Processing and maintaining referrals, as well as developing channels to foster new ones, remain common choke points in home-based care.

Referral-related challenges emerged as a common theme for operational bottlenecks, industry leaders told Home Health Care News. To ease these burdens, companies are trying out AI tools, clinician-led outreach and tightened relationships with franchise owner-operators.

“Overall in the industry, I think the bottleneck is: once the brand gets the referral, it’s getting the staff [and] connecting the caregiver to the client,” Solenvia Caregivers founder and CEO Bryan Dylewski told HHCN. “That’s what I see as the biggest issue.”

Innovive Health receives referrals from numerous different partners, including hospitals, rehabilitation centers, skilled nursing facilities, community partners and state organizations, the company’s director of rehabilitation and home health aides (HHA) Kimberly Greenberg told HHCN.

The referrals themselves can also require different amounts of labor to parse through.

“We could get referrals where it’s 100 pages of paperwork. We could get very little paperwork at all,” Greenberg said. “Being able to accept referrals we know we can address their needs in a way that’s appropriate and timely — while also understanding there is a need for clinical judgment in those decisions — is a challenge.”

Innovive Health, based in Medford, Massachusetts, provides home health services, home care, occupational and physical therapy, and behavioral health services across Massachusetts, Colorado and Iowa.

To address the referral bottlenecks, Innovive is piloting HIPAA-compliant AI-based tools to help sort incoming referrals while retaining clinical judgment in decisions involving compliance and patient safety, Greenberg said.

While Innovive focuses on managing paperwork once a patient is referred, Los Angeles-based HealthView targeted friction earlier in the pipeline. The company’s referral roadblocks centered around onboarding and communicating with new physicians and partners, said Monica Cutia, the company’s vice president of clinical operations.

To streamline the referral process, HealthView found success in staffing clinicians in its marketing, sales and outreach teams, Cutia said. These teams are called care continuum managers, or CCMs.

“A doctor would rather speak to a nurse than somebody who doesn’t have that clinical background,” Cutia said.

Therefore, the CCMs would do rounds with physicians, as well as getting to know the medical assistants and nurse practitioners. Though fixing the bottleneck has been slow, Cutia said HealthView receives better coordination and collaboration in the referral process since CCMs gained more ownership in building and maintaining referral relationships.

HealthView provides home health, in-home physical therapy, palliative care, hospice care and occupational therapy in California’s Los Angeles, Orange, Riverside and San Bernardino counties.

Beyond managing and staffing referrals, expanding into new markets presents its own operational hurdles. Solenvia Caregivers relies on local franchise owner-operators to drive business development in the field, Dylewski said.

“We have seen bottlenecks on the sales-side or business development-side in developing territories,” Dylewski said. “This is where we see the franchising as being a win-win for us because the owner-operators are in the field to develop their territories.”

Middletown, Connecticut-based Solenvia Caregivers provides non-medical home care services, including live-in, overnight and 24/7 care, across Massachusetts and Connecticut. In August, the company signed its first franchise expansion partnership to expand into two territories in Florida.

While referrals are certainly an issue, so are compressed margins, said Jason Growe, founder and chief development officer at LiveWell Partners. Growe said flat or potentially declining Medicare Advantage reimbursement, coupled with worsening labor pressure, is making it harder for branches to maintain healthy gross margins.

St. Louis, Missouri-based LiveWell Partners provides home healthcare services across Michigan, Ohio, Illinois, Missouri and Kansas.

Deploying AI tools has helped boost productivity at LiveWell, particularly in clinical documentation, Growe said. This has allowed clinicians to spend more time focused on patients rather than devices. In addition, LiveWell’s AI solutions help back-office employees work effectively too,

“It helps with the bottlenecks and just makes people more productive and helps them enjoy their jobs better, because they feel like they’re able to get more done coming to work every day,” Growe said.