Efficiency: The Tailwind Pushing Back on Home Care's Headwinds

Date: November 14, 2022 Lincoln Intelligence Group

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Efficiency is the Tailwind Pushing Back on Home Care’s Headwinds

Our business model, which has weathered numerous storms across several decades, now faces an intimidating reality: Payers not only want to pay us less than our value, but in some cases less than our cost. In the words of the CEO of a large member of our Group, this reality galvanizes a unifying mantra of, “We must be more efficient. We can get more efficient. And we will.”

How should we think about driving efficiency within home care operations? Operations can be thought of simply as the movement of resources and information through processing and time. (Note: In a services business, people are the key resource.) Focusing on these four key elements - resource, information, processing, and time - yields a very useful four-part framework for thinking about home-based care operations.

We call this framework the “RIIT” approach (pronounced ‘right’), where RIIT stands for Resource, Intervention, Information, and Time.

  1. Resource: The correct, properly trained clinician or caregiver is deployed with access to appropriate equipment, supplies, medications, etc.
  2. Intervention: The right type of intervention or therapy (i.e., process) is utilized.
  3. Information: The right information is communicated to the right parties.
  4. Time: The right resource, intervention, or information arrives at the right moment, without any wasted time, motion, or process.


Our business is a “human machine” that harnesses people to care for other people. As such, the deployment of direct care resources (as opposed to indirect or “back office” resources) is a main determinant of clinical and financial outcomes. More specifically, the recruiting, training, and scheduling of human resources is our main lever for success.

While there are many variables to consider, we have found that businesses of all shapes and sizes tend to home in on five key disciplines:

  1. Branding their business as best-in-class both operationally and reputationally.
  2. Maintaining a competitive employment proposition around variables such as culture, advancement, compensation, and benefits.
  3. Training, developing, credentialing, and managing a mix of inexperienced and experienced talent.
  4. Ensuring the right number and type of visits are performed at the time needed, and that supporting resources and materials are available when needed.
  5. Setting and enforcing productivity models that regulate the overall business engine.


What needs to happen in the caregiving moment...is it therapeutic, educational, or perhaps supportive? Enforcing proper interventions ensures everyone is working to the top of license and spreading scarce clinicians and caregivers among the patient/client base by substituting less skilled resources whenever appropriate. High-performing providers also use a variety of predictive tools to supplement human analysis and decision-making, increasing the efficacy of each intervention.


Information is the lifeblood of a care ecosystem. We've found there are five key pieces of the information value stream:

  1. Effectively receiving and transmitting the information needed for proper intake, scheduling, billing, and other back-office functions.
  2. Connecting the front lines of care seamlessly with the back office, e.g. EMR.
  3. Disseminating patient data compliantly within the extended care team, including families.
  4. Automating tasks and processes to eliminate error and waste.
  5. Exchanging patient status and other information with sites of care (inter-operability).


The passage of time is a unifying principle of operations management: What’s happening and when? In a scheduling-intensive business such as home care, the elimination of wasted time is a key determinant of overall efficiency. Many businesses in our circle adhere to LEAN principles to guide their process improvement.