What is the impact of the CMS 80-20 rule and recent Medicaid rate adjustments on the home health industry? Unlock the secrets to modernizing home health operations with Jesse Howard, Vice President of Operations for Girling Personal Care. Jesse dives deep into the financial strains and staffing challenges home health providers face, particularly in Texas, where low Medicaid reimbursement rates and competitive wages make it hard to sustain quality care. Listen in as this episode presents a comprehensive understanding of how these financial pressures affect operations and what home health agencies can do to stay competitive.
If you liked this episode and want to learn more about all things home-based care, you can explore all our episodes at alayacare.com/homehealth360.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jesse Howard (00:00):
On a just a day-to-day basis, we are pretty
much already at 80-20.
Of course, that is mostprofoundly affected because of
the very low Medicaidreimbursement rates that we live
today and then just trying tobe competitive in a very
competitive atmosphere.
Things are pretty good in thestate of Texas and we compete
(00:23):
with the same pool of potentialemployees that every other
retail manufacturing, everyindustrial group that's out
there.
The de facto minimum wage inthe state of Texas has to be
somewhere close to $15 to $17per hour, which is really above
my Medicaid reimbursement rates.
(00:44):
So already pretty much in the80-20 space when you start
thinking of 80% of thosereimbursements having to go to
those home care workers.
Erin Vallier (01:11):
Welcome to another episode of the Home Health 360
podcast, where we speak tohome-based care professionals
from around the globe.
I'm your host, E erin Vallier,and today I am joined by Jesse
Howard.
Jesse is the Vice President ofOperations for Girling Personal
Care, which is a home healthorganization licensed in all 254
counties with 16 locationsthroughout Texas.
(01:32):
They serve thousands ofMedicaid recipients as well as
veterans and private dutyclients.
Jesse has been in the homehealth space for over 20 years,
starting in the medicalequipment sector, but he quickly
hopped over to the home healthindustry.
Over his tenure, he has servedin a variety of sales and
(01:52):
leadership roles and has been inhis current role since 2018.
And when Jesse is not thinkingabout how to solve all the
problems in home health care,you can probably find him
fishing or maybe hanging outwith his wife of almost 40 years
, or one of his three kids ortwo grandchildren.
Welcome to the show, J jesse.
Jesse Howard (02:14):
Man, you made me sound so good Wow.
Erin Vallier (02:17):
Well, I think you are so good.
We have a hot topic today, andthat is how to modernize your
operations to survive in today'shome health environment.
Are you ready?
Jesse Howard (02:32):
I have a lot of opinions.
I don't know what they're worth, but I have a lot of opinions,
Erin.
Erin Vallier (02:37):
They're expert opinions.
People, they're expert opinions.
Let's dive in opinions.
Let's dive in.
Given the recent passing of theCMS 80-20 rule and the
significant rate changes forMedicaid services, how are these
regulatory changes affectingoperations in general, maybe
(02:57):
even your operations, and whatstrategies can you implement to
mitigate their effects?
Jesse Howard (03:04):
So maybe we can pick it apart a little bit.
The 80-20 rule, erin, honestlyI don't know where that's going
to land.
You know a couple of factors.
We've got a federal electioncoming up very soon, at the end
of 2024.
Depending on how that electionshakes out, this all may be a
moot point right?
We've seen all kind of policychanges happen, with
(03:28):
administration changes.
And then the other part is whatis it?
A six-year roll-in or somethinglike that, six years before
it's implemented?
So in our life, six years is along time.
On a just a day-to-day basis, weare pretty much already at
80-20.
Of course, that is mostprofoundly affected because of
(03:49):
the very low Medicaidreimbursement rates that we live
today.
And then just trying to becompetitive in a very
competitive atmosphere.
Things are pretty good in thestate of of Texas and we compete
with the same pool of potentialemployees that every other
retail manufacturing, everyindustrial group that's out
(04:13):
there.
We're all vying for the sameemployee right and the de facto
minimum wage.
This is not scientific, butjust driving up and down I-35
and looking at billboards, thede facto minimum wage in the
state of Texas has to besomewhere close to $15 to $17
per hour, which is really abovemy Medicaid reimbursement rates,
(04:34):
so already pretty much in the80-20 space, when you start
thinking of 80% of thosereimbursements having to go to
those home care workers.
As far as low reimbursementrates and the challenges that we
have as a provider today in thestate of Texas we did get a
very nice increase for our PCAs,which is wonderful.
(04:56):
Prior to that the rate was$8.11.
We got a nice $2.49 raise forthose folks in 2023.
But unfortunately, the way thatthe reimbursement rate was
rolled out, payroll taxes andbenefits were calculated
differently and that resulted atabout a $0.35 per hour loss to
(05:16):
providers.
And when you throw a negative$0.35 per hour in there with the
fact that we've not gotten anytype of operational increase in
over 17 years, it just was verybrutal.
Every provider that I'm awareof always dipped way past what
the minimum rate for PCAs wereto pay additional rates just to
(05:39):
try to recruit and try to retainemployees.
So when you take another 35cents an hour away from me, it
really hurts.
The other part that we so manytimes overlook and just don't
address it's important toaddress the home caregivers we
have to right those are thefolks that are on the front
lines out there.
We've got to get those folks outthere, otherwise we never serve
(06:01):
the hours that Mr and Mrs Jonesare approved to receive.
But we have a team ofoperational employees,
administrative employees, thatare out there managing and
helping us manage the electronicvisit verification system, and
(06:26):
all of those so-called profitsthat providers should be
receiving go to pay all of thosefolks that do that
administrative work.
And those folks are also beinghired at very competitive wages
as well.
So when you think of callcenters that are out there and
so many other jobs that areavailable, I can't hire those
folks at $10 an hour.
We have to go way above andbeyond.
So it all goes into the 35 centper hour loss, which means
(06:48):
there's less operational fundsto go around to help me be
competitive in a verycompetitive space and then, of
course, to retain those people.
At the end of the day, profitsare not a dirty word.
Profits are the engine thatkeeps businesses moving right.
Erin Vallier (07:03):
Yeah, it should reflect the impact that you're
having.
There's nothing wrong withmaking a profit.
More profit means you'reserving more people.
Jesse Howard (07:11):
That's right, as you continue to narrow margins.
At the end of the day, how fardo you narrow margins where
providers just can't provide theservice?
