Having a unique business model is a strength, but it also means dedicating time to explain how the company operates and its overall value add. It’s a position Klein has often found himself in.

“I used to have a boss that referred to that as an ‘evangelical sale,’ because you actually have to evangelize what you’re doing,” he told Home Health Care News on the latest episode of the Disrupt podcast. “People don’t know what it is at first.”

New York-based Vesta Healthcare is a specialized medical group for individuals receiving home-based care services. The company oversees, coordinates and supervises care in the home. It recently raised $65 million in a Series C funding round.

At the center of all of this is the belief that caregivers are an integral part of health care. HHCN recently caught up with Klein, who went into detail on this topic. During the conversation, Klein also talked about where sees home-based care business opportunities and how the company has been able to expand so rapidly.

Below is that conversation, edited for length and clarity.

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HHCN: For the listeners that are unfamiliar with Vesta Healthcare, can you go into detail about your company’s business model and how it works with home care providers?

Klein: We are a specialized medical group for people with long-term home care. We have a highly-integrated network of non-medical providers, particularly personal care agencies, but other provider types as well. We get referred patients from the community and other providers the way that anybody would get referred, and then we work with the agencies that are servicing those folks to integrate the [people] who are providing that care, and their service coordinators and what have you, into the care that’s actually being delivered.

It’s a unique model that allows us to take the insights and access that people in the home have and convert it into actionable events for medical care delivery, in a way that the medical side of the house can reimburse for. I think it’s very effective in engaging the home in terms of improving quality of care.

Let’s take a step back, can you share with listeners what your health care background is, particularly on the home-based care side?

I grew up in a home care family. My dad worked for a health plan. My mom is a social worker. My grandparents worked in health care as well. Health care is kind of in the blood.

I ended up starting my health care career working for a company in New York called Visiting Nurse Service of New York (reporters note: The company is now VNS Health). It’s one of the oldest and largest nonprofit home care companies around.

I had the very weird entry point of implementing an episodic reimbursement program for home care, Medicare, PPS — that I’m sure many people here know. I really started my health care career from the standpoint of value-based home care. Over the past 20 years, I’ve had the ability to work on this from a variety of perspectives. I’ve been an operator of a plan. I’ve been a vendor that’s focused on in-home assessments and care management. I’ve done episodes of care payments, but all of it has been really around this idea that the home is a very important, overlooked and disconnected setting of care. If you can engage the people that are there, as part of the delivery system, you can actually create better outcomes, as well as reduce cost and improve satisfaction.

I’ll give you one quick anecdote. When I was working at VNS, I was on a project for one of their executives. I had the ability to actually go out and do a whole bunch of home care visits studying what happened in the home. I remember being absolutely blown away by what these nurses and aides were doing. I came back, a naive 20 something, talking to my boss about how great all this stuff was, and what a difference it must have made. His comment was something to the effect of, ‘wouldn’t it be great if?’

What came from that was the idea that, ‘Oh, wait a second, this part of the system actually isn’t being used properly.’ Later on, I had another person there refer to home care as the caboose of health care. That’s been one of the things that I’ve spent a lot of time thinking about and working on ever since.

Caregivers — whether informal family caregivers or ones with agencies — are such big pieces of Vesta Healthcare’s puzzle. Why is that so?

They’re the ones that have the most access and positions of trust. We got into this with the idea of making health care better, and there’s been a tremendous amount of investment and innovation in the system.

This caboose part of it — if you look from a dollar spend perspective and a population spend perspective, it’s actually a very large caboose. It’s kind of gigantic. It makes up a huge percentage of state Medicaid budgets. If you look at people who are older adults with functional limitations, the likelihood that you end up on Medicaid. You look at the size of the workforce, you’re talking about millions of paid aides, tens of millions of caregivers, it dwarfs almost anything else, but it really doesn’t get a lot of focus. We built a company, and a program, around the idea that the enormous resource — which I’ve come to call the dark matter of the health care system — we can do good things if we engage it. That’s why it’s the center.

Your company recently raised $65 million in funding. Can you walk listeners through Vesta Healthcare’s funding history, and what this latest round of funding will enable the company to accomplish?

Vesta Healthcare was founded in 2019 and we were founded out of a prior company.

What we did was we raised our initial round of capital from some of the original investors. That would be what you would consider round A. That was really designed to get us proof of concept. Can we demonstrate that we have a business that folks are interested in working with? We did that, and then shortly thereafter, we ended up doing our B round. That was really designed to help us scale, because we had some demonstration that what we were doing was working. The B round was designed to get us to a point where we had essentially unit economics. We knew that our business was working, economically, so it would be viable in the long term.

We hit some pretty rough market conditions over the past few years. The health care innovation landscape has been a very tough place to actually access capital in, and I’m really fortunate to have great investors and partners that have helped us along this journey, and we were able to grow and scale during that time. Then earlier this year, we were able to raise our C round, which is a growth round that’s designed to help us digest all the opportunities that we’ve been developing over these past few years, so we’ve been growing very rapidly. You may have seen that we were on the Inc. 5000 for the fastest growing companies, almost 1,000% growth over the past three years. We have more than that lined up over the next few years.

Growth is expensive. You have to hire, you have to invest. We’ve expanded our footprint geographically. We’ve expanded the programming that we can support. In addition to our present models, there’s a new one called GUIDE coming out that we’re going to participate in. There’s other value-based, aligned programs that we participate in. All that requires investment.

What this round of investment is going to do is twofold. We use debt to help finance some acquisitions that helped us catalyze our growth, so it retires that older debt. The equity portion of it is primary equity that we’re using to grow the company to the next stage.

Let’s talk a little bit about Vesta Healthcare’s expansion. In 2021, the company was in five states, and now it’s in 21 states. How have you expanded so rapidly, and where do you want to go next?

We’re seeing patients in 12 states, and we have 21 we can see patients in. What we’re doing is basically following our referral patterns. We don’t ever enter a state without there being someone that’s bringing us into the state.

The nature of our business is that you’ve got imperfect overlap between payers and providers. We work with home care agencies that cover multiple states. We start with them in one state, and they want to expand with us. We go to the next state with them. When we get to the next state with them, we have to get to scale, so we apply for network participation. I’m really proud that we’re in network with over 100 health plans at this point in time. Then we use the ability to be in that state with a partner as a catalyst to recruit other partners to work with us, which then does the same thing again. It brings us into new geographies, and we repeat it all over. We’re just following where the growth is taking us, and that’s been the reason why it’s happening so quickly.

What are some of the growth barriers that you’re seeing in the market? More importantly, how is Vesta Healthcare navigating these challenges?

First and foremost, for a company like ours, the biggest barrier to growth is understanding what we are. If you go and talk to most participants in the system, they probably say, ‘Hey, we already do care management in some form or another,’ and they do. There’s lots of care management out there. If we’re a different form of current care management, or we’re not care management at all, then what are we?

