As presented at the Home Care Association of Florida Annual Conference (HCAF) June 23, 2010, My Health Care Manager CEO Alan Stanford and Take Care Home Health Care Founder Sue Wise present on this timely topic that will help home care practices generate additional income.

1. Adding value and revenue to
your home care practice with
Geriatric Care Management
Home Care Association of Florida Annual Conference
Orlando, June 23, 2010
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2. z
• x
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3. 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
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4. The problem: Our health care “system” is not
friendly or easy to navigate for seniors
Providers and Issues
■ Transportation
■ Doctor #1 - Primary Care
■ Doctor(s) #2 (& #3) - Specialist(s) Insurance
■ Prescriptions and Renewals
■ Pharmacy - Local
Family and Pharmacy - Mail Away
Loved Ones ■ Clinic(s)
■ Hospital(s)
■ Skilled Nursing Facility/Rehabilitation
■ Outpatient Treatment/Therapy
■ Home Health Care Provider(s)
Seniors ■ Insurance - Medicare A & B
Caregivers and Their Health ■ Insurance - Medicare C - Advantage
Housekeepers Care ■ Insurance - Medicare D
Their Faith ■ Insurance - Supplemental
■ Insurance - Home Health Care
■ Insurance - Long Term Care
■ Insurance - Other (A,D&D, Cancer, etc.)
■ Independent Living - Home or Facility
Professional ■ Assisted Living - Home or Facility
Advisors ■ Long Term Care - Home or Facility
■ Housing Modifications
■ Health Power of Attorney
■ Living Will
■ Communications with Trust Officer
■ Retirement/Nursing Home Options
■ Other
© My Health Care Manager, Inc.
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5. And home care is just one of the many issues
seniors and their families have to deal with
Providers and Issues
■ Transportation
■ Doctor #1 - Primary Care
■ Doctor(s) #2 (& #3) - Specialist(s) Insurance
■ Prescriptions and Renewals
■ Pharmacy - Local
Family and Pharmacy - Mail Away
Loved Ones ■ Clinic(s)
■ Hospital(s)
■ Skilled Nursing Facility/Rehabilitation
■ Outpatient Treatment/Therapy
■ Home Health Care Provider(s)
Seniors ■ Insurance - Medicare A & B
Caregivers and Their Health ■ Insurance - Medicare C - Advantage
Housekeepers Care ■ Insurance - Medicare D
Their Faith ■ Insurance - Supplemental
■ Insurance - Home Health Care
■ Insurance - Long Term Care
■ Insurance - Other (A,D&D, Cancer, etc.)
■ Independent Living - Home or Facility
Professional ■ Assisted Living - Home or Facility
Advisors ■ Long Term Care - Home or Facility
■ Housing Modifications
■ Health Power of Attorney
■ Living Will
■ Communications with Trust Officer
■ Retirement/Nursing Home Options
■ Other
© My Health Care Manager, Inc.
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6. But properly supported Geriatric Care Management
services can assist in the spectrum of senior issues
Entire Yellow Background: Providers and Issues
Geriatric Care Management ■ Transportation
Service Area ■ Doctor #1 - Primary Care
■ Doctor(s) #2 (& #3) - Specialist(s) Insurance
■ Prescriptions and Renewals
■ Pharmacy - Local
Family and Pharmacy - Mail Away
Loved Ones ■ Clinic(s)
■ Hospital(s)
■ Skilled Nursing Facility/Rehabilitation
■ Outpatient Treatment/Therapy
■ Home Health Care Provider(s)
Seniors ■ Insurance - Medicare A & B
Caregivers and Their Health ■ Insurance - Medicare C - Advantage
Housekeepers Care ■ Insurance - Medicare D
Their Faith ■ Insurance - Supplemental
■ Insurance - Home Health Care
■ Insurance - Long Term Care
■ Insurance - Other (A,D&D, Cancer, etc.)
■ Independent Living - Home or Facility
Professional ■ Assisted Living - Home or Facility
Advisors ■ Long Term Care - Home or Facility
■ Housing Modifications
■ Health Power of Attorney
■ Living Will
■ Communications with Trust Officer
■ Retirement/Nursing Home Options
■ Other
© My Health Care Manager, Inc.
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7. 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.
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8. Health care is a provider-based “system”, with
business models defined by reimbursement sources
Senior Health Care Continuum
Consumer Provider
Families Navigation Support Providers Payors / Others*
My Health Care Manager Primary Care Physician
■ Navigation ■ Well-being
■ Compassion ■ Holistic & Psychosocial Medicare A
■ Education & Compliance ■ On-going assistance Specialists,Clinics & Hospitals Medicare B
■ Technology and tools ■ Caregiver assistance
Independent Geriatric Care Manager ? ? Medicare Advantage
Commercial Geriatric Care Management Companies
Skilled Nursing Facility & Rehabilitation Other Insurance
Skilled Nursing
Home Health
Companion Service
Disease Management
Community & Faith Based Services
Prescription Medicines Medicare D
Senior Living Community
Independent Living Long Term Care
Assisted Living Insurance
Skilled Care Medicare
Advance Directives
Estate Planning
*(Medicaid
Money Management Not Included)
© My Health Care Manager, LLC 2007
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9. 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
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10. 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
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11. Who provides Geriatric Care Management? Cont’d
• 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 11

12. 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
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13. 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
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14. 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?
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15. Adding Geriatric Care Management can enhance
the value of your home health agency in 3 ways:
1. 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
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16. Adding Geriatric Care Management can enhance the
value of your home health agency in 3 ways: Cont’d
2. 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
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17. Adding Geriatric Care Management can enhance the
value of your home health agency in 3 ways: Cont’d
3. 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
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18. Current home care clients tend to be episodic and
engaged at the later stages of aging
Insurance with Case and Disease Management
Hospital System
Hospitalization Hospitalization
Initial <30
Acute Day
Primary Care Care Repeat
Physician
Patient and
Consumer
Bright Yellow: Home Health
Family and Family Involvement
Loved Ones
© My Health Care Manager, Inc.
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19. Adding Geriatric Care Management services to
your agency significantly increases your reach
Insurance with Case and Disease Management
Hospital System
Hospitalization Hospitalization
Initial
Acute <30 Day
Primary Care Care Repeat
Physician
Patient and
Consumer Geriatric Care Management
Family and Family Involvement
Loved Ones
© My Health Care Manager, Inc.
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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
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26. 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
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27. Contact Us
Susanne Wise, RN, MBA
swise@takecarehomehealth.com
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
astanford@myhealthcaremanager.com
My Health Care Manager, Inc.
8520 Allison Pointe Blvd.
Indianapolis, Indiana 46250
317-598-8921
www.myhealthcaremanager.com
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