The home-based care staffing environment will always be a challenge for providers, but things look far better now than they did two years ago in the wake of the pandemic. However, one area that remains a lingering problem for providers is nurses, and specifically nurses who are leveraging a worker shortage to maximize earning power. 

A confluence of factors made recruiting and retaining home-based care workers from 2020 to the beginning of 2023 a major headache.

Increased government aid kept a large amount of workers on the sidelines, for extended periods of time. Meanwhile, many clinical professionals either retired or exited the industry after being burnt out by pandemic-related pressure.

Most of that has abated, but home health providers have told me that one issue definitively remains, and that’s bringing on – and hanging onto – nurses.

“If I had 200 nurses show up in my parking lot, I would hire them all without interviewing them,” Bill English, president and CEO of Accurate Home Care, told me in jest at the Continuum conference last year.

English’s joke was layered with some truth, however. Home health providers are desperate for nurses, and affordable ones. Without them, it’s tough to grow – or in some cases, to even survive.

In May of 2023, Adam Holton – then the chief people officer at Amedisys (Nasdaq: AMED) – told me that nurses jumping ship to collect sign-on bonuses was one of the company’s gravest concerns.

He and many other leaders hoped that particular issue would subside as the public health emergency was put further into the rearview, but recent conversations I’ve had suggest that it hasn’t.

In this week’s exclusive, members-only HHCN+ Update, I take a closer look at one of the most pressing issues facing the home health industry, which is a widespread inability to sustainably hang onto a vital workforce.

Home health care’s nursing problem

In May 2023, when I chatted with Holton, Amedisys had some of the best data on home-based care workers in the industry. Its applicant tracking system, specifically, was one of the company tools he was touting.

And that’s also why he was so sure of this problem with home health nurses, or nurses in general.

“When there’s a severe shortage, you expect some of this,” Holton said. “But there’s ample evidence that there is still a contingent of nurses who are really taking advantage of going from one sign-on bonus to another.”

Jeff Knapp, the chief people officer at Bayada, was also a part of that conversation. He agreed, and called Bayada’s nursing woes not a sourcing issue, but a retention issue.

For certain, there are ways to keep the less financially inclined nurses onboard. Those include good company culture, solid training, proper recognition, bonuses and, in general, competitive compensation.

But the average home health provider doesn’t have time to waste and money to blow. And when they are hiring nurses who then turn around and leave in short order, that amounts to a significant financial loss. The recruiting and training costs add up, with little return on investment.

In April 2022, an analysis in Health Affairs showed that the total supply of registered nurses decreased by more than 100,000 from 2020 to 2021, which was the largest decrease in supply in the last 40 years.

Another analysis, published by the Health Resources and Services Administration in November 2022, projected a U.S. shortage of close to 80,000 nurses in 2025, a problem that’s expected to continue – and even exacerbate – throughout the decade.

Specifically within home health care, a study published in the National Library of Medicine in 2021 found over 30% of full-time registered nurses and about 25% of licensed practical nurses left their position in a large home health care agency “over the course of a year.”

To make matters worse, health systems – which compete with home health agencies for nurses – often have more financial resources. At the same time, skilled nursing facilities (SNFs) are soon to be subject to a minimum staffing mandate, which could also increase competition over a small pool of nurses.

And the issue Holton brought to my attention nearly a year and a half ago hasn’t gone away.

For instance, in Care Advantage’s case, nurses are actually declining sign-on bonuses that may tie them to the company for a longer period of time. They’re doing that, in many cases, so they can eventually jump ship for other offers.

“All the big companies are paying high retention bonuses and sign-on bonuses,” Joe Navarro, the chief people officer at Care Advantage, told me this week during Home Health Care News’ Staffing Summit. “It’s to the point that, when I’m interviewing and hiring nurses, when I offer a sign-on bonus, they say they don’t need one. Because they want to be able to jump three months from now, four months from now, for better compensation.”

For large home health providers, that’s an issue. For smaller providers, it’s hard to even enter the competition.

Care Advantage has a large regional presence. Still, nurses jumping ship has become one of its biggest challenges.

“It’s very hard to attract and retain nurses at this point,” Navarro said. “And I think that’s one of the biggest challenges that there is in the industry.”

A costly turnover problem is also magnified in light of the current payment environment in home health care.

It costs far more now to hire and retain a nurse, but all the while, the Centers for Medicare & Medicaid Services (CMS) is reducing home health payment. The agency has cut core payments the past two years, and proposed a third straight cut for 2025.

On the other side of payment, Medicare Advantage (MA) plans are often paying rates for home health care that fall below the cost of care.

Navarro suggested one solution, which was to ensure nurses fall in love with the company culture shortly after joining.

Home health providers could also employ strategies to get a better sense of which nurses are more likely to stay for the long haul.

Having a nurse on staff is better than not having him or her on staff. But if that nurse is set to leave fewer than 90 days in, the economics on that hire could turn upside down.

The post The Home Health Nursing Problem That Isn’t Going Away appeared first on Home Health Care News.

Home Health Care News recently spoke with 15 home-based care leaders for our annual “Executive Forecast” articles, which we published at the end of last year.

Those executives’ responses covered a wide range of topics, and were surprisingly and refreshingly diverse. But, in the end, a few themes emerged.

In part, these answers helped form our home care and home health trend predictions, released last week and this week, respectively.

But the specific executive perspectives are worth revisiting.

