Cincinnati-based FirstLight Home Care is one of the largest and fastest growing home care franchise networks in the country. Despite sustained levels of past success, FirstLight — like the home care industry itself — has had to evolve in the face of emerging challenges and opportunities.

For FirstLight, that means guiding its franchise locations through the ongoing caregiver shortage, while also putting in place infrastructure that appeals to Medicare Advantage (MA) plans. Additionally, it means reinforcing the business model with multiple specialized care lines to better tackle brain health and certain complex diseases, according to CEO and co-founder Jeff Bevis.

Bevis discussed FirstLight’s evolution and growth plans during his recent appearance on the Disrupt podcast for Home Health Care News.

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Below are some highlights from HHCN’s conversation with Jeff Bevis, edited for length and clarity.

HHCN: I want to start by highlighting FirstLight’s 2018 momentum, then shift into strategic plans for 2019 and industry trends. FirstLight was named to Franchise Times’ Fast & Serious List in January. What have been your keys for achieving and sustaining growth across your franchise network?

Bevis: There are several core items including continued focused on our franchise development process as far as how we go about finding the right franchise owners. We’ve also stayed focused on client satisfaction — and caregiver retention and turnover.

We’ve reported in the past how FirstLight has been pushing a conversion model, bringing independent agencies into the fold. The first conversion was Hearthside Home Care last year. How’s that going?

I think Hearthside is off to a great start in their conversion with us. They’re just outside of Greensboro, North Carolina.

Do you have any more conversions in your pipeline?

We do.

We have several other conversions within our pipeline — at least seven right now that are in different parts of the country. We really see that as a major injection to our growth — not only for the coming year but for several years to come based on the fragmentation of the industry.

I imagine a conversion model can help in some states where there are regulatory hurdles or barriers to opening up new agencies.

That’s exactly right.

In North Carolina right now, in fact, conversion is the only opportunity. There’s a moratorium on new licenses there. So that’s very true. In North Carolina, for us to add more offices in the short-term, this is the only way to go about it.

Let’s say I’m a standalone, mom-and-pop home care agency. Why should I consider converting to FirstLight? What are the pros and cons for me?

Pros would be that you’re not in it alone anymore, meaning you have support and infrastructure you can lean on across every aspect of the business — technology, branding, operations, recruiting, marketing — you name it. You don’t have to come up with your own programs, your own solutions, your own kind of evolution.

Especially as the industry is growing, having people in alliances or being part of a larger system — that’s going to become even more important.

On the negative side, you are losing total independence. But you’re still going to be an entrepreneur. You’re still going to have your own company. It’ll just be part of a larger brand.

And there are franchising fees.

Correct. It’s a negative or positive depending on how you look at it. We see the big draw to home care agencies as they’ve got it grow [with FirstLight’s help]. We’ve got to help them probably double or triple in size to help offset some of that financial cost of them paying royalties.

Joining a larger network may also add appeal to MA plans, I’ve heard.

Very, very true. With MA plans as well as larger alliance companies around the country, they want consistency. They want accreditation. They want technology.

We connected not too long ago and you told me FirstLight was seeing strong growth when it comes to third-party payers. Can you touch on that briefly?

The third-party payers we see are primarily related to areas like long-term care insurance, Veterans Administration and some of the regional and national contracts that span across our industry. It’s not that we’re giving up or not seeing growth in the private-pay side — we are — we’re just seeing even more interest and growth from the third-party pay side as we grow the system in more and more markets.

U.S. MA penetration is expected to hit roughly 50% within the next decade or so. The program itself is becoming more flexible in allowing for in-home services and supports. When does FirstLight project the real MA opportunity to arrive — and what are you doing to position the franchise system to capitalize on that?

We are seeing Medicare Advantage opportunities arriving now. The Centers for Medicare & Medicaid Services (CMS) change was effective as of Jan. 1 of this year. We are getting more individual inquiries from individual policyholders, people asking about our services and who have heard in-home care services are now available with their policy.

From a plan and carrier standpoint, you’re going to see that more in the years ahead, probably next year when carriers have had their full, normal actuarial cycle time to go through and rate, price things.

But we’re putting all the infrastructure in place now: electronic health record (EHR) systems, accreditation standards, electronic visit verification (EVV) requirements. Those will all be core points no matter who the carrier is if you want to play in the Medicare Advantage space.

What else can you tell me about what FirstLight is doing in connecting with the big MA entities? Have you had conversations already or do you have any plans?

Yes and yes. I’ve already had conversations with major carriers. We have more of those that are ongoing with additional, smaller regional carriers. We don’t see that there will be slow or no growth this year. We just think it’s going to be slower than what hits next year with the full range of carriers are going to be after it.

Changing topics: FirstLight has been coming out with a lot of new service offerings. One of those is FirstLight’s new brain health program, which is designed to promote neuroplasticity. Why do that?

The brain health program revolves around a couple of different components. We were able to partner with a company called Ageless Grace, which focuses on movement and the value of movement as it affects brain health.

It’s about improving brain health and flexibility for existing clients, as well as potential new clients. Physically, too, it helps people just move around and not be so restricted in their home or facility — wherever we’re providing care. It’s also about doing things differently. If you brush your teeth with your right hand, maybe try brushing your teeth with your left hand.

You’re taking basic day-to-day movements and putting a different twist on them.

We see Ageless Grace as a component in addition to our enhanced dementia care training. Then we also have Constant Therapy.

By the way, rolling out specialized care lines was one of the trends HHCN predicted for 2019. Thanks for making us look good.

Your crystal ball is a good one.

And Ageless Grace, as you pointed out, is different than your specialized dementia care training program.

Right. We wanted to make sure that our caregivers were properly trained in dealing with patients, clients, families that had early dementia signs or diagnoses. That’s not that same type of basic service offering.

How do caregivers view the training program?

We think that’s a major component to this too. It’s enhancing caregivers’ professional development. They’re learning. And it helps FirstLight stand out to them as an employer of choice or as a company they want to stay with for the long term.

FirstLight has also incorporated a new FirstLight health care solutions segment too, something to help leverage remote patient monitoring and telehealth by being the eyes and ears in the home. Can you tell me a little bit about that program?

This is another new offering we’re rolling out later this year that’s going to incorporate several different aspects, including remote patient monitoring and telehealth devices. Literally have clients in their homes download their vital signs, take a pulse oximeter reading, take a blood reading. That’s sent via cell network to a nurse call-in center and is able to be triaged or prioritized if a client has gained weight or is retaining water, for example.

We’re very excited about the remote patient monitoring component of this. We have a great new partnership with a telehealth provider that we’re excited to be part of. They have a number of major insurance carrier contracts that we’re going to be able to partner with as well.

Is there a tentative launch date?

March 1 will be our next pilot launch of 18 more offices. We’ve had three offices in pilot for about the last 12 months. We’re going to be adding more and more offices every quarter through 2019.

I want to jump around again. Let’s go back to recruitment and retention. What’s your outlook with that?

We think recruitment and retention are going to continue to be challenging. We do think that more creative recruiting sources and tools — along with targeting more unconventional age groups — could make a big difference. That’s what we have been doing here. Caregiver turnover has got to be one of the most important metrics that every home care company is measuring on a day-to-day, week-to-week basis.

Our turnaround continues to run at about 20% to 22%.