Home Care U - How the CMS Quadruple Aim Model Inspired a Home Care Business and Resulted in Millions (Guy Tommasi)

Episode Date: September 30, 2024

Lifetime Care at Home was one of the first non-medical home care agencies in the country to incorporate the CMS Quadruple Aim Value Based Care pillars into its care model. Guy Tommasi, former Managing Director of 13 years, is here to share how he captured millions in revenue by increasing cases, improving operations, and elevating company culture.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 everyone to Home Care U. I am Miriam Allred, Head of Partnerships at CareSwitch. It's great to be back with all of you. I know we canceled the live sessions the last couple of weeks. I have since moved to Texas and visited Florida in the last several weeks. So it's been very busy over here, but we have released some really great episodes the last couple of weeks. So make sure you're following along wherever you get your podcasts, Spotify, Apple Podcasts, Google, they're all out there. So make sure you're listening to those. But I'm really excited to be back live with all of you today to interview someone that I've had in the queue for a long time, but he's as busy as I am. And so we're here finally together. I've got Guy Tomasi.

He's the former managing director of Lifetime Care at Home and is now currently the president and CEO of Corcoran Consulting Group. So better late than never, Guy. We're here today. Thank you so much for joining me. Hi, Miriam. Better late than never. And it's great to be here with you. Thanks for inviting me and the opportunity to share my

thoughts with you and with the audience. So thanks. Absolutely. Better late than never, right? So you and I have known each other for several years, and I think you were kind of one of the early, you know, maybe thought leaders that I came in contact with when I came to this industry about five or six years ago. And so I've known you for a while and known of you, and we've had a lot of great conversations. And I think a lot of people listening to this will hopefully know of you and have learned from you via webinars or events or conferences. And so you have coined some kind of specific concepts in the industry that have taken flight. And so I want to bring those to life today and for us to

talk through those. So before we get into that, I want to give you a couple of minutes to introduce yourself, talk a little bit about your background in home care, and then also spend a couple of minutes talking about what you're up to today with Corcoran and some of the projects and initiatives that you're working on in Connecticut. Great. Sure will. Thanks. Well, I've been in this industry, actually in the healthcare industry, for over 40 years. My background spans the fields of hospital, home health, which is the skill side, and the last 25 years as a provider, as you alluded to as well, in the home care or the non-medical space. I do consider myself an industry thought leader and strategist. I try to take a future-focused

approach in helping home care agencies, specifically to become more data-centered, value-based, service-first providers, I found that approach has always positioned these agencies, as it did ours at themedical provider in Connecticut to incorporate the quadruple aim, which has now become the quintuple aim. better outcomes, improved client and caregiver satisfaction at a lower cost as part of our value-based care protocol. And those results, the data really established our value proposition statement and solidified our seat at that table. Today, as you mentioned, I am the president and CEO of Corcoran Consulting Group. After I semi-retired, I guess, from the provider side, I stepped into this new role. And it's exciting. It really is very exciting. Corcoran is a mid-sized firm that provides operational financial growth solutions for home-based care providers. We focus on four areas, home health, hospice, home care, which is

the non-medical mergers and acquisition. And I think, Marion, the thing that separates us from a lot of consulting firms is that our team is a team of experts who've all done what our audience has done. Every one of us have either owned, sat at the highest levels in leadership in every one of those four services. So when I say to those listening, I've been in your shoes. We've been in your shoes. I've had those same sleepless nights. I get the calls at three o'clock in the morning from an irate client. Been there. And I think that's what helps us better understand what our clients are going through because we've done it and we're going through it. And the advice that we always, I always say we're not about theory. We're about practical best practices because that's what works. And today in Connecticut, we're involved in an exciting and a historic sequence of events of history here in Connecticut.

For the non-medical industry here in Connecticut, we're a non-licensure state. So anybody can jump in and become a homemaker companion provider, which is how it's listed. And for years, this piece of the industry in Connecticut has come under the Department of Consumer Protection. Unfortunately, that's also lumped in with the casinos here, the grocery stores, the gas stations, never really got the recognition it needed. Well, legislatively, that got changed last year, and the decision was made to transition this group to the Department of Public Health and be incorporated into the health care system, home and community-based services in Connecticut. We, our firm, Corcoran Consulting, was chosen by the state to lead in that transition.

