Home Care U - 5 Metrics to Keep a Closer Eye On in 2025 (Todd Austin)

Episode Date: December 16, 2024

In this episode, Todd Austin, President and COO of Activated Insights, unpacks key takeaways from the 2024 Benchmarking Report and explores the evolving role of data in the home care industry. He highlights five critical metrics home care owners should closely monitor in 2025 to drive growth, improve care quality, and stay competitive. Todd shares actionable insights on where the industry still has room to improve and how data-driven decision-making can transform operations.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

welcome back to home care you i hope you're all having a great week i hope december is treating everyone well and that you're hitting your goals and milestones for the end of the year i know it's an exciting maybe distracting time but i hope everyone is wrapping up the year very well i'm your host miriam allred head of partnerships here at care switch home care you was brought to you by care switch the ai powered home care operating system check us out at caresSwitch. HomeCareU is brought to you by CareSwitch, the AI-powered home care operating system. Check us out at careswitch.com if you want to learn more. Today, I'm excited for the conversation. I'm joined by Todd Austin, the COO of Activated Insight, formerly known as HomeCarePulse. Some of you may not know this. I thought I'd share a little background, but I actually worked for HomeCarePulse before joining the team at CareSwitch. And so Todd and I go a little ways back. And funny story,

I was reminiscing on this before we jumped on. I actually worked with Todd's mom in the radio industry before coming to home care. She and I both quickly realized that I was not a good fit for selling radio ads. So she actually introduced me to Todd, which is really funny. So long story short, I worked for Home Care Pulse under the direction of Eric Madsen and Todd Austin. And they took a chance on me. And I learned and grew a lot while I was there. And I, you know, it's safe to say that they helped me get my start and laid the foundation for where I am today. So I'm excited to reconnect, Todd. Thanks for being here.

How are you doing today? Doing well, doing well. And that's a fun memory lane to go down. It feels like forever ago that was the case, but it was not too long. And the great thing is everybody on the line knows, you know, once you get in home care, healthcare, you know, you just can't leave it. There's so much passion. There's so much mission. You know, there's so much opportunity. You know, once you're in, you're in. There's no leaving. So I was really excited for the conversation today. Yeah, it gets in your blood and it's hard to leave. And I think we're both finding ourselves

still here after quite a while. So I think that rings true. I think a lot of people listening probably know you and maybe know bits and pieces of your background. But I always like to give you like an extended introduction here. Talk about yourself, your background, your family. You've been on quite the journey with Home Care Pulse and I've seen a lot and grown a lot. So maybe just kind of start their personal background, pre-home care, and then kind of your journey at Home Care Pulse. Yeah, for sure. And for those that have heard it, I'll give you the extended version today. And it's fun because we get to kind of talk about our why and why we're here. what drew us to home care for you. It was different than me when I was five years old. So my mom, who Miriam met, was with my brother and they got in a car accident.

And he was hospitalized. He was in Salt Lake, which is a close region to where we grew up. And he spent about six months there. So he was paralyzed and permanently brain damaged. And he finally got to come home. And not to put too much damper in the mood, but we had nurses in our home and caregivers in our home from when he was, so he was three years older than me. So from when he was eight until he was 16, when he passed away. And it's unfortunate, but through this, our family was able to receive so much support from Visiting Angels, Alliance Home Health. So we, I got to have experienced this from a very young age. And I remember, you know, some of the great caregivers, I remember sitting down with them. There were some, there were some awesome ones, you know, some of the great caregivers, I remember sitting down with them. There were some awesome

ones, you know, not that any were better than the others, but I think some, you know, took affection to the family, not just the individual receiving care. And what was so unique about this is outside of being a firefighter or a professional athlete growing up, you know, I always, you know, anchored back to one individual nurse and caregiver. Her name was Barbara. She came to my wedding. She's seen all my kids grow up. I get Christmas cards from her. And this is 30 years ago now that this connection and this bond between, you know, a young child and a caregiver has just stayed there. And she's been such a big part of our life. I always thought, like, I wish that she understood

and got the recognition she deserved and the support she deserved. And so as I got older, and I was introduced to the founder of Home Care Pulse and saw what he was building, I instantly said, oh, you know, it just connected to me. And I wanted to be a part of it and join. So I joined in, you know, coming from various technology companies in 2018. And we've been able to, you know, so far partner with 14,000 care organizations across the United States and Canada and help them provide, you know, clarity into what their employees, their clients, their patients, residents are wanting. And then through that journey, we've been able to add additional

capabilities into our product that supports that journey too, whether it's employee training and upscaling, care certification, you know, automation of specific processes during hiring. And I just keep, I get excited because it's so fun to go and say, you know, this journey started when I was five and I didn't know it. And it gets to continue. And I get to live my life through all the care providers that are on the call today. It's like, every day I go, oh, you know, I can't imagine where the barber is out there that's making this impact. I just hope they know, you know, how much it is. And I look at our survey results and go, there's thousands, millions of barbers out there that are impacting others' lives like

she did mine. I'm so glad you shared that and that we started there because I don't know that a lot of people know kind of that backstory, but it's really personal and really intimate. So I appreciate you sharing that and really speaks to just the level of passion that you have for what you do. Take us back. Today, we're going to talk about data and the prompt that I've given you. I want to dive into five metrics that agencies need to keep a closer eye on in 2025. And there's a lot of data points out there. There's a lot of metrics out there. So I'm excited to get into the five that you think providers should be focusing more on. Take us back to the thinking of the benchmarking report. Again, I think a lot of people have this context, but there's always new people, new listeners on here. So I like to give the context. Bring us back to the early days

