What Home Care Employers Need to Know About Offering Major Medical (Joseph Kitonga)

42% of Direct Care Workers rely on public health coverage (PHI) and on average only 32% of agencies doing $1.6-4.9M in annual revenue are offering major medical. Joseph Kitonga, CEO of Vitable, breaks down what small, medium, and large agencies need to know about ACA compliance, nuances for part-time and FTEs, major medical plan options, and other advice and warnings when it comes to offer major medical. (See the chapter highlights below to skip to the content relevant to your size.)

Play Episode

min

Nov 25, 2025

What Home Care Employers Need to Know About Offering Major Medical (Joseph Kitonga)

Miriam Allred (00:10)
Hey everyone, welcome back to the Home Care Strategy Lab. This is Miriam Allred, your host. It's great to be back with all of you. In the lab today, I'm sitting across from Joseph Kitonga the founder and CEO of Vitable Health. Joseph, welcome to the lab.

Joe (00:24)
Thank you for having me.

Miriam Allred (00:26)
I'm excited to reconnect. You and I have crossed paths over the years and it's been a minute since we've reconnected, but I'm excited to hear and learn more about what you guys are up to and want to pick your brain on all things health insurance, major medical for these home care companies. You launched several years ago and now you're working with 600, 700 home care companies. And so you've grown a lot. You've got a lot of experience under your belt. And when I think of you, I think of kind of the medical health insurance guru or expert in the industry. And so I want to pick your brain on all things health insurance.

Before we do that, want to have you introduce yourself. Tell everyone a little bit about your personal background working in home care, your mom running a company. Give us kind of the story behind what you're building today.

Joe (01:06)
Well, thank you for having me, Miriam. It's been awesome to watch your journey and the just quality and caliber of conversations you've had on. so like my background starts with my family and I immigrated from Kenya to the US when I was 13. And I was really privileged that Philadelphia was willing to adopt me and my family and

I grew up watching my parents, once we immigrated to the U.S., especially many immigrants, chasing the American dream. started a, my mom and my dad were actually caregivers when we moved to the U.S. and then they started a small business, a senior care agency, a home care agency, that they grew to a meaningful size over the last decade and a half, about 200 caregivers. And for 10 years, I basically worked for my mom and her agency, everything from going back at

to the very beginning as they were, they started it in Pennsylvania, was as they were applying to get licenses and were rejected and reapplying. I'd come from school and said that my mom would have me sit in front of the computer and help her with filling out the forms. Once they were approved, getting the initial patients, ⁓ I played the guitar and my mom would have me go to the senior living centers all around Philadelphia, play the guitar so that they could get in front of patients and

all through getting the, it's just been like phenomenal journey watching my mom, my dad sort of build this business, it's a really difficult business to be in because it's also like, think the most, like agencies do the most important work in our community is taking care of our seniors and know.

people with disabilities in their homes and bringing empathy to every interaction. there are constantly challenges every day that I think most businesses, most other businesses probably don't comprehend. this was the foundational piece of my upbringing, just helping and working alongside my parents as they built this agency over the last decade and a half. But before that, I studied computer work.

High school, I studied computer engineering, Penn State, and then interned for three summers at Microsoft working on Xbox. I think it just, being at Microsoft in Seattle, emphasized this disparity of care and access that I'd go to in the summers and I'd have perfect health care. No deductibles, on-site clinic, no co-pays. It's just I show up and everything is taken care of.

And I'd go home in the summers, at the end of the summer, and help my parents out for a bit. their caregivers would come when they were sick and say, I'm feeling really sick, and I don't even have $100 to go pay for copay. For the few that did have coverage, and for those that didn't have coverage, they were stuck over utilizing the emergency room, where 70 % of visits are unnecessary, costing an average of $1,300 per visit, which is a lot of money for anyone.

But it's especially taxing for the everyday worker, given that most Americans don't have $400 saved up for a medical emergency. It makes upward mobility more difficult and just perpetuates a cycle of debt. But more importantly, at least to me, as I came to learn, it also leads to worse health outcomes. And the stat that sort of blew my mind is that in Philadelphia, two zip codes just five miles apart. The average life expectancy difference is 20 years.

