The Impact of COVID-19 on Home and Community-Based Services Providers

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While the COVID-19 pandemic hit healthcare hard, it’s been especially challenging for home and community-based services providers. From caregiver shortages and new regulations, to new tech adoption and implementation, homecare providers have had to quickly adapt to changing needs and expectations, while continuing to provide quality care to a mass increase of patients in the home.

And as eager as Americans may be to leave their homes after two years of shutdowns and quarantines, at the same time, many consumers are now reevaluating the way they prefer to receive care – with many in favor of options that would allow them to remain out of a hospital or facility. In fact, up to $265 billion worth of care services currently being delivered in clinics, facilities and physician offices could shift to the home by 2025.

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Stephen Vaccaro, president at HHAeXchange, took some time to do a brief Q&A to address this.

1. Tell us about your background, HHAeXchange and your role at the company.

My name is Stephen Vaccaro, and I serve as president at HHAeXchange, the leading provider of homecare management solutions for providers, managed care organizations (MCOs), and state Medicaid agencies. In my role, I lead HHAeXchange’s market strategy and the national expansion of our providers and portfolios. I have over 25 years of leadership experience in the healthcare industry, having spent time on both the payer and provider sides of the market. I also have a background in sales, service delivery, strategic planning, project management, profit and loss management, product development, and acquisition integration.

2. COVID-19 played a major role in the growth of home care. In your opinion, how has this changed the industry and what kind of demand can we expect moving forward?

  • COVID-19 brought to light how significantly social determinants of health (SDOH) affect population health as a whole. Because of this, the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs began working to improve investment efforts into the innovative and solution-driven initiatives surrounding SDOH. For example, it is now realized that Medicaid MCOs may be better equipped to address members’ SDOH and health equity compared to fee-for-service models, most notably when pertaining to population health management strategy, health equities, care coordination, and value-based payment.
  • In the future, I expect we’ll see this demand continue its trajectory, and that’s partly because the homecare market is growing to comprise a multitude of forms. The perception that homecare consists of aides visiting elderly patients is no longer the full reality; homecare now covers everything from non-skilled and skilled nursing care, hospital at home, physical therapy, aging in place, and everything in between. As different facets of the medical community change, adapt, and take advantage of the conveniences that technology affords – and as they see the difference efficient homecare can have on patient outcomes – the market’s expansion will be tremendous.

3. What are some of the challenges currently facing home and community-based services providers as a result of rapid expansion in the market?

  • The industry’s intense growth over the past few years means that providers are having a difficult time keeping up in the caregiver recruitment and retention areas. In addition, because there is such pressure to quickly fill vacancies without any gaps in care, not enough attention is given to training and orientation. Too often, homecare workers receive inadequate formal training which, when combined with low pay, long hours, and a lack of respect for the skill required to do their jobs, equates to high turnover and job dissatisfaction. There’s no one-size-fits-all solution to these issues, but healthcare leaders can start by supporting the implementation of training standards and programs and establishing Medicaid reimbursement strategies that reward improvements in pay and working conditions. Regulations thwarting the full utilization of homecare workers must be addressed as well.

4. How are providers leveraging technology to address macro trends like the Great Resignation while ensuring consistent and effective homecare?

  • Macro trends like the Great Resignation, while not always positive, do offer the industry an opportunity to leverage the roles of homecare providers in innovative and cost-effective ways. Essentially, providers must adapt rapidly by utilizing available resources to become more efficient and streamline their capabilities – that means embracing technology that allows for the improvement of existing processes and simplify caregivers’ jobs. 
  • More providers are utilizing connected care platforms and personal emergency response systems to link patients with their caregivers. Having comprehensive homecare provider platforms is an easily implemented, intuitive solution that can have big implications to benefit both patients and staff. Essentially, technology can fill gaps to ensure that treatment is not being sacrificed. HHAeXchange, for example, not only supplements patient-caregiver communications, but also provides tools for scheduling and referrals, reporting, billing and payroll, clinical information gathering, compliance verification and more. 

5. What role does social determinants of health play in improving member outcomes and lowering healthcare costs – and how does this factor into the home caregiver’s role?

  • SDOH, which includes health-related behaviors, socioeconomic factors, and physical environment factors like the conditions in which people are born, grow, live, work and age, have a huge impact on homecare, as they allow caregivers and providers to see the patient holistically – instead of only being aware of one aspect of their overall situation and health profile.
  • Due to the frequency of their visits and the personal connections made, caregivers have key insights into their patients’ health and well-being that others within the healthcare continuum might not. For instance, since they provide care directly in a patient’s home, caregivers see whether or not individuals are eating, drinking, bathing, etc. They also may be able to identify social and environmental issues, such as unsafe conditions, limited access to food, or lack of a support network with whom the member can connect, thus better enabling the provider to address troublesome SDOH. By preventing the need for emergency care and hospital stays, patient outcomes and healthcare costs are improved

6. How is HHAeXchange helping to address the challenges associated with social determinants of health and improve value-based care?

  • Rather than reimbursing providers based on the quantity of services delivered, value-based care pays providers based on the quality of care they give patients. Caregivers are in a position to improve that quality of care when they can observe, note, and report changes in condition and other potential health risks back to the agency. So, convenient and organized access to the data they collect is more critical than ever. The challenge here is making sure that data is faithfully recorded in an accurate and timely fashion and shared with the appropriate parties. Simply collecting it isn’t enough, and it’s easy for important facts to get lost or overlooked when the documentation and sharing process is lacking, whether that’s because it’s overly complex and time-consuming or not thorough enough.
  • HHAeXchange is committed to overcoming that challenge by providing comprehensive payer and provider platforms equipped with the essential tools homecare workers need in order to collect information in patients’ homes, initiate the proper care services, and drive better outcomes. Additionally, our cloud-based healthcare software then dynamically links those contracted providers to the payers, enabling improved communication, visit verification, increased compliance and overall operational effectiveness.

7. What does the future of the homecare industry look like to you?

  • I think technology’s critical role in the growth and success of the industry will become even more important. We also need to listen to all stakeholders, and that means allowing patients, providers, payers, and homecare attendants to have a voice in shaping the future of the industry. The market is poised for unprecedented growth which, when combined with the very large aging population represented by the Baby Boomers, means homecare has no choice but to keep up. Utilizing technology to streamline all aspects of the market and make lives easier is easily the most attractive option for bringing in and retaining qualified staff. That’s what it all comes down to – when the people who comprise each level of the homecare industry are given useful solutions, the market as a whole thrives.