We all know there's a shortageof caregivers, which means we're
all spending more dollars torecruit and to retain employees
and, again, without the profitside of it, I can't hire the
(07:32):
operational teams to support thebusiness that I'm mandated to
manage.
So it's been quite a challenge.
Erin Vallier (07:39):
What's your magic bullet, because I don't like the
math that you're talking.
It seems like, just visually,you're in the red, no matter
what you do, so is there astrategy that you can use to
mitigate it?
Does that mean diversifyingpayers or like?
What do you do?
Jesse Howard (07:55):
You know, we try to be as efficient as possible.
We try to use technology tomanage our business.
We do everything we can to usetechnology to help us recruit
what worked yesterday in the oldgreen sheet newspapers and
Craigslist maybe they're notalways the most productive, so
you have to look under everyrock trying to find a way to
(08:17):
reach people volume game.
We have unprecedented numbersand even the state of Texas has
reported this.
So I know we're not alone,aaron.
We have unprecedented numbersof what we call providers of
choice, and what that is iswhere Mr and Mrs Jones may have
a family member that qualifiesor a good close friend of the
family that they trust thatqualifies to be a caregiver.
(08:40):
So that's one of the ways thatwe've worked to try to recruit
people and it's been effective.
And again, like I shared withyou, I know that we're not alone
in that, because the state ofTexas published a very
comprehensive white paper and Ithink they quoted caregivers of
choice at around 70% of theworkers in the state of Texas
(09:02):
and you know that's pretty spoton.
Erin Vallier (09:05):
Wow, that's big.
Okay, you know, that's prettyspot on Wow that's big.
Okay, you touched on a lot ofthings that I think we're going
to dive into in more depth as weget into this conversation,
which was efficiency, maximizingthe use of technology and being
creative with recruiting.
Let's peel back the onion here.
So, beyond those regulatorychanges we just talked about,
(09:25):
there's other challengesStaffing, which you touched on a
bit, operational efficiencies,which we haven't really dug into
that much, but these things aremaking it difficult to run your
business effectively.
So tell me a little bit how youcan address these challenges
and maintain stability and thequality of care that you're
delivering.
Jesse Howard (09:44):
Erin.
I don't want to speak for theindustry, so these are just
where I see things, my opinionof what can be done, and I think
that our biggest challenge andthe most impactful thing that
providers like us can do is tocontinue working with
legislators to educate them onthe needs, the impact of not
(10:05):
addressing these reimbursementissues on the Medicaid
recipients, educating them onthe fact that community-based
home care costs one-third theamount of facility care.
The truth is, we're going topay for health care.
It's going to get paid, right.
You're going to pay providers,whether it's personal care,
private duty, nursing or homehealth.
Whatever the case may be, we'regoing to pay for that.
(10:27):
Now, it may be paid at the ERlevel, it may be paid at a
nursing home level, but we haveproven that home-based home care
can save two-thirds the amountof money that's typically spent
when a client or a patient goesto a higher level of care.
So we just have to educatethose legislators on yeah, it
(10:48):
sounds like an increase to methat you're just throwing more
money at personal care, but atthe end of the day, the overall
spend is reduced because you'resaving two-thirds on the back
end.
So I think that's where ourlargest challenge and largest
opportunity is I'm really prettynew when it comes to going to
the Capitol and talking tolegislators.
(11:08):
It's just something I justreally don't have a history of,
and it's really been veryeye-opening to see how many
people are in their doorway withtheir handout.
So I have an appreciation thatwhen I show up and start talking
about personal care, they'relike who are you and where do
you plug in?
Because there's every industryis doing the same thing, right?
(11:31):
So fortunately we've had ourchampions that either come from
a home care space or forwhatever reason, have been able
to really understand what it iswe do.
But honestly, Aaron, I thinkthat's our largest opportunity
and largest challenge justtrying to really distill this
information and the needs, thevery real needs, down to the
(11:52):
level where legislators cangrasp it and hopefully support
what we're trying to do.
Erin Vallier (11:59):
And we have six years to do it, because that's
when the roll's out.
So, everybody listening, getinvolved at the state and the
national level and use yourvoice.
Yeah, that's what I'm hearingyou say.
All right, so let's talk aboutwhat you can do to stay afloat
in the interim.
Taking our voices tolegislative authority is going
(12:22):
to take some time and we stillhave to run our businesses until
they start listening to us.
So how crucial is it going tobe for home care providers to
modernize their operations toremain competitive and live
viable, to remain competitiveand be viable.
Jesse Howard (12:37):
It's imperative.
What's that old saying Ifyou're not moving forward,
you're moving backwards, becausethere is no, just idle.
Everything is moving one way orthe other.
So we have to keep moving.
And goes back to what I shared.
We're spending unprecedenteddollars trying to recruit.
We're looking at every avenue.
I can't tell you how manydifferent avenues we've
attempted to recruit.
(12:58):
Avenue.
I can't tell you how manydifferent avenues we've
attempted to recruit.
Sometimes they're not fruitful.
We move on, but at the end ofthe day, our task is to deliver
as many appropriate hours thatMr and Mrs Jones is authorized
to receive in their home.
Right, and we have a caregivershortage in our company, just
like every other provider that Iknow of.
There are a number of providersthat I keep up with frequently
(13:21):
we talk, so I know that we'renot alone.
We continue to look for everyopportunity.
And then, of course, theefficiency of just trying to
deliver that care in a mostefficient manner with as few
touch points as we can, because,at the end of the day, every
time one of our employees has toget involved in the whole
process, that costs money, right.
So trying to make that asefficient as possible so
(13:45):
attendants are confident andcomfortable with showing up when
they're supposed to show up andclocking in and clocking out
when they're supposed to.
And we've done some things toreally try to grow our employee
satisfaction because, it's true,not everyone works for money.
(14:05):
It's absolutely important,right?
If you stop paying me, I'm notsure how long I'll stay around,
but at the end of the day, moneyis not the only reason I'm here
, right, and I think that's truefor every person in our company
.
So we've spent a lot of effortsand it's really paid off.
This is something that wemeasure.
I think it's kind of anindustry secret of ours, so I'm
(14:27):
not going to go into detail butwe've really spent a lot of time
investing in our PCAs and it'smade a difference.
It really has.
So those kind of things, justlooking for an opportunity where
people are happy to go to work,they're satisfied with the work
that they do and they want tokeep showing up.
So, anyway, everybody has theirchallenges and it doesn't
matter if you're an attendant orif you're a coordinator or if
(14:50):
you're the vice president of anoperation.
