By Monica E. Oss, Chief Executive Officer, OPEN MINDS
Health plan and consumer expectations of access to hybrid services—in-office, virtual, and in-home—have been high since the pandemic and are likely to continue. And the proportion of home-based services is on the increase. New estimates find that up to $265 billion worth of services for Medicare fee-for-service (FFS) and Medicare Advantage beneficiaries could shift to the home by 2025—an additional 15% to 40% of Medicare services. Those numbers include diversion of 15% to 20% of emergency-department and urgent care to home-based alternatives, as well as 30% to 40% of outpatient behavioral health visits.
The challenges for executive teams are first, how to set up the infrastructure that facilitates this new delivery system, and second, how to staff these new models. That was the focus of the session, Innovative Program Approaches To Home-Based Services For Children, at The 2023 OPEN MINDS Home-Based Services Summit. The session featured Don Taylor, Executive Director for Pacific Clinics, along with Anna Fernandez, Director of Mental Health and Tara Beckman, Chief Program Officer for Hope Services.
The speakers provided great insight into the workforce issues in delivering home-based services. They identified the ability to engage consumers and lived experience as two critical factors.
“We’re looking for someone with the potential to learn and grow, and at the same time, someone who we think may be able to engage well,” said Mr. Taylor. “When it comes down to it, engagement is number one when you are out there in the communities. We believe we can develop people, but we need that baseline mindset.”
“It is a very hard responsibility that we have to choose someone that needs to go in the home of our client,” said Ms. Fernandez. “When somebody goes to the home, even if the supervisor is available, you cannot really be there. It is a difficult choice when looking at the job applicant. We must do it from many lenses. The skillset is important, but there are also other qualities in terms of being confident that this person will go to the home and do good work.”
Both organizations were struggling with filling supervisory and managerial roles for home-based services as well. Mr. Taylor said that traditionally supervisor recruitment focused on education, but education is not as good a predictor of success as it has been in other areas. Ms. Beckman said that one critical criterion is that supervisors and managers need the ability to coach using a coaching model.
“It’s important to really empower the managers and the supervisors to learn the coaching model because they are working independently in the community,” said Ms. Beckman. “It is so important for them to know how to react and how to respond to certain situations, especially situations involving crises. That increases the importance of leadership and management trainings, and for supervisors to really be trained well in the coaching model.”
The organizations have adopted some unique practices to retain the staff who provide in-home services. There is the need to address logistical issues, like scheduling systems that minimize drive times and group consumers in geographic clusters. And there is a need for flexibility in that scheduling. One key issue is the distribution of in-home cases, with a team structure that assures that no one team member was assigned to all the most difficult cases. And not surprisingly, both organizations have found that relationships with supervisors are critical to retention.
As organizations respond to the growing demand for in-home services, executive teams will need both the infrastructure and talent management practices to make that happen. These hybrid service delivery competencies will be critical to sustainability for most provider organizations in the decade ahead.