Leading a Comprehensive Approach to Prevent Healthcare System Entropy: A Review on Sahara Home Care Services and Impact of Homecare Services on Healthcare ()
1. Introduction
During the last few weeks of December, Armaghan M. Rana, CEO of Sahara Home Care, and his team were heavily absorbed by year-end audits and reporting. Rana was eager to share the strategic initiatives he led to ensure Sahara’s continued growth and success of his business. The organization’s mission broadly focuses on looking after the seniors in Chicago and providing access to health advantages and quality care. “Our mission is to empower the individuals and family members of the elderly population of Chicago and the suburbs to better their quality of living through progressive education and valuable social services that will help sustain their well-being and independence.” [1].
Sahara dates back to its formation in 2007. In the Urdu language, the word Sahara means “support.” The sole purpose of its formation was based on a personal experience when Rana’s uncle, who was terminally ill due to cancer, had no one to look after him. While he volunteered to take care of him at the age of 14, it is that time when the thoughts pondered about the care one needs in dire times of illness. Of course, the vision of Sahara was not there quite yet; however, experiencing the suffering of a loved one so closely moved him deeply, and thus, this life-changing event left an impact on his life. Over the next few years, he completed his Bachelor’s in Computer Science in Pakistan and continued to do a lot of volunteer work to help those in need.
Rana’s family had a strong background in running businesses, and he felt he had an element of leadership to drive the change. After his graduation, he moved to the United States to pursue work experience and had the opportunity to work in a home care organization. It was there when he observed gaps in care and had the urge to open a senior care organization. The concept gradually formed to establish an entity focused on senior care and fill in those care gaps that can benefit the members and service them. The support system also helps positively impact the overall healthcare system by providing senior citizens the care and health literacy they need to enable them to make informed decisions about their health and wellbeing.
Initially, the business was formed in Illinois, based on a partnership name as U&F Sons, using their mothers’ initials. However, it was later renamed to align with its vision of providing support, Sahara, to the communities. In the beginning years, it was meant to serve the South Asian population who were not fluent in English and did not have the ability to understand their health plans and health needs to sort of bridge between the gaps. It was only in 2009 that they availed the opportunity for a contract for home care. With around 8 years of experience and exposure in the industry and a mindset of helping the community within this field, Rana went ahead and took the lead in establishing his organization. While covering the initial years of his setup, Armaghan Rana shared with great pride, “We started off with a small 600 sq ft office in Villa Park, and our contract was initiated in 2010. May of 2010 is when our contract was enforced, and since then, Alhumdullilah (Grace of God), we have been able to do good along with very good, hardworking, sincere staff members.” Today, the ownership takes much pride in its established standards and its mark in the industry.
At first, Sahara was opened to serve the immigrant population, including the elderly communities from India, Pakistan and various other Asian countries, with the goal of helping them provide care and support. However, in 2015, its network eventually expanded to serve all the senior citizens eligible through the insurance plans, thus, it transitioned its business model to grow a diverse network of clients and members. Initially, there was only about one entity in the market serving South Asian communities, but the numbers in these organizations have gone up, primarily serving the state of Illinois.
The home care service system has an enormous scope and provides a generous cost savings opportunity to our healthcare systems. Improvements in care, building one-on-one connections with the patients, and providing aid through personal care and home care to senior citizens can undoubtedly open the horizons and reform the healthcare system. Candidates who qualify for those advantages save annually on insurance premiums and get their basic wellness and health awareness within the comfort of their homes. In the long run, it relieves pressure on the patient to make hospital visits or ER visits by giving the advantage of non-medical home healthcare and the companionship of the caregiver. As people age, their health needs continue to evolve, and they need a support system to transition through the phases of life.
With continuous changes to healthcare policies, increasing healthcare costs tied to hospitals, pharmacies, health insurance, research and laboratory, and drug manufacturing can have adverse effects on the elderly population. Given the current challenges with capacity planning, shortage of workers, continuous changes to regulations, and high risks associated with patient data and compliances, patient safety, payment reimbursement delays, remote and rural locations, and lack of healthcare literacy in patients, establishing an effective home care solution service is the need of the hour. In parallel to these challenges, there is a massive influx of immigrant population that is getting old and faces language barriers when learning about their health or communicating their health issues. Alongside an aging population that needs increasing care and assistance in daily living needs, we now have to cater to immigrant populations who are facing barriers in accessing healthcare. In this age of automation, with more and more companies moving towards digitalization, a gap exists between patient preferences and digital adoption.
It was not too long ago when the world experienced a healthcare catastrophe and healthcare system failure due to COVID-19, which was an eye opener for us to understand how under prepared we were to handle the disease that took our loved ones or impacted us in one or the other way. The effects of COVID-19 further reinstated the importance of adequate and effective healthcare and home care services that can play a crucial role in safeguarding senior populations and stabilizing our healthcare system. Thus, based on the challenges mentioned, a solid infrastructure of in-home care services is required to attain maximum value and optimal solutions.
