When Dr. Cleamon Moorer, Jr., acquired American Advantage Home Care Inc. in June 2019, he understandably envisioned the Patient-Driven Groupings Model (PDGM) being his business’s No. 1 challenge in the year ahead.
But then the COVID-19 virus came along, forcing Moorer to totally rethink his home health agency’s priorities and future plans. So far, that has partly meant leaning more heavily on transitional care programs, opening up a new call center and reevaluating certain business expenses to maximize efficiency — all while growing at a more than 400% clip.
“I think for smaller agencies, the key is value,” Moorer told Home Health Care News. “What is the value that we offer in our communities? What makes us ‘rare’? What’s something we do that’s hard to imitate? Then pairing all that with operational efficiency.”
Headquartered in Dearborn, American Advantage Home Care provides skilled nursing, rehab and specialty care services across nearly a dozen Michigan counties. The agency has been around since 2012, initially launching as a provider that catered to Dearborn’s Muslim and Arabic residents.
“The previous owners founded the agency with the sole intent of serving Muslim [and] Arabic residents in Dearborn,” said Moorer, who currently serves as American Advantage Home Care’s president and CEO. “Since we acquired it over a year ago, we’ve been able to grow it and expand greatly.”
Prior to Moorer’s involvement, American Advantage Home Care’s average daily census hovered around 13 patients. Its census is now around 75 patients and growing by the day, even with the continued disruption caused by the public health emergency.
Overall, Moorer anticipates that American Advantage Home Care’s annual revenue will check in somewhere between $1.5 million and $2 million in 2020. Moving forward, he hopes to grow the business by strategically expanding in and around Detroit.
“So many of the patients in Detroit are left out of the ecosystem of skilled home health care, where the brands that they know are only the large hospital-based branches of home health care,” Moorer said. “We see a great opportunity to get into the urban neighborhoods and communities, where a lot of agencies don’t have the desire or the interest to go. We want to better serve those neighborhoods.”
A more holistic approach
After acquiring American Advantage Home Care, Moorer worked diligently to become “a PDGM scholar,” a mission that included several industry workshops and reading up on the payment overhaul whenever possible.
Similar to many of its peers, the agency’s approach to PDGM has been focused on accurate coding, a greater utilization of nursing visits and improved communication with referral sources. In regard to that latter point, that sometimes means following up with patients’ physicians to better document underlying conditions and health problems.
“We’re finding ourselves being more holistic in our approach, where we get a referral and look at the referral from the standpoint of, ‘What’s missing about this particular patient and his or her health background?’” Moorer said. “From there, we get on the phone with a primary care physician and dig a little bit deeper into these diagnosis codes.”
American Advantage Home Care’s preparation has allowed the first year of PDGM to be relatively balanced compared to the Prospective Payment System (PPS), he noted.
But while the agency’s PDGM plans called for more nursing visits, it still sees a critical need for therapy in response to the coronavirus. Many patients who contract the COVID-19 virus end up with symptoms that linger for months, including extreme fatigue and muscle weakness.
“We’re looking at some of those patients that need a little more therapy than they would normally need, due to the recovery period,” Moorer said.
In the early days of the public health emergency, the fast-growing American Advantage Home Care saw its home health volumes dip by about 20%. Volume has since rebounded, despite the more recent surges that Detroit and neighboring areas have seen over the past couple of months.
“We are, here in Southeast Michigan, going through a resurgence,” Moorer said. “We do have a small percentage of our census that did test positively. We’ve also been able to take care of some patients who tested positively initially, then tested negatively a couple of weeks later.”
Moorer previously explained to HHCN how his business was seeing an increased need in transitional care programs that help nursing home residents return to their or a family member’s home.
Additionally, American Advantage Home Care is seeing a need to establish more “touch points” with patients. To do so, Moorer set up a call center inside of Durfee, an innovation hub located on Detroit’s west side.
Durfee — ran out of a converted school, where each classroom houses a different business — is the perfect site for American Advantage Home Care because of its health care connections, Moorer said. There are a couple of clinics at Durfee and a cancer support group, as well as a soon-to-be Blue Cross Blue Shield of Michigan office.
“We decided to look at our current roster of patients and assign intake specialists in that office to do weekly check-in calls. Sometimes we do those a couple of times a week,” Moorer said. “From a technology and monitoring standpoint, we have also started to look at televisits, though Medicare hasn’t developed a reimbursement model yet for home health care.”
Leading a Black-owned agency
Apart from PDGM and the coronavirus, there’s another topic that should be on home health providers’ radar: the ongoing conversation about racial justice, highlighted by months of protests throughout the U.S.
Broadly, the home health workforce is largely made up of people of color. Although minority groups have been shown to receive home-based care less often than white individuals, many organizations are ramping up efforts to deliver services to traditionally underserved populations.
Owned and operated by Moorer, who’s Black, American Advantage Home Care has an edge when understanding racial justice on both accounts, he believes.
“I do believe that,” he said. “And I also believe that [we have an advantage] with the discharge planners as well.”
Generally, Moorer said, American Advantage Home Care has built a trusted reputation with Black patients and communities. Hospital discharge planners know that and, in turn, feel more comfortable referring patients to the agency.
“When you know the streets, the different communities and the area — it’s not just Google Maps for you — that makes a key difference,” Moorer said. “It really does. It makes you more relatable and approachable.”