These salaries can impact job satisfaction and cause employees to seek employment elsewhere, according to the 2024 Activated Insights Benchmarking Report. Some organizations are turning to recognition to combat this trend.

“Employee recognition is no longer a ‘nice to do,’” Michelle Cone, senior vice president of training and brand programs at HomeWell Care Services, told Home Health Care News. “Recognizing employees should be considered table stakes in this post-pandemic landscape. With a focus on employee retention, engagement, and overall satisfaction and its direct correlation to top-quality care, recognition to support retention and drive satisfaction is vital.”

HomeWell Care Services, based in Burkburnett, Texas, offers personal care, companionship, and homemaker services for seniors and other homebound individuals.

“Recognition is critical to maintaining an engaged and innovative pool of talent because it staves off burnout and invigorates our shared sense of purpose,” Jeff Knapp, chief people officer of Bayada, told HHCN. “All employees – and I’d say even more so in the helping professions like home care – feel energized to give their best when others recognize that their work is worthwhile and that they are making a difference.”

Headquartered in Moorestown, New Jersey, Bayada provides in-home clinical care and support services for children and adults, including hospice, behavioral health and rehabilitation in 21 states and five countries.

With agencies vying for skilled and experienced caregivers, brands prioritizing employee recognition stand out. Recognition programs that attract and retain top talent give agencies a competitive advantage in a rapidly growing industry.

“We have several recognition and reward programs,” Knapp said. “For office staff, excellence awards are one favorite. Employees are nominated and selected yearly and celebrated at our annual gathering. Categories include clinical leadership, client services leadership and enterprise support. We also give years of service awards to recognize employee loyalty and commitment.”

Knapp said that what Bayada’s recognition and rewards programs have in common is that they are peer-driven.

“You can get a shout-out from your colleagues, manager, even clients and families,” he said. “I think employees value this most because it’s tangible and group-sourced. You can see in that honoree what excellence looks like and it illustrates and reinforces for everyone how their own talents and discretionary effort contribute to our larger mission to help the people we serve enjoy a better quality of life in the safety and comfort of home.”

Cone said that HomeWell, as a brand, discovered that what matters most is how you recognize employees. Consistency is key.

“Communicate to your team how what they do matters and is appreciated,” Cone said. “How much their presence and who they are positively impacts their clients’ lives. Share with them how they impact the industry. Don’t assume they know the difference they make.”

She suggested listening to your team. Find out what they need or want. Find out what the company is doing well and what can be improved. Understand why they stay or why they leave.

“Some tangibles that we have found employees prefer include recognizing an employee who has demonstrated outstanding performance and dedication,” Cone said. “A peer-to-peer recognition allows staff members to nominate a team member for recognition. Training and professional development opportunities work well. Ensure it’s paid training and offer certifications. Build out career paths or promotions based on training. Publicize these opportunities as rewards for staff who have demonstrated a commitment to learning and self improvement.”

While some recognition opportunities are set at a monthly cadence, it is important to recognize employees at the moment based on things like client acknowledgments during satisfaction surveys or the willingness to accept emergency shifts. Recognition and positive customer feedback boost morale, help retain team members and enhance job satisfaction, improving satisfaction scores.

Enhanced scores can provide a competitive advantage that can be leveraged in local markets to support client and caregiver acquisition and retention efforts.

“We identified that office staff satisfaction and turnover significantly impact caregiver satisfaction and turnover, as well as client satisfaction and turnover,” Cone said. “We shifted focus upstream of the caregivers by creating a support and retention strategy for office staff – those key internal associates – giving them what they want and need to be confident and successful in their roles.”

Cone said that by building intentional retention strategies around office staff, HomeWell has witnessed an impact on caregiver retention. She said over 75% of HomeWell’s caregivers have been active over 90 days, and less than 10% of franchisees surveyed said they had to turn away business due to a lack of caregivers.

“Retention matters to our home care clients because staff turnover understandably causes them anxiety,” Knapp said. “Entering their homes is a sacred trust. They come to trust and rely on their caregivers and clinicians, but also on the familiar voices who answer the phone every day. We become the family they choose. By retaining staff, you retain the valuable social capital and expertise you invest in building and that is measurably good for client satisfaction, care quality and business results.”

The post Bayada, HomeWell Leaders Share Strategies For Recognizing And Retaining Office Staff 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.

At a macro level, home health organizations are struggling with Medicare Advantage (MA) for two main reasons: benefit design and reimbursement.

In order to build stronger relationships with MA plans, agencies are undergoing a strategic shift in their service offerings to meet the unique challenges posed by MA patients.

Those shifts include partnering with other stakeholders to have a clear understanding of what MA plans want.

“Right now, the benefit design of MA plans feels like it’s designed simply to minimize costs,” Michael Johnson, president of home health at BAYADA Home Health Care, told Home Health Care News. “How do we design a benefit that maximizes outcome but takes costs into effect? That’s where we’ve been at odds with each other. They’re trying to control their costs and their assumption is that we’re not interested in costs. The reality is we — home health agencies and MA plans — are interested in both.”

