Right at Home Sets Sights on ‘Boomer Consumers’ with Custom Aging-in-Place Approach

For reasons beyond the coronavirus alone, 2020 was an unprecedented, action-packed year for home care operators. This year is guaranteed to bring more disruption as well, particularly as U.S. demographics continue to skew older and as the overall health care system looks to decentralize traditional models.

Omaha, Nebraska-based Right at Home — an international home care franchise system with roughly 500 domestic locations — is working to stay ahead of the curve.

In part, that means launching new service offerings to better target “boomer consumers,” a population that prefers to take charge of their aging-in-place strategy. It also means accelerating market development with a mix of de novos locations, new franchise openings and acquisitions.

To learn more about Right at Home’s 2020 and plans for 2021, Home Health Care News recently caught up with CEO and President Brian Petranick. Highlights from that conversation are below, edited for length and clarity.

HHCN: Can you start by briefly recapping Right at Home’s 2020, if that’s even possible after all the challenges you had to face?

Petranick: It was an interesting year. And this is a good time for this conversation, because I’ve been doing a bunch of reflection on 2020 over the last few weeks. I always get very reflective this time of year.

Let me start off by saying that I am incredibly proud of our team, including both our franchise system and our corporate-owned locations. I’m so proud of everybody, top to bottom in our network, in addition to our international partners. With COVID-19, we saw the real concern surface toward the end of February. Then all sudden, by March, it was like, “Oh my god! Here we are. We’ve got a potential pandemic on our hands.”

I’m sure every organization out there did some level of projecting, thinking about worst-case scenarios. We certainly did. And you know what? We never came close to that. We had about a six-week period of time where our business faced pretty significant losses. That was from March 1 to the middle of April. From that point on, we’ve been building back up and growing very steadily. We actually had a record level of volume across our system during the last week in February, right before the pandemic became “official.” We had our highest amount of volume in the domestic U.S. system — ever.

Well, we got back to that volume. We even exceeded those record numbers by September. We’ve been hanging around that all-time high, breaking records week after week. We’re on a pretty good trajectory here. But with that being said, we know infection rates shot up right after Thanksgiving and may rise again due to the winter holidays.

Again, I would say, in summation, that I’m incredibly proud of our year and our people. I’m proud of the way people responded. I know they’re tired. They’re fatigued. But they’re resilient. We’ve learned a lot about our team here at Right at Home, in terms of how we can respond to a crisis and how quickly we can make decisions. There are so many positives that have come out of this really awful year, at least from that standpoint.

How did Right at Home grow in terms of number of new territories or new locations?

We probably had a little bit lesser growth in that area than we’ve had in the past. Some of that is obviously due to the pandemic. But looking back on 2020, we are finishing up with a handful of — maybe about 10 — new operating territories. Some of those are corporate-owned, while some are new franchises that have opened.

What were the biggest challenges you had to navigate in 2020? I know you already mentioned fatigue, for example. There’s, of course, personal protective equipment (PPE) procurement.

I think it was broadly managing the volume and the speed of change in an efficient and effective manner. Early on, there was so much information flowing from different sources — PPE policies, infection protocols and more. We had to figure out, at the corporate level, how to get all of that information and filter it in a meaningful way to the people who are operating the local offices.

Our goal was to take that information and give our team the tools to act on it without having to think a whole lot. Instead of operators having to do their own extensive research, we wanted to say, “Hey, we’re here. This is what we know. This is what we’re learning. Here’s how you need to apply this in your business.”

There was a lot to decipher. But out of everything, I think we got the most questions about dealing with the Paycheck Protection Program (PPP) loan and PPE protocols. Understandably, there was also confusion about cities being shut down, with caregivers sometimes being in this murky area of “essential” or “non-essential.”

So much changed on a daily, even hourly basis. Ultimately, I think our biggest success was our ability to take all of that information and rapidly distribute it in a meaningful way, allowing our partners to focus on their caregivers and clients.

The debate around home care staff being “essential” from a regulation standpoint surprised me. Was that somewhat revealing to you? Seems like there’s a ton of advocacy left to do.

