Traditional home care often requires minimum service hours, creating distinct challenges for both providers and clients. The new method alleviates pain points such as affordability and labor costs by charging for specific tasks completed rather than time spent at home.
Honolulu, Hawaii-based Vivia Cares has launched a task-based billing model to improve affordability for customers and stability and working conditions for caregivers. According to the company, this model has led to a surge in demand for its services.
“When our customers call us, we tell them we're not selling their time,” Duane Rankaone, CEO of Vivia Cares, told Home Health Care News. “We sell tasks and results.”
Vivia Cares was formed in 2020 through the merger of a traditional home care agency and a technology company to address a severe shortage of caregivers due to Hawaii's aging and shrinking population.
“At the time, we had been running a traditional hourly home care agency for 15 years, and we said this wasn't going to work,” Langkaon said. “The minimum wage was going up, but our wages were going up even more because we were competing with retailers and restaurants for labor. Hotels in particular were paying a lot more money just to keep staff, so they had to raise their rates as well. It got to the point where it felt like it was getting out of reach for the average person.”
Internal task-based billing
Vivia's model includes a call center where employees assess a family's needs and proactively account for the often-expensive costs of care. These workers can help families determine which tasks can be done by family and friends and which tasks should be done by qualified professionals.
Arrangements are not time-based. Instead, caregivers visit eight to 10 people a day and stay until pre-determined tasks are completed. For example, if a task involves showering a client with dementia, the caregiver will help the client complete it, even if it takes 20 minutes or an issue delays completion by an hour.
In most cases, showers only take 20 minutes, but clients won't pay extra for the extra time.
Vivia created a task-based billing model by determining what constitutes a good job for caregivers. In discussions with the company's top caregivers, the company found that caregivers want stable work hours, additional pay (although they say it's not an incentive), and the need for transportation.
In response, Vivia decided to guarantee caregivers a 40-hour work week, a 30% raise, and a company car.
Company leaders then met with customers and asked them what they liked and disliked about home care. Complaints included minimum working hours and irregularities among caregivers. The company has also developed its own pricing model based on customer feedback.
After launching the task-based model, Langkaon said demand for the service “suddenly exploded.”
The new model offers significant benefits to caregivers and clients, but requires a different demographic of caregivers. Some of the company's traditional top caregivers turned down job offers to join the new model.
“The pace is very different,” Rankaon said. “Sitting with one customer all day is very different than visiting eight to 10 customers a day. We ended up having to develop a training program and recruit a younger demographic who enjoyed the pace and didn't mind driving.”
They also have to meet client expectations, Rankaon said.
“We all know that we basically share caregivers in our neighborhoods,” she says. “We've had incidents where the caregiver arrives and the client doesn't look well and calls the nurse. The nurse FaceTimes and says, 'You have to call 911.'” That's going to take a little while. Because our protocol is to stay until you get in the ambulance (arrive). If so, the office would end up calling every next client (say to the client), “Oh, there's an emergency in our neighborhood.” I'll be a little late. Do you want to reschedule?’ Just having that constant communication makes a huge difference. ”
The future of home medical care
Other models are also disrupting some of the traditional elements of home care. For example, a brief care model allows clients to receive care for just 10 to 15 minutes, sometimes multiple times a day. Healthcare providers using this model argue that it better meets the needs of their clients and allows caregivers to spend more time with their clients.
Langcaon said that while alternative models may be on the rise, the traditional home care model is not going away. Vivia Care's services are split approximately 50% traditional home care and 50% task-based home care.
“There will always be people who need 24/7 monitoring, people who need constant care,” she said. “But what's certainly gone is the shifts between shifts, the four-hour, six-hour, eight-hour shifts, because people have… figured out how to make it happen with multiple visits a day. So, for example, if someone needs help with meals, breakfast, lunch, dinner, right? Instead of an eight-hour shift, it's three 20-minute visits.”
A task-based business allows caregivers to see far more clients, with 30 caregivers serving 350 patients and 74 caregivers serving 350 patients in a task-based business, Rankaone said.
Rankaone said task-based billing is unusual in the home care industry, but Vivia Cares is experimenting with expanding the model in Washington state. The demand for these services is as high as in Hawaii, she said, but the lower population density requires a different approach. The company is currently developing a virtual training program suitable for conditions in Washington and other states, and plans to eventually share the program with other home care providers.
“It's not an easy model to replicate, but our goal is to take it down to the technology, the scripts, the training, and put it all together in a package so that anyone can do it within a few years,” Langkaon said.
