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Episode 31

Growth and financial health strategies for home care agencies according to industry experts

Jeff Howell:

Welcome to Home Health 360, a podcast presented by AlayaCare I’m your host Jeff Howell, and this is the show about learning from the best at home health care from around the globe.

Andrew Donlin: Hello, everyone. Welcome to today’s webinar. We’ll give you all a chance to come in for, for for a few seconds. Here I am, Home Healthcare news editor Andrew Downland. Thank you to Alli Care for sponsoring today’s webinar. Um, and thank you to the audience, uh, for joining today. I think it’ll be a really good session. We’re gonna be talking about growth strategies for home-based care agencies. Um, and before we get started, I wanted to, uh, introduce our panelists. The first is Tony ot, who is the market leader of US Home Health and Hospice for live care. Tony has been in the home health industry since eight. He was the CIO of a multi-state interim healthcare franchise from thousand eight into 2017. He then transitioned to the software side of the industry. He was the CEO of Delta Health Technologies from 17, and so it was acquired by Care In, we have Jeff Howell, who’s the director of Growth for I Care.

Andrew Donlin: Jeff has been the director of growth for the past five years, overseeing sales and marketing activities for a team of 40. Previously, Jeff ran the largest corporate real estate blog in the world. And then we have finally, Billy Agno. She’s the senior customer enabling consultant for live care. Billy has, uh, been in, uh, she has 25 years of healthcare experience, and the majority of it has been in home and community based care. She’s a proven professional who is an extreme sense detailed knowledge of the personal care industry. Specifically, just as a reminder to the audience, you’re all allowed to ask questions at any point. Um, in the, in the q&a function here. We’ll try to get to as many of those as we can, uh, whether it’s during the webinar, uh, during the panel discussion or after when we get to questions, um, at the end of the, at the end of the webinar.

Andrew Donlin: Um, but do feel free to submit those. Okay. So today, uh, for, for our panelists and audience, we’re gonna be going over the present. Uh, uh, the presentation is going to be about, um, in some ways, uh, this survey that H A T N conducted in partnership with ELI Care based on growth and the financial health in today’s home based care market. And just wanted to highlight a few takeaways, um, everyone before we got into the panel discussion. Uh, the first one is that 46% of our respondents on the surveys reported that they had little or low confidence that their technology could scale to meet their organization’s future growth needs. The second one is that 76% of respondents said their organization uses multiple different tech, multiple technologies, excuse me, to support operational processes. And the third one is that 40% of respondents describe their organization’s ability to accept referrals as better than compared to January of 2022.

Andrew Donlin: Those are just a few of the takeaways. There’s a lot of other really interesting nuggets from the preliminary results from that survey, which will be coming out soon. Um, and all, you’ll be able to access that at some point, but I believe you’re also able to get an copy if you wish. Okay. Not to the fun part. So, uh, I just put off a few of those takeaways from the, uh, survey, but there’s obviously a lot more in there. First, I just wanna ask all the panelists, uh, Jeff, starting with you, what really stood out to you in the survey result?

Jeff Howell: Yeah, sure. Uh, thanks Andrew. So, um, referral growth was the number one answer on what’s gonna have the biggest impact on growth. And it was by a mile. It was actually about as much as the other six answers combined. And in fact, it was triple the next most popular answer, which was actually just having a marketing strategy. And so it really drives home the point that this is really a referral driven business. And when we look at what the answer was to what are the most important channels, 96% we’re either referral or word of mouth. And only 3% said online advertising or traditional marketing. So it almost makes you think that the in home care there shouldn’t be a marketing department, but it really should be rebranded as a referral management department. Uh, and then the other thing that stood out to me was that two-thirds of respondents said that their business is growing, which presumably is a good thing because, um, there’s no doubt about the demand that’s out there, but you can’t fulfill demand if you don’t have supply. So hopefully that’s a sign that, uh, the supply of caregivers is bouncing back in order for agencies to be back in growth mode.

Andrew Donlin: Yeah. Jeff, I thought that note was really interesting as well. Um, it seems like even though there’s headwinds and there’s issues to get around, everyone is in growth mode. Um, I shouldn’t say everyone, but most everyone, um, okay. Thank you, Jeff. Tony, what about you? Um, I

Tony Ott: Thought some of the points Jeff made were, were very interesting as well, thinking of these agencies in growth mode. And I was surprised that some were even talking about, um, I think it was, yeah, 32% said they were, their hiring plans were slowing. So maybe this supply of caregivers, it seems that for the last year or so, when you’re like, What’s the top three issues? Well, it’d be hiring caregivers, hiring caregivers, hiring caregivers, and it doesn’t, it feels that we’re, we’re not there as much. Not that there’s an unlimited supply or that it’s not a problem, it’s just not so much the only problem. So seeing, um, agencies in growth mode is nice to see.

Andrew Donlin: Yeah. Billy, what about you?

Billie Agnone: Yeah, thank you, Andrew. I, I’m right in line with Jeff and Tony on this one. We, we know post pandemic with covid, things slowed down the consumer, the client. They, they didn’t want, um, the caregiver in their home with the Covid pandemic and the caregivers with school and home. They’re, they’re now back out and they’re in the workforce. One of the interesting things that I’m seeing as a trend is just really, um,

being proactive and a lot of resources placed into that recruiting strategy and really a lot of it around the travel. And one of the survey questions that we had is where did, where did these provider, where did the agencies, um, place themselves with the travel reimbursement? And I found that very interesting. You know, the, the majority were lined up in the, in the same rating category. The other thing that I’m seeing is not only are agencies and providers, um, reimbursing travel, they’re also reimbursing mileage on top of that. So that doesn’t shock me to see that we’re seeing an increase. The,

Andrew Donlin: Obviously there’s a lot, there’s a lot of growth from 2020 to 20 to 20 in the homebased care space, Um, now that we were in 20. And what are some of the trends that you’re seeing in terms of growth? Uh, I think much some, but where do you expect growth to go in the next year?

