Home Health Care News: Brad, what career experiences do you most draw from in your role today as COO of Careficient?
Brad Caldwell: I have been in the home care and hospice space since I was a 22-year-old telehealth sales rep. While selling telehealth, I would spend two days a month in the field with a customer helping install telehealth units. That experience changed my life. Often technology vendors don’t understand what our caregivers experience each day in the real world. My first time ever in a home in Camden, New Jersey, the RN and I walked in to find this amazing World War 2 veteran. He was quick to tell me all about the war and show pictures.
The RN explained that his only visitors or social interaction in months was her. While listening to some of the most amazing stories, I looked over and saw a long extension cord with two plugs. I had to follow the cord. It went through the house out back to the neighbor’s house. He had no electricity but had his TV plugged in and his telehealth monitor on. However, he did not have his oxygen machine plugged in.
I asked why, and he said, “I’m so scared if I don’t do my vitals every day that this amazing woman will stop coming to see me. She is why I’m alive and she has provided me with a purpose again.”
It was at that point that I realized I will never leave this space. Since that day it has been my mission to give these caregivers the best tools, so they can take care of the people that need them the most and in the place they want to be in the most: the home
Bill Creach founded Careficient in 2016. What did he see in the market that led him to found the company?
Caldwell: Careficient was originally developed while Bill was working as CEO of eSolutions, which he founded. His customers had been using four, five, even six platforms to try to run their businesses. Bill has never been a fan of classifying our solution as an EMR because we do so much more. His vision was to create a single platform that can be used for all service lines and handle all aspects of the business, so he developed Careficient AMS — the agency management system.
Bill looked at it from the operator’s perspective. How can we help our customers deliver the most efficient care — hence, Careficient — they can while navigating them through the stringent regulator environments we are forced to operate in today? We do this with one big caveat helping customer keep the focus on the patient. This approach was extremely successful for Bill at eSolutions, which was sold in Aug 2020 to Waystar for an impressive evaluation of $1.3 billion.
Describe the Careficient approach. How does it differ from other companies?
Caldwell: Good question. We were recently recognized as an Inc. 5000 fastest-growing company. Keeping this amazing culture and vision when you are growing extremely fast is a challenge, but we do a few things to make sure this will never change.
One is that we sign up customers to which Careficient can show value quickly. In other words, our ideal customer. We do not take on customers that may not be a good mutual fit. I have seen other vendors close any deal with a pulse just to turn around and lose that customer in the implementation process. No one wins in that situation.
Our other key area of focus is keeping our organizational chart streamlined and our team nimble so we can react fast when our customer needs us the most. A perfect example of this are the new EVV mandate requirements. We had to move quickly to develop a mobile app that can satisfy these requirements for the end user. Considering how many specific and different aggregators exist, we quickly realized that we could never get ahead of it by ourselves, so we partnered with CellTrak’s EVVLink.
This important partnership lets us put our best resources back on the core product and deliver for our customers.
Staffing remains a major difficulty for home health agencies. How does Careficient impact staffing challenges?
Caldwell: “Careficient” is more than just a catchy name. It speaks to the core of our system. Careficient helps our customers be the most efficient they can be, while retaining regulatory compliance. This protects the caregiver while equipping them with the data they need to provide the best care in the industry. Focus on the patient!
You talk about Careficient as helping people be part of a family. How does Careficient drive that familial feeling among clients, and why is that important?
Caldwell: It is extremely important to us that we only hire the best of the best from the industry. Our Vice President of Clinical & Regulatory, Kristie Meers, is the perfect example. She has been a surveyor for two of the largest surveying companies in our industry and is involved in all aspects of development and deployment, where her wealth of knowledge makes a real impact for our customers. We will not put them at risk with anything regulatory. You will hear other companies say their system is easy to use, but that doesn’t mean it protects users from regulatory risk and all the penalties that can come with that.
