Heal — which has raised more than $71 million since launching in 2014 — and 24 Hour Home Care announced a new partnership agreement Tuesday. The move is yet another example of an innovative collaboration between a home care provider and on-demand company, as well as a signal of future relationships likely to emerge thanks to more flexible Medicare Advantage (MA) policies.

“Once [Medicare Advantage] made some rulings on how you can be reimbursed for house call visits, that opened the door for us and Heal,” 24 Hour Home Care owner and co-founder Ryan Iwamoto told Home Health Care News. “At the end of the day, we wanted to provide this as another service for our clients, as it’s obviously a value-add to our existing offerings.”

Founded by Iwamoto, David Allerby and Tyner Brenneman-Slay in 2008, 24 Hour Home Care provides non-medical home care services to older adults and children with developmental disabilities in California, Arizona and Texas.

While the partnership with Heal adds to 24 Hour Home Care’s appeal, it also helps connect the on-demand house call startup with several thousand prospective users.

So far, Heal has provided more than 100,000 house calls across its current markets of California, Virginia, Washington, D.C., and — most recently — Atlanta. Heal house calls can be booked on-demand, 365 days per year and coordinated within a two-hour window.

In the past, users have typically booked Heal appointments via smartphone app or internet browser, presenting barriers to those without access. Under the new partnership, 24 Hour Home Care workers will now be able to help older adults schedule house calls with Heal doctors during their regular visits.

“The context of what seniors want as they age is to be independent and have the ability to stay in their house,” Nick Desai, co-founder and CEO of Heal, told HHCN. “Home care workers — especially those from a large and high-quality agency like 24 Hour Home Care — are a big part of making that happen.”

More partnerships on the horizon

Doctors booked through 24 Hour Home Care and Heal offer a variety of services, including primary care and non-emergency urgent care visits, in addition to flu shots and wellness checks.

Although its partnership with 24 Hour Home Care is officially its first in the space, Heal has long been vocal about its interest in working with home care providers.

“Coordinating medical care driven by a doctor with the day-to-day living assistance of a home care worker in a person’s home is uniquely effective,” Desai said, noting that more partnerships are on the horizon.

In terms of partners, 24 Hour Home Care is one with ample momentum, coming off two years of strong growth. After seeing revenues of about $71 million and $80 million in 2017 and 2018, respectively, 24 Hour Home Care is projected to bring in roughly $93 million in 2019.

Heal and 24 Hour Home Care are both based in Los Angeles.

No stranger to the on-demand economy, 24 Hour Home Care has been working with ride-hailing companies Uber and Lyft since 2015 in a similar capacity. It’s that familiarity and awareness of the value that on-demand services bring that made a partnership with Heal so attractive, according to Iwamoto.

“We saw that opportunity and need with our clients — older adults — for on-demand technology and ordering rides,” he said. “Most seniors didn’t have a smartphone, so we knew that we could help arrange transportation to the people we provide services for. We’ve had a lot of success with it.”

Branded as RideWith24, those partnerships between Lyft, Uber and 24 Hour Home Care arrange upward of 2,000 rides per month.

“When I first heard what [Heal] did, I had that same vision that I had when looking at Uber and Lyft for RideWith24,” Iwamoto said. “It was again about bridging that gap between the older adult and, in this case, an on-demand house-call doctor.”

Besides its partnerships with Uber, Lyft and Heal, 24 Hour Home Care has similarly collaborated with Cedars-Sinai Medical Center to support the Los Angeles-based hospital’s high-risk discharged patient population.

‘Not possible’ without Medicare Advantage

Heal is in-network with all major PPO insurance companies in California and covered by select MA plans.

Meanwhile, 24 Hour Home Care is currently working with two MA plans in California. The home care provider — which declined to name the specific plans — was able to secure those arrangements by connecting with them shortly after the Centers for Medicare & Medicaid Services (CMS) began opening the door for non-medical in-home care services and supports as supplemental benefits in April 2018.

“The two that we’ve been working with, I think they’ve always kind of had it on their radar,” Iwamoto said. “We met with them really quickly and suggested some ways of utilizing [home care.] They actually listened to what we had to say — and we’re working with some of their members right now.”

Earlier this month, CMS continued its push to roll up in-home care services and supports under MA or the 2020 plan year, announcing it would allow any benefits that “have a reasonable expectation of improving or maintaing the health or overall function” of beneficiaries with chronic conditions.

These and other changes largely drive the partnership between Heal and 24 Hour Home Care.

“It was not possible to really meaningfully see a large range of their patients until the Medicare rule change that only took place Jan. 1, 2019,” Desai said. “[Medicare Advantage] is thankfully moving in the director of liberating providers — quality providers — to provide care in the home. It’s integrating traditional care models with home care models with digital care models.”

Apart from on-demand doctor house calls, Heal also offers remote patient monitoring services through its Heal Hub, which helps monitor blood pressure, blood oxygen levels and other biometrics in real time. 24 Hour Home Care will assist clients in maintaining compliance with their Heal Hub usage if remote patient monitoring is recommended by a doctor.

Building hospital appeal

Beyond offering clients another on-demand service, 24 Hour Home Care believes partnering with Heal will boost its hospital and health system standing.

RideWith24, for example, has propelled 24 Hour Home Care into contracts with more than 100 health care organizations, including more than 40 hospitals, according to Iwamoto.

“We work with a lot of hospitals, skilled nursing facilities and, you know, they’re under the gun to make sure their patients aren’t being readmitted,” Iwamoto said. “One of the biggest reasons for patients being readmitted is because they don’t see their primary care physician.”

Heal and 24 Hour Home Care are initially testing out their partnership in the Los Angeles area before expanding to further markets.

In addition to teaming up with Heal, 24 Hour Home Care recently underwent a subtle rebranding; it had previously been known as “24Hr HomeCare.” The decision to tweak its name was, in part, a way to celebrate the home care provider’s 10-year anniversary, Iwamoto said.