Everybody has challenges, right, and everybody has days that
you're like, oh, my goodness, Igot to do this again or my
goodness, that day went wrong.
Everybody has days like that.
But at the end of the day, do Imake it easy for my employees
to show up?
Do they understand theimportance of what they do?
Do they understand what needsto happen if something goes
(15:13):
wrong during their day?
Right, so people don't havethat frustration of wondering
and people don't have thefrustration of saying, well, I
don't know who to turn to right.
So we've spent a lot of timereally trying to improve that
situation where people are justhappier to show up and do their
job.
Erin Vallier (15:30):
So what I'm hearing you say is, in terms of
modernization, it's imperativeand the focus should be on
making your employees feel safeand supported and that they like
the tools that they're usingand their jobs are way more
efficient with those tools thanwithout them.
Can you elaborate on some ofthe risks of not adapting to
(15:53):
this evolving landscape we findourselves in?
Jesse Howard (15:55):
Well, certainly the downside is you're going to
have to serve fewer clients atsome point.
You just can't do that.
We have picked up business invarious parts of Texas from
other providers that havedecided to get out of personal
care, out of the Medicaidbusiness.
It's interesting that the onesthat have were sticking around
(16:16):
and doing private duty home care, but they're just not going to
deal with Medicaid anymore.
So that's what happens.
That's the reality.
If people are not able to havea margin where they can continue
to pay employees and it's aviable business people are going
to move on.
So I don't think the state ofTexas wants to be a Texas
(16:39):
Medicaid-run business forpersonal care.
I think they want to continueto contract with providers like
me.
Providers have to be profitable.
Right Providers have to be ableto give a return to their
investors.
It's like I said earlierprofits are not a dirty word,
they're purely the engine, ormaybe the gasoline.
Maybe that runs the engineright.
Erin Vallier (17:00):
Absolutely, absolutely.
So when we talk aboutmodernizing operations, what
exactly does that entail in youropinion.
Jesse Howard (17:10):
Well, you want my 30,000-foot view because I'm
pretty passionate about this.
Erin Vallier (17:14):
Yeah.
Jesse Howard (17:15):
Give it to me, to me, as I shared with you.
Information, connectivity allof those things are our future.
We know that right.
But there is still a hugeopportunity that I think we're
missing with not sharing clienthealth information, real-time
connectivity to clients andcaregivers, to really and truly
minimize ER visits and make ahuge difference in the life of
(17:39):
these clients.
Personal care is in the homemore hours per week than any
other industry.
Home health can be there, butthat's intermittent.
Hospice can be there, butthey're going to be there to do
tasks and meet the needs of theparticular client or patient and
family at specific times.
Obviously, facility care is notin the home.
(18:01):
Even house call doctors,they're not in the home hours
like we are.
Aaron, I was part of anorganization a number of years
ago where we developed a teamthat really kind of surrounded
the client or the patient and wehad nurses, we had home health,
we had hospice, we had nurseliaisons and we helped to ensure
(18:26):
that the client was receivingthe proper level of care.
This was something the clientsor patients and families could
opt into and we had follow-upsin place where we were making
sure the client was receivingwhat they needed at the right
time, whether it was a dischargefrom the hospital to home.
Did they understand thedischarge papers?
Did they get the medicationsthat they needed when they got
(18:49):
home?
Did they get the appropriatemedical equipment?
Once they got home, did Mr andMrs Jones say, look, we're going
home, we can do this on theirown.
And two days later they foundout that, oh my gosh, this is
just overwhelming, we need morehelp.
So we were there to pick thosepieces up and provide the care
they needed when they needed it,and it was just a great thing.
(19:10):
We were able to reducehospitalizations and, of course,
that very important return tothe hospital right.
So many times there'smedication errors.
People get out of the hospitalon Friday and they're back in
the hospital on Tuesday.
So we were able to do a lot ofthose things and really provide,
I thought, great care.
And so, in my mind, what I keepthinking is that we need to get
(19:32):
out of our silos.
Yes, we get referrals from thestate of Texas, we get referrals
from different managed careorganizations, but there is just
so little communication interms of what medications is the
client on, what's been theirdisease processes.
I really and truly see a worldif we could do it.
(19:53):
Where personal care is used bythe state of Texas or used by
the managed care organizations,where there's more resources,
there's more education, where wecan really and truly have lines
of communication built, whereour caregiver understands what's
going on in the life of thatpatient every day and when they
(20:14):
go in there they see andunderstand signs and symptoms of
something going wrong.
There's a nurse that they cancall and say hey, I'm Jesse, I'm
here to see Erin today.
And when I got here, erinreally looks like she's having
struggle, breathing right.
And we put Erin on the phoneand the nurse can kind of walk
through with Erin.
What's going on, right?
(20:35):
Well, yeah, I didn't weigh thismorning and I didn't take my
medications last night.
Okay, well, let's do this right, and I'm making that up, aaron,
I am not a clinician, so I'mnot giving you medical advice.
But, again, we spend so manyhours in the home and, yes, it's
important what we do every day.
I mean, we truly help peoplestay independent with our
(20:55):
bathing them and helping them,getting dressed and making sure
they have food to eat andpreparing that food so they have
the nutrition that they need,but there's just so much more
care that I truly believe couldbe delivered.
But I don't control the pursestrings and, as I reminded you
earlier, we're going to pay forthis care.
One way or the other.
We're going to pay for the care.
(21:16):
I just really believe someonesmarter than me could really
move the money around andconnect us all in a better way,
whether it's certainly EMRs.
In the age of information, Iknow EMRs can talk to each other
.
Let's share that information,let's put the resources in place
where, if something is going on, we can very quickly escalate
(21:39):
it and then maybe diffuse asituation.
But that's going to take so manypeople involved.
It's going to take legislatorswilling to take a hard look at
where's the money being spent.
It's going to take HHSC.
It's going to take MCOs thewillingness to look at where the
money's being spent.
It's going to take MCOs thewillingness to look at where the
(22:01):
money's being spent and thenreally start moving this money
around.
Making it up.
We get more money or the MCOsmove the money from one place to
another where differentdivisions have more resources.
That, at the end of the day,de-escalate all these situations
that Mr and Mrs Jones have,because, let's be honest, one
trip to the ER is going to beabout $14,000, $15,000 or more.
(22:23):
Right, you can buy a whole lotof personal care for $14,000, a
whole lot.
