casJeff Howell (00:01):

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 in home healthcare from around the globe.

Jeff Howell (00:18):

Hey, everyone, and welcome to another edition of Home Health 360, where we speak with leaders in home care and home health from across the globe. Today I’ve got Adrian Schauer, the CEO of AlayaCare, and we’re looking ahead to 2023 and beyond, and we’re talking today about predictions for home care and home health. Adrian, thanks for taking the time today.

Adrian Schauer (00:37):

Yeah, thanks for having me, Jeff.

Jeff Howell (00:39):

At the AlayaCare Better Outcomes Conference, you declared war on repetitive tasks, and your first prediction is that this will finally be the year that agencies actually finally are able to win the war on repetitive tasks. So what do you mean by that?

Adrian Schauer (00:56):

Yeah, well, I think this is a good news and a bad news story at the same time, on the bad news size of the side of the ledger is that margin compression has become such an issue for providers of in-home care that they have no choice but to tackle the overhead costs in their business. Now, the good news is that tools have arrived to finally enable that. And if I illustrate a few examples, so you know, our point of view here at AlayaCare is that you want your people in the head office doing only the tasks that involve building a relationship or exercising real discretion and making decisions. And when you look at what’s happening in the back office of the typical home care home health agency today, you have a lot of clicking that doesn’t involve either of those two things.

(01:50):

And so we have tools like AlayaCare Connector and some advanced AI and optimization tools that, for example, can take the clicks out of offering out open shifts. So when there’s a call off, typically a coordinator will go through, will find potential replacements for those visits, and we’ll go and either offer them out or assign them directly. And we know that can be auto automated away. We’ve got great case studies about it. Another example would be more on the clinical side. And if you look at what a, you know, a typical clinical supervisor would do, they’re often trying to keep an eye on, you know, 50, 60, 70 client records at a time with a big stream of incoming structured data, but also narrative notes. And so it’s very hard to stay on top of that. But we have natural language processing tools that can automatically read all those notes and flag ones that might indicate some patient risk that, that the supervisor should dig into. So those are a couple of examples. I look at some, some of the some of the work we’ve done with some of our larger customers, and there are millions and millions of dollars worth of overhead cost that we can automate away by looking at those repetitive tasks, figuring out where the machine can replace some of the things the humans are doing, where again, there’s no real relationship being built or leveraged and no true decisions being made.

Jeff Howell (03:24):

So from a framework standpoint, really identifying those $10 an hour tasks and the a hundred dollars an hour tasks, and then figuring out what you can get the machine to do the, the natural language processing, my understanding is that it’s really scanning unstructured progress notes and nursing notes. And I presume that the agencies come up with some kind of a scoring system so that if an aid types in that a client has a swollen foot or, or a rash, the agency is categorizing those specific words and then the system is scanning through and then the scores get created in real time onto a dashboard. Is that right?

Adrian Schauer (04:05):

Yeah, mostly correct. Except that we don’t rely on the individual home care agency to train the model. We’ve trained those models across you know millions of interventions that have happened. And so the, the, the model’s been trained on all that data and then surfaces for the individual agencies notes that we, you know, we think require some oversight. You know, there, there are false positives for sure, but compared to the ocean of information otherwise one would have to sift through it’s a real time saver and also helps with patient outcomes.

Jeff Howell (04:46):

So that’s that’s great news because my understanding is that machine learning just takes such a mountain of data to actually learn that it’s really not scalable for an individual customer to do that themselves, but really leveraging the aggregate of the industry.

Adrian Schauer (05:01):

Exactly. And a lot care’s really standing on the shoulder of giants here. There’s been unbelievable progress in in natural language processing. And you hear about you know, chatGPT, which is the successor to GPT three, and you know, now the AI can you know, is our passing touring tests. They can really chat with you in a way that’s relatively indistinguishable from a human. So we’re not we’re not there yet in terms of how that will come into the care world, but the capabilities just keep racing ahead.

Jeff Howell (05:36):

Yeah. Okay. Prediction number two. You see a world of simplified operations to become part of care delivery and you have a unique outlook on referrals and subcontractor markets. Give us some insight into that.