“We wanted to do something special just in refreshing our brand,” he said. “We haven’t touched it since we launched with three owners back in the day. We wanted to do something a little bit more modern, something that fit with our culture.”

The rebranding — which included an update to the organization’s logo and brand colors — was also an effort to avoid the common misspellings that became common with “24Hr HomeCare.”

The post 24 Hour Home Care Partners with On-Demand House Call Startup Heal appeared first on Home Health Care News.

Silver Spring, Maryland-based home care provider LifeMatters has hired a new COO.

Daniel Gold comes to the position after serving as executive vice president and COO of HomeCare.com, which offers tools and technologies to connect families and caregivers. Gold has worked in different capacities within the post-acute care since the early 1990s.

LifeMatters employs more than 1,300 caregivers, with four offices in the Mid-Atlantic, specifically in Maryland and the greater Washington D.C., area. The company offers both skilled and non-medical care services.

“Our objective is to maintain a leadership position in the home care industry, deliver great care to our clients and improve outcomes while affiliating with leading healthcare partners,” Gold said in a press release announcing the news. “Our plans are to grow the company organically through selected acquisitions as we expand into new markets and services.”

Additionally, Gold aims to broaden LifeMatters’ relationships with Medicare Advantage plans, ACOs and other payment models.

Earlier this month, CMS further expanded the supplemental benefits covered under Medicare Advantage in 2020, opening the door for a variety of non-medical benefits to be covered under MA plans and creating even more opportunities for home care providers to become partners in MA contracts.

HHS inspector general announces resignation

After more than 14 years on the job, Daniel Levinson, the Department of Health and Human Services (HHS) inspector general, has announced he will resign May 31.

The Office of Inspector General (OIG) announced the news earlier this month. Levinson, who spent more than 35 years in government, will move on to other endeavors, while Principal Deputy Inspector General Joanne Chiedi will serve as acting inspector general when Levinson steps down, according to an OIG spokesperson.

In a statement following the announcement of the news, Secretary of Health and Human Services Alex Azar praised Levinson’s recent work ramping up OIG oversight.

“In 2018, it was an honor to see OIG participate in another record-breaking Healthcare Fraud Takedown Day, charging defendants with schemes involving more than $2 billion in false billings,” Azar said.

As HHCN previously reported, OIG reported $2.91 billion in expected investigative recoveries during 2018.

Despite Levinson’s departure, efforts to tackle fraud, waste and abuse in home health and hospice can only be expected to increase if OIG’s 2020 budget request is approved.

In the request submitted last month, OIG requested an extra $10 million in funding specifically to tackle home- and community-based fraud. The money would help finance several anti-fraud initiatives, including putting more “boots on the ground” to investigate suspicious activity.

Uber Health hires new legal director

Uber Health has hired a new legal director.

Lamis Hossain comes to the position after three years as assistant general counsel for McKesson Specialty Health, which delivers specialty drugs to doctors and health care providers across the country.

In total, she spent nearly 17 years with global healthcare services and medical supply company McKesson Corporation (NYSE: MCK), serving in several different divisions and capacities.

San Francisco-based Uber first launched its health care unit, Uber Health, last year. The HIPPA-compliant platform allows health care providers to request and pay for rides for patients, ensuring they make it to appointments. Rather than using an app, the ride-hailing company sends passenger text messages with their ride information.

Missed medical appointments take a major toll on the health care system, with a total estimated impact of $150 billion. Additionally, missed appointments can lead to a decline in patient condition, especially for seniors whose risk of developing complex conditions increases with age.

Since launching, Uber Health has already partnered with several home care providers.

Examples include Georgetown Home Care, a private duty home care provider based in Washington, D.C.; Right at Home, a home care franchise with more than 550 locations nationwide; and 24Hr HomeCare, a home care provider with 16 locations throughout California, Arizona and Texas.

The post LifeMatters Hires New COO, HHS Inspector General to Resign appeared first on Home Health Care News.

Earlier in February, Lyft announced it was expanding its partnerships with Blue Cross Blue Shield (BCBS) and Humana Inc. (NYSE: HUM) to further capitalize on the expanded supplemental benefits offered under the Medicare Advantage (MA) program, which include transportation services.

“We’ve seen the positive impact transportation can have, not just on costs and operational efficiencies, but also on an individual’s overall health,” Megan Callahan, vice president of health care at Lyft, told Home Health Care News in an email. “That’s why we were excited to hear that the Centers for Medicare & Medicaid Services (CMS) announced new flexibility for MA plans to innovate with services that promote member health and wellness.”

In expanding its partnerships with high profile payers, San Francisco-based Lyft will be able to provide transportation to select BCBS and Humana members enrolled in Medicare Advantage plans, in turn helping seniors get to and from medical appointments.

Currently, roughly 3.6 million people — many of whom are older adults — miss medical appoints every year. Beyond taking seniors to doctor’s appointments, Lyft will also provide some members transportation to places like pharmacies and fitness centers to meet a broader range of health needs.

These partnerships are just the beginning, Callahan said, which could suggest there’s room for Lyft to further build upon its relationships with home care providers throughout the country. Some of its current provider partners include Comfort Keepers and 24Hr HomeCare.

“We look forward to partnering with MA plans around the country to leverage the flexibility provided by CMS to test and make these new models a reality for patients, as we know that scaling investments and partnerships for innovative transportation models will improve health outcomes, decrease costs for patients, payers, and the government, and combat social isolation,” Callahan said.

Showing its commitment to its health arm, Lyft brought on Callahan last year as the company’s first-ever vice president of health care. Previously, Callahan was a top executive at McKesson’s Change Healthcare, a health care IT company.

Additionally, Lyft’s numbers are a testament to its goals: The number of health care rides Lyft provided in the third quarter of 2018 was triple the same period the year before and now makes up a “sizable chunk” of the ride-hailing company’s business, Lyft’s Chief Business Officer David Baga told CNBC in March. He also recently touted the company’s progress in the space on Bloomberg Technology.

