[Sponsored] Benefits of the In-Home Care Franchise Model in a Post-COVID World

The last 10 months for in-home care providers
brought challenge upon challenge — most of which arose as a direct result of
the COVID-19 pandemic.

Care providers across the industry took heroic
measures to make it through the crisis, from personal protective equipment
(PPE) procurement to navigating social-distancing requirements and managing
staff on a remote basis. Additional operational hurdles included rapidly
learning cutting-edge technologies and implementing new protocols geared toward
infection control.

For in-home care operators that struggled
through the crisis, the opportunity to join a franchise may be more appealing
than ever. Apart from the proven business model, joining a large-scale
franchise system also offers support, accreditation and national brand
recognition — and that’s just the tip of the iceberg.

“I put myself in the shoes of those
independent agencies and think of what it must have been like to go through
this pandemic on your own,” says Shelly Sun, CEO and founder of national
in-home care franchise company BrightStar Care. “You’re barely able as a small
business owner to manage through the changes, let alone position yourself for
growth.”

The coming year is bright for in-home care
providers for a number of reasons. A national franchise can provide support to
not only survive, but thrive in the months and years to come.

Benefits
of a national brand

For operators considering an exit strategy in
the coming years, a franchise partner can lend credibility, scale opportunities
and provide a support infrastructure that is appealing to prospective buyers.

“A lot of individual agencies have become
exhausted,” Sun says. “In the next one to three years, maybe they were planning
to sell their business. … It’s going to be a lot easier to sell when tied to a
national brand with the opportunity to maximize the business model and scale.”

For example, BrightStar Care agencies are Joint
Commission-accredited, which can be a taxing undertaking for independent
agencies to pursue. Further, BrightStar Care offers a national accounts team to
help drive referrals to its franchisees, and has the corporate infrastructure to help franchisees with unforeseen events,
such as the need for PPE. BrightStar Care, based in Illinois, invested millions
of dollars in PPE procurement and distribution in 2020, storing supplies and
providing them at cost to franchisees throughout the pandemic.

Such a backbone of support adds value, with
franchisees historically garnering higher multiples in some markets than their
independent counterparts when the time comes to sell the business.

The rise
of skilled care

In addition to personal and companion care, BrightStar
Care franchisees also provide skilled care. With increasing demand for skilled
care in the home post-pandemic, being able to offer skilled services alongside
non-skilled services will be a key differentiator, Sun says.

BrightStar Care helps its franchisees become
equipped to offer those services, which can be a challenging shift for
independent agencies.

“It’s a value-based complement to others in
the post-acute space to be able to offer skilled and unskilled care,” says Sun,
noting the rising cost of labor particularly among the nursing workforce. “It’s
an opportunity to layer in additional revenue.”

Having staffing capabilities is also an
advantage in securing cross-continuum opportunities.

Hospitals, for instance, are increasingly
looking to move acute care into the home. To do so, they need caregivers on the
ground — and the track record of well-equipped in-home care organizations.

Recruiting
and Retention

With staffing cited as the top challenge among
in-home care providers year after year, and the pandemic only adding to the
difficulties around staffing, the support and name recognition of a national
franchisor can provide visibility and credibility to the recruiting
process.

Within the BrightStar Care organization, all
agencies having Joint Commission accreditation is another critical benefit,
both in terms of supporting staff and providing quality outcomes for care
recipients. Nurses and caregivers appreciate being a part of a brand focused on
providing a higher standard of care.

“There’s an opportunity for agency owners to
head into 2021 with the ability to broaden their business model,” Sun says.
“Being able to ensure quality programs to keep the workforce and clients safe
can help take small businesses to the next level.”

BrightStar
Care is a national private duty home care and medical staffing franchise with
nearly 340 locations which provide medical and non-medical services to clients
within their homes, as well as supplemental care staff to corporate clients.
BrightStar Care franchise locations across the country employ over 20,000
caregivers and over 3,500 nurses who play a unique role in overseeing the care
for each individual client. To learn more about becoming a franchisee please
visit
brightstarfranchising.com.

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Beyond the Pandemic: 9 Overlooked Stories from 2020

The ongoing COVID-19 pandemic dominated headlines in 2020 — and rightfully so.

But there were plenty of other storylines that defined the year, including the launch of the Patient-Driven Groupings Model (PDGM), the conclusion of a hotly contested presidential election and the execution of multiple industry-shaping transactions.

These are nine of the most overlooked stories from 2020, as determined by Home Health Care News. All of these stories were popular amongst our readers, but HHCN considers these stories “overlooked” because they didn’t capture quite the same attention they would have in any other year.