In this week’s exclusive, members-only HHCN+ Update, I analyze the executive outlooks and offer key takeaways, including:

– An impending upheaval of the traditional home health business model

– The supply and demand labor issue

– An Increase in efforts related to AI and other future-facing technologies

Coming to grips with Medicare Advantage penetration

In HHCN’s home health trends piece, we wrote about the evaporating home health fee-for-service business model.

Even Amedisys Inc. (Nasdaq: AMED), which is likely to be a part of one of the largest payer organizations in the country soon, is adjusting operations with Medicare Advantage (MA) in mind.

Amedisys CEO Richard Ashworth is particularly focused on his company – and the industry at large – coming to the table with better data to demonstrate value in 2024.

“Data and analytics to drive the value proposition will be an important focus for 2024,” he told HHCN. “It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.”

Ashworth sees data and analytics as integral to negotiations with payers. But he also believes that home health providers can boost their value by coordinating care, or being a liaison to other services such as personal care, housekeeping and rides, among others.

“I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024,” he said. “The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity.”

New Day Healthcare CEO G. Scott Herman, who is running one of the more quickly growing home health providers in the country, believes that home health providers are considerably behind in adjusting to take care of a home health population that is skewing more and more toward MA over traditional Medicare.

It’s one of the reasons New Day is operating a remote home health model in Texas.

The visits are in person, but the company does not have brick-and-mortar locations tied to a certain area. That is in order to keep overhead costs down.

“What our company is doing is, we’re focused on understanding exactly how those Medicare Advantage payers work, building models that support them that are remote and that are driven with data and analytics through our ‘Carelytics’ system,” Herman told HHCN. “Models where we can sit down and understand how to work with patients longitudinally, do cross referrals internally and then take the business that those payers really need to take in markets where they’re struggling with providers.”

Home health leaders may not agree on the best way to achieve sustainability in a world more dominated by MA. But they are reaching a near-consensus on the fact that providers do need to adjust operations to survive, and that continued MA penetration is both a threat and a reality.

“2024 is the year for tomorrow’s home care provider to build plans on how to thrive — not just survive — with Medicare Advantage,” Frontpoint Health CEO Brent Korte told HHCN. “The home health industry is going to see disruption in 2024 and subsequent years. It’s an exciting time to be part of this industry.”

Labor difficulties

Accurate Home Care CEO Bill English quipped at Aging Media Network’s Continuum conference that, if 200 nurses showed up in his parking lot tomorrow, he’d hire them on the spot without conducting interviews.

Though there’s been some investment in home health nursing platforms by companies like LHC Group and BrightStar Care, there’s still a severe nursing shortage. On top of that, home health care tends to be a more difficult sector to recruit nurses to.

“There are plenty of challenges on the horizon, but America needs more nurses,” English told HCHN. “It will take another 5 to 10 years for supply to meet demand.”

That supply and demand will result in increased costs for home health providers yet again, Intrepid USA CEO John Kunysz added.

“I believe 2024 will include continued scarcity of labor and pressure to increase labor wage rates across the board — particularly for patient-facing team members,” he said.

That’s where the Centers for Medicare & Medicaid Services’ (CMS) rate cuts really hurt.

Providers are having to pay more for nurses than ever. Rate increases from CMS – or MA plans, for that matter – are not keeping pace.

That leaves the industry in a precarious position. Home health leaders are left to scramble for ways to become more efficient with the same amount of nurses and caregivers.

“We can find better use of technology and virtual care models to create at least a 30% increase in labor productivity for our existing labor resources,” Kunysz continued. “The supply isn’t increasing, so you have to drive labor efficiencies and productivity through technology that also reduces the burden on clinicians.”

Integrating AI

Slimmer margins and labor challenges will all but force providers to consider utilizing AI and other technologies in 2024.

They won’t be able to put the cart before the horse, however. AI tools will be rendered useless if there’s not enough quality data to be inputted into those tools.

VNS Health CEO Dan Savitt believes a heavier reliance on those sorts of tools will be table stakes in the future.

“The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies,” he said.

In looking for that 30% increase in productivity, Kunysz and Intrepid are also looking at AI as a potential solution.

“We’re finding ways to integrate AI into our clinical documentation processes to reduce the variability of the documentation quality and reduce the time burden on clinicians,” Kunysz said.

Home care providers are also looking to integrate AI to solve similar challenges.

The cost of delivering home care has skyrocketed. Agencies either have to raise the billing rates – pricing a group of clients out in the meantime – or find better ways to keep the cost of care down.

Reducing caregiver turnover, for instance, is one way to keep costs down.

“There are a range of ways AI can be applied to caregiver recruitment and retention,” Griswold CEO Michael Slupecki told HHCN. “From writing job postings, to chatting initially with applicants, to scheduling interviews, AI can eliminate several time-consuming steps in the hiring process. Once onboarded, AI can drive ongoing caregiver engagement to measure job satisfaction, provide rewards, give recognition, and even assign training.”

On the client side, providers also see AI as a tool to deliver better care.

“Increased capacity for predictive modeling through AI will empower home care leaders to enhance service offerings to improve the quality of care, patient health, comfort and independence,” Emma Dickison, the CEO and president of Home Helpers, told HHCN.

Slupecki added that predictive analytics driven by data and AI can aid in fall mitigation, UTI detection, medication adherence and other areas.

“AI technologies are changing and improving faster than we can implement and will impact the future of home care indefinitely,” he said.

The post How Medicare Advantage, Labor, AI Will Shape Home-Based Care In 2024 appeared first on Home Health Care News.