So I know I'm kind of on mybully pole bit, but when I think
of modernization my mind goesfrom just computers to really a
whole change in the way that wedo business, because today
there's just very littletransparency in terms of what
(22:46):
medication error rates, diseasemortality rates, disease-related
healthcare spending rates Ijust see very little of that.
Again, I keep throwing thedisclaimer out there.
Somebody smarter than me thattruly has the spending ability
to really take a look at thisand let's just be honest about
it Where's the money going?
And let's kind of reverseengineer this thing, aaron, and
(23:11):
say the money's going here, whatis out there today that could
really impact the overall spend?
And hey, maybe somebody's donethat in the back room, but I
don't feel it, I don't see it.
Somebody's not listening tothem.
I don't think they are.
I'm just a little cog in thewheel, aaron.
So you've allowed me to throw a30,000 foot view out there and a
(23:32):
lot of this is kind of areflection on where I've been
and I saw the impact that wewere able to make and I just
think there's a greatopportunity for the state of
Texas to really develop some,maybe a task force with the
right people to reverse engineerand I think that's the right
term.
Just reverse engineerhealthcare today and let's look
(23:54):
at where the money spent is.
Let's not be greedy.
Let's really and truly thinkabout where is the money being
spent, who's it being spent onand is there a way to minimize
that?
You know, for tomorrow.
Erin Vallier (24:08):
Yeah, I appreciate you sharing your perspective,
and I think that it's not just aTexas problem.
I think it's applicable toevery single state in this
nation.
We all have our own version ofwhat's going on in Texas.
For sure, these lessons areuniversal, and what I'm hearing
is we just need a paradigm shiftin our business structures so
(24:29):
that we're not so siloed, and weneed to modernize our processes
so that we can communicateacross the whole spectrum, all
the levels of care, and thething that ties it all up is
this beautiful technology bow.
And I want to ask just aquestion about technology,
because I know that you guysheavily leverage technology.
(24:52):
You're a fan of leveragingtechnology so that you can do
more with less.
What are some keyfunctionalities or support that
the industry needs from yourtechnology partners in order to
facilitate modernizationeffectively?
Jesse Howard (25:09):
Boy?
I'm not sure I have an answerfor that.
I know we live in the weeds ona day-to-day basis, just with
everything going on and thesheer effort of recruiting,
retaining, trying to get ourattendants to clock in and clock
out as they should.
That's an effort we continue tolearn every day.
(25:51):
We are fine-tuning that to meetthe needs.
So I think there's moreefficiencies to be found there.
I know that one thing that wecontinue to struggle with and we
still have not found the realkey, and that's a very efficient
way to communicate with ourattendants in the field.
I think we're getting there,but I know that there is just
huge upside if we could reallybe very efficient with that, as
I shared with you a little bitago.
You know we've done a lot toreally work with them, to
communicate, make sure thatthey're pleased with what's
going on and all those kinds ofthings, but there's a great
opportunity, I think, tocommunicate more with them.
(26:12):
What generation are we on?
Are we on generation X, Y, Z?
I don't remember which one.
I'm older than you, Erin, so Idon't know what.
Erin Vallier (26:21):
In a couple of years we're going to have to
start the alphabet over.
Jesse Howard (26:25):
So this generation and I'm just thinking, you know
, I've got a daughter that'sgoing to be 23 coming up here in
a little bit and she goesnowhere without her telephone,
right, and I've even fallen preyto that a little bit how
efficiently can we, on a dailybasis, communicate with our
employees, whether that and I'mnot condoning WhatsApp or
anything else there are just somany methods of communication
(26:47):
today.
Getting information, maybe it'sjust general information, maybe
it's just things that arecheck-ins and things like that,
so there's a great opportunityto have better connectivity with
our attendants.
So when I think of technologyas something that's needed today
, most specifically today, thatcould, I think, really make a
(27:07):
difference on our business,that's one thing that my mind
comes back to.
Not sure I answered yourquestion, erin.
Erin Vallier (27:12):
I don't know.
It was a great answer.
You need more support reachingyour field workers in a way that
is easy and effective, and youneed a way to streamline your
back office so you're notspending too much time with the
visit verification so you canget paid in a faster method.
That was an excellent answer.
Jesse Howard (27:32):
You say that so much more eloquently than I
could.
Erin Vallier (27:34):
I was just listening to everything you said
.
You said that yourself.
I just have one more questionfor you.
If there's any final thoughts,you have any essential keys to
success that you want to sharewith the home care providers
that are listening today on howto modernize their operations, I
would love for you to share.
Jesse Howard (27:53):
Well, erin, I think we probably have more
questions than we have answers.
To be quite honest with you,it's been a challenging number
of years, especially since COVIDand everything COVID did to all
of us and when I say that, I'mtalking about from providers to
clients to attendants.
It's just a different world.
Honestly, we're living in avery different world.
People have different mindsetsthan they did today, and the
(28:17):
only thing I know to tellanybody what to do or what may
be the next step is just to keeptrying different things, and
I'm not being cliche, I'm beingvery sincere when I say this.
We have tried and failed somany different things and we
keep trying.
Sometimes we hit upon somethingthat works, but we just don't
have the answers.
(28:37):
So we keep looking and tryingdifferent things that really may
make an impact, and we'vestumbled across some things that
make an incremental impact andsometimes we've had some that
had a little bit more impact.
If I was to share any advicewith anybody out there, just
keep trying different things,right?
I hope you would hear from thepeople that I work with If you
(28:57):
ask them.
I think, and I hope they wouldtell you, that I never walk into
the room thinking I have allthe answers, because usually I
don't.
There's almost certainlysomeone smarter than I am in the
room.
So I think that's just theattitude you got to take, right,
and just keep asking anddigging and don't be embarrassed
if it doesn't work.
Don't be egotistical about it.
(29:17):
So I don't know.
That's all I got for you.
Erin Vallier (29:21):
That's sage advice right there, though.
Try something.
If it doesn't work, learn fromit, try something else, and keep
doing that until you figure itout, because there really is no
failure.
You just learn what doesn'twork.
Yeah, just keep learning andkeep growing.
I love it.
Jesse, thank you so much forhopping on the show today and
sharing all of your wisdom withour listeners.
(29:43):
It has been an absolutepleasure.
Jesse Howard (29:45):
Well, erin, you're very kind.
Thank you, I appreciate youincluded me in this.
You have a great day.
Erin Vallier (29:50):
Home Health 360 is presented by Alaya Care and
hosted by Erin Valliere.
