Elara Caring has had to juggle a lot of challenges over the past year.
The COVID-19 pandemic is the most obvious one. On top of that, Elara Caring is still relatively new, having formed in 2018 through the combination of Great Lakes Caring, National Home Health Care and Jordan Health Services.
When the public health emergency hit, the company was still putting the finishing touches on its integration strategy while adjusting to the Patient-Driven Groupings Model (PDGM) at the same time.
There was a lot Elara Caring needed to accomplish, CEO Scott Powers recalled. Instead of getting derailed by COVID-19, the organization used the crisis to get things done.
“We viewed the situation and thought, ‘Let’s not waste a good crisis,’” said Powers, speaking at the Home Health Care News PDGM Summit earlier this month.
Elara Caring is one of the 10 largest home health providers in the U.S., according to the Atlanta-based data and technology firm LexisNexis Risk Solutions. The Addison, Texas-based provider currently has about 225 offices across 16 states, where it’s 32,000 caregivers take care of around 65,000 patients daily.
At the PDGM Summit, Powers described how he was able to leverage the COVID-19 crisis to move his company forward, shifting Elara’s model to be better suited for the pandemic and more prepared for the future.
“We were trying to integrate three companies,” Powers said. “And so this became somewhat of a catalyzing moment for us as an organization. We kind of became one company through this process.”
Elara Caring offers skilled home health, hospice, personal care and in-home behavioral health services, which gives it a unique value proposition, the CEO noted.
“We’re probably 90% of the way there from an integration standpoint — our tools and processes are all there. It’s really just making sure now that we are one organization and one culture,” Powers said. “And this pandemic has really accelerated that, in my opinion, because it got us focused on what really matters, which is providing care in the middle of a once-in-a-lifetime crisis.”
In addition to getting everyone on the same page, the pandemic also triggered more innovation at Elara.
There were systems Powers and his team knew they needed to build. The last year gave them the opportunity to focus on those goals and hone in on the company’s core beliefs.
The company’s quality of care, Powers said, has gone from a “needs improvement” by his judgment to “best in class.” Its retention rate has improved significantly and its financial results have improved.
“Knock on wood, but we’ve kept people safe,” Powers said. “While it’s been a super challenging year, in a strange way, it was good timing for us to kind of build the company we knew we needed to build. So we’re very proud of what we’ve been able to do — and now I’m excited to see what we can do once the pandemic is over.”
How the business changed
In order to adapt to a turbulent environment, Elara Caring changed its referral strategy to target physicians.
The move stemmed from access issues at the onset of the pandemic, but has turned out well for the company throughout.
“It was pretty straightforward. First and foremost, we needed to go where the patients were,” Powers said. “When things got locked down, access became a challenge for us and for the patients we serve. So, it was just a natural extension to say, ‘How do we still serve patients?’”
Another element of targeting physician-based referrals was about the patients that Elara cares for in general. It deals with a lot of individuals with ongoing, chronic needs, and community-based referrals are important to serve those needs through the continuum of care.
“Having access to physicians lined up specifically with what we do well,” Powers said.
A lot of those physicians also didn’t have telehealth platforms unless they were a part of a larger network, so Elara Caring was also able to solve a need for them during the public health emergency.
In the past, business tended to be characterized by half community-based referrals and half facility-based referrals. Before the pandemic, those community-based referrals were beginning to dip below 45%. Once March hit, however, that percentage began climbing back up to more than 50%.
But patients are still coming out of those facility-based settings, so despite all the effort to maintain good community-based referral sources, Powers expects that number to level off.
“Overall, we’ve really taken his opportunity to change how we work with referral partners,” Powers said. “We’ve basically taken the whole referral process, broken it down into pieces and said, ‘What’s wasteful? Let’s remove the waste. Let’s automate those things. Let’s make ourselves the easy button of referral partners.’ And as a result, our customers, patients and employees are all satisfied with us.”
As it pertains to PDGM, Elara Caring got off to a rough start. The combined challenges facing the organization made it tough to adjust to the new payment model on the fly.
That’s beginning to turn as well. Powers gave his organization a “C-” grade at the beginning of 2020 for its adaptation to PDGM. Now, he believes Elara Caring is closer to a “B+.”
The 30-day billing period has been the hardest adjustment, Powers said.
“I would say the 30-day periods have been the most significant change because we’ve gotten twice the number of bills … and there’s more working capital requirements,” Powers said. “You’ve just got to be tighter locally to make sure you’re optimizing your local care delivery performance.”
Low-utilization payment adjustments (LUPAs) haven’t been as big of a pain point, but it has depended on the area.
“It’s been regional for us,” Powers said. “In certain markets, we were really good at it and in mid-single digits in terms of LUPAs. In others, we had LUPAs in the teens. So driving that consistency in those best practices and really getting everybody to understand the process of avoiding LUPAs, that’s been something we’re [focused on].”
Turning toward growth
Despite a bevy of resources, Elara Caring has had to get its feet underneath it to get to this point.
“I think we still have some pockets in the field where we really needed to make sure people were educated about PDGM,” Powers said. “And that’s not a criticism. It’s just that we’re trying to integrate three companies, and that entails a lot. We just weren’t as sharp early on as we needed to be.”
Now that the tide is turning, though, Elara Caring is ready to set its sights on growth.
It’s looking to take a phased approach in acquiring new companies in all of its lines of business: home health, hospice, personal care and behavioral health services. The company wants to “complete its bingo card” in certain markets, going deeper in areas where it already exists with all of its service lines.
As they do so, Powers believes it’ll have a marked advantage thanks to its formation process.
“There’s nobody in the industry who’s had to deal with the types of integration that we’ve dealt with in the past two to three years,” Powers said. “We’ve made the mistakes. We’ve learned, and we’ve built the integration playbook. We know what not to do again. And more importantly, we know what’s important. So we feel like we’re ready.”