For Accurate Home Care, the biggest pain point isn’t retention, it’s recruiting new nurses to hire.

“If I had 200 nurses show up in my parking lot, I would hire them all without interviewing them,” Bill English, president and CEO of Accurate Home Care, said in jest at Aging Media Network’s Continuum conference last month.

Accurate Home Care is a Minnesota-based provider that offers home health care, private-duty nursing and non-medical home care.

The nursing shortage isn’t an issue that English believes can be solved in the next five years.

“The country is not producing enough nurses coming out of the schools,” he said. “If you talk to any president or CEO of a major health care system, they’ll tell you the number one thing is nurses. We lost so many nurses during COVID.”

English noted that prior to the start of the pandemic, Accurate Home Care had about 350 nurses. The company currently employs roughly 220.

One of Accurate Home Care’s biggest strategies for combating the nursing shortage is positioning the company as the employer of choice and focusing on culture.

“We have to focus heavily on culture, and we have to focus heavily on purpose, and try to attract those who have a heart for home care, and the money is secondary to them,” English said. “Those are the nurses that we went after. Today, we were voted as one of the top 200 workplaces in Minnesota by the Star Tribune.”

Similarly, Ari Medoff — CEO of Arosa — believes that home care providers looking to recruit new caregivers need to position themselves to offer a more appealing alternative than industry competitors.

“For every one of our teammates working for Arosa, there are 32 other caregivers out there working for Visiting Angels, Home Instead, Comfort Keepers [etc…],” he said during the conference. “We need to go find the best of those [people], and show them that we have a better package and better opportunities for them. In our world, I don’t think there’s the same overall labor shortage that may be on the nursing side.”

Arosa is a Los Angeles, California-based home care company that has 29 locations in nine states.

The company isn’t just thinking about recruitment on the caregiver side, Arosa is also working to build a pipeline of care managers.

“There are not many care managers out there in the country, there’s probably 2,000 or 3,000,” Medoff said. “We need 5,000 to 10,000. We need the best, most entrepreneurial social workers, nurses and occupational therapists, thinking about the possibility of care management. We’re doing internships, and we are out there looking for those individuals.”

On a company-wide level, Arosa has leaned into building creative employee benefit packages. For instance, the company set up an emergency assistance fund as a response to the pandemic, but continues to build it today.

As for the future of home-based care, English hopes that he will soon see more legislators that understand business, which could in turn lead to a better staffing climate for providers.

“I would say you can’t be a legislator unless you’ve run a business and have lost at least $500,000 out of your own pocket,” he said. “Then we will get better legislation, and regulations across the board.”

English thinks that home-based care being covered under private insurance could be a way forward.

“If it [were up to] me, I would set this up entirely through private insurance,” he said. “I would incentivize private insurance, through the tax code, to provide a safety net for everybody.”

The post Home-Based Leaders Are Focusing On Culture, Creative Benefits To Mitigate Staffing Challenges appeared first on Home Health Care News.

There’s a confusing outlook right now for both providers of home care and home health care. More value, worth and attention is being placed on those respective industries than ever. But, all the while, providers are facing some of their toughest challenges as 2024 nears.

The attention being placed on home-based care is not leading to a windfall for them. Increased awareness and attention on an industry generally means its operators stand to benefit. That has not been the case for most thus far.

In 2020, that’s what many of us expected, even with an acute pandemic and staffing shortage to get through.

Instead, longtime providers with the sense to see home care’s value years before it was widely popularized are handcuffed by inflation, rate cuts and internal operational challenges.

But their leaders, front-line workers and back-office staff would be wise to keep their heads up.

Demand will continue increasing for the foreseeable future. And, though there’s always been ebbs and flows in the home-based care business, providers are now dealing with those ebbs and flows from a much more advantageous position than they were in years past.

When Bo Schembeckler took over Michigan’s football program – during a period of turmoil in the late 1960s – he coined a phrase as players were deciding whether to stay and put in the work under a new regime or, alternatively, to quit or leave.

“Those who stay will be champions.”

It’s not easy right now for new providers, nor for old providers. But those who power through, with the sense that brought them to home-based care in the first place, will ultimately reap the benefits.

That’s the topic of this year’s final, members-only HHCN+ Update.

Turnaround time

While some of the largest home health providers in the country get gobbled up by insurers, the smaller ones are struggling to survive.

“It’s about finding people,” Accurate Home Care CEO Bill English told me earlier this month at Aging Media Network’s Continuum conference. “If I had 200 nurses show up in my parking lot, I would hire them all without interviewing them. [That shortage], that’s probably the biggest pain point.”

Accurate Home Care is a Minnesota-based provider that offers home health care, private-duty nursing and non-medical home care. It covers 43 of the 87 Minnesota counties.

English did not mean that literally, but he got his point across.

He came to the company, in part, to turn it around. In one month in 2018, the company lost $536,000 on $2 million in revenue.

“We had the sub-debt lender put more money in over time in 2018 so we could survive,” English said. “And we had it turned in 2020, in January and February and in the first half of March. And then COVID hit, and boom, we’re back into it again.”

Now, English and Accurate Home Care are on the path to a second turnaround. It hasn’t been easy.

As a provider with limited resources, English and the rest of his staff have had to work day and night to keep things afloat. Culture hasn’t been one of many crucial components. Instead, at times, it has been the only component to keep people around.