Our charge is to basically provide guidance, recommendations to the state in this transition. So we're excited about that because we have a say in how that's going to take place. We've done a lot of research. We've talked to many people throughout the country, and we're in the home stretch in providing recommendations. And hopefully, the state will look at that. I'm sure it will come back with more questions and have this proposal become reality. And I think it's really, really important that the non-medical agencies here in Connecticut really get merged up, if you will, with the public health side. Because that's really when it's going to raise its awareness, its position in the healthcare ecosystem, so many benefits.

And yes, you know, there's concerns as well. The concerns are, hey, is this really going to become so regulated that you're going to tie our hands? That's a concern. And we have to go and get research on how that transition will take place. Hopefully, that they'll understand, they meaning Department of Public Health, will understand this is not about nurses. This is not about therapists. It's about those who are providing non-medical activities of daily living and how the two can live together. So it's exciting. Maybe a little long winded, but it's exciting.

No, that was great. What an incredible opportunity for you. You have seen and heard and been on the ground floor of home care for so many years. And now look at, you know, you and Corcoran having this opportunity to really shape the next decades of home care in the state of Connecticut. I think it's absolutely incredible. You mentioned that Lifetime was the first or one of the first non-medical home care companies in Connecticut. Today,

I know you follow the numbers pretty closely. We're talking how many agencies are there in the state of Connecticut? Oh, boy. Well, when we first started this, which I'm sure we'll talk about, there were 700 agencies in Connecticut. These are considered homemaker companion. As of two weeks ago, there was 1,030 agencies in the state of Connecticut, which is about 1,020 more than you need for the size of our state. Because we're not licensure and the bars, I'm sad to say, the bar is so low that a lot of people jump into it. And there's probably agencies, Miriam, that mom and pop may be out of their kitchen table. Maybe they have four clients, five clients. They might be the actual caregiver for those clients, but they're listed and registered with the Department of Consumer Protection. And so there is a lot. Will all of these decide to transition if accepted by

the state? I'm not sure. I'm not sure how many of these thousand will transition over because there's going to be maybe licensure involved. There might be additional expenses involved. So it's going to be interesting to see how many of those 1,030 actually transition over if approved and the statement's forward. Well, you know me. My brain's already going to a year from now when I interview you again and we talk about the outcomes because you're just about to get this confirmed and finalized and approved by the end of the year. And so then the work really starts, which is the implementation, the execution of all this.

So know that I'll stay in touch so we can close the loop on how this is all going. So today, I really want to talk about your time at Lifetime and some of the incredible things that you accomplished. And so I want to start by talking about value-based care. That can sound maybe a little buzzwordy. You know, we use that term quite a bit and we have more so in the last several years, but you and your organization took it upon yourselves to adopt a value-based care approach. And you looked to the CMS quadruple aim concept, and that really helped kind of shape or reshape the organization. And so can you start by sharing a little bit about the CMS quadruple aim concept, what it is and how that was born? And then we'll get into how you translated that into a model for Lifetime.

Sure. Well, the quadruple aim, actually it started as the triple aim. And that's how CMS initially kicked off this whole paradigm shift. And the paradigm shift basically was going from how much a provider does, which is known as fee-for-service, to how well a client does, which is value-based care. And it was really looking at population health. It was looking at how to make things better using outcome data. Looking at both the macro social determinants of health, which is about transportation and nutrition, holistic care. It's evolving into patient-centered care. We hear that a lot. And it was how can we improve the quality of care at a lower cost by reducing hospital readmissions and having a positive patient-slash-client outcome. CMS looked at that. And again, it started as the

triple aim, which was about value rehospitalization. It was about quality of care. And it was about client satisfaction or patient satisfaction. A couple of years after that, CMS recognized and realized that these three, this triple aim, is an environment of support for the clinician, for the provider, and they burn out or there's no recourse, this entire concept falls, fails. So CMS said, we're going to add a fourth component. And that's going to be, we have the satisfaction for client slash patient. Now we're going to add satisfaction of the clinician or the caregiver. And that, Miriam, brought together the quadruple aim so that all the four pillars now addressed the clients, the caregivers, re-hospitalization, functional slash quality. So that's how, in a nutshell, the value-based concept came to be starting as the triple aim and then transitioned

to the quadruple aim. And you can say what you want, and I was one of those, good and bad with CMS. But they recognized that in order for any of this to succeed, the doer, the clinician, the nurse, the caregiver, the home health aide has to be supported in this process. Otherwise, it fails. Absolutely. Well, thank you for overviewing that. I think everyone has kind of an understanding of what the quadruple aim looks like. Talk to us about what lifetime looked like before you implemented your own, you know, quadruple aim concept and then what, you know, what it looked like before, how you kind of adopted or adapted that model, and then what were the outcomes of having this more value-based care mindset as a business? Sure. Well, at Lifetime, our involvement with value-based care really was born out of necessity, was

