerate.”

Part of that innovative delivery includes home-based care. Bluestone focuses on treating chronically ill and disabled patients in a variety of settings, but the home is one of its primary focuses.

“The start of [Bluestone] was basically to pick up people who were falling through the cracks,” Stivland said.

In order to do so, Bluestone is very payer agnostic, he explained. Treating older adults and individuals with disabilities in different settings requires flexibility, and that’s why the company has aimed to be agile in terms of where it treats patients and how it gets paid for that care.

“We’re pretty scrappy,” Stivland said. “We call it our Lego stack of piecing together different insurance plans. We have dozens of different insurance contracts, and I think we have nine different risk-based contracts in different markets. So we really try to be able to service anybody, no matter what payer they’re using.”

Bluestone had never taken any investment money until the Blue Venture Fund came along, and that was for good reason. But now that it was entering value-based contracting, it needed to be able to cover significant, upfront payments.

“In some of these contacts, we plan on taking on full risk, so we needed that financial backing,” Stivland said.

Still, the company will remain agnostic to payers despite its relationship with the Blue Venture Fund.

Now that it has the backing of WindRose and the BVF, Bluestone can get more creative and aggressive when it comes to risk-based contracts. The company will continue to survey the scene when it comes to those opportunities, even looking at options like direct contracting with the federal government.

Partnering with home health agencies

Bluestone has grown significantly since its launch. It’s looking to continue to do so in the near future as well.

“We have a number of different options that we’re looking at,” Stivland said. “We’re looking at some partnerships with assisted living [operators], and are considering other states and other payment models. We’ll definitely be looking at growing, and where that is will depend a little bit on where we find the best partners.”

Some of those partners may be home health agencies, which Bluestone already works with extensively.

“If you look at the assisted living environment, they don’t provide a significant amount of care in any state, and the Florida assisted living environment doesn’t do any direct care,” Stivland said. “So when patients need something, home health care is what we rely on.”

And moving forward, Stivland believes that reliance on home health workers and agencies will only grow larger.

Since the onset of the pandemic, Bluestone — like a lot of others — has noticed an uptick in the amount of people who need care, but who want to stay at their own homes in their own communities.

“I think it’s important to have that option for people,” Stivland said. “And moving forward, it’s a big opportunity for home care agencies to have those programs for people where they can stay at home and be safe with the right technology and the right services coming in.”