Billie Agnone: Yeah, so where I see the growth to go is, um, in the home and community base for sure. We are seeing, um, increases in the, the waiver medicaid waiver population passed on to the providers on the self pay side of the business. We’re seeing a more creative approach with an a car boutique type of business where they’re being really resourceful and specializing in areas that the most vulnerable need the care in. And cause of that, we’re seeing those increases being passed on to the recruiting of that home care associate. Um, the other thing that I’m seeing is more of a partnership with the family and the client on recruiting that caregiver, that trusted advisor. And when we see that the client and, and the family are really being participants in that, they’ve already got that connection, that trusted connection, and the agencies are sponsoring with the certifications and the programs, um, that is required to provide these services. And you know, when, when we see that the client’s happy and the home care associate’s happy, the business just grows. That provider starts becoming the premier provider, um, and their community. I really look to see more of the home and community based sector just continue to increase and just blossom.

Andrew Donlin: I think that makes a lot of sense. Uh, Tony, can you hear me all right? Yes, I can. Thanks. Okay, great. Uh, so what do you have to add in terms of just growth trends, uh, moving into

Tony Ott: 23? Yeah, one of the, the main trends, it seems that we’re continuing to see, and maybe we’ll see a slow down with some of these economic changes, but the consolidation in the market, right? That mergers and acquisitions just are, are part of the industry and the consolidation. And then recently even seeing payer sources entering the market, you know, United Healthcare, Humana, things like this. So it, we’re seeing, we’ve seen for years, you know, mergers happen and consolidation, but it seems that that trend is, is continuing and probably gonna, we’re gonna see more of it in the coming years.

Andrew Donlin: Yeah, and certainly, like you said, you, you mentioned payers, there’s also retailers, right? There’s cvs, Walgreens, uh, everyone wants to get, um, in, into the home based care mix. And I think that also leaves room though, Tony, for some of the strategic

buyers just because they understand the business and, and, you know, they have an edge that way, that they do understand a lot of the headwinds and, and how to manage those. So I think the m and a space will be interesting, especially as more and more players get involved, um, uh, in the space. Jeff, anything to add?

Jeff Howell: Well, these two are, uh, stealing my thunder, but I will, uh, echo that. The first franchise in home care, uh, only started in 1982. So the industry, we don’t have a Coke and a Pepsi. We’ve got the biggest player probably has less than 5% market share, even though they’re a multibillion dollar player. Uh, what I noticed is that with Covid, every family that could pull a family member out of a building did so. And with that, what we’re seeing is an expansion in the service lines that agencies want to offer because all of a sudden the world woke up to this thing called home care. And we’re starting to see and realize that care provided in the home is far less expensive than waiting until someone has to go to a facility. And then what plays into that is the ability to do creative funding packages.

Jeff Howell: So I think we’re gonna see the rise of the family caregiver and you see these, um, CD pap programs in New York and these, uh, the ability for family caregivers to get compensated for the work that they do. And then lastly, I would add that in 2018, most agencies didn’t even know what a BI tool was. And now every home care agency we speak to wants to be a data driven agency where they’re collecting, they’re analyzing. As we move to a value-based pay world, everyone wants to create a report to show that they’re producing better outcomes. Uh, but we’re still at the stage where only two thirds of agencies actually do any clinical reporting at all.

Andrew Donlin: Yeah, certainly. Um, with payers becoming involved in the space and value-based care, Jeff, as you mentioned, and then also on the home health side, you know, just proving your worth to other payers like cms, um, and just making sure they know the outcomes are that much better in the home data is becoming really, uh, imperative for agencies to be able to survive and also thrive. Um, okay. So obviously there’s so much demand that, as we touched on before, everyone’s in growth mode. Everyone sees more opportunities out there at the same time. Are you all seeing any examples of home care agencies that may be standing out because of something specific that they’re doing a secret sauce, if you will, Although, let’s start with you.

Billie Agnone: Yeah, So thank you. What we do know is that the care associate is that trusted advisor. And when the providers, when I’m seeing, I’m seeing startups do this, establish agencies when they’re really putting a lot of thought in the process of recruiting and retaining that workforce, they are seeing expansion. One thing that I love that I’m seeing is, in addition to the ongoing CEOs or in-service education, that ongoing education, a lot of agencies are also being very creative and thoughtful and offering support services to their care associates. And in turn, what’s happening is the care, they’re retention, they’re retaining their caregivers. And when you have that trusted advisor that’s happy, the caregiver, they start sharing their story. When the client and the family’s happy,

they start sharing their story. And then when the care management team hears that the clients are happy, they start sharing that story and the, the agency just blossoms. So just really putting an effort on high satisfaction in the agencies that are doing that, they’re seeing immediate rewards.

Andrew Donlin: Okay. Great. And Tony, what, what about you?

Tony Ott: Yeah, actually my, um, mine was right along the lines of Billy is that, so a lot of agencies, the ones that are thriving, are figuring out how to do better with the employees. It’s how do I retain employees? How do I, it’s one thing to get ’em in the door or to get them to apply. How do we get them to work, get them work that’s closer to their home, get them where they’re not just traveling all the time. Um, and coming up with systematic ways of having touchpoints with their employees because right, we think of traditional office area where you can manage by walking around. You can stop in this cubicle, in this cubicle that doesn’t work in home care, right? We can’t, we, So they have to find systematic ways to make sure once someone’s been here a week, we have a touch point, or after their first day we call ’em, how did it go?