The differences in an MA patient

In 2021, 3 million traditional Medicare recipients received home health care at a cost of $17 billion. It’s unclear how much home health care costs for Medicare Advantage patients, although researchers with the University of Washington (UW) suggest the figure is likely less.

Medicare Advantage plans have claimed an increasing share of Medicare beneficiaries, surpassing the 50% threshold in 2023. This shift means a larger portion of beneficiaries now rely on MA plans rather than traditional Medicare.

While MA plans offer additional benefits, they frequently implement cost-cutting measures such as copays and prior authorization. Medicare pays MA plans a capitated rate per beneficiary to cover enrollee health needs, incentivizing them to coordinate care and minimize expenses, some experts believe.

Working through those cost-cutting tendencies is what Bayada and other home health agencies are grappling with.

At the same time, agencies are finding out that MA patients — generally speaking — are different from traditional Medicare patients in a lot of ways.

That recent study from UW found that home health patients under MA plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits.

In the study, MA patients had shorter home health length of stay by 1.62 days and had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively.

The results of the study suggest that MA patients receive shorter and less intensive home health care versus traditional Medicare patients with similar needs.

“Similar to previous research, we found that Medicare Advantage patients receiving home health were younger and more racially and ethnically diverse than traditional Medicare patients,” Rachel Prusynski, a professor at the University of Washington School of Medicine, told HHCN. “But while they were less medically and clinically complicated, they also had fewer social resources.”

Compared to traditional Medicare patients, patients under MA plans were more likely to live alone and live in areas with more poverty, unemployment and less access to transportation, Prusynski added.

Not only were MA patients healthier across the board, the study found that MA patients were less likely to have cognitive impairment, had fewer recent falls, fewer pressure sores, less pain and were taking fewer medications.

With that in mind, it’s up to home health agencies to adapt.

“Broadly speaking, Medicare Advantage patients don’t have as much medical need as the population we typically see,” Johnson said. “The fact that there are fewer visits delivered is not a surprise. Now, we’re forced to think about how those visits are delivered.”

How to adapt

In order to address some of these differences, home health agencies need to form the right relationships.

“The first thing we’re thinking about is, how do we partner with managed care organizations to tap into the extra services they provide around care management?” Johnson said. “If they’re doing some of that work, home health providers shouldn’t feel obligated to do that same work. We could share the load, in theory. It’s easier said than done, but it’s certainly a reasonable goal.”

Using the study’s findings as a research tool, Bayada has started to consider tinkering with its clinical mix based on a patient’s specific needs.

“If you’ve got a limited number of visits, which is generally the case, and there is less clinical need, should we be using more therapy and less nursing?” Johnson said. “We’re digging into that and being more thoughtful about our care plans. We’ve got plenty of clinically complex patients in both MA and traditional Medicare to keep our nurses busy. It’s this other population that we’re trying to tap into.”

The other component is pace.

In other words, if home health agencies have a fixed number of visits set by an MA plan, how are those visits paced in a way where they’re most beneficial for the patient, while also improving outcomes and keeping costs down.

“There’s a difference between delivering eight visits in 30 days and delivering eight visits in 60 days,” Johnson said. “Time does several things. It gives the patient the opportunity to learn and really understand their care plan. I don’t care how good your wound care is, Mother Nature is only going to heal the wound so fast.”

Instead of going to a patient’s home once per week for two months, Bayada may spread those visits out to allow a more measured coaching environment between a nurse or therapist and their patient.

Taking risk

Medicare Advantage plans have historically used a lot of strategies to reduce costs of home health care, Prusynski said.

Things like prior authorization requirements, visit limits and network restrictions are a few examples. One way to avoid some of those cost-cutting strategies for home health agencies is to take on risk of their own.

“If the payer is the only one that has any risk, of course they’re going to manage the costs,” Johnson said. “Things like case rates, which we and a lot of organizations are doing, is one way to take on risk. So rather than paying me for eight individual visits, an MA plan pays me a lump sum and then basically steps away and says, ‘OK, deliver it how you would.’ This gives us the opportunity for more time with an expectation that we’re hitting specific metrics.”

At the end of the day, everyone wins if a patient is able to get better at home on a reasonable amount of visits.

“Much of our outcomes are related to the benefit design that everybody’s dealing with,” Johnson said. “My message to other home health providers, particularly larger ones, is let’s start thinking about who we can partner with to understand our data better and change our behaviors. Then we can go to MA payers and have more meaningful conversations about benefit design.”

The post Why Bayada Is Reconsidering How It Deals With Home Health Patients Under MA Plans appeared first on Home Health Care News.

In 2024, providers will need to prepare for a very different environment that does not include these financial buffers.