of Home Care Pulse and why data was such a big part of the story and of the founding of this company. Yeah, I mean, 15 years ago, as we can probably all envision, you know, in home care, the amount of fragmentation that existed and the amount of information that wasn't shared. And, you know, it was very, you know, territorial, regional. And so the idea came through at the time of the Private Duty Association, now the HCAOA, around how do we continue to have this process and conversation of the rising tide lifts all boats? And part of that was data sharing. And so the first benchmark report was put together. You know, it was small, had some financial data. I think it was like 22 pages. You know, it's hard to think that we're

at like 220 pages now of just cram-packed data, but it's evolved over the years to make sure that we're tracking, sharing, both celebrating and finding opportunities to improve. So yeah, when you'd asked me for five, I was like, okay, what are the five? What would be my five that maybe people have thought about, but with a different twist? And then maybe opportunities that will help tell the story for care providers better on why they're the provider of choice. When you were just referencing those older benchmarking reports, I remember seeing some of those, you know, 10, 15 years ago. Like you said, we're talking 20 pages, some really simple charts and graphs. And it's amazing how far we've come,

how far your company's come, how far the data has come, how far that report has come. And now thousands and thousands of people participate in every year and look forward to it. You know, people say it's like Christmas morning when they get their best working report because it's just crammed full of data and insights that help them run their businesses. Quick, quick plug idea. Maybe you guys need to do like some sort of review of all of the data, because I think even looking at the data 15 years ago is really interesting just to see how far the industry has come. I think we talk a lot about the last maybe three, five years, but to give maybe newcomers or newer businesses perspective over the last 10 or 15 years would be really interesting.

Before we get into the five KPIs, what were some of your personal ahas just looking at the data from this year? Every year there's things that stand out to you. I know you spend a lot of time in there. What were just some of the things that stood out to you personally? Oh, man. I mean, I think the big one always for me is that we as an industry don't do a good job of zooming out. And what I mean by that, we're constantly looking at the ups and downs and the peaks and valleys, and we don't actually see how up and to the right this hockey stick is of home care because we're so zoomed in on the process. And so for me, it was like, how an absolute grind. You know, whether you're a technology vendor, whether you're a provider, you know, in many instances, it's almost a, you know, 24-7, I can't believe how some of these things have changed seven years. Maybe we'll have to come out with like aed in on how do we improve this process? How do I automate this or how do I leverage AI today to do this? Was it helping complete care notes or smart scheduling or whatever it may be? That's phenomenal.

And we're so much more efficient. And the level of care, it's very little as much sitter service now or light housekeeping as much as it is like we're plugged into the care continuum. We're here and we're here to stay. And that's really important. I like this idea of zooming out. I think it's applicable at both the agency level and industry level. Like you said, these businesses, everyone listening to this knows

there's ups and downs and plateaus in this business. But hopefully, and the goal is you zoom out 1, 3, 5, 10 years and you're on that upward trajectory. And I think, I don't know, this might be cliche, but that's good to just remember the growth and the hope and the opportunities at stake to get you through the hard times, to get you through the valleys. You have to remember and be able to look ahead. I even take that to my time at Home Care Pulse. Home Care Pulse was so good at five-year planning and talking about like that five-year, the historical five years, where we've come from and where we're going. And I know that me as an employee gave me a lot of

perspective. And so I think as home care businesses, as teams, being able to look back and look forward and look ahead really helps in some of the harder times. Any thoughts on that? Yeah. Yeah. I mean, I think that's what I'm trying to articulate is, you know, it's okay to say you're great. You know, it's okay to say, you know, you're doing good work or you're the best provider because of X, Y, Z reason. You know, we don't say that enough. You know, you looked across, you know, we'll use maybe recruitment as an example. You know, everybody on the line and everybody that listens, you know, I have to imagine you have a lot of high empathy to be in this space. And, you know, with empathy comes a lot of humble attitude. You know, but when you compare your hiring and you look down

the street and you go, you know, the Marriott or the Starbucks or the whoever is hiring, they do a phenomenal job of saying that they're great and that they're the best employer and they provide the best opportunities and there's advancement and, you know, all of those things. Us as a home care industry, we don't do that because it's like heads down focus. I'm not going to talk about myself. I don't want to shed a light on me. I want it to be about the patient and the care, the caregiver, the client, whatever it may be, the resident, you know, for the various care settings. And it's like, it's okay to say you're great. Actually, we need to say it more, you know, for us to continue to receive, you know,

the momentum and the spotlight that all the care providers deserve. And I think that's a really important element that doesn't exist today. I don't know how to pull it out because it's just the core DNA of heads down, work hard, we have empathy. But at the same time, as you zoom out, look around and say, gosh, we are great. Look at all these great individuals. Look at all the long-term tenured employees. Look at all the care hours provided. What would they have done without? You know, and it's like, it would have been hard because, you know,

if it's not you, who? And I think that's a little more of the mentality we can install going forward. I like what you're saying. The thing that comes to mind for me is like leaning into your differentiators and getting really good at communicating those things, communicating why you're different, why you're better, why you're the best. And I think we as, as home care providers have a long way to go in that. Like you said, there's just a lot of like empathy, humility that, you know, is just like so deeply ingrained in a lot of us that it doesn't come naturally, you know, to tout ourselves or to build ourselves up. That kind of leads me to the next question before we get into it is we've come a long way the last decade, the last 15 years when it comes to data and home care. And I think we've both seen a lot of improvement even in the last five years. But I do still sometimes hear people, thought leaders, leaders of these businesses say that we're not quite there. You know, it's like we're getting a seat at the table, but still we're kind of looked down upon or we're not fully embracing the continuum. What's your take there?

