HIStalk Interviews David Baiada, CEO, Bayada

David Baiada, MBA is CEO of Bayada Home Health Care of Moorestown, NJ.

Tell me about yourself and the company.

We are going on 50 years as a provider of home-based healthcare services. We are based in the Philadelphia area, in southern New Jersey. The business was started by my dad who, at the age of 27, was an aspiring social entrepreneur before the term really existed. Through mission-centered, people-oriented focus on culture, connectedness, and service, we have — little by little over a long period of time, almost entirely through organic growth — become one of the largest providers in the country, with about 30,000 employees across 24 states and eight countries.

Because of our scale in a quite fragmented industry and our diversity of services, we deliver eight different types of service, depending on where we are in the country or in the world. Our long-term orientation as an entrepreneurial, not-for-profit organization is focused on long-term sustainability and continued growth adaptation to the market. That makes us a little bit different in terms in the ways that we invest in and position ourselves to continue to make an impact in the communities we serve.

What is changing about home health and the involvement of health systems in it?

While the delivery of services in the home is clearly not a new phenomenon, the societal attention and perpetual reflection on safety and health at home has been clearly spotlighted over the last 12 to 14 months. Never has there been a time where literally every single American is staring at the TV every night thinking about, how do I stay safe and healthy in my house? 

That has created a bit of an awakening for the healthcare industry. Maybe we can deliver a high-quality service at scale at a lower cost in the place that people prefer, which is their living room or their home versus an institution, where appropriate. Maybe we can use technology to deliver certain types of services and interventions virtually or by video.

All of these things are not new. We’ve been working in the home for centuries. We have been delivering remote monitoring and virtual care for a decade or more. But the last 14 months clearly have created a bright spotlight on the power and opportunity that exists with the things that we can do in the home.

What impact did the pandemic have on the home care model and on your business?

The most important thing we saw is the validation that these amazing people — nurses, therapists, home health aides, and others who have chosen a profession to take care of people in the community — rose to the occasion. They are used to walking into the unknown, whether it’s COVID-19 or any other type of illness or environment. Clinicians that have chosen this profession rose to the occasion, and it was super inspiring to watch people, when appropriately prepared with PPE and clear protocol, walk into the unknown and navigate whatever was necessary to take care of people, whether it’s the thousands of COVID-positive patients that we took care of or the unknown of what was happening in that home related to risk and potential infection or otherwise.

The business implications were all over the map. The biggest implication is that volumes are up and down for different parts of the country with infection rates. That created, and continues to create, a wet blanket of ambiguity and unpredictability of what might happen tomorrow with protocol and infection risk. Then you compound that with the ambiguity, complexity, and unpredictability of what’s happening in their personal lives, with their kids and families, school, travel, and all these other factors. Ambiguity and unpredictability has been a major force, not just in our organization, but in our lives more broadly.

Does scale help you recruit and retain employees for the hard job of going into the homes of clients, especially given the reimbursement challenges?

We have dealt with cycles of shortages in different labor markets, whether it’s geographic or different types of workforce, for decades. We have now clearly entered a phase where the cycle is no longer a cycle, it’s a perpetual of supply shortage. The demand for our services — along with other macro factors like population, demographics ,and aging – has taken us into a cycle of permanent shortage for all types of in-home care delivery, nursing and home health aides in particular.

We are spending a lot of time, using our scale as you alluded to, to differentiate as an employer, to be more sophisticated in how we find people and how we create opportunity for them. We have a diverse, large organization with lots of different types of services, which creates lots of opportunities for people that are interested in doing new things, trying new settings, and picking up new skills. Our scale helps with that for sure.

But a lot of this is about figuring out how to create an environment in which people feel supported and engaged so that they stay. That really is a part of how we think about this challenge, which again is no longer a cycle. The demand for our services will continue to increasingly outstrip the supply of caregivers for decades, so this is the heart of the matter for us.

What services or technologies could help family members who unexpectedly take on the role of primary caregiver?

Virtual care and remote monitoring are a huge opportunity for family caregivers. It reduces the burden of having to get to a doctor’s appointment and creates the ability to monitor signs and symptoms proactively to avoid risk. There’s lots of incredible technology that is emerging and being adopted more quickly in sophisticated ways for both virtual care and remote monitoring. That’s a huge benefit to the family caregiver.

