Demand for home-based care remains strong – but operational scalability continues to loom as one of the industry’s biggest challenges.
New technologies and efficiency-enhancing tools are offering new ways to address operational scalability, but leaders still face a complex set of decisions, from which technologies to adopt to reimbursement strategies, workforce frameworks and care models to sustain growth.
“When I look at the macro landscape, … we have acuity rising, the documentation and compliance requirements are increasing and then you have labor costs increasing – that is squeezing our margins,” Tracy Ongena, founder and executive chairman of Alvita Care, said on a recent Home Health Care News webinar. “Can we coordinate more complex care without increasing overhead? That’s where we’re really leaning into evaluating manual processes and workflow, and how we can get some margin wins with automation and AI solutions.”
New York City-based Alvita Care is a private-pay home-based care provider operating in New York and New Jersey. Founded in 2012, the company’s services include home care, private duty nursing and care management.
For Cincinnati, Ohio-based Trinity In-Home Care, margins are getting squeezed not because reimbursement rates have fallen dramatically, but because they have not risen to the same degree as compliance and workforce costs. For owner and founder Aaron Stapleton, who is also the board president of Home Care Association of America, the challenge boils down to workforce sustainability.
“Our clients are at a higher acuity, so we need to train our employees for higher acuity level needs, but we’re not always in a private pay [environment], able to hit a benchmark of 50% bill-to-pay. And so there’s the in my opinion, the challenge is really trying to figure out how you fix the workforce sustainability issue, but also don’t lose your margin, and therefore don’t lose your mission.”
Trinity provides in-home services, including assistance with activities of daily living (ADLs) and licensed nursing. The company employs over 210 people and has assisted over 1,500 clients since its founding in 2011.
For Joe Shannon, vice president of business development at HomeCentris Healthcare, staffing conditions have stabilized, though they remain far from ideal across both home health and personal care. Reimbursement pressures from Medicare and Medicaid also continue to pose challenges.
The potential of technology
With the continual demand for services, the most significant opportunity for Alvita Care lies in productivity expansion, specifically increasing caregiver utilization, reducing churn and improving schedule matching accuracy. To achieve these goals, the company has looked to technology and predictive analytics.
Alvita Care recently layered an AI tool on top of its workflow automation tools to help with care coordination tasks, Ongena said.
“It’s not to replace people, it’s to enhance their jobs, because if anyone’s done a coordination job, and I did when I first started the company, it is incredibly difficult,” Ongena said. “You’re constantly multitasking, and just when you think you have a schedule perfect, somebody calls out, and then your whole jigsaw puzzle just falls apart. The AI bot has really revolutionized the way that we can do that efficiently, and our team is so happy that we’ve done that.”
The most exciting technology is the one that reduces the number of administrative tasks for employees, Stapleton said. The company has seen measurable improvements from a tool that listens to incoming calls and automatically tags caregiver call-outs in its scheduling system. This allows workers to focus more on quality and continuity of care, Stapleton said.
Not all providers are rushing to adopt AI, but technology is already improving efficiency and helping providers tackle operational scalability challenges.
“We’re a little on the fringes with the AI piece,” Shannon said. “We are using a group that’s really helped us with electronic visit verification on the home care side, with creating prompts and reminders. Taking that out of somebody’s hand and automating that has been super helpful. … Our EMR, on our skilled home health side, is AI forward, synthesizing information, making recommendations on care plans, medication, administration, reconciliation, those kinds of things, in the hopes to have administrative efficiencies and allowing our clinicians to work at the top of their license.”
HomeCentris Healthcare is evaluating tools that would bring both its skilled home health and personal home care service lines under one electronic medical record (EMR) to assist with care coordination across service lines.
For Shannon, while making these evaluations, the most crucial key to success is investing in the company’s employees.
Similarly, leadership and communication are the primary growth strategies for Stapleton.
“The agencies that professionalize caregiving rather than just treat it as transactional, those are the ones that are going to come ahead over the next three, five, 10 years, and those are the ones that are really going to help us grow the industry,” he said.
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