Behind The Development, Scaling Of Help at Home’s Care Coordination Program

Personal home care providers have long considered themselves the “eyes and ears of the home.” With that comes great responsibility, for certain.

It also comes with great opportunity – opportunity that agencies have not always taken advantage of.

One of the largest home care providers in the U.S. is trying to capitalize on that opportunity, and transform the delivery of personal care on the way.

In the latest episode of HHCN+TALKS, Julie McCarter, the care coordination president at the Chicago-based Help at Home, sat down with Home Health Care News to talk about her journey in personal care, how Help at Home is uniquely capable of implementing an ambitious care coordination program and what it means for the home care industry as a whole.

The recording and transcript of the conversation are below.

HHCN: Julie, before we get into the interview, let’s start with a quick introduction to who you are, what Help at Home does and your background with the company.

McCarter: I’m the president of care coordination, a business segment that we have created here at Help at Home. We are the largest personal care provider in the U.S. We have a 30-year history in the home care space with a focus on dual-eligible clients that we serve. We’re in 12 states and we serve 70,000 clients and employ 50,000 caregivers.

If those aren’t enough numbers, I’m always impressed with the fact that we just closed out 2022 serving 70 million hours in the homes of the clients that we serve. Yes, 70 million hours. We’re in people’s homes an average of 20 hours a week and our relationships with our clients are an average of four years in length.

We spend a ton of time with our clients and we have longitudinal duration relationships with our clients, which is really the foundation for building a care coordination business.

What drew you to the home care industry, and then more specifically, to Help at Home?

I have had what I’ll call an enduring health care career. I’ve been in health care for a number of decades and I really seek out opportunities to grow value and impact.

I’ve spent a number of those decades with health insurance companies on the payer side. When I thought about what my next set of opportunities could be, I specifically sought out things that got me closer to the patient, closer to the client.

I started to put those criteria together. When I thought about stepping into the home care space and serving dual-eligible seniors, the most vulnerable folks here in the nation, the opportunity at Help at Home called to me. Especially with the ability to create this care coordination program.

How did your new role as care coordination president come to be?

Care coordination has been in a pilot mode within Help at Home since 2021. This was a concept that was in a proof-of-concept stage before I joined the company in 2022. It’s really an opportunity to connect home care to the broader health care ecosystem.

The scale of Help at Home, the size that we are and the density that we represent in a number of states, puts us in this incredibly unique position to coordinate care and close gaps in care for the clients that we serve.

This also allows us to point out to important stakeholders, risk-bearing MCOs, managed care organizations, risk-bearing providers and create interesting value-based relationships to step into the care coordination space. That’s really the precursor and what got us into this.

Of course, there’s a business here to build, and to move from proof of concept to that building of the business in 2022.

What exactly is care coordination?

At Help at Home, we are the eyes and ears of what’s going on with our clients. We are the first observers of changes in their conditions. These are changes across physical issues, behavioral issues and environmental issues.

As we are observing those changes, we can collect that information through technology, analyze it, wrap it with more clinical assessments and interventions and then point it out to that broader health care ecosystem and make connections for our clients that they need.

We can activate primary care visits if that’s what’s needed. We can activate specialty care and activate more community resources if mental health is appearing to be a growing problem for the person.

This is one way for us to reach out to the communities around our clients in order to support them. Partners alongside us see value in that. We’re in their homes every day throughout a given week and there are managed Medicaid entities who are needing us to step in and help to close social determinants of health issues or dual plans that are looking for us to help close specific gaps in care.

What does the program look like now? Where is the care coordination program live and how large is it currently?

We are up and running in Illinois and Pennsylvania and looking to head into Indianapolis actually in the next 10 days. That will be our third market in which we will launch and then we’ll go beyond that as well.

We have 2,000 clients under program management in care coordination. We’re actively managing a population of clients in those markets alongside risk-bearing provider partnerships and managed Medicaid dual-plan partnerships.

What was the implementation of the pilot like, and what were some of the main lessons you learned throughout that process?

Our early focus was on implementation, growing, building and establishing the program. Those were the three key areas that have emerged as the most important areas of our focus.

Number one, of course, is building out the clinical team that supports our caregivers. Our clinical team is composed of nurses, RNs, LPNs, social workers and community health workers. As we step into markets, the creation and building of that team has been an area of focus.

Second is technology: data and analytics. I’ve described at a high level the fact that we’re really taking those hours in the home and translating them through a simple observation survey in the hands of our caregivers. This survey, which is on their phone, takes about three minutes to complete and they can do that for us on a weekly basis. We really grow a longitudinal data set about our clients.

