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What does radical transformation mean for home-based care? Insights from discussions with leaders attending HomeCare 100

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‘Radical transformation,’ this year’s theme from the HomeCare 100 Winter Conference in January, prompted many discussions among home-based care leaders and industry experts in the halls of the Fairmont Scottdale Princess. But what does it truly mean, and why did one of the most exclusive home-based care conferences in North America decide to anchor their event around this theme? 

What does radical transformation mean for a home-based care business? And why is it important for the industry? 

“Transformation is understood as a profound change which requires a fundamental shift in mindset. Radical transformation, on the other hand, looks at the root cause of problems and gets to the core of the issue. This usually requires a shift away from the type of thinking that created the problem(s) in the first place.” Beyond sustainability – radical transformation: What does that mean, and how do we do it?

Since before the pandemic, the home-based care industry has gone through numerous challenges and hardships related to care worker churn, growing demand, increases in costs, and constant changes in government regulations related to home-based care reimbursements – just to name a few.  

It’s obvious the world of home-based care is constantly changing, and it’s high time for organizations to revamp their strategies and give their business models a fresh spin – aka a radical transformation. With demand skyrocketing and resources thinning out, organizations should be evaluating their current systems and looking into new tools to stay ahead. 

For home-based care, radical transformation means breaking away from the old procedural and operational norms and looking for new ways to do business and raise the bar.  

Why does the home-based care industry need radical transformation? 

The global home-based care market is rising, projected to grow from $288.38 billion in 2023 to a whopping $505.81 billion by 2030 at a compound annual growth rate (CAGR) of 8.4%. This surge in demand coincides with an aging American population that necessitates an additional 3.3 million healthcare professionals and support staff by 2030. 

Many leadership panels and industry events throughout the last few years have focused conversations on these issues and how best to tackle them. For example, in 2023, Home Care Magazine hosted a webinar panel of operations leaders in home-based care to talk about the various trends, challenges, and opportunities facing the industry. They spoke about the thriving patient demand, which pushed the need for streamlined operations to maintain and scale their business, as well as strategies to combat the labor crisis. 

“The old business models aren’t good enough anymore. We need value, courage, a focus on results, and a willingness to challenge the status quo,” said AlayaCare CEO Adrian Schauer, who highlighted the need for a shift in business models during his keynote at the Better Outcomes User Conference 2023.  

Based on our conversations with several distinguished leaders at the HomeCare 100 conference, we’ve asked about their perspectives on why businesses and the home-based care industry need radical transformation. We learned that challenges such as, 

  • Labor shortages and costs 
  • Overburdened processes within operations 
  • Reimbursement rates  

…to name a few, are the fuel to the engine that seeks a new transformation in how they do business.  For example, Angelo Spinola, Shareholder/Practice Chair of Home Health of Polsinelli Law Firm, explained to us that the reimbursement rates currently don’t match the labor costs, and the labor prices are constantly increasing. For their clients, their reimbursement rate isn’t enough for them to compliantly pay their employees overtime.  

Dr. Marshalina Ramos, President of Premier Home Health Care, expressed struggles with labor shortages and labor costs and how only radical transformation and innovation can overcome these challenges. She explains how “labor is absolutely impossible to get right now, so we have to use tools and innovation to win. Because we are competing for the same 4-5 people, and we are all paying the same, and it’s not that people will come for innovation; they’ll come for a different type of leadership and something radical.”  

With the right approach and tools, home-based care organizations can create a radical transformation that will propel them in this changing landscape. It’s time to turn these challenges into opportunities for growth and sustainability – but how? 

Radical transformation isn’t a new concept; folks in the industry are preaching it louder this year than ever before. Some businesses have already begun to implement radical changes and have seen success. Some have even expressed where they plan to invest their time and energy to achieve the transformation they require to combat these challenges successfully. Here are a few examples of how businesses have and are planning to achieve radical transformation, as well as examples from our interviews with industry leaders at the HomeCare 100 conference.  

1. More diversity within leadership positions in home-based care 

A standout example of radical transformation is the need for more diversity in home-based care leadership and even a different kind of leadership than the norm. In fact, stretching the boundaries outside of the norm is the future! 

