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A local restaurant may need three cooks, two cashiers and a manager to get by on a daily basis. It’s a simple equation to figure out.
For home health providers, however, the amount of workers they need to provide care every day isn’t as simple.
It has become tougher for a variety of reasons, but namely because more workers are opting into part-time or PRN work since the onset of the pandemic. With a larger portion of workers deciding when they want to work, the day-to-day calculus becomes much more complex.
“Everybody keeps talking about labor,” Enhabit Inc. (NYSE: EHAB) CEO Barb Jacobsmeyer told Home Health Care News last year. “But I would say for us, this year, there’s a little bit of a different focus on that. And that is really getting a feel for what the true clinician headcount is that we need to have.”
Enhabit spun off from Encompass Health Corporation (NYSE: EHC) in July 2022. Since then, its leaders have been focused on three things, for the most part: better contracts with Medicare Advantage (MA) plans, recruitment and retention, and, lastly, identifying that “true clinician headcount.”
The Dallas-based company provides home health and hospice services across 34 states. Its network includes 252 home health locations and 105 hospice locations.
“When a clinician is full time or part time, we are able to plan for a certain level of availability to complete patient visits each week,” Tanya Marion, the chief human resources officer at Enhabit, told HHCN. “Availability can vary considerably if a clinician is PRN. A PRN clinician may work only occasionally, or they could be available for a significant number of hours each week. It can vary. This is a greater focus for us now because we have more clinicians in part-time and PRN roles than we have historically.”
Enhabit’s investments have paid off. Of late, the company believes it is far closer to figuring out the staffing mix it needs to be successful.
“[We’ve improved] quite a bit,” Marion said. “Over the last year, we have really focused on our people analytics, which allows us to have a much better understanding of our workforce. This includes understanding shifts from full-time work, to part-time work, to PRN and back, as well as how many hours we can anticipate our PRN clinicians to work.”
That has also helped Enhabit understand how many patient visits it can accommodate on a daily and weekly basis.
Additionally, it is now better able to recognize the “internal movement of employees,” as Marion put it. In other words, Enhabit leaders now know which positions tend to fill from within. Therefore, it can recruit to backfill other open positions more proactively.
Identifying a true clinician headcount
Just under 40% of Enhabit’s nurses are currently considered PRNs.
“We currently have more PRN employees than we have historically, but this isn’t unique to Enhabit or health care,” Marion said. “The workforce, in general, is seeking more flexibility in work schedules, which is why we hear more and more about gig workers. Employees want to pick up shifts when and where they prefer, and that may change from week to week.”
Marion is right that the shift is not unique to Enhabit. Its peers – such as Amedisys Inc. (Nasdaq: AMED), Bayada Home Health Care and others – have all told HHCN they are working around the same issues internally.
“We have the same issues,” Bayada Chief People Officer Jeff Knapp said earlier this month at HHCN’s Staffing Summit. “But, that sense of flexibility for gig workers and part-time workers is also part of the employee value proposition for home health as well. So, we’re really trying to drive on the technology side of trying to make it easier to match caregivers with clients, and do it faster.”
Amedisys has turned to connectRN, a staffing solutions company, to help out with this evolution in home health staffing.
The former took part in the latter’s $76 million funding round in 2021. Amedisys is now, in essence, offloading its part-time-worker efforts to connectRN to fill shifts more efficiently.
“Amedisys is expert at managing full-time employees,” Cora Jaulin, the VP of home health at connectRN, said at Home Health Care News’ Capital + Strategy event earlier this year. “The thing that we do well is support a per diem workforce. We leverage our expertise together.”
Amedisys and connectRN have worked on two separate pilots together.
In the first one, Amedisys used connectRN staff – or the gig labor pool – to supplement its staffing levels, wherever they may be on a given day, week, or month. That has led to a 15% to 25% reduction in labor costs.
In the second one, Amedisys introduced the connectRN platform to its own employees. That way, workers already employed by the company can pick up extra shifts as they see fit.
“What happens on a Friday is, if our scheduler calls the nurse, and they don’t get that message until 5 p.m., they then call back to the office saying I could do a couple hours on Saturday,” Geoffrey Abraskin – a senior vice president at Amedisys – said at Capital + Strategy. “But the office is closed, so we lose capacity. This allows that workforce that is not the always the easiest to get a hold of – because they have other commitments – the ability to pick up work through the connectRN platform and support us that way.”
A newfound strength for Enhabit
Initially, the inability to identify a true clinician headcount was a headwind for Enhabit. Since then, however, its leaders believe the time, attention and tech the company has dedicated toward the issue could turn it into a recruitment differentiator.
“We believe our ability to easily accommodate PRN clinicians is an advantage and helps us attract employees who seek that more flexible schedule,” Marion said. “It also allows us to flex our workforce up or down easily based on patient needs.”
After analyzing the relevant data and utilizing the relevant technology to help it solve that math problem at large, Enhabit is able to leverage different recruitment angles in different markets.
For instance, Enhabit has identified what it considers critical markets, ones where it believes it has “the most opportunity to serve patients.”
In those markets, it now has the ability to take a more strategic approach to talent acquisition.
“We now understand our full-time equivalent clinician headcount,” Marion said. “So we are able to recruit for exactly what we need in those communities and devote additional resources to meeting these needs.”