We’re understanding when the client is really stable across those physical, behavioral, environmental issues — or when there are changes happening in the conditions of that client.

The third area is the partners: heading out into the marketplace, talking to really interesting partners about the value we can create and establishing those contracts, which have a value-based orientation to them. Those have been the early areas of focus as we’ve built the business.

As far as lessons go, the program construction is really built to serve the needs of this population, this dually-eligible population. We absolutely understood that the presence of community health workers on our care coordination team was critical.

80% of what most of us are dealing with in life, with regard to our health, actually has to do with the environment and our lifestyle choices. The community health worker is an incredibly impactful part of our team that heads into the home of our clients and can help them to stick to that diet change that they need to make for their heart conditions.

The importance of the community health worker to serve this population and be a part of our team has been a really important insight early on.

What is the value of having a care coordination program for personal care?

I love that question because I like to think about value through the lens of the two most important stakeholders in the mix here: the caregiver and the client.

The value that I wake up and think about every day and my team around me thinks about — and for sure the broader team at Help at Home thinks about — is whether we are creating value for our clients and our caregivers.

I’ll start with the client. Nine out of 10 of us want to remain in the home as long as we possibly can in our lives. You just start with that. We have the desire to be safe and independent and be in that less-costly setting versus an institution as we age. Care coordination can absolutely support and enable that desire of our clients.

We can keep them safe at home longer, we can help them transition to home if they are coming out of an institutional stay and we can help close gaps in care that they’re having while they’re in that home.

Value to the client is really first and foremost. Now I’ll pivot to the value of the caregiver.

Let’s face it, this is a tough job. It’s a lonely job. We need more caregivers than we have today and we’re only going to need more as we continue to age here in the U.S. What I really appreciate is that the culture at Help at Home is thinking about the importance of that caregiver role. The culture of caring for the caregiver comes through here. This is a role that we’ve got to treat with a ton of respect.

We actually have to empower these people to have the most impact they can possibly have and value their career choice. Care coordination elevates the value of their time in the home. That simple observation they can make can alert us to something as needed — nothing makes my day more than the feedback from a caregiver that they really do feel appreciated. It takes a village to care for their clients and we can activate that village for them.

What do you hope to achieve with the program in three to five years?

First of all, we’ll be in multiple markets at that point and serving a meaningful portion of the Help at Home population of clients. Growth matters. Growth is about the ability to impact more people.

We’re incredibly measured in our orientation, meaning this is a data-driven program and measuring our results is absolutely critical.

I’ll give some examples of spaces that absolutely will be measured over time and some early results that we’re seeing already, which are pretty exciting. We are measuring the satisfaction of our clients, of our caregivers and the tenure of both. Think about those two measures. If care coordination is fulfilling its promise of caring for people, helping them stay in the home longer and helping a caregiver feel surrounded by a supportive team, if all of those things are being accomplished, we will absolutely have higher satisfaction across our caregiver teams, our clients and longer tenure of both.

This just matters. We’re in a business where we employ net new caregivers every single month in this country and we want them to stay with us as long as possible. Satisfaction and tenure are important results.

The second set of results is obvious: let’s prevent avoidable events. The care coordination clinical interventions that we can create for our clients should absolutely reduce ER visits, inpatient stays, institutionalizations, all of these things. Those are really unfortunate events for clients. No one wants to do any three of those things and they’re costly. This can be measured not only through avoidance and decreases but through an overall decrease in cost to the population.

The final thing: you’ve heard me say the phrase “close gaps in care.” Gaps in care are very structured for us. Can we help to close blood pressure gaps in care for the partners that we are working with? The answer is yes. Early data is showing that we’re closing the blood pressure gap in care for a partner at a rate of 30%.

A second example is, can we help a partner close their annual wellness visit gap? The answer is yes.

These are hard-to-reach patients and hard-to-reach clients that we have trusting and long-standing relationships with that we can help to activate within the broader health care system. We’re closing that gap at a rate of 14% for a risk-bearing provider. Those are just examples of what matters to the partner that we’re working with.

What is the professional level of the community health worker in the program?

This is actually why it’s a really effective model. Caregivers need to operate at the top of their license. A caregiver is not necessarily a nurse, of course, and not necessarily a trained clinician.

Our community health workers have to answer survey questions like: Is there food in the refrigerator? Do the smoke detectors work? Has my client’s mood changed? Is my client breathing differently or having difficulty breathing?