First, we want to thank ouramazing guests and listeners.
Second, new episodes air everymonth, so be sure to subscribe
today so you don't miss anepisode.
And, last but not least, if youlike this episode and want to
learn more about all thingshome-based care, you can explore
(30:12):
all of our episodes ataliacarecom slash home health
360 or visit us on your favoritepodcast platform.
On a just a day-to-day basis, we are pretty
much already at 80-20.
Of course, that is mostprofoundly affected because of
the very low Medicaidreimbursement rates that we live
today and then just trying tobe competitive in a very
competitive atmosphere.
Things are pretty good in thestate of Texas and we compete
(00:23):
with the same pool of potentialemployees that every other
retail manufacturing, everyindustrial group that's out
there.
The de facto minimum wage inthe state of Texas has to be
somewhere close to $15 to $17per hour, which is really above
my Medicaid reimbursement rates.
(00:44):
So already pretty much in the80-20 space when you start
thinking of 80% of thosereimbursements having to go to
those home care workers.
Erin Vallier (01:11):
Welcome to another episode of the Home Health 360
podcast, where we speak tohome-based care professionals
from around the globe.
I'm your host, E erin Vallier,and today I am joined by Jesse
Howard.
Jesse is the Vice President ofOperations for Girling Personal
Care, which is a home healthorganization licensed in all 254
counties with 16 locationsthroughout Texas.
(01:32):
They serve thousands ofMedicaid recipients as well as
veterans and private dutyclients.
Jesse has been in the homehealth space for over 20 years,
starting in the medicalequipment sector, but he quickly
hopped over to the home healthindustry.
Over his tenure, he has servedin a variety of sales and
(01:52):
leadership roles and has been inhis current role since 2018.
And when Jesse is not thinkingabout how to solve all the
problems in home health care,you can probably find him
fishing or maybe hanging outwith his wife of almost 40 years
, or one of his three kids ortwo grandchildren.
Welcome to the show, J jesse.
Jesse Howard (02:14):
Man, you made me sound so good Wow.
Erin Vallier (02:17):
Well, I think you are so good.
We have a hot topic today, andthat is how to modernize your
operations to survive in today'shome health environment.
Are you ready?
Jesse Howard (02:32):
I have a lot of opinions.
I don't know what they're worth, but I have a lot of opinions,
Erin.
Erin Vallier (02:37):
They're expert opinions.
People, they're expert opinions.
Let's dive in opinions.
Let's dive in.
Given the recent passing of theCMS 80-20 rule and the
significant rate changes forMedicaid services, how are these
regulatory changes affectingoperations in general, maybe
(02:57):
even your operations, and whatstrategies can you implement to
mitigate their effects?
Jesse Howard (03:04):
So maybe we can pick it apart a little bit.
The 80-20 rule, erin, honestlyI don't know where that's going
to land.
You know a couple of factors.
We've got a federal electioncoming up very soon, at the end
of 2024.
Depending on how that electionshakes out, this all may be a
moot point right?
We've seen all kind of policychanges happen, with
(03:28):
administration changes.
And then the other part is whatis it?
A six-year roll-in or somethinglike that, six years before
it's implemented?
So in our life, six years is along time.
On a just a day-to-day basis, weare pretty much already at
80-20.
Of course, that is mostprofoundly affected because of
(03:49):
the very low Medicaidreimbursement rates that we live
today.
And then just trying to becompetitive in a very
competitive atmosphere.
Things are pretty good in thestate of of Texas and we compete
with the same pool of potentialemployees that every other
retail manufacturing, everyindustrial group that's out
(04:13):
there.
We're all vying for the sameemployee right and the de facto
minimum wage.
This is not scientific, butjust driving up and down I-35
and looking at billboards, thede facto minimum wage in the
state of Texas has to besomewhere close to $15 to $17
per hour, which is really abovemy Medicaid reimbursement rates,
(04:34):
so already pretty much in the80-20 space, when you start
thinking of 80% of thosereimbursements having to go to
those home care workers.
As far as low reimbursementrates and the challenges that we
have as a provider today in thestate of Texas we did get a
very nice increase for our PCAs,which is wonderful.
(04:56):
Prior to that the rate was$8.11.
We got a nice $2.49 raise forthose folks in 2023.
But unfortunately, the way thatthe reimbursement rate was
rolled out, payroll taxes andbenefits were calculated
differently and that resulted atabout a $0.35 per hour loss to
(05:16):
providers.
And when you throw a negative$0.35 per hour in there with the
fact that we've not gotten anytype of operational increase in
over 17 years, it just was verybrutal.
Every provider that I'm awareof always dipped way past what
the minimum rate for PCAs wereto pay additional rates just to
(05:39):
try to recruit and try to retainemployees.
So when you take another 35cents an hour away from me, it
really hurts.
The other part that we so manytimes overlook and just don't
address it's important toaddress the home caregivers we
have to right those are thefolks that are on the front
lines out there.
We've got to get those folks outthere, otherwise we never serve
(06:01):
the hours that Mr and Mrs Jonesare approved to receive.
But we have a team ofoperational employees,
administrative employees, thatare out there managing and
helping us manage the electronicvisit verification system, and
(06:26):
all of those so-called profitsthat providers should be
receiving go to pay all of thosefolks that do that
administrative work.
And those folks are also beinghired at very competitive wages
as well.
So when you think of callcenters that are out there and
so many other jobs that areavailable, I can't hire those
folks at $10 an hour.
We have to go way above andbeyond.
So it all goes into the 35 centper hour loss, which means
(06:48):
there's less operational fundsto go around to help me be
competitive in a verycompetitive space and then, of
course, to retain those people.
At the end of the day, profitsare not a dirty word.
Profits are the engine thatkeeps businesses moving right.
Erin Vallier (07:03):
Yeah, it should reflect the impact that you're
having.
There's nothing wrong withmaking a profit.
More profit means you'reserving more people.
Jesse Howard (07:11):
That's right, as you continue to narrow margins.
At the end of the day, how fardo you narrow margins where
providers just can't provide theservice?
We all know there's a shortageof caregivers, which means we're
all spending more dollars torecruit and to retain employees
and, again, without the profitside of it, I can't hire the
(07:32):
operational teams to support thebusiness that I'm mandated to
manage.
So it's been quite a challenge.
Erin Vallier (07:39):
What's your magic bullet, because I don't like the
math that you're talking.
It seems like, just visually,you're in the red, no matter
what you do, so is there astrategy that you can use to
mitigate it?