Another example is what I will bucket as care coordination and transparency tools. We have worked with, and continue to work with, a lot of partners to experiment around how to make it easier for family caregivers to understand what’s going on and why and the interaction of all these different silos in the healthcare system. Everything from scheduling of appointments to messaging with providers to history and medication reconciliation. There’s just so much to manage when you have a sick, at-risk, or vulnerable parent or loved one. If you have ever had to navigate the system, it’s really complex, and some of the technology and tools out there are trying to break down that complexity and simplify it for the family caregiver. I think they are making an impact.

What levels of integration, continuity of care, and accountability are you seeing between hospitals and home care organizations?

It has been emerging for a while, but in the past 18 months and certainly the last 12, the dialog in the health system boardroom around the strategic importance of home and community-based care delivery, the extension of the health system’s brand into the home, the seamlessness of the transition from acute to home — it’s moving way up the strategic priority list. You are seeing a lot of health systems say, we need to be really good at this. Some, to the extreme, are saying, we are going to start reducing inpatient beds over time.

All this is part of a broader shift, too. Payment could unfold over time where health systems are taking on an increasing percentage of the risk dollar, in which case when at risk for total cost of care, they are now properly incentivized to think creatively about how non-acute or less-expensive remote, virtual, and home-based care can help them create better experiences and better outcomes at a lower cost. We have a whole channel, a joint venture of structures with health systems that are designed specifically in this context. How do we jointly own home and then Bayada-managed home-based care delivery capabilities for a health system to give them instant access and continuous innovation around best-in-class, world-class, home-based care?

What new technologies are important to your business?

What I like about what’s happening in the market, and this spotlight on the importance of home-based care in the continuum in an increasing way, is that it is inviting a lot of capital and innovation to the challenges we face.

When we talk about challenges related to health system integration and extension of their capabilities into the home, one of the most fundamental challenges that health systems face — and it has an impact on Bayada as a home-based provider — is how a transition works. How do you coordinate someone’s transition from a hospital bed to their living room and all of the steps and coordination that happens along the way? They may have a stop at a skilled nursing facility. They may need new medications, but they have no transportation to get them. They may need coordination and conversations between multiple specialists.

All these things happen in silos. You are constantly repeating lots of different information to different people in the system. Platforms like Dina’s care-at-home platform and network are trying to create seamless transitional care, and that provides benefits to the patient and their family. They get empowered with an understanding of what’s happening. It has benefits to the health system that is trying to ensure that this person has a path home in a timely way. It has benefits to us as a home-based provider, because we then are empowered with historical information context before we enter the house, which helps us create a better service and keep them safe at home, which then ultimately creates a virtuous cycle because we’re avoiding unnecessary readmission and other types of further risk.

Dina is a great example of solving a complex but straightforward problem. When someone arrives at a hospital, how do you make sure that the transition out of the hospital back to home with any steps in between happens in a way that’s actually productive versus super frustrating?

What impact are you seeing from private equity’s increasing investment in healthcare, especially in home care, long-term care, and hospice care?

Our industry was, for a long time, a textbook definition for a cottage industry — highly fragmented, mostly local and small proprietor-owned or not-for-profit organizations. When sophisticated investment and capital comes into an industry, it usually increases the level of competition, which hopefully means that the services and the quality of services goes up for the patient, for the end user. It’s probably too early to tell about how that impact will play out, but in general it is drawing a lot of attention.

Also, third-party investors, financial sponsors like private equity firms, have a lot of relationships and a lot of credibility. The ability for them to put money to work to innovate, but then also put relationships to work to help ensure that those that control the funding and that control the future of healthcare delivery and regulation have adequate visibility and exposure to the power of home-based care. That’s a benefit. A rising tide raises all boats. This is a huge industry with a lot of people that are vulnerable and need a lot of help, and the more sophisticated, competitive innovation, the better.

What changes do you expect in home care over the next three to five years?

The percentage of healthcare services that can be and will be reimbursed and supported from a regulatory perspective to be delivered in the home will continue to increase meaningfully. That will be empowered by better capabilities from organizations like ours. Better technology that makes this delegation of services more palatable, which would include things like virtual care delivery and telemedicine, et cetera. Then ultimately it will be made possible by regulatory evolution and adequate reimbursement. Home care has been an underfunded segment of the system, and to empower scalability of some of this innovation that will enable increases in home-based care for the appropriate types of services, regulatory and reimbursement structures have to evolve, too.

Ultimately, the outcome is that a higher percentage of services will be delivered in the home than they are today, which ultimately is what’s right for the patients as their preferred setting with better outcomes and lower costs.