Transcend Strategy Group, based in Curtice, Ohio, provides data-driven insights to help home care companies make better business decisions.

Of the caregivers surveyed, 25% of those who have experienced or witnessed violence or harassment either didn’t feel comfortable reporting these events or did report but didn’t feel their organization was supportive.

“Home-based care organizations encounter unique challenges in safeguarding their staff due to their limited control over the environments they enter and the individuals they engage with,” Nicole McCann-Davis, Transcend’s senior client advisor and research director, told Home Health Care News. “It is essential to balance providing responsive, compliant and respectful support to patients and families and ensuring that staff are optimally equipped to perform their responsibilities effectively and confidently.”

Federal and state agencies require robust emergency management response plans for most types of home-based care. A crucial part of that is two-way communication. Over 50% of respondents said their employer communicated about potential safety risks. When dealing with a distributed workforce, multiple communication methods are generally necessary for all types of unplanned situations and emergencies.

Providing caregivers background information on clients and their family situations can help prevent unfortunate incidents. It’s important to consistently and thoroughly warn staff about potential risks in the neighborhood, the mental health of the client or family members, substance abuse issues or the presence of weapons. These should be considered standard practices for home-based care agencies.

It’s important to note that there is a generational gap among those who report witnessing violence. Individuals in the 35-44 age group were more likely than those over 55 to have experienced or witnessed physical violence in the workplace. Going further into the data, people aged 55 and above were more likely to feel empowered to establish appropriate safety measures while providing care.

“I do not believe that any organization intentionally fails to protect its employees from workplace violence,” McCann-Davis said. “Often, resource limitations or the difficulty of balancing competing priorities can pose challenges. While many organizations actively invest time and resources into violence prevention, more work remains until all participants consistently report feeling fully supported by their organization.”

Leaders are taking action

The good news is that home-based care leaders are taking action. Transcend reported that some common themes emerged around leaders providing further safety resources.

“Some of the high-level insights included in the report are focused on improved communication around safety and overall empowerment of staff to have autonomy over their safety,” McCann-Davis said. “Participants want to have confidence that their employer values them as much as they value patient care. Employers must apply the same principles in home-based care such as compassion, transparent communication and access to resources.”

Training is common in agencies, covering topics such as de-escalation tactics, self-care and stress management, and communication strategies for cultural sensitivities.

When asked about the kind of support they would like from their employers, respondents expressed a desire for concrete action and consequences for negative behavior, regardless of who the aggressor may be. They also mentioned feeling valued when acknowledged and supported in their response to harassment or violence.

Technology has become a central component in many safety protocols.

Certain organizations are providing their staff with wearable safety devices that, when activated, open a microphone connecting to a 24-hour call center. This allows someone to listen as the individual leaves the location and walks to their car and enables them to contact authorities in case of an emergency.

Organizations also have reported success in providing field staff with cell phones preloaded with applications to help them report safety events related to caregivers or patients.

“In evaluating their principle preferences for employer support, participants predominantly sought accountability, comprehensive training and education, and recognition of their emotional experiences,” McCann-Davis said. “While innovative resources, such as safety devices and applications, can be effective if budgetary constraints allow, their impact will be significantly diminished without integrating cognitive empathy. Workplace safety risk escalates when employees feel uncomfortable disclosing essential information to their employers.”

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That’s one key takeaway from a new report released by Transcend Strategy Group, an at-home care-focused growth strategy firm. The report is an overview of value-based care’s history, as well as a guide to help providers operate in a larger value-based ecosystem.

In general, home-based care providers are staring down the barrel of a health care landscape that is increasingly embracing value-based care.

Specifically, the Centers for Medicare & Medicaid Services (CMS) has been vocal about its goal of having 100% of all Medicare beneficiaries in a value-based program by 2030.

There are ways that providers are already embracing value-based care, according to the report.

On the home health side, providers are forming arrangements with Medicare Advantage (MA) plans and operating under the Home Health Value-Based Purchasing (HHVBP) program, while home care providers are often offering personal care services as part of MA plans’ supplemental benefits.

The report also highlighted a number of programs that are driving value-based care, such as the Medicare Choices Model, HHVBP, ACO REACH and the GUIDE Model.

As health care shifts further into the value-based care space, it’s critical for home-based care leaders to prepare their organizations for this change.

“You have to be thoughtful and strategic about all of this,” Tony Kudner, chief strategy officer at Transcend, told Home Health Care News. “Some agencies think, ‘We’ll just get the right data set, and that’ll be our value-based initiative for the year or we’ll hire one person who deals with contracting.’ We think about it in terms of six steps.”