One of the things we’ve had to learn how to do over the past few years is tell our story, which is why I told it the way I did. We’re a specialized medical group for people with long-term home care. We oversee and coordinate and supervise care in the home, and we engage the aides and caregivers as part of that. When you start to frame it in that sense, many payers will recognize that they don’t have a provider or network that’s doing this. Many providers will recognize that they would benefit from this. This is something that could help them improve their own businesses and improve their own quality. That’s the first part, I used to have a boss that referred to that as an ‘evangelical sale’ because you actually have to evangelize what you’re doing. People don’t know what it is at first.

The second part of it is just the inertia of the delivery system. If you’ve ever tried to get a contract with a payer, get in network, get anything through that stuff, it just takes a long time. We come in through the front door in most places. There’s nothing fast about it. We have to get in network. We have to get credentialed. You have to recruit credentialed providers. You have to get to scale. All of that takes a long time and a lot of resources. Which comes back to having great partners. But once it’s in, it also tends to be pretty durable.

Where are you seeing key home-based care business opportunities right now?

I think that the future of care in the home is in the earliest innings right now. The ability for technology to rapidly upskill and scale what can happen, the ability of better information flow will enable much more personalized approaches that do a much better job of using the home setting as an actual setting of care. Payment models have to continue to innovate to support that.

If I were looking at ways to continue to expand what folks do, I would be looking at how to get skilled agencies to the top of their license, how to move end-of-life care into the home on a greater basis, how to upskill the non-skilled, to get them to the top of their ability levels. I would be looking at virtual models that can augment home-based models, so you can get greater scale out of them. I would be looking at personalized approaches for management of medications. I would be looking at ways to really simplify getting things like DME into the home.

I think there’s so many different places here where, in the home, you can do things that will ultimately be higher quality and lower cost. Behind that, I think there’s also a ton of back-end stuff right now. There is a lot of administrative burden that happens around home-based care. As the system gets smarter on this and understands what it’s doing, it will be able to eliminate a lot of the paperwork and back and forth that, frankly, exists because of the complexity of the system, but doesn’t add any value.

As CEO, what goals do you have for the near-term future?

I want us to clearly demonstrate the value that integrated care in the home creates.

There’s still too much evangelizing happening around this. I’ve met some folks who are innovating around similar models, and I cheer for them. We have to get to a place where the notion that care in the home that’s not integrated is an anathema. That you would always expect that care in the home is going to be part of just care in general.

Secondly, to make sure that the business that we’re running is sustainable. I run a business. I have to make sure that what I’m doing works economically. I have to be really careful as we grow, that we don’t take on too much. I have to be really careful that we continue to perform well. The second part, as a CEO, is to run a great company. I would say the third part of it is to make sure that I am a very valuable partner.

If I’m not a valuable partner, I’m going to lose my partners. I need to make sure that the folks that I’m working with on the provider and the payer side are experiencing the value that we set out to create for them, and in my mind, that does extend all the way to the caregivers. Whether you’re a family member, or an aide in this system, I believe there should be a material difference to being supported by someone like us, where you feel greater access, greater support, greater control, greater participation.

The post How Vesta Healthcare Raised Over $60M To ‘Integrate’ Personal Home Care appeared first on Home Health Care News.

Home Health Care News recently spoke with Special Touch Home Care CEO Evan Ostrovsky about the company’s 40-year history, serving 150,000 patients, its expansion into New York’s Consumer Directed Personal Assistance Program (CDPAP) as a fiscal intermediary, and how the company expects to grow amid these changes.

Below is that conversation, edited for length and clarity.

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HHCN: Let’s start with some background on yourself and Special Touch Home Care.

Ostrovsky: My father founded Special Touch in 1984. I started working for the company in the summer when I was about 15. When I finished graduate school in 2004, I started working full-time.

My approach was hands-on. I worked in different departments to comprehensively understand the company’s operations. I focused on recruitment and addressing urgent needs. Later, I oversaw all human resources, including recruitment and compliance for home health and personal care aides.

As CEO, my primary goal is to ensure the company’s daily operations run smoothly and efficiently. I am committed to addressing all patient needs and ensuring all departments operate at their best, and I’m constantly seeking ways to enhance and innovate our services. I am always exploring new technologies and processes to keep us at the forefront of home care.

About ten years ago, we began providing services as a fiscal intermediary through the CDPAP program, bringing exciting new things within the company.

We offer services in many languages and tailor our services to different cultures. Because New York City is a highly diverse city, it’s benefited us to serve those groups and make them feel as comfortable doing business with us as possible.

Outside of CDPAP, what service lines do you have? Do you do Medicare-certified home health care, or is it more Medicaid-based home and community services?

Most of our services are Medicaid and long-term care. We see a certain percentage of Medicare patients. Regarding lines of business, we are home care services, home health aides, and private-care attendants, so that’s what we’ve been doing since the company’s inception. We’ve added the CDPAP service, where we’re a fiscal intermediary.

We do some nursing to manage our services, primarily the home care service, but we bill for the home health aide, personal care aide and consumer-directed program.

Is there any private-pay element to the business?

We have a private-pay population, but it’s a small percentage of our overall services. Probably less than 5% of the company is private pay.

What is running a home care business in New York like right now?

Operating in New York is extremely rewarding. We know that we are making a difference in people’s lives. We allow them to stay in their homes instead of going to facilities. To that end, we do it because we love it.

In recent years, the business has faced challenges. A lot of that has to do with wage parity and mandates. We appreciate that, through those mandates, our caregivers are earning more money. Our caregivers have significant benefits, including health insurance and vacation time. When wage mandates kicked in, ensuring we had the reimbursement to cover those was challenging, but those came through.

Regulation changes improve the quality of care, patient safety and other aspects of our work. We appreciate the Department of Health’s efforts to improve the quality of care and the services we provide. After over 40 years of dealing with these issues, we handle new regulatory requirements well.

With CDPAP, you’re optimistic about the program and your involvement. Can you give us a breakdown of what things have been like within that program as a fiscal intermediary, and is it your plan to continue being one in the future?

We started offering fiscal intermediary services about ten years ago. Some patients switched from our home care services to the CDPAP program, so we started investigating and providing those services.

We’re proponents of this program. It allows people who might not otherwise be comfortable with home care services to get the care they need to help them live quality lives. It also gives people greater independence to select their caregiver and oversee their care. You may have situations where a client’s personal assistant can’t work anymore, and they’ll switch from CDPAP to home care service or vice versa. We need to be there for them on both sides. We don’t want patients to go elsewhere for services when we can provide them.

It’s been a fast-growing part of our business. It’s been fast growing in New York, and ever since we started, the Department of Health has implemented specific authorizations or approval programs. Because we are experienced, we were one of the 62 agencies initially approved for the program. Even though things could change at the last minute, we hope that changes will allow us to keep doing this business because we love it.

What do you think New York could do better for home care providers or beneficiaries? What would improve the state of home care in New York right now?

The state does a great job of offering good benefits. New York sees that not only is it highly appreciated by the patients because it helps them live a better life, but it is also a better alternative, even financially, than a nursing home or assisted living facility.

