The health care landscape is experiencing a shift, with in-home care services at its core. As payers and regulators continue to seek efficiencies in the care delivery process, care providers are reassessing their offerings.
Many are adding services they have not provided historically as a way to capture more of the care continuum. Those historically focused on home health may be pursuing hospice care; or those focused on the private duty personal care market might consider the growing opportunity in private duty nursing, for example.
“For us, private duty is both skilled and unskilled,” says Dave Lamb, general manager of CareMaster Medical, based in Griffin, Georgia. “It depends on what the client needs — dependent care with CNAs, or skilled nursing or sometimes a combination of both.”
Today’s challenges and opportunities
Many of today’s challenges arise from the labor market, and providers cite staffing as a top concern. Changing payment models and government reimbursements contribute additional uncertainties, as regulators continue to favor value-based care and measured patient outcomes.
“There’s no question that the U.S. home care industry is undergoing rapid and unprecedented change,” says Adrian Schauer, founder and CEO of a venture capital-financed home care technology platform called AlayaCare. “Some call it the ‘perfect storm’ — a set of concurrent challenges that can start to batter any agency’s ability to stay afloat.”
Schauer cites the perfect storm challenge as the following:
- Caregiver shortages and the resulting margin compression
- Influx of aging, chronically ill baby boomers
- And a shift from quantity to quality care that deliver health outcomes.
CareMaster Medical, which has been in business for 33 years, sees the rising challenges firsthand.
“Our [baby boomer] generation is putting tremendous pressure on the health care market in general,” Lamb says. “It’s exciting but daunting at the same time … If you are looking at 12% to 15% burden [with current reimbursements and costs], it only gives you $2 to $3 of margin to pay your bills. It’s not sustainable.”
The rise of private duty nursing
Given the rising health care needs among those who have chronic health conditions requiring nursing care, private duty nursing is one service some agencies are pursuing. Private duty nursing is a covered benefit under some state Medicaid programs, including Georgia, and it is also offered under a private-pay model by many agencies, particularly those that already offer skilled nursing services.
CareMaster Medical started out as a staffing agency for nurses and the ability to offer private duty nursing became appealing as a way to cover a whole host of patient needs, regardless of payment type or need for skilled services, Lamb says. The company provides private duty nursing under Georgia’s Medicaid program, and is also certified to offer services in Alabama and South Carolina.
“From our perspective we see better results when we deliver a broader set of services beyond siloed ‘medical’ vs. ‘non-medical,’ Lamb says. “Integrated, collaborative and coordinated care on the full continuum is part of unlocking better health outcomes.”
As a result, the agency is able to meet the needs of many types of patients and care recipients in their homes, whether they need health care or personal care, or have specific needs relating to an injury or chronic condition.
Where technology can help
Coordinating the many professionals who deliver the care, as well as a complex patient-mix, comes with additional challenges. One practice CareMaster Medical implemented for its private duty cases was to include a nurse manager for each case who serves as a care coordinator between the care team, patient and family.
The company also sought a technology solution that would help manage care and provide continuity of care for its many patients and patient needs.
“We want to be able to provide real-time care,” Lamb says. “In my mind, the essence of taking care of someone in the home is best served when we have the ability to provide real-time care. Under our previous system, reporting moves to the end of the week. If someone is late to turn in paperwork, we might find something had happened that we were not aware of. That is not acceptable.”
The company began using AlayaCare’s platform in 2017 after vetting many technology providers. It now runs scheduling, tasks, patient signatures, employee payments, communication, data routing and more through the system, essentially using the elements it needs to support care delivery and operations.
“We try and view the home care world through the lens of a service provider,” Schauer says. “There is no single solution that completely gives an agency the freedom, flexibility and speed to keep up with change and innovation for various service lines. So, with that in mind, the answer isn’t an isolated system, but instead it’s a flexible software platform that bridges other systems via APIs (Application Programing Interfaces) that allows payers, providers and their practice management solutions to ‘talk to each other’ in real time in bi-directional synchronization.
The platform allows clients to use the product in a way that best suits their needs by removing any barriers between data sources. It also supports an integrated care mix including skilled and non-skilled services from an EHR and charting perspective, and ultimately the patient outcomes can be improved as a result.
“When two or more of the services are not delivered in a coordinated and collaborative manner, gaps occur which adversely affect the client’s ability to achieve health outcomes, limit the ability of the providers of care and frustrate the client who must repeat and relay information several times,” Schauer says. “AlayaCare core strength is its flexibility to deliver a full continuum of care that ranges from low acute day programs to higher acute nursing tasks and even remote monitoring.”
Providers like CareMaster and their partnership with AlayaCare believe the future of post-acute care is ultimately about delivering better health outcomes, including shifts into new care delivery services, like private duty nursing. The greater the ability for providers to leverage their data, the greater their chance of thriving in this new landscape.
To learn more about AlayaCare’s private duty nursing solution, visit http://www.alayacare.com.