‘Mindset Change’ Helping Home-Based Care Providers Work Through Staffing, Payer Struggles

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Top home-based care leaders from across the country gathered at the end of March in Washington, D.C. We got to hear from many of them at Home Health Care News’ Capital + Strategy event last Thursday.

While they are advocating for a better regulatory environment – whether in personal home care or home health care – almost all of them are now operating with an understanding of the hand they’ve been dealt.

The headwinds are strong, but the value proposition, these leaders believe, is stronger.


Providers are no longer holding a sign that says, “We’re valuable.” They are handing out pamphlets with detailed bullet points on why they are valuable and how that should be recognized in the payer community, whether by the Centers for Medicare & Medicaid Services (CMS) or Medicare Advantage (MA) plans.

“There’s been a mindset that’s changed over the last couple of years,” Daniel Schwartz, chief strategy officer for Elara Caring, said at the event. “A couple of years ago, the conversation was that we had a battle to be fought and an enemy to attack. Now, … there’s a recognition that when home care is properly deployed, it adds value for plans’ members. That was not always a prevalent mindset.”

All the while, they are looking to drive efficiencies throughout their operations. The staffing crisis is no longer cause for woe-is-me rhetoric, but instead, an issue that they are finding ways through.


“We will never have enough caregivers – ever,” AccordCare CEO Brandon Ballew also said at the event. “Even if we passed a handful of bills and got people away from flipping burgers or [other areas], we just don’t have enough.”

MA enrollment and job vacancies remain on the rise.

Thus, the successful home-based care companies will find ways to prove their value to payer sources while driving efficiencies in 2023 and beyond.

How they’re going to do that is the topic of this week’s members-only, exclusive HHCN+ Update.

How to make do

Given Ballew’s assertion that meeting the worker demand in home-based care is virtually impossible, companies will have to augment their workforces.

They’ll have to do that through stretching out those workers based on their abilities and time, and also through technology.

“I think there are technology improvements that are critical,” Ballew said. “We’ve now seen technology partners that were outside of the home care industry start to get interested in home care. They’re starting to apply products that they had in other areas, saying, ‘Hey, I think that might work in home care.’ We’re recognizing that we can possibly reduce some hours, maybe reduce some visits, because we’ve got technical, logical connections, and we can be smarter about care interventions in the home by using that technology.”

The Atlanta-based AccordCare is a provider of both personal home care and home health care services in eight states: New York, Connecticut, New Jersey, Georgia, South Carolina, North Carolina, Alabama and Florida.

Ballew also believes that Accordcare can leverage all its workers’ skills, creating a more flexible workforce in the meantime.

“Push the envelope on what you can do with their training and licensure,” he continued. “Don’t go outside of it; I’m not saying do that. But I need that aide to do as much as they possibly can. And that’s likely more than they’ve done in the past. We hope we can get them to do more in the future. And that goes for LPNs, PTs – up and down the board.”

On the home health side, clinicians are already having to see more patients than before, but performing less visits per patient.

“Overall, the agencies have done a great job in figuring out where to apply those two less visits per episode,” Scott Pattillo, chief strategy officer for the technology platform Homecare Homebase, said at the event. “And, amazingly enough, we’ve not seen [an uptick] there in rehospitalizations.”

Technology and dealmaking

A burgeoning area like home-based care is bound to be disrupted by technology. But disruption is not necessarily a bad thing. In fact, it can be what keeps providers’ heads above water.

It’s also becoming an increasingly important part of merging two businesses after a deal.

“When bringing two disparate business lines together, you need to have a strategy to bring the software together,” Geoff Darling, the SVP of corporate development and strategy at the home care software company AlayaCare, said at the event. “Whether it’s your first big deal or the first of a series of deals you’re going to do, you need to have a playbook developed for how you bring those target systems together.”

On that note, valuations are not coming down – especially in the low- to mid-sized market. Despite the fact that providers are not getting what they want from policymakers in D.C., sellers are still getting what they want, monetarily, in deals.

“The lower end of the market is holding up fine,” Mertz Taggart Managing Partner Cory Mertz told HHCN. “I can make the case that values for companies in this size range are higher today than before interest rates started to rise.”

Fair pricing for value

Rates for services have always been a point of contention between CMS and home health providers. The same can be said for MA plans and home-based care providers generally.

Part of that is just based on how plans work.

“I think what makes it difficult is understanding how large organizations like health insurance companies work,” Joy Cameron, the associate vice president of public policy at Humana Inc. (NYSE: HUM), said at Capital + Strategy. “Honestly, it’s a lot about capacity and coming together and talking about how many patients [a provider can take in]. If you’re going to work hard and get into a value-based relationship, let’s make sure you have the capacity to take these patients and that every time one gets referred to you, it’s not getting pushed off.”

Plans are becoming more well-informed on how home-based care providers operate.

At the same time, providers are starting to understand that they need to tell providers what they can do to help them, and not just demand more pay.

“So, how can we improve that relationship?” Cameron continued. “How can we improve that back and forth? How much can we automate when it comes to prior authorization and things like that? We’ve done a lot to really improve the way that works on our end, especially with our known providers, to just make it a lot smoother.”

Those relationships are improving, leaders suggest. But in the areas where they’re not, those leaders are taking note.

“We are payer agnostic, but we’re payer selective,” Traditions Health CEO David Klementz also said.

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