Bayou Home Care Owner: It Takes More Than Quality Care to Keep Home Health Businesses Alive

In the past, home health providers could almost exclusively focus on quality of patient care, sit back and watch their businesses thrive. Today, there are far more variables to factor into the equation for operational success.

That’s according to registered nurse Donald Lirette, who also happens to serve as executive director and owner of Bayou Home Care in Louisiana.

“In today’s home health landscape, it definitely takes a lot more than quality patient care to stay alive,” Lirette told Home Health Care News. “And that’s been our biggest challenge.”


After working in the home health field for more than a decade, Lirette and a partner founded the steadily expanding Bayou Home Care in 2003. With six total locations, the company makes its headquarters in Houma, Louisiana, “right in the middle of Cajun Country,” according to Lirette.

As a home health provider, Bayou Home Care provides the traditional mix of skilled nursing and therapy services, while also offering medical social worker and transitional care liaison services. Its current average daily census is about 650 patients, a number that will soon more than double following a recent transaction agreement.

There are seemingly countless challenges home health operators now face, but likely none are more prominent than the Patient-Driven Groupings Model (PDGM). Among its challenges, PDGM comes with cash flow obstacles and changes to therapy reimbursement, plus a baked-in behavioral adjustment upward of 4.36%.


“PDGM is a fair payment system,” Lirette said. “But if agencies don’t change the way they deliver care, they’ll find themselves in the financial crisis pretty quick — even if they’re providing quality care.”

As part of its strategy to stay on top of PDGM, Bayou Home Care turned to predictive analytics.

Specifically, the provider began using WellSky’s CareInsights platform in November.

A portfolio company of TPG Capital, WellSky serves more than 14,000 client sites globally, including hospital systems, home health agencies, hospice providers and other health care entities. Its CareInsights platform leverages historical data from more than 7 million patient episodes to help providers risk-stratify patients, refine their utilization patterns and monitor outcomes in real time. 

Nearly 600 clinical sites are currently using CareInsights analytics, according to WellSky.

Predictive analytics success

Bayou Home Care turned to predictive analytics to refine its operations at a time when it’s also looking to grow. The company secured private equity backing in 2019, then kicked off 2020 by agreeing to acquire three more home health providers.

Taking those acquisitions into account, Bayou Home Care’s patient census would spike to 1,500, according to Lirette.

“Our goal is to acquire a hospice company and grow our platform into Texas. We have a few companies we’re currently looking at in Texas, for both home health and hospice,” he said. “Our goal is to get our home health centers to about 3,000 [patients] and our hospice centers to 500 within the next few years.”

Predictive analytics similarly fits into those growth goals, as maximizing visit efficiency enables Bayou Home Care to deploy resources elsewhere. CareInsights itself is currently free to use during a special pilot period, though it will later require a monthly subscription fee following the first quarter.

Broadly, there are three key areas that predictive analytics tools need to address, according to Wes Little, WellSky’s chief analytics officer. For starters, tools need to actually deliver at the point of care.

“The No. 1 priority for any analytics solution in home health care should be, ‘How do we make the people who are actually at the tip of the spear smarter in every single interaction that they have with a patient?’” Little told HHCN.

Additionally, predictive analytics tools also need to support care managers, mainly by helping them identify the most vulnerable patients.

“Care managers need to be able to focus in PDGM on the 20% of patients who are likely to drive 80% of the overall variation in cost and quality,” Little said.

Finally, tools must offer real-time capabilities.

When it comes to PDGM’s impact on Bayou Home Care, the provider actually expects a 10% to 12% lift in Medicare payments, Lirette said. That’s mostly because Bayou Home Care has a lot of institutional referrals, shorter lengths of stay and a lot of complicated wound patients.

It has no plans to alter therapy utilization, as it has always been a low-utilization therapy provider compared to regional and national averages.

“We never really experienced any hiccups because we’ve always provided appropriate patient care along the way and didn’t game the system,” Lirette said. “We expect to keep doing the same thing.”

The re-hospitalization race

Apart from PDGM, the constant battle against re-hospitalization rates is another struggle home health providers face. Industry-wide, providers are in a never-ending race based on who can get re-hospitalization rates closest to 0% — and, in turn, appeal to potential referral partners.

CareInsights has helped with that, too, Lirette said.

After beginning to use CareInsights technology, Bayou’s branch in Houma, Louisiana reduced their re-hospitalizations by 27% over a three-month period.

“It’s a win for the patient to ensure appropriate care is given to decreasing their risk for re-hospitalization,” Lirette said. “And, of course, it’s a win for the for the agency, because we all know that in today’s environment, acute care facilities only partner with agencies with low hospitalization rates.”

*Editor’s note (Feb. 28, 2020): An earlier version of this story incorrectly stated that CareInsights pulls data from 600 sites of care. CareInsights leverages data from more than 7 million historical patient episodes; 600 sites of care are currently using CareInsights.

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