Elara Caring Chair and CEO Scott Powers said his company hopes to expand its client-base as growth in value-based care blurs the lines between clinical and non-clinical home care.
The Centers for Medicare and Medicaid Services has set a goal of moving Medicare beneficiaries into value-based care arrangements by 2030. The initiative incentivizes providers to deliver better care at lower costs, which Powers said will give home-based care providers more flexibility in how they take care of patients.
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Dallas-based Elara Caring is one of the nation’s largest providers of home-based healthcare services and is jointly owned by private equity firms, Blue Wolf Capital Partners and Kelso and Company. Elara Caring sponsored a recent healthcare competition at Yale University School of Management where graduate students developed healthcare solutions aimed at improving care coordination, patient outcomes and employee engagement and retention.
Powers said the company is looking for opportunities to expand its home health, home care, hospice and behavioral health services beyond the 18 states and 60,000 patients it serves.
Technology is a big part of how Elara Caring's growth plan, Powers said in an interview. He said the company is relying on technology to collect data on patients, evaluate their conditions and even determine if a home care aide, rather than a nurse, can adequately provide healthcare to a patient. The interview has been edited for length and clarity.
How are value-based care arrangements changing the delivery of care?
If you are in an agreement with a payer and are being paid a case rate, you are getting a payment for a certain period of time. It no longer looks like a skilled episode of care. It looks like an outcomes-based agreement. In those types of agreements, payers aren’t specifying what types of care you have to give. They are specifying that you keep the readmission rate down, and they'll pay you for it.
We can substitute a clinical resource for a non-clinical resource at certain times to really provide the lowest cost care needed, depending on the situation. It now starts to blur the lines between a skilled business and a personal care service business that only we can provide. It’s really making sure that you’ve got the right resource at the right time for the right issue.
How are you using technology to accomplish this?
One of the benefits of having a very digital workforce is our ability to track changes in a patient's condition.
Before one of our attendants can leave a client’s house for the day, they have to answer a series of nine questions on their phone that allows them to log out of the visit and get paid. These questions include: is the client missing medication, did they fall, does the client have food insecurity, do they have dizziness and did they go to the ER yesterday?
Since we are in the home pretty much every day with these clients, the system will trigger an alert if there is a problem. That allows someone like a nurse or a care coordinator to reach out to the caregiver and the client. The system is pervasive with 20,000 caregivers, so we have a pretty large vault of information that we can act upon. It’s driving real reductions in hospitalizations that we can quantify, so we can drive a clinical outcome with a non-clinical resource.
How else are you using technology to deliver care?
Wound care is a pretty intensive skilled capability that not everybody can do. We partnered with Swift Medical for that. Their technology takes pictures of wounds and uses artificial intelligence to measure the depth of a wound. It provides recommendations on the frequency of care and the next steps. The technology takes some of the nurse variability out of it and, as a result, you can get a better outcome by using technology to measure these things versus humans measuring them.
We’ve also put some central capabilities around the technology through our Elara Connect engine, which is a centralized care team that ingests the data. We have a wound care nurse who looks at all of the wounds we are caring for digitally through the app. She can make recommendations, such as whether we should we be accelerating visits. It’s an additional care layer that allows us to get a better outcome.
Are you looking to expand through acquisitions?
We are and we are being very selective and very focused. Our focus is really around that continuum of care.
The Elara Connect platform that we built allows us to serve patients across our different service lines. For example, if we have a skilled business, but we don’t have a hospice business, we want to buy a hospice business because there are synergies that are good for the patient and for growth.
Do you see more opportunities on the clinical or non-clinical side?
There is room to grow for both skilled home health and hospice. For personal care, it is more state specific. But when it comes to home care, the patients want that care, it is the lowest cost setting, and outcomes are only going to get better and better in the home. For those reasons, you have to take a long-term view on this industry. I think all of those segments will be targeted for consolidation because they are the right place for care and a good place to be.
How does your involvement in the Yale competition fit into your future plans?
We pride ourselves on being innovative. We want to change the game, not just play the game. We gave contestants some information asking them how they would lower the cost of care, increase access to care and provide better outcomes. They are in a case competition to bring the best ideas forward. So, we’ll get some really cool ideas from people who are maybe more progressive about thinking through delivering healthcare. We can then translate that into how we try to reinvent the industry that we’re in.