Exactly. I think, to some degree, it was eye-opening. But we’ve always known that some people, policymakers and insurance companies don’t truly understand what it is that we do. When policies are rushed out the door during a pandemic and you see that you’re not included in something important, it crystalizes that idea.

It’s good and bad. The bad is that it highlights how others view our industry at the moment. And the good is that we can more clearly see where there are opportunities to start open discussions about home care.

Listen, policymakers have been trying to figure it all out. They also need help. Right at Home — independently, as well as a part of the bigger coalition of the Home Care Association of America (HCAOA) and other advocacy groups — continues to get in front of policymakers to have those key conversations. That will benefit us, long term.

It’s going to be interesting to watch as policymakers and others start writing new policies and reimbursement schedules around shifting more care into the home. Do they really understand the dynamics of the home environment and all the different types of care delivery models?

How about two or three predictions for the new year. What do you expect for home care in 2021, maybe even looking beyond COVID-19?

None of this is probably going to be a surprise for you. But I would start by saying that we’re clearly on a path where there is just more change, more disruption coming. I’m talking about changes in the health care system, changes in U.S. demographics, changes to reimbursement models — all of those things. As we think about home care in 2021, we need to expect more change.

This acceleration to the pace of disruption is partly due to the pandemic. That isn’t doing anything to slow the changes down. But we’re also coming off of a presidential election. There could be some big philosophical changes coming into the White House. For as much as people want 2021 to be calm and a year where we get back to normal, there will be a lot to navigate. I think it’s going to be a lot like 2020, just in different ways.

With all that disruption will likewise come an increase to the level of sophistication within home care. Operators — independent home care providers and individuals who are part of a franchise system — will have to become more sophisticated in their approach to business. Wage pressures are increasing. Service costs are increasing costs. The traditional structures of health care are evolving, with more Medicare Advantage opportunities and new initiatives, including hospital-at-home programs. Operators will need to be overall more sophisticated to succeed.

What else? I would say — again, not shocking — there will be more collaboration between home health, home care and the broader health care sector. There’s just so much focus right now on bringing down the cost of care. The best way to do that is with stronger collaboration across the board.

A final prediction for 2021 is that the “boomer consumer” will take centerstage. We’re starting to deal a lot more with baby boomers — and they just have very, very different demands in regard to the care they want. They want to control that care and how they interact with their care providers. We should see a lot more focus on the boomer consumer outside of health care, too.

What’s an example of that? How is your “boomer consumer” different than the traditional home care consumer from a generation before?

It’s a great question. Some of this will probably be overly broad, but I think the generation before — the post-depression era, let’s say — was a generation that didn’t question their doctors. If a doctor said, “Here, this is what you need,” then they just did it. They were raised to listen to their doctors. That’s not the boomer generation or any other generation. They’re the WebMD generation, the Google generation. They’re used to going in and searching for answers on their own. And they’re used to getting what they want.

Boomers have had a lot of resources. They’re typically wealthy, as a group. They’re used to BMWs, Starbucks and those types of things. I think they’re going to expect more from their home care providers, more from all of their health care providers.

We’ve already seen some of that, right? If you look at the way hospitals were in the 80s and, to some degree, the 90s, you had to pay all kinds of money for a private room. Now, some of these hospitals are like hotels. You get a single room. You’re ordering off of menus. We’ve all got different expectations now.

We’ve already operationalized some of those changes, but there’s definitely more coming because we’re still on the leading edge of the baby boom generation. At the end of the day, they want more communication, more choice and a better experience.

How about two or three predictions for Right at Home? What specific goals or strategies did you have in mind for 2021?

You’ll definitely see from us more accelerated market development. I don’t think that’s a secret. At this point, everybody knows we’re opening up more corporate-owned locations, where we’re doing de novos. That means going into markets where we don’t have offices now and opening from scratch. We’re also growing through acquisition of independents in some of the markets where we’re interested in going. We’re still franchising. We’re just kind of agnostic to how we grow. But we want more market development. That’s No. 1.