1. “NAHC’s Dombi: Agencies Aren’t Panicking in the Streets Over PDGM”

It was relatively early into PDGM’s first year, but it nonetheless became clear in March that the overhaul wasn’t as devastating as many initially predicted. “We’ve not heard anything about large closures of agencies or any kind of panic in the streets,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN at the time. “And strangely enough, the one thing we’re surprised we haven’t heard so far is the cash flow impact.”

Yes, PDGM presented numerous challenges — and the model certainly still has its flaws. For the most part, though, home health providers large and small met those difficulties with a combination of creativity and perseverance.

2. “Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021”

Related to PDGM is the plan by the U.S. Centers for Medicare & Medicaid Services (CMS) to phase out Requests for Anticipated Payment (RAPs) entirely in 2021. While home health operators knew about this plan way back in 2019, new details emerged about stiff financial penalties for late no-pay RAPs moving forward. If an agency submits a no-pay RAP one day late next year, the result could be a 20% reduction to its 30-day payment amount.

3. “Aging-in-Place Company Amedisys to Acquire AseraCare Hospice for $235 Million”

The pandemic may have delayed some home health, hospice and home care M&A activity, but it didn’t stop it entirely. In fact, there were multiple industry-shaping deals that took place in 2020, including Amedisys Inc.’s (Nasdaq: AMED) $235 million deal for Compassionate Care Hospice, announced in April. This was a huge acquisition for Amedisys, which now ranks as a top-five home health and hospice provider in terms of market share. “AseraCare is a great hospice company,” Amedisys CEO and President Paul Kusserow told HHCN. “When we decided that hospice was a business line we wanted to move forward in back in 2016, we actually approached AseraCare. But they weren’t for sale.”

4. “AccentCare, Seasons Hospice to Merge”

Another M&A blockbuster from 2020: the planned merger between AccentCare Inc. and Seasons Hospice & Palliative Care. After joining forces, the combined AccentCare-Seasons enterprise will be among the five largest home health and hospice providers in the nation. “This is incredibly complimentary to our own approach toward strategic markets and being very focused on working with large health systems,” AccentCare CEO Steve Rodgers told HHCN in November.

5. “LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity”

Over the past four years, the home health industry has steadily advanced its position in Washington, D.C., and within the administration of President Donald Trump. Come January, there will be a new team in the White House that’s led by President-elect Joe Biden. While his administration will bring plenty of new perspectives on health care policy, home health providers will likely maintain their standing.

6. “Caregiver Turnover Rate Falls to 64% as Home Care Agencies ‘Flatten the Curve’”

Turnover remained a trouble spot for most home care agencies, though the overall turnover rate actually improved year over year, according to Home Care Pulse. Better pay and benefits, plus stronger training programs that enable career advancement, are just some of the reasons caregivers are staying in their positions for longer.

7. “Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal”

There could be multiple headlines here at No. 7. The main takeaway? This year was the year of the special purpose acquisition company (SPAC), or blank-check company. In October, Clover Health announced it was going public through a SPAC. Most recently, Deerfield Healthcare Technology Acquisitions Corp. (Nasdaq: DFHT) announced it was acquiring CareMax Medical Group and IMC Medical Group Holdings, then combining them in a blank-check company of their own. There were other SPAC plays, too, with 2021 certain to bring several more.

8. “Senior Helpers, BrightStar Are Venturing Out of the Home to Serve Seniors. Here’s Why.”

Home care operators continued to take bold steps in 2020, thinking outside the box and expanding into new services lines. Senior Helpers and BrightStar Care were two good examples of that trend, with each making progress on its home care-adjacent businesses. For Seniors Helpers, that is its Town Square franchising model. For BrightStar care, it’s the company’s senior living franchise strategy. “We saw that many of our clients, as they progressed and had a change in condition, had higher-acuity needs,” BrightStar Care CEO Shelly Sun said during an HHCN event. “The family wanted to be able to move them out of the home to something with more socialization. They were looking for recommendations from us for assisted living facilities or, in many cases, dementia and memory care communities in their area.”

9. “In-Home Care Agencies May Look to Cut Costs by Scrapping Brick-and-Mortar Offices”

To be fair, this one definitely has to do with COVID-19. But it’s somewhat of an overlooked and indirect aspect of the pandemic. In 2020, businesses across industries shifted operations from physical offices to remote setups, typically without any major problems. Moving forward, it will be interesting to see if cash-strapped home care agencies decide to cut costs and jettison the traditional office.