Humana — which currently contracts with LogistiCare, the nation’s largest non-emergency medical transportation (NEMT) provider, on select MA plans — could not provide data on how many seniors the expanded partnership would serve.

“We hope to incorporate Lyft into our transportation mix sometime in the next several months,” a Humana spokesperson told HHCN in a statement. “This is the first time LogistiCare will offer transportation via Lyft to Humana members.”

BCBS did not provide HHCN comment for this story.

Meanwhile, Lyft’s expanded partnerships with Blue Cross and Humana are just a piece of the pie when it comes to helping seniors age in place.

Last year, HHCN reported that the company was working with GreatCall and taking its aging in place transportation program nationwide. Instead of using an app to hail a ride, seniors can call an operator and tell them where they’d like to go.

Similarly, Lyft has also recently updated its concierge product, which allows providers and living facilities to request rides for seniors.

“We specifically designed our new product updates with seniors in mind, including introducing automated calls to landlines for riders that need it, so they can be made aware of their ride details,” Callahan said.

The post Lyft Continues to Target Seniors, Social Determinants of Health Ahead of IPO appeared first on Home Health Care News.

“There’s no specific data that is publicly available that speaks to [at-home care companies], but in general, the whole health care sector is experiencing an increase in the severity of claims and the frequency of claims,” John Atkinson, managing director at insurance broker Willis Towers Watson, told Home Health Care News. “Home health care would be included in that.”

From an insurance purchasing perspective, that could mean at-home care companies will be subject to increased requests for information when purchasing insurance.

Additionally, it could impact the structure of insurance programs and, in some areas, increase premiums, Kirsten Beasley, head of health care broking at Willis Towers Watson, told HHCN.

In many ways, home health and home care insurance claim trends are comparable to those in senior living, a segment for which more insurance data exists, Atkinson said. In both settings, as clients age in place, they are living longer and becoming frailer.

As such, liability insurance rates for the senior living industry could increase by as much as 30% in 2019, according to Willis Towers Watson. But for at-home care companies, liability is only one part of the puzzle.

Auto

Home health and home care companies can expect to see the most premium increases and policy tightening within the automobile insurance realm, Beasley said.

Unlike in senior living, where professional drivers use company vehicles, at-home care companies employ hundreds to thousands of caregivers who more often than not drive their own cars to and from clients while on the clock.

“There are cases where the caregiver or the aide may run errands for [a client], and over the course of her driving to and from one home health care visit to another home health care visit, she’s actually working on behalf of the agency driving her vehicle,” Atkinson said. “If there’s an accident that occurs, there could be liability that inures to the home health company as well as to the driver.”

As such, driver safety programs and driving background checks will become increasingly important when screening caregivers in the years to come, Beasley said.

“I absolutely think that is a key feature of having a robust fleet safety,” Beasley said. “I also think you’re going to see an increase in use of other technologies, like Uber and Lyft, to defray that exposure.”

To Beasley’s point, many home care agencies have already started teaming up with ride-hailing companies. The list includes El Segundo, California-based 24Hr HomeCare, which coordinates hundreds of rides for its employees on a yearly basis, though not necessarily for insurance liability purposes.

Workman’s comp

Workman’s compensation, which protects employers and benefits employees for claims arising out of the work environment, is also different for at-home care companies compared to senior living providers.

“[For caregivers], there’s really no oversight or ability to control the environment,” Atkinson said. “So from a workman’s compensation standpoint, you’re taking these work environments as you get them.”

In some cases, that puts caregivers at a greater risk, for example, presenting trip hazards or leaving them without devices to properly lift and move residents. Additionally, lack of supervision makes it difficult to ensure safe practices or discern whether injuries occurred at work.

However, providers can manage risk by developing quality care programs akin to those used in in-patient health care organizations.

“It’s not rocket science,” Atkinson said. “It’s really attention to detail and blocking and tackling on a day-to-day basis to make sure that as an operator, you’re attracting and retaining as qualified talent as you can and trying to train and educate people the best you can to minimize risk.”

General liability

The same principles apply in minimizing general liability claims, which can arise when clients are injured while under a caregiver’s watch.

“We instruct our clients to help patients assess the hazards within their own environment and make sure they’re aware of them,” Atkinson said. By optimizing homes for aging in place, providers can then minimize incidents such as falls, which are projected to kill thousands of older adults and cost nearly $60 billion by the year 2020.

Launched in 2015, the Louisville, Colorado-based Living in Place Institute works with the Universal Design Living Laboratory to help home health providers identify and address potential obstacles in their clients’ homes. Kendal at Home is among several providers that have turned to the living lab for home-safety expertise.

In the senior living industry, liability claims and settlements are on the rise, with the of bulk claims coming from facilities dealing with higher acuity levels of care such as assisted living and memory care. Often times, senior in these facilities enter at an older age and are less healthy.

As such, general liability premiums are on the rise in senior living, but that’s not necessarily the case in home health care.

For one, at-home caregivers aren’t responsible for clients 24 hours per day. Additionally, clients are often more autonomous and have higher levels of functional ability. For these reasons and others, the rise in general liability claims is less pronounced for at-home care companies.

“I would say that overall, if the home health organization has not seen a whole bunch of losses in claims, they should not expect to get premium increases [in this area] just because of [the market’s] transitional state,” Beasley said.

The post Insurance Risks for At-Home Care Agencies and How to Address Them appeared first on Home Health Care News.

About one in five older adults give up driving after turning 65, according to a recent nationwide poll spearheaded by the National Aging and Disability Transportation Center, a partnership between the National Association of Area Agencies on Aging (N4A) and Easterseals. On an annual basis, that’s about 600,000 people each year.

“What we learned [from the survey] was striking — and a confirmation of what we had suspected, but hadn’t known for certain,” Virginia Dize, director of N4A’s transportation program, told Home Health Care News. “Most older adults and people with disabilities either drive themselves or rely on caregivers for a majority of their transportation needs. Whether they are planning transportation or providing the transportation themselves, caregivers clearly play a critical role.”