No. 2, we’re thinking about all these changes that are happening in health care. We want to make sure we’re moving in the right direction. We want to make sure that we’re buttoned up on our data and thinking strategically about how we’re leveraging our data. We’re going to continue to put a lot of focus on our, like I talked about earlier, sophistication level. We know that we need to position ourselves best for working with the broader health care system and home health partners.

Lastly, we’re looking at all kinds of different ways to broaden our value proposition to our clients. That partly means hitting on what the boomer consumer wants. We’re not thinking about ourselves as just a home care company. How do we think broader? Where are there other opportunities to add to our own value proposition? There are some really interesting models out there that we’re looking at.

What do you mean by that?

Care coordination is an example. To use one analogy: Most people, when they build a custom home, they don’t do it themselves. You could hire a plumber. You could hire an electrician. You could hire a framer. You can hire all of those people individually. You can have somebody come in and put your foundation in and do your grading and all of that stuff. You don’t need the contractor.

But what the contractor does is make it easy. The contractor becomes the middleman and coordinates all of those other things. All you have to do, as the homeowner, is decide on design, your choice of your tile, your carpet, your paint. I think there’s going to be more of a demand for that type of service in home care.

If you think about it, there’s probably 5,000 different pieces of technology that somebody can bring into the home to help with the aging process. Well, who in their right mind has time to research 5,000 pieces of technology, from a consumer perspective? Or 50 home care companies? Or 20 transportation companies? I think there is an opportunity for somebody that can come in and help people manage the broader aging process, not just one aspect of it.

What else is important to touch on?

One of the things we have to be very, very cognizant of is the impact of COVID fatigue. I can’t stress that enough. We’ve had a strong year at Right at Home. I’m incredibly proud of our team. But we’re tired. People are just tired after operating at really, really high levels for nine or 10 months. COVID fatigue is real. It’s a challenge, but people are going to have to fight that off as best as they possibly can in 2021.

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New York Moves Up COVID-19 Vaccination Eligibility for Home Care, Hospice Workers

Home care and hospice workers are now part of the pool of New Yorkers eligible to receive the COVID-19 vaccine.

The New York State Department of Health originally announced that home care and hospice workers would be eligible to receive the first dose of the vaccine starting on Jan. 11. This placed these individuals in the Week 5 group of the state vaccination program.

The department updated that plan last Monday, moving home care and hospice workers to the Week 4 group receiving the vaccine starting on Jan. 4. 

This development didn’t just happen overnight. In fact, it was the result of a significant push from New York home-based care associations, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.

“I would say that is a huge development, and it’s something that we’ve been pushing for several weeks to ensure that there was a prioritization in Phase 1A for home care and hospice workers,” he said. “It took a lot of conversations with the state department of health and the city department of health.”

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Noyes noted that — because of the infrastructure currently in place, which involves the 10 regional hubs of New York overseeing the vaccination system — the distribution-planning process involved multiple conversations with various agencies and players. 

Home Healthcare Workers of America was also part of the overall advocacy push. The organization, which represents over 26,000 in-home care workers, saw firsthand the need for urgency when it comes to vaccination.

“During this time, tragically, we have lost 12 aides from the start of this to the present,” Joe Pecora Jr., the organization’s vice president, told HHCN. “Our members were desperately asking for access to the vaccine. We’re happy that the governor’s office and the department of health have agreed to move up their eligibility. This is a lifeline.”

New York state employs more than 210,000 home care aides, labor statistics show.

Home Healthcare Workers of America is a part of the International Union of Journeymen and Allied Trades (IUJAT). The organization represents workers primarily located in the five boroughs of New York City.

Throughout the COVID-19 emergency, visibility has been a major challenge for home-based care organizations. At times, this resulted in these organizations being overlooked.

Being prioritized for vaccine eligibility represents a shift, according to Noyes.