“We’ve had success in many states, over the last couple of years,” Dave Totaro, chief government affairs officer at Bayada Home Health Care, recently said during a Home Health Care News webinar. “Notably, [we saw] big increases in states like Missouri and Delaware, which hadn’t seen increases for over maybe one or two decades. Given the fact that these funds are drying up, on the federal level, [we expect that] states are going to begin to pull back.”

There might even be enough of a discrepancy between funding in different states that even large companies will consider leaving markets that make it difficult for providers to deliver care services.

Many providers are already having to deny upwards of 65% to 75% of their referrals, according to Totaro.

“Higher reimbursement states, like Massachusetts, Delaware, even New Jersey might be a bit better off, but eventually, if you can’t provide care because you’re losing money, you can’t provide quality care,” he said. “We’ll probably have to make those hard decisions. No health care provider ever wants to leave patients without health care.”

Lower reimbursement states such as Mississippi, and others, may see providers leave these markets.

Emmet O’Gara, CEO of Sandata, emphasized that most providers will try to face the unique challenges of each state before deciding to stop operating in a specific market.

“I think for the most part, we’ve seen folks positioning themselves to be as successful in the state they serve, as they can, versus wholesale, ‘I’m out of here,’” he said during the webinar. “Regulation can alter that path. Most of the folks that we work with are in this business because they are mission driven, economic realities, of course, can challenge that.”

Though some providers might be slow to exit a state entirely, this doesn’t mean that there won’t be some kind of fallout.

For example, a company may decide that they will keep operating in a state, but choose to pull out specific pockets in that market, Care Advantage CEO Tim Hanold said during the webinar.

“It might not be wholesale — folks moving out of a state — but its rural communities, it’s deep cultural pockets,” he said. “Areas without scale that don’t have density, and don’t have favorable economics. Those are the ones that will suffer.”

Further compounding challenges is Medicaid redetermination, which is happening in many states across the country. Totaro thinks this will make things even tougher for providers.

Even with rumors of additional funding, Totaro believes that it’s unlikely that this will actually result in more money being distributed.

“We do hear on the Hill that there is some talk, particularly among Democrats, for some additional funding in 2024, along the lines of the American Rescue Plan, but in reality they’re just generating headlines, and maybe some election year talking points for themselves,” he said. “I doubt we’re going to see any kind of reimbursement funding increases happen from the federal government.”

The post Why Medicaid HCBS Providers May Pull Their Business From Unfavorable Markets appeared first on Home Health Care News.

Broadly, home health deserts are low-income communities that are the hardest to staff and where people who need home health care are unable to access it. A home health desert can be a rural or urban area, according to Dan Savitt, president and CEO of VNS Health.

VNS Health is one of the home health providers that has been at the forefront of the movement to bring quality care to home health deserts. Bayada Home Health Care is another provider working toward this mission.

Savitt explained that patients who don’t receive care in the home often end up experiencing more issues down the line.

“Patients who are referred to home health and receive it within seven days are far less likely to end up back in the hospital, and they have lower mortality rates than those who don’t get home health,” he said during a recent Home Health Care News webinar. “The fact that the system can’t support it today means that it’s costing the nation more.”

Savitt also noted that communities that are predominantly made up of racial and ethnic minorities are more likely to be home health deserts.

“Lack of access happens to be in racial and ethnic minority neighborhoods,” he said. “They are much less likely to get that care they need within seven days. They’re much more likely, and we’re seeing this in our communities, to end back in the hospital. Then they are at greater risk.”

A University of Michigan study recently found that nurses are less likely to give Black patients, compared to white patients, referrals to home health when being discharged from the hospital.

Watch: 2024 Home Health Outlook webinar (click)

In fact, the study found that about 22% of Black patients were receiving home health referrals by discharge nurses, compared to 27% of white patients.

The South Bronx is one of the home health deserts VNS Health is working to address.

“There are a million people in the Bronx, so it’s not a small surface area,” Savitt said. “It’s bad enough that, overall, in New York City only 50% of the referrals are getting admitted into home health — it’s less than a third in the Bronx.”

Addresing home health deserts means additional costs for providers.

“North Philadelphia is a tough area to cover, so is rural Vermont, very different geographies, but with similar challenges,” Michael Johnson, practice president for home health at Bayada, said during the webinar. “Those costs are not included in any reimbursement.”

Due to this, VNS Health is advocating for MedPAC and the Centers for Medicare & Medicaid Services (CMS) to measure access and capacity based on the ability to take on admissions, and not based on the number of agencies in the area.

“MedPAC and CMS measure access to home health services based on the number of beneficiaries living in a zip code by one, or more agencies,” Savitt said. “If there’s one more agency in a zip code, check the box from a CMS and MedPAC standpoint. That has to change.”

Savitt also called for Congress, MedPAC and CMS to get a better understanding of the home health desert crisis from the patient perspective.

“I spent enough time in D.C. to know that the people making and setting policy don’t understand the work that we all do every day,” he said.

Johnson pointed out the importance of payer advocacy outside of CMS, as well.