Does that mean diversifyingpayers or like?
What do you do?
Jesse Howard (07:55):
You know, we try to be as efficient as possible.
We try to use technology tomanage our business.
We do everything we can to usetechnology to help us recruit
what worked yesterday in the oldgreen sheet newspapers and
Craigslist maybe they're notalways the most productive, so
you have to look under everyrock trying to find a way to
(08:17):
reach people volume game.
We have unprecedented numbersand even the state of Texas has
reported this.
So I know we're not alone,aaron.
We have unprecedented numbersof what we call providers of
choice, and what that is iswhere Mr and Mrs Jones may have
a family member that qualifiesor a good close friend of the
family that they trust thatqualifies to be a caregiver.
(08:40):
So that's one of the ways thatwe've worked to try to recruit
people and it's been effective.
And again, like I shared withyou, I know that we're not alone
in that, because the state ofTexas published a very
comprehensive white paper and Ithink they quoted caregivers of
choice at around 70% of theworkers in the state of Texas
(09:02):
and you know that's pretty spoton.
Erin Vallier (09:05):
Wow, that's big.
Okay, you know, that's prettyspot on Wow that's big.
Okay, you touched on a lot ofthings that I think we're going
to dive into in more depth as weget into this conversation,
which was efficiency, maximizingthe use of technology and being
creative with recruiting.
Let's peel back the onion here.
So, beyond those regulatorychanges we just talked about,
(09:25):
there's other challengesStaffing, which you touched on a
bit, operational efficiencies,which we haven't really dug into
that much, but these things aremaking it difficult to run your
business effectively.
So tell me a little bit how youcan address these challenges
and maintain stability and thequality of care that you're
delivering.
Jesse Howard (09:44):
Erin.
I don't want to speak for theindustry, so these are just
where I see things, my opinionof what can be done, and I think
that our biggest challenge andthe most impactful thing that
providers like us can do is tocontinue working with
legislators to educate them onthe needs, the impact of not
(10:05):
addressing these reimbursementissues on the Medicaid
recipients, educating them onthe fact that community-based
home care costs one-third theamount of facility care.
The truth is, we're going topay for health care.
It's going to get paid, right.
You're going to pay providers,whether it's personal care,
private duty, nursing or homehealth.
Whatever the case may be, we'regoing to pay for that.
(10:27):
Now, it may be paid at the ERlevel, it may be paid at a
nursing home level, but we haveproven that home-based home care
can save two-thirds the amountof money that's typically spent
when a client or a patient goesto a higher level of care.
So we just have to educatethose legislators on yeah, it
(10:48):
sounds like an increase to methat you're just throwing more
money at personal care, but atthe end of the day, the overall
spend is reduced because you'resaving two-thirds on the back
end.
So I think that's where ourlargest challenge and largest
opportunity is I'm really prettynew when it comes to going to
the Capitol and talking tolegislators.
(11:08):
It's just something I justreally don't have a history of,
and it's really been veryeye-opening to see how many
people are in their doorway withtheir handout.
So I have an appreciation thatwhen I show up and start talking
about personal care, they'relike who are you and where do
you plug in?
Because there's every industryis doing the same thing, right?
(11:31):
So fortunately we've had ourchampions that either come from
a home care space or forwhatever reason, have been able
to really understand what it iswe do.
But honestly, Aaron, I thinkthat's our largest opportunity
and largest challenge justtrying to really distill this
information and the needs, thevery real needs, down to the
(11:52):
level where legislators cangrasp it and hopefully support
what we're trying to do.
Erin Vallier (11:59):
And we have six years to do it, because that's
when the roll's out.
So, everybody listening, getinvolved at the state and the
national level and use yourvoice.
Yeah, that's what I'm hearingyou say.
All right, so let's talk aboutwhat you can do to stay afloat
in the interim.
Taking our voices tolegislative authority is going
(12:22):
to take some time and we stillhave to run our businesses until
they start listening to us.
So how crucial is it going tobe for home care providers to
modernize their operations toremain competitive and live
viable, to remain competitiveand be viable.
Jesse Howard (12:37):
It's imperative.
What's that old saying Ifyou're not moving forward,
you're moving backwards, becausethere is no, just idle.
Everything is moving one way orthe other.
So we have to keep moving.
And goes back to what I shared.
We're spending unprecedenteddollars trying to recruit.
We're looking at every avenue.
I can't tell you how manydifferent avenues we've
attempted to recruit.
(12:58):
Avenue.
I can't tell you how manydifferent avenues we've
attempted to recruit.
Sometimes they're not fruitful.
We move on, but at the end ofthe day, our task is to deliver
as many appropriate hours thatMr and Mrs Jones is authorized
to receive in their home.
Right, and we have a caregivershortage in our company, just
like every other provider that Iknow of.
There are a number of providersthat I keep up with frequently
(13:21):
we talk, so I know that we'renot alone.
We continue to look for everyopportunity.
And then, of course, theefficiency of just trying to
deliver that care in a mostefficient manner with as few
touch points as we can, because,at the end of the day, every
time one of our employees has toget involved in the whole
process, that costs money, right.
So trying to make that asefficient as possible so
(13:45):
attendants are confident andcomfortable with showing up when
they're supposed to show up andclocking in and clocking out
when they're supposed to.
And we've done some things toreally try to grow our employee
satisfaction because, it's true,not everyone works for money.
(14:05):
It's absolutely important,right?
If you stop paying me, I'm notsure how long I'll stay around,
but at the end of the day, moneyis not the only reason I'm here
, right, and I think that's truefor every person in our company
.
So we've spent a lot of effortsand it's really paid off.
This is something that wemeasure.
I think it's kind of anindustry secret of ours, so I'm
(14:27):
not going to go into detail butwe've really spent a lot of time
investing in our PCAs and it'smade a difference.
It really has.
So those kind of things, justlooking for an opportunity where
people are happy to go to work,they're satisfied with the work
that they do and they want tokeep showing up.
So, anyway, everybody has theirchallenges and it doesn't
matter if you're an attendant orif you're a coordinator or if
(14:50):
you're the vice president of anoperation.
Everybody has challenges, right, and everybody has days that
you're like, oh, my goodness, Igot to do this again or my
goodness, that day went wrong.
Everybody has days like that.
But at the end of the day, do Imake it easy for my employees
to show up?
Do they understand theimportance of what they do?
Do they understand what needsto happen if something goes
(15:13):
wrong during their day?