Is there still a lot of room for improvement? Are we inching our way closer to being really data-driven industry? Or where, you know, where do we still lack to get there if we're not there yet? Yeah, I mean, I think there's like 20% that are there, 80% that are trying and 20% that are wondering what just happened today. And so for everybody, they're probably in a little different part of that journey. And even just one of the data points we want to talk about is hospital readmission rate. And it's like, how many people are actually tracking, you know, and it's still an extremely

low number at 25%. So, you know, one in four individual organizations are tracking readmissions, which, you know, that's one of the biggest reimbursement items for the care continuum is, are we keeping the client patient out of the hospital? be reliant on someone else to call us in into the situation into the home versus saying no this is this is prescribed as part of you know your you know exit into whatever care setting and they skilled nursing you know hospital you need home care and here's the list of home care organizations that you need to work with versus like you need home health and then home health calls home care and you're always relying on that referral source. And I think that's the difference that we want to get to is, you know, you need home health and you need home care.

Here's the list. Here's the quality scores for each of them. And this is, you know, how they're put together. And I think that's that's the journey we want to get towards is where, you know, at Discharge, you know, we're part of the conversation versus like, let Home Health assess. And then Home Health, if you think home care is needed, you know, give them a call. Yeah, this is a perfect segue into why we're having this conversation and why we have these conversations is we need not 25% of businesses tracking

readmission rates, we need 100% of businesses tracking readmission rates, we need 100% of businesses tracking readmission rates. And so that's why, you know, what sparks these calls is we have to continue to talk about data and metrics in order to be top of mind in the continuum. So let's get into it. Let's start with metric number one. So you've given me these ahead of time, so I'll kind of prompt them to you. Metric number one is retention rates. And I'm assuming you're referring to both client and caregiver retention rates. So why do you think we need an enhanced focus on retention going into 2025? Yeah. And I think we're going to do a better job at this activated insights around how we talk about this. So let's first talk about our employees. And we really have to stop, you know, hyper focusing

on turnover, you know, 79, 77, 64, whatever it is, we got to start to talk about, you know, what is your retention rate? So yeah, if you're at the industry median, and it's 79.2%, we'll round up, then your retention rate is 20%. Why did that 20% stay? And how do you find more of those individuals that have the same fundamental values of that 20% versus like, we're just going to keep hiring the same 80% that turnover on a consistent basis. So that's part of it for me is, you know, we've got to shift this mindset away from like, hey, turnover, and it's just, ah, it's part of it. And it's like, yeah, turnover is part of every business. We have turnover, your hey, turnover, and it's just, ah, it's part of it. And it's like, yeah, turnover is part of every business. We have turnover. Your business has turnover. You know,

some of that's controllable. Some of it's not controllable. But, you know, what I think a lot of industries do a good job of is they talk about the why people stay and they don't get too hyper-focused on the why people leave. And I think that's an opportunity for a lot of organizations to just take a, just, it's the same thing. It's the same measurement, but instead of looking at the big number of the why that turned over, you know, let's spend more time

talking to the ones that are staying and learning why they're staying and incorporate that more into our messaging, whether it's they're here because, you know, the flexible scheduling or the communication or they really love this career path. How many times does that make it into the job ad versus like, I need someone to work this shift at these hours in these five zip codes, you know, is like telling our story. And I think it'll help organizations a lot tell their story if they start talking about the 20% that stay or the 50% that stay in other organizations. And then hopefully you can get it to talking about the 70% that stay. And now we're talking about, oh, we're turning over 30, 35%, which is probably always going to be the case when you look at

the masters or you look at the different segments of data. The top organizations are losing 25% of their employee base, not 70%, 80%. I think that's the opportunity when you think about employee and saying retention rate versus what's your turnover rate. Like you said, I think it starts with a mindset shift and just like terminology. We talk a lot about turnover. We talk a lot about churn, like you're saying, and it's like, okay, let's just flip the script and talk more about retention than we do turnover. that emotion into recruiting. And then these people turn around and leave within three months. And that's just like a perpetual emotional cycle. That's almost just like a pit, you know, it's just a lot of lost time, energy and emotion. But, you know, obviously, you have to be recruiting and recruiting takes a lot of effort. But put as much time, if not more time into retention,

because that will fuel and help power your recruitment if you focus on retention. The reason I say it's a distraction, you were at HCAOA and I interviewed these caregivers and I interviewed a lot of caregivers leading up to that. And a lot of the people I talked to have said, I've been with this agency for two, three, four years, but there was this sentiment of, you know, I'm like forgotten. You know, they spent a lot of time and focused on me my first year, but now here I am year two, three, four, and they don't really talk to me. They don't really text me. I don't really know the office that well. And that leads

them to leave. And so we need to focus on the people that are tenured. The people that have been there for two, three, five, ten years, likely are your most important employees. And the last thing you want to do is forget about them because you're too busy focused on acquiring more caregivers. Yeah. And I mean, it's a math exercise that probably doesn't happen enough, you know, but, you know, if you sit down monthly or quarterly and you just say, you know, okay, I employ 100 people and it's $3,900 per person loss, I see the light bulb click for a lot of organizations. If they see the data that we publish and they go, oh, you know, that's my number. It's probably that not that high, but then they go and crunch it themselves and they go, oh my gosh, I'm spending a hundred thousand dollars. And then the worst part of that is like 55% of it's in

the first hundred days. It's like, we've gotten zero ROI out of that employee. And I don't want to just think about a caregiver as an ROI because there's so much more than that, like what you said. But at the same sense, if our hiring practices can't keep someone post 100 days to where they've been able to work a shift and make an impact in your business. You've been able to create some continuity with them. Like that, that's, that's a slog of a struggle for a business to grow. And I think that that's what also on the other hand is causing to a little bit of concerning the client retention, right? Is if we're constantly introducing new caregivers and they're two shifts and gone,