Adrian Schauer (05:51):

Yeah, absolutely. So one of the things we’ve noticed really in all the markets in which we operate is that, you know, these sustained years of labor shortages have meant that home care providers just have had to get creative in terms of how they try and bring together supply and demand. And we see more and more providers using subcontractors to pick up parts of care that they can’t service with their own staff. And whereas that’s a good news story on the one hand because you get, get greater collaboration in the market it can also lead to lots of inefficiencies relative to what you get when you’re you’re dispatching your own staff to a given case. So listeners would’ve probably heard me talk about AlayaMarket previously. So we’re leveraging that technology not just to put together new agency or agencies who want to collaborate in a marketplace but also to help automate the subcontracting that’s already happening in their business.

(06:54):

And so anything we can do to better connect providers with other providers to better connect the providers with the clients and with the the caregivers, that was a real opportunity for improvement. And if I wanna just highlight two other features we have, in addition to AlayaMarket so many of our clients use our, our client and family portal, which now can be deployed as a native mobile app, and they’re combining that with a secure chat within the product to really allow more asynchronous communication between the clients and their families, the caregivers and the coordinators at at hq. So there’s some real advances there.

Jeff Howell (07:38):

That’s great. Now, I recorded an episode with Nevvon and, and James and Allen had let me know that the demand for home health aids right now is currently at three or 4 million, and that’s gonna be about 7 million in 2025. So prediction number three is that you believe that agencies will offer more growth opportunities and continuous learning.

Adrian Schauer (08:01):

This industry will not solve its labor problems by each individual agency getting better at recruitment and retention. Obviously that’s a competitive advantage, but unless we find a way to grow the labor pool, we’re never gonna meet the, the demand of our aging societies. So I think there are two aspects. There’s bringing new people into the caregiving profession and making sure they’re skilled up in as low-touch away as possible. And then the second aspect is taking people already in the profession and moving them up into higher and higher skilled type roles. And so the trajectory of someone who enters the industry, maybe as as a personal care worker or home health aid, and then work their way up into LPN type skill levels, you know, won’t be for everybody. But there’s a real potential there to, to upskill the labor force. And, you know, as you, as you say, yes, there’s a big shortage of supply on the personal care side, but the same is true on the skilled side as well. So I think we really as an industry have to take this seriously and figure out how we can not only bring people in the, into the profession, the caregiving profession, but then upskill them over time.

Jeff Howell (09:23):

Yeah. And in that recording, I was really shocked to find out that the Department of Health really only you know, brought online training as a mainstay in 2017. And if you look at it from that perspective, you know, it really just is it’s such an immature industry relative to how long we’ve had con activity. And from that standpoint, you know, when I was speaking with with Neon, they were talking about, you know, the explosion of doing training in the mother tongue of caregivers. And as we all know, there’s a lot of immigrant caregivers and they had a really interesting new legacy of care mentorship program that they’re seeing early success with on a an 89% retention rate where it’s this formalized mentorship program. Cuz as you know, the caregivers tend to leave agencies during this early period where they, they haven’t had their hours ramped up and they haven’t had the love ramped up either, right? So they just hire, they get hired they feel a little isolated, they’re not getting the shifts and the the office does a poor job of connecting with them and staying in touch with them.

Adrian Schauer (10:28):

Yeah. That, that first 30, 60, 90 days of new employment is, is absolutely the risk period. So I think that’s that’s a great program. And, you know, I congratulate Nevvon. They’re they’re really doing great things in the industry.

Jeff Howell (10:42):

Mm-Hmm. . Yeah. And, and Care Academy has been doing some programs around upskilling home health aids to be able to take courses with them as part of their regular curriculum to, to move up to be an ACNA as well. So that’s some pretty interesting things that they’re up

Adrian Schauer (10:57):

To. Yeah, a absolutely, and if you look at what the difference between a job and a career is often that ladder of opportunity. And so the more, as an industry, we can help create those ladders of opportunity for people who enter the profession, you know, the more this is gonna be a, a domain that people wanna build their careers.

Jeff Howell (11:17):

All right. Prediction number four, agencies will break convention and seek new funding sources.

Adrian Schauer (11:22):

Absolutely. So there are many flavors around this prediction and as our listeners know, AlayaCare operates you know, in all parts of the US and Canada, in Australia and the Middle East, New Zealand, a little bit in Asia. And so we see lots of different models and lots of different funding sources. What I will say as a, as a general trend is that most of the public funding, the reimbursement rates are not keeping pace with wage inflation. So you’ve got a, a lot of pressure and it’s putting a lot of pressure on this sector in general, which, you know, tying back to the previous point means it, it’s very hard to attract people into the, the in-home care profession. On the flip side, the news is full everywhere with overflowing emergency rooms, you know, hospitals that are operating beyond capacity. And so the solution is absolutely to get people out of institutional care and back into their home.