And it's not rocket science why that's the case. There's a few variables that contribute to it. But the one that I felt was absolutely within our control was that there's just a lack of access to high quality preventive care. And so I was wrestling with this. We know what great care looks like. It's access that's the problem. And technology is uniquely suited to solving access problems. But I just felt like no one was focused.

on helping employers like my mom. At my mom's business, you'd have ADP and HR payroll reps and workers knocking down the door every day. I actually can't remember one health insurance rep coming in. It's just like this. for most agencies, they are likely familiar with the Blue Crosses and United of the World.

offer, you know, they automatically disqualify the home care agencies because they can't meet the enrollment requirements. And it's just this it's like this huge problem. but it's just no one was focused on. I just felt like this is really backwards because it's something that is absolutely within our control. And so anyway, like I dropped out my last year of school to focus on building Vitable full time. we

the core of what we're building is just how can we help employers like my mom offer affordable, high quality health plans and benefits to their caregivers in a way that enables them to attract and retain talent, to be compliant with ACA, the Affordable Care Act, and also to help them grow and save money on unnecessary spend that oftentimes creeps in.

‍

And today we serve about, I think, close to 700 agencies with over 130,000 employees. so, but the, I actually think, although they were probably the largest home care focus health plan in the country, but we're so early and it wasn't until recently that we started sharing our message more broadly because I think

There's such a need for affordable healthcare, but oftentimes the options that are available for employers like my mom were awful and they just perpetuate the problem that continues to exist. And we are singularly focused on helping caregivers and their employers get access to high quality care. And our belief is that

And as we go on, I can share bit more about how we do it. But our belief is that if you make health care affordable, and all of our plans include primary care through doctors that actually work for our medical group for free, our belief is that if you reduce the barrier for getting access to care, like no co-opays, no deductibles, no complicated terms, you just turn on your app and have a visit same day instead of waiting three weeks taking off of work, a shift that you probably can't afford.

You know, our belief is that over time you actually get to increase the average life expectancy of the patients and members by probably five to ten years. Just like it's not rocket science, it's really simple things, but it requires a level of being unrelenting to just an empathy to understand the unique needs and challenges that caregivers and their employers have. that's been,

probably our biggest advantage and our reason for existing as a company.

Miriam Allred (07:57)
Okay, great introduction. And I've already got loads of questions based off what you just shared, but I love actually the contrast. I didn't know your Microsoft background, but I love that you were working, you know, high-end, you know, top, top 100 companies and they have like this premium healthcare experience. And then in the summer you'd go back to Philadelphia, be back at your mom's agency and see like the stark contrast of the reality of healthcare and the lack thereof offer to these caregivers. Like I love that contrast and you.

coming back to the home care world and thinking like, wow, this has got to change. Like it really is backwards. Okay. Lots of questions though, to just like get right into this. You have worked with so many home care companies at this point in time. I want you to think through the lens of these operators, what are the most common misunderstandings when it comes to offering health insurance? Again, I think people don't know what they don't know.

⁓ You know, when they hit that 50 employee mark as they continue to scale, like what, when you talk to these home care companies, what are the things that they don't understand or are just flat out wrong about?

Joe (08:55)
I think one, and this was true of my mom, I think that there's a misconception, I guess I'll use two examples. One, employers or agencies reach 50 full-time equivalent employees, they do have to offer ACA compliant plans or get fined by the IRS. oftentimes we'll speak to an agency that is

that has close to 100 and is yet to offer a plan. there's a bit of a, well, I probably will not get fined and I'm willing to take the risk. they later get audited and fined by the IRS and reach back out to us. I think the...

It's just such a distraction and it's so costly. It's called the sledgehammer fine for a reason. But the reason the ACA carved in the Part A of the Affordable Care Act, and there's Part A and Part B, and Part A is the really hefty fine.

And the reason it was carved in was to offer these minimal essential services, like these MEC plans or minimal essential coverage plans often cover these essential services that are mostly preventative services and some vaccines. And the reason was that if you increase access to preventative care, like at least the thought was like, if you increase access to preventative care, then you'll ⁓ help reduce the downstream sort of cost of care, like over time, and also like people live healthier, longer lives.

know, the, and so it's, these plans are not, I guess, complex, but they are quite awful. And so my parents, when they first saw these plans that they were offered, they said, these plans are basic, it's just a tax. It's a tax to employers to offer this check the box compliance solution, which is like, honestly, most of the health plans that are focused on agencies are really, really awful.

And so my parents, like a lot of the owners that we work with, when they hit 50, they're faced with this choice, is, I am willing to take the risk and we'll roll the dice and see what happens.

‍

Download Transcript