two shifts and gone, four shifts and gone, we lose a lot of trust and faith with our clients that you are the right one to protect and care for mom, dad, grandpa, grandma, whoever it may be. Yeah. Let's shift gears a little bit and talk about client retention. I think a lot of people listening to this put a lot of focus on new client acquisition. Like we talked about at the start, there's a lot of ups and downs in this business because clients come and go clients pass away. That's inevitable in this business. And so there's a lot of focus like caregiver recruitment on client acquisition, but client retention is equally, if not more important than client acquisition because these clients can be with you for months, years, several years. And that's, again, not from an ROI perspective, but just, you know, the life cycle of a client can be substantial and be important. What can owners do to put more focus on client retention this year? Yeah, I think it's, you know, not losing sight that there's, you know, there's pedals and the wheel on the bike that we're on. And what I mean by that is we talk a lot about our staff and we don't talk a lot about our clients. You know, we build

a care plan, you know, depending on the state, maybe there's reassessments every 30, 60, 90 days, whatever the state guideline is, and that's it. And when home care was booming and turnover was lower, and if everybody kind of sits and goes, okay, when it was 50% six years ago, when turnover was 50% in the industry, you know, six, seven years ago, all we talked about were clients, what the clients want, what kind of care they wanted, how do we optimize shifts for them? You know, how do we provide more care for them? And I get it. You know, you need the staff to be able to have that conversation. But we can't lose the sight of also the worst case scenario for a business is a home care business is when we have client turnover. And our number one way of getting new clients is word of mouth, right? So we have client turnover.

That probably means our word of mouth is going down. And we have caregiver turnover. So our acquisition costs of both areas in our business skyrocket. That's what I'm seeing is you start to go look at the acquisition costs for clients and caregivers, and they're both going up. And that's just eating into gross margin of profit of the business. And that's the lifeblood of providing great care is a good financially healthy business. You know, that's how we make sure that individuals receive great care and individuals receive great employment. But there's no way when you look at the businesses that are struggling the most in home care, they're the ones that have high client acquisition costs because client turnover and high caregiver costs because caregiver turnover. I mean, you can't write both checks at the same time. That's why I say you've got to be able to pedal

the bike, you know, and stay balanced at the same time, but it takes both. You can't do one or the other. I like that analogy. I hadn't thought of it like that. That's cool. I want to get tactical for just a second here. We had a really great session with Brian last week, and we were really like in the weeds on some of this. I want to hear your perspective on when we think about retention. Oftentimes, it comes down to like communication and touch points with these people. Again, we shouldn't be going months or years without talking to a client or talking to a caregiver. And so obviously you all have tools and resources in place to send out surveys and have these touch points be automated. How far does that go? Can some of these touch points be automated to the point of increasing retention rates? Yeah, I mean, I think to an extent, but, you know, home care isn't a software. You know, it's not Netflix.

And, you know, you can just only check on it when you want it or need it. So providing care is completely different. And I think sometimes, you know, we bring someone on service, you know, they get to six months. And then this is where I think the reassessment is so important is because the client's needs are changing. And are we communicating to them the care needs that are changing along the way? More hours, more services, different, you know, sophistication of the caregiver. You know, maybe it's early dementia, Alzheimer's, and it's like, you know, the original caregiver is not certified in that. So, part of this is about having not just

a care plan that is set and forget it, but it's you are both the family members and the person receiving care, you know, you're their subject matter expert along the way, and they need to know what is changing and what, how they should adapt and learn. And I think that's why we saw so much around, you know, a shift with, you know, away from family caregivers is because that was the problem, is they didn't know what to look for. They didn't have the subject matter expertise. And that's why, you know, professional caregiving is, is a real thing now is because of that. So I think to get to the root of your question is, you know, it's, it can't be like a Friday checkup call, just like, hey, how are you doing? It's got to be a combination of personal touch, you know, care advisement, and then, of course, care satisfaction. You know,

it's got to be all three. And I think there's a right cadence that would exist of each of those where, you know, I think the right care assessment is 30 to 60 days, you know, no longer, you know, no shorter than 30. And then in the same sense, you know, you know, calling them and just leaving a voicemail or, you know, sending an email to the family member, letting them know what the notes said. And then of course, you know, following up on both your promoters and your tractors in your surveys are equally as important, but that can help automate and give you a good sense and feel of the tone of your clients.

But at the same sense, there's so much more that goes on to provide care. And there's lost care hours in there too. These are activities that will generate your business more money and keep the individual safe at home where they want to be longer. I think you got to the root of, one of the,

maybe the roots of retention issues is needs change for both the client and the caregiver. And if you go long periods of time, not knowing that those needs have changed, you will lose these people. They will turn over. And, and you, like you said, you know, the re reassessment and checking in on the client is sometimes outlined pretty clearly. It's not as clear cut for the caregiver, you know, there's no official maybe reassessment of the caregiver and their progress, but you need to think of it from that same lens. I've even heard people talk about like caregiver care plans, which is essentially the same thing. And there is like reassessment and replanning with the caregiver. And so the root of this being you you go long periods of time without knowing deeply and personally the needs of these people, you're going to lose them. So that was really

well said. Let's keep going here. I know we should spend a lot of time on retention, but I think that's extremely important. And everybody does need to put more focus on that in 2025. The second metric that you've identified that you actually just referenced is customer acquisition costs. So explain your thinking as to why we need more focus on that. Yeah, I think like I said, five years ago, it was $208. Today, it's $800. That's a really hard dynamic to swallow when you also say it's $3,900 to replace an employee. That's just, that's not, you know, lost revenue. That's just pure costs. So we're talking, you know, big economic swings in both the lifeblood of our businesses. And that's, you know, really hard. And so there's tactical things that organizations can