We like to focus on underserved groups who may not know the services exist or cannot find a company that can work with them in their language. Not too long ago, the state gave us some grant money, and we used that money to build up our language abilities. It requires a specific investment when you want to service a different language. You’ve got to translate everything into that language. You need employees to be able to work with the caregivers and patients. Grants for things like that help us serve underserved groups. That grant money also helped us offer bonuses for people who would travel from or to areas where it’s not as easy to get to. That may be a one-time thing, but we want to see things like that ongoing.

We also would like grant money to help with educational programs to offer to our employees to better care for our patients. The state has provided grant money to help us train caregivers to improve their skills, ability to care for people, cultural competency, etc. We would like to see more of that because it really does help. It makes caregivers feel more valued, helps them develop their skills and helps them better serve our patients.

You recently reached 150,000 patients cared for since the company’s founding. How do you plan to continue growing?

We’ve always put the patient first in our business, focusing on services and the diverse population of New York City. That’s what got us to where we are, and we want to continue that.

As far as what we’re looking to do going forward, we see that this is an aging population, and you have different people, maybe decision-makers for patients, looking in other places than they used to for care. We have put a lot of time and effort into our website to educate those people. We also created a new site for the CDPAP program that offers information to help them decide if it’s right for them and to help them reach out to us when they’re ready to do that.

We’ve placed information on social media channels for people looking for care for themselves, a family member or a friend. If they’re in the CDPAP program, they can get information there and reach out to us when they need assistance.

Internally, we’ve always focused on our hiring practices. My brother and I hire most of the office staff because it’s crucial to ensure we get the right people in place and continue to provide outstanding service.

In addition, we’re exploring expanding our geographic reach. We primarily offer in-home care services in New York City and Westchester, but we think it’s time to offer services throughout New York State. That requires licensing and adding new services such as therapy and nursing. We’re also looking to explore areas to add to our product offering to help us grow as a company.

Regarding geographic expansion and organic growth within your current markets, what do you see as the largest barriers?

When it comes to growing in different geographic areas, it’s always been essential for us to offer our services correctly. We don’t want to provide a service that is not as good as what we’re doing in New York City.

We’ve had a training program in New York City for a long time, which has helped us ensure that we have caregivers ready. When we moved to Staten Island, we started training and certifying caregivers there. By doing that, we quickly became one of the largest home care agencies in Staten Island.

Our goal of reaching new language groups and cultures is challenging, especially when it starts small. You need to devote resources, and that’s always challenging, but it’s a welcome challenge.

Do you feel as though your staffing situation has improved? If so, why do you think that is? Is it due to external factors, internal initiatives or both?

Interestingly, staffing was relatively easy for us in 2004 when I started recruitment without much advertising. Word of mouth, historically, has been almost all we’ve ever needed. Our only advertising was for hardship service areas and certain language groups.

COVID-19 made it more difficult. A lot of people were scared to go into a patient’s home, and staffing became challenging during that period. But as that ended, we’re back to where people walk into our offices throughout New York City looking to work for us. So, we’re back to where the only areas we might need to focus on are the challenging service areas and languages. Offering training programs is an advantage for us.

Do you feel like one of the untapped areas of opportunity you’ve been going after remains that language piece, where you are willing to go into these neighborhoods where there may be language barriers and train caregivers to service those clients?

We’ve been doing English, Russian, Spanish, and Chinese and have translated everything into those languages for a long time. There are still a lot of groups out there that have a hard time finding providers that can work with them in their languages. We do see that as an area of growth. If you become the agency that provides services to those people, that’s a great opportunity. We do that with our home care agency and also with CDPAP.

Is there a particular technology you feel you need to unlock in the future or a technology you have adopted recently that will soon become table stakes for providers?

I firmly believe we need to adopt the latest technology. Regarding reimbursement, there’s not a lot of extra money for overhead, so you want to do as much as you can with as little as you can and use technology to improve the experience of your patients and consumers.

We all jumped into online education during the COVID-19 pandemic. Now, we’ve improved our phone system with a voiceover IP system for more accessible communication between caregivers and patients in the company, and that is critically important as fewer people are showing up to the offices. Right now, we’re converting from paper to digital charts. That comes with the nurses having a direct connection to the office, which helps us react to any issues they might see quicker and complete paperwork more efficiently.

From my perspective, I’m looking for something that can automate our processes so we can focus on tasks that require a human touch, such as talking to patients and helping when issues arise. We see technology as a way to be more efficient and spend more time dealing with people.

What excites you most about Special Touch Home Care’s future?

I am proud of what we do to make a difference in people’s lives. This kind of senior care will only become a more significant issue as we look to the future. I’m excited to see what happens as the population ages and how we can better use our services to care for them. Our goal is to help patients live their best lives.

We’re looking forward to seeing the changes in the health system over time and how patient outcomes are improving. We’re also looking forward to devoting more time and effort to expanding our reach and the scope of our services.

The post Special Touch Home Care CEO Looks Toward Expansion, Technology And The Next 150,000 Patients appeared first on Home Health Care News.

For this episode of Disrupt, we caught up with Evan Ostrovsky, the CEO of Special Touch Home Care. During the conversation, Ostrovsky talks about how he plans to take his agency from Point A to Point B in the near-term future.

Listen to this episode of Disrupt to learn:

– What’s next for CDPAP intermediaries in New York

– The opportunities and challenges of operating a home care agency in New York

– Keys to contemporary home care growth

– And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

The post Disrupt Podcast: Evan Ostrovsky, CEO, Special Touch Home Care appeared first on Home Health Care News.

Organizations such as the Partnership for Quality Home Healthcare (PQHH) and Hearts for Home Care have been the engine behind making home health care a “squeaky wheel,” which they hope will gain the attention of legislators.

Home Health Care News recently caught up with PQHH CEO Joanne Cunningham and David Totaro, the president and executive director of Hearts for Home Care. Totaro also serves as the chief government affairs officer for Bayada Home Healthcare. During the conversation, Cunningham and Totaro shared their predictions for the upcoming home health proposed rule.

Plus, Cunningham explained why an election year is a good opportunity to push forward home health advocacy efforts, and Totaro explained past “wins” from home-based care advocacy.

Below is that conversation, edited for length and clarity.

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HHCN: What do you expect from the proposed home health payment rule, which usually drops in late June or early July?

Cunningham: I anticipate that what we will see, given CMS’s posture and prior rulemaking cycles, is the continuation of the policy that will put in place permanent cuts to the Medicare home health program. We’re bracing ourselves for an additional sizable permanent cut. We don’t know exactly what CMS has planned for the temporary cuts, otherwise known as the clawback cuts. We will certainly see, at a minimum, CMS identify what their new projected value of the temporary cuts are. At the end of last year, it was in the final rule, $3.4 billion in clawbacks that they were planning at some point, and we will see updated temporary adjustment numbers. That $3.4 billion is expected to go up.