really born out of a competitive differentiator. As I said, we first started doing this back in 2016. And in Connecticut at that time, there were some 700 other providers, all pretty much doing the same thing. So it was very difficult for ourselves from the other 699 or so. We had to be different. We had to be different. We had to stand out. And remember, non-medical really wasn't thought of as part of the healthcare continuum, at least in Connecticut. By virtue of how we were classified, homemaker, companion, agency, that in itself

took away what we were doing as far as any personal care. So the rest of the referral sources, the rest of the industry really didn't know what we could do, what we can do. So we have to change that perspective. We have to be different. We have to get to the top, if you will. And education alone wasn't doing it. You can only say so much before it just becomes noise. And I realized that the only way we were going to gain this level of support to be recognized as a supportive partner was to begin to identify data, good, measurable data that produced the outcomes that CMS was looking for. We said, you know, we need to get married up better. The key was our mindset had to be all about the referral sources. It's all about them.

It's not about us. And I had to remember that because they didn't know about Lifetime from the perspective of how to be a good supportive partner, we had to start talking like them. We had to start thinking like them. They needed to see us as an equal, not just a babysitter. Saying how good we were, that just doesn't cut it when you're competing with 700 agencies. And this was still prior to the revisions of the COPs that took place, the conditions of participation in 2019. So we had to show our value through data. It's quantifiable. It tells the story. So the challenge initially, Marion, was, okay, so what data should we use? What data are we going to track that is going to be important? Because remember,

it had to be about them. What were their, we call them pain points today, but challenges back then? What were the referral sources, the payers experiencing that we can assist with? Because quite honestly, they didn't care and they still don't care what software package we're using. I don't care what our scheduling package is. They don't care what our overtime is because it has no impact on them. They want to know, okay, what are you guys going to do for us? That's the mindset we have to have.

So I said it earlier, it's got to be about them. And then how do we cooperate this new paradigm with this data into a non-medical model? And that's where the inspiration came in to be, is, okay, according to the Kaiser Family Foundation, 80% of an individual's health outcome is non-medical related, 80%. We looked at that and said, okay, well, and those factors is what contributed to rehospitalization, functional impairedness, satisfaction. And we said these pain points that they're dealing with involve the ADLs, the activities of daily living, which we were doing every day. So when we looked at it, we said, okay, 80% of an individual's health outcomes are non-medical.

The drivers are based on ADLs. The stars were starting to line up, and the wheel had already been invented. If anybody knows me, you know I'm a strong proponent of the KISS principle. Keep it simple. Because if you get too much in the weeds, you're just going to lose people's attention. And so we incorporated that model. We developed a non-medical model to run parallel with that. We spoke the language.

We were able to show our re-hospital. We were able to show our re-hospital. We were able to show the satisfaction rate. We were able to show the functional impairments, and we began to talk their language. That, Marianne, catapulted us to practically the top in the state. We, within six months of launching that, we partnered with three other hospitals and six other home health skilled agencies. And we experienced some incredible growth

in that period of time. Yeah, we did. We took a dip during COVID and then it jumped up the following year. So that's how Lifetime really began to incorporate. It was based out of trying to be different and how were they going to see us compared to the others? And we had to be different. And data

is what really made the difference. Amazing. Amazing. And transformed the business completely, which is really, you know, the incredible piece of almost just like a mindset shift and then a new model and, you know, really just accelerated the business. I want to get into the weeds a little bit about how you, how and what you use to track these metrics, because I think a lot of people may be asking, you know, how did you track client and caregiver satisfaction? How did you track hospitalizations? How did you track, you know, the improved outcomes? So can you, can you share specifically naming names and how to's of how you actually, and what you use to track these things? Cause that's a key part of this is how you actually did it. That's, you know, can be the challenging piece.

Yes. And it is. And it, and it was, I think one of the things that we, that I want to really emphasize is, and I saw it more on, I see it more in this role than I did when I was on the provider side, because as a provider, you're focused on your agency and everything that goes with it. What I would say is you need to separate your tracking mechanisms, meaning we all hear about the KPIs, the key performance indicators. Got it. That's an individual measuring stick, if you will. The KPIs is what all of us and all of our agencies use as the barometer for what we do internally. Help keep us going.