“I do believe that enlightened payers want to take care of their communities,” he said. “We actually have more in common with payers, in terms of keeping a population of people healthy. How do we build partnerships, because that is a big factor in terms of access.”

The post Home Health Providers Are Tackling ‘Home Health Deserts,’ Calling On CMS To Help appeared first on Home Health Care News.

One of the most difficult issues for leaders is sifting through all of the solutions out there and choosing the ones that fit their businesses. That’s why, before considering what technology to invest in, providers should map out their overarching strategies.

“First, let’s reevaluate what our strategic plan is,” Aveanna Healthcare Holdings CEO Jeff Shaner said during a panel discussion at Home Care 100 this week. “Let’s make sure that everything we’re doing is aligned with a strategic plan, including technology, and make sure everything is relevant for where we want to go. You’ve got to know where you want to go.”

The Atlanta-based Aveanna (Nasdaq: AVAH) delivers home care, home health care and pediatric care services to patients across 33 states.

Once that strategy is set in stone, and there’s a recognition of technology that helps move that strategy forward, things become more clear, Shaner said.

He also mentioned an investment in Workday (Nasdaq: WDAY) technology, which he said he “hated” for the first five years. In its sixth year, however, once integration was completed and the original vision for the technology was coming into focus, he changed his opinion.

“It’s a long-term commitment to implement technology, and then to eventually use it to actually innovate,” Shaner said.

David Baiada – the CEO of a similarly large company, Bayada Home Health Care – struck a the same tone when it came to technology.

“It’s about making the right choices, and organizing all of the ideas so that we can prioritize – and then properly allocating capital to the right things, in the right order,” Baiada said on the panel.

Based in Philadelphia, Bayada provides home-based care services via its more than 26,000 care professionals. The company has locations in 23 states, as well as in Canada, Germany, India, Ireland, New Zealand, South Korea and the U.K.

Baiada said that his company has been intentional and forward-thinking in its tech investments for a while. But not to the point where it was being truly disruptive.

That may change in the near term, he said.

“We’ve started to think about how we’re entering an era where there might be opportunity to skip a step or two and be a little more disruptive,” Baiada said. “But the problem with that is it requires bigger bets, bigger amounts of change.”

When it comes to tech investment and disruption, there’s different benefits that come with being a smaller or larger organization.

For Aveanna and Bayada, there’s more capital to push forward into those areas. At the same time, a technology investment or change can spell trouble in an organization with locations across the country – and world – and multiple service lines.

On that issue, the Cincinnati-based FirstLight Home Care sits in a unique position. It is a very large company – with about 200 locations across the country – but it also is a franchisor.

That means one change could affect hundreds of different owners at the local level, within their smaller businesses.

In order to keep everyone on the same page, “a lot of phone calls” are required, according to FirstLight CEO Glee McAnanly.

“I look at technology as foundational to everything we do,” McAnanly said on the panel. “I wish we could come up with a new word other than technology, though, because I think people kind of roll their eyes and think, ‘Oh, good, a new technology. That’s great. What’s that mean?’”

FirstLight is mainly focused on driving the capture of better data and analytics.

To combat those eye rolls, the company routinely rolls out pilot programs to prove to franchisees that better technology, here or there, will improve their businesses.

All three companies recognize that investment in tech will never be for the faint of heart.

“It’s a multi-year journey,” Shaner said. “Nothing is done in a month, nothing is done in a week. These are the commitments to a strategic plan that take us months, quarters, and ultimately years to be successful.”

The post Bayada, FirstLight, Aveanna Leaders Divulge Their Best Tech Investment Tips appeared first on Home Health Care News.

At Bayada Home Health Care, these priorities include focusing on the employee experience, as well as clinical-model evolution.

“How do we take what we learned to be successful with PDGM and transition that to being successful with TPS, and to some degree transition that to be successful with MA expansion given the limitations,” Michael Johnson, practice president for home health at Bayada, said during a recent Home Health Care News webinar. “We’re working on how to continue to be relevant even though there’s payer pressure.”

Watch (click here): 2024 Home Health Outlook webinar

Like Bayada, the employee experience is also top of mind at VNS Health.

Dan Savitt, president and CEO of the company, described retention improvement efforts as “critical.”

“How do we, as an organization, become that employer of choice for any field clinician who wants to work in home- and community-based care,” he said during the webinar. “That’s not an easy nut to crack, so we’re continuing to focus on that.”

The other side of staffing is recruitment. One way that VNS Health is widening its talent pool is by partnering with nursing schools.

“Many of us partner with nursing schools; it’s the right thing to do,” Savitt said. “We have created a new partnership, which we’re excited about. As nurses roll through their program, they can specialize in home health. We delivered the curriculum over the last year and gave them new experiences in the field, so that we have better success with new grads.”

In general, a lot of VNS Health’s retention efforts with new hires is about zeroing-in on that first 12 to 18 months. Savitt pointed out that once an employee reaches the two-year mark, the likelihood of retention increases.