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BrightStar Care Targets Health System, Payer Partnerships with Latest Pilot

Two Chicago-based in-home care companies are teaming up in a move that illustrates bigger home care trends.

On Tuesday, BrightStar Care — one of the largest home care franchisers in the nation — announced it’s joining Dina’s digital home care coordination network. In doing so, the home care and senior living franchise organization hopes to enhance its ability to work with hospital and health plan partners.

“We felt Dina’s vision for enabling greater coordination of care really aligned with our vision of leveraging BrightStar’s network to provide solutions for health systems and payers,” Dean Ulizio, BrightStar Care’s chief strategy officer, told Home Health Care News in an email. “We also were impressed by how their platform automates communication and referral-process workflow at a time when traditional approaches and methods have been tested by the COVID pandemic and changing health care landscape.”

While its headquarters is in Chicago, BrightStar Care’s overall franchise network spans 340 locations, with about 75% of the U.S. population able to reach a local office within a 30-minute drive. BrightStar’s care portfolio ranges from medical-level home care and hospice services, to companionship support and other non-medical offerings.

Its new partner — Dina — is an in-home care technology provider that helps providers, hospitals, payers and others coordinate services around the home. Founded in 2015 as “Prepared Health,” the company initially started out as a health care communication platform inspired by social media.

Since then, however, Dina has evolved to also help its partners collect all sorts of patient data from inside the home. The tech company additionally helps partners by using AI to recommend evidence-based, non-medical interventions that can lead to fewer ER visits and unnecessary hospitalizations.

Recently, Dina expanded its services to include a light-weight remote patient monitoring package, too.

“Dina’s model of care is coming together around this label we’re using more and more called ‘care traffic control,’ which really helps hospitals and health plans up-level or upscale their traditional case management or population-health functions,” Dina President and CEO Ashish Shah told HHCN. “That’s to be able to more closely coordinate and monitor patients in the future care setting — the home.”

BrightStar Care will initially work with Dina in the Philadelphia market, where Dina has built a strong partnership network of home health, hospital and skilled nursing facilities (SNFs).

Through the Dina platform, all of those groups can now turn to BrightStar to fill non-medical home care needs focused on social determinants of health.

“They’re going to be a good, large player in that market,” Shah said. “And they’ll join in with groups like Bayada Home Health Care, Holy Redeemer and others that we have partnered with in that region.”

There are a few use-cases that BrightStar Care is particularly excited about, including the automation of the referral process.

Broadly, Dina makes it easier for discharge planners and case managers to choose providers based on quality and geography, streamlining communication and workflows, Ulizio said.

“Dina also has a capability around coordinating care throughout the client’s journey, where family members, providers and home care staff can communicate with each other and create a circle of care around the individual,” he added.

Although BrightStar Care plans to first test out Dina in Philadelphia, there’s a good chance the partnership will grow to additional markets in the not-too-distant future.

“Over the years, we’ve learned that successful rollouts start with successful pilots,” Ulizio said. “They give you the opportunity to learn what you don’t know, gain understanding of how the marketplace and end clients will react, and identify what challenges our franchisees will have. While we often launch in selected markets with a new program, it is almost always with the intent of vetting the program to prepare it for a systemwide launch.”

On a general level, the new partnership between BrightStar Care and Dina reflects the increasingly important role home care plays in managing populations. That role will likely grow more critical in days to come.

As a result of record-breaking COVID-19 numbers this November, health care organizations continue to look for ways to shift care into the home and out of facilities.

“COVID has definitely accelerated at-home care delivery models, whether it’s high-acuity hospital-at-home services, SNF-at-home services or dialysis at home,” Shah said. “We’re just seeing an explosion of care being transitioned to the home. That’s one major driver of our model, because it’s not any one provider that can deliver everything you need. It’s often a collection of different service providers that need to be tightly coordinated.”

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Amedisys Expands Personal Care Network Through New Partnership with BrightStar Care

One of the largest home care franchises in the country is teaming up with one of the nation’s largest home health providers.

Chicago-based BrightStar Care signed a care coordination agreement with Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED), adding BrightStar’s agencies to Amedisys’ personal care network.

The personal care network’s goal is to facilitate care coordination between Amedisys’ home health and hospice centers and the personal care providers it partners with.

The agreement with BrightStar expands Amedisys’ personal care network to 1,211 partner agencies in 39 states. The network helps the company manage chronically ill patients’ activities of daily living, which, in turn, drives down hospital admissions and lowers cost of care.