(12:26):

And so really, what, what I would encourage, you know, many of our customers to do is to say, okay, if that intermediate funder is not meeting the moment, go and speak directly with the hospitals or the health systems that are dealing with the very expensive downside of not being able to shift care home and start to strike individual contracts. And so that can take the flavor of hospital at home. It can take the flavor of transitions programs, which we see really gaining momentum in Ontario. You also have models like birds org which is all about community nursing and, and really empowering that care team in the community to make decisions for the benefit of clients. So there’s a lot of innovation out there and you know, even some of the innovation which is building momentum, but is yet to materialize in a meaningful way. You know, I’m thinking about the, the home care benefit and Medicare Advantage plans. You know, we, we see that as building momentum.

Jeff Howell (13:31):

I love the bertz ERG model because I feel like it addresses the, the Achilles heel of home care, and that is yeah, everyone wants care delivered in the home, but it, it poses these scheduling and, and route logistics challenges by having care workers constantly having to spend so much time on the road as opposed to delivering care.

Adrian Schauer (13:52):

Absolutely. And it, it’s also very much about whole person care, right? And acknowledging that sometimes the best decisions are made closest to context. And you know, we can trust these nursing teams to really figure out what the client needs to live well in their home. And this more paternalistic model of, you know, centralized assessment and, and, and service planning has its benefits, but it also has its downside. So, so we’re real big supporters of be Over Care here.

Jeff Howell (14:23):

All right, we’re on our fifth and last prediction for 2023. Agencies will resist the commodification of our industry. What do you mean by that?

Adrian Schauer (14:32):

So I, I would almost say the recommodification of our industry. So if you look historically, home care was largely a fee for service industry, and mostly you got paid for an hour of care. There’s been lots of innovation in reimbursement models and in how the, the market thinks about home care, you know, a shift to towards different flavors of value-based reimbursement. Ultimately what everybody wants are those patient outcomes, not hours of care. And so I see this specifically in how Medicare Advantage plans are starting to contract with home health agencies, and they want to be the ones making the, the value decisions. And to push the in-home care down the value chain into a fee for service will pay you for an hour of care, as opposed to an envelope or a bundle where the accountability sits with a home health agency to go and make the decisions that will lead to better patient outcomes.

(15:36):

So I think as an industry, we know that demand greatly exceeds supply. And so though it might not feel that way on a day in, day out basis, we actually have power in our health systems just because the scarcity of in-home care delivery resources. And if we act more together as an industry and say, no, we are a value added partner, higher up the value chain, we want to be paid to deliver a patient outcome, not just for an hour of care. I think you’ll see us really claim the, the, the power we should have in the care system, and ultimately that’ll lead to better experiences for our care workers and also better experiences for the clients at the end of the day.

Jeff Howell (16:20):

Well, Adrian, I enjoy hearing your insights every year. Don’t be surprised if you may see me recycle some of your content as my own on my LinkedIn feed, ,

Adrian Schauer (16:29):

Feel free

Jeff Howell (16:31):

Get you outta here on this. Give us a reason to be optimistic over the next year and beyond for care in the place that clients call home.

Adrian Schauer (16:39):

I think I’ve, I’ve two main sources of optimism. And number one, the world in general is coming into a tough economic cycle right now. So that’s gonna have tough consequences and many places of the economy, but in home care, we are gonna be an increasingly an employer of choice. It’s, it’s not easy work, but it’s meaningful work and there’s lots of, lots of demand and we can meet the moment. So that’s number one. Number two is I think one of the silver linings of the pandemic is that the world’s really come to understand that the safest and most desirable place for care to occur is in the home. And as things loosen a little bit in the, in the labor market, I think we’re gonna find home care really have its moment over this next decade.

Jeff Howell (17:34):

Yeah, I agree and I’m excited for it. Well, thanks for coming on, Adrian. It’s a pleasure as always.

Adrian Schauer (17:40):

Same here. Thank you, Jeff.

Jeff Howell (17:43):

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 alayacare.com/homehealth360, that’s spelled Home Health 360, or Search Home Health 360 on any of your favorite 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 alayacare.com/homehealth360 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.