Additionally, VNS Health is also focused on things like optimizing the company’s clinical resources to expand capacity, becoming a differentiated market leader in patient experience and quality outcome and admin efficiency, according to Savitt.

On its end, Bayada implemented a nurse residency program. The company has been able to achieve a 97% renewal rate for nurses that come through the program, according to Johnson.

Working with the company’s EMR partner to reduce the documentation burden that field clinicians face is another important area of focus.

“How do we do things that help people spend more time with people,” Johnson said. “Home care is the most onerous documentation environment I’ve ever worked in. That’s part of the reason good clinicians leave. They’re spending time with their tablet, not with the patient. Five minutes more on the tablet, five minutes less with the patient.”

Companies like CareXM — a triage technology platform — have been front and center when it comes to helping home health organizations rebalance their nursing workload.

“We focus on three areas — after-hours triage, care coordination, and a sense of proactive patient engagement,” CareXM CEO Si Luo said during the webinar. “We typically engage with customers to assess their current staffing structure related to those areas, and attempt to characterize, ‘What does the overall workload look like, today, for each team at different time intervals?’ We often spot opportunities, together, to apply coordination and workflow technologies that help home health organizations run much leaner in these areas while achieving a greater surface area of impact and engagement.”

For many home health providers, keeping an eye on how the payer landscape is shaping up in 2024 will also be crucial to their businesses.

On its end, VNS Health has found the managed care landscape to be a challenge.

“We have a little bit of a unique opportunity in New York, because we have such a big market share, we ultimately had to use termination as a method by which to really get people to the table,” Savitt said.

Savitt also noted that the administrative burden of managing payer contract requirements has become unsustainable for providers.

“For every managed care organization, I typically have two or three relationships, one with commercial, one with Medicaid, and one with Medicare,” he said. “Multiply the number of managed care organizations by all their business lines, you’re talking about 15 to 20 relationships and administrative complexities. The no managed care, less managed care for organizations is going to be a lever that the industry will continue to pull because we really don’t have a lot of other levers at this point.”

Bayada recently signed a contract with a large regional national payer.

Ultimately, Johnson believes that for providers that can handle uncertainty and ambiguity, now is the best time to be working in health care.

“That’s the only time things change,” he said. “You can complain about it, or you can lean in. I think there are payers now, particularly with the movement towards payer-providers, like a Humana or Optum, there are other payers that are interested in saying, ‘Hey, how can we start to get more creative?’”

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In 2023, the decreasing influence of COVID-19 did not mitigate the overall operating pressures home health providers were forced to face. In the new year, there still remains plenty of opportunity, but much to work through to tap into that opportunity.

More proposed rate cuts to home health reimbursement are expected from the Centers for Medicare & Medicaid Services (CMS). All the while, Medicare Advantage (MA) penetration is likely to continue.

By midyear, three – or more – of the largest home health entities in the country could be owned by payers. That could impact the industry at large in a number of ways. Providers not owned by payers will still have to find better ways to work with them, whether that’s through higher-rate contracts or more value- and risk-based ones.

But the home is where care is headed. Longstanding providers stand to benefit from that, so long as they can get their ducks in a row operationally.

Below are all of the home health trends HHCN believes should be on providers’ radar in 2024, based on research, reporting and extensive industry knowledge.

Curious what we forecasted for last year? Revisit our 2023 predictions here.

HHCN’s home care trends predictions, published last week, can be revisited here.

The fee-for-service landscape of yesteryear will be no longer

For years, home health providers were able to rely on the sturdy support of traditional fee-for-service Medicare reimbursement. That will no longer be the case in 2024 – and beyond.

CMS, in a vacuum, provides a reasonable rate for home health services. If providers weren’t aware of that, the the Medicare Payment Advisory Commission (MedPAC) is happy to remind them. 

MA beneficiaries have been growing steadily for the past decade, but providers in certain markets were able to stave off poor rates. A healthy mix was achievable, with a heavy reliance on the fee-for-service dollar. 

But, in 2023, over 50% of Medicare beneficiaries were underneath an MA plan, according to the Kaiser Family Foundation. That number is expected to continue ticking up.

On the other end, CMS is seemingly hellbent on denying traditional Medicare rate increases in the future, despite inflationary pressures.

From a reimbursement perspective, the walls are caving in on home health providers from both sides.

“The trend in Medicare Advantage continues to just rapidly outpace preparation by the industry,” New Day Healthcare CEO Scott G. Herman told HHCN in December. “Unless you’re building something specifically for MA, the ability to hold the 50-plus percent of traditional Medicare episodic mix in home health – it’s really just gone.”

In 2024, with the fee-for-service model eroding, home health providers will have to invest in operational models that can withstand MA rates and stagnant traditional Medicare rates.

Risk- and value-based care represent an opportunity for providers to get closer to what they believe they’re owed, so long as they can find partners willing to enter into appropriate agreements with them.

