to the future
8 steps to being out front on business innovation
by Bradley Smith

In a recent article in HomeCare, National Association for Home Care & Hospice President Bill Dombi said: “To thrive in health care, and particularly home health care, one must be ceaseless in exploring innovation, tireless in employing creativity, and willing to roll with the punches that inevitably come when you challenge institutionalized health care powers. That all translates to a willingness to not only embrace change, but to lead it.”

I strongly agree with this sentiment. The one point I will add is that the concrete actions you take based upon what you learn from exploring innovation must be made judiciously and supported by what you understand about industry dynamics. Innovation can do wonders for a homecare business and its clients, but only if the innovation pursued and embraced aligns with regulatory, financial, clinical and operational trends and developments. Misguided efforts around innovation, a lack of support for it, or suboptimal execution can produce lackluster results with the potential to harm or even cripple a home health agency (HHA) or home medical equipment (HME) provider.

Here are eight of the steps your agency should consider taking—if it hasn’t already—to further innovate your business in order to achieve short- and long-term success.

1. Explore new services & service lines.

Disruption in the health care delivery system opens doors to those businesses willing and able to step up and address changing needs and demands. Companies that have the financial means and resources to expand beyond their traditional services and pursue new service lines are in a strong position to set themselves up for growth.

For example, some home health agencies are developing programs to provide staffing support to senior living facilities. Others are expanding the types of services offered to their clients to include things like transportation and shopping. I’m even hearing about agencies providing non-health care services, with caregivers who help with staff screening and take temperatures, as well as offer guidance and training on proper safety protocols.

It is difficult to predict how long some new services will remain viable. However, as long as companies that pursue growth opportunities make smart investments in technology and remain nimble, there will almost always be ways to pivot services and personnel to pursue new avenues or strengthen core operations and offerings.

2. Be open to a merger or acquisition.   

Perhaps the most significant barrier to the pursuit of innovation is a lack of capital. A desire to invest in something new is vastly different from the ability to invest. While there are various ways to raise capital, one approach that can deliver benefits going beyond the issuing of a check is selling your company.

A buyer who is willing to support the growth of your business can provide the funding you need to make investments. The right buyer can also bring a mix of knowledge, experience and professional contacts that help you make smarter decisions about where to invest and how to execute a plan to capitalize on how and where you innovate. To find a partner that will not only pay a fair price for your business but can also provide valuable expertise during this transitional period, engage a merger and acquisition advisor that specializes in home health or HME.

3. Respond to changing client dynamics.

Despite a turbulent year, homecare companies are well-positioned for success—as long as they put themselves in that position. The appeal of home health services may be at an all-time high. They represent a safe alternative to receiving care at other types of facilities (e.g., nursing homes, skilled nursing facilities, hospitals). This is especially true for elderly clients and those with multiple health conditions who are more susceptible to COVID-19, and for those who may have postponed care due to concerns about the novel coronavirus. In addition, the aging U.S. population and continuing shift toward value-based payments all play into the attractiveness of these services.

Home health agencies have an opportunity to benefit from the growing demand for home services and increasing client base. Pivotal to agencies capturing this client volume will be increasing awareness of services and differentiating the home health approach to care. In competitive markets, businesses will need to go one step further and distinguish themselves from competitors, in part by playing up investments in innovations designed to improve quality, safety and security for clients.

HHAs and HME providers looking to take advantage of this window of opportunity will want to consider various marketing mechanisms to reach and inform prospective clients and referral sources, including those requiring financial investment (e.g., television ads, digital marketing, print collateral) and those that predominantly require time (e.g., interviews with media, encouraging word-of-mouth referrals from past and current clients, social media posts, publicizing testimonials).

4. Embrace & build mechanisms to better support the virtual world.

While nothing is ever assured, one can comfortably assume there are at least two emerging trends that are here to stay: telehealth and the remote workforce. Companies that want to remain competitive will need a plan to support the virtual demands from and for clients and staff.

A much larger portion of the consumer population now has first-hand experience with telehealth and various types of telehealth delivery systems, such as remote physiological monitoring. Fair Health’s monthly telehealth tracker shows that telehealth claim lines increased more than 3,500% from August 2019 to August 2020, growing from about 0.2% of all medical claim lines to about 6%. HHAs were permitted to provide even more services to beneficiaries via telecommunications technology within the 30-day period of care thanks to regulatory rule changes.