Tony Ott: Because these are valuable associates that that turnover not, is it only costly to, to find the next associate? It’s, it maybe you weren’t able to cover the patient. You maybe that patient, they probably love that caregiver that’s leaving. So we see that the losing of good employees is so, IPO is so painful to the agency. The agencies that stand out are the ones that have, have reduced that turnover rate and they’re watching it and they’re figuring out, how can we measure this? Cause it’s not always another dollar in the paycheck. Obviously everyone appreciates that, but there’s other ways to make sure those employees stick around.

Andrew Donlin: Yeah. And even if those cost money in the short term, the long term, uh, investment is really gonna pay off because the cost of turnover is a lot higher than it’s to, um, invest in your employees, uh, now. So, um, that, that’s something that at our recent, uh, conference, uh, future in New York City, just last month, we heard a lot about that scheduling piece. And I know Care, um, you know, has a tool and works well with that scheduling piece. Just how painful that can be for employees in Homebased care when they’re, you know, all over the town and, and they don’t feel like they’re being as efficient as they can be and actually doing the job that they for, which is caring for people. Um, Jeff, is there anything else that you wanna add before we on

Jeff Howell: Yeah, I was gonna say speed to hire. So the silver lining with Covid is that it allowed everyone to just hit the reset button on doing things the way we’ve always done them. So here’s an agency that has over 10,000 caregivers, and they took the opportunity to reduce the time to hire from days down to hours. So imagine most home care agency websites, if there’s a career section, often there’ll be a PDF or a Word document that you download, and then there’ll be an email on that page that you now have to print up, fill out the form, scan it, and then go back to the site, find that email address and send it

off. And then you don’t know what happens. And here’s a big agency that’s not able to pivot quickly, and they were able to have it so that you can fill in a form on their website if the logic matches what they’ve set up on their end, there will be a workflow where a coordinator will get a text message.

Jeff Howell: In that text message, it’s a phone number of the person to call. That caregiver will get a text message confirmation that their, uh, submission has been received. Then they’ll get a be getting a phone call within 120 seconds. And in an industry where there’s too many clients and not enough staff, you’re, what you wanna do is you wanna market to the staff and their ability to condense that cycle time immediately says what it’s gonna be like to work with this company. And their, uh, rate of hiring has exploded. And all of these tools are actually free, and they’re easy to, they’re easy to learn, and there’s no coding required. So the ability for companies to pivot and start sprinting, all the tools are out there, uh, you just need to figure out like how to go use them. And you don’t need any developers. And, you know, they, they basically start off as free and they go up by marginal amount based on high volumes. But, you know, this is a 10,000 caregiver company that, uh, they started off with these same tools for free. And right now they pay a really low amount for them and everything is just automated and just works really well for their staff as well as for the prospective candidates as well.

Andrew Donlin: And Jeff, you mentioned that that was a large agency, so you can only imagine some of the workflow efficiencies that can be ironed out even in the smaller agencies. I imagine those are going on there too. So why do you think that some of those small things are still not addressed within home based care agencies? Things that can be easily addressed but aren’t, um, and could be hindering agencies?

Jeff Howell: I mean, I, I would say that the smaller the agency, uh, the more challenge they are with wearing all the hats of the business, right? Mm-hmm. , and especially if you’re living in the Medicaid space, uh, you’re running a really challenging business where it’s low margins, your denial rates on your claims are maybe 20 or 30%. Uh, it’s hard for operators to just, uh, get their business up and running. And so they just feel like they’re just trying to keep their head above water. Uh, so for them to take a step outside of working, you know, in their business to work on their business, it’s just a real struggle. And agencies that get to a higher level, they can bring in the right people that can focus on solving the right problems with, with perspective that they have from, you know, doing this before.

Andrew Donlin: Okay, great. So moving on. Uh, part of home based care growing and popularity is that companies, uh, health systems outside of Homebased Care or more, more traditionally outside of Homebased Care, are looking to partner with home based care agencies. Likewise, homebased care agencies are looking to partner, um, you know, for growth opportunities. Um, so how can you build those partnerships and find the right partnerships to leverage over time, uh, to contribute to your agency’s growth? Uh, Tony, let’s start with you again.

Tony Ott: Yeah, obviously, you know, these partnerships are essential in order to grow your agency. Um, I, some agencies it’s based on, um, that they, the Geo Geographic footprint that they cover, they can cover an area, they might even be able to partner with a health system that has their own home care agencies, but that need to, um, care outside of that. Also, just partnering, because most agencies can’t cover all lines of service. They, they need partners. They, they may be able to do the personal care, but they’re not gonna do, you know, skilled pediatrics or, or all of these types of things. So usually many of these, even competing agencies have areas where they can sometimes help one another. And between those partnerships, um, they can see opportunities for growth because we’re seeing even more specialization. It feels in the market that agencies aren’t doing a little bit of everything. They’re having to figure out what they do and do that efficiently.

Andrew Donlin: Okay, great. And Billy, what do you think?

Billie Agnone: Yeah, Andrew, thank you. Right in line with Tony and agree with Tony. I, I have a pleasure to work with startups. And so, you know, as startup, they have their best practice, they have their niche of what they’re gonna do. And when that provider finds their focus on what they do well and something that they’re very passionate about, then they’re gonna grow that business. And as they stick with the basics, they adopt those best practice and do what they do well all day, every day, and then find that joint venture or that partnership with other agencies. It allows them to offer continuity and share that business back and forth. So they’re able to build their business, focus on what they do and what they do best, and then have that partnership to offer those additional services. At the same time the clients getting the continuity that they need.

