Senior Helpers CEO: Private Duty Gains Health Care Cred, Influence

Senior Helpers, one of the nation’s largest home care franchise companies, has joined the Healthcare Leadership Council (HLC), a coalition of chief executives from all health care disciplines that develops policies, plans and programs to achieve a greater system for quality, affordable care.

The addition marks the first private duty provider on the HLC and comes at a time when private duty may be on the cusp of being included as a supplemental benefit with Medicare Advantage plans. HLC’s members include major health care players, including Aetna, Pfizer, Mayo Clinic and many more.

Home Health Care News caught up with Peter Ross, CEO of Senior Helpers, to learn more about the role of Senior Helpers on the HLC and where home care is headed in the care continuum. Ross is also the head of the Home Care Associations of America (HCAOA).

What is the role of the Healthcare Leadership Council (HLC)?

The HLC is a coalition of CEOs from all disciplines within health care. The focus is to drive quality of care and making sure policies and laws are focused on care quality. We’re working with Congress and legislators and the Department of Health and Human Services (HHS) to make sure the health care system is being represented, to mandate that quality care is always looked at as the first priority.

We had a chance near the end of last year to start having conversations understanding where I felt home care belonged as part of the health care continuum. We’ve been working very hard to work with legislators on the value of home care. Mary Grealy (president of HLC) saw the benefits [of home care] and realized that they had no representation in that space. She liked my vision for where I see home care.

The silver tsunami is on the shore now, and I don’t think the health care system is ready. I believe home care plays a huge role in that.

What is your vision for home care?

What I dream about every day is that home care would be considered an option rather than automatically putting people into facilities.

When I look at the market, I divide it into three components. I break it down by ability to pay. You have this middle class to upper to wealthy class, and these folks can afford home care. It is still he most inexpensive opportunity to live out your life in your own home, in my opinion. These folks can take advantage of that and have the resources to pay privately. That’s probably about the top 30% to 40% of the senior population. Those folks have that ability to drive their wants, and their needs are met by home care.

But then you have the Medicaid population, folks who are eligible for Medicaid waiver. And they do so in a way that gives them some care, not usually the care they need, but at least by the government and some Veterans Affairs (VA) work.

Then you have this huge middle part—folks who aren’t wealthy enough to pay privately and not poor enough to qualify for state or federal aid for coverage. My dream is finding a way that we can service that pocket of the market. I have nothing against facilities for the right type of medical situations, but what happens is they can’t get home care, can’t get reimbursed, but mom and dad can get long-term care facility coverage as part of Medicare and Medicaid in the facility.

The problem about that is mom or dad don’t want to go—96% of seniors want to live it out at home. This is a huge burden to the government because it they are covered by Medicare or Medicaid, it’s a quarter of a  rmillion dollars in rent alone, not even the health care. You start looking at this huge issue and that’s where home care can come into play.

What does it mean that Senior Helpers is the first in-home care provider on the council? 

It’s part of that dream.

You have a vision of home care becoming more relevant. I don’t think it’s just because of Senior Helpers. The membership of the HLC is rightly the who’s-who in the health care system. Home care for many years was not considered health care at all.

Senior Helpers, back in 2002, [was branded] non-medical, non-skilled, which I thought was totally ridiculous. We were part of the health care system and have skilled caregivers. We do a lot of training, especially around chronic illnesses. Having HLC realize that private duty home care plays a role and needs a seat at the table, I think it’s a huge deal. I really do think they are finally accepting, which for many years we were on the outside looking in.

What was your reaction to the Centers for Medicare & Medicaid Services (CMS) announcing home care supports could be added to Medicare Advantage plans in 2019? What opportunities do you see when it comes to engaging with the federal payers, as either a direct benefit or as a risk-bearing partner?

Hallelujah.

With CMS … you have to read between the lines. My first reaction was ecstatic, but I had to calm down because I had to read what they were actually saying. I’m very happy with it. I think it’s a good step in the right direction and it makes sense. MA plans are all risk bearing. I’ve had conversations with MA plans before and looked at pilots to look at bundles and ways to cut costs and improve outcomes. Eventually getting Medicare to recognize home care would be next, below [achieving] world peace and [ending] world hunger, but we’re working on it.

The MA companies have always bought into [home care], but haven’t had approval to pay for it. I wish it was today, but I’ll take it for 2019.

Written by Amy Baxter

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Amy Baxter
Assistant Editor at Home Health Care News
When not writing about all things home health, Amy fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."

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