“Whether it was [personal protective equipment] status or authorization to visit patients in their own homes when there were travel restrictions in place, this has been an issue,” he said. “To now have, at this pivotal stage of the vaccination rollout, home care and hospice workers in early, that is an important accomplishment.”

For now, HCA-NYS has been keeping its members updated on the logistics and procedures for actually getting the vaccine.

It’s a process that has run the gamut, according to Noyes.

“For instance, some agencies, I understand, have ordered the vaccine, and I don’t know whether they’ve received it yet, but they have plans to vaccinate their own staff — to actually have their own agency be the point of dispensing a vaccine for their workers,” he said.

Meanwhile, other agencies have opted to instruct their staff to essentially make their own appointments with the various dispensing hubs that are being set up across the state.

In these cases, HCA-NYS has provided instructions around what information workers need to bring to these appointments in order to prove they’re Phase 1A. Similarly, it has helped its members understand what documentation they need to retrieve from the vaccination site.

So far, New York City’s mass vaccination efforts have gotten off to a rough start.

Despite a surge of new COVID-19 cases, few people have been vaccinated. This has left public health experts concerned, according to reports from The New York Times.

Overall, only 167,949 of 489,325 doses of the vaccine — roughly 34% — have been administered as of Friday. The rate for New York state overall is over 40%, according to The New York Times.

The vaccination rollout potentially creating hiccups that would impact home care and hospice workers is a concern, according to Noyes.

“Home care and hospice workers are now in priority 1A,” he said. “But if there’s concern that the vaccine is not being administered to health care workers at the rate it should be because of hesitancy, … then there’s going to be a big impetus to push through to the other phases. Certainly, there are other priority groups that need the vaccine quickly, but my concern is whether or not this push could squeeze out access for home care and hospice workers.”

Elsewhere, early last week Los Angeles County’s home care companies received confirmation that non-medical caregivers are part of the first group eligible for vaccination.

Prior to this confirmation, home care companies weren’t clear on whether their employees were part of this group, which includes their home health counterparts.

Home health leaders and clinicians in various parts of the country have also begun to highlight their vaccine experiences on social media. That group includes Dr. Steve Landers, president and CEO of the Visiting Nurse Association Health Group Inc.

Senior living operators have ramped up their vaccination efforts as well.

On Dec. 21, for example, Brookdale Senior Living Inc. (NYSE: BKD) announced it had held its first community vaccine clinics, with plans to schedule more across the company’s 726 communities.

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Quincy Medical Group Goes All In on Hospital-at-Home Program

When Quincy Medical Group (QMG) began developing a hospital-at-home program over a year ago, it recognized the concept as a way to reduce costs and risk, while simultaneously increasing hospital capacity and supporting a seamless transition of care.

But in a broader sense, QMG wanted to stick to its commitment to “transform health care” — and that’s why it began investing in the home. That’s also why the organization is clear about its hospital-at-home program’s origins.

QMG had been looking to implement something similar for at least three years. The program is coming to fruition at the peak of the COVID-19 pandemic, but that is merely a coincidence.

After a sit down with Dr. Tom Price — who formerly served as the secretary of the U.S. Department of Health and Human Services (HHS) — its physician-led board decided to pursue what was then an out-of-the-box option and invest in hospital-level care at home.

“The board has had a main purpose of delivering quality health care more cost effectively,” QMG Interim Chief Medical Officer Dr. Rick Noble told Home Health Care News. “We realized the federal government was looking at all out-of-the-box options on being able to deliver quality care, … and that’s when we started looking at the hospital-at-home model.”

Quincy, Illinois-based QMG has over 155 doctors, nurse practitioners and physician assistants that offer care to about 250,000 people in 16 locations throughout Illinois, Iowa and Missouri.

Hospital-at-home models have always made sense, at least from cost-savings, comfortability and logistical standpoints. What was lagging was a reimbursement method from the U.S. Centers for Medicare & Medicaid Services (CMS) that made it worth it.

That has begun to change, and CMS has now approved over 50 hospitals under its new hospital-at-home initiative. Dubbed “Acute Hospital Care at Home,” the initiative is designed to give hospitals unprecedented flexibilities to treat hospital patients where they live.