There's goals. We look at those weekly, monthly, quarterly. It keeps us on track. They're measuring tools as to how we can continue to get better and are we meeting our goals. Keep those. We have to. But you need to develop another parameter of what I call key tracking metrics. And these key tracking metrics have to line up with what the referral sources or today we call them the stakeholders are dealing with.

What you're going to have to do is, first and foremost, you've got to be committed. If anybody is going to do this, They cannot give it 99%. It has to be 100% starting with senior leadership. Because once you start tracking this and you start doing tracking every 30, 60, 90 days and you don't, you are going to lose big time. Believe me, I've seen agencies do that and their reputation gets hit and hit hard. But when you start tracking, the easiest place to start is with your re-hospitalization. Sadly, only 22%, 23% of the agencies track that. And as a competitor, I thought it was great. Great. Don't track it. That's better for me. But as an industry, that is something we need to start tracking right off the bat because re-hospitalization

is the acid test that CMS uses today when you talk about PDGM and the Home Health Value-Based Purchasing Program. So every agency should know what their re-hospitalization rate is. Perfect example, and I'll be happy to if you want to share this with your audience at some point, but we had a tool that we used that what I call started the journey. And what it was is when we got a call to do an open, our case manager would go out and do a functional evaluation, not an assessment. In Connecticut, you can't say assessment because that's considered medical. We did a functional evaluation. And what it is, is a checklist that our client manager would go out, look at the client, and basically do the activities of daily living. How well do they ambulate?

Are they bed bound or not? Do they need assistance with dress changing? How about toileting? Again, dressing. And there was a score, zero to five. Zero, meaning they need a lot of attention. Five, meaning no. Five, meaning, yeah, they can self-care in certain areas. That was done on the day of admission. And it was listed, there was six of them listed. 30 days later, she went back out, did the same evaluation was there any changes does zero become a three does zero become a one does five become a three and then care plans were built based on those numbers. After 60 days, the same thing, and after 90 days,

the same thing, because we wanted, because that information went into the functional category, which part of the quadruple aim was the quality piece. During that process, you start to look at risk factors for hospitalization. Are they a fall risk? Yes or no? That's a hospital risk factor. Are they able to have their meds? Are they taking their meds? Potential risk factor. Nutrition. Are they eating? Are they there as a cardiac and congestive heart failure?

Are they having a low-sodium diet? Yes or no? These are all risk factors that also help build the care plan. I'll also encourage everyone to make sure that your software partner is able to assist you in tracking this information. We had to start off manually. And then we worked with our software company to get our partner to get this into the system. And then what they did was now we were able to prioritize because the algorithm, based on the information that we put in,

started to identify those patients with high risk. And that created a new care plan to ensure they didn't go into the hospital. And then that was able to produce a dashboard that showed our rehospitalization rate. Really is not as difficult as this may sound. It's easy. It's just got to be committed. And then you're able to identify the satisfaction. The satisfaction, years ago, we used to do that by telephone and by mail, but that was also subjective. So we brought in a third party who conducted those types of of surveys for us on the clients and on the caregiver. Every 30 days, they would call 10% of our clients, 10% of our caregivers, ask them the questions that we reviewed with them, which also were the questions that CMS was asking home health and hospitals to ask their patients so that we were able to show a mirror and that established the satisfaction scores. So 50% of the quadrupling was being done

automatically every month. And when you pulled it together, Marion, we had a one-page dashboard. How many of us, if you ask your audience to raise your hands, and I'm one of them, used to go to our referral sources with the 8x10 folder loaded with everything we could do. They open it and everything falls out. We developed one page dashboard. The four quadrants, clear as can be, succinct, set our hospitalization rate, functional, it – and now it becomes – it still is. It's just normal business every day. Normal business every day. So there are components.

You need to have some partners, the right software company to work with you, partner, and you'll be able to build this together. And I promise you, especially today with the way the reimbursements are hitting the hospitals and the skilled side, having this information is the X factor that's going to make your agency stand out. This is so good, Guy. I'm biting my tongue because I want to jump in here, but this is really, really great. I want to start by identifying some low-hanging fruit that I see that I just kind of discovered as you were talking. You mentioned in the state of Connecticut that you don't use the word assessment, but the concept that you're referring to, I think everyone can understand, which is there's that initial evaluation or assessment.