“Today, we were voted as one of the top 200 workplaces in Minnesota by the Star Tribune,” English said, with visible emotion on his face. “I got a great staff. I love my staff. And our retention rate of care providers is 72%. And for the office, it’s over 80%. And it’s not because we pay the most, or we have the most interesting jobs. It’s because of the culture that we have built.”

If English and Accurate Home Care made the justifiable choice to forgo a second turnaround, hundreds of people would have lost their jobs. Hundreds more would have lost their access to necessary care services.

Like many providers of its size, Accurate Home Care has been through the ringer over the last five years. Giving up now, however, would keep it from realizing the fully grown fruit from its labor.

As interest rates come down in 2024 – hopefully – there will be more money to be put behind providers. More nurses will be coming to home-based care in the near-term future, so long as institutions continue to invest in those pipelines.

More care will be coming to the home.

When it does, the country will begin to fully recognize the value of these providers and these workers.

The New York-based HCR Home Care – like Accurate Home Care – is another provider I’ve talked to with a similar plight.

HCR Home Care has been around for half a century. It built a statewide home-based care business, allowing employees to have a stake in the business along the way.

That used to be one of its primary draws, until COVID-19 hit.

“We experienced extremely high turnover during COVID, much like many other agencies did,” HCR Home Care President Suzanne Suzanne Turchetti told me earlier this month. “Our profits were significantly decreased during COVID. So, we haven’t been able to contribute as much as we used to, to the [employee ownership] plan.”

But I caught Turchetti at the right time. Unbeknownst to me, another turnaround there is ongoing.

She started as an assistant to the former president of HCR Home Care. Since then, she’s worked in every department of the business. Now, she’s running the whole shop.

Turchetti’s story is one that’s unique to home care. She plans to leverage that experience to get HCR Home Care where it needs to be in 2024 and beyond.

“COVID took a lot from all of us,” she said. “But we keep rebuilding.”

To ease some of the margin pressure that’s hit its home health and home care segments, HCR Home Care is banking on technology – as well as its part-owner employees – to drive revenues back up.

“Our job as agencies is to be prepared,” Turchetti said. “With staffing, education and technology, in order to meet that demand. Home care has historically been one of the last thought of parts of the continuum of care. But with COVID, it’s really come to the forefront, and I think there’s going to be an increased amount of attention on home care as consolidation in the industry happens, as payers look to find the most inexpensive way to care for their members.”

The home-based care space is not for the faint of heart. But America’s seniors depend on these providers. Without them, we’d all be much worse off.

Leaders and workers know that. But they should also know that better times are ahead. In my opinion, they’ll be happy they stuck things out when they did.

“It’s a good time to be in home care, in my opinion,” Turchetti said.

The post Survival Instincts, Inevitable Tailwinds Will Guide Home-Based Care Providers Through Current Tough Times appeared first on Home Health Care News.

Home health leaders are focused on mitigating margin compression, utilizing more technology, leveraging artificial intelligence, working smarter with MA plans and more in the new year.

Home Health Care News heard from six of these home health industry leaders, who shared their views on the biggest trends, challenges and opportunities that will define home health care in 2024 and beyond.

***

We will continue to see the importance of traditional Medicare in the home health industry with increasing momentum on Medicare Advantage. Data and analytics to drive the value proposition will be an important focus for 2024. It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.

We will continue to see labor challenges impacting market capacity. In addition, the impact to margin of the payer mix and specific payer strategies designed to maximize care will be critical in 2024. Exploring innovative ways to use technology and its effect on potential efficiency and care delivery will continue into 2024 as well.

I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024. The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity. Care coordination with other important social determinant drivers – like personal care, transportation, meals delivery and physical activity, as well as clinical care coordination with the health system, primary care doctors and emergent referral sources for quality and timeliness of care, will all be important in the upcoming year.

There is great opportunity in market growth, as more and more people are in need of home care services. We will look to grow capacity in the market through workforce solutions, efficiency and unique partnerships of care delivery and coordination, all driving more market growth.

– Richard Ashworth, president and CEO of Amedisys

***

Several challenges from 2023 continue to impact home care — most notably, the recently finalized 2024 cuts to Medicare home care reimbursement rates. We will continue to advocate a rollback of these cuts, and with support for our position in Congress, we’re optimistic progress will come.

As the labor shortage continues, home care patient referrals continue to go unfilled. Recruiting and retaining talented clinicians is critical. We can expect more flexible hiring approaches including part-time positions, flex-time scheduling and gig labor across the industry.

2024 will bring growing emphasis on insurer efficiencies in coordinating home care services. For example, several national health plans are already taking steps to reduce authorization requirements and in a push to consolidate the managed long-term care (MLTC) market. In New York, the state is requiring low-performing MLTC plans to be absorbed into higher-performing plans — a process that’s now underway. Look, too, for insurers to accelerate the shift of dual-eligible Medicaid recipients to integrated Medicare-Medicaid plans — a trend we’re seeing in New York State and among national for-profit Medicare Advantage insurers.

Growth opportunities in 2024 include increased linkage of home care patients to community-based mental health providers — a promising option for addressing America’s mental health crisis. The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies.

– Dan Savitt, president and CEO of VNS Health

***

In 2024, I believe small agencies who are barely profitable will continue to hang on, mainly because the owner can’t sell at a price point the owner personally needs. But running the agency will continue to take an emotional toll for those owners, further tiring them and creating a greater clash point down the road.

There are plenty of challenges on the horizon, but America needs more nurses. It will take another five to 10 years for supply to meet demand.