“We thought that the federal government may at some point in time be moving toward this type of a program,” Noble said. “And so we stuck to it.”

John Hopkins and others pioneered the model in the 90s, with Mount Sinai and others hopping on board since.

QMG will be doing the same. It has entered into a licensing agreement with Johns Hopkins to facilitate its own version of the organization’s hospital-at-home model.

“This way, we won’t have to reinvent the wheel,” Noble said. “We basically purchased their best care protocols that we’re going to implement.”

It’s been a process that’s taken over two-and-a-half years to materialize. QMG is hoping to be fully operational with its program by mid- to late-2021.

“I think we were way out ahead of the curve,” Noble said. “We started it for the right reasons. And then all of a sudden, here’s a situation that shows not only us — but hopefully others such as CMS — that these programs are really needed and that they should be reimbursed. Because this isn’t going to be the last health issue that’s going to occur in the next 50 years and put a burden on our health care system.”

QMG put out a press release announcing its hospital-at-home efforts in November, though the program is not fully operational yet.

It did so because it wants to accomplish a few things first through awareness, Noble noted.

“What we want people to know is that they can expect change to occur, that we in the health care community are fluid, and we’re willing to change and look outside the box,” Noble said. “We don’t want to feel like they only have one option. I want them to know that we are proactively looking at a way to [make sure they have options] in the future.”

Generally, the hospital-at-home program is set to treat low-acuity patients that would normally have shorter hospital stays. For instance, patients who have mild congestive heart failure, shortness of breath, COPD, emphysema, skin infections or pneumonia, among other conditions.

Those patients, if they qualify and would like to be treated in the home, will be overseen by a team of physicians, therapists, nurses and rehab specialists when applicable.

“If we can really refine this and allow physicians to lead, it will just show how much we can change the scope of healthcare delivery,” Noble said. “And it’ll benefit us down the road as well.”

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Success at a glance: finding unidentified coverage

It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit.

Banner Health chose to automate its patient access processes with eCare NEXT from Experian Health. The solution, which integrates directly with Banner Health’s acute and ambulatory electronic health records (EHRs), automates the organization’s preregistration workflow, including medical necessity and financial clearance. This improves registration accuracy, provides more accurate patient estimates and reduces the number of denials on the front end.

Banner Health has benefited by incorporating a mix of Experian Health products that integrate directly and collaborate with other technologies and workflows already in place:

  • Decrease in eligibility errors. With eCare NEXT, initial denials due to eligibility errors have been reduced by $30M in the first quarter alone since going live with Experian Health.
  • Significant cost savings. With more accurate estimates, Banner Health has seen significant cost savings on the front end from more efficient coverage discovery. The system is consistently finding 30+% unique or new coverage in the patient access workflow.
  • Improved staff engagement and satisfaction. Automation has greatly reduced manual inputs, enabling staff to focus more on the patient rather than systems and logins required for patient intake.

Our partnership with Experian Health helps Banner Health’s revenue cycle team deliver on its mission of “getting it right, at the right time, every time.” 
— Becky Peters, Executive Director of Patient Access Services, Banner Health

Want to learn more about Banner Health’s success in finding unidentified coverage earlier in the revenue cycle? Sign up for the January 21 webinar below, where attendees will gain insight into the organization’s proven workflow and processes.

Register here.

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Interim’s New Recruitment Campaign Targets Job Candidates Looking to Make a Career Transition

Finding enough workers has been a longstanding pain point for in-home care providers. With the launch of a new national recruitment campaign, Interim HealthCare wants to take a proactive approach to address those persistent challenges.

Interim is a Sunrise, Florida-based in-home care franchise with more than 530 locations across the U.S.

The company recently launched “Made for This,” a recruitment campaign that focuses on placing job candidates in careers in the home-based care industry.

“We are innovating again,” Jennifer Sheets, president and CEO of Interim, told Home Health Care News. “We’re at the table realizing that the health care industry is facing critical shortages. We’re all focused on recruiting — and we always have been.”

