From ‘Simple Things’ To AI: What Innovation Means For 3 At-Home Care Providers

HHCN’s FUTURE Conference, taking place in Dallas Sept. 15-17, will be an excellent opportunity to learn more about the topics discussed in this article and other ways providers are innovating. To learn more and reserve your ticket, click here.

Innovation in the home-based care industry is driving meaningful change, not always by reinventing care delivery, but by making it easier and more efficient.

By leveraging technology and other innovations, providers such as Bayada, Help at Home and HealthView Home Healthcare Services are improving recruitment, reducing falls and making home-based care workers’ jobs easier – though reimbursement rates and policies threaten providers’ abilities to innovate.

“Innovation isn’t necessarily when you create the DeLorean in the movie ‘Back to the Future,’” Mike Johnson, chief researcher of home care innovation at Bayada Home Health Care, said on a recent Home Health Care News webinar. “Innovation could simply be doing care slightly better. We go from simple things that make a big impact to maybe big things that make a big impact.”

Pennsauken Township, New Jersey-based Bayada provides home health, home care, hospice and behavioral health care services in 22 states as well as internationally. Overall, Bayada has about 32,000 employees nationwide. In 2019, the company transitioned to become a nonprofit organization.

Innovative techniques, including technology, are also helping providers succeed under risk-bearing or value-based models by delivering actionable data to meet reimbursement requirements, according to Monica Cutia, vice president of clinical operations at HealthView Home Healthcare Services.

“Over the past couple of years, [we’ve seen] shifting the focus from volume of patients to that quality of care, and then the outcomes of the care that we provided,” Cutia said. “What we’re seeing is the leveraging of the data, the care plans and the use of technology to really deliver that care, timely, efficiently, and make sure at the same time that everything is patient-centered, that it is personalized to each patient.”

Cerritos, California-based HealthView’s offerings include in-home skilled nursing visits, private duty nursing, respite care and personal care. The provider was initially founded as a non-profit adult daycare program before moving to focus on home health and was sold in 1996 as a for-profit operation.

Technological innovations

Among the major technological innovations in home-based care is remote patient monitoring. This technology, coupled with predictive analytics, can help home-based care providers stay tuned into constantly evolving health conditions.

“We cannot be there 24/7, so by partnering with physicians, with hospitals and with our assisted living facilities, we’ve been able to be able to put in these technologies so that we can identify changes in our patients and identify potential issues before they go to the hospital, before there’s a huge emergency,” Cutia said. “So shifting our approach to a more reactive than a proactive [one] has really helped us to prevent those hospitalizations, improve the patient outcomes and keep the patient at home where they want to be and not in the acute care settings.”

Remote patient monitoring paired with risk prediction models helps Bayada identify high-risk patients, adjust care plans and better allocate resources. These tools have been “incredibly helpful” to care quality, Johnson said.

Bayada is also working toward using technology to reduce patient falls. The provider is in the process of building risk algorithms that use its electronic medical record (EMR) to identify when patients are at risk of falling and intervene to reduce falls.

While Bayada is still in the process of developing this technology and determining the best interventions to deploy, preliminary results show a 40% reduction in the rate of injurious falls.

Technology is also helping address one of the most significant and ever-present challenges in the home-based care industry: workforce shortages.

Technology, including AI, is one way to enable caregivers to better focus on client care, according to Sarah Anderson, senior vice president of caregiving, Help at Home.

“What energizes me the most is how focused we are in making [caregivers’] jobs easier,” Anderson said. “Making things easy is hard, but I think … enabling them to better focus on client care is probably the most important thing we can do. Whether that’s removing administrative burden from our caregivers or being able to match them to the right client with a click of a button. We’re launching technology that’s designed to make their everyday experience smoother, faster and just plain easier.”

Chicago-based Help at Home offers home care in 11 states. It operates over 200 locations and employs 60,000 caregivers. The company added 1,300 caregivers and 1,500 clients to its count with its acquisition of Caregiver Services Inc. in November. 

Help at Home’s caregiver-focused technologies include a platform that allows applicants to schedule interviews online, 24/7, when applying for roles. The provider has seen significant success with this model, Anderson said, and hires 3,000 to 4,000 net caregivers each month. 

The company has also digitized paperwork, lessening the burden for caregivers and administrative staff. Allowing nurses to use voice data capture for notes limits time spent in the office and enables more time in the field with clients, Anderson said.

Improving operating systems also helps with retention. Caregivers do not leave their jobs because they do not want to take care of clients, Anderson said, they leave because they dislike the work that comes along with it. By taking some tasks off caregivers’ plates, Help at Home has achieved 94.6% caregiver retention in the first 30 days.

HealthView is also leveraging technology to make processes more efficient. Creating interoperable platforms that streamline documentation and communication between clinicians, physicians, offices and community partners makes it easier for back-office staff to receive updates from the field and to receive orders from doctors in a more timely fashion.

“The theme for us is really unburdening our clinicians and utilizing these tools like AI or finding EMR systems that really help that workflow, that give the time back to the clinicians, that give that time back to the patients and the families,” Cutia said. “Ultimately, as clinicians, that’s who we are, that’s what we do.”

Challenges to innovation

From the risks of overusing AI to policies that could impede providers’ adoption of the most cutting-edge techniques, implementing innovative strategies is not without its challenges.

While AI can be a tool to ease worker burdens, improve care and efficiency, providers should also keep some concerns regarding the technology in mind.

“What I’m probably most worried about is that people are going to trust AI before they should,” Johnson said. “Where your work has to be spent is in checking the accuracy. … If we turn on AI ambient listening and so forth and say, ‘Okay, this is great, [we] cut your time in half. Now you have got to see twice as many patients,’ that’s not a win either. You still need that time to check the note and the discipline to make sure we don’t trust it until we trust it.”

While the technology is not yet perfect, the industry is largely being careful with it, Andersaid said, and people should not be afraid of leveraging AI.

Inconsistencies across payers also make innovating difficult, Cutia said.

“Medicare, MediCal, private insurances, everybody has their own rules, their own set of requirements,” she said. “Going across 100 different requirements, it is hard to scale any new model, because Medicare is expecting this, Medicaid is expecting this, and then UnitedHealth wants X, Y and Z from us. You’re asking clinicians to do 100 different things for the same outcome, and so it does eat a lot of time. It does take away from the patient.”

The proposed Medicare home health reimbursement cut, which amounts to a total cut of 9%, poses a major threat to home health providers seeking to innovate, Johnson said. The proposed cut and efforts to claw back payments send a message that CMS does not trust providers, he said, falsely conflating a few bad actors with the entire industry.

Fighting the proposed Medicare home health payment cut is Johnson’s top priority for the coming year.

“What the policy makers need to understand is our operating surplus is part of our innovation fund,” Johnson said. “How are we going to get better? We self-fund, we self-invest, we’re happy to do it. But we need to think about surplus as more than just money that’s going into the bank account of executives. We’re going to be spending a lot of time and energy fighting this particular cut, because it’s going to be really detrimental if we can’t get it removed.”