– Bill English, president and CEO of Accurate Home Care

***

I believe 2024 will include continued scarcity of labor and pressure to increase labor wage rates across the board — particularly for patient-facing team members. I expect continued expansion of MA plans into rural markets. The biggest health care reform we could pass would be to prohibit the use of the term Medicare in any of these commercial insurance products. It’s completely false advertising.

There will be tight access to capital to support acquisition roll ups due to high interest rates, increased political uncertainty and tension that prevents us from having a cohesive national approach to funding the aging-in-place goals everyone wants.

Other challenges ahead include margin erosion due to increased labor costs, reduced revenue associated with Medicare Advantage plan penetration and a lack of top-tier management talent that is as skilled and adaptable as we have seen historically in the acute care market segments. We simply need more leaders who instinctively innovate and solve problems versus clinicians and managers waiting to be told what to do by their large financial planning and analysis teams.

As far as opportunities go, we’re finding ways to integrate AI into our clinical documentation processes to reduce the variability of the documentation quality and reduce the time burden on clinicians. We can begin to work with payers to shift our care focus from post-acute and measuring hospital readmission rates, to a more pre-acute and aging-in-place model measuring unplanned hospital admissions in the first place.

There’s also room for better integration and utilization of non-skilled home care as the driver for entry into the post-acute care continuum versus acting like it’s 1969 and we’re all looking for our next Medicare patient discharge following a five-day hospital stay. We can find better use of technology and virtual care models to create at least a 30% increase in labor productivity for our existing labor resources. The supply isn’t increasing, so you have to drive labor efficiencies and productivity through technology that also reduces the burden on clinicians.

– John Kunysz, president and CEO of Intrepid USA Healthcare Services

***

From where it stands now, 2024 will be the first year that most states will be tipping over 50% of Medicare Advantage penetration. Nationally, we will all have to contend with the reality that MA is here to stay and about to define the way we provide care.

On the latter point, 2024 is the year for tomorrow’s home care provider to build plans on how to thrive — not just survive — with Medicare Advantage. The home health industry is going to see disruption in 2024 and subsequent years. It’s an exciting time to be part of this industry.

– Brent Korte, CEO of Frontpoint Health

***

The market has never lost confidence in home health’s ability to grow — nor lost confidence in the importance it has in the post-acute segment. I think confidence will restore as acquisitions occur and more focus comes on it. I think you’ll begin to see the market dynamically shift back toward investor prowess in the M&A piece. Folks are going to want to be invested in the long-term mechanics of home care.

The trend in Medicare Advantage continues to rapidly outpace preparation by the industry — unless you’re building something specifically for MA. The world’s changed. The ability to hold the 50-plus traditional Medicare episodic mix in home health is really just gone. It’s just not something that occurs in the markets we look at. It’s very difficult to hold that type of mix.

Now, the ability to expand the business and expand episodic care, unfortunately, comes with the failure of some smaller companies or the acquisition of those companies so that we can grab that market share and grab episodic business.

What our company is doing is, we’re focused on understanding exactly how those Medicare Advantage payers work, building models that support them that are remote and that are driven with data and analytics through our Carelytics system. Models where we can sit down and understand how to work with patients longitudinally, do cross referrals internally and then take the business that those payers really need to take in markets where they’re struggling with providers.

It comes from creating a very efficient model of care delivery, which is predominantly focused on having the finite nursing resources and managing that to the absolute best of our ability. In our case, anything that does not have to be managed by a nurse, we take it out of their hands and we manage it by others. We don’t want them to work on those tasks. We’re focused on the execution of highly capable nurses and the things that only they can do.

– G. Scott Herman, founder and CEO of New Day Healthcare

The post 2024 Executive Forecast: What 6 Top Home Health Leaders Expect Next Year appeared first on Home Health Care News.

In the midst of the first full performance year for the expanded Home Health Value-Based Purchasing (HHVBP) model, providers are figuring out where they are succeeding and where there is room for improvement.

HHVBP continues to save hundreds of millions of dollars each year, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

And the initial set of HHVBP scores — on the provider side — is influencing the operations of home health providers of all sizes.

“We are steering the entire company towards value outcomes,” Ananth Mohan, COO of Elara Caring, told Home Health Care News. “It adds to the complexity of how we do business, so you have to be sophisticated about it. With the midway point scores, it’s really geared us up and reaffirms that this is the way the world’s going to go.”

HHVBP scores

The HHVBP model, which CMS expanded from nine demonstration states to home health agencies across the country on Jan. 1, 2023, was implemented to incentivize home health agencies to improve the quality of care they provide to Medicare beneficiaries.

The goal of the model is to link Medicare reimbursement to the quality of care, rather than just the quantity or volume of services.

The way CMS does that is through quality measures and performance scoring. Those measures include patient outcomes, patient experience, process measures and timely initiation of care.

Each category has specific measures that contribute to the overall performance score. The performance period usually lasts a year. During that time, CMS evaluates the data that providers share, and, from that, a score is returned to providers that can negatively or positively affect their reimbursement.

After reviewing the scores Elara Caring received at the six-month point, Mohan is pleased with the early results. In particular, Mohan is encouraged in how the results have affected day-to-day operations.

“On the hospitalization front, the results made us think about being more programmatic,” he said. “It changed how we think about centers of excellence around certain diseases, how we think about which areas of the company where we’re more hospital-heavy. It’s also changed the way we think about things like remote patient monitoring. RPM is not incentivized today, so you’re essentially giving it away. But if you’re giving it away in this mode,l then it matters, because it drives outcomes.”