“We’re focused on understanding exactly how those Medicare Advantage players work, building remote models that support them, that are driven with data and analytics,” Herman continued. “We need to sit down and understand how to work with patients longitudinally, how to do cross referrals internally, and then take the business that those players really need us to take in markets where they’re struggling with providers.”

It will become clear whether payers will be allies or foes in home health care 

UnitedHealth Group (NYSE: UNH) and Humana (Nasdaq: HUM) are two of the biggest health care companies in the country. They’re also both now heavily involved in home health care.

On UnitedHealth Group’s end, it owns LHC Group and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED). Humana, of course, owns CenterWell Home Health, formerly Kindred at Home.

Legacy home health providers have mixed feelings about whether these companies being in the home health business will be a good or bad thing.

Some providers feel queasy about it, knowing that they’ve been at odds with these players before in MA negotiations. Others believe more eyes and more investment in home-based health care is always a good thing.

But advocacy efforts will offer a first glimpse at whether these players will be behind home health providers’ universal causes.

“We start processing all of this, thinking, ‘OK. Is this a good thing or a bad thing in the aggregate?’” National Association for Home Care & Hospice President William A. Dombi told HHCN last year. “And I think we start seeing some really positive elements to it. There may be a home care company who would disagree with that, for their own personal circumstances. I can respect that and understand it, but at the same time, how do we take the energy entering into this space and really turn it into something positive for everyone?”

CMS is likely to propose more rate cuts in June. When it does, it will become more clear whether the large payers are willing to fight alongside home health providers. Alternatively, it could show they’re more focused on MA policy, and view home health care as more of a side project.

More payers will lessen, remove prior-authorization requirements for home health services

Medicare Advantage penetration gives MA plans an inherent advantage. But more care shifting to the home, in part because of shifting patient preferences, gives home health providers an advantage in negotiations.

Home health referral rejection rates are at an all-time high, according to companies like WellSky that track such things.

Plans unable to work well with home health providers will lag behind. Their beneficiaries will need home health services as much as ever.

Outside of rates, providers have expressed prior authorization requirements as one of their top gripes with plans.

“The prior authorization process should be based upon the patient’s primary diagnosis and have a standard number of visit authorizations based upon evidence-based medicine,” Intrepid Healthcare CEO John Kunysz told HHCN in October. “Care delayed is care denied.”

In 2023, providers began to gain momentum in terms of lessened or removed prior authorization requirements. HHCN expects that momentum to continue in 2024. It makes sense for the providers and patients.

BCBS of Massachusetts removed prior authorization requirements for home care services last year, recognizing that patient care was being delayed.

“By removing prior authorization requirements for home care services, we’ll help hospitals to expedite discharges at a time when many are struggling with overcrowding,” BCBS of Massachusetts Chief Medical Officer Dr. Sandhya Rao told HHCN in November. “This change will also reduce delays for Blue Cross members ready to transition their care from hospital to home.”

Cigna (NYSE: CI) did, too. The company removed hundreds of prior authorization codes in 2023, and is in the process of doing the same for MA, specifically.

Expect ‘passive acquisitions’ and accelerated consolidation

Home health operators face a mountain of challenges, from the unrelenting labor crisis and skyrocketing demand, to the margin shrink tied to contracting fee-for-service rates. Simply put: The cost of doing business is higher than ever.

And that’s unlikely to change in 2024.

In light of that reality, HHCN anticipates further consolidation for the home health industry over the next 11 months. That consolidation will happen in the form of M&A activity, agency closures and “passive acquisitions,” or one provider agreeing to take on a distressed provider’s patient population.

There are signs that this accelerated consolidation has already started.

In August, St. Joseph’s Health revealed plans to close its home health care agency, citing economic challenges. Around the same time, a home health program in Alaska was forced to shut down “mainly due to federal regulations that make operating it challenging and inefficient.” A few months later, Boone Health announced it was closing its home care and hospice service lines.

On the M&A front, the fourth quarter of 2023 brought at least 13 home health-related transactions, according to data from M&A advisory firm Mertz Taggart. In terms of volume, that tied for the second-most deals since the end of 2021.

It’s important to underscore that consolidation alone isn’t HHCN’s prediction, as consolidation in the home health industry has been happening for years.

In fact, the home health industry has actually seen its number of active agencies decrease since at least 2014. According to data from the most recent Home Health Chartbook released by the Research Institute for Home Care (RIHC), there were 11,353 active home health agencies in 2022, 11,474 in 2021, 11,565 in 2020, and 11,569 in 2019.

HHCN’s forecast, more specifically, is that the pace of consolidation will speed up by a noticeable degree.

The public market will look different

Every new year brings new speculation in the home health space about which companies could go public and which publicly traded companies could change ownership.

In the years following the COVID-19 pandemic, many home-based care companies considered going public, but their tuned change when the economy took a downturn.

There are a few companies HHCN is keeping an eye on, starting with Enhabit Inc. (NYSE: EHAB).

