Once the ink on a deal is dry, home-based providers face the arduous assignment of integrating two disparate companies.

Companies well-versed in managing post-acquisition transition periods have seen success by embracing visibility and establishing trust. Strategically integrating acquisitions can also unlock added value, including fresh strategies and increased employee engagement.

At Choice Health at Home, working to establish trust is the first thing the company’s leaders do to ensure a smooth integration after a deal is complete.

“You really have to bridge the cultures … [and] this starts way before that document is signed,” David Jackson, CEO, Choice Health at Home, said last month at Home Health Care News’ Capital+Strategy conference. “You have to find the people who are going to drive the business forward. You want to be in front of them, and you want to establish trust.”

Tyler, Texas-based Choice provides home health care, hospice, home care, palliative care and rehab services in Arizona, Colorado, Kansas, Nevada, Oklahoma, Texas and Utah.

Similar to Jackson, Kathy Poland, chief operating officer and co-founder of New Day Healthcare, believes it is critical to establish a foundation with the people who make up the organization early.

“As you’re building that relationship with those people at the company you’ve just invested in — it pays so many dividends in the future, because what you’re ultimately doing is building trust, and you cannot move forward in an integration, or scaling a business, unless you have that trust as a foundation,” she said during the discussion. “You cannot skip that step.”

Fairview, Texas-based New Day has roughly 33 locations across Texas, Missouri, Kansas, Illinois and Missouri. The company offers various home-based care services, including home health care, personal care services and hospice and serves nearly 150,000 patients annually.

When it comes to integrations post-transaction, New Day Healthcare is a veteran. Overall, the company has completed about 50 integrations since its launch in 2020.

Preparations before closing the deal

Early in the integration process, Jackson also stresses the importance of providing employees with visibility around the financial, operational and compliance functions of the new organization that the company has just taken on.

“If you don’t have visibility … you will be a pile up, not a roll up,” he said. “If you’re thinking about investing dollars, you want to gain visibility. We want to allow clinical compliance teams, operational teams and finance teams to get visibility of the organization, so that we can manage the steering wheel.”

Challenges can still arise even for organizations armed with compliance, operational and finance teams.

One of the ways Choice Health at Home handles integration challenges is through transparency with staff regarding the integration process’s next steps.

Staff will want to know how the changes taking place will impact them personally, Jackson said. Choice Health at Home makes an HR professional available to staff to address questions about topics like employee benefit packages, for example.

For New Day, leveraging technology has aided the company in navigating some of the common challenges that arise during the integration process. The company worked with Carelytics, a system that combines data from electronic medical records (EMRs), patient records and payer systems nationwide.

“We have Carelytics sitting on the top of all of our EMRs, all of our accounting systems, all of our HR systems … all of that information is feeding up into one system,” Poland said. “We’ve got visibility in the business, which then settles down the crew and helps with some of the challenges.”

After the transaction

Along with building trust, forming a connection and communicating with new staff can also lead to new business or clinical strategies.

“You buy a business, you sit down and talk with a nurse, they start talking about a clinical strategy, and you’re just like, ‘Wow, that’d be great to incorporate,’” Jackson said. “The cool thing about that is, as soon as you let them share something about what makes them special, they are all of a sudden buying into your organization.”

After a transaction, the integration period can be a good time to assess the company overall and determine what the combined organization should look like going forward, according to Helen Adeosun, CEO and founder of online caregiver training platform CareAcademy.

“[Integration can be used] as a reset and a cultural alignment across the organization,” she said. “A really great example, we worked with Dial Senior Living. They were in the middle of bringing on other facilities across the country, and it was a real opportunity to step back and say, ‘Who do we want to become?’ We worked hand-in-hand with the leadership and really set a framework beyond the routine care management.”

Boston-based CareAcademy provides home care agencies with professional development training and upskilling for direct care workers.

After completing a transaction, providers often must manage an entirely new employee roster in addition to their current staff. Managing a new staff requires that everyone has the necessary training, and that training is uniform across the organization.

“First, start from a place of understanding what people know and what they have,” Adeosun said. “Look at the training record. Look at wherever that information may come from.”

Once an organization establishes this, it can determine the best way to approach education.

“There are lots of ways to integrate and process in education, always starting from a base level of you show up, you lean in, you have that as the requisite, and then we are here to capacity build within the organization,” Adeosun said.

Overall, Poland believes that most providers have good intentions behind their integration efforts, but it’s essential to embrace change.

“We’re interacting with people and teams, and so sometimes the best plan is something you have to pivot [away from],” she said. “Be prepared to pivot when something is not actually working the way you planned it.”