And then in most states, there's a form of reassessment at that 30, 60, 90 day mark that you mentioned. And I think the thing that's standing out to me is I don't think a lot of people are using that data and information to take to their referral partners. We talk a lot about hospitalizations and fall prevention. Those are extremely important. And again, like you mentioned, if you're not tracking those, that's the place to start. But what's standing out to me that you're saying is, you know, at that 60 and 90 day mark, you're going back, marking these, you know, risks and identifying, you know, the progress or the lack thereof with these ADLs, that's also data or ammo that you can take to these referral partners. Here's how we're impacting, you know,

mentioned like nutrition or socialization or exercise, or, you know, they're no longer bed bound. Those also are really, you know, important data points that agencies are probably already loosely tracking today, more so because they have to check the box on, you know, the reassessment. But think of that more so as data and information that you're arming yourself with that you can take to these referral partners and say, here are the outcomes that we're driving with our patients. And so again, I think it's probably taking place in the agency already, but how do you, you know you extract that information and interpret it so that you can take that out to these referral partners? And you're right. It is low-hanging fruit.

We do this every day with the activities of daily living. One of the problems or challenges, whatever words people are most comfortable with, is our industry, the non-medical industry, has never really been mandated to collect this data. You know, on the skills side, they're mandated to collect all sorts of information because so much is driven because of reimbursement. Yeah, those of us who've had the Medicaid waiver programs, any type of government programs, yes, there's forms you got to fill out. There's data that you have to respond to or provide. But any of this that we're talking about, rehospitalization, functional impairments, satisfaction is not mandated to provide. So when someone does, like we did, you get, you know, I always say to my staff, I want to be able to show the referral sources a wow factor. I want to show them something and they go, wow.

We haven't seen this from a home care agency, from a homemaker companion agency, from a personal care, whatever you want to call that agency. Because it speaks directly to what you're doing. From a personal care, whatever you want to call that agency. Okay. Because it speaks directly to what you're doing. And it's this 30, 60, 90 days. Why? Because that's what the rest of the stakeholders are looking for. They're looking for consistency. Hospitals. hospitals. We all know that within 30 days, if they go back into the hospital,

they get dinged by CMS, right? Medicare hits them. There's going to be some 76% of hospitals 2024 are going to get some type of violation that's going to have a direct impact in their Medicare reimbursement. Anywhere from one to 4% because of a 30-day re-hospitalization for the same diagnosis. So when we started a 30-day re-hospitalization, we went to a hospital and said, here's our re-hospitalization rate. It's lower than your hospital and it's lower than the state. We did a program called Stay at Home Program, where we gave 30 hours of free care. Now, you got to know your cost of care. I said to that hospital, we'll keep your patient home for 30 days. So they owned back in, in here's our numbers and if we do so you and i work out a contract that you pay me which is going to be a whole lot cheaper

than getting ding from medicare now the c And again, it gives you the opportunity to speak in a different language, which is theirs. And you're talking about four data tracking metrics, not a whole mess of them. And I think when hear that here oh what data they you know we all said oh boy if i introduce more data to my staff they're going to throw me out the window but if you present it as differentiator which is going to increase our revenue oh, by the way, is going to benefit all of us, and you have a good direction, good plan, you will be recognized above all. And quickly, if you look at the patient-driven groupings model, the home health value-based purchasing, What do we say? Oh, clinical, that's medical, that's not for us. Well, if you look at PDGM, there's a whole section of their weighted score

on the functional activities. If you look, Maren, at those functional activities, I think eight out of nine of them are ADLs. They're non-medical. So we're already doing things that can impact the rest of the stakeholders that they may not even know about. But if we can get the non-medical to continue, like you said, it's low-hanging fruit. We don't have to invent the wheel. It's already there. The data is already there. You know, we could really catapult our industry as a key. You talk about a position at the table.

We could be the lead seat at the table. And I don't say that just to say it. Because the way reimbursement is today, the different regulations are today, we, and I still say we, can be the driver of this bus, not just the passenger. I love that. And your comment about, you know, when you see PDGM, you know, you put your hand up that, you know, I just took that personally because it's true. A lot of times we see headlines or we hear things and we think, oh, you know, we're home care, that's not relevant to us. But like you're saying is, no, we need to understand their talking points. We need to read that material. We need to be very familiar with

what they're talking about, what they're saying, so that when we do go approach them and work with them, we are speaking their same language and know what they're going through and how we can supplement or support what they're doing. And if you look at those two in particular, just because we're talking about that, and you peel it back, you'll see that so much of what's in the home health value-based purchasing, PDGM, are non-medical drivers or very similar. And their home health value-based purchasing, HCAPs, right? We've all heard of H-caps. Those are the ones, those are essentially the satisfaction questions that are asked. Well, we did the same thing.

