Adding Value and Revenue to Your Home Care Practice with Geriatric Care Management

Adding value and revenue to your home care practice with Geriatric Care Management Home Care Association of Florida Annual Conference Orlando, June 23, 2010

And Alan Stanford, CEO and founder of My Health Care Manager, Indianapolis
A national company that is
dedicated and specialized
in improving the well-being of older adults
Develops and licenses industry-leading knowledge and decision support systems dealing with the issues and options of aging
Home care agency licensees in Sarasota-Bradenton-Venice, Cincinnati, Indianapolis, Denver, Greenville, Seattle-Tacoma, and Gainesville with 40 more in discussion stage
Provides Eldercare employee benefit program covering nearly 100,000 employees and distributed directly and by WellPoint through state Blue Cross/Blue Shield plans

The problem: Our health care “system” is not friendly or easy to navigate for seniors

And home care is just one of the many issues seniors and their families have to deal with

But properly supported Geriatric Care Management services can assist in the spectrum of senior issues

The problem is huge today, and getting worse.
Over 40 million seniors (65+) today and growing at 12% a year to around 70 million by 2050.
Problems are overwhelming
Family members remain the key source of help for their parents, but many are working and raising their own families from many miles away.
The Medicare and Medicare Advantage insurance programs primarily limit their reimbursements to symptoms, diagnoses and problems, not the complex set of inter-related issues of “aging,” and Part D is confusing.
The problem is larger than the resources available to help.

Health care is a provider-based “system”, with business models defined by reimbursement sources

What is Geriatric Care Management?
Most common agreement on definition:
Guidance on aging issues including coordinating, coaching and advocacy in liaison with health team
Usually provided by professionals in an unlicensed service area
Most often privately paid for by the senior or their family members
Holistic in approach addressing many components of a person’s life that are not addressed by health care providers
Family communications are usually enhanced
Services tend to be ongoing rather than episodic
With the complexities of caring for seniors, Geriatric Care Management is more important than ever before

Who provides Geriatric Care Management?
Historically a cottage industry known for individuals or small groups practicing on a solo basis in local areas
The National Association of Professional Geriatric Care Managers has standards, qualifications and a code of ethics for its members who must hold a certification in care management
Some individual Geriatric Care Managers are practicing in your service areas and may be referring home care cases ( www.caremanager.org ) + zip code

Some new entrants are combining Geriatric Care Management with home care into a single branch office offering
SeniorBridge ( www.seniorbridge.com ) is an early leader in the combined office offering with 11 offices in the Northeast, 15 in Florida and 5 others plus a care network
LivHome ( www.livhome.com ) is expanding out of their Los Angeles start with offices in California, Illinois, Massachusetts, Maryland, Texas and Virginia.
Often their expansion strategies involve acquiring local home care agencies and converting them to full-service branch offices
Acquisition challenges include valuation in a “down” market
Usually only one agency purchased in a trading area
Who provides Geriatric Care Management? Cont’d

My company, My Health Care Manager, is taking a different path by helping organizations already serving senior clients expand into Geriatric Care Management with systems, knowledge, experience and support
Home health and home care agencies
Certified
Private duty
Hospital systems
Relationship management and coordination
Continuum of Care strategies
Senior living residences
Care coordination and facilitation
Family communications
Who provides Geriatric Care Management? Cont’d

We’re bringing the power of technology to bear on the problem
Knowledge Management and Decision Support technologies are required
Predictable support plans and recommendations regardless of the caregiver’s education and experience
Best practices of caregiving and care managing from national experts and practical care manager success
Secure Internet technology to link, with permission, family members and providers with the care manager
Safe and private storage of important information including a Personal Health Record that is accessible when needed

Your agency has the option of adding Geriatric Care Management services to expand its services
Geriatric Care Management services complement current services and deal with issues usually not provided or reimbursed, such as:
How long can I remain in my home?
How long can I keep driving?
How can we care for our parents from a distance?
How can I better understand my doctors and their advice?
What help is available to help me manage my medicines?
If I have to move, what are my options?
Who can help us improve our family communications?
If I want to move to a senior community, how do I choose it?
We need to get our plans in order. Who can we trust to help?

Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways:
For clients and patients:
Assistance from a trusted source on all issues of aging – not just current services
Continuous relationship and support between medical episodes of care
Improved family involvement in care plans and continuing family communications
A “family friendly” point of contact for remote family caregivers

For influencers and referral sources:
A sorely needed consumer-oriented addition to the provider-dominated health care “system”
A source of guidance through complicated and confusing health care choices
A business partner to support other providers when their business models can’t support continuing services
Discharge planners
Skilled Nursing Facilities
Physicians and their nurses
Senior Living Residences
Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways: Cont’d

For your home care agency:
New markets
The ability to serve clients before they need home care
New positioning of your agency for referrals
Diversification of revenues from reimbursed to private pay
Career alternatives for nurses or social workers who desire to stay engaged with patients and work on their holistic issues and support them on all of their issues, including family communications
Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways: Cont’d

Current home care clients tend to be episodic and engaged at the later stages of aging

Adding Geriatric Care Management services to your agency significantly increases your reach

Just as in home care, the business model is driven by clients, costs and margins
Clients
A key advantage is providing new services for current cases
Referral sources increase with the additional services
Costs
Early economics are significantly affected if dedicated personnel are used or if a variable labor/cost model is used
Non-chargeable time is used for agency development
Margins
A goal of 40-50% gross margin is the target, before SG&A

Clients come from new sources
Independent trusted advisors
Estate planners and trust attorneys
Financial planners and bankers
Elder law attorneys
Providers with business models limited by reimbursement who want to help their patients
Discharges to hospital home health
Skilled Nursing Facilities
Physicians and other health care providers
Senior Living Residences

Rates and services vary
Often quoted hourly rates range from $75 to $200 per hour with $100 to $125 frequently experienced
Current services available range from hourly services to one-on-one relationships, with some Geriatric Care Managers serving as court-appointed guardians or working with or for elder law attorneys
There is no consistent definition of services, quality or charges throughout the U.S. which makes it difficult for consumers to make choices and decisions

Cost drivers are controlled by management
An early decision is whether to establish a new identity and location for the service
Name and logo
Physically separate location or entry?
A proven development and marketing leader is key
Either a shared current one or a new hire
The amount of overhead assigned is a company-by-company decision

Margins are directly affected by chargeable time for Care Managers and sales expenses
If a potential Care Manager is currently in your agency and you can pro-rate the time, costs are transferred as billings progress
A more serious commitment involves dedicating Care Managers to the Geriatric Care Management practice
The decision to dedicate a full or part-time business development person is critical for momentum

We’ll be seeing the impact of health reform as more is learned and experienced
Accountable Care Organizations (ACOs) may emerge as the driving force behind coordinating care between physicians and care providers, hospitals and home care
Home care agencies partnering with ACOs may add continuity of care and oversight dimensions to the challenges ACOs will face in meeting CMS objectives
Geriatric Care Management services align with CMS objectives
Current CMS reimbursement rates will continue to be under tremendous pressure for reduction, thus diversity in revenue sources becomes critically important

And, if you have any doubts by now, we do believe Geriatric Care Management can add value and revenue to your home care practice!
Now it’s time for questions and discussion

Susanne Wise, RN, MBA
[email_address]
Take Care Private Duty Home Health Care
Take Care Advisor
3982 and 3920 Bee Ridge Road
Sarasota, Florida 34233
www.takecarehomehealth.com
www.takecareadvisor.com
Alan Stanford
[email_address]
My Health Care Manager, Inc.
8520 Allison Pointe Blvd.
Indianapolis, Indiana 46250
317-598-8921
www.myhealthcaremanager.com
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Adding Value and Revenue to Your Home Care Practice with Geriatric Care Management

by My Health Care Manager, Inc.

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Adding Value and Revenue to Your Home Care Practice with Geriatric Care Management Presentation Transcript