Totaro: I think Joanne summarized that very well. There hasn’t been anything that I’ve seen over the last, say, six to nine months, that doesn’t signal more of the same. CMS hasn’t changed their rate setting model at all, so I think we’re going to see additional cuts and clawbacks. That’s why my team and I have been advocating on the Hill since the rule was released last year. We still have a lot of work yet to be done.

What have cuts done to the home health care industry over the last couple of years? What has been compromised? What has changed for the worse?

Totaro: I think we can all agree that when you get cuts of this magnitude, and you’ve got red flags indicating that there are going to be future cuts, it all sets up a planning scenario for your providers that’s just fraught with uncertainty. This impacts investments. Investments are important to home care. Investment in technology, investment in solving the workforce shortage situation, through developing programs for recruitment and retention, and even expanding into regions where access to care has not yet been achieved. All of these supposedly are goals of CMS as well, but these cuts really act in an opposite direction. Without a doubt, it has impacted our rural and hard to access urban regions. It has caused many agencies to begin to assess their ability to even sustain their business. I’ve seen data, just recently, which suggests that more than half of the agencies providing care are considering whether they can actually continue to sustain their business, or certainly must reduce services altogether.

Joanne, Dave has mentioned that he and his team have been on the Hill since the rule last year. Can you detail what the schedule in a given year looks like for home health advocacy?

Cunningham: What we’re doing, really throughout the entire calendar year, is policy and advocacy. Policy, because we’re always trying to think through policy responses, either through the legislative process or the regulatory process, that would present a way for the proposed rule, the payment model that we’re living under, ways for it to be improved. Then the other piece of that is advocacy. Since 2020, we have been working under this PDGM payment model, which going into this, I think the industry and the home health community writ large was excited about. Its promise was that this would be a more refined coding system and payment system that would better match a patient’s condition to payment. Instead, since 2020, we have seen growing cuts that are accelerating, with essentially cuts going into at least 2028 and probably beyond.

We’ve had to deal with a mounting level of cuts, so part of what we constantly have to do is make sure that policymakers understand, very vividly, the impact of these. The other thing that’s worth really talking about and digging into is the fact that at a time when the general population not just prefers care in the home, but is clamoring for more of it, we have a Medicare home health program that is dwindling. [One that] is under such financial strain and pressure, its future is uncertain. I just don’t know how that syncs up with what the public at large wants and needs. Demographics are pointing to more care in the home, not less.

Dave, on that note, can you detail some of the wins you’ve seen at Bayada over the years when it comes to advocacy?

Totaro: I would just like to add one thing to what Joanne was saying. Our schedule has always been go-go-go. There is no stop and go with advocacy. Consistency is what really matters. One of the things that we’ve learned over the last six to nine months is that our role as providers is to change the narrative from a discussion about cost and cuts, to a narrative about why or how these cuts are going to impact the lives of our legislators’ constituents. We heard through many of our meetings that they’re very interested in understanding how actions they have taken or will take, affect the lives of these folks. That’s why we believe that you never stop. You continue to bring folks to your meetings that are going to be able to humanize this issue, rather than have it based on data.

To address your other question. I’ve been very happy to lead one of the industry’s strongest advocacy teams, Hearts for Home Care, which is a separate, but affiliated social welfare organization of Bayada Home Health Care. We were formed, dedicated to solely supporting advocacy efforts. We did this because we believe strongly that advocacy works. I know it’s hard for many today to believe that it’s worth the time and effort to actually sit down with your legislator, because we’ve seen what goes on in DC or in Harrisburg, Pennsylvania, or almost in any state capitol. I’ve said this to many, I’ve questioned whether a bill that would designate the second Sunday in May as a day to honor all mothers would actually get passed today in the U.S. Congress, but consistency does work.

For example, last year alone [my team] participated in 17 different advocacy efforts around Medicaid in the markets that we support. Through our efforts, we realized more than $325 million in home- and community-based investments by state legislatures. We also, just recently, completed a study where we showed consistent advocacy initiatives and compared the results to those states where we have not had consistency in our efforts. We discovered that since 2015, in the states where we’ve had a consistent advocacy effort, year after year, our Medicaid rates have actually increased on average by 23%. In those states where we have not had a consistent effort, for a number of different reasons, our Medicaid rates have actually been cut, on average by about 7%. I could go on and on about the success we’ve had at state and federal levels, but just let me say that Congress actually saw home health as a solution rather than a cost during the COVID crisis. That’s because, I believe, that we all came together as one industry with one strong loud voice.

Joanne, when we talk about grassroots advocacy, what do we really mean by that? What do providers need to do in order to be a part of those efforts?

Cunningham: It’s really simple. They can go to our website or NAHC’s website and get engaged with a click of a button.

What we mean is that there are thousands and thousand and thousands of home health advocates around the country, including many of those who work for home health organizations and home care organizations. If you ever did a visit with an agency like Bayada, you’re going to meet an awful lot of people who have a lot of choices in the health care sector, regarding where to work, and they choose to work for an organization that delivers care in the home. One of the reasons is that they’ve experienced it firsthand, they’ve seen the benefit, and how valuable it is to the people who receive care in the home. They’ve never looked back. They’ve never left the sector, so we do have a passionate workforce.

We also have what I call grass tops, and that is the senior leaders of home health organizations who tend to have very strong relationships with policymakers in their communities. Some of those individuals are folks like Dave Totaro, as well as other senior leaders at Bayada and every home care organization in the country. We really rely on them to lend they’re personal commitment to deliver that message to senior policymakers either on Capitol Hill or in state capitals all across the country.

What’s the single most important thing providers can do?

Cunningham: Whatever you have already done, whether it’s a phone call, an email, a visit, do it again, because repetition matters in advocacy. It’s going to take more than a single person making a single phone call, or a single email. It has to be done over and over and over again, in order to have the punch that it needs. Home health is competing with not just every other sector of health care, who also is expressing their desire to see policy and legislative change. We’re competing against all kinds of other interests, transportation, the environment, taxes, housing. We’ve got to make sure that we keep our message front and center with lawmakers and policy makers more than just once. It’s got to be repeated and sustained and consistent over a period of time. Otherwise, our voices get drowned out by others. Volume matters, and the number of voices matters. That’s the reason why we’ve got to dial up anything that we’ve done before by another 50%. If every advocate did that, then we would see some significant massive change and increase in uptick in our advocacy.

What’s the ultimate goal for advocacy this year? What, realistically, can be achieved by advocacy this year, in order to put home health providers in a better spot by year end?

Totaro: Our ultimate goal this year is to stop those cuts, whether its current or future clawbacks. We have a bill in Congress that’s been sponsored by Senator Stabenow and Collins, both very respected longtime advocates for home health care, and Representative Sewell and Smith, that we’re advocating for. It’s our goal to get that legislation passed this year.

Joanne, we spoke maybe last month and you said that it was a good thing that it’s an election year because legislators are more in touch with their constituents.