And what we did was we mirrored those questions with our program. Would you recommend the provider? Was your caregiver, in our case, caregiver on time? In their case, was your nurse on time? Would you again recommend your agency? Things that are non-medical. Yeah, basically rewriting, rewriting their terms to be applicable to us and abiding by those same standards. Absolutely. And that's what they could relate to. When I was saying about the talking their language, when I do my presentations, many times I'll put up on the screen that language and then put up a non-medical model. And I kind of blend them

together. And people were like, geez, we never really thought they were so close together. And it is. And again, I go back to when you think 80% of outcomes are non-medical, that's the driver for us. I hope everyone listening is writing that statistic down because that statistic alone is one that you can go and verbalize to these referral partners that we as home care are actually managing and facilitating 80% of those outcomes. 80%. Go on to the Kaiser Family Foundation. 80%. Go on to the Kaiser Family Foundation. Yeah. One of the questions that we're talking a lot about data and metrics. And one of the things

that has stood out to me is you mentioned, we talk a lot about KPIs and we use the term KPI, key performance indicator, but you are coining this term of key tracking metrics and drawing a distinction between them. And I want to understand your perspective. Are these key tracking metrics, are they exclusively this quadruple aim concept or are there additional key tracking. One external, that data set is external tracking. And it's specifically designed to track the value-based pillars of the quadruple aim. I said earlier, there's now a fifth aim that it's easier to implement than pronounce, and it's called a quintuple aim. And just recently, CMS added this piece that was for the access of care and equity so that this availability of care was open to everyone. And the driver behind that, Miriam, is the social determinants of health. The social determinants of health are all the non-medical drivers. Nutrition, education, transportation, housing.

Everything, again, that we do. So even with the addition of this fifth pillar, from a provider's perspective. It's not like, oh my God, now I got to figure out something else. No, we're doing it. We're already doing it when it comes to transportation.

How many providers, and we were one who did that. Now Mrs. Jones has to go to the doctor's appointment. Okay, we picked her up. We used her car. How many times did we go to take them to the pharmacy so they can pick up their prescriptions? So as you look at these key tracking metrics, there really isn't anything new that we haven't been doing. It's just now has some maybe different words to it. And the other key piece to this is these five components now can be used across the board, regardless of the stakeholder. It's not that you have to develop five for the hospital,

five for the skill side, five for the Medicare Advantage groups, the ACO groups. No. These five can be used with every sector of the ecosystem, everyone. Yeah. Hospitals may be looking at your 30-day re-hospitalization more than your satisfaction scores, but that's still key for them because of star ratings. So every stakeholder may have a different priority in those five, but everyone are clued in because every one of those, Miriam, have a financial impact to that bottom line. Every one. And if you read into the value-based system, five of the, let's say, stated goals have some verbiage that's financially related. This is so good. And I'm so glad that you drew that distinction because I think a lot of businesses are morphing all of these metrics together, internal KPIs, external key tracking metrics. But I love that you are drawing this line of internal metrics versus external metrics and really simplifying the external metrics. Here are the five things that we as a business impact.

And these are the five metrics that I can go out and, you know, come to this, draw this distinction for themselves. So here are the internal metrics, the performance indicators for our team and the goals and the things that they're trying to accomplish. And then also tying those to these external metrics. How does everyone and what they're doing day in and day out actually influence these metrics that then we take to our referral partners to drive new business? And again, I'm sorry, but I can still remember when I was going marketing this, I only took two sheets of paper, my dashboard that we just talked about, and maybe something about lifetime. And I would challenge the discharge planner, the transitional care manager, the home health manager, I would say to them, there's going to be over 600 agencies probably

knocking on your door, asking for your business. Ask them to show you this type of a dashboard with these outcomes. It'll be the fastest meeting you ever had. Now, I knew my audience because I knew the state of Connecticut. And I can tell you, I got calls from discharge planners at the hospital saying, Guy, I did ask that question. And they were the fastest meeting I ever had because they didn't have that information. So it works. And before I know we're getting out of time, don't forget, in 2019, CMS had the revisions of the conditions of participation. In the home health side, any discharge to post-acute care providers have to be accompanied with data to show outcomes. The days of, I love Guy, I love his agency, I'm just going to keep sending him my business because he's always there for me, are going away if haven't already. They, under the COPs, have to be able to provide families, caregivers, those providers who have already presented and demonstrated that they have positive data outcomes. So you want to continue to rise to the top?