The Dallas-based Elara Caring is one of the largest home health, home care and hospice providers in the country, with about 200 locations across 17 states.

The HHVBP model has given Elara Caring insights into what is working and what isn’t working at different locations.

For instance, the midpoint check-in has reinforced the need for predictive tools.

“Otherwise, we’re always just looking backward,” Mohan said. “So, we built an in-house, custom predictive tool that our branches are able to use and see on a real-time basis what they’re good at and what they need to improve on. I continue to be impressed at how this resonates culturally with people. If you give them the right tools, they can make an impact. We’re seeing that.”

On the flip side, the early results have shown that reducing hospitalizations will be a “never-ending challenge.”

For patient satisfaction and OASIS scores, the simplified strategy is to see where improvements need to be made and to stay on top of them. For clinically-driven results, it’s a tricker task.

“Because acuity is going up,” Mohan siad. “Just when you think you’ve cracked it, you’re going to get sicker patients and you’ll run into situations you can’t expect. So, I’m not satisfied with where we are, but that’s probably all of us in the industry.”

A renewed focus on patient satisfaction

For other providers, the HHVBP results have reinforced a new focus on patient and customer satisfaction.

“If we’re knocking our patient satisfaction customer service out of the park from the moment we call our patients, our entire score can flourish,” Nicoleen Meyer, VP of clinical services at Accurate Home Care, told HHCN.

Accurate Home Care is a Minnesota-based home care and home health provider that operates in half of the state’s 87 counties.

As care in the home shifts to more value-based models, Meyer believes it’s critical to do everything possible to have top-tier customer service. It’s the baseline for any successful provider in a value-based system, she said.

“When your patient meets all their goals, they’re discharged from care and get that survey and think, ‘My gosh, my nurse was so great, I had such a great experience,’” Meyer said. “If they actually got better, are healthier, didn’t go back to the hospital — what you’ve done is reduced your hospitalization rates, improved your OASIS scoring and process measures and your whole HHCAHPS scores thrive because of that.”

Being a smaller provider, Accurate Home Care has to look for every advantage it can find. When Meyer initially looked through what would make up the total HHVBP performance scores, she immediately drew the line from patient satisfaction to quality scores.

“The other things are important too, but this one feels like low-hanging fruit,” Meyer said. “You don’t need a nursing degree to understand the importance of customer service.”

Looking ahead

Providers spent years prepping for HHVBP, but now they’ll need to adjust.

Accurate Home Care, for instance, will be more focused on the OASIS process.

“OASIS, while it is intended to be objective and user friendly, it’s really anything but,” Meyer said. “It’s not a science, it’s an art. It may come down to the way our nurses are asking and answering the questions. Right now, there’s even more of a focus on educating our staff on these kinds of things in order to improve those scores.”

For Elara Caring, it goes back to hospitalizations and the difficulties in finding a good balance with programs as acuity in the home rises. Getting and evaluating risk scores, Mohan has found, doesn’t tell the full picture like it used to.

“You can get risk scores, but what we found was just risk scores weren’t enough,” he said. “You have to marry it with disease, at least in terms of how you develop pathways. We’ve evolved that. It used to be that if you’re high-risk, you’re in a high-risk program. Now it’s if you’re high-risk COPD, that looks different than if you’re high-risk cardiac.”

It’s still early, but the early HHVBP scores have already changed the way providers are operating.

“On the OASIS front, it accelerated the work we were already doing,” Mohan said. “On the hospitalization front, it made us get more programmatic, and on the patient satisfaction front, it made us operate on a real-time level versus leaving it all to chance.”

The post What Home Health Providers Are Learning From HHVBP’s First Full Year appeared first on Home Health Care News.

The drop in transaction volume at the high end of the home health market has cleared an interesting path for smaller standalone agencies.

Investment experts are seeing strong demand and valuations for mom-and-pops, and those smaller providers are seeing it themselves.

“The private equity platform companies that planned to exit over the last year and a half have not been able to exit because, at the high end of the market, values have come down,” Cory Mertz told Home Health Care News. “Those guys are actively looking for transactions because they need to continue to grow, and the way they’re going to do that is through add-on acquisitions.”

At the high end of the market — or deals in the $100 million to $1 billion range — transaction volume has come down due to capital becoming more expensive, among other reasons. Transactions at that end tend to be more highly leveraged, so the space is seeing fewer large transactions.

Those economic factors could potentially have a positive effect on smaller agencies looking to sell within the next few years.

“I see it as a pretty active market,” Kevin Colman, president and CEO of Home Healthcare Solutions Company, told HHCN. “It may be a little bit slower as we speak today just because of the overall financial environment and with interest rates a little bit higher, but I’ve been approached by a couple of private equity firms in the past who have expressed interest. I’ve decided not to go that route right now, but when the time calls for it down the road, we’d certainly be open to it when we’re ready to exit.”

Home Healthcare Solutions Company is a Chicago-based home health provider that handles an average of 60 to 80 admissions every month.

“I’m very bullish on the market because the home health industry isn’t going away,” Colman continued. “Everything is moving to the home. And at the end of the day, Medicare home health is still probably the only federal Medicare program out there that actually saves the program money. As long as that’s the case, people are going to want to be in this industry from an owner/operator and a private equity standpoint.”

Mertz defines the “low end” of the market as deals between $3 million and $50 million, but it’s an unscientific range.