The key steps that providers need to take include: defining and tracking value; determining risk tolerance; identifying potential payer partners; having strong data; preparing front-line and mid-level staff; and preparing for any other challenges ahead, according to the report.

Ultimately, providers will no longer be able to sit on the sidelines and avoid engaging in value-based care, according to Kudner.

“The status quo will not hold,” he said. “Relying on your episodic business to offset the losses that some providers are taking on the MA side is not a sustainable business model, nor will it help you grow in the long term. On the home care side, I think the same thing is true. Building resilience at this point, and being able to proactively offer delegated risk providers solutions to help them manage their global spend, will be more successful than trying to simply grab as many hours as are allotted by a health plan through Medicaid for a patient.”

What’s more, Kudner believes that providers that don’t engage with value-based care could see it negatively impact their organization, in comparison to competitors.

“Expanding your skill set is going to be table stakes,” he said. “If you don’t do that, you’re going to see the other providers who are trying to adapt to this changing landscape start to get those referrals.”

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AccentCare has named Saurabh Gupta as its new chief financial officer. The appointment is effective Jan. 8, 2024.

Prior to this appointment, Gupta was CFO at Envision Medical Group. Before that, he served as senior vice president for financial planning and analysis at Steward Health Care, one of the largest accountable care organizations.

“Saurabh is a highly regarded leader in the health care space with a strong track record of driving financial strength and business innovation,” AccentCare CEO Laura Tortorella said in a press release. “Leveraging his deep industry expertise and experience driving outcomes at high-growth companies, he will contribute to our mission of putting the patient at the center of everything we do. I am confident Saurabh will be a key member of our leadership team as AccentCare continues to provide excellent care in the post-acute space now and into the future.”

AccentCare is one of the largest home health and hospice providers in the country. The Dallas-based company also provides personal home care, palliative care and other home-based care services. Its footprint includes 250 locations across 31 states and the District of Columbia, and it serves more than 200,000 individuals each year.

In his new role, Gupta will be in charge of leading financial strategies and execution to drive business performance.

“I am excited to join AccentCare and support its mission to provide best-in-class care,” Gupta said in the press release. “AccentCare has a unique value proposition and strong foundation in the growing post-acute care industry. I look forward to partnering with the team to help accelerate its growth trajectory and continue to serve as the provider of choice in the industry.”

Aveanna Healthcare names chief revenue officer

James Elkington has been promoted to the role of chief revenue cycle officer at Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH).

The company made the announcement in a recent LinkedIn post, where the organization described Elkington as “integral to Aveanna’s success for over seven years.”

“His forty-plus years of experience in leading finance, operations, and revenue cycle management teams has helped to bolster our financial strength, and his leadership has created a culture within our RCM operations that is focused on excellence,” the company wrote. “We are truly fortunate to have James leading our RCM Team in his expanded role within the company.”

Aveanna delivers pediatric care, home health care and hospice care to patients in 33 states.

Most recently, Elkington served as a senior vice president in revenue cycle management at Aveanna. Prior to that, he served in leadership roles with Piedmont Healthcare and HCA Healthcare (NYSE: HCA).

Papa promotes new chief operating officer

Papa has promoted Shaila Parikh to the role of chief operating officer.

“I’m thrilled to be part of the team working to end loneliness and isolation with real human connections,” Parikh said in a LinkedIn post. “I love being a part of a mission driven company where our tech enables people to laugh, connect and find meaning.”

Prior to Parikh’s promotion, she was the senior vice president of growth, marketplace and customer experience at Papa.

“In her role overseeing growth marketplace and, more recently, the Care Team, Shaila has improved the quality of our Pal network and is embedding a consumer experience mindset into the fabric of the work,” the company wrote in a LinkedIn post announcing the appointment. “In her expanded and elevated role, Shaila will help accelerate our efforts to build world-class operations in service of our clients, members, and Papa Pals. A culture champion, thoughtful leader, and metric-driven executive, we are excited to see where Shaila takes us.”

Papa delivers companionship services to older adults in their homes.

Transcend Strategy Group makes new hires and promotions

Transcend Strategy Group has made a series of new hires, and made a number of promotions among its current team members.

“New and newly promoted team members demonstrate Transcend’s commitment to helping clients effectively manage change, maximize sales and marketing performance, as well as expand and retain a diversified workforce,” the company wrote in a press statement.

Transcend Strategy Group is a health care-at home growth strategy firm that is based in Toledo, Ohio.

Tony Kudner joined Transcend Strategy Group as its chief strategy officer. Most recently, Kudner served as senior vice president of marketing and communications at AccentCare.