Roughly 3.6 million people — many of whom are older adults — miss their medical appoints each year as well.

For these reasons, several home care franchisers and independent companies have made transportation a focal point of their system-wide operations. They include Omaha, Nebraska-based Right at Home and El Segundo, California-based 24Hr HomeCare. Over the past 12 months, 24Hr HomeCare has coordinated more than 21,000 rides  through business alliances with both Uber and Lyft.

Founded in 2008, 24Hr HomeCare has 16 locations throughout California, Arizona and Texas.

The demand and need for transportation services is clear, Gavin Ward, regional director of strategy and partnerships for the company, told HHCN. But implementing a transportation line of business is not necessarily a simple task.

“In order to truly have a transportation program or line of business, we believe that we have to have dedicated experts and staff who are able to handle the volume we have,” Ward said. “If you’re a home care company that wants to be able to provide these services, you need to invest in the infrastructure — and that includes dedicated people.”

Inside 24Hr HomeCare’s transportation line

Home care companies can launch transportation service lines in a variety of ways, but the most common avenue is establishing relationships with ride-hailing providers such as Lyft or Uber, complementing them with an independent fleet of caregiver and agency vehicles.

For example, 24Hr HomeCare started providing transportation services to clients when it first launched, pulling from its caregivers’ pool of cars and vans. It then began developing relationships with Lyft and Uber in 2015.

Today, the independent company brands its transportation offerings as RideWith24.

“For me, there are two big components, with one being the medical piece and allowing people to access health care and appointments in a much easier way — typically at a lower cost than a taxi or other means of transportation,” Ward said. “The second piece is geared toward socialization, helping clients get to religious functions or meet up with friends.”

When it comes to ride-hailing partnerships, 24Hr HomeCare passes Lyft or Uber transportation costs along to consumers, their family members or the facility requesting service. For those who are strictly using 24Hr HomeCare as a way to get from Point A to Point B, then agencies coordinating rides tack on up to $10 per ride.

That upcharge helps cover the cost of the three full-time community partnership coordinators 24Hr HomeCare employs, Ward said, adding that the average ride costs $17.41. About 32% of people using the RideWith24 program only use it for transportation and are not receiving home care.

“You have to invest in people, but you also have to invest in the accounting side,” he said.

Notably, roughly half of transportation requests come from contracted partners — 24Hr HomeCare works with dozens of acute-care medical centers — and are related to a discharge or medical appointment.

When home care agencies provide services to both regular clients and those who, perhaps, just need a one-time ride, they can be an important resource, said Dize, who also serves as co-director of the National Aging and Disability Transportation Center.

“Home care agencies that provide transportation to their clients are an important part of the solution,” she said. “However, agencies may limit their transportation services to clients who already receive home care assistance or offer rides solely to certain destinations, such as doctors’ offices. Consumers who can only afford to pay for a limited number of hours of home care assistance may also hesitate to use their hours for transportation which can be time-consuming.”

A foot in the door

Similar to 24Hr HomeCare, Right at Home also routinely teams up with Lyft and Uber. Its ride-hailing efforts began as part of a pilot program with about 25 owners in 2017 and have gradually expanded since, Kerin Zuger, vice president of business development and strategic partners for Right at Home, told HHCN.

Founded in 1995, Right at Home as more than 550 locations across the United States.

As part of the franchise relationships with Lyft and Uber, Right at Home owners are required to work with only one of the ride-hailing powerhouses. The transportation line is then marketed as Right at Home Transportation, with add-on language clarifying whether its “powered by Lyft” or “powered by Uber.”

Owners have flexibility in deciding how to pass along costs to clients. Not many Right at Home owners opt to mark up costs for coordinating an Uber or Lyft ride, Zuger said. When they do, though, it could lead to created revenue.

“Not a lot of owners mark up [transportation costs], but I recommend that they do, especially if there’s staff dedicated to transportation and coordination,” Zuger said. “If you have a person in your office doing dispatch, that takes time and effort, so you need to at least make sure you’re covering your cost on that.”

The biggest bonus to Right at Home’s transportation line: a foot in the door with hospitals looking to improve upon the patient discharge process.

“Home care owners have a tendency to think they … don’t bring enough value to be able to walk into a hospital and say, ‘I’m here, and I can help keep people out of the hospital and reduce cost,’” Zuger said. “What transportation does is it opens that door. We can say, ‘Hey, last quarter you spent $25,000 on taxi cab services. What about instead of using taxis, you just call Right at Home Transportation.”

As part of its appeal to hospitals and the discharge process, Right at Home alerts discharge nurses as soon as a driver shows up, while also letting them know when a patient gets home. Right at Home additionally ensures that patients don’t leave discharge paperwork in their ride home.

“We’ve identified that, yes, hospitals are going to be a major target for us moving into 2019 and beyond,” Zuger said. “We need to make sure that Right at Home is rolling off their tongue all the time.”

One reason for some cautiousness in touting the benefits of ride-hailing services: past research has questioned their impact.

In fact, a 2018 study published in JAMA Internal Medicine found that offering free Lyft rides to Medicaid patients for an upcoming medical appointment did not reduce the rate of missed appointments.

The study, which included nearly 800 Philadelphians who were patients with Medicaid at one of two Penn Medicine primary care practices, found that the missed appointment rate for those offered a free Lyft ride and those not offered a ride was practically identical: 36.5 % vs. 36.7%.

However, the study did not focus specifically on Lyft rides coordinated with the help of a home care agency.

Furthermore, the benefits of a strong transportation line extend past community partners and clients. Seamless transportation can also be a draw for recruiting qualified caregivers, who may not always have access to a vehicle.

About 6% of the rides 24Hr HomeCare coordinated in the past 12 months were for its own internal employees, Ward said. That’s about 1,300 rides in total, he said.

The post Transportation Services Help Home Care Forge Hospital Ties, Can Drive Revenue appeared first on Home Health Care News.