These are very simple observations. We all make them every day. Community health workers, by training, are not necessarily nurses or social workers by licensure or certification. These are people who actually live in the community in which they serve. They oftentimes are affiliated with religious organizations or other community organizations and they’re absolutely committed to serving the community in which they live. That is the type of community health worker that we are employing.

What is Help at Home’s perspective on future capabilities of home care agencies in the home?

Health care wants to be in the home. Especially in a dual population, health care needs to be in the home. This is actually how we will reach and create an impact for these patients and clients.

Then you have to ask, “How does health care get into the home?”

There are a number of ways and point solutions that exist across our industry. We can bring emergency rooms in the home, skilled nursing facilities into the home, annual wellness visits into the home. I just think that for Help at Home and care coordination — and more entities should be doing this — there are a lot of patients who need us doing exactly this.

What’s the additional activation that we should create and enable through those precious home care hours that we are serving today? This gets back to the top-of-license conversation. We should expect a caregiver to activate some really important observations and insights for us and then support the needs that emerge from that.

I think that’s where I start. Health care wants to be in the home and home care is there, so it’s our responsibility to step up and make more of this model.

What are some challenges and opportunities you’re facing and are excited about in the near-term future?

When I think about challenges, in this space specifically, health care can be very fragmented. That’s absolutely magnified in the home care space. Home care is incredibly fragmented. That, to me, is a challenge. However, that can be pivoted to an opportunity when you start with a company like Help at Home.

Again, we’re the largest personal care provider in the U.S. We’re incredibly dense in the first markets in which I’m focused on. We’re able to step into a totally different opportunity against that fragmentation, and if you think about it, scale and density matter because we can turn to the stakeholders on the other side of us like risk-bearing providers, managed Medicaid plans, dual plans, and we’re sizeable enough and meaningful enough that there’s an impact we can create together.

We move from the challenge of fragmentation to realizing our size and scale, and now with a really interesting care coordination program, we can attract business partners who want to listen to us and want to work with us because we can make a difference to a meaningful portion of the population.

Those partners have been really interestingly open to innovating together and tying that capability and reward structure to creating positive outcomes for these clients.

In addition to care workers and community workers, what informal care team members tend to participate on the team?

Part of our technology build, as we step into a care coordination relationship with our client, is we build what we call a household record about that client. We start getting to know that client through the lens of who is that person’s caregiver or caregivers. Sometimes people have more than one. Who are the other people within that household? Who’s surrounding that person and possibly has a role in supporting that client? Who’s their primary care provider?

We actually think it’s incredibly important for us to become knowledgeable about who’s the quarterback of this person’s care because honestly, if the answer is, “don’t have one”, “don’t have a good one”, “haven’t seen one in a while”, that’s something that we step in there and facilitate as well.

Then of course we have our own team that wraps around that client. Whether that’s a nurse-aligned community health worker, I view all of that as what becomes the household record around that client.

That question is also related to the reality in our caregiver space. Sometimes caregivers are professional caregivers and this is their career choice. Sometimes caregivers are family members and that obviously varies across different states. We have both in our model so I’m actually really excited to continue to experience that nuance.

How does a professional caregiver feel supported by this program and how does that differ from a family caregiver? I expect there to be nuances, but in the end, both need to just feel like they’re wrapped around with a ton of support.

Now that the pilot’s off and running and you’re in multiple states, are there any opportunities that have come about that you didn’t initially foresee?

Something that I appreciated when I joined Help at Home in 2022 was this orientation of caring for the caregiver. That’s just a cultural orientation of our company. When you have that orientation, you focus a lot of time on matching a caregiver to a client for long-term relationships. That’s obviously a professional statement and doesn’t necessarily pertain to the family caregiver.

I think this program lends to the opportunity in retaining our caregivers for far longer than our competitors and then really turning to focus on upskilling career development for our caregivers.

I think half of our administrative roles that support our operations are people that are prior caregivers. Those are all things that are in the culture of Help at Home with regard to how we think about our caregivers.

Do you contract directly with health plans?

Yes.

Big picture, what do you think — if anything — will change in the personal home care space, and do you have any bold predictions for 2023?

I’ll put your question in the context of just what I get to do every day, so in a care coordination context for Help at Home. My bold prediction is we will absolutely grow and scale this business to create more impact for our clients.

I think our impact is limitless. I think that when we create incredibly positive outcomes for our clients and for our partners that we’re working with, those risk-bearing MCOs, risk-bearing providers, we become the provider of choice in the home care space.

That’s a fantastic outcome right there, as well as the outcome that we create for that caregiver elevation. I would hope that we are a lead voice in the industry of elevating the importance and the understanding of that caregiver role and really lifting up the respect for the role.