Andrew Donlin: And, and I think that’s a great point, especially because, you know, health systems and all these other entities that are trying to get into the home, home base care agencies have to remember they’re the expert there. You know, they understand the home so they can offer something to these hospital home programs, these higher acuity, um, level type care programs at home. Um, and, and there are plenty of examples of both home health and home care agencies entering into those agreements, not partnerships. Um, Jeff, how about you?

Jeff Howell: Yeah, I mean, I thought about this question, not from a referral source, but really from a tech stack and, uh, integrations and interoperability. So I’ll give you an example. We, uh, we use HubSpot. We used to use Salesforce and our decisions on future partners. The first question is, can you integrate with our existing ecosystem, right? So there’s some advantages where you might be with Salesforce because they’re already partnered with another major tool that you use. And, um, you know, like some of the pain that I’ve heard from companies that are out there, they say, Well, we’re using one system for this. Uh, but then for onboarding caregivers a totally different system and they don’t talk to each other and it’s very painful for everybody involved. Um, I’m gonna give a

shadow to, uh, a company that actually has created a really cool reward system for caregivers.

Jeff Howell: And this is a perfect example of how it can tie into a system of record so that you don’t live in multiple systems, but the company is Caribou rewards. And they’ve actually found a way to reward caregivers, to recruit other caregivers to, uh, score points if they clock in and clock out on time to score points if they get all their ADLs done on their shift. And it’s these micro rewards that encourage the right behaviors that not only will, uh, help attract and retain caregivers to work and, and do the right things and refer other caregivers, uh, but it’s an example of how you can grow your business because you chose a partner that maybe went with another partner and it lives with this entire ecosystem, rather than just saying, you know, the, on the initial slide, it talked about how many agencies feel like they have so many different systems, but it doesn’t matter how many systems you have, you should have a lot of systems cuz there’s no one company that does everything. But the importance is that you’ve selected this family of softwares that can all work together to be this, uh, a gestalt a uh, the, the whole being greater than the sum of the parts.

Andrew Donlin: Yeah. And Jeff, I’m glad that you brought that up because I think the first step for the home based care, the greater universe was getting tech in the first place, right? And now it’s about how you make that tech work and everything together. Um, and like you said, making sure those, those, uh, technologies are talking to each other, it makes sense for your caregivers at the ground level. Um, okay, so obviously recruitment and retention is something that we’ve been talking about a lot. Um, no one on this, uh, call either as a panelist or an audience member is a stranger to the fact that staffing is an issue. But, um, I think some home-based care providers are finding ways to do better with staffing, especially compared to last year, even the year before where things got really dire. Um, what are some examples of that? Um, Jeff, we can start with you and then move around.

Jeff Howell: Yeah, sure. So, uh, our data is similar to what Home Care Pulse, uh, publishes with respect to what do exiting caregivers site as the top reasons why they leave agencies. And it’s that they feel like they’ve signed up for a job and then the office stopped communicating with them. So a visit may get canceled, they weren’t notified. They, they’re not getting any offers for any shifts. The number two is not pay. Number three is pay number two is not getting the hours that they need, right? Because they know what hourly rate they’ve signed up for. But they also said, Hey, I need 40 hours a week, otherwise I need to go get a job elsewhere. Uh, but to address number one, the communication, I’ll give credit to, uh, Steven Tweed at, uh, Home Care CEO on this. He runs a mastermind group of agencies that are in the top 10% of the business.

Jeff Howell: And, uh, they came up with an actual structured, uh, engineered 90 day program of communication. Because what it really comes down to is that if you incentivize your back office staff with this structured communication approach, it changes the culture of

the agency. And it’s not that your coordinators and schedulers just say, Well, I’m gonna send this shift to, uh, Billy, cuz I know Billy and she’s reliable and she needs the hours. The, the turnover rate is however you measure it, somewhere between 60 and 80%. And the biggest issue is the people that come in and then they feel like, I signed up for this and then no one got back in touch with me and I hardly got any offers. And then one third of caregivers end up leaving the, the agency without even filling one single shift. And what happens is that the schedulers are just so busy, they don’t have time to think about, I need to be in touch with Billy. So she feels connected to the company.

Andrew Donlin: Absolutely. Uh, that’s a huge problem. I, I touched on that a little bit before, but, um, that’s one pain point I think home base care providers are really gonna need to address, um, in the next few years. And the ones that do it best are really gonna thrive. The ones that struggle with it, that they’re gonna feel it. Um, Billy, what would you, what would be your advice to agencies on how to, uh, how to better address some of these issues?

Billie Agnone: Absolutely. There, there’s, there’s a fundamental of exactly what Jeff said is when you’re recruiting your talent, it’s very important to understand what geographic area that talent is able to provide care in so quickly, getting that that care associate in the right place immediately after the onboarding and the training, and additionally giving them the tools that they need, that they feel inclusive, all of that care team, that they have a mobile application system that they can communicate back and forth with the back office, that their questions are being answered timely. Um, and there’s an involvement there using the task to be able to submit information and using the mobile application to communicate and secure messaging. When a caregiver has to pick up the phone and call the back office and be on hold or go through an automatic system, it’s taking away from that care time. So then they have a tendency right, not to be as proactive, so make it in as seamless as possible and inclusive environment where they’re part of that care team and rewarding them, rewarding them on the care that they provide, um, and the service delivery, um, based upon the service utilization and their metrics.

Andrew Donlin: Yeah, and that goes back to one of those survey results, which is that almost half of agencies don’t know, um, or don’t have confidence that, uh, the technology that they have right now is going to, uh, be able to keep up with their future growth or at least help their future growth. Um, so on that note too, in terms of artificial intelligence, digital tools, other sorts of technology that can supplement the caregiving profession, um, obviously, you know, we don’t think that AI is going to take over, um, caregiving in the home or anything like that, but there are ways, very simple ways through technology that caregiving can become an easier produ profession because of those technology tools. So what do you all foresee happening in those areas? What sorts of, uh, ways can agencies improve workflows in that manner? Uh, tell me, let’s start with you here.