do that can improve this. And we've talked about this, tracking every inquiry. Those that do that don't, difference of $800,000. Just track your inquiries and you just probably gained your business $800,000. I mean, I don't know what more pleads the case of focus on a few of these very tactical statistics and it'll make your business a lot better than that. But I mean, that's like, it's almost a good question to ask back to you too. You know, you're in tune with the industry. You know, why do you think some of these practical applications that have such high ROI aren't taken advantage of? I think it comes, the thought that comes to mind for me is sources. There are a lot of channels or sources that you're gaining

clients, that people are gaining clients from. And a lot of times it's a spray and pray approach and people just are wasting time and effort and energy in the wrong channel. So like you said, it just comes back to tracking every inquiry. That just comes back to training the office and setting expectations. If that expectation gets loose and people stop tracking it for a short period of time, that's just, you know, training out the doors. Just people aren't keeping up with the right processes. It does take a lot of work. You know, when we say track every inquiry, to you and I, that sounds pretty easy. You know, when it's all said done, you know, it's a lot of work, but again, it's going to save you so much time and money if you know which sources are generating the clients. And if you know what the costs are

associated with that, like you said, a couple of years ago, 200 today, 800, a new client from a word of mouth referral versus someone that's coming from a place for mom, like totally different costs, totally different approaches, totally different amounts of work that goes into each of those. So your team needs to understand all of these different sources and the costs associated with those in order to refine and fine tune what's working for your business. You mentioned that word of mouth is the number one source for new client acquisition. Is that right? Yeah, I mean, it's been consistent.

If you were to go back over five years, you know, it's consistently in the top three. So I still use it as number one. It's bounced around in year from, you know, one to three. But then when you look at the, you know, customer acquisition costs that come from that too, it's the most cost efficient way. You know, once again, when you've got the compression of how much it costs to hire an employee now, you've got to find money in your business. So what are those avenues where you can attract clients that cost potentially the least amount of money. I think where people get hung up on this is tracking this at scale. I know you have worked with a lot of large businesses that have probably figured this out, you know, how to actually track this at scale. Any insights into like tactics or operations that you've seen that have worked well

for people to track this at scale? Yeah, I think a lot of it comes down to like their agency management platform. Like how are they coming in? You know, have they thought about what reports they want as they configured it? I think many times, you know, we change a software and we think about what do we have to do to be day one ready, but we don't think about day 30 when we want to look back and say, hey, you know, what reports do I want that is going to inform my decision making in the business? It's more or less like, how do I get people scheduled tomorrow? And it's like, well, how do you, you know, that's obviously extremely important. But, you know, how do you grow your

business in 30 days? And I think it's a very forgotten step in it. So I think, once again, this is not to use the same term we started with, but this is the zooming out for the progress to then be able to zoom in on what processes you need to change. And I think that's a quarterly item that every business owner administrator needs to do. We used to call clarity breaks internally. I know that's a reference term a lot in home care, but, you know, how often are they going and saying, why is this data hard to get? You know, should it be hard to get? You know, and a lot of times what I've found of these larger organizations is they spent more time implementing so that it was easier to reap the rewards

of the work that's done every day. Yeah, I'm glad you said zoom out because I actually think a lot of it comes down to that. The thought I was having too is we were talking, I was mentioning the needs of clients and caregivers change. Also your acquisition, your client acquisition sources change.

One month, your word of mouth referrals maybe high, the next month it may be high. The next month, it may be low. The next month, it might be somewhere in the middle. The sources change. And you need to be able to zoom out and see that from a quarterly or even an annual perspective and start to see those trends. We're coming up on the holidays. There might be a lot of word of mouth referrals around the holidays because there's a lot of family in the home, there's a lot of just talk about loved ones and how things are going. And so it, as you, as you go along in home care, as the longer you're in this business, you should be able to zoom out and identify the trends year over year. So when July hits and referrals are low, it shouldn't

catch you off guard, but you should be proactive leading up to July to make sure you've got, you know, the clientele that you need to keep going. And so I like that we come back to this like zooming in and out, because I actually think it's really important on all of these metrics that we're talking about to see it for what it is in the short term, but also to better understand it for what it is when you zoom out even further than that. And what I would say too, I'm going to put Miriam on the spot on her, on her own show, but, but let's, let's talk about like top five, you know, you know, acquisition and where they come from. Right. So if you were to say, if you're under 5 million in business, it's word of mouth, you're paying for leads from like a

place for mom, then your VA, and then you you're you're spending a bunch of money on sel so search engine so so we'll just stay at the top four right and then if you were to say okay you're you're over five million how does that change okay we're amount that's still your number one but then va is number two and then you know waiver programs are number three and then ccrc's are number four so it's like it it dramatically. And that's the question I keep going as like, you know, how can we help, you know, organizations under 5 million tool up in a extremely fast way to where they're no longer having to always pay for every single client they get. That there's some organic in it with the inorganic that they're paying for. And I think that's the difference. So the question is like, how do we do that?