Right, so people don't havethat frustration of wondering
and people don't have thefrustration of saying, well, I
don't know who to turn to right.
So we've spent a lot of timereally trying to improve that
situation where people are justhappier to show up and do their
job.
Erin Vallier (15:30):
So what I'm hearing you say is, in terms of
modernization, it's imperativeand the focus should be on
making your employees feel safeand supported and that they like
the tools that they're usingand their jobs are way more
efficient with those tools thanwithout them.
Can you elaborate on some ofthe risks of not adapting to
(15:53):
this evolving landscape we findourselves in?
Jesse Howard (15:55):
Well, certainly the downside is you're going to
have to serve fewer clients atsome point.
You just can't do that.
We have picked up business invarious parts of Texas from
other providers that havedecided to get out of personal
care, out of the Medicaidbusiness.
It's interesting that the onesthat have were sticking around
(16:16):
and doing private duty home care, but they're just not going to
deal with Medicaid anymore.
So that's what happens.
That's the reality.
If people are not able to havea margin where they can continue
to pay employees and it's aviable business people are going
to move on.
So I don't think the state ofTexas wants to be a Texas
(16:39):
Medicaid-run business forpersonal care.
I think they want to continueto contract with providers like
me.
Providers have to be profitable.
Right Providers have to be ableto give a return to their
investors.
It's like I said earlierprofits are not a dirty word,
they're purely the engine, ormaybe the gasoline.
Maybe that runs the engineright.
Erin Vallier (17:00):
Absolutely, absolutely.
So when we talk aboutmodernizing operations, what
exactly does that entail in youropinion.
Jesse Howard (17:10):
Well, you want my 30,000-foot view because I'm
pretty passionate about this.
Erin Vallier (17:14):
Yeah.
Jesse Howard (17:15):
Give it to me, to me, as I shared with you.
Information, connectivity allof those things are our future.
We know that right.
But there is still a hugeopportunity that I think we're
missing with not sharing clienthealth information, real-time
connectivity to clients andcaregivers, to really and truly
minimize ER visits and make ahuge difference in the life of
(17:39):
these clients.
Personal care is in the homemore hours per week than any
other industry.
Home health can be there, butthat's intermittent.
Hospice can be there, butthey're going to be there to do
tasks and meet the needs of theparticular client or patient and
family at specific times.
Obviously, facility care is notin the home.
(18:01):
Even house call doctors,they're not in the home hours
like we are.
Aaron, I was part of anorganization a number of years
ago where we developed a teamthat really kind of surrounded
the client or the patient and wehad nurses, we had home health,
we had hospice, we had nurseliaisons and we helped to ensure
(18:26):
that the client was receivingthe proper level of care.
This was something the clientsor patients and families could
opt into and we had follow-upsin place where we were making
sure the client was receivingwhat they needed at the right
time, whether it was a dischargefrom the hospital to home.
Did they understand thedischarge papers?
Did they get the medicationsthat they needed when they got
(18:49):
home?
Did they get the appropriatemedical equipment?
Once they got home, did Mr andMrs Jones say, look, we're going
home, we can do this on theirown.
And two days later they foundout that, oh my gosh, this is
just overwhelming, we need morehelp.
So we were there to pick thosepieces up and provide the care
they needed when they needed it,and it was just a great thing.
(19:10):
We were able to reducehospitalizations and, of course,
that very important return tothe hospital right.
So many times there'smedication errors.
People get out of the hospitalon Friday and they're back in
the hospital on Tuesday.
So we were able to do a lot ofthose things and really provide,
I thought, great care.
And so, in my mind, what I keepthinking is that we need to get
(19:32):
out of our silos.
Yes, we get referrals from thestate of Texas, we get referrals
from different managed careorganizations, but there is just
so little communication interms of what medications is the
client on, what's been theirdisease processes.
I really and truly see a worldif we could do it.
(19:53):
Where personal care is used bythe state of Texas or used by
the managed care organizations,where there's more resources,
there's more education, where wecan really and truly have lines
of communication built, whereour caregiver understands what's
going on in the life of thatpatient every day and when they
(20:14):
go in there they see andunderstand signs and symptoms of
something going wrong.
There's a nurse that they cancall and say hey, I'm Jesse, I'm
here to see Erin today.
And when I got here, erinreally looks like she's having
struggle, breathing right.
And we put Erin on the phoneand the nurse can kind of walk
through with Erin.
What's going on, right?
(20:35):
Well, yeah, I didn't weigh thismorning and I didn't take my
medications last night.
Okay, well, let's do this right, and I'm making that up, aaron,
I am not a clinician, so I'mnot giving you medical advice.
But, again, we spend so manyhours in the home and, yes, it's
important what we do every day.
I mean, we truly help peoplestay independent with our
(20:55):
bathing them and helping them,getting dressed and making sure
they have food to eat andpreparing that food so they have
the nutrition that they need,but there's just so much more
care that I truly believe couldbe delivered.
But I don't control the pursestrings and, as I reminded you
earlier, we're going to pay forthis care.
One way or the other.
We're going to pay for the care.
(21:16):
I just really believe someonesmarter than me could really
move the money around andconnect us all in a better way,
whether it's certainly EMRs.
In the age of information, Iknow EMRs can talk to each other
.
Let's share that information,let's put the resources in place
where, if something is going on, we can very quickly escalate
(21:39):
it and then maybe diffuse asituation.
But that's going to take so manypeople involved.
It's going to take legislatorswilling to take a hard look at
where's the money being spent.
It's going to take HHSC.
It's going to take MCOs thewillingness to look at where the
money's being spent.
It's going to take MCOs thewillingness to look at where the
(22:01):
money's being spent and thenreally start moving this money
around.
Making it up.
We get more money or the MCOsmove the money from one place to
another where differentdivisions have more resources.
That, at the end of the day,de-escalate all these situations
that Mr and Mrs Jones have,because, let's be honest, one
trip to the ER is going to beabout $14,000, $15,000 or more.
(22:23):
Right, you can buy a whole lotof personal care for $14,000, a
whole lot.
So I know I'm kind of on mybully pole bit, but when I think
of modernization my mind goesfrom just computers to really a
whole change in the way that wedo business, because today
there's just very littletransparency in terms of what
(22:46):
medication error rates, diseasemortality rates, disease-related
healthcare spending rates Ijust see very little of that.
Again, I keep throwing thedisclaimer out there.