The home health and hospice provider is possibly headed toward a sale. It’s not unrealistic to expect the company to end up in the hands of an already publicly traded company – that would be acquiring the company for strategic purposes – or a private equity firm. 

On the other side of things, BrightSpring Health Services has filed for an IPO and is eyeing a $3.1 billion valuation.

The home- and community-based services provider first planned to go public with a goal of raising $800 million in 2021. The company nixed that plan soon after, but is running it back.

Help at Home, another home- and community-based provider, is also reportedly gauging interest in a sale. The company, backed by The Vistria Group and Centerbridge Partners, has been rumored as a potential candidate for an IPO in the past.

Payer innovation teams will play an even greater role at their organizations

In a move to diversify payer sources and embrace value-based care, some of the largest home health companies in the industry have thrown their weight behind internal payer innovation teams.

In 2024, this will only intensify, as providers look to rely less on fee-for-services Medicare.

In this respect, companies like Enhabit, Bayada Home Health Care and VNS Health are already ahead of the pack.

As a result, Bayada has been able to increase the amount of managed care revenue tied to the company’s value-based contracts. VNS Health set its sights on taking on more risk, and has also achieved 68% managed care penetration in New York. Enhabit has negotiated agreements with 37 — and counting — MA and commercial payers.

Ultimately, providers that have put payer innovation front and center at their organizations believe that it has allowed their companies to operate more autonomously.

“It allows us not to be beholden to one individual payer, if we’re having a difficult negotiation,” Devin Woodley, vice president of managed care contracting and B2B sales at VNS Health, previously told Home Health Care News. “It also helps us on the referral side. One of the reasons why referral sources love us is because we’re contracting with, essentially, every major payer.”

More home health providers will incorporate mental health care

It’s been well established that seniors prefer to age in their home, and receive care there.

Concurrently, the demand for behavioral health services in the U.S. has continued to skyrocket in recent years.

This, naturally, opens the door for home health providers to reach a patient population whose behavioral health needs are often underserved.

Specifically, fewer than 50% of seniors with mental and/or substance use disorders receive treatment, according to the National Academy of Medicine.

Some providers have already stepped into this opportunity to deliver care to this population of older adults. Innovive Health — a Medford, Massachusetts-based home health company — has made offering care to Medicaid-eligible seniors with severe mental illnesses a priority.

“They’re a very challenging population to treat and manage,” CEO Joe McDonough previously told HHCN. “They’re often resistant to care. There’s a lot of social determinants, as far as having adequate housing, adequate food supply, adequate access to medications. This is a population that continually has challenges, as far as access to care.”

Due to Innovive’s care delivery model, the company has seen positive outcomes among its patient population.

“We’ve seen a market decrease in hospitalizations as well as ED utilizations in this population,” McDonough said. “This is because we provide intensive case management. We also ensure medication compliance, and coordinate with all providers to make sure that they have a treatment plan that assures the most optimal outcomes.”

Additional contributions from HHCN reporter Joyce Famakinwa, HHCN reporter Patrick Filbin and HHCN Managing Editor Bob Holly.

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As the demand for home-based care continues to rise, so does the need for more intensive care plans as patients continue to be sicker and more complex.

Home health agencies are feeling this “acuity creep,” and they’re adjusting. But at times, it’s hard to keep up.

“When I’m talking about acuity creep, I’m thinking about how much need do the patients in our care models require?” Michael Johnson, president of home health and hospice at Bayada Home Health Care, said. “It’s not just medical needs, either — there’s a social need as well. We’ve seen a definite increase in the needs of our patients.”

The Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.

In order to find out if the acuity creep had affected Bayada, Johnson recently dug through the last four years of PDGM data for patient diagnoses and found a noticeable decrease in categories like musculoskeletal rehab and an increase of patients who needed neuro rehab, cardiac and complex behavioral health.

The last three categories can be filed under “more need,” Johnson said. With the need for intense care comes the need for more nurses, home health aides and other caregivers.

“When they’re sicker — as we’ve seen it — we need nursing care for the same person,” Johnson said. “In the case where there’s a nursing shortage, that becomes a bit of a crunch, so from a staffing perspective, that’s been a challenge. When I think about need, I think about workforce.”

Eric Gommel — chief strategy officer at Virginia Health Services — is also focused on workforce development due to this acuity creep.

Virginia Health Services is a provider of home health, palliative and hospice care, and also offers senior housing and other nursing services.

The company has invested heavily in apprentice programs and career ladder initiatives as a way to combat the acuity creep.

“They’re the primary people taking care of our seniors,” Gommel said. “It’s the sad reality of our society that we expect the most out of our children and these caregivers – and we pay them the least.”

Many of the issues that arise when trying to take care of more complex patients, Gommel has found, are in the preparation and education of staff members.

“On the acuity side, when I think of [Institutional Special Needs Plans] or value-based plans, the physician is very skilled and is on top of it; the insurance company is on top of it; the training and ability to handle those higher acuity patients is where the problem lies,” Gommel said. “You have to invest in your team, and that means making sure they’re not turning over and you’re spending time preparing them for these changes.”