The program between the three companies offers additional support to the Los Angeles-based hospital’s high-risk discharged patient population by extending Cedars-Sinai’s care management services through the use of non-clinical caregivers, referred to as “Care Extenders” under the partnership.

Home care services were provided by both 24Hr HomeCare and Honor in similar capacities.

“The overall idea of it was to be able to extend [Cedars-Sinai’s] eyes and ears into the home, be able to improve some of those outcomes and control some of those costs,” Zachary Morgan, regional director of strategy and partnerships at 24Hr HomeCare, told Home Health Care News.

El Segundo, California-based 24Hr HomeCare is a private duty in-home care company. In 2017, the provider served about 5,000 private-pay clients across its offices in California, Arizona and Texas. Among its offerings, 24Hr HomeCare provides companionship, transportation and meal preparation services. It was recently named one of the fastest growing U.S. companies in 2018, according to Inc. magazine.

Cedars-Sinai Medical Center is a part of the Cedars-Sinai Health System. Throughout its operations, the health system serves more than 1 million people each year across more than 40 locations, working with more than 4,500 physicians and nurses.

San Francisco-based Honor — backed by $115 million in venture capital since launching in 2014 — is a non-medical home care company that provides care to clients in California, Texas and New Mexico. As part of its business model, Honor partners with local home care agencies to manage their caregiver recruiting, scheduling, payroll and other back-office logistics, while also sharing from its large pool of care professionals.

Curbing readmissions 

The three-way program between 24Hr HomeCare, Cedars-Sinai and Honor focuses on patients with multiple comorbidities, including those managing conditions such as diabetes, asthma and heart failure. The program also provides care for patients with challenging social and economic circumstances, frail patients and patients who have generally experienced acute or catastrophic events, Kelley Hart, executive director of care coordination at Cedars-Sinai Medical Network, told HHCN via email.

“I would say that we learned the value of having a partner who could be in the patient’s home as an extension of the office-based care manager,” Hart said. “We saw the positive impact of having patients return to their homes instead of going to another level of care.”

Specifically, the program targeted Cedars-Sinai’s full-risk United Healthcare Medicare Advantage population of 2,800 patients.

For 24Hr HomeCare and Honor, the pilot was a perfect opportunity to showcase to patients and hospital systems the benefit of home care, executives from each told HHCN.

The 30-day acute-care episode rate was 14% under the Care Extender program, according to 24Hr HomeCare, well-below the general population’s acute-care episode rate of 18%.

Preventing patients from returning to the hospital after discharges — an idea that has become a rallying cry for home health and home care agencies alike — is a key part of the shift toward value-based care. Moving forward, health systems that are able to successfully slash readmission rates will thrive, while those that cannot will likely suffer penalties and payment reductions.

“Cedars-Sinai is another example of a progressive health care organization setting new standards for quality and innovation in patient care, ” Nita Sommers, president of Honor, told HHCN via email. “Their commitment to Care Extenders demonstrates the critical value of providing qualified, in-home care to help older patients recover and reduce re-admissions rates. We believe this is one of the best practices for ensuring an optimal care experience from in-hospital to in-home care.”

Hospital readmissions cost Medicare about $26 billion annually, with about $17 billion spent on avoidable hospital trips after discharge, according to data from the Center for Health Information and Analysis.

Humana, Inc. (NYSE: HUM) and other insurance giants have previously highlighted their interest in working with organizations that have proven methods for curbing hospital readmissions. Humana, in particular, has turned its attention to home-based care.

Decreasing SNF stays

Cedars-Sinai has formalized the Care Extender program and plans to roll out services to its patients in November.

The total costs associated with initially testing the program were slightly more than $28,000, or roughly the average cost of one United Healthcare admission to Cedars-Sinai, according to data provided by Cedars-Sinai Finance.

Cedars-Sinai used foundation funds to pay for the pilot.

“When we started this pilot program, the belief was that we could provide a much-needed service to patients who needed a little extra assistance to get by and remain in their homes,” Hart said. “With the rising cost of health care, we all need to think outside the box and find ways to lower the cost of care while improving the quality of care patients receive.”

In addition to reducing acute-care episode rates, the Care Extender program was also shown to shorten the number of days patients spent in skilled nursing facilities (SNFs). Under the program, SNF length of stay was decreased by one day, dropping from 22 days to 21 days.

Cedars-Sinai wasn’t alone in reaping the benefits from the partnership, as patients seemed to appreciate the Care Extender program, leading to potential new business opportunities for both 24Hr HomeCare and Honor.

In some cases, patients hired a care provider to stick around longer after experiencing the benefit of having one in their homes, Hart said.

“We received a greater than 80% extremely satisfied response from those patients who experienced the Care Extender program,” she said.

24Hr HomeCare and Honor were chosen after a selection committee interviewed agencies that sent proposals to partner with Cedars-Sinai.

Leaders from 24Hr HomeCare and Cedars-Sinai were keynote speakers for a recent C-Suite Invitational Event in Oakland. The event was the first time that Cedars-Sinai and 24Hr HomeCare had publicly spoken about the hospital and home care collaboration.

Written by Kaitlyn Mattson

The post 24Hr HomeCare, Honor Link Up with Cedars-Sinai to Curb Readmission Rates appeared first on Home Health Care News.

Care Indeed, Cherished Companions Home Care and 24Hr HomeCare are among the non-medical home care companies to make 2018’s top workplaces list, compiled by Activated Insights, a Great Place to Work subsidiary focused on senior care. Great Lakes Caring — now a part of the recently formed home health, personal care and hospice powerhouse Elara Caring — headlined the group of majority Medicare-certified home health and hospice providers that made the cut.

To put together the inaugural Best Workplaces in Aging Services list, broken down into senior housing and at-home care categories, Great Place to Work analyzed survey results from more than 162,000 employees across nearly all 50 states. Top workplaces were evaluated based on a variety of factors, including respect, fairness and leadership competence.

One of the most surprising takeaways from this year’s list: Home- and community-based care workers generally like their workplaces more than their senior housing and skilled nursing facility peers.