In October, lawmakers, recognizing the value of home health agencies leveraging telehealth to provide care and support, introduced the Home Health Emergency Access to Telehealth (HEAT) Act (see page 8). It’s a bipartisan bill to provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during this health crisis and any future public health emergencies. For some home health agencies, telehealth was already playing an important role in providing continuous care to clients prior to the pandemic. Now that the benefits of telehealth are better understood by consumers, there may soon be an expectation for virtual care in a care plan. Lawmakers and payers will hopefully continue to expand their support of its usage.

On the staffing side, many employees are already accustomed to some form of remote work, visiting their agencies’ offices only for meetings, training and other activities requiring face-to-face interactions. The pandemic has put a brighter spotlight on the value of virtual work, which has helped reduce in-person contact between team members. In addition, the ability for remote staff to leverage telehealth has also reduced the number of necessary in-person visits to clients. Home health agencies that want to keep staff satisfied with their work, better attract future employees and help their workers more effectively and safely care for clients will want to strengthen their virtual infrastructure. Investments to consider may include secure communications platforms, information technology support and staff and client training.

5. Avoid COVID-19 blinders.

While COVID-19 is receiving the lion’s share of attention, and justifiably so, it is not the only dynamic driving change in this space. As advisable as it is to pay close attention to the pandemic and adjust operations accordingly, you will also need to remain cognizant of and respond to other trends, such as the Patient Driven Groupings Model (PDGM) and possible regulatory changes in response to its challenges; changes to the durable medical equipment competitive bidding program; the growing demand for diversity, equity and inclusion; an increasing importance of and potential for big data and analytics; continued evolution of Medicare Advantage; and the anticipated expansion of regulatory oversight.

You do not want to allow yourself to become so consumed with the public health emergency that you overlook those forces that may also have a significant impact on your agency.

6. Don’t resist change.

If you believe that the way you ran your company prior to COVID-19 should work just as well after the pandemic, you may be in for a rude awakening. This is one of those pivotal moments when homecare owners, like most businesses, must reevaluate their operations, determine which processes and practices can remain effective and which cannot, and assess what changes and innovations must be embraced for businesses to stay solvent—or even to come out of this period with a more solid footing than before.

7. Monitor industry trends & developments.

The health care delivery system was experiencing significant changes before the pandemic. COVID-19 kicked those changes into overdrive. We came into the year expecting competitive bidding, PDGM and a phaseout of requests for anticipated payment—and how these would affect the industry—to be among the dominant stories of 2020. You can now add the likes of telehealth, surges in transactions and consolidation, a potential reshaping of the Medicare home health benefit, a remote workforce and a slew of other developments to that list. And there’s good reason to believe that new or evolving disruptors will greatly affect homecare companies going forward.

Considering the speed that change is occurring, prioritize keeping a finger on the pulse of the industry and health care as a whole. Assess emerging trends and developments to determine what should necessitate an immediate response or the initiation of new plans. If you are considering whether to make significant changes to your operations, such as exploring whether to launch a telehealth program or sell your agency, engage with experts—even if you don’t anticipate moving forward immediately. Experienced advisors can answer questions, fill in knowledge gaps you didn’t know existed and provide recommendations. And by engaging sooner than later, you can hit the ground running when the time comes to make the change rather than starting from scratch.

8. Stay current on regulatory developments.

This step is essential for making educated and compliant decisions that may transform your agency. Since the beginning of the pandemic, government has issued numerous waivers and rules meant to help businesses respond to the novel coronavirus. These requirements have touched on a wide range of issues, including telehealth, the Stark Law, on-site visits, deferment of tax payments, payroll expenses and plans of care.

Owners must ensure that they are closely monitoring regulatory developments to understand if and when waivers expire, future changes to rules, and how to appropriately leverage rule changes, whether temporary or permanent. Doing so is critical to delivering effective care in this challenging environment, keeping finances sound and identifying worthwhile opportunities to pursue innovation. Without a strong understanding of how rules may affect your company, you run the risk of investing at the wrong time or in the wrong opportunity.

Always Be Innovating (Intelligently)

We’re well into this public health crisis and are seeing how critical it is for home health and HME providers to adapt to the “new normal.” Many businesses have undergone substantial changes, yet it is likely that they will need to do even more to emerge from the pandemic in a strong position to thrive in the post-COVID-19 era. Innovation has the potential to help agencies take small and large steps forward, but the decisions concerning whether to pursue specific types of innovation must supported by research and, when available, expert guidance. This will better help ensure you can reap the rewards of daring to be different.

Bradley Smith, ATP, CMAA, is a former durable medical equipment provider owner, and is currently a managing director/partner with the international healthcare M+A firm VERTESS. He is a member of HomeCare’s editorial advisory board. If you would like to personally discuss this article, the value of your health care company/practice, or how to get the best price when you sell it, you can reach Smith directly at (817) 793-3773 or