According to Skilled Nursing News, ‘Of the 20 largest skilled nursing providers in the United States, only four are now led by women – a stark contrast to the frontline staff who primarily identify as female. While 80% of the overall health care workforce are women, only 19% of hospitals are led by women, and only 4% of health care companies have a female CEO.’ However, for long-term care, the number of female C-Suite leaders in the states is lower than in the rest of the healthcare field.  

Only 19% of hospitals are led by women and only 4% of health care companies have a female CEO.

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Fortunately, some home-based care businesses are changing the norm and hiring female C-suite leaders and visible minorities. Having a diverse group of leaders in an organization invites different perspectives, ideas, and talent, which can benefit the organization.

For example, a Deloitte study found that companies with inclusive hiring, promotion, development, leadership, and team management generate about 30% more revenue per employee than competitors without such policies.  

We had the privilege to speak with Dr. Marshalina Ramos, President of Premier Home Health Care, who shared with us that as a woman of color, being the president of Premier is already a radical transformation for her organization.

“I am educated on a different level, and they’ve never had a clinician leading the team. So that alone is already radical.”  

Dr. Marshalina Ramos, President of Premier Home Health Care

It’s amazing to see radical change already in action when it comes to more diversity within leadership, but we still have a long way to go.  

“I see that there are many men in private equity. And I understand that we need money to fuel our mission. At the same time, let’s remember that we should all be working together, provide on that same note,” said Samara Beckwith, Executive VP for Public Policy, Chapters Health Systems, when asked about her perspective on female leaders in the industry.  

It’ll take time for the whole industry to transform this way, but like most changes, it takes some steps to get there.  

2. Home-based care alignment within the care continuum 

When the pandemic hit, there was a large shift in the need for home-based care. We all witnessed the demand skyrocket, and organizations were scrambling to meet the overwhelming volume while also dealing with the effects of the pandemic on their staff. Since then, home-based care has been recognized within the healthcare industry as a vital part of the care continuum.  

For example, last year, a $150 billion pledge was announced to home and community-based services. This new budget signals a major shift in delivering healthcare, with much greater emphasis on including home-based care within the care continuum.  

“This investment will help millions of people across the country access high-quality care while improving the quality of jobs for home care workers. We thank President Biden and the administration for recognizing the value of home care as part of the care continuum and their commitment to helping Americans age in place safely and with dignity,” said Adrian Schauer, CEO of AlayaCare, in How the budget pledge is improving access to quality, affordable health care.  

More hospitals are starting to align with home-based care agencies or creating home-based care services of their own. Naomi Goldapple, SVP of Data & Intelligence at AlayaCare, shared about how these alignments are breaking down silos and barriers when interviewed at HomeCare 100.  

This is because now they are integrated and have the same software systems, allowing the flow of information from one to another. “We do see across all our markets, all our geographies, those barriers are coming down because there is really a push for hospital-at-home and keeping people at home. With tools like remote patient monitoring, all that data that is collected at home goes back to the primary physicians and is shared with the care worker. All of that is becoming a lot more fluid than it was before, which is great because we need to keep people at home.” 

Even in Canada, we see the public sector partnering with the private sector for home-based care to boost collaboration between the services and providers. Doctors, nurses, specialists, and other health professionals work hand-in-hand to deliver holistic care to patients at home. As Adrian Schauer stated in his 2024 predictions, we can expect this collaborative approach to be the norm rather than the exception.  

“[Home-based care] are still perceived to be a vital part of the care continuum. Hospitals desperately need to know that they have home-based care available for discharged patients. And especially with hospitals discharging earlier, quicker and sicker, having the home care support in the marketplace is absolutely critical.”

Marki Flannery, AlayaCare board member

And yet, there’s still work to be done. When we asked Angelo Spinola of Polsinelli Law Firm about how he thinks home-based care is perceived congressionally, everybody is now in favor of home-based care, and all the elements are there for a full alignment. However, not all reimbursement rates currently align with the increasing costs of home care. Angelo explained how government policies are always changing, and some are not keeping up with the cost of care. “There are areas of the government that are not catching up and not understanding that there’s a component, an increasing cost to the provision of care that we must match on a reimbursement perspective.”  

