Former Home Health Leaders Turning Their Attention to Non-Medical Home Care

In order for AccordCare to reach its goals of becoming a nationally recognized provider, the Marietta, Georgia-based company is dedicated to offering a diversified set of services to its clients.

Brandon Ballew, the CEO of AccordCare, is a former Kindred at Home executive. But as the home health industry changed, he saw increased opportunity on the non-medical home care side.

Emerging from the COVID-19 pandemic, Ballew hopes the private-duty home care provider grows more organically than it has in the previous two years. Hiring new caregivers will be a key component of that.

The company offers personal care, skilled nursing, clinically complex care and companion services in New York, Connecticut, New Jersey, Georgia, North Carolina, South Carolina, Alabama and Florida.

For this episode of Disrupt, Home Health Care News sat down with Ballew to chat about how the rapidly growing home care provider plans to plant its flags in the near-term future and why he believes non-medical home care offers up so much opportunity.

Highlights from the conversation are below, edited for length and clarity.

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HHCN: You’ve come from the home health space, having previously worked for Kindred at Home. Now you’re in the non-medical home care world. Why are you excited about that space in particular?

Ballew: I think the non-medical group has really been under-appreciated over the past several years as the maturation of the post-acute space has happened with certified home health and hospice really being aggregated up into larger providers. The non-medical side has really stayed kind of mom and pop, and franchised, and nobody’s really taking up the opportunity to put those assets together. That was really our mission.

I really think that certified home health and hospice plays a great role in the post-acute continuum, but they’re missing that consistency of care for folks that stay in the home for long periods of time. That’s what our non-medical group does. We’re there every day. We get to see them and interact with our clients — and make sure they stay safe. We’re helping them with activities of daily living (ADLs) and are better eyes and ears for what’s going on in their homes. I think as we mature that industry, then we can partner with home health and hospice groups to round out a post-acute home model.

How do you go about making those partnerships in the places that you operate?

Down in Florida, we work together with two local groups as we transition patients and information between our non-skilled and our skilled side.

In our other geographies, we are partnering with best of class groups that have a commitment to compliance and clinical innovation. We share information back and forth on the needs of the client. Whether the patient needs to be served by a RN, a physical therapist or a home health aide in our scenario, we should make that transparent and seamless for them and able to identify the right skill needed at the right time for those clients. Finding those partners that believe in that and can match that intensity for us, those are the groups we’re looking for.

Despite being a home care provider, you still have diversification of services. What’s the value in that diversity?

In our industry specifically, the languages are very different given the different payment models that are out there today. It’s helpful to be able to speak to each one of those folks on their own terms as a provider.

We can speak to those different providers in their terms based on what the needs of the patients are. I think that helps out a lot that we know and understand what’s going on in those groups and can speak their language. Then internally ourselves, as we diversify both our employee base as well as our payer base, it helps us to spread that risk over the different areas if there’s ups and downs in the different markets.

Leading an organization that’s primarily in home care, has there been any surprise challenges or surprise opportunities? Or do you think your perspective, being unique in coming from home health care, has really served you well?

They’re definitely unique. I will say at Kindred at Home, while we had the large home health business, we also did have a large hospice and a pretty decent sized personal care business as well. I had been familiar with all three different product lines. Coming here is probably more of a size issue than anything. We were such a large company across many states.

Now, really diving deep into Medicaid programs within each particular state has been eye opening. While I’d never want to go through it again, the COVID landscape driving folks from facilities into their homes and needing to have that one-on-one attention for long periods of time, that’s something that home care services do that certified home health or hospice doesn’t necessarily do. Then [you have to learn] how to deal with each one of those states and the programs within the states.

Even if you’re in New York, for example, there are multiple programs depending on the acuity level and the needs of those clients. You have to know how to navigate each one of those programs within each state and each one does it a little differently. So you really have to be on your game.

What are the biggest challenges and opportunities you’re focused on this year?

At the end of 2021 and then beginning of 2022, Omicron was a significant impediment to our organization. We had to fight through that in the first quarter. Now, as we’re coming out of that, we’re looking at all of our processes, specifically our onboarding, recruiting and retention efforts. It is an unbelievably tight labor market. It has always been difficult in the post-acute space, but that has really escalated over the past couple of years, whether it’s been federal programs or folks just reevaluating what they wanted to do for a living.

[We’re focused on being the company] that can attract and retain qualified caregivers who want to make a difference in people’s lives. How do we differentiate ourselves and give those people an opportunity in the home, in an environment where they can thrive and do what they want to do? That’s really been our focus this year. We believe if you can bring on the talent and give them an opportunity and an environment to thrive in, that will bring growth. The demand for our services continues.