Make sure that they know that. Make sure that they know you know those revisions of the COPs. And that's why you've got this dashboard. It's all about the proof, the proof of the outcomes. No longer, you know, we say, you know, gone are the days of donuts and coffee and business cards and doing business with people that you like. Of course, there's still an element there, but in these really competitive markets, you have to be able to prove to these people your worth and the values and the outcomes that you can drive for them.

Right. And that's the differentiator. It is absolutely the differentiator. All else being the same, yes, your relationship is going to make the difference. But if you have both the data and the relationship, nobody is going to touch your agency. Hmm. I want to let you share what has since happened to Lifetime because all of this work that you put in, all of the success that you had, you mentioned that it drove new relationships with three big hospital systems, which I think is every home care business's dream to be able to solidify that business from a hospital. But Lifetime has since merged with a larger healthcare system in the state. So can you just talk about the culmination of all of this really, which has

been the evolution to then merge with a hospital system? Sure. Lifetime had a partnership with a, our sister company was a home health skill nursing company. And we worked very well together. They had hospice and traditional skill side, and we provided all the non-medical side. It really was a really nice partnership and nice relationship. And several years ago, back in probably started in 21, 22, Yale New Haven Health System and our sister company started to talk about getting brought into the fold at Yale. This was one piece of the pie that they did not have in their post-acute care offerings. And as negotiations go and worked out, worked out, and everybody came to agreement and Lifetime and our sister company merged up with Yale. And I was very happy with that. Obviously, it was a, you know, a star for us.

But I met with several of the people from the hospital and we were chatting and they said Lifetime was the only non-medical that Yale brought on. They had already three other home health skilled partners, but they were looking for the non-medical. And the driver was Lifetime because of the outcomes, the dashboard, that we were the only ones who were able to provide that information. And they felt that that was very significant, very promising that they now were able to pull together a complete continuum of post-acute care that also included this non-medical personal care piece. And as far as I know, and I keep my ear to the ground, Lifetime is still the only non-medical provider in the Yale system. If that's not a pat on the back, then I don't

know what is. I think it just shows all of the hard work and the evolution of lifetime really culminated in this opportunity for a hospital system to recognize the value and the outcomes that you all had created. And I think not every owner is owner is in it, you know, builds it to sell, but I think there is an end game for every business. And so you, you do start to think about these partnerships, these opportunities, these hospital or healthcare systems, and where do you fit into that? And I think being recognized and being able to merge with those businesses is really just, you know, a seal of approval of all of the hard work that you put in. Oh, thank you. It was fun. Yeah. A lot of work, a seal of approval of all of the hard work that you put in. Oh, thank you. It was fun.

Yeah, a lot of work, a lot of work, but a great opportunity. But it was fun because it was innovative. It was different. And everybody bought into it. I think that's the important piece, Miriam, is we had everybody bought into it. And, you know, a lot more people having a say in what was going on and involving others. And it really, because I think it was new and different, it was exciting. I'm not going to kid you. There was some frustrations along the way. But overall, everybody knew the goal and wanted to all be part of that. So it was very successful.

It worked out. Well, I want to just end by giving you a couple minutes to share what your hopes are and excitement are for the future. You mentioned your retirement with Lifetime, but getting pulled into Corcoran and just the excitement and the opportunities for the future. You mentioned, you know, your, your retirement with Lifetime, but, you know, getting pulled into Corcoran and just the, the excitement and the opportunities ahead of you. But I, I want you to think maybe a little bit bigger, even for just a minute. And what, what looking forward, what emerging trends or maybe even disruptions do you see on, on the horizon for home care and what excites you to keep going? Home care is probably at the best place it's ever been. You know, unfortunately, I got to thank a little bit of COVID for that to help us and the position does very well. But what I would say is always be willing to think outside the box because that's the attraction.

That's what separates everyone from the rest of the pack. There are some incredible home-based care models coming that are good and are evolving. The hospital at home program. Again, an offshoot of COVID. We were involved in a hospital at home program. Again, an offshoot of COVID. We were involved in a hospital at home program. And the rewards for our staff were incredible. They were doing all the same thing, but they were working in an interdisciplinary team. They felt like they were, wow, I'm working with doctors. I'm working with nurses. I'm side by side with all these monitors. Exciting.