“As a category of home- and community-based services, the average score was higher than the senior housing and care category,” Activated Insights CEO Jacquelyn Kung told Home Health Care News. “The overall employee Trust Index score was higher, which I found surprising.”

Broadly, the Great Place to Work’s Trust Index gauges employee experience and perception of their workplaces. The positive feedback from home- and community-based care workers was striking, Kung said, because employees are so often disconnected from office support and colleagues while they’re out in the field.

“A lot of people, including myself, had the ingoing hypothesis that they would be at least equally — if not less — happy,” Kung said. “No. It turns out, on average, employees who work on the home- and community-based care side are happier.”

Closer relationships with seniors is one possible explanation for the higher satisfaction levels, she said.

Reviewing the results

Throughout its research, Great Place to Work has found that great workplaces consistently see higher revenue growth and lower turnover rates than their less-than-spectacular competitors.

That’s a point likely to get the attention of the several thousand home care and home health agencies operating across the country, especially as they juggle with the looming wave of retiring baby boomers and an inevitable caregiver shortage, Kung said.

Menlo Park, California-based Care Indeed checked in at No. 2 in the at-home category. More than 90% of Care Indeed’s surveyed employees reported that their workplaces have great atmospheres, rewards, communication and bosses.

Care Indeed provides non-medical home care — hourly or live-in — throughout parts of central California and in Seattle.

“Care Indeed takes great pride in creating a culture of kindness, compassion and authenticity,” Care Indeed COO Vanessa Valerio told Home Health Care News in a statement. “While we want Care Indeed to remain profitable and continue to grow, we will not do anything that will harm or negatively affect the things that have made our company successful. Efficiency and profitability are great, but if they threaten our company’s core value in any way, we will not go that route.”

To create a successful workplace culture, Care Indeed has taken steps to recognize caregivers through a monthly appreciation day. The company also provides food and other perks to employees, while organizing social events, sports tournaments and quarterly support groups.

“We serve two sides of the home care equation: care recipients and care providers,” Valerio said. “I strongly feel that using this achievement helps improve our market positioning in this industry. The quality of service that our caregivers provide is greatly influenced by the quality of service they receive from the company.”

In addition to Care Indeed, Cherished Companions Home Care (No. 3) and 24Hr HomeCare (No.4), Care to Stay Home (No. 6) and CompassCare, LLC (No. 9) also made Fortune’s list of best workplaces in aging services on the non-medical front.

In terms of Medicare home health companies, Great Lakes Caring earned the highest spot on the list, coming in at No. 5. Backed by private equity firms Blue Wolf Capital Parters and Kelso & Company, Michigan-based Great Lakes Caring merged with Texas-based Jordan Health Services and Connecticut-based National Home Health Care earlier this year. The three companies combined into Addison, Texas-based Elara Caring.

“We look forward to introducing these engagement attributes from the Great Lakes Caring culture throughout Elara Caring,” Scott Herman, Elara Caring CEO, told HHCN in an email. “Great Lakes Caring’s dedication to high quality patient care is representative of our mission, to provide patients with the right care, at the right time, and in the right place.”

Elara Caring serves more than 65,000 patients daily across 16 states, employing about 32,500 caregivers in total.

“Home health and Hospice workers are faced with challenging work day in and day out — taking care of the sick and aging,” Marcy Miller, chief nursing officer at Elara Caring, told HHCN in an email. “We must provide them with a support system, provide them with the tools they need to succeed, and remind them daily how important their contributions are to our patients.”

Other majority Medicare certified home health and hospice providers on the list include Constellation Health Services (No. 7), Grandcare Health Services (No. 8) and Alacare Home Health and Hospice (No. 10).

The No. 1 spot in the at-home care category went to Dallas-based Eagle Creek Therapy Services.

For consideration, companies in the 50 Best Workplaces for Aging Services list had to first achieve Great Place to Work certification. The certification process involves submitting an application and having at least 55% of employees fill out a survey, which is administered over a two-week period.

Standalone hospices and other observations 

Compared to similar Great Place to Work lists looking at other industries, the vast majority of surveyed workers were hourly employees, as opposed to salaried, Kung said. Likewise, there was a noticeable trend of more female employees, which lines up with what’s known about home-based caregiver demographics.

On a high level, aging services employees rated their workplaces more highly than in other industries in purpose and job meaning, according to Kung.

“People really feel a sense of purpose working in aging services,” she said. “That’s in terms of pride, in terms of ‘this is more than just a job.'”

Besides her role as Activated Insights CEO, Kung was one of the co-founders of ClearCare, a company that provides cloud-based software solutions to private duty home care agencies.

“When I was day-to-day looking at the data at ClearCare, you could see a huge variability in the thousands of agencies,” Kung said. “One the culture side and the people side, that’s what you see as well. The overall point is that good people practices translate into better operations.”

No standalone hospices made the inaugural list, though that’s possibly tied to the fact there are relatively few standalone hospices remaining, according to Kung.

In 2019, Activated Insights plans on further digging into best workplaces in aging serves by more closely investigating why employees feel the way they do, she said.

Written by Robert Holly

The post Care Indeed, Great Lakes Caring Among ‘Best Workplaces’ in Aging Services Sector appeared first on Home Health Care News.

Baton Rouge, Louisiana-based home health, hospice and personal care company Amedisys, Inc. (Nasdaq: AMED) announced Tuesday that it has found its new top HR officer.

Sharon Brunecz will join Amedisys as chief human resource officer, replacing Larry Pernosky, who recently announced his retirement. Prior to joining Amedisys, Brunecz served as HR chief for U.S. Acute Care Solutions, a physician-owned provider of integrated acute care services.

“Sharon’s depth of expertise in human capital strategies will be invaluable as we continue our quest in becoming the industry’s employer of choice to attract and retain the best of the best to care for our patients,” said President and CEO Paul Kusserow in the announcement.

In total, the publicly traded Amedisys has more than 17,500 employees in nearly three dozen states, company statistics show.