How do we help everybody and how do organizations solve that problem? The first thing that comes to mind for me that I hear from owners that are getting started is establishing long-term relationships. You know, when you're getting started, establishing long-term relationships. You know, when you're getting started, you know, first year in business, you likely can't go and approach the hospital system in your market and go and start winning business. There might be some unicorns out there that can do that, that are just phenomenal at sales, but you have to plant a lot of seeds with really impactful relationships from year one, because it might not be until year five or when you're 5 million in revenue

that you can actually start acquiring those clients. And so I think it's actually setting a really strong foundation and building relationships that will turn into bigger opportunities when you're ready, because likely, you know, you're not ready that first year to take on massive amounts of clients

or high complexity clients. So it's establishing relationships. The other thing that comes to mind is also branding. We talked about at the beginning, just like differentiating and branding and leaning into who you are and what makes you different. Home care is getting more and more crowded. Almost every market across the country at this point is getting more crowded than ever. And so you really do want to stand out. And so thinking about your brand, thinking about your website, thinking about your messaging, thinking about your recruitment ads and all of that compounds and making it really good and leaning into your differentiators, that can be understated.

You're one, you're five, you're 10. It's not uncommon for us to see home care businesses that rebrand five years in, you know, because they're realizing that their messaging is out of date and it's because they're trying to do more to resonate. And so those are the two things that come to mind is like building long lasting relationships and also owning in and honing your brand

even from the beginning to last you into later years. Yeah, yeah, love that. No, yeah. Thanks for letting me ask you the question. Yeah, that was great. I know our time is going fast here. I want to make sure we get to these other three. Let's talk about readmission rates. We kind of teased this earlier on in the conversation, but this is probably one that we could spend quite a bit of time talking about is just tracking readmissions. I think you said only about 25% of agencies are tracking this today. Why is that? Why aren't more people tracking it? What's at the root of that,

do you think? Well, I think it's like entering into the space and going, here's how I obtained my license. And that's the first mindset. So I, step one is not just how do I get my license, but how do I fit into the conversation with the hospital system, you know, the home health organization and understanding what problem they're trying to solve and then also working to solve, help them solve their problem. I think that's where, you know, you see the organizations that you said that are very rare that are able to go in and be, you know, very good at sales. And many times they're just presenting the data. And that data supports the same use case that the

hospital, the skilled nursing, the home health organization are all graded on, which is readmissions, right? And so I think that's what we have as a kind of fundamental problem is what we have to do to get a license or to maintain a license or to meet a state survey, whatever it may be to be joint commission accredited. It doesn't include tracking readmissions. And so I think that's part of why there's this a little bit of this grind. But the 25% that are, you know, so here's something that when we were doing a look back, only 25% of organizations track readmissions rate. If you take that 25% and say, who are these organizations, organizations that are tracking readmissions rate are growing at 16% annually. So if you track that back three years, they're doubling the industry's average growth rate because they are fitting into the ecosystem of the broader healthcare.

And I think that's the opportunity people haven't really seen is like, why? Like, why should I track this? And I think that's part of what everybody needs to, you know, start to do is I track this because it's going to help me communicate with my referral sources that I'm the provider that will help them meet their care goals so that they can continue to receive the reimbursement rate at the highest level. Because readmissions, star ratings, those are all, you know, key items to how they get

compensated for providing care. And if you can do that, you know, then I think it helps that broader conversation of growth too. That was really good. It's bringing me back to, you and I both know Guy Tomasi. He speaks a lot about this and the value that it drove for his business. I also had Home Well of New Jersey on a couple of weeks ago and they talked just about how this metric alone can like, you know, small hinges swing big doors, that phrase, like readmission rate alone, you go in there and you talk about that, you're speaking their same language, like you're talking about, you go into those more complex facilities and you start talking about this and they're like, oh, these people do know what they're talking about. Okay. Wow. I'm going to listen to them because they understand the outcomes that we're trying to drive. And so it just gets you on their playing

field and builds that credibility so that they do refer business to you. So this one alone, and I want to bring it back to you said 16% growth year over year for those people tracking it. Honestly, I don't know why everyone listening to this doesn't hear that and start tracking it tomorrow. We've been talking about this metric for a few years now, I would say maybe the last three or four years. And I'm surprised that we don't see that number going up more faster, but that's what we're after. Everyone listening to this, everyone hearing about readmission rate needs to start tracking it because the data is clear. There are obvious benefits to tracking it.

Yeah. And I mean, once again, in a crowded environment, like you said, how do you differentiate? And it's like, hey, only 25% is doing this. 75% isn't. So there's a good chance that in your market, you could be the only one tracking this. And so then when you sit down and you do the initial assessment, you have that conversation and you're, oh, where is mom or dad coming from? What kind of care is husband or wife need? And they're like, oh, yep, we were just at short stay skilled nursing. We need some help with this. And you're like, oh, great. You know, our number one goal is to make sure that you don't go back there. So you're healthy, you know, and happy at home. And this is our success rate at that. And then the next person

walks in and they ask the question, like, what are the odds that I go back into skilled nursing? Like, what are the odds that I get readmitted? i you know i don't know it's like i i mean that's where it's like the story can be so cohesive and differentiated but you gotta start with the foundation this is where it's just like we don't think about this when we built our pamphlet and we started our business and we said, you know, I've got this brand, you know, I'm going to provide great care. I walked in, you know, and gave it to the home health organization or assisted living, skilled nursing and said, hey, you know, I would love to be a partner of yours. And they're like, oh yeah, you know, put it on the pile of the other

20 that walked in and then you keep doing that over and over and over again. You bring some cookies and you made a friend and, you know, they throw you a few referrals every now and then. But I think that's the difference of getting every referral from getting a few referrals. Yeah. I was just thinking back to, you know, these numbers too, Guy Tomasi's example. And he would say he was one in 600 in Connecticut that were taking readmission rates to these facilities, to these hospital systems. And I would say, God, what are the other 599 doing? And he just shrugged, but it's to his benefit.