Tony Ott: Yeah, the, when I saw, saw this question, I thought even more of the back office, traditionally I thought of the, the caregiver, but in the back office there’s ways this

technology can help, um, okay, care. So for example, um, we have a group called All Eli Labs within all ELI Care doing things like predictive analysis, doing things like shift optimization. So if we look at all of our shifts and all of our caregivers, do we have caregivers over here driving this direction to take care of someone and, and there’s a caregiver that lives right close to them. So things like optimizing that, things like, um, an engine to look through, visit notes and see if there were falls reported in the narratives that no one reported. So things where we can use technology, predictive analytics to help us, you know, manage by exception and get rid of some of the, um, to really optimize it. Again, it doesn’t, um, replace any of the caregiver, It doesn’t replace the nurse, but what it can do is just make it more efficient.

Andrew Donlin: Yep. Billy, what about you?

Billie Agnone: Yeah, virtual care is just real time video conferencing with the, their clientele, the customer that’s in the home. You know, what it allows the agency is it allows them to have that traditional, um, face to face real time care. And then also it also allows them to have that high touch, um, change of condition immediate look at a consumer or the clients, um, when that in-home care professional is calling you in with the change of condition, what we do know is that, um, high touch model increases, um, high performance from both the home care associate as well as satisfaction from the client. And when those change of conditions get called in and the caregiver can be present, they can help that back office triage. What those situations are to identify what are the next steps also can reduce hospitalizations.

Andrew Donlin: Jeff ho, can we op, uh, you know, make those workflows more efficient?

Jeff Howell: Well, first of all, I think, uh, the real exciting thing is the automation of other industries that will allow us to get more caregivers, right? So it’s gonna be a lot easier to have, uh, self-driving uber cars than robots that can give baths. So I’m excited about, uh, how our industry can benefit from this. And then my thoughts are really, it’s not, in my view, the coordinating of care is secondary to remote patient monitoring, right? So what’s the company that has the most health data in the world? It’s Fitbit, right? They’ve got billions of hours of sleep data. How are we going to, uh, create the greatest savings possible? Well, we’re going to keep people out of hospitals and we’re gonna do it proactively. So it’s all about the tracking of the data that leads into predictive models so that that data can flow to home care and home health agencies.

Jeff Howell: And we’re not reacting, we’re proactively saying, Hey, here’s the data on someone that has this particular ICD 10 code and they’re exhibiting the symptoms that we would see if X is happening. So if we can prevent a negative health event, then uh, we’re gonna save tens of thousands of dollars from the next hospitalization and, uh, whatever the number is, it’s something like 95% of the costs of healthcare are from 5% of people. And that’s where we’re go. We need to save the money and that’s how we’re gonna create better outcomes is that we’re not reacting, we’re proacting.

Andrew Donlin: So Jeff, I want to follow up on one of those points, which I thought was really interesting. So, because so much automation is going to be going on outside of home based care and caregiving, uh, you think that will bring in more workers because some of those jobs will no longer be available, but of course the human touch and the caregiving is still gonna be needed.

Jeff Howell: I mean, you, you’re also, you know, the person who is the persona of a truck driver isn’t necessarily someone that has a calling for home care. Um, but you’re going to have, you know, shift just like you have shifting demographics, you’re going to have, um, you know, just a shifting workforce. And so if the dollars are there and if we, um, support it and there’s, there’s more money on the table for caregivers and we can get more people into the industry, it just makes sense to me that while people are afraid of the robots taking over, um, you know, we, we would be, uh, we li live in a better world if we had fewer Amazon, uh, warehouse, uh, folks and all of that is automated. We had more people in the caregiving profession.

Andrew Donlin: Yeah. Who knows how long the retail industry was. You still require that big of a workforce, which is often one of the, um, areas that takes away from home based care as of today. Okay. So moving on to the next question. Um, how can data and business intelligence help drive growth for home care agencies? I think this is a very important question, um, because Jeff, you know, you said earlier this is a place where a lot of home agencies may have flagged a little bit over the last decade. So how can they leverage that?

Jeff Howell: So I would say like even big health systems aren’t really either happy or that advanced on their health informatics. And if you look at your average home care agency, you know, might have a sense of a, you know, 75 caregivers and 75 clients or something like that, you’re not gonna be collecting so much data that you’re predicting negative health events, but you have to start collecting data to begin with. So you have to have, you have to be off of paper, you have to have some kind of app with a digital form in the hands of caregivers. And then, uh, those caregivers need to be trained to be collecting the right data in the field. So as an example, if we, if we as an industry say only 12% of knee replacement cases end up in a hospitalization due to an infection, well that’s what the aggregate data can tell us.

Jeff Howell: But we need to be, uh, creating the right way to measure that at the point of care. And if you’re still on paper, you have no way to track that. If you have a mobile app that caregivers aren’t using, you have no way to track that. If you’re not creating the forms to collect that data, you can’t report on it. And you know, the technology is there as your friend, but you know, it’s a people process that you have to wrap around it. And then even if you’re reporting all, all this, what’s your sales team doing with that data, right? Are they meeting with referral sources so that you can steal an unfair share of the market with this information? Or are they still living in a world where their next referral source is whoever they took out to lunch last , right? And so, uh, you know, it,

you have to have every step in that chain to be able to not only produce the best outcomes, but run the best business.

Andrew Donlin: Bill, I feel like you probably have a really good perspective on this. What are your thoughts?