Cunningham: I think that anytime it’s an election year, Congress is acutely aware of the fact that they’re all up for reelection. We will use that to our advantage. We will make sure that the squeaky wheel of home health gets the grease this year, and make sure that we are putting in place a policy that can be supported, and ensure that we have removed any obstacles in our way. We do look at an election year as an opportunity.

The post ‘Lot Of Work To Be Done’: What Home Health Leaders Expect From Payment Rulemaking In 2024 appeared first on Home Health Care News.

For this episode of Disrupt, we caught up with Joanne Cunningham, the CEO of the Partnership for Quality Home Healthcare, and David Totaro, the chief government affairs officer at Bayada Home Healthcare. During the conversation, Cunningham and Totaro discuss all things related to home health payment.

Listen to this episode of Disrupt to learn:

– What may come next for home health payment

– How providers and advocates are fighting back against further home health cuts

– The chances of Congressional intervention to stop those cuts

– And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

The post Disrupt Podcast: Joanne Cunningham, Partnership for Quality Home Healthcare; David Totaro, Bayada Home Healthcare appeared first on Home Health Care News.

Helping these kinds of home-based care companies see success in these arrangements has become Integrated Home Care Services’ sweet spot as a driver of value-based care.

Paul Pino, co-founder and chief growth and analytics officer at Integrated Home Care Services, recently joined Home Health Care News’ Disrupt podcast to talk about the roadblocks smaller providers face when trying to enter value-based care arrangements, and how his company helps navigate these challenges.

During the conversation, Pino also explained why working with each individual managed care plan is a unique experience, and touched on what the future could look like for home-based, value-based care.

Below is that conversation, edited for length and clarity.

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HHCN: For those who don’t know, can you share a little bit about your journey in home-based care and your role with Integrated?

Pino: I came to home-based care about 20 years ago. I had been a corporate investment banker. I had started doing deals, or transactions, within the home care space, and I was introduced to someone within the home care sector. We decided to go into business together.

I joined that first business in the early 2000s. We grew it. It was a fully capitated home health, home infusion and DME company that contracted with Medicare Advantage and managed Medicaid payers. I believe we sold that company around 2012. In 2015, my partners and I came back into the market and we founded Integrated Home Care Services.

Today we’re really focused on value-based care. How does Integrated Home Care Services fit into the value-based care picture? How are you trying to advance this area forward, so to speak?

When we speak about the topic of value-based care, it appears that everyone has a different opinion on what value-based care is.

I would say that back about 20 years ago, value-based care was limited to capitated risk-based agreements, where in which the value was derived from an alignment in payment methodology from payers. Now, IHCS is a traditionally – or a largely – capitated vendor, although we have different payment types and different payment arrangements that include other types of value-based oriented revenue streams.

If you think about touch caps, if you think about capitation with reconciliations and other threshold-based payment arrangements, we handle all of those. But what we really find is of significant value is not just a payment arrangement. From our perspective, every one of our contracts has significant SLA associated with them. That includes specifications around quality, specifications around turnaround times, and compliance and other metrics, that our plan partners, our providers – and more importantly – our patients all appreciate and derive some sort of value from.

I totally agree when you say that everybody has their own perception of what it means to deliver value-based care. Some people really fixate on the quality component, some people really fixate on the cost component. At the end of the day, value-based care is really all of it together.

I agree 100%, it has to be all of it. You need high quality, you need speed and you need some sort of financial arrangement that makes sense for all people, right?

You really want to incentivize the right type of care, not just an abundance of care. There’s additional fee-for-service models, right? There’s people that are coming in and just performing services. They’re performing those services so that they can be compensated, but traditionally, there is no tie in to outcomes and to other performance metrics. When you think about the way that a managed care plan that has experience in value-based care, they’re also tying folks that manage the home care benefit to many more value-based oriented criteria.

Similar to ‘everybody has their own definition of value-based care.’ I think a lot of people care about different outcomes and different metrics. I think that rehospitalization rate is obviously a really big one. I think the rate of missed visits into the home is one I’ve heard talked about more. What are some of the most important outcomes metrics?

There’s an old saying that if you’ve worked with one managed care plan, you’ve only worked with one managed care plan. I think they all have their specific views around utilization and other parameters that they feel are most important.

One of the things that’s often missed, as we talk about this post-acute care space … we think a lot about diversion, right? Think about pre-acute, think about the fact that there are patients out there that are suffering from chronic condition sets that require very basic types of medical equipment or other items, or some sort of intervention. When you have the availability of services — we view DME, home health, home infusion, LTSS, and PDN as all part of our service offering — you’re really able to pivot and do what’s right for the patient at any point in time. With a simple phone call to IHCS, either a care coordinator at a health plan, or a physician or other folks can just reach out to us and make sure that a patient that doesn’t need to present it in the emergency room is seen.

You’ve seen a lot of activity recently in terms of mandates coming down from CMS. You’ve seen the recent view around the managed care rules, everyone has an opinion. The states have been doing all of this care coordination in lieu of service type business for many years.

Right now, what we find is that the services that we’ve been performing on the front end to make sure that a patient is seen and seen quickly, we’re already working around what we believe is to be the appropriate and most expeditious way of serving a member before they present. As you indicated, though, when you think about readmissions, there’s this misconception around them. In many instances, especially if you’re looking at Medicare Advantage plans or other traditional fee-for-service payer, what you’ll find is that many of the plans are not necessarily on the hook for the readmission. You’ll find that, in many cases, the hospital and the methodology of payment under some sort of traditional DRG-like structure, they’re on the hook.

What we find is that it’s not just about readmissions, in terms of cost savings, but it really is about the patient journey around whether or not a readmission is avoidable. A lot of people just focus on the cost structure. Having a patient re-present, having a patient potentially have a hospital-acquired condition that comes into their life, and also what you see in terms of the dislocation from that patient’s home and their family, all those things are high-quality oriented issues that don’t necessarily, in every instance, cost the plan additional money.

What would you say some of the biggest challenges are today for home-based care providers when trying to seek out these value-based care opportunities, and then do well in them if they enter into one of these arrangements?

Realistically speaking, what we find when we’re thinking about smaller providers that want to work with us under a value-based arrangement, is a lack of capacity to serve an entire population.

When you’re thinking about your traditional value-based arrangement, you have someone that says, “Hey, I’m going to take this book, or this geography, or this group of patients, and I’m going to perform X, Y, or Z. The results that I yield will provide X, Y, and Z as well.” What we find is that a lack of capacity to serve large swaths of a population can really slow down someone’s ability to have some sort of true value-based arrangement. Now, if the value-based arrangement with a plan is focused on a quality-only component then, quite frankly, the issue that they have is getting a network management person to sign a contract that’s unique, and to come up with an appropriate reimbursement structure for that provider, when they have so many other provider network agreements that they have to configure. It’s really understanding whether or not you can make a significant enough dent to garner some sort of unique contract.

If I’m that person with the managed care plan, setting up a value-based care arrangement, do I just copy and paste the language from one home-based care provider to another, or am I really trying to cater it to what that provider does well?