Like you said, the 25% that are doing it, they're likely dominating in their market. Their businesses are thriving. It's setting them apart. And so everyone has the opportunity to do this. It's just a matter of taking initiative or not. So I'm glad we squeezed that in there. If anyone is listening, you know, take this away. Start tracking readmission rates in 2025. We've just got 10 minutes left. Let's

hit these last two before we run out of time. The number four is actually customer turnover, if I've got this right. And so we've talked about this kind of at the beginning, but I'm curious from what lens you see us talking about customer turnover and why it should be a focus. Yeah, just it's more or less like, you know, going back to what we said is, you know, how long are your clients staying on service, you know, understanding why they're going off of service. You know, there's been a slight uptick. I mean, some would maybe say it's, you know, not statistically relevant because it's not a 10% swing. But a 3% swing of customer discharge because of satisfaction

is a lot when you talk about, you know, $1.8 billion of the data that we got through the benchmark report, right, of revenue data. So it's like, that's the one for me as it's been two years in a row where that number has gone up. And it's like, ah, it's not, it's not a big one. But it's much easier to keep the clients you have that you've already acquired than it is to go start the wheel all over again. And so I think there's an opportunity right now to do it earlier versus when it gets to 10% swing and it's like, oh, this is a problem.

I think for everybody listening today, you know, there's this opportunity to like re-anchor back to client satisfaction and, you know, making sure that they're here for the long term. And then once again, doing the reassessments to make sure that you're adapting care to keep them on service and happy at home. Yeah, that's the number one goal. I think there's room for opportunity to slice and dice turnover even more so. I think you all have done a really great job of leading some of the conversations about breaking down the first 90 to 100 days of a caregiver's journey. We should see the client's journey from a similar lens. What does that first 100 days look like? What does that first six months look like? What does that year mark look like? When are these

clients turning over and why? And dig into that. If you're losing people in the first 90 days, there's issues and root issues to extract there. If they're angles and thinking about it even from that caregiver perspective, which is, you know, what are the issues in the first 90 days? What are the issues longer term? And thinking about, you know, the lifetime of service of the client and breaking that down even further. Yeah. Yeah. I mean, it's the start of service is requested by family member, you know, or healthcare provider said they needed it. You know, those are the top two reasons, you know, if you were to just summarize them in a digestible format. And then it's like stopping service, you know, you can't control clients passing away, which is the number one, you know, with over 50% of clients going off service being there.

The other good news is the second one is that they met their goals. Their wellness goals have been met. And that's where it's, you know, what was that wellness goal? And is that, does that need to be completely off service? Or is that a different frequency of touch to support them? And then the one that I think we can do a better job of continuing to stay a part of the journey is that they required a higher level of care. So that's the third one. The rest are all related to dissatisfaction of service. And it's like, okay, well, what ones can we control? And it's like, how can we continue to learn how to adopt

our services to stay part of the care journey as they require different care services? That's great for our staff if we're able to keep that client as part of the journey and our staff is able to then have a career ladder here that as the sophistication of our clients grow, they're able to support them because their care level acuity is improved too. And so that's where, for me, those are the two controllables that I look at when I think about, you know, customer turnover and length of service and how it used to be longer than what it is today. Do you have that data pulled up in front of you? I know you said 50% pass away, but then do you have the numbers for the second and third or no? I know the second and third off the top of my head. So don't ask that. So the wellness is like

just over 16% and then higher level of care is like just over 15%. So that's where it's like you're 50, 16, 15, which is a vast majority. But then that's why I said, you know, the rest are all related to like, you know, quality of care. They're unhappy with the quality of care. The staff turnover was a big one or the scheduling, you know, you couldn't meet the scheduling visits. That's the rest of the pocket. And it's like, oh, you know, we want to, once again, instead of focusing similar to what we said with turnover, let's talk about retention. Same thing here. Yes, we can't control a client passing away, and that's unfortunate.

But we can control the small number, which is 10% of the reason why a client leaves, which is all the unsatisfaction. And then the 15% that their care needs changed. Yeah, I'm glad you brought broke that down because that gets back to that slicing and dicing if you understand going into it that 50% of your clients are going to pass away and there's going to be that inevitable churn that alone just gives you like better context and understanding when you're analyzing your turnover it's like okay naturally 50% yes it's nice to know, you know, kind of average length of service for those people. It can vary so widely because every client's different. But

again, just breaking that down further to help you better understand the context of these numbers will be less of a, you know, surprise when it comes up and you're doing your annual review. And it's like, okay, why are 80% of our clients turning over? It's like, okay, there's three reasons that we can't really control, but there's 20% that we can and let's focus there. That's the level of turnover that we have to get to, to be able to solve for more of it. Let's hit this last one. In the last five minutes, payer sources. This is another one that we've talked more about the last few years. There's still a lot of focus on private pay. There's obviously the impending Medicaid

ruling that people are talking about somewhat. But what's your take on diversification of payer sources or consolidation of payer sources? What should people be thinking about going into the new year? Yeah, I put this one because it is very talked about. And, in my panel in Seattle, we talked about payer sources there too. And the worry there is it seems like every couple years there's a swing. And so my thought is don't rush to diversify. Understand your unique value proposition. And there's plenty of clients with inside that segment for you to hit your goals. And, you know, those that diversify too early, it seems like they have stagnant growth.

