< PreviousTo A Successful Payer Diversification Strategy The Keys Kristen Duell Kristen Duell has over 20 years of experience in the healthcare and home-based care industry, where she’s held positions from non-clinical caretaker to CEO. After making the shift to working in technology, she’s used her first-hand experience to invoke widespread industry changes with scalable solutions. She brings her dedication to mobilizing all factors of the pre- and post-acute care space to HCP in her role as Chief Marketing Officer. https://www.homecarepulse.com/11 Y ou’ve probably heard the saying that you shouldn’t put all your eggs in one basket. The same goes for your payment reimbursements. As the home-based care industry continues to expand and post-acute services are becoming more in demand, agencies are perfectly positioned for growth by embracing payer diversification. Through a diversified payer mix, agencies can meet the rising demands of healthcare and continue delivering superior care to their clients and patients. WHAT IS PAYER DIVERSIFICATION AND SERVICE DIVERSIFICATION While you likely know the nuances of payer diversification, it’s important to take a step back to understand the basics fully. So, what’s payer diversity? Diversified payers refer to the sources an agency uses to pay for clients’ and patients’ expenses. They include federal (Medicare), state (Medicaid), and private payers (commercial & self-pay, publicly traded insurance companies, and employer-funded benefits plans). Service diversity, on the other hand, refers to the range of services an agency is providing and requesting reimbursement for. One payer is capable of reimbursing multiple services. THE BENEFITS OF DIVERSIFICATION Home care has evolved over the years, and how we approach payment and services has had to keep up the pace. Clients and patients expect more comprehensive services, along with more payment options—and the agencies that can meet those needs are the ones who will continue to grow their businesses and provide more well- rounded client and patient support. The benefits don’t end there, though. Payer diversification sets a firm foundation for agencies to generate positive cash flow, build upon their operations, minimize financial health risks, strengthen referral source partnerships, and focus on providing value-based care—and it’s not just your agency that reaps the rewards. A diversified payer mix gives clients and patients comfort, knowing they can choose a provider that focuses on an individualized care plan without creating unnecessary financial burdens. This also provides your staff with more options; the more diversified your payer mix, the more patients you’ll be able to care for, and the more opportunities there will be for your staff to take on more hours, learn new skills, and climb the career ladder. IS YOUR AGENCY READY TO DIVERSIFY? Whether you’re already invested in payer diversification or are looking to implement these strategies at your agency, there’s one question you need to be asking: Are we ready? Diversifying too early could not only not yield the results you’re hoping for, but also exacerbate a weight that you’re not yet ready to carry. A self-audit of your business, your goals, who you are as an agency, and what processes you already have in place is a great starting point. Here are a few questions you’ll want to ask as you’re gearing up for this change: #1: Am I tracking key metrics that prove value to payer sources? According to the 2022 HCP Benchmarking Report, only 21.8% of providers tracked readmission rates last year. Tracking the data and focusing on what you can do to improve is the first step to demonstrating your value to payer sources—and with so few agencies already doing this, it is a surefire way to stand out. If you haven’t already created a tracking program to capture these key metrics at your agency, there’s no better time to start than now. #2: Am I holding regular meetings with my staff to proactively identify and address any problems that arise? In your role as an agency owner, you’ve probably mastered the skill of juggling multiple priorities; however, this doesn’t mean you’re always aware of everything that’s happening in your organization. In order to establish a solid foundation for payment diversification, you must be proactive and ready for any challenges. This begins with open communication among your team members. By holding regular meetings, you have the chance to address any concerns or problems before they escalate into something that will negatively influence your reputation. #3: Do I know how I will implement new procedures and ensure they’re followed by all staff members? Significant changes to operations can take a toll on the productivity of your staff. By preparing ahead of time and putting strong procedures in place, you reduce the risk of unnecessary mistakes or confusion. Being prepared can save you time that might otherwise be spent on damage control in the future. #4: Do I have enough office staff to handle additional administration as we begin to work with more payer sources? More payer sources mean more work for your organization. Is your team capable of taking on more than they are currently doing, or do you have the budget to hire more office staff? If so, it might be worth it to explore how your agency can utilize diversified payer sources. When it comes to private pay, an issue with a client will only affect your relationship with that client; however, with other payer sources, a whole host of people can be affected. Make sure you fully understand the requirements of each source you’ll be working with before deciding how to diversify. Diversified payer sources typically have more stringent requirements with more variance by the state than private pay, so it’s important to determine whether you have the appropriate internal tools and processes to meet the demands. BUILDING RELATIONSHIPS WITH PAYER SOURCES The relationships you build with payer sources play a huge role in ensuring your diversification efforts succeed, and