Nine times out of ten, there’s a standard network agreement, and the only thing that changes within the network agreement is specifically around reimbursement. What you’ll find is, “Hey, here’s our agreement. Here’s a provider fee schedule associated with the agreement.”

Now at IHCS, we have the ability to customize down to the provider level. We have the ability to set up rules in place and other conditions, where a value-based arrangement with a downstream provider is something that we’re more than willing to do, given the appropriate parameters. For us, one of the most important components of our service offering and the manner in which we contract with payers, is the time to staff.

If you think about the speed in which one is required to staff in order to be able to adequately discharge a patient in a coordinated fashion, so that that patient doesn’t re-present within the emergency room, or any any facet of the hospital, or inpatient setting, we need to coordinate all lines of business. If you think of a home health agency that needs to show up after the infusion medication gets there, that infusion medication needs to get there after the patients in the hospital bed. All these functions are things that require coordination.

When you have an entity like ours that’s working with multiple providers to make sure that we’re getting the most appropriate provider out there, as quickly as possible, these things can change. We’re not looking for the easiest provider to call, we’re looking for the best provider to call. In almost all of our arrangements, when we go live, and in almost all of our utilization, small to regional providers have the bulk of our business. Our competitors have a significant amount of exposure, and services being provided by large national home care entities, and by large national DME companies.

When you think about the way that our network participants are assembled, it really is different, we really do focus on the smaller entities. From our standpoint, customizing around those smaller entities and making sure that those entities understand the potential volume that they’re going to be receiving really makes a significant impact for them, in terms of planning. It also allows us to really plan around the ability to meet our SLAs on discharges.

Can you walk me through a real world example of a value-based care arrangement in home-based care?

We recently went into the market of South Carolina in a very large way. What we recognized before going into that market was that there were significant concentrations of utilization, specifically around home health, that were being directed to entities that may not have necessarily had certain utilization patterns that we wanted to continue.

We set up parameters, working relationships and guarantees around quality and staffing, and speed to staffing and communication with a core group of network participants that you would consider to be regional to small entities. With those arrangements in place, and with their clinical reporting, we have found that we have right size utilization to the point where these entities are always busy now. They’re not busy with turning around the same patient over and over. They’re meeting their goals, and then they’re receiving additional referrals. What we’ve seen with certain entities is the ability not only to come up with a methodology in which they want it to contract, but also deliver on the promises of “If you need us to staff, we will make someone available to staff. As long as we agree that if we continue to perform this way, we will continue to receive the amount of volume that we’re receiving.”

Those types of arrangements with these providers — there’s some that we’ve looked at now that have grown tenfold, in terms of volume that they’re receiving from this specific planned cohort. We’re really excited for them, and they’re really excited about working with us.

How do you see the future of value-based care in home-based care contexts evolving, as we look ahead at 2025, 2026, five years from now?

Let me start with a little bit about our team. Our team has a significant amount of managed care experience, we have provider expertise. Our home care leads … have over 30 years in certain instances, and certainly over 20 years in provider-oriented experience. Our senior team has a significant amount of managed care experience, coming from a diverse background. I’ve personally had the opportunity to establish and build out a large primary care risk-based MSO..

When you think about value-based care, what you need to start with is who is responsible for the dollar value of what’s being provided, and then ultimately, who is accountable to make sure that those dollars are adequately allocated? When you think through that component, then you start making assessments around, what is it that you’re going to be able to do to positively impact those stakeholders, by positively impacting all other components of care? In our specific case, we’ve started working very closely with risk-based entities. When we start speaking to them about how they want us to grow alongside them, what we have found is that the value-based arrangement and environment that we see evolving is going to be one that goes outside of your traditional skilled home-based care.

What we find is that we are being pushed more and more to make sure that we’re looking at whole-person care, that we’re looking at what specific things a member needs, in order to be able to be home. This includes components of contracting around identifying certain aspects of what’s happening within the home, whether it be food insufficiency, whether it be loneliness, whether it be, believe it or not, electricity. All those components, I believe, are going to become more and more salient as we see true value unlocked within the home setting.

The post How Integrated Home Care Services Unlocks Value-Based Care For Home-Based Care Providers appeared first on Home Health Care News.

The Dallas-based Signify is a health care platform that combines technology, analytics and networks to create value-based payment programs, which are highly sought after in today’s health care landscape. The company is CVS Health’s connection to the home, reaching members through millions of in-home visits per year.

Paymon Farazi, the president of Signify Health, recently joined Home Health Care News’ Disrupt podcast to talk about Signify’s direction over a year after the CVS deal was closed, how the company could work with traditional home-based care providers in the future and where Farazi sees Signify – and health care – headed in the near- and long-term future.

Below is that conversation, edited for length and clarity.

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HHCN: Okay Paymon, I’d love to start with an overview of Signify Health for our listeners and readers.

Farazi: Signify Health has a mission that’s pretty common in health care: build trusted relationships that make people healthier. And we have a unique way of doing that.

We basically do in-home health evaluations; we’re going into over 3 million homes in 2024. And the purpose of those visits is to really meet members where they are, do a full, end-to-end assessment of their current health situation, and help them think about what the next steps on their health journey should be.

That’s the core of the product offering; it is free to members. We call and schedule appointments with members across Affordable Care Act plans, Medicaid plans and Medicare Advantage plans across the United States. It’s free to them, completely funded by the health plans, who are our clients.

One of the unique aspects of our company is we have many customers: the members, our customers; the health plans, our customers; the clinicians in the field, I think of them as our customers. I could go on and on. But we have to make all those constituents happy and pleased with that product, which is again at the core an assessment of that person’s health and giving them a path forward for how to take care of themselves better.

What has changed since CVS Health acquired Signify Health?

It’s been great.

The CVS health leadership team deserves a ton of credit for a lot, but two things in particular really stand out to me.

One was they started out by asking us, what other investment can we give you to help you achieve your long-term goals? So they poured a lot of money, a lot of investment into the logistics platform that helps run our whole business, basically putting people into homes across America.

And they put a lot of money into the clinical network.

How do we grow and maintain the very best clinical network in America? That is our aspiration.

And then the second thing was around how they could help us do things like partnerships across pharmacy and retail to bring greater value to our health plan clients.

They were really determined and insistent on us being multipayer business going forward, which we were in the first place. They wanted us to continue to enhance those relationships with other payers, like Humana, like Florida Blue, etcetera.

Overall, we’ve accelerated a lot of things we were focused on before the closing of the deal.

I want to dive into the in-home assessments a little bit further. There’s been a lot of research conducted about Medicare Advantage plans utilizing those, through companies like Signify. Similar to a traditional home health or home care visit, you see things related to a patient’s health journey that you wouldn’t see otherwise. Can you explain, from your perspective, the value of those assessments?

The first thing I would share is that I wish everybody listening could go do a ride along with one of our clinicians. That’s the best way to experience in-home evaluations and the value to the member.

