Payer Diversification, Caregiver Financial Flexibility Are Top Home Care Trends for 2020

An increased focus on social determinants of health and the financial well-being of caregivers will shape the home care industry in 2020, AlayaCare founder and CEO Adrian Schauer told Home Health Care News.

A rise in technology partnerships and in-home care providers’ strategic efforts to diversify payer streams will likewise factor into next year’s industry identity, Schauer predicted. In addition to serving as AlayaCare’s CEO, Schauer was recently recognized as an HHCN Future Leaders Awards winner for the vendors and professional services category.

Founded in 2014, Montreal-based AlayaCare is a cloud-based home care technology provider that serves more than 3,000 agencies across the U.S., Canada and Australia. Among its services, the well-funded AlayaCare helps with back-office tasks like scheduling, billing and electronic referral intake, while also assisting with remote patient monitoring and more.


Inovia Capital, Caisse de dépôt et placement du Québec and Investissement Québec are three of AlayaCare’s investors. The group invested more than $38 million (USD) in AlayaCare in July, a funding amount split between new equity and early-investor stock.

Generally speaking, AlayaCare’s recent momentum and growing list of provider clients give the company a good feel for where home care is headed next year, according to Schauer.

“There are a number of trends we see playing out in 2020, and they’re all slightly different in nature,” he said.


Home care’s social, financial priorities

“Social determinants of health” (SDoH) became a popular phrase in 2019, despite the fact hospitals and physicians still aren’t screening for those factors, which include an individual’s access to transportation and risk of social isolation.

Federal health care policymakers and private insurers are partly to thank for the SDoH focus.

Throughout the past couple of years, the Centers for Medicare & Medicaid Services (CMS) created new avenues for Medicare Advantage (MA) plans to address social challenges, specifically by expanding the types of in-home services and supports they’re allowed to offer as supplemental benefits.

About 12% of the 3,148 MA plans available to Medicare beneficiaries in 2020 will take advantage of that expansion in 2020, many with SDoH-related benefits. Leaders from Aetna, Anthem Inc. (NYSE: ANTM) and Humana Inc. (NYSE: HUM) — three of the largest MA players — each recently touted their SDoH strategies on HHCN.

“People aren’t just medical diagnoses,” Aetna Medicare CMO Dr. Robert Mirsky told HHCN earlier in November. “Many seniors also have overlying or underlying or behavioral health issues. Making sure that we’re taking care of their social needs, their personal needs so that they can have a high quality of life is really important.”

The year ahead will bring more of the same, especially as home care providers’ SDoH-related data capabilities improve, Schauer said.

Senior Helpers, which launched a “micro-social determinants of health” tool this fall, is just one example of home care’s evolving data capabilities.

“I mean, social isolation is going to be more predictive of adverse health events than even your heart rate is,” Schauer said. “I think the evidence is in.”

The focus on social determinants of health won’t go away in 2020 — and nor will the caregiver crisis. That means the overall financial well-being of caregivers is guaranteed to remain a pressing issue, too.

About one in six U.S. caregivers currently live in poverty, according to New York-baed advocacy organization PHI. In 2018, inflation-adjusted median hourly home care wages were $11.52, with workers bringing in an annual income of $16,200.

To strengthen caregivers’ financial status, some home care agencies have implemented daily-pay programs. Others — including AlayaCare client Integracare and San Francisco-based Honor — are building out internal methods for ensuring caregivers receive stable hours and income stability.

Taking care of older adults is a difficult job — and one that often pays less than the $15-an-hour positions currently being offered by retail giants Walmart (NYSE: WMT) and Amazon (Nasdaq: AMZN).

Any financial flexibility and predictability home care agencies can afford workers will be an edge in 2020.

“Home care is a tough job and you have to be competitive, but that’s harder than ever,” Schauer said. “A lot of care workers in this industry are paycheck to paycheck.”

The financial well-being of home care workers will be a trend in 2020 despite what happens in the broader economy, as some economists are projecting a relatively gloomy global landscape next year, Schauer noted.

“Regardless of shifting labor markets … investing in employee financial well-being is never a poor strategy,” he said.

Mixing it up

Besides social determinants and caregivers’ financial well-being, payer diversification will also be a hot topic in 2020.

Indeed, Schauer said he has seen many of the private-pay businesses AlayaCare works with starting to court third-party payers and government health programs. On the flip side, historically government-reimbursement agencies are beginning to open private-pay service lines as well.

Medicare Advantage is additionally growing into a new revenue stream for some.

“Private-duty agencies are doing more Medicaid, and Medicaid agencies are doing more private-duty,” Schauer said. “And as long-term care insurance becomes more prevalent, more and more agencies are taking on the assignment of benefits themselves. Instead of just delivering visits, invoicing clients and letting them claim back for insurance, they’re taking charge of that program.”

Schauer’s final prediction for 2020: In-home care providers will realize “it now takes a village” to deliver home care.

In other words: Providers will more often turn to a plethora of cloud-based technology partners that all work seamlessly together.

“Providers being able to put together a set of specialized apps that help them differentiate their business and deliver great care, that’s probably my [No. 1 prediction for 2020],” Schauer said. “I think the time is finally right in this industry, which I think is a few years behind certain others relative to the adoption of cloud-based software with open API’s.”

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