The relationship will be piloted with care centers in Pennsylvania and Texas. If all goes well, the plan is to expand the footprint of the relationship.

“If COVID-19 has taught us anything, it’s that America’s seniors need quality care in the home more than ever before to stay safe and feel supported,” Amedisys CEO Paul Kusserow said in a press release announcing the news. “I’m delighted to welcome the incredible BrightStar Care caregivers as care coordination partners in expanding access to a much-needed continuum of care that improves patient outcomes and lowers costs.”

Amedisys has 480 care centers in 38 states and Washington, D.C. Its home health operating income for Q2 was nearly $50 million. It also provides personal care services, but that offering makes up a much smaller slice of its business.

Meanwhile, BrightStar Care has 340 personal care locations in 38 states, reaching about 75% of the U.S. population. The two company’s footprints overlap significantly, the release said.

Amedisys’ personal care network dates back to 2019, when the provider partnered with the home care software company ClearCare Inc. on the  project as a means to expand its reach and capabilities in the home. It was also a way to open the door for Medicare Advantage (MA) opportunities, Kusserow said at the 2019 Home Health Care News Summit in Chicago.

These partnerships allow Amedisys to enter the personal care arena without acquiring personal care companies. Those deals have presented challenges for the company in the past, Kusserow said.

The news comes on the heels of an already big year for BrightStar, which has expanded its personal care and senior living footprint, as well as built an effective and massive PPE pipeline for its franchisees during the height of COVID-19. 

“We’re excited to partner with Amedisys to bring to life our shared vision of re-imagining healthcare. Together, we strive to help Americans age in place safely, while improving the care experience and patient outcomes through the entirety of their home care journey,” BrightStar Care CEO and Founder Shelly Sun said in the press release. “We’re both passionate about delivering the highest standard of care, and BrightStar Care is uniquely positioned to provide Amedisys a personal care network that meets these high standards.”

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Home Care Companies Create New Revenue Streams by Helping Businesses Safely Reopen

After weeks — in some cases, months — of closures due to the coronavirus, businesses across the U.S. began reopening in early June. But by July, many of those same businesses were forced to go in the opposite direction, thanks to a national resurgence of COVID-19 cases.

As shops, manufacturing plants and warehouses again attempt reopening, many are turning to traditionally consumer-facing home care providers for backup. To help prevent the spread of the coronavirus, Senior Helpers, BrightStar Care, 24 Hour Home Care and several other organizations have expanded their service lines to offer screening services for unexpected business partners.

It’s a revenue-diversification opportunity that wasn’t on the home care industry’s radar, but it’s one likely to stick around for a while, according to Senior Helpers CEO Peter Ross.

“It’s a service that you and I would never have dreamed of months ago, but it’s come to fruition,” Ross told Home Health Care News. “I wouldn’t say our numbers are better than last year because of that, but certainly it has shown our flexibility and our ability to help the community.”

With a corporate headquarters in Maryland, Senior Helpers has more than 320 home care offices in its global franchise network, which covers parts of Canada and Australia in addition to the United States.

Many of Senior Helpers’ franchise owners have struck contracts to do temperature checks and related COVID-19 screenings for local businesses, Ross said. To support them in that mission, the franchiser sent forehead thermometers to owners and created an electronic brochure to help with marketing.

“We’ve noticed a bunch of opportunities across our system,” he said. “We’ve been finding a lot of manufacturing plants, warehouses, different types of factories … weren’t taking the proper precautions to do what they needed to do.”

Illinois-based BrightStar Care — another home care franchise giant with more than 340 locations in the U.S. — has taken similar steps to help businesses safely reopen. On top of doing temperature checks, the franchiser has also connected different businesses to its personal protective equipment (PPE) distribution center.

“Outside of securing PPE inventory for BrightStar Care franchisees to ensure the safety of their caregivers and clients, we’ve also shared access to our PPE distribution center with fellow business owners,” CEO Shelly Sun told HHCN. “We want to do our part in helping communities re-open safely, so that’s why we felt it was important to share access to our PPE supplies.”

Moving into B2B

In 2019, home care agencies typically sourced the bulk of their revenue from hourly in-home care, followed by live-in care, geriatric care and alert monitoring, according to the 2020 Home Care Benchmarking Study from market research and education firm Home Care Pulse.

But many of the home care professionals who participated in the benchmarking study said they expect to generate revenue from new avenues brought on by health screenings tied to the public health emergency in 2020.