Additionally, 100% of our employees have been referrals of other employees or customers. We have had zero staff turnover, which provides additional comfort for customers. Our first customers have been working with the same people since day one. Earlier I mentioned that our staff is nimble, and part of that is that the salesperson becomes the client’s account manager. That way, there is great consistency in the relationship with key contacts, yet the salesperson also never tries to oversell something they can’t deliver. That creates accountability from the outset that allows clients to trust that even during the sales process there’s a long-term plan for success.
What are the top areas of home health management that you see agencies requiring assistance?
Caldwell: The biggest trend we are seeing is the diversification of payors and business lines. A few years ago, you would see a company that was 100% Medicare home care only. Now companies are not only being forced to have a diverse payor mix but are adding additional business lines like hospice, self-pay, unskilled Medicaid, and home care.
This has created a huge opportunity for Careficient, since we have one of the only single platform solutions for all business lines and it’s been that way since the inception of the company.
How does Careficient help agencies work within PDGM?
Caldwell: Careficient has several tools to assist agencies with PDGM. First is the OASIS scrubber, which guides and analyzes OASIS answers to ensure compliance. The system gives recommendations and suggests proper diagnosis codes when appropriate. This is a real-time scrubber as opposed to the overnight process other vendors offer.
Next is the PDGM analyzer, which calculates PDGM reimbursement to the penny. It will show total reimbursement, projected reimbursement and LUPA for both first and second 30-day episodes. Our software goes one step further, though, and calculates projected staffing cost based on the care plan frequency and duration. Agencies are able to correct and adjust OASIS and care plans before transmitting OASIS or submitting physician orders.
We have a tool that validates schedule changes. Careficient proactively alerts agencies if any change in a scheduled visit will, one, move a visit to a subsequent 30-day PDGM window, or, two, if moving the visit triggers a LUPA. These are real-time validations, not a static report. We prevent issues from happening in the first place, rather than simply reporting them after the fact.
We have an integrated billing tool, which works with all invoices and claims for PDGM payers, showing not just the financials, but information from the PDGM analyzer. All claims are submitted directly in Careficient via electronic transmissions. We pick up the payments and post against invoices. The whiteboard or workbasket tool proactively tracks and monitors all RAPs, whether it’s RAPs ready, unbilled RAPs or ready for billing, thus avoiding delays and penalties. In 2022 when NOA (Notice of Admission) kicks in, functionality tracking the NOA will be in Careficient as well.
Lastly, we offer a multitude of reports where the agency can monitor all PDGM patient billing and care status. Then you have our regular functionality of Physician e-signatures, built in and included e-faxing, live orders tracking/alerts, Review Choice Determination (RCD) claims tracking. These items ensure and assist agencies stay compliant, organized and minimize risk.
Entering this year, no one knew fully what to expect in the home health industry. What has been the biggest surprise to you in the industry this year? What impact do you think that surprise will have on the industry in 2022?
Caldwell: I have been extremely surprised with the massive pent-up demand during COVID-19 for a single platform system across all business lines. Because of COVID, agency owners had to rely on their vendor partners more than ever. Some quickly realized that their current software vendor could no longer satisfy their needs due to so many regulatory changes placed on them. No matter what business line a customer or prospect does, they are under significant regulatory pressures, and some of the legacy systems in the market just can’t handle those pressures today.
There’s also the massive consolidation of vendors in the market, which is forcing them to sunset product lines as they try to solve for the future. It has pushed agencies to demand more from their technology solutions, and to value the substance over just a trendy interface. Having a partnership and relationship with clients and backing it up with real industry expertise means more than ever before, that is why we have a customer for life approach.
I often think back to that World War 2 veteran in Camden, New Jersey, and ask myself, is Careficient helping caregivers like her do a better job for that amazing man? Is it allowing people to be taken care of where they want to be taken care of, in the home?
Don’t allow your vendors to treat you like another number. Every agency is different and needs to find that partner that will treat them that way. The vendor needs to solve your problems with you and have the ability to be nimble as your needs change. That’s what we work to do with this amazing family we call Careficient.