Nicole McCann-Davis was named senior client advisor and research director at Transcend Strategy Group. McCann-Davis previously served as chief health equity officer and vice president of communications.

In addition to new hires, Transcend Strategy Group also promoted Courtney Penn, Alex Hall and Erin Hefflinger.

Penn was promoted to the role of senior client advisor, Hall was promoted to the role of creative director and Hefflinger was promoted to the role of associate director of digital strategy and analytics.

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A number of factors are transforming the environment in which home-based care providers operate: the rise of value-based care, regulatory scrutiny, reimbursement falling behind rising costs and staffing shortages.

Amid all of that, more than ever, providers need to sell their worth.

“Whether it’s value-based care, talking about diversifying risk or other factors, the opportunity to meaningfully differentiate an organization through the lens of its strengths is actually a tremendous opportunity for smaller providers to compete against larger ones,” Transcend Strategy Group President and CEO Stephanie Johnston told Home Health Care News.

In a new research report, Johnson and her colleagues outlined a number of potential strategies that providers can follow to be better equipped for change in home-based care.

It’s no longer enough for agencies to trust that high-quality care and word-of-mouth reputation alone will sustain their businesses, the report argues.

In order for agencies to thrive today and in the future, a strong value proposition to payers is a critical aspect of an agency’s business operation. In particular, having a diversified referral mix could be a core component for driving sustainability.

“Way too often — and still recently — we hear people tell us that they are still relying on a primary referral source to drive volume,” Johnston said. “Basic risk management will tell you that [strategy] is too risky for today’s care providers at home. They need to think about diversifying their referral mix.”

Johnston compared it to an investment portfolio. Logic would tell an investor not to go all in on one investment asset. Instead, one would manage risk across multiple assets.

“That’s exactly what home care providers should do,” Johnston said. “They should think about a referral portfolio that they’re managing that should include relationships with physicians, hospitals, SNFs and patients and families themselves.”

Relying on hospitals as a primary referral source, where highly acute patients are likely to come from, can create unwanted exposure when staffing becomes a problem, for instance.

From a staffing perspective, Transcend’s report also encourages providers to embrace family caregivers. Many providers, the report argues, are focusing on fighting for the same pieces of the pie.

By looking outside the box and welcoming family caregivers into the employee fold, the pie can be expanded.

“Patients and families are the greatest barrier or accelerator to access and utilization,” Johnston said. “Our research has shown time and time again — whether it’s serving patients and families, serving the nursing workforce or serving underserved populations — that perceptions of care that people experienced earlier in the continuum influence their utilization of home health and hospice care. Patients and families continue to play a significant role, and I think people are just starting to wake up to that because they played such a critical role during COVID.”

Embracing family caregivers can also lead to huge financial benefits.

“In our experience, organizations that actively engaged patients and families earlier experience a considerable return on investment,” Johnston said. “We’ve been tracking that ROI for the past 10 to 15 years, and the average rate of return is about $30 million, or 40 to 50 times what they’re usually investing in building those relationships.”

Prioritizing diversification — in all stages and levels of the business — will also let payers know that a provider is looking ahead to the future as opposed to doing things as they’ve always been done, Johnson argued.

“Organizations that can effectively represent the communities that they serve, whether that’s from an employment mix standpoint, patient and family mix standpoint, or a referral mix standpoint, are going to have more compelling and more holistic stories to tell payers about their ability to impact care in the communities they serve,” she said.

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On their end, however, referring physicians often fail to see the differences between home health agencies and other in-home care providers, new research from senior care consulting firm Transcend Strategy Group suggests.

“We think these findings are extremely important,” Transcend Chief Strategy Officer Stan Massey told Home Health Care News. “Because different providers certainly aren’t all equal.”

To learn more about home health, hospice and palliative care referrals, Transcend surveyed 150 professionals working within different physician offices. Specific job titles included office managers, medical directors and referral coordinators, among others.

Overall, 81% of respondents said they see little to no differentiation between hospice, home health and palliative care providers, on average.

With home health, in particular, 19% of respondents said home health agencies were “all the same,” with 57% saying agencies varied slightly. Just 23% of physician office respondents said home health agencies “varied significantly.”

Transcend polled the respondents on agencies’ quality of care, services offered, responsiveness and reputation. The consulting firm also asked about communication and the “ease of working with” home health agencies.

“I mean, some level of quality clinical care is absolutely a necessity to stay in business, or you’re not going to get referrals,” Massey said. “However, there really are differences in the types of services and the types of nuances between providers.”

Physician office staff saw the least amount of differentiation between home health agencies when it came to “services offered,” according to the research. In other words, referral sources believed all agencies provided the same basic nursing and rehab services, despite the fact many agencies specialize in certain conditions and disease states.

