Contributors: Adam Groff, MD ’06, WG ’06 and David Baiada, WG ’06 To learn more about Adam and David, click here.
Home health care is well positioned to meet the challenge of caring for people with higher quality and lower cost. In this first of two articles, we will discuss the current home health industry and our belief that the most important driver of success is a focus on people. The second article will explore how this focus on people will also be critical with emerging, high-value home health care models.
People enjoy the comfort of being at home. Whether it is the familiarity of surroundings or the closeness to friends and family, for many, home is a place where people can be themselves in an environment they control. Even when illness strikes or physical challenges make activities difficult, almost everyone would prefer to recuperate or adapt to life in their home.
As our population ages, the demand for services that keep people at home will greatly increase. In addition, there will be a continued emphasis on community-based over institutional care for younger people with special needs. Compounding these demands, governments, employers, providers, and households will struggle with the need to reduce the total cost of care. Home-based health care offers tremendous potential in meeting the challenge of increasing access while improving quality and reducing cost.
There is already a large industry that serves people in their homes – and it is growing quickly. CMS estimates that total home health care expenditures was about $82 billion in 2014, and this will nearly double to $156 billion by 2024.i These projections may prove conservative if existing and new models of home-based care are able to displace care provided in more expensive settings like hospitals and skilled nursing facilities.
Inspired by the success of hot “on demand” services like Uber and Airbnb, a new generation of companies have entered the home care market. Venture capitalists have invested in start-ups like Honor ($20MM raised), HomeHero ($23MM), and HomeTeam ($11MM).ii These companies focus on connecting non-medical private-pay caregivers with seniors using technology. While these models are unproven, there are compelling reasons to believe that technology will help to improve convenience and the efficiency of delivering home care. These new entrants into the home health care industry will learn quickly that consistent execution is very difficult. There are many variables and unexpected challenges that continuously arise when providing care at home – whether it is staffing challenges, unique client dynamics, or even natural disasters. Technology will help, but home-based care will always require people heroically helping other people to live in their homes. The companies that figure out how to empower people to consistently overcome the unexpected are the ones that will be successful.
For forty years, BAYADA Home Health Care has been learning how to provide greater access to high-quality care that helps people live safely at home. Started by Mark Baiada in Philadelphia in 1975, BAYADA is now the largest private home-based health care company in the United States. With nearly 300 service offices in 22 states, and recent international expansion to India and soon Germany, BAYADA employs over 25,000 people. BAYADA is unique in being a multi-payer, multi-service line organization with national scale. Our employees range across the spectrum of healthcare disciplines and include registered nurses, licensed practical nurses, physical therapists, occupational therapists, social workers, home health aides, physicians, nurse practitioners, and spiritual counselors. We rely on thousands of people, traveling many miles, to care for many tens of thousands of patients in their own homes each year. Our people are spread out across the country, and their workspace is another person’s home rather than an office or clinic. BAYADA’s core competency is managing a mobile, home-based workforce. This competency is the link that integrates across our specialty models, payer types, and clinical disciplines. Our only true “product” is the ability to field compassionate caregivers who deliver high-quality care with reliability, wherever a patient lives and overcoming whatever challenges they face. It may sound simple, but the ability to do this in many markets at scale is exceptionally difficult. From our own lessons and in observing other successful companies, we believe that empowering people is the key success factor in home health care. While most companies in any industry will embrace this concept, the nature of our work in home health care requires this focus on people as the core strategy. For this strategy to work, a culture with a shared purpose for helping people is the key. Some of the tools we think can be used to reinforce culture to help manage a mobile workforce include:
• a genuine and meaningful statement of mission, vision and values that becomes a living, daily ritual (BAYADA call’s its written philosophy The BAYADA Way)
• selection for people who seek a higher purpose in their work
• transparency across an organization with strategy, quality, and financial performance to build trust
• treating employees fairly and generously, including those that may struggle with their work
• accountability through granular financial systems so that employees are careful stewards of human and financial resources
• compensation systems that align with the company’s success
• focus on quality, with growth and financial success as a by-product
• recognition for those who provide service that is above and beyond
For home-based care to meet its potential in increasing access to care while improving quality and reducing cost, we believe this strategic focus on people will be critical. We’ve spent forty years refining our model, and there is still plenty of work to be done, but the future of healthcare looks very promising for BAYADA and other people-focused organizations.
In the next article, we will discuss several examples of innovations in home health care services, partnership, and payment models that we are pursuing. These include home-based primary care (housecalls), managed service agreements with health systems, and value-based payment. We will also discuss how a strategy of focus on people can be applied to these innovations.
Contact Adam at: [email protected]
Contact David at: [email protected]
References:
i. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports NationalHealthExpendData/NationalHealthAccountsProjected.html
ii. https://www.crunchbase.com