One of the next steps, Angelo said, “is getting through all the bureaucracy. To create an affordable program. What’s the next step in battling that bureaucracy? I think there are a million fires. Because you’ve got Medicaid at the state level with hundreds of those programs. Sometimes, the reimbursement is good; sometimes, it’s not.” In addition, Angelo brought up an excellent point on how much the community of home-based care providers is working collectively at events like HomeCare 100 to advocate for change. It will take some time, but the industry is closer to aligning with the healthcare system.  

Home-based care being recognized within the care continuum and the steps that the government and providers are taking to align it with hospitals and other healthcare systems are transformations AlayaCare is excited to see moving forward.  

3. New technology, like AI and LLMs, changing how you do business 

One of the most radical of all transformations in home-based care is the tools you use to make those decisions and changes. Artificial intelligence (AI) and large language models (LLM) are some of the new technologies poised to radicalize the home-based care industry. Many providers are adopting new technologies to change how they do business, just like the example of remote patient monitoring Naomi mentioned in an earlier section above. 

So, what is so great about AI and LLMs that have the industry buzzing?  

Quick definitions

Large language models (LLM) are large deep learning models pre-trained on vast amounts of data. 
Artificial intelligence (AI) is the collection of different technologies that allow the machine to act at the human level of intelligence. This means it can process required learning from past experiences and self-correction to make a certain decision and to reach a certain conclusion.   

We chatted with Michael Ross, the Senior Vice President of Partnerships at TapCheck, about the role of AI and LLMs in the industry. He shared his insights on how the major hurdle before the advent of this technology was accessing and deciphering the vast amounts of institutional data that were compartmentalized. However, with the introduction of LLMs, this data can be effectively used to answer questions and solve problems more efficiently. In essence, LLMs can tap into your system’s wealth of information and bring it forward to resolve issues quickly. 

“So that’s really the power. It used to be the concept of expert systems, and you’d ask it one of the FAQs, and it provides a given answer. But now, these LLMs are the expert system model. We are on the cusp of optimizing billing and reimbursements, and the applicability of it is endless. I’m sure we’re going to see a lot of innovation in this space for 5 to 10 years.”   

Michael Ross, the Senior Vice President of Partnerships at TapCheck

These types of use cases can improve patient outcomes and build the confidence and capabilities of clinicians and caregivers. In his 2024 predictions, Adrian Schauer explained in detail the importance of AI in patient risk stratification, detecting health anomalies, and boosting collaboration, communication, and efficiency between stakeholders in the care continuum. AI also provides predictive analytics, enabling caregivers and nurses to identify and address potential health issues early on.   

“It’s a paradigm shift in care delivery, allowing us to move from reactive to proactive care management in all home-based care markets,” said Adrian Schauer.

The industry seems to be rapidly innovating by adopting these tools to improve not only patient outcomes but also to improve their business operations.  For example, challenges like the labor shortage have put pressure on the margins, and there’s a need to focus on back-end efficiencies. Naomi Goldapple explained to us how at these events, “everybody still wants to talk about how to streamline the operations. Everyone wants to talk about how to retain and attract care workers. Everyone wants to talk about how to improve their margins.” This interest in improving efficiencies isn’t going away anytime soon, and technology like AI and LLMs are one radical way to do that.  

The road to change is set – we just need the right fuel  

Based on these themes and examples, the need for radical transformation in our industry is certain. Whether it is by diversifying leadership roles to bring more opportunities and opening a different perspective in leadership, to working with the government and other providers for a better alignment of home-based care with the healthcare system, to adopting new radical technologies like AI and LLMs to help solve inefficiencies and business challenges, and other forms of change we haven’t had a chance to talk about – these themes and trends are just the tip of the iceberg, as there’s a long road ahead. But the home-based care industry is set on a direction of growth, success, and opportunity —it just needs some radical transformation to fuel themselves to get there.  

Watch a snippet of our insightful chats with leaders and experts at HomeCare 100 below

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