Like, when we have, we have very little data and we've not done a very good job of, you know, going back and saying, you know, hey, year over year, this same organization participated and submitted their data. Like, how has this business changed? But when we have, you know, those that like jump, tried to jump into too many programs, you know, seem like their growth rate slowed. And so, I don't know if that is because of that, but I think it could easily, you know, seem like their growth rate slowed. And so I don't know if that is because of that, but I think it could easily, you could easily draw the line and say, yeah, you know, different payer sources can be a distraction to the business too. You don't have to do it to be successful. There's plenty of pure private pay. There's plenty of pure VA. There's plenty,

whatever you do, you've got to do a really good job of it before you had to do second, third, fourth program. Yeah, that's the thing. I think this is what you're alluding to that I would add is just keeping a pulse on the whole payer landscape. There has been a significant uptick in VA this past year. Doesn't necessarily mean we're going to continue to see that in 2025. It really is like things change and change relatively quickly, even year over year. And so keeping a pulse on the full landscape, you know, this year you may be leaning into private pay, but next year you may start thinking about VA. And so just keeping a pulse on the landscape to know what's coming and what to prepare for. And I hear you on not moving too

quickly. You know, I think a lot of businesses see headlines or see updates from other companies and they think, oh, I need to get into Medicaid. I need to get into VA. I need to focus more on LTC. There's a lot of FOMO, I think, when it comes to payer sources. But like you were ending there is there's every business model has essentially been proven and can be successful. You can be purely VA, you can be purely Medicaid, you can be all five, you know, and be successful. Like there's no one right way. It's just a matter of being really good at your expertise and leaning in there, especially before you go and start to diversify. So I think that's kind of all to be said on this.

Anything else you'd add to pay your sources? No, I think you said it great. You know, the grass isn't greener on the other side. I have similar problems. You just have to go acquire the clients. You still got to do all the things that you have to do. And, you know, sometimes for us, once again, we'll end in the same thing we started. Zoom out. Like, do you want to do that or do you want to stay hyper-focused and be the expert in, you know, whatever program it is? You know, I think there's a great opportunity to stay hyper focused and be the expert in you know whatever program it is you know i think there's a great opportunity to stay focused and leverage focus in 25 because there's continual noise out there and i think these data points for me were opportunities of like if you

focus on these you'll have a great great 2025 all right i'm going to put you on the spot at our last minute here. A lot of people know about Activated Insights and what you all do. You are expanding services, what feels like almost all the time. So give us a quick elevator pitch of Activated Insights so that those listening know if they should reach out and what services they can engage with you all. Yeah, yeah. So we're a complimentary organization to your EMR and HRIS system that help you uncover blind spots and build various programs for your care teams to overall elevate the care staff.

So whether that's experience management, listening to your clients or employees, training to meet your compliance needs with inside your business. Or if you do need to increase your hiring funnel, we've got programs and tools for that. And then in the same sense, we love posting data and providing data to the industry and continuing to support each and every one that listens, whether you're a customer or not a customer. We want to be part of your organization's growth journey, whether that's directly or indirectly.

And so, yeah, reach out to us. We would love to both talk or connect, or you can find us online at activatedinsights.com. So plenty of ways to find us and learn about us. But ultimately, we're a complimentary service that plugs into your EMR, HRIS system that helps you elevate the level of care you provide. Awesome. Awesome. Awesome. I know we're in December. The benchmarking survey comes out usually in the new year. It might be too early to ask, but do you have dates

or rough dates for people to know when to expect to take the survey? Yeah, I think we'll be on track, you know, right after the first year to open up the survey. So, you know, test worksheets will be going out here soon so that you can start to prepare your data and think about what you put, you know, put into it. Once again, if you participate, it's free. So you get all this data for free if you participate. If you don't, you know, then we're going to charge you a lot of money. I'm just kidding. It's not that much. But it's a great opportunity to audit your business, to go and pull your data and say, wow, this was really hard to pull. We should be tracking this more often and audit your various systems that you utilize. And so, you know, yeah, as the first of the year comes up and the prep worksheet comes out, I would

encourage everybody to do the prep worksheet. Whether you submit your data or you don't, the prep worksheet is a great foundational item to get prepared for 2025 and audit your systems. Yeah, I'll back everything that you just said. My advice is take advantage of the prep work. Take advantage of the survey because, like you said, it's a great way to look at your business, audit your business. I hear people say, oh, the survey is too long. It's too hard. It's too in-depth. But it's like, those are the questions you should be asking yourself and asking your business. And so use

it as a resource and an opportunity and a tool. You also do it at the start of the year. A lot of people are doing year-end planning and gathering all their numbers and their metrics from the year-end. It's intentional why it's at the start of the year. A lot of people are doing year-end planning and gathering all their numbers and their metrics from the year-end. It's intentional why it's at the start of the year because likely you should have all that data and information and really just be able to fill this out pretty seamlessly. So take advantage of it. And the benchmarking report is free if you do. Can't overstate how impactful that can be to every single business in this industry. So Todd, this has been a lot of fun. I think you've done a great job. We've talked about a lot of things. We went a lot of different directions, but all in all, I think 2025 is shaping up to be an exciting year. And I hope people listening to this really take

this to heart and start implementing and tracking and diving into these metrics and they really will be better off for it. Yeah. Yeah. Appreciate it. Thank you for hosting and thanks for Memory Lane. And once again,, appreciate the opportunity. We'll talk soon. Absolutely. Well, for everyone listening live, thanks for being here. For everyone listening to the podcast afterwards, I hope you enjoyed this episode.

We will be back next Wednesday, same day, same time for the last episode of 2024, which is hard to believe. And I'm actually gonna jump on with a few members of the CareSwitch team. And we're gonna recap the AI innovations and growth we saw over the past year and share some updates and some highlights of what we're looking forward to when it comes to AI and 2025 and home care. So stay tuned. Thanks again, Todd. Bye, everyone. That's a wrap. This podcast was made by the team at CareSwitch, the first AI-powered management software for home care

agencies. If you want to automate away the menial of your day-to-day with AI so that you and your team can focus on giving great care, check us out at careswitch.com.