Folks are getting older, folks are getting sicker and folks want to be in the home. We can provide that, but we have to have the supply of caregivers in order to be able to take care of them there. That becomes the real crux of what home care agencies need to do as we compete not only with each other, but with other venues and settings in health care.

Is that something that you’re taking into account when looking at potential acquisitions down the line? Acquiring more caregivers?

We look for geography so we can expand our footprint. We want well-run organizations that have a commitment to culture. We want to make sure that our culture matches with them. Cultural fit is a huge deal when you’re looking at an acquisition. Unfortunately, our industry on the home care side has been highly commoditized given the rate reimbursement environment. It forced providers to commoditize a lot of those caregivers.

We are taking a different approach where we want to invest and lean into those groups. We understand that might have a short-term margin impact, but we think the long term benefits are going to be better. So acquisition wise, we want to make sure that those folks have the same methodology and mentality that we do at AccordCare.

Has anything worked in terms of strategies you’ve deployed in order to keep caregivers on or attract new caregivers?

It’s a little difficult to gauge given the environment of the past two years whether some things were working or not.

It’s very difficult for us to compete with the federal unemployment benefits and things that were there. We’ve had about six to eight months and you had a couple of those [months] taken away with Omicron. Things are starting to stick. That takes a lot of discipline on making sure you’re staying consistent with the message and getting it out to people. Whether it’s working or not, I’ll be honest with you, it’s too early to tell.

I think you’ve got to have a little bit more runway before we call anything a victory or a failure just yet.

Some providers anecdotally have been saying that inflation is causing some caregivers who maybe were sidelined for the last couple of years to come back into the market. Is that something that you guys have seen at all?

We are seeing higher traffic flow.

I don’t know if it’s inflation or what’s causing it, but we are seeing both higher numbers and a higher quality of candidates come through the pipeline.

I think as folks leave their previous employment, they’re now going to reevaluate what work they want to do for a living. I think we’ll see people that might not have been in our industry start to explore this as an alternative. Not only do we have the option of giving people a decent wage and a good place to work, but [this line of work consists of] taking care of people. That offers an intrinsic value that a lot of other industries cannot offer. We’re starting to see people want to be a part of that. People are starting to come back to work and we’re starting to see new folks outside the industry start to join, which we need desperately. We do not have enough caregivers in this country to meet the needs and demands that we’ve got.

Have you had to raise rates at all on the private-duty side? If so, have clients pushed back on that, or has it generally been accepted?

It’s a little market-specific and case-specific. We have had to raise some rates as we have increased pay for our caregivers. A decent amount of our businesses are Medicaid so they have been able to fund some increases in Medicaid programs that were largely unfunded over the past several years. They’re just catching up to a normal wage rate. On our private side where we can raise prices, we have done so selectively in particular markets. I think everyone understands the inflation that we’re all feeling, particularly on caregivers and that non-medical side that needs a higher wage.

Last time we spoke, you talked about managing the clinical side more for personal care patients and how that was something that you guys felt you could do, but something that isn’t considered as much industry wide. Can you elaborate on that for our listeners?

What I’ve seen is there’s really two types of home care providers on the non-medical side. You’ve got some groups that are really attacking that non-clinical side. [They] want to help you with light housekeeping, meal prep, daily living needs. That’s really where they want to stay focused. Some states actually mandate that that’s all you do, depending on what your regulatory licensure allows you to do.

Given my background and the background of a lot of our executive leadership team, we’re a little bit more skilled in nature. We have over-invested in clinical support for both our clients and our caregivers, whether that’s in education or training. From a health care standpoint, we want to be able to arm our folks with the right language, [the ability to] look for visual cues, understand medications and what have you. We’d like to take a little bit more of a clinical lead on that.

The home care industry is notoriously bad when it comes to collecting and tracking data. Is there anything specific that AccordCare has really honed in on via data tracking since you got there?

We’re still in our infancy, and that’s at AccordCare as well as in our industry. I saw a statistic the other day that said only 18% of current home care providers even track any kind of clinical outcomes. We are definitely in that 18% and probably on the leading side of that. Unfortunately, given the software limitations that are out there in the world today, we’re having to do a lot of it manually.

Are you more focused on de novo growth or acquisitive growth?

We will continue to explore all of those things. We have been very acquisitive over the past two years and we will continue to do that. We have started a handful of de novos and we’ll continue to look for markets adjacent to ours to continue to leverage and start brand new locations. But I really want to get organic growth back and growing again.

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