Another Home Care Pulse report highlighting the impact of the COVID-19 virus on home care had similar findings.

“In our impact report that we [previously] released, a little over 50% of businesses said that their service lines were going to adapt and change based on learnings in the middle of the pandemic versus post pandemic,” Home Care Pulse COO Todd Austin told HHCN. “This is definitely one example — screening.”

Besides helping warehouses and manufacturing plants safely reopen, Austin said he’s also heard agencies are doing screenings at airports and various retail locations.

“Home care has had a little bit of B2B exposure through providing staffing and shipping to some facilities, but it’s never been a true B2B [industry],” he noted. ‘And that’s what 2021 will likely bring. home care agencies won’t just focus on B2C, but also more B2B service lines to where they can go out and network with other businesses.”

Per its screening contracts with non-health care businesses, Senior Helpers sends in rotating teams of certified nursing assistants (CNAs) or home health aides to cover different shifts of employees going into work. It typically does temperature checks, charging by the hour for those services.

“The last thing you want to do in a factory is let an employee who’s got COVID in with another couple hundred other people, with all of them working a few feet apart,” Ross said. “Look at what happened with all the different meatpacking plants in the country because of that issue.”

A July report from the U.S. Centers for Disease Control and Prevention reported that 23 states had COVID-19 outbreaks in meat and poultry processing facilities, with 16,233 cases in 239 facilities. Those outbreaks included 86 COVID-19-related deaths.

Senior Helpers has also used its screening contracts as an organic way of touting its caregiving services, Ross said.

“People say, ‘Oh, well, tell me more about Senior Helpers.’ They might need help in the home for their mother, their uncle, their grandfather,” he said. “From our perspective, it’s just a great investment in the community to keep people safe. And it certainly helps to drive the brand.”

That organic information campaign may also inspire some people to branch out into home care, perhaps even opening their own Senior Helpers franchise location one day, Ross said. It’s something that could factor into the strong growth the franchiser has seen lately.

“We’ve been growing really well, to the tune of 25 to 30 new owners a year,” Ross said. “We’ve been bringing more people on at a higher pace during COVID.”

On its end, BrightStar Care’s locally owned-and-operated agencies have provided screening services to 270 customers, including multiple Fortune 500 companies, as of mid-July, according to Sun.

BrightStar Care screening services are typically conducted by either a registered nurse (RN) or licensed practical nurse (LPN). Services range from taking vitals and conducting screenings, to interviewing employees and documenting answers for HR files.

Rates are based on the number of hours that the RNs and LPNs serve the needs of the customer.

“We’ll continue offering screening services as long as they are needed. We are proud to be able to support our communities and businesses to ensure safe reopenings,” Sun said. “We see staffing services as a long-term opportunity since each of our agencies have RNs, LPNs and CNAs on staff and have a 20-year history of providing staffing services in addition to home care. We are able to deliver on the skilled and non-skilled services, and [we’re] ready to provide future staffing services from screening to administering vaccines.”

Outside interest

California-based 24 Hour Home Care officially launched “SAFER at work by 24 Hour Home Care” to help with reopenings. The independent and fast-growing home care company has a team of 3,000 on-staff screeners to not only assist businesses, but also government buildings, schools and more, its website says.

But home care providers aren’t the only ones helping businesses reopen safely. Some of the technology companies that partner with home care agencies or post-acute care providers have gotten into the screening game as well.

Dina — an AI-powered care coordination platform that works with some of the largest home health providers and health systems around — is one example.

As of mid-July, Dina has two non-health care company screening customers: one municipality and one food manufacturer, President and CEO Ashish Shah told HHCN in an email. Those customers represent roughly 1,200 users, he noted.

Dina is helping home care agencies with screenings, too. Overall, Dina has helped facilitate more than 1 million employee screenings.

“We’re seeing more non-medical home-based care agencies start to step up and ask for help,” Shah said. ‘They’re finding very creative ways to use technology to check in on their patients and staff. And we’re seeing more non-healthcare businesses adopt our screening products to do exactly what hospitals and health care providers are doing to take care of their caregivers and patients.”

Home care agencies interested in launching new safe reopening business lines should keep two key things in mind, Home Care Pulse’s Austin said.

Caregivers screening dozens or even hundreds of workers need to have necessary PPE. Additionally, agencies should consider assigning one employee to one site to limit their exposure and possible virus spread.

“The first thing agencies need to do is make sure that the individual doing the screening is isolated to that [one location], whether it’s consumer screening or employment screening,” Austin said. “That’s step No. 1.”

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