While the findings come across as a negative for the industry, they also suggest there’s referral ground to be gained for agencies that can improve their marketing and communications efforts, Massey noted.

“This research opens huge opportunities for agencies that are successful in communicating or even defining what their differentiating factors are, being able to explain that to referring physician offices,” he said.

Further supporting that notion: Of the survey respondents, less than half of physician office staff said that they regularly refer to a specific home health provider. Yet 73% said that they frequently or regularly refer patients to a specialist.

To come across as specialists instead of generic home health providers, agencies should approach referral partners with data that strategically supports their clinical expertise, Massey explained.

“The metrics that agencies are currently using to measure patient performance,” he said. “Is there a way to further slice and dice that by condition or disease state, just to show this proven track record of how successful they are in meeting key metrics?”

In addition to the survey findings, Massey pointed out home health referral relationships remain strained due to the ongoing COVID-19 pandemic.

Last spring, many physician offices, assisted living facilities and other traditional referral sources began closing their doors to outsiders. Home health agencies had started to rebuild many of those relationships, but then the delta variant caused some referral sources to restrict access again.

“It’s still a pain point. Agencies, I think, started to rebuild, at least until this delta variant came along,” Massey said. “Some of the facilities were starting to relax their policies. They might still ask people to wear masks to come into the facilities, but at least they were letting people start to come in again.”

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Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the coronavirus, according to a recent survey from health care research and consulting firm Transcend Strategy Group.

As part of its survey, Transcend reviewed feedback from about 1,000 respondents, all of whom were family health care decision-makers. Broadly, those decision-makers were more likely to be women between the ages of 40 and 45 years old.

“One of the biggest takeaways … was that 65% of respondents agreed that COVID-19 had completely changed their perception about the best way to care for aging seniors,” Stan Massey, a partner at Transcend Strategy, said Wednesday during a National Association for Home Care & Hospice (NAHC) webinar. “I’ll give you a little spoiler alert: That mind-shift has landed squarely in the favor of home-based care providers.”

Nearly half of survey participants said they had previously considered placing a loved one in a long-term care facility in the future, but have now taken that option off the table.

Additionally, despite the home-based care arena’s own struggles with procuring personal protective equipment (PPE), survey respondents were still overwhelmingly confident that in-home caregivers were following necessary protocols during COVID-19.

In all likelihood, the shift in thinking is not temporary. Within the survey, respondents suggested that their perception of the long-term care options had been changed for good.

“COVID-19 has changed opinions from this point forward,” Massey said. “It had such an impact on families that we feel this ripple effect of really wanting to take every precaution, even if a vaccine for COVID-19 does emerge.”

The concerns are driven, in large part, due to the staggering death toll in facilities across the U.S. Newly released federal statistics show nearly 26,000 people have died from COVID-19 in nursing homes through May.

Family decision-makers’ newfound appreciation of home-based care will likely offer future opportunities for providers looking to grow their businesses.

LHC Group Inc. (LHCG) Chief Strategy and Innovation Officer Bruce Greenstein echoed a similar sentiment Tuesday during a presentation at the Jefferies Virtual Healthcare Conference.

“[The coronavirus is going to change] the psyche of the way people are going to view … long-term care facilities for the rest of our generation,” Greenstein said.

Harnessing momentum

In tandem with family members’ bullishness on home-based care is their increased interest in the value of telehealth.

Over 60% of individuals who participated in the Transcend survey said they’re likely to explore telehealth options in the future.

Telehealth claim lines in the U.S. increased 4,347% between March 2019 and March 2020, according to FAIR Health’s Monthly Telehealth Regional Tracker. A claim line is an individual service listed on an insurance claim.

Though the Centers for Medicare & Medicaid Services (CMS) has not yet authorized the ability for home-based care agencies to be reimbursed for telehealth as they would be for in-person visits, restrictions on remote patient monitoring have been eased. The agency has loosened some of the red tape surrounding virtual care and has encouraged its use during the COVID-19 outbreak.

“When the restrictions started being [removed] off of telehealth, we really thought that it was like letting the genie out of the bottle. And it’s only going to improve from here,” Massey said.

Even if a provider is unable to bill for telehealth services, having good telehealth practices in place could increase the likelihood of a client initiating care plans with them.

“Even if you’re not able to be reimbursed for the delivery of care through telehealth, be thinking holistically about how you deliver adjacent values,” Transcend CEO Stephanie Johnston said on the webinar. “There’s a lot more openness and flexibility within the regulatory framework now for home health providers to get really creative and innovative.”

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