Billie Agnone: Absolutely. I mean, you, you, you can’t improve on something that you’re not tracking. If you’re not tracking all of your segments, then you’re not gonna grow your business and improve on it. An example would be, you know, what are the services that you’re providing against what you’re authorized? What type of mis services and patterns are you receiving and why are those services being missed? Um, how many days has it taking you to hire from an applicant and from that applicant to get to orientation and orientation to their first visit? And how many hours is the typical new hire working? What, what data are we seeing in our clinical outcomes? Right? Better outcomes brings a better business. And when you’re tracking those trends and you’re seeing what you’re doing really well at, you can do more of it. And the things that you need to improve at Ben, you can offer more education so that you can improve in those scores to do a lot more of that.

Andrew Donlin: Okay. Greg, Tony, anything to add?

Tony Ott: Um, on the, along the same lines of what Billy was mentioning, we also have areas on not the care, but on the business. What are, as we see, you know, more pressure on reimbursement and managed Medicare being such a big deal, managed Medicaid pressure there, pressure on the other side to provide greater benefits and greater pay. Well, are you measuring, do you know what, what your gross margins are? Do you understand which lines of business are profitable? Cause we want to provide care, but we also have to survive as a business. So we also need to be measuring, you know, doing that kind of bi on how, how is this going to work? What kind of rates can we accept and can’t we accept? So that kind of measurement also is obviously most are doing this, they may, we may need to even do it to a greater degree as we get continued challenges in the, in the industry.

Andrew Donlin: Okay, great. I just wanna answer a few questions from the audience before we move on. And again, to the audience, uh, keep submitting questions and we’ll try to get to as many as we can at the end of the webinar. But, uh, first just a, a few quick ones. Jeff, what was the name of the rewards program you mentioned again?

Jeff Howell: Uh, Caribou Care. I think it’s caribou dot c a r e instead

Andrew Donlin: Great. And then Tony, um, what do you think is an unacceptable turnover percentage for a home health agency?

Tony Ott: Oh, I really don’t have a number off the top of my head and I’ve seen various ways to measure it. Um, the, to me the key is figuring out what your baseline is, whatever

method you choose, is it based on in the first this many months or that, and then, and then sticking with it to see whether your methods are, are working, whether you’re trying to mitigate it. So I, the, as Jeff mentioned, it kind of depends on how you measure it. Probably 60% is pretty, um, 80% we we’re seeing it pretty high numbers and probably different parts of home care are different as well. But, um, I think and

Andrew Donlin: Parts of GE geographically too, that’s gonna

Tony Ott: Matter. Yeah, that’s right. Yep.

Andrew Donlin: Um, okay. So back to Tony, you, when we were talking about m and a earlier, you mentioned payers getting into the space. Um, I mentioned retailers getting into the space. They’re also, again, the vast majority of home based caries are trying to grow or think that they, they’re in a growth stage, what’s, which means they’re likely open to, uh, mergers and acquisitions in the coming year. Um, where do you all see, uh, the m and a space right now? What are you expecting, uh, in the next year or so? Uh, Jeff, we’ll start with you here.

Tony Ott: Uh, I mean, we’re seeing some things we haven’t seen before, like, uh, advocate, uh, Aurora acquired senior helpers, right? So you don’t see, you know, health systems acquiring personal care agencies. And I think that ties into this blending world of, uh, services and and size and scale that companies are going for. I think we’re gonna see, we always talk about baby boomers and the, the need for more care as people get older, but we rarely talk about, um, home care agency owners are the same age as well. So there’s a lot in the, in the small business world, there’s all kinds of businesses where people are trying to retire and their kids don’t wanna take over the family business. And I think that’s gonna accelerate and add to this idea that, um, there’s gonna be a lot of consolidation. And then what I’ve also noticed is that in the Medicaid space, usually there’s kind of like, uh, businesses are, uh, industries are a bell curve and there’s the fat middle.

Jeff Howell: And uh, I feel like it’s kind of the skinny middle because if you’re a Medicaid agency and I’m getting care from mom, I wanna have that local warm feeling like, you know, this is, this is the care for my mom. Um, or on the other end I’m going with a really big agency that uses a clearinghouse and, you know, is it’s a low margin business. So they’re make, they’re running a business based on volume. And so it makes it hard for the ones that are in between. And then I think what you’ll see is those, the, the skinny middle, those, those ones will be, uh, looking to exit the business. And I think the ones that’ll benefit from that are the large acquiring, uh, agencies that like, uh, help at home. For example, acquiring Preferred in New York. They weren’t in New York and they just acquired 5,000 clients just by making that one acquisition. So I think we’re gonna see whether you’re not in a geography or you’re not in a service line, you’re not gonna grow it, you’re gonna go buy it.

Billie Agnone: Absolutely. Um, we’re, we’re gonna see more of the providers that have the capital to go in and tuck in the smaller medium businesses, the small guys, they’re able to sustain. But when you get to that medium size, your margins get really tight. So you have to grow your business. And if you’re not able to do that quickly, then there’s opportunities to, you know, to sell that business onto the, the big guy. And there’s a lot of those big guys that have the capital that wanna come in and grow their business. Not only are they growing their business in the home and community base, but I’m also saying they wanna expand their services and an easy quick way to expand their services is to acquire, um, another agency that has a service line that they don’t have and it allows ’em to, you know, add on to that acquired business.

Andrew Donlin: Okay, great. Tony?

Tony Ott: Um, nothing really to add. I think Billy and Jeff ca covered it well, it, we’re gonna see more and more m and a. No, I don’t think anyone expects us to see it slow down, so

Andrew Donlin: Yeah, it, it, it sounds like things are, are gonna keep ticking up here. So exciting, uh, year for that, for those that keep an eye on the m and a space in home based care. Okay, final question for me and then we can get more and again to some of the audience questions. Um, I wanna know, you know, home care agencies, um, obviously feel a critical need, um, with the aging in place movement as that gains momentum, um, what do you think the next push will be for home care and how can home care agencies get on the bandwagon early? Um, in, in other words, what’s the next big frontier? Um, Billy, let’s start with you on this one.