“We will not see a lot of transactions with multiples in the mid-to high-teens right now,” Mertz said. “But the lower end of the market is holding up fine. I can make the case that values for companies in this size range are higher today than before interest rates started to rise.”

The value of home health care is clearly recognized by the largest health care companies in the country, including the largest payers and retailers.

But smaller agencies may have a harder time expressing the value they provide, given a lack of resources to do so.

“In this environment, the more services you’re able to provide and the more you’re able to make your agency a one-stop shop to provide that continuity of care, the better off you’ll be,” Colman said. “I’m really as bullish as ever. I think COVID flushed a lot of the weaker players out who couldn’t get the staff and I think that’s actually kind of made it better for the agencies that were able to stick around.”

Companies that prove they have versatility and a strong financial foundation will be what pique investor interest. Profitability becomes even more imperative when margins are tight, Mertz said.

“I talk to buyers all the time, and right now they tell me, ‘We’re seeing a lot of deals, but really nothing of any quality,’” Mertz said. “There’s a real scarcity of quality opportunities out there for these private equity-backed – and even the publicly traded – companies to really sink their teeth into.”

There’s still plenty of interest in smaller home health companies that are performing well.

Over the next three to five years, Accurate Home Care hopes to be one of those companies. Accurate is a Minnesota-based home care and home health provider that operates in half of the state’s 87 counties.

“We initially came in to be the turnaround firm because this thing was within, easily, a couple of weeks of bankruptcy,” Bill English, president and CEO of Accurate Home Care, told HHCN. “We stepped in as a majority owner on Jan. 1 of 2018 and in the first month, we lost $536,000 on $2 million of revenue. By January 2020, we were profitable.”

Two months later, COVID-19 hit and Accurate lost 30% of its nurses. Today, the company is profitable and healthy, with English having to right-size the business twice in five years.

English, also a partner with the consulting firm Platinum Group, believes the right exit will be there in the near-term future.

“I don’t know that it’s not a fruitful market right now, I’m just not sure we’re a good buy right now,” English said. “Most companies don’t want to buy headaches and we’re just emerging from a migraine.”

In another year or two — maybe three — English believes that will change, especially for a buyer who doesn’t have a footprint in Minnesota. Accurate Home Care has a versatility that is tough to come by, he said.

“We’re in 43 of the 87 counties in Minnesota and we’re looking to expand,” he said. “We have a unique service line. There aren’t a lot of companies that do non-medical, plus private-duty nursing, plus home health.”

The post Amid Financial Market Turmoil, Big Players Look To Smaller, High-Quality Home Health Agencies To Grow appeared first on Home Health Care News.

Accurate Home Care, LLC (AHC), based in Otsego, Minnesota, has named Bill English as chief operating officer. Accurate Home Care provides home health care services throughout Minnesota and was founded in 2002.

In his new role, English will focus on company-wide system changes and honing company culture, according to a press release. English is a former business owner with more than 20 years of business leadership experience.

Over the past four years he has worked as interim CEO/COO within companies in need of growth and improvement.

Traditions Health Care Holding Co. Appoints Chief Compliance Officer

Chris Anderson has been named chief compliance officer at Traditions Health Care Holding Company, LLC, an investment portfolio that focuses on health care businesses including home health, hospice, outpatient therapy, software, legal and professional services, and more.

Anderson brings 25 years of health care compliance experience. He is the former vice president of compliance at Triad Hospitals, Inc., which is part of Community Health Systems (NYSE: CYH) — a health system with 51 hospitals and 10 outpatient surgery centers. He also served as senior vice president and chief compliance officer at Genitive Health Services, now part of Kindred at Home.

Anderson is also a member of the Health Care Compliance Association, and former chair of its home care group. He is a board member of four health care charity ventures with interests in Guatemala, Romania and Moldova.

Crossroads Hospice & Palliative Care Names CMO 

Timothy Ihrig, PhD, has been named chief medical officer of Crossroads Hospice & Palliative Care, a hospice provider with locations in seven states.

Ihrig, based in Des Moines, Iowa, has been endorsed by the Center to Advance Palliative Care as a clinician-educator and serves as a consultant to palliative care entities and accountable care organizations (ACOs) globally.

Crossroads does not plan to open an Iowa location.

Written by Amy Baxter

The post Movers & Shakers: Accurate Home Care Names COO appeared first on Home Health Care News.

Technology company Axxess has named Dennis Petroskey as senior vice president of corporate communications. In this role, he oversees all internal and external communications and messaging for the company.

Prior to joining Axxess, Petroskey served as senior vice president of communications for the U.S. Travel Association in Washington, D.C. He also served as vice president of corporate communication for Fox in Los Angeles and BMG Entertainment in New York City. He has also previously served as a Capitol Hill press secretary and a newspaper reporter.

Accurate Home Care Names New President and CEO

Otsego, Minnesota-based Accurate Home Care, LLC and its majority owner, Generation Growth Capital Fun II, LLP, named Richard “Rick” Bourne as president and CEO of the company.

Bourne was most recently president and CEO of Home Health United in Madison, Wisconsin. Prior to that, he was president of Spectrum Medical, Inc. in Great Fall, Montana.

Accurate’s current CEO and founder, Amy Nelson, will remain with the company as chief corporate development officer. In this role, she will support Bourne in growing the business.

