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Centralize or Localize -- What About Partnerships?

Katie Roper's picture

By Katie Roper, VP of Health Care Strategy and Partnerships, Home Care Assistance

Like many players in healthcare, a large national provider of in-home care constantly struggles to balance the benefits of scale with the benefits of locality. Home Care Assistance has almost 200 offices nationally, and so we should be able to drive economies of scale. Yet we find that sometimes the benefits of a close connection to the local community outweigh the benefits of scale. In this series of blog posts, I’ll share with you some of our thinking on this balancing act, and I welcome your contribution to the conversation.

As I talk to large, multi-location companies in the healthcare continuum, it’s clear to me that they struggle along with us to balance these opposing factors.  

Home Care Senior Living as Partners

I was recently talking to a large senior housing provider (you’d know them). They loved the idea of partnering with Home Care Assistance to offer standardized in-home care in all their communities. It would enable them to ensure the same quality, the same procedures, the same staff training - without having to invest in building their own home care organization.  

Yet they knew that in at least some of their communities, a strong partnership already existed with a local home care provider. Despite obvious benefits of standards and scale, they didn’t want to “rock the boat.”

I’ve also been talking with a large home health provider (you’d know them, too). They loved the idea of partnering so that we could better coordinate their medical services with our non-medical care, offering seamless services to our clients, many of whom use both services. We came up with a list of markets in which we might get started.

Local Hesitation

But when I spoke with our local teams in the field, there was hesitation. “In my market, [that provider] isn’t well regarded, and we have a strong relationship already with [another provider],” said one of our offices. I also hesitate to rock the boat by forcing things with our local offices.

And it isn’t just us. One friend of mine who runs a senior community says that his corporate home care has gotten awful after they lost a key employee, but they’re not allowed officially to use other partners. He offered to sneak us in.  

Still, if you look at macro-level trends in health care, there’s a definite swing to scale and standards. System automation like electronic health records works better at scale. Accountable Care Organizations are driving standards. Increasing compliance burdens drive scale, just to reduce overhead.  

For health care consumers, bigger is often better.  

  • A big central billing department is often more accurate than a local accounts receivable person.

  • A large health system is more likely to be part of more insurance networks.  

  • A centralized call center can answer consumer questions more quickly and accurately than the receptionist who happens to pick up the phone.  

In my own health journey, I was initially sad to see my long-time independent doctor was recently acquired by the health behemoth that’s gobbling up all our local medical offices. But this meant that he could see the date of my most recent tetanus shot ten years ago (I had forgotten), that I had an advance directive on file with the local hospital, and that my recent blood work by another doctor was normal and we didn’t need to run the tests again.  

So I think we’re all going to have to get better at standards, and the smart companies are going to reap the benefits of scale. What do you think?

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