Billie Agnone: Yeah, I think we’re gonna see more primary care in the house call sector. Um, we know that it’s going to improve outcomes, it’s gonna reduce the cost. Um, it’s going to allow the most vulnerable population to get that primary care in their home. Me and legislation is allowing more for PR nurse practitioners to provide in the home and the home care. Um, I’ve seen it myself with my own aging mother. You know, she’s got comorbidities and she is home bound in her home. And now that we have primary care and we have all of the an the, um, Meals on Wheels and Home Care associates and all the other additional services, she’s been hospital free for every year and a half. So what we do know is when we layer a bond, these additional services and all of the is received in the home, we are receiving better outcomes.

Andrew Donlin: Okay, great. Jeff, how about you?

Jeff Howell: So I think there’s gonna be funding by necessity and um, you know, we just did some research on a PPA funding for Pennsylvania and uh, it opened on July 1st. It closes at the end of the year, there’s $38 million available and it’s $40,000 per request. So if you do the math, that would cover 950 home care agencies. And there are just so many agencies that, as we talked about before, they’re just trying to keep their head above water and there’s all these $40,000 would go a long way towards caregiver recruitment

training, caregiver pay. And uh, my view is that, you know, this, these dollars are gonna be around regardless of where you’re tuning into today, this is a challenge in just about every single uh, country out there. And so I would encourage everyone to make sure that they’re on top of all the advantages that they can get that, that are out there.

Jeff Howell: And then secondly, we haven’t talked about this yet with all of this consolidation, most people get into the business because they have a passion for delivering care and they don’t think about the end at the beginning. And you really, as the industry matures, you know, if you’re running a good business, you’re gonna be in a spot to be able to make a handsome exit and you should be taking the steps today to position that exit. And a lot of people really just kind of continue on in their business without thinking, what would it look like today if I were to tie a nice ribbon on this business so that an acquirer would look at me and make the choice to acquire me instead of somebody else.

Andrew Donlin: Absolutely. Um, Tony, what about you?

Tony Ott: Um, I think in the future we’re going to see as we already have, and um, Billy and Jeff mentioned it bo both in earlier comments on more technology in the home, remote patient monitoring, being able to provide more care with less caregivers and better care and better outcomes, keeping people out of the home. And I think technology, uh, I thought of the right, the expression that necessities the mother of invention and for the analogy that came to my mind was our grocery stores, at least in Ohio where I live pre covid, you could do self checkout, but honestly it was yearly. If you had 10 items you would do that and there were cashiers everywhere. Well then they didn’t have cashiers, so what did they do? They figured it out. Now they can run 12 cash registers with two people and they, and so the technology was there to help solve the problem. And it’s just, I think we’re these technologies that exist when we have been too expensive or didn’t make sense in the home, it’s gonna make sense because we are gonna, we have a continued aging population, a shrinking workforce sometimes. So I think we’re gonna see technology ha it will have to be part of that solution.

Andrew Donlin: Yep. Another great point Tony. Um, okay, so let’s get to some of the audience questions. To the audience, thank you for interacting with us so much throughout this. Um, again, I appreciate the audience sending questions throughout. It makes the discussion more lively and interesting. Okay, so the first question that I think we’ll go with, um, and take this where you want to, uh, are, are you all seeing any under accessed or undervalued referral sources that could be leveraged for quick wins? Um, obviously this can be, you know, home care, home health, whatever, whatever you all are thinking. Who wants to start with this one?

Tony Ott: Yeah, the one I was thinking is one we had talked about before is, is partnering. Finding other agencies who, who don’t do the type of care you do or, or referral sources that have their own agency but that it’s doesn’t cover the g doesn’t cover the geography where your agency is. So if there’s an agency that’s just doing rehab services and they go

well they might have personal care, they don’t have the personal care workers, they need a partner to help with that. So I think the partnering maybe is a way to, um, is the one that comes to my mind.

Billie Agnone: Yeah, and I would say community education just about the services that you provide. What we do know is that when the individual needs the in-home cur service, it’s an immediate need and they don’t have a lot of time to start doing the research that they need. So really offering community services out and to the communities that you provide care and allowing the consumers to know that you’re there, what you do and your outcomes of the care that you provide.

Jeff Howell: Uh, I would add, uh, although it was, you know, very low numbers on the respondents on how much value there is to the digital marketing or traditional marketing means, I would also say that most home care agencies have not invested much or not, uh, as skilled at ranking better in Google or having a better website experience. There’s a tool called call page and you can go to call, I believe it’s free for the first 30 in the month. It actually flips an intake form. So if I come by your website and I say, I’d like to uh, get in touch with somebody or fill in a form cuz I want to set up a time to see if care for mom is right with your agency, when you click on the little button it says, we’re gonna call you in 28 seconds and all you have to do is put in your phone number and then it does a blast to the people that you’ve put on that list. And within 28 seconds you’re speaking with that agency without having to pick up the phone yourself. And uh, it’s that quick response time and it’s what you’re saying to the prospects with that, with that, uh, with that level, like with that, with those steps that uh, even the paid version of this is $30 a month and uh, those forms, that’s a referral source. Somebody found you online and is interested in speaking with you. And I’ve never seen a home care agency that has a tool like this.

Andrew Donlin: Very interesting. Um, okay. Uh, and, and just a smaller question before we move on, uh, someone lost reception for a little bit, Jeff, when you were talking about that money in Pennsylvania, can you explain again about those ARPA funds?

