Over the past few months, home health providers across the country have had to quickly adapt their operations to the coronavirus and the business challenges that come with it.
For Dallas, Texas-based Intrepid USA Healthcare Services — one of the largest home health, hospice and home care companies in the country — innovation has meant completely virtualizing its business operations while forging closer ties with patients and staff. It has also meant carefully navigating federal support efforts, including CARES Act relief funding.
“We started getting a sense that we were going to have some major challenges early on,” Intrepid CEO John Kunysz told Home Health Care News.
With roughly 1,700 active employees and 75 local care centers across 17 states, Intrepid is currently ranked as the 12th-largest home health provider in the U.S., according to the most recent industry ranking from LexisNexis. In 2019, the company cared for more than 22,000 patients under its home health service line alone.
While all home health providers have had to innovate, the need was even more urgent for Intrepid, which Kunysz affectionately refers to as “a flyover-state home health company.” Many of Intrepid’s patients and staff live in remote, rural areas, often meaning the provider is their main bridge to the broader U.S. health care system.
“As a company, we are the hills, hollers, bayous, backwoods, barrier islands, beaches, deserts and prairies of these United States,” Kunysz said.
Intrepid’s COVID-19 response kicked off in earnest in early March. The company had been following the spread of the coronavirus since the start of the year, but then decided to fully virtualize its internal operations on March 6, at least a week before most businesses started sending employees home.
Oddly enough, it was Starbucks, Salesforce and fortunate family connections that helped trigger Intrepid’s early actions.
“At the time, my son was working for Starbucks, and my daughter was with Salesforce,” Kunysz said. “I found out both their offices had sent people home. That was a huge heads up. I remember calling our leadership team saying, ‘We’ve got to send everybody home, immediately.’”
Fortunately, Intrepid had already invested a lot of time and resources in virtualizing certain office functions, according to Kunysz. As a result, it was able to shift to an entirely remote strategy by March 10.
“By the time we woke up on Tuesday, March 10, everything was completely virtualized, with people working remotely across the entire enterprise,” he said. “And that’s pretty phenomenal, considering we’re talking about 1,700 people and a timeline of about four days, including the weekend.”
Sifting through rumors
After virtualizing its business operations, Intrepid began holding daily, company-wide town hall meetings. The primary goal of the town hall meetings is to sift through inaccurate information and support employees, particularly caregivers and clinicians still conducting home visits, Dr. Robert Parker, Intrepid’s chief clinical and compliance officer, told HHCN.
They were especially valuable early on, when all sorts of misinformation was being circulated throughout the general public.
“I started our daily town hall calls with the company, really, to do rumor control and [show employees] that leadership was present with them and listening,” Parker said. “We were working fast and furious just to digest everything that was coming out, to make sure that people were latching onto accurate information.”
Broadly, the daily town halls have helped demonstrate Intrepid’s commitment to its staff. They have also served as a means of transparency, with regular updates on personal protective equipment (PPE) and other hot-button topics.
So far, Intrepid has been able to manage on the PPE front, according to Parker. The company’s PPE success is partly linked to the Accreditation Commission for Health Care (ACHC) process Intrepid went through in 2019, which required Intrepid to solidify its infection control and prevention practices.
“We immediately took inventory of everything company-wide,” Parker said. “And then as we needed to, we started distributing from one location to another to help balance things out, if need be.”
While the Trump administration has previously touted a strategic national stockpile of PPE, Intrepid — like most home health businesses — has largely had to look out for itself. In-home care providers continue to be left off of PPE priority lists, perhaps even more frequently now than before as government officials look to begin reopening nursing homes.
“We kept hearing about the strategic surplus and how there was this huge surplus that was going to get out there,” Parker said. “But quickly, we realized that wasn’t going to happen. We actually went very extreme and started looking at alternative items that could be used if we got to a certain point.”
Turning to technology
During the COVID-19 crisis, about eight out of 10 home-based care agencies saw a dip in admissions, with most agencies seeing a reduction of more than 15%, a recent survey from the National Association for Home Care & Hospice (NAHC) revealed.
But Intrepid USA Healthcare Services never saw a sudden drop across its operations — or a sudden spike.
“We’re a flyover-state home health care company,” Kunysz. “And that has insulated us from a lot of the tremendous swings that have occurred with patient censuses in the major Metro markets.”
Although it’s insulated, Intrepid has been caring for COVID-positive patients, the company confirmed. Similarly, it has had staff members who have contracted the virus.
In addition to virtualizing its business operations and strengthening internal communication, Intrepid also ramped up the use of an innovative, multi-purpose technology tool it had begun using last fall. Originally, the plan was to pilot the tool in a handful of locations in the early part of 2020.
Broadly, the tool allowed Intrepid to conduct company-wide health screening for all employees — not just clinicians or caregivers. It also added to Intrepid’s video-conferencing capabilities with physicians, patients and their families.
“We started mandating, across the board, that everybody did daily health screenings,” said Kunysz, who takes his own temperature while using the screening tool each morning. “We put messaging out to our patients and referral sources that we screen anybody coming into your home, daily. You’re safer with our people than you are with a family member.”
With company operations in a relatively stable position, Intrepid leadership is now working to figure out how to use the funding it received through the CARES Act’s Provider Relief Fund.
Many home health companies are in the same position, including Brookdale Senior living Inc. (NYSE: BKD) and Encompass Health Corporation (NYSE: EHC), the latter of which announced Tuesday it has returned $237 million in funding received through the CARES Act.
“We already had adequate enough capital and resources, we felt, to be able to weather the COVID-19 issues,” Kunysz said. “We completely segregated all of the advances and the funds … into separate accounts, so that they’re restricted-use accounts. It’s kind of like a petty-cash box that you can only use for COVID-19 based upon what [the U.S. Department of Health and Human Services] gave us as far as guidelines.”
Despite challenges and questions in the present, Kunysz said he expects an acceleration of health care in the home long term.
“About 125 years ago, all care was delivered in the home, and you only went to the hospital if you were incredibly sick,” he said. “The care needs to be done in the home — and all patients should be seen there, when possible. That’s going to be the No. 1 fundamental change.”