Graham Healthcare Group Welcomes Two New CEOs For Home Health, Hospice Segments

Graham Healthcare Group, a subsidiary of Graham Holdings Company (NYSE: GHC), announced earlier this month that is has named CEOs for both its home health and hospice segments.

David Curtis is set to take over as CEO of Graham Healthcare Group Home Health, while Justin DeWitte fills the same position for Graham Healthcare Group Hospice. The two new executives will jointly lead Graham Healthcare Group’s home health and hospice efforts across Michigan, Illinois and Pennsylvania.

Before being named CEO, Curtis served as Graham Healthcare Group Home Health’s chief operating officer, responsible for day-to-day operations of Celtic Home Health, Residential Home Health and Mary Free Bed At Home.

DeWitte previously served as COO of Graham Healthcare Group Hospice, overseeing operations of Celtic Hospice Residential Hospice. He also served as president of Graham Health Services.

Combined, the two executives have 20 years experience with the company.

Graham Healthcare Group is based in Troy, Michigan. It operates throughout 114 U.S. counties and, according to the company, has served more than 57,000 patients.

ONEgeneration Adds Newest Board Member

West Coast nonprofit ONEgeneration announced last week that it has added its newest board member.

Gasia Majarian — managing director of 24Hr HomeCare’s Encino, California, office — was chosen as ONEgeneration’s latest board member because of her “expertise in home care services,” according to the announcement. Majarian has been working with Los Angeles-based 24Hr HomeCare since 2014, during which time she “worked closely” with ONEgeneration’s team.

The decision to add Majarian was unanimous, according to the announcement.

ONEgeneration’s services include adult daycare, childcare, transportation and nutrition programs, often for low-income or homebound seniors. With the addition of Majarian, ONEgeneration’s board count bumps up to 22 members.

The nonprofit is located in the San Fernando Valley area.

Written by Robert Holly

The post Movers & Shakers: Amedisys Names Chief HR Officer appeared first on Home Health Care News.

The language of the proposal led to questions, still unanswered, about which specific services could be covered under MA plans. However, home care providers and insurance companies are interpreting the new proposal as good news.

Expanding benefits

Although the language in the proposal was vague in regards to specific services, CMS’ move is being hailed by major home health care providers such as Baton Rouge, Louisiana-based Amedisys (Nasdaq: AMED).

“It’s a very good sign for Amedisys and the patients that we care for,” Mike Trigilio, president of the company’s growing personal care business, told Home Health Care News. “We don’t know a lot of the details today, but as a leading indicator, it is great [news].”

One specific facet of the proposal—an expansion of benefit flexibility—is reason for excitement, according to Eve Gelb, senior vice president of healthcare services for SCAN, one of the nation’s largest non-profit Medicare Advantage plans. SCAN has more than 187,000 members in California.

The changes could enable SCAN to offer benefits based more on needs of individuals rather than uniformly across a patient population—which could help contain the costs of adding these additional benefits.

“As an organization that cares for lots of frail and medically complex individuals, we’ve always struggled with a benefit uniformity,” Gelb told HHCN. “General advances on flexibility with how benefits are administered is a big win.”

The additional supplemental benefits are also a big win, she said, noting that SCAN has already been offering personal care services to its dual eligible patients—those that qualify for Medicare as well as Medicaid. But opening up all Medicare Advantage plans to non-skilled in-home care could take some time, as the organization wants to ensure the benefits are affordable and will last.

When SCAN first began as a demonstration program 35 years ago, it offered non-skilled home care for all its beneficiaries, according to Geld.

“That demonstration was the longest running in Medicare, and it wound down in 2003,” Gelb said. “So, we had to take those services away from our beneficiaries who were Medicare eligible, and those services really do enable individuals to stay living in the community, which we believe is better for Medicare.”

To ensure that beneficiaries would be able to keep new in-home care benefits, SCAN will evaluate the cost of additional benefits and go through the bid process.

SCAN isn’t the only Medicare Advantage provider looking forward to the changes. Louisville-based Humana (NYSE: HUM), which operates its own home care business and recently moved to acquired the home care operations of Kindred Healthcare (NYSE: KND), also sees more opportunity. Humana is one of the nation’s largest for-profit Medicare Advantage payers.

“Humana’s experience and the research literature clearly demonstrate that health is influenced by more than just medical-specific factors,” Humana told HHCN. “Indeed, social determinants of health (SDOH), such as food security, housing, transportation and social interaction, play a role in the overall health of the seniors we serve. Humana is encouraged that CMS is considering flexibilities in the rules that will allow Medicare Advantage plans to better target these needs.”

Seeking deals

Some private duty providers, such as California-based 24Hr HomeCare, have already dipped their toes into alternative payment models in Medicare, and see this MA proposal as a related opportunity.

24Hr HomeCare offers non-medical home care in California, Arizona and Texas, and has managed to secure pilot contracts with a number of health systems as a private duty, non-risk bearing partner in certain models, such as bundled payments. The relationships that the company has forged in these arrangements should help it win Medicare Advantage, according to Regional Director of Strategy and Partnerships Gavin Ward.

“I had a big grin on my face,” Ward told HHCN, referring to when he learned of the announcement from CMS. “We have been saying in the next two years we think Medicare will pay for home care. This is more of a direct statement from [CMS] that they are going to pay through Medicare Advantage.”

24Hr HomeCare’s business is 80% private pay, while about 20% of revenue comes from other funding sources, including the Department of Veterans Affairs (VA) and local grants. As the proposal for non-skilled in-home care moves forward within MA plans, the company will seek to become a provider with MA payors.

“Because our industry is franchised and a lot of mom-and-pop organizations, I think it’s difficult for smaller home care organizations to have the bandwidth to have research and development to go after that business,” he said. “They’re just sustaining their normal business. I would say the majority of companies may not be ready to take this on, but those that have already participated in at-risk relationships…we’ve been able to go through the proposal process and put some skin in the game ourselves.”