The other concern for home health agencies is that now that star ratings have dollars attached to them — through the Home Health Value-Based Purchasing (HHVBP) Model — agencies might take fewer complex patients for reimbursement reasons.

“Hopefully that doesn’t happen, but we can’t keep up with demand,” Johnson said.

Regardless of how quickly higher acuity patients are getting care into the home, both Johnson and Gommel believe investments made in home-based care are good ones.

“I do wholeheartedly believe that the home is going to be the growing center for where people are going to receive their care,” Gommel said. “I have that unpopular stance where I’m still trying to figure out what the role of a SNF is, and how many beds we actually need. I’m betting on home.”

Then again, home health agencies need qualified and prepared nurses in order to make those investments worthwhile.

“A really good home health aide is worth his or her weight in gold,” Johnson said.

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Enough time has passed since the CY 2024 home health payment rule was finalized for providers to dive into its details, mull them over and respond.

Though the rule is more favorable than the proposal the U.S. Centers for Medicare & Medicaid Services (CMS) first introduced in June, home health providers are not pleased with the final outcome.

CMS didn’t address – and in some cases furthered – the concerns that many providers and industry stakeholders raised in the months and weeks leading up to the rule’s finalization.

The rule comes with a 0.8%, or $140 million, aggregate increase to home health payments. In June, CMS proposed a 2.2% aggregate decrease for 2024, which would have been an aggregate decrease of $375 million.

Plus, the rule finalized a -2.890% adjustment, which is half of the cut originally proposed back in June.

“My initial reaction was that where we landed was an improvement over what was proposed,” Choice Health at Home CEO David Jackson told Home Health Care News. “I believe home health provides substantial economic upside for the Medicare program and for the beneficiaries. I continue to disagree with the methodology, as far as how it’s viewed as budget neutral.”

When the rule was first released, some providers felt that relief. But that quickly wore off.

“I quickly came to the stark realization that CMS still was continuing with deep cuts — albeit they were kicking them down the road — despite the prevalence of respected third-party data highlighting that cuts have made problems with access to care a reality, not just an assumption,” David Totaro, chief government affairs officer at Bayada Home Health Care, told HHCN.

Similar to Totaro and Jackson, other providers have voiced pushback to what they believe is CMS doubling down on its intention to implement the permanent adjustment cuts in the coming years.

Providers pointed out that even though the rule reduces a portion of the overall cut that CMS will be collecting next year, the total amount of the cut actually increased in the rule.

“According to their language in the rule, it is likely to increase again next year, when they continue to run these permanent adjustment calculations,” Andrew Baird, vice president of government affairs and policy counsel at Enhabit Inc. (NYSE: EHAB), told HHCN. “The fact that a smaller percentage of the cuts will be applied just in 2024 really is not much comfort, compared to CMS’ much larger commitment to a multi-year policy of continued permanent adjustment cuts.”

One of the more troubling aspects of the rule, cited by a number of providers, was what they believe is CMS’ flat out rejection of data and evidence, regarding patient access to home health, as well as the rising cost of care.

During the public comment period, a number of providers, industry stakeholders and advocacy associations cited data that painted a bleak picture of the struggles providers were already facing, and the ways that additional cuts would further disrupt access to care.

“It’s such a concerning posture from our regulators, because it just further creates this notion of a black box of policy generation, where only CMS insights and information are valid inputs in the overall process,” Baird said. “It really, ultimately, sort of begs the question, will any stakeholder data, will any stakeholder evidence, ever be sufficient for consideration by CMS in this process?”

Totaro also described CMS as seemingly “dismissive” of the data they received from various members of the home health industry. He also noted that CMS has yet to address the fact that home health care is underfunded.

“Instead, they are continuing to push a policy that proposes deep cuts year after year because of their interpretation of budget neutrality, creating serious long-term implications for the entire industry,” Totaro said. “Let’s not be fooled — while the net impact of the 2024 rule is a positive gain of 0.8%, it is solely due to a woefully low market basket update of 3.0%.”

Totaro offered mild praise for CMS’ continued focus on health equities, however.

“It’s good to know that we have the same goals and objectives to ensure that all marginalized populations have access to health policies, but that we just differ on how to get there,” he said.

Looking ahead, providers are determining what the final rule’s impacts will mean for business.

At Bayada, this may mean limiting investment into certain areas of the business, according to Totaro.

“In the short term, a 0.8% increase will not cover the increased expenses that we all have faced in the past year,” he said. “Longer term, the fact is that businesses hate indecision. With nearly $4 billion in clawback cuts still pending, without any idea when they might occur, our business will be hesitant to invest in innovation and expansion.”

For Enhabit, the focus will be on managing resources as efficiently and responsibly as possible while waiting to see what the fallout will be.

“At Enhabit, we’re going to continue delivering what we promise, which is providing a better way to care for every single patient wherever they call home in this country,” Baird said.

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