Somebody smarter than me thattruly has the spending ability
to really take a look at thisand let's just be honest about
it Where's the money going?
And let's kind of reverseengineer this thing, aaron, and
(23:11):
say the money's going here, whatis out there today that could
really impact the overall spend?
And hey, maybe somebody's donethat in the back room, but I
don't feel it, I don't see it.
Somebody's not listening tothem.
I don't think they are.
I'm just a little cog in thewheel, aaron.
So you've allowed me to throw a30,000 foot view out there and a
(23:32):
lot of this is kind of areflection on where I've been
and I saw the impact that wewere able to make and I just
think there's a greatopportunity for the state of
Texas to really develop some,maybe a task force with the
right people to reverse engineerand I think that's the right
term.
Just reverse engineerhealthcare today and let's look
(23:54):
at where the money spent is.
Let's not be greedy.
Let's really and truly thinkabout where is the money being
spent, who's it being spent onand is there a way to minimize
that?
You know, for tomorrow.
Erin Vallier (24:08):
Yeah, I appreciate you sharing your perspective,
and I think that it's not just aTexas problem.
I think it's applicable toevery single state in this
nation.
We all have our own version ofwhat's going on in Texas.
For sure, these lessons areuniversal, and what I'm hearing
is we just need a paradigm shiftin our business structures so
(24:29):
that we're not so siloed, and weneed to modernize our processes
so that we can communicateacross the whole spectrum, all
the levels of care, and thething that ties it all up is
this beautiful technology bow.
And I want to ask just aquestion about technology,
because I know that you guysheavily leverage technology.
(24:52):
You're a fan of leveragingtechnology so that you can do
more with less.
What are some keyfunctionalities or support that
the industry needs from yourtechnology partners in order to
facilitate modernizationeffectively?
Jesse Howard (25:09):
Boy?
I'm not sure I have an answerfor that.
I know we live in the weeds ona day-to-day basis, just with
everything going on and thesheer effort of recruiting,
retaining, trying to get ourattendants to clock in and clock
out as they should.
That's an effort we continue tolearn every day.
(25:51):
We are fine-tuning that to meetthe needs.
So I think there's moreefficiencies to be found there.
I know that one thing that wecontinue to struggle with and we
still have not found the realkey, and that's a very efficient
way to communicate with ourattendants in the field.
I think we're getting there,but I know that there is just
huge upside if we could reallybe very efficient with that, as
I shared with you a little bitago.
You know we've done a lot toreally work with them, to
communicate, make sure thatthey're pleased with what's
going on and all those kinds ofthings, but there's a great
opportunity, I think, tocommunicate more with them.
(26:12):
What generation are we on?
Are we on generation X, Y, Z?
I don't remember which one.
I'm older than you, Erin, so Idon't know what.
Erin Vallier (26:21):
In a couple of years we're going to have to
start the alphabet over.
Jesse Howard (26:25):
So this generation and I'm just thinking, you know
, I've got a daughter that'sgoing to be 23 coming up here in
a little bit and she goesnowhere without her telephone,
right, and I've even fallen preyto that a little bit how
efficiently can we, on a dailybasis, communicate with our
employees, whether that and I'mnot condoning WhatsApp or
anything else there are just somany methods of communication
(26:47):
today.
Getting information, maybe it'sjust general information, maybe
it's just things that arecheck-ins and things like that,
so there's a great opportunityto have better connectivity with
our attendants.
So when I think of technologyas something that's needed today
, most specifically today, thatcould, I think, really make a
(27:07):
difference on our business,that's one thing that my mind
comes back to.
Not sure I answered yourquestion, erin.
Erin Vallier (27:12):
I don't know.
It was a great answer.
You need more support reachingyour field workers in a way that
is easy and effective, and youneed a way to streamline your
back office so you're notspending too much time with the
visit verification so you canget paid in a faster method.
That was an excellent answer.
Jesse Howard (27:32):
You say that so much more eloquently than I
could.
Erin Vallier (27:34):
I was just listening to everything you said
.
You said that yourself.
I just have one more questionfor you.
If there's any final thoughts,you have any essential keys to
success that you want to sharewith the home care providers
that are listening today on howto modernize their operations, I
would love for you to share.
Jesse Howard (27:53):
Well, erin, I think we probably have more
questions than we have answers.
To be quite honest with you,it's been a challenging number
of years, especially since COVIDand everything COVID did to all
of us and when I say that, I'mtalking about from providers to
clients to attendants.
It's just a different world.
Honestly, we're living in avery different world.
People have different mindsetsthan they did today, and the
(28:17):
only thing I know to tellanybody what to do or what may
be the next step is just to keeptrying different things, and
I'm not being cliche, I'm beingvery sincere when I say this.
We have tried and failed somany different things and we
keep trying.
Sometimes we hit upon somethingthat works, but we just don't
have the answers.
(28:37):
So we keep looking and tryingdifferent things that really may
make an impact, and we'vestumbled across some things that
make an incremental impact andsometimes we've had some that
had a little bit more impact.
If I was to share any advicewith anybody out there, just
keep trying different things,right?
I hope you would hear from thepeople that I work with If you
(28:57):
ask them.
I think, and I hope they wouldtell you, that I never walk into
the room thinking I have allthe answers, because usually I
don't.
There's almost certainlysomeone smarter than I am in the
room.
So I think that's just theattitude you got to take, right,
and just keep asking anddigging and don't be embarrassed
if it doesn't work.
Don't be egotistical about it.
(29:17):
So I don't know.
That's all I got for you.
Erin Vallier (29:21):
That's sage advice right there, though.
Try something.
If it doesn't work, learn fromit, try something else, and keep
doing that until you figure itout, because there really is no
failure.
You just learn what doesn'twork.
Yeah, just keep learning andkeep growing.
I love it.
Jesse, thank you so much forhopping on the show today and
sharing all of your wisdom withour listeners.
(29:43):
It has been an absolutepleasure.
Jesse Howard (29:45):
Well, erin, you're very kind.
Thank you, I appreciate youincluded me in this.
You have a great day.
Erin Vallier (29:50):
Home Health 360 is presented by Alaya Care and
hosted by Erin Valliere.
First, we want to thank ouramazing guests and listeners.
Second, new episodes air everymonth, so be sure to subscribe
today so you don't miss anepisode.
And, last but not least, if youlike this episode and want to
learn more about all thingshome-based care, you can explore
(30:12):
all of our episodes ataliacarecom slash home health
360 or visit us on your favoritepodcast platform.
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