It will take some time before a finalized proposal moves forward, including a comment period before CMS can issue a final proposal. 24Hr Home Care is not sitting on its hands in the meantime.

“Now is the time to strike, while the iron is hot,” Ward said. “Get those meetings to get the designs submitted—that will be our effort in California, Arizona and Texas.”

Home care advantages

For a company like Amedisys, which is one of the nation’s largest home health care providers, with 432 care centers in 34 states, the expansion of benefits in MA could be a big boon down the line.

Not only has Amedisys been ramping up its personal care services division, becoming the largest provider in Massachusetts in the last two years, the company has also upped its exposure to Medicare Advantage.

Approximately 75% of the company’s business is within traditional fee-for-service Medicare, with another 25% in non-fee-for-service, including Medicaid, charity care and Medicare Advantage. The overlap leaves Amedisys ready to take on new MA contracts, while providers without a personal care and home health business won’t have the same advantage, according to Amedisys CEO Paul Kusserow, who formerly was an executive at Humana.

“There are basically three companies that play in this space—us, Kindred and Almost Family,” Kusserow said of the personal care overlap in home health. “There are some smaller, private players. I think of the publicly traded companies, if Almost Family combines with LHC Group everybody has a play in it. I think it’s going to be very additive particularly as MA penetration continues to grow.”

Seeing non-skilled in-home care being added to MA may be a sign of things to come, as other benefits have also been floated to integrate into MA.

Specifically, hospice care and palliative care are being looked at as supplemental benefits down the road, Gelb said.

See CMS’ full announcement here.

Written by Amy Baxter

The post Medicare Advantage Home Care Proposal Excites Providers, Payers appeared first on Home Health Care News.

Private duty caregivers are often the first lines of defense against rising acuity levels, but there are some signs when a client needs more advanced care.

Home Health Care News reached out to home care companies to get their insights on how they keep an eye out for this situation—and how they handle it when it arises.

The Tipping Point

Knowing when clients should receive more care, such as skilled nursing or other institutional care, shouldn’t put home care providers in a tough place. In other words, when it’s clear patients need more care, private duty providers shouldn’t be tempted to hold onto clients longer than they should.

“One temptation in our industry is to take cases that cross the line of what a caregiver can or can’t do because of the revenue,” Gavin Ward, regional director of strategy and partnerships at Los Angeles-based 24Hr HomeCare, told Home Health Care News.

24Hr HomeCare, which has 3,000 employees and locations in California, Arizona and Dallas, provides personal care, transportation, light housekeeping and medication reminders.

But skilled care, wound care specialty care and medication administration are outside the company’s scope, Ward told HHCN. Clients with higher acuity can sometimes need additional services in the future.

In most cases, home care, with the support of other services, can surpass that of assisted living or skilled nursing care, Lynn Gardini, president of Home Helpers of Central Pennsylvania in Altoona, told HHCN. Home Helpers, a home care franchisor, is based in Cincinnati and has more than 325 offices.

Even with support, there are some instances where a client may need to transition from home care to more intensive services.

“Whenever the needs become so great that it’s taking a mental and physical toll on the family is really the tipping point,” Gardini explained.

Some general indications that clients likely need more advanced care, include wandering, aggression and medical fragility, according to Gardini.

Vital signs

Home care providers, in general, tend to look for vital signs of increased risks when thinking about if clients need more advanced care, according to Wendy Raney, who owns a Homewatch CareGivers office in Texas. Homewatch CareGivers is based in Greenwood Village, Colorado, and has more than 100 franchise partners.

“I think No. 1 about the safety of the individual,” Raney told HHCN.

Raney’s agency monitors a range of indicators, including signs of depressions, falls, activities of daily living (ADLs), grooming and medication management. It also uses the General Practitioner assessment of Cognition (GPCOG), a screening tool for dementia, to track clients’ cognitive ability.

Clinical nurses on staff also perform clinical evaluations, though she noted the protocol for rising acuity varies from case to case. When more advanced care is needed, a conversation then takes place with family members or the client.

“Once our nursing staff takes a look at that situation… we then go back to the decision-makers,” she said. “Sometimes that’s family, sometimes they have a guardian, and sometimes it’s the individual, and those are the most difficult conversations.”

Rising acuity

Home care providers may be getting used to having these kinds of conversation, or at least expect more of them in the future, as higher acuity levels have generally been observed across the industry.

“We’re starting to see patients with higher acuity situations that we’ve seen in the past,” Ward told HHCN. “We’re seeing patients that may come directly from the hospital more often now than we did a couple years ago. The way reimbursement is happening right now, there’s that incentive to send them home.”

To address this, 24Hr has boosted staff training, particularly on care coordination, to ensure proper communication with every person who has a role in caring for the client.

Raney, for her part, has seen more patients from skilled nursing facilities (SNF) and rehabilitation facilities. In addition to a variety of training for Homewatch’s caregivers, she stressed the importance of staying on top of clients who cannot be left alone, and documenting any changes.  

“We’re making sure that we’re staying in constant communication with the family, that they know what’s going on,” she said. “At any time they’re wanting something different from what we’re providing, we can let them know.”

This observation is complicated by the overwhelming desire by clients to remain in their home as they age.

“[A]s they decline, their preference is certainly to stay at home, and while their decline continues their preference to stay at home stays the same,” Gardini said.

Communication, presence are paramount 

As home care providers continue to deal with rising acuity levels in clients, communication is emerging as the cornerstone of continuing the relationship, providers told HHCN.

Clear and candid conversations between caregivers and clients and family members are crucial to prevent being blindsided if needs increase.

“You must set forth your expections to the family and to the individual for what can be provided in the home and what cannot be provided,” Gardini said. 

And in the midst of communicating with family and doctors, the client should not be forgotten.

“It’s very important that the client participate in the discussion whenever possible, because it is their life,” Gardini said.

Written by Maggie Flynn

The post Red Flags for Rising Acuity in Home Care appeared first on Home Health Care News.