Trinity Health Names Mike Slubowski as President and COO

Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation, has named Mike Sublowski to serve as president and COO, effective May 15, 2017. Sublowski will report to CEO Richard J. Gilfillan and be responsible for operational and clinical activities across the system.

Slubowski is currently president and CEO of SCL Health and a board member of the Catholic Health Association. He has 35 years of experience as a health care leader. Prior to his tenure at SCL Health, he worked at Trinity Health as president of hospital and health networks for the system. He has also held leadership positions at other health systems in Michigan and Arizona.

Complia Health Appoints New Chief Information Officer 

Complia Health, a home health care and hospice software solutions provider, appointed Chris Azar to the executive team as chief information officer (CIO). In this role, he will be responsible for all development and IT operations, and play a key role in shaping the technology agenda for Complia.

Azar has more than 25 years of IT leadership focusing on software architecture and product development. Most recently, Azar served as the chief architect at Cognizant, where he was responsible for working with organizations to effectively drive product convergence and innovation. Prior to that, he was the practice lead at Kanbay, Inc., a Global IT Services firm.

LifeCare Health Partners Names New CEO 

LifeCare Health Partners, a Plano, Texas-based healthcare services provider encompassing the LifeCare Family of Hospitals and post-acute care services, including transitional care, inpatient behavioral health treatment and home-based care, named Jim Murray as its new CEO, effective April 1, 2017.

LifeCare also promoted Chief Operating Officer Frank Battafarano to president and COO.

Murray will take the helm at LifeCare Health Partners after a 28-year career with Humana, where he served as chief financial officer as well as chief operating officer.

Battafarano has served as LifeCare’s COO since 2014, after a 20-year career with Kindred Healthcare (NYSE: KND).

Corridor Group’s New VP of Marketing and Innovation 

Corridor Group, a home health care and hospice consulting group, has announced Mary Morrisey-Gabriel as the company’s vice president of marketing and innovation.

Morrisey-Gabriel recently joined Corridor through the acquisition of Transpirus, where she was chief sales officer for four years. Prior to that, she was a strategic advisor to Transpirus following its divestiture from Gentiva Consulting in 2012.

She was also formerly the chief sales and marketing officer for Gentiva Health Services from 2001 to 2007, and supported Genitiva with the acquisition of Healthfield through 2009.

Excel Health Group Appoints New Board Member

Excel Health Group, a market intelligence data analytics company, appointed Tom Maxwell to its board of directors. Maxwell is CEO of Maxwell Health Care Associates, a home health and hospice technology and operations services provider.

He will play a key role in the development of Excel Health’s market intelligence products and services. Prior to launching Maxwell Health Care Associates, Maxwell served as chief operating officer and chief strategy officer for Homecare Homebase.

Written by Amy Baxter

The post Movers & Shakers: Accurate Home Care’s New President & CEO appeared first on Home Health Care News.

In the most recent Inc. Magazine’s Inc. 5000 list, 13 home care companies made the cut. It’s no surprise these companies snagged spots on the list, especially now that home care franchises are taking the franchise market by storm.

The 2016 Inc. 5000 is a compilation of the fastest-growing private companies in the country across more than 30 industries ranging from logistics and media to manufacturing and health.

These are the home health care companies that continue to pave the way for success in the industry:

#489—Sunny Days In-Home Care

#827—Providia Home Care

#1545—Capitol Home Health

#2036—FirstLight HomeCare Franchising

#2295—24Hr HomeCare

#3305— Senior1Care

#3357—Home Care Assistance

#3865—SYNERGY HomeCare

#3806—BrightStar Care

#3989—CT in Home Assistance

#4108—Great Lakes Caring Home Health and Hospice

#4639—Home Instead Senior Care Birmingham, Alabama

#4990—Accurate Home Care

Coming in the No. 1 spot among the fastest-growing home health companies, Sunny Days In-Home Care, located in McMurray, Pennsylvania, has seen a growth rate of 776% in the last three years, according to the Inc. 5000. Taking second, Fort Myers, Florida-based Providia Home Care has seen a growth rate of 480% in the last three years. The company reached $13.2 million in revenue last year, according to Naples Daily News.

Of the 13 home care companies on the list, FirstLight HomeCare Franchising announced that the accolade comes at a time when the company has grown to more than 134 locations in 31 states. Its gross sales reached more than $3.9 million in 2015, up from $2.6 million in 2014, according to a recent company press release. This is the second year in a row FirstLight has been named on the Inc. 5000 list.

“In the last three years, our company has grown by over 183% and when you consider that we have only been franchising since 2010, that expansion is even more impressive,” Bill McPherson, executive director of franchise development at FirstLight Home Care, said in a press release.

BrightStar Care also has released news this week to expand its market in Philadelphia, with 26 new home care locations. The company has a target of 50 new franchises around the country this year.

Of the group, 24Hr HomeCare is ranked on the list for the fourth year in a row, according to a recent press release from the company. One partnership 24Hr HomeCare established in 2015 with Uber and the UberAssist program to help transport seniors from hospitals back home set the pace for other home care providers to start thinking about how to better integrate their programs with transportation services.

“The fact that we’ve been able to sustain our rapid growth for such an extended period of time attests to our company’s ability to adapt to a developing industry, adopt innovative new technologies and processes for senior care, and above all, continue to hire the best,” said Ryan Iwamoto, co-founder and chief marketing officer of 24Hr HomeCare.

Written by Alana Stramowski

The post Inc. Names 13 Home Care Companies Among Nation’s Fastest-Growing appeared first on Home Health Care News.