I’ve done dozens of these at this point since I’ve been at Signify. And every single time I do it, I come out of it with this renewed sense of energy and purpose, because it’s so obvious the value that you provide to the member.

The minimum scenario is you’re connecting with a human being and listening to their health care issues. That alone provides tremendous value. And then we go above and beyond that by basically assessing what drugs they’re taking, highlighting questions to ask for their primary care provider. We’re giving them this end-to-end strategy on how to work on their health.

Anecdotally, it just feels amazing to do these visits.

To give you some numbers, our clinicians spend – on average – two to two and a half more time in the home than an appointment in an office setting.

What you can imagine is that extended period of time allows you to do, again, a much more comprehensive visit on health history – where things have been, and where they’re going.

I assume that it is nice to now be in a situation – for Signify and for patients – where patients can easily be connected to other health care services, such as primary care. There’s value in being able to bank on those connections, for all parties involved, no?

That’s exactly right.

Our clinicians are amazing, and all of them want to do something to help that individual. It’s not about just doing the visit and moving on, they want to make sure they’re taking care of themselves. And since we’ve been acquired, we’ve leaned into those kinds of partnerships with our sister companies, whether it be MinuteClinic, or the pharmacy, or Oak Street.

We did this huge program with Oak Street Health last year around finding members a primary care provider. We can get them scheduled for a primary care visit, and make sure that we close that loop. This is a product capability that we’ve built over the last several years, we call it care coordination pathways. Post-visit, how do we get you into the follow-up step, whatever that step might be.

I also imagine the more in-home evaluations you do on behalf of MA, those beget even more visits because entities are realizing the value of them. You’re able to show the results of patients previously visited in the home.

That’s exactly right. Last year, we closed almost 10 million care gaps across all the visits that we did. That certainly helps highlight the value of the visit to our health plan partners, and keeps them wanting us to do more of these things.

It’s about gap identification, but it’s also about a pleasant member experience – have the halo effect around the members. Letting them know that this is what it feels like to be a part of this health plan, to have someone in the home, to be connected to services.

Those things help contribute to potential growth. I will also add to that, while our core and our historical growth has been in Medicare Advantage, we are seeing increasing demand from Affordable Care Act and Medicaid plans.

You’re an Optum veteran, a company very much so in the home-based care game, through LHC Group and potentially through Amedisys here shortly. Humana is in a similar position with CenterWell. CVS Health owns Signify and Oak Street, while Walgreens backs VillageMD and owns CareCentrix. Why do you think this trend has materialized, and how will it change health care moving forward?

It’s a great question, and I think about this a lot.

And I believe we’re building these things because this is what members want.

I spend a lot of time with customers of various stripes, trying to understand what their needs are, where the pain points are, and then how we can help solve those. And one of the more obvious trends in health care over the last few years has been the realization that they don’t want to go into an office setting.

Some people want the visit to come to them.

And it’s all of us noticing this broader trend of how we make things more convenient, and help the person get care in their home rather than forcing them to go to another setting. And I believe that, as this happens at a greater and greater frequency, that the limiter will be around: How can you economically do that?

Because home visits can be more expensive. There’s a whole different apparatus of cost that you have to build in order to schedule 3, 4 or 5 million appointments, and that’s probably the rate limiter. But my hope is that as more and more demand comes from members and patients for these kinds of services, that economic picture will fix itself – and expand the number of services that can be done in the home.

If at all, how do you currently work with home health and home care providers?

We don’t today. But that’s something that is possible through the care coordination pathways product.

There’s nothing limiting us from doing that, other than conversations with our health plan partners and those entities to make sure that that’s turned on. I have had partnership conversations with different home health providers. And we’re starting to explore more of that in the rest of 2024. But nothing that has been sort of finalized at this point. But I would say again – the apparatus is built for it. So the only thing preventing us is making sure we find the right, most sensical partnership.

Where do you want Signify to be in three to five years?

To me, it’s really two things, at least from a product offering perspective. One is to continue to extend that core business. Can we try to do more visits across Medicare Advantage, the Affordable Care Act and Medicaid customers? That’s key.

The second is, can we do more in the home? And I would note two sub-themes under that. We do lots of diagnostic testing in the home, we call it our diagnostic and preventative services or DPS product line. We believe there’s a lot more room to grow in doing testing in the home. We want to do that at a larger scale.

And then the second sub theme under doing more in the home is are there adjacent services we could provide, like caretaking? What else could we send a Signify person in the home to do?

We’re actively in the process of figuring that out, so we can extend more services to our members.

And then, do you have a short- or long-term prediction for health care broadly that you can share with us?

The consumerization of health care will continue to make progress.

Health care companies will be focused on becoming more customer-oriented companies. That will drive us to do more of meeting the consumer where they are, which we believe again, is going to be in the home. They want convenience, they want things to be easier. So, you’ll see more and more of that.

Delivering meds to your doorstep, delivering care in the home. There’s so much more that we can do there. We’re just we’re just scratching the surface.

The post Signify Health President: ‘We’re Just Scratching The Surface’ On What Can Be Done In The Home  appeared first on Home Health Care News.

For this episode of Disrupt, we caught up with Paymon Farazi, the president of Signify Health. During the conversation, Farazi breaks down Signify Health’s near-term and long-term goals as a value- and home-based care enabler.

Listen to this episode of Disrupt to learn:

– How at-home care can drive value for retailers like CVS, as well as payers

– How Signify coordinates care for all of its health care partners

– What the future of the company looks like under the CVS umbrella

– And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

The post Disrupt Podcast: Paymon Farazi, President, Signify Health appeared first on Home Health Care News.

That’s why Tribute Home Care’s CEO, John Sneath, has largely focused on perfecting the wheel rather than reinventing it.

Tribute was founded in 2012, as the brainchild of Sneath, who served as president and COO of HouseWorks for nearly a decade. The company operates in Massachusetts, Maryland, Illinois and Northern Virginia.

Sneath believes that one of the biggest components of delivering quality care is the caregivers. At Tribute, making sure that the company is able to recruit and retain efficient caregivers is paramount. The company has spent the years building an enviable employee benefits page, and compensating caregivers at rate higher than others in the markets it serves.

Sneath recently joined Home Health Care News for its latest episode of the Disrupt podcast. During the conversation, he also explained why Tribute is doubling down on its private-pay business model, how the company is working to improve the customer experience and how he has seen caregivers change over the years.

Subscribe to Disrupt to be notified when new episodes are released. Listen today on Apple Podcasts or SoundCloud.

HHCN: Within your private-pay model, how do you manage volatility if a few clients happen to leave the company at the same time?

Sneath: The way we’re managing it, and I think we’re probably late to the game here, is that we’re making sure that every market has a full-time dedicated salesperson.

For years, we’ve been wrestling with that, and really relying on the director of our marketplace to also do the sales work, thinking that the quality of our service would sort of speak for itself, and create enough word of mouth, but the marketplace is competitive enough. We’ve seen this volatility enough that we want to try and smooth the waves. By having dedicated salespeople, we’re able to generate a more consistent flow of leads, so when those drops happen, it’s not quite as shocking and hard to overcome.