aside from being dependable, timely, and attentive, there are several other important things payers are looking for. New payer sources want to see what you’ve done, not just what you do, making your outcomes your most valuable resource. The data you share, whether it be client satisfaction scores, caregiver satisfaction scores, your net promoter score, readmission rates, or fall rates, is a testament to your successes. With the ability to demonstrate your value through outcomes, you’ll gain a seat at the table with more payers. Payers also want to know more about your reimbursement rates, time frames, billing, and more. To move forward in your relationship with these organizations, you must demonstrate your value and establish a clear line of communication. WHAT CAN YOU DO NEXT? Diversification might feel overwhelming, but it doesn’t have to be. Here’s how you should prepare: ● Be specific and intentional about your business goals ● Begin to diversify your payer set ● Form partnerships with agencies that offer a wide range of services ● Strengthen your relationships with referral sources ● Be proactive in managing compliance Get self paced industry training for as low as $97 per month. Home Care Evolution Daily is a self guided program with weekly tips and strategies! It’s time to stop the guesswork. Hit your goals sooner than you thought possible with Home Care Evolution Daily. Subscribe to Home Care Evolution Daily today and you’ll get: Never get stuck guessing what to do next for your business. Sign up for Home Care Evolution Daily today. www.homecareevolution.com/daily • Exclusive Video trainings • Strategies designed to help you build your business and get more clients • Templates making it easy to implement and get results • Proven Marketing Methods tested and proven by 100’s of home care businesses • Monthly Private Webinar Training keeping you up to date on what’s working NOW • Private Facebook Marketing Group giving you support, accountability, and a direct line of access to get questions answered • Weekly Marketing Tips direct from the best in the industryMarketing With Passion THE KEY TO A SUCCESSFUL MARKETER Melissa has 20+ years of healthcare industry experience. She currently works for Home Care Evolution (formerly Hurricane Marketing Enterprises), where she coaches home care agency owners and their teams with their marketing, operations, recruitment, and retention needs. Melissa has extensive experience and success with all levels of home care companies, from start-ups to established ($10+ million agencies) home care companies across the country. Within the last few years, she has created and developed several coaching classes with Home Care Evolution, now being offered to hundreds of clients. Her most popular classes include, but are not limited to, “How to Market During Lockdown,” “How to Market After Lockdown,” and “Marketing Strategies using Medicare.gov”. Melissa prides herself on the tremendous knowledge and experience she has obtained during her career and continues to challenge herself and her clients to exceed personal and business goals. Prior to becoming a coach, she was a VP of Marketing and business partner for a home care nurse registry in Florida for 3.5 years. Melissa oversaw the marketing and business development of the company throughout the offices in Florida. https://homecareevolution.com/ Melissa Bagley Business Coach, Home Care Evolution 15 I have found that passion is the core of success in home care. After analyzing every unsuccessful hire, I had made, with my successful hires, a personal story or connection was always the missing piece. This was what initially attracted them to home care, and it was also a necessity. A story, just like I had, was what created the passion and drive that all my successful marketers had kept them strong during all the ups and downs that home care inevitably entails. Therefore, the first thing I now ask anyone I am interviewing for a home care position is, “What is your story? What experiences have you had that make you want to work in home care.” The story that gave me a passion for working in home care first started with my grandfather. My grandfather was an engineer for NASA, a strong German man that could do anything he put his mind to. However, when he was diagnosed with Alzheimer’s disease, that quickly changed. I watched how this disease affected my grandfather and everyone around him. Alzheimer’s had turned my grandfather into someone I didn’t even recognize. He became violent at times, forgetful of basic tasks, ignorant of the things he once knew, and simply unrecognizable. The feeling of helplessness I constantly felt when around him began to consume me, as I know it also had with my grandmother and the rest of my family, who loved him dearly. This was when it became my mission to learn and provide everything I could to help others who were dealing with Alzheimer’s, along with suffering from multiple chronic conditions just like my grandfather. When searching for that “unicorn” and it gets to the interview stage, it’s essential to ask them about their story. You are looking for them to describe a story about someone close to them affected by a tragic disease, condition, or situation that impacted their life so drastically that they now put all their heart and soul into wanting to help others. This passion will lead to the success you are looking for. Anyone can be trained and taught all the tips and tricks needed to work in home care, but the rockstars will have a story that will serve as the passion that fuels them to be that “unicorn”. I have had the pleasure of working in the healthcare industry for over fifteen years, and within this time, I have been an administrator, VP of marketing, partner, and now a coach of home care. I would say, at least once a week, I get asked the question, “What should I look for when hiring a marketer?” This has been a question that I have struggled with mastering for many years, as I am sure any manager or owner can relate. I have hired countless rockstars over the