So the home-based care models, they have continuing care retirement communities without walls. So there's memberships, but you can still have access to that continuum care environment. Look at those. These are all new programs. The PACE program, the GUIDE program for dementia. These are all evolving that are going to demand and require the home care piece, the non-medical. Technology. Look at what's going on with the technology and innovation. AI, don't be intimidated by it. Are we there yet as an industry? Not yet,

but there's a lot of programs. I know two agencies in particular right now are working on intake, AI intake, because staffing is challenging. So they're using AI for some of their intake process. I listened to it, and it was absolutely amazing what they're doing with that AI. And again, it's a supportive partner. It's not there to replace the caregiver, the personal touch, but to supplement it. Partnerships. Partnerships, in my opinion, will be the key to surviving. Partnerships allow, whether they're formal or informal, simple handshake. I had a partnership with a pharmacy on a handshake. I was able to call at 2 o'clock in the morning.

Somebody's coming home from the emergency room. Here, go out and give a prescription. They need some prescriptions. He benefited and I benefited by that. So partnerships allows for growth and new programs and shared resources. And of course, you got Medicare Advantage coming. Good or bad, it's here, 52% Medicare beneficiaries. So there's a lot of good stuff going on. Be open to it. Be aggressive.

Don't be afraid. And don't be afraid to reach out and ask for help. Don't be afraid to start partnerships because there is strength in numbers. So that's where the future is great. I think the future is very bright, more than ever. I'd love to hear this from someone that's been in the industry for several decades. And that's not to date you, but to just to contextualize your experience. You've been doing this for so long, but to hear you say, you know, the future is brighter than ever. Home

care is in the best place it's ever been, you know, gives young people like me just hope that we've worked hard and we've gotten to where we are today, but we've got a lot of work ahead of us. And just one personal thing to share. I've heard you talk a lot about these concepts over the last five years that I've been around. And to be frank, I don't see enough adoption of this. And I think we've got a long ways to go. But I hope people listening to this understand that the top home care businesses in your market, they are doing this. The people that really rise to the top, like you mentioned, the businesses that

succeed to 10, 20, a lot more in revenue, they are executing on these types of concepts. And so if you want to compete, if you want to have a seat at the table, if you want to win in your market, it really starts with some of these fundamentals that Guy has been talking about. And so I love to have you on, Guy. I love to talk to you because I really think that just more businesses and owners need to be thinking about these concepts and implementing them in their businesses. And like you said, it may sound overwhelming. It may sound like a lot of work, but it really is just getting back to the basics and getting organized and getting these principles in place and then getting that buy-in from the team and working together to accomplish it. So I love to talk about this. I could talk about it all day and I love to reconnect with you

and I think really highly of you. And I'm honestly just grateful for all the work that you've done for this industry, for what you're doing in Connecticut. I think this industry has a lot to learn from you and you've put in so much work and I hope you feel a sense of accomplishment. Well, I do. Thank you, Miriam, for those kind words. I'm passionate about our industry succeeding and I know it can. I will take any opportunity to get in front of people and talk about it because this is an exciting time. And those who, you know, it's a mindset. You said it. Those who want to now, you know, we're no longer just companions and homemakers. Those who want to do that, that's fine. And I don't disrespect that.

But those who really want to be part of the system in a very collaborative way, take advantage of these new programs, these new opportunities, because you're not reinventing the wheel. You've been doing it every single day. It's now categorizing it and blending it with the rest of the ecosystem. And you're going to look back and say, why didn't we do this sooner? I couldn't have said it better myself, Guy. Thank you so much for giving us an hour of your time. I know you're busy and you've got some busy months ahead of you. So thank you for giving us this time. I hope everyone here live has enjoyed this session and everyone that listens to the recording

really enjoys this session. What is, I know you're busy, but is there a way that people can get in contact with you via email or online or Corcoran? Sure. What do you recommend? I'd love to chat with people, not even if it's business or work related, just to share my thoughts. And anybody who's interested, you can reach me at GT at Corcoran, that's C-O-R-C-O-R-A-N

consultants.com. And feel free to ask me questions or whatever. I'm more than happy to help. Amazing. That's a generous offer. You are a wealth of knowledge. So I do highly recommend people take advantage of the opportunity to speak with you. And one note, I'll include your email and Corcoran's website in the show notes here.

So if anyone's listening to this, wherever you're listening to it, you can grab the links out of the show notes. So Guy, thank you so much. I hope you have a great rest of the year and I wish you all the best with what's ahead of you and look forward to reconnecting again soon. Absolutely. I look forward to it. Thank you so much, Marion, for having me on and great seeing you again. Likewise. Thank you everyone for being here today and we'll look forward to seeing you back same day, same time next week. Goodbye for now. 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.