Jeff Howell: Yeah, you can just Google a RPA a funding Pennsylvania. Um, it, if someone wants to just email directly, I can send them, there’s an application form that you actually have to then print up and, and that there’s an email to send it to. So my email is So you should see my name on the screen there and I’d be happy to get back to you and attach the form.

Andrew Donlin: Okay, thank you Jeff. Okay, here’s another good one. Could you talk about some of the challenges that are associated with onboarding new caregivers, um, when it comes to a platform or technologies, um, and some of the ways you can overcome that as an agency?

Billie Agnone: Yeah, that’s a great question. And you know, just filling in the time of, you know, making sure that the, the client care is still being provided and that needs to be the priority, but we also need to ensure that the caregiving staff are onboarded onto that application timely, efficiently and they have the tools and the resources that they need. And we have found through, um, university and Eli Care University and community programs, we’ve been able to offer that remotely when the caregiver is available at their own time, right? They could just go into that application and do the onboarding and take the self-assessment, um, quizzes that is ensuring that they’re competent in, um, the application.

Andrew Donlin: Jeff, Tony

Jeff Howell: I would say like if, I mean in my view there’s three caregiver training tools that really, uh, have most of the market. So there’s Care Academy, there’s Home Care Pulse, and there’s neon. And um, as far as I know, I think they integrate with all kinds of different systems of record as well. And the pain that I’ve heard is from the agencies that say, Well we have this other learning management system and it lives outside of our system of record and we have to have this separate login and a separate process and caregivers only wanna log in and clock into the app that we have. It’s just important that as much as possible that your whole Text Act talks to each other and there’s fewer logins, fewer things to to be in. And if you can live in one environment and have the other tools that pop up in there, um, that’s like the best, uh, the best of all worlds. Right.

Andrew Donlin: Tony?

Tony Ott: Um, I would just add the other part of onboarding that can um, hold things up is just, just the other paperwork for just becoming an employee. So making sure we do have systems talking, whether it’s your EMR system talking to your payroll system and that we’ve, we can get through this process quickly be, as Jeff mentioned, you know, a third of these employees never take a shift. It could be because they need a paycheck next week. So if we can get through that process and keep them from just taking a another job, right? Streamlining that is going to not only get them working quickly, get them happier, it’s going to obviously bring benefits to the agency if we can get them on out on cases and then onboarded onto the software and with through, through whatever other types of education they need.

Andrew Donlin: Okay. And then this other question is a great segue cuz it’s sort of on the other other end of the question I just asked, um, which is, so with more and more of this technology being implement the home based care, how do you handle it on the patient’s side? Um, you know, there’s a lot of seniors who obviously aren’t technology savvy, technologically savvy, um, and also there’s a, a lot of people that live in rural areas with low broadband access and uh, internet sometimes is a struggle. How do you get over those hurdles?

Billie Agnone: Yeah, thank you Andrew. A lot of the, um, senior centers on the area agencies, they offer volunteer time that goes out and does education to the seniors to allow them

resources of how to, um, utilize the different, um, technology avenues when it comes to the royal areas and the inability to access the mobile applications. That’s where offline capabilities come into play. And what we find is when the caregiver has the ability to download their application and still provide care through their mobile application, it’s ensuring that that client is getting the continuity of the services, their services are being provided based upon their plan of care and the caregiver is still, you know, within those best practices and is doing that continuous care based upon the client care without interruption.

Andrew Donlin: Tony?

Tony Ott: Yeah, along with, um, Billy, the, the idea of being offline is, is a key and because then making sure that the caregiver experience doesn’t have to change based on whether the patient has internet access at the home, the caregiver, they need to be able to have a consistent experience in their mobile application and not have to keep track of who has internet at their house and who doesn’t. So I think that, um, that’s a key way to make that, um, better. And then also when there is that there doesn’t have to be a burden on the patient during the checkout process. Maybe there’s a signature required or something like that, but we don’t need require a, a caregiver app, I mean a family portal app or anything, but even though sometimes it can be available.

Andrew Donlin: Jeff, final thoughts?

Jeff Howell: I mean, I was gonna bring up the family portal as a, uh, light version of, you know, seeing how the care is going. So whether the senior doesn’t have any family and they can have this, uh, view of what care is coming up next and what’s been documented and, you know, what care has been provided and who the care team is. And then that is extended to the family as well, just as a, and you can request more care and you can provide feedback through that portal. So if, uh, you know, if the son lives in Seattle and, uh, and the daughter lives in Austin, that they can both check in and see how care is going.

Andrew Donlin: All right. Fantastic. Thank you Billy, Tony and Jeff. Um, you all were great and thank you to the audience for both listening and, and providing some of those questions. Um, very happy to have you on and, and, and answer some of those. Um, and thank you again to Eli care for sponsoring this webinar. And, um, if you do have any questions, you can reach out to one of us. My email is a and maybe I could connect you with one of these folks. Thank you.

Jeff Howell: Our pleasure. Bye.

Jeff Howell: Home Health 360 is presented by AlayaCare. First off, we wanna thank our amazing guests and listeners. To get more episodes, you can go to, that’s

spelled Home Health 360, or Search Home Health 360 on any of your favourite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening, and we’ll see you next time.

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Home Health 360 - Episode 31

Episode Description

Growth is a top priority among home care providers, even during difficult economic times. Providers are making significant strides in positioning home-based care as an essential component of the broader health care continuum, but there still is a way to go.

On Oct 4th, 2022, Home Health Care News, in partnership with AlayaCare, hosted a webinar: “Growth Strategies for Home Care Agencies”. Moderated by Andrew Donlin, editor at HHCN, this webinar featured AlayaCare experts. Listen to hear more about home-based care growth plans and what strategies are best for home care organizations to continue to grow and be successful in the industry.

Episode Resources