years, and I have also hired some marketers that unfortunately failed to meet my expectations—trying to find that “unicorn” of a marketer that checked off every box I had required for the position was hard and sometimes seemed impossible. However, I can successfully say I have finally figured out what is needed to hire the “unicorn” I was always searching for, and that was making sure all my hires had passion. “If you are not passionate from the start, you will never stick it out.” Steve Jobs1617Why This Is The Perfect Time To Open A Non-Medical Home Care Agency And How To Do It! Brian Machlis Brian is the Director of Start-Up Services for Home Care Evolution. Brian graduated from Cornell University with a Bachelor of Science Degree and has spent a large part of his career owning, managing, and developing small to medium business opportunities. Brian started in the home care industry over 20 years ago by first investing in a franchise system. It didn’t take long for Brian to realize the royalty expense of being in a franchise system, along with challenges such as not having entrepreneurial flexibility, being in a restricted or pre-defined geographic territory, and the disputes that occurred warranted a change. As such, Brian branded his own agency, brought on Steve “The Hurricane” Weiss as his Director of Business Development. Together they built up a large, profitable home care agency valued at over $10 million in sales per year in today’s money. Steve recently lured Brian out of retirement to lead the Start-Up Services Division for Home Care Evolution. It is an exciting time here at HCE. https://homecareevolution.com/19 T he numbers tell the story. Home care is a booming business. The projections of our aging population in the United States are in obvious growth mode. Twenty years ago, the census of 65+ was approximately 36 million. This number is expected to double by 2030. Whether our country goes into a recession, our political landscape changes, or the stock market corrects itself, the aging population grows and spends regardless, as does the demand for non-medical services for seniors who prefer to stay home. This is guaranteed business now and in the future. OVERCOMING MULTIPLE BARRIERS What are the barriers to getting into this business? Money, time, and knowledge jump off the page first. As in any start- up business, you need money to start. If you look at a franchise system to invest in, you can expect start-up fees to be at least $100,000. This accounts for a minimum initial fee of $50,000 to $75,000, let alone the costs for state licensing, lost income during the ramp- up period of at least three months, training of other staff, office start-up costs, vendor contracts, deposits, and more. If you are a caregiver working for someone else and think you can do a better job, make sure you have the financial resources, including the loss of income, to even consider going into this industry. Of course, the payout and profitability are the ultimate rewards for a business entrepreneur, and it doesn’t hurt that you would be providing a valuable service that seniors truly need. There is a risk for the reward; not everyone makes it, but for those hungry and willing, there are few business opportunities out there to grow a business relatively quickly. Additionally, there are several “side” opportunities to increase revenue, such as offering Personal Emergency Response Systems, Managed Care Services, and Nurse Staffing. GET THE BALL ROLLING Money starts the ball rolling. You can’t open a business without money to invest. The next biggest investment is your time. There is a ramp-up period that includes time to learn the business, let alone the time it takes to turn a profit. If you are stepping away from a paid job to build a home care business, you need to be prepared to weather the financial storm of not having guaranteed work income to help pay the rent, groceries, and so on of your life, let alone new business expenses like office staff, rent, marketing, and more. The actual time commitment to opening a home care industry is a minimum full-time investment, typically three months prior to opening your doors. It doesn’t stop there. Home Care services require full-time ownership involvement to run the operation properly to grow it. If you think opening and running a home care industry will be easy or doing this as part-time work to profitability, you are sadly mistaken and will be set up for disappointment. Part of the time commitment is learning the industry, not just the caregiving piece, but all facets, including running an operation; creating and executing a sales and marketing plan, how to handle recruitment; how to stay in compliance with state and federal laws; how to handle HR functions like I-9 compliance; managing finances; managing client needs, quality control oversight; billing, payroll and more. All of this is typical for your day-to-day operations, but what do you do to get started? LAYING OUT THE FOUNDATION Some of the obvious answers to getting started in this industry is to talk with your accountant or financial advisor. Again, you need money to start and operate your business while potentially giving up income from a current job. There is a risk, and it’s crucial to know your financial position before you start. Then what? It’s a smart idea to speak with an attorney. Are you planning on starting this business with a partner? If the answer is yes and you don’t have a formalized operating agreement spelling out responsibilities and more, your business or personal relationship could become problematic. Franchise opportunities are still the biggest draw for new business owners. There are tons of them out there, but be careful. I started out years ago as part of a franchise system and despised it. It’s difficult enough to invest $50k or more just to have a defined territory, but the royalties make a difference in your profitability. That said, the industry standard royalty is 5% of your gross, which potentially strips away 25% or more of your profitability. Next >