You’ve been in the business a long time. What do you think has changed the most in home care, since you entered it?

Overall, service quality has improved, I think competitiveness has driven that. Agencies seem to be – from everything we can tell – better at hiring, using better systems. Prices and wages since we started have basically increased. That’s been very good for caregivers, not great for customers, but as it turns out, I think we were all leaving money on the table. I think people that need home care are willing to pay more than we used to think. There are much larger entities than there were when we started, and those are getting better and better at scaling, although not so much at scaling de novo, more through acquisitions.

I would say, [in terms of] the fundamental service itself, nobody’s really come up with a game-changing or disruptive kind of approach to the service. It’s still very much about the caregiver, very much about the service, and leadership. I don’t see that changing anytime soon.

What are your main priorities for 2024, or even 2025? What are things that you think Tribute needs to get better at?

One very big priority this year is to take another look at our brand, and how we talk about our brand with the language we use, and then make sure that the brand is showing up at each critical touch point. We have a working group that focuses on this all the time, which we convened a couple of months ago.

How do we take a first call? What do we want that experience to be like? How do we respond to an inquiry? How do we do the assessment when we go into the home? What’s the start of care like, when problems arise? How are we resolving those? At each of those places, where the customers are likely to assess how things are going, we want to make sure that’s a very Tribute experience. More and more, we want tribute to stand for something. It’s hard to brand what we do. We’re not selling widgets, and it’s not something you can touch or taste, so it’s hard to brand. It’s all about language, so trying to get that language right.

Secondly, volume growth, particularly in our two newest markets. We grew at about 15% last year in volume, and we’re looking to do a little bit better than that this year. Part of that is the sales force I talked about, making sure that in a niche market, we’ve got a head of sales. In fact, we’re hiring a head of sales for the company as well.

Third is caregiver quality. Always focusing on making sure that we’re offering caregivers the right kind of professional development and support so they can get better at what they’re doing. Making sure we’re hiring enough people. That’s always our biggest problem, and probably always will be. Leadership and professional development at all levels, we want to develop leaders from within as much as possible, particularly leaders that can run markets. We’ve got a program that does that. That’s our focus for the rest of the year.

What will be the biggest challenges? What’s going to keep you from achieving those goals, if anything?

The number of caregivers, for sure. We get about 1,300 applicants, system wide, a month. We end up hiring 19 or 20, there are probably five to 10 that we’re not hiring because either we’re focused on the wrong thing, or we just miss something. We’re trying to bring an objective assessment into the process. We can get better at defining exactly the qualities that drive success and then how to find those.

We also simultaneously work on turnover and that fluctuates between 45% and 55% in spite of everything we do. But we’d like to keep bringing that down. That’ll be a big challenge. As you mentioned, smoothing out the growth curve, reducing the big swings that we see. Then leadership, making sure we’ve got the right leaders in the right place moving us forward, particularly in revenue growth.

Do you think growth in the future will mostly come from organic or inorganic means? In other words, do you see any acquisitions in your future?

Some of the people I talked to, almost all of them in fact, have done acquisitions over the years, we haven’t.

I suppose the reason is the culture of our business, the quality of the service, is so critical we just can’t sort of see our way how that would work. We really haven’t looked at that too seriously. We might at some point, but I would imagine five years from now it’ll be the same story.

We’re growing internally, and maybe we’ve added another market to start from scratch. It takes expertise to be good at acquisitions, and it’s just not our expertise. We don’t have any experience doing that, and I worry about the distraction and the challenges associated with that.

You’re pretty certain that you want to go even deeper with private pay. When did you make that decision, especially given that so many other providers are diversifying? Did you see an opportunity almost to zag?

No, it’s been that way from the beginning. It even goes back to when I started an adult daycare business in my 30s. I wanted to focus on private-pay, particularly because I like the idea that if we can provide a great service, then we can charge for a great service. If we can charge a premium, we can pay the people that do the service, and pay them fairly and offer the kinds of benefits that people want. That’s been the case at Tribute.

We’re typically $2 to $3 higher than anybody else in the marketplace. That’s been critical to our ability to attract great caregivers, and offer them the kind of pay and benefits that everybody’s looking for. We have a program called Tribute Secure, which about a quarter of our caregivers are in. It salaries caregivers, so they get paid, whether they’re on a client or not. That’s actually not that costly, but there are costs associated with investing in that and setting that up, so I just liked the flexibility that private pay gives us at the end of the day.

Have you noticed any behavioral changes among caregivers? Do they want things now that they may not have wanted five to 10 to 15 years ago?

PTO would be one. Way back at HouseWorks, we didn’t offer PTO. We didn’t offer it when we started Tribute.

We sort of started with health insurance, in addition to wage, and we realized, and through survey work and talking to caregivers, how valuable the paid time off was. This typically gets somebody who’s working full-time hours about two weeks of paid time off a year. Many of our caregivers are per diem, so they can take other time off unpaid, but that’s a benefit that had we thought more about it, we would have gotten to where we are sooner. People work really hard at Tribute and they deserve time off. We want to give it to them and not have it be a financial burden. We added 401(k) match two years ago, and that’s been well received. One of the indications, for us, that people are making a living wage is if they’re able to save money. A good chunk of our caregivers are in that 401(k), and that number is climbing.

What’s a prediction that you have, over the next five years, for the home care industry at large?

I think there will continue to be more consolidation and focus on revenue growth. From a competitive standpoint, what excites me about that is to some extent it’s at the expense of quality. Our experience is when we have had strong competitors, and they’ve been purchased by a big company doing roll ups – we tend to not hear about those agencies after they’ve been purchased. By and large, these roll ups have hurt quality, but that’s given us an opportunity.

I think the diversification happening with the payer mix will continue to happen, because private pay is really hard.

I don’t see the caregiver situation changing much, unless we do something about immigration, and for sure, we should be actively working to increase immigration for caregivers.

We think a lot about what would disrupt the service delivery model, and we come up short there. That’s why we just keep focusing on the very basics of the service. I think for the foreseeable future, it’s going be all about the caregiver. That’s what clients want, and that’s the most important aspect of the service. We got to just keep working on getting that better and better.

The post Why Tribute Home Care Is Doubling Down On The Private-Pay Business Model appeared first on Home Health Care News.

For this episode of Disrupt, we caught up with John Sneath, the founder and CEO of Tribute Home Care. During the conversation, Sneath provides a unique perspective on his home care agency, and why it may be approaching things a bit differently than others.

Listen to this episode of Disrupt to learn:

– Why Tribute Home Care is doubling down on private-pay personal care

– The biggest contemporary challenges facing the business, along with opportunities Sneath sees to improve staffing and operations in the near term

– How the company gets away with hiring on 1%-2% of its caregiver applicants

– And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

The post Disrupt Podcast: John Sneath, founder and CEO, Tribute Home Care appeared first on Home Health Care News.