In part, in-home care providers have struggled with recruiting enough workers simply because consumer demand is so high. The overall employment of home health and personal care aides, in fact, is projected to grow 34% from 2019 to 2029, much faster than the average for all other occupations, according to the U.S. Bureau of Labor Statistics (BLS).

But being an in-home care worker is also a difficult job, one that’s sometimes overshadowed by similar caregiver roles in other settings.

As part of its new recruiting efforts, Interim’s campaign includes opportunities for professional expansion, professional development and specialized training, Sheets said. All of those points are critical for cultivating a new candidate pool.

“What we’re trying to do here is create a new pool of candidates who are different from anybody we’ve recruited in the past,” Sheets added.

In some ways, the current climate has laid out the groundwork for Interim’s recruiting campaign.

For starters, the COVID-19 emergency has resulted in a surge in unemployment. About 25% of adults in the U.S. report that they or someone in their household have lost their job, according to the Pew Research Center.

Job loss was especially prevalent among individuals working in service industries in the months following the onset of the pandemic.

Roughly 1.9 million store-based retail workers were unemployed as of June, according to BLS. The leisure and hospitality industry had lost 7.7 million jobs as of May.

Additionally, 5.5 million food service workers experienced job loss.

People working in these service-oriented industries often already possess the qualities that providers are looking for when it comes to job candidates, home care experts believe.

This creates the opportunity for a career change for these workers and gives the in-home care industry a recruitment boon, according to Sheets.

“We really wanted to highlight the open door for a professional career change,” she said. “There are a lot of people out of work. There are a lot of people who are already in a customer service-facing industry. These people already have a heart for servant leadership and may not even realize that they’re actually perfect for — or made for — health care. That was the idea behind it.”

Aside from trying to reach individuals who have a background in other service-related industries, Made for This also targets individuals who are looking for “purpose-driven” work. A desire to transition into a mission-driven job is a common goal for individuals following economic recessions.

Interim’s campaign is also setting its sights on individuals who are already working in health care and interested in transitioning into the home-based care side.

“If somebody wants to go from a restaurant employee to a CNA, or from a CNA to an LPN or therapist, we can support them along the way,” Sheets said. “It’s about pathways to help them go from that setting to a health care setting, or to go from a hospital setting to a home care setting.”

In order to help someone transition into home-based care, the campaign tailors training and education based on an individual’s background and experience.

“You can’t just go from one setting to the other, so this program is about helping people fill those gaps through education, through mentoring, through a very defined onboarding and orientation process,” Sheets said. The biggest thing to keep in mind, from my perspective, is what Interim brings to the table.”

Sheets is referencing Interim’s 54-year history of training people to be successful in the health care space.

Carolina Lobo, the company’s chief people officer, calls this ability the organization’s “lifeline.”

Amid the public health emergency, Sheets points out that there are a number of reasons the home setting may have a new appeal for those currently working in hospitals.

“We find that nurses and therapists are getting burned out in the hospital setting — especially in the midst of the pandemic,” she said. “They want more control in their lives. They’re looking for flexibility. A lot of them are also heads of household. They’re looking for ways to work around their kids’ virtual learning environment, and they want autonomy to make a long-term impact.”

For Sheets, helping clinicians who want to switch lanes career-wise comes from personal experience. She is a former ICU nurse who would go on to hold a leadership position running several hospitals, before ultimately landing in her current position.

“I realized I wanted to be a part of home care after I had my own story,” she said. “I had my father and my grandmother on home care, home health and hospice services at the same time, and I wanted to be a part of that setting. I realized that [this setting] was driving the real quality of life that people want and deserve.”

Although it’s still early in the new year, looking ahead, Sheets believes the industry will continue to see critical shortages as it relates to the 2021 labor landscape.

“Hopefully, a lot of health care workers will get the vaccine, but we’re still going to deal with people who are out because of an exposure,” she said. “This environment is extremely hard for the health care worker, … so we’re going to see a higher burnout — even more than we are seeing now.”

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