We have all seen, felt, and lived through the perils of COVID-19. What started off as an assumption of an outbreak in China ended up in a pandemic, causing the world to shut down back in 2020. Hospitals and healthcare facilities face immense pressures in terms of capacity. The overburdening of health systems, high admission rates, longer wait times, low equipment to support quality treatment, shortage of vaccines, overworked staff, and lack of medical infrastructure to support a massive crisis exposed the hidden problems and brought them to the surface, where providers faced a dilemma on making treatment choices, indicated a failed healthcare system, which was not prepared for the emergency at such a high caliber. This forever changed the healthcare system, leading healthcare providers to reimagine and reshape their future care models and plans to deal with such catastrophes in the future.
Hospital emergency wards have a certain capacity and must maintain their operations within the threshold. Overly sick patients, especially the elderly population, are the most vulnerable ones who utilize hospital and healthcare services. Needless to say, this also adds additional costs and risks, higher provider charges, increased insurance rates, and higher copays for treatments. Ultimately, the domino effect causes extreme disorder and entropy within the healthcare system, leading costs to be absorbed by patients. These symptoms have weaved deeply within the healthcare industry, causing a rippling effect to be felt by everyone in the cycle. Nevertheless, government, hospitals, health insurance companies, providers, research and biotechnology companies, and startup health care companies offering wellness programs, for example, are all bound to mitigate the risks through processes that will unburden the load the entire system is bearing and build sustainable delivery solutions that address the needs of modern healthcare.
We explore Sahara Home Care Service which was opened as a small organization with the purpose of helping the South Asian elderly communities and senior citizens, that strives to ease the aging transition, help patients embrace their journey, and provide them with independence, companionship, and a sense of peace to their clients. We look into the challenges associated with work planning, staffing issues, business expansion, the impacts on the organization during COVID-19, and their plans to continue to build scaled work methods to remain competitive in the industry. Some strategies that made them successful are their ability to change according to the changing policies, efficient training tools, and technology to track resource allocations. They also have bilingual services, an added benefit to patients with limited English proficiency.
Currently, Sahara has built a large network of 4000+ home care professionals, 18+ home care services, 5000+ senior clients, and a 99% satisfaction rate [1]. The main goal for Sahara is to incorporate a value-based system for the patients. They want their clients to associate Sahara with positivity and comfort and tag a relative value to the organization. Based on some of the challenges associated with payment and reimbursement models and resource allocation, we present recommendations that benefit the Sahara organization and the healthcare system. The strategies they applied to help mitigate the challenges, i.e., standardizing processes, market studies and expansion, heavy involvement in state health affairs, continuous staff training, high customer service, and integrations with technology to adapt them to the changing needs allow them to have a competitive advantage within the industry.
Based on the individual case study on Sahara Hom Care Services and the existing research, we can conclude that a correlation exists between homecare solution services and eliminating the burden on hospitals, contributing to reducing the healthcare system entropy. Although home care services cannot substitute major health treatments provided by hospitals and providers, some basic level of checkups through work aides can help decrease the need for hospital and provider visits.
2. Literature Review
Studies indicate that home care services are experiencing a steady growth in demand and revenue [2]. Sahara mainly offers four services: Community Care Program (CCP), Homecare Senior Assistance, Respite Care, and Outreach. Each of those services provides value-based care to its members and acts as a supplement on top of care management. Through an expanded network and diverse and multilingual staff, CCP provides the option to seniors the ability to hire a family member to serve as their home caregiver, adding their comp. Their Senior Assistance program is an essential program that provides comprehensive elderly in-home care services covering a wide range of activities, from personal care to household care. Additionally, they offer Respite Care, which is offered temporarily to relieve the regular caregiver and can be beneficial to the caregiver who needs personal or emergency time off. Above all, their Outreach program activities, i.e., individual home visits, community events to inform members and clients on the entire process, and essential screenings, contribute to providing high-quality care with value propositions that sustain their expanded networks [1].
In parallel to the above, Sahara offers benefits coordination and application assistance for seniors who cover SNAP, Medicaid, Medicare, Cash Assistance, Social Security Administration money, Supplement Income, Social Security Disability Income, Free Ride card, Free Cell Phone, License Plate Discount, and Senior Housing [1].
The company vastly invests its operations in continued training, matching the right care with the right caregiver, and skillset applicable to the right client. Factors such as client costs covered through their plans and income level play a role in deciding the placement of members to specific care plans. The multilingual staff can help build a level of comfort with the immigrant population. According to the data published on their website, “Our Homecare Aides speak English and/or Urdu, Hindi, Gujarati, Punjabi, Sindhi, Bengali, Arabic, Malayalam, Pashto, Assyrian, Bosnian, Spanish, Tagalog; other South Asian Languages.” [1]. Their services enable them to provide independence to the clients in making critical decisions that work best according to their health conditions.
The COVID-19 pandemic taught us to be prepared for any crisis. The healthcare crisis we all got to witness led to a movement. Healthcare companies are now on a constant quest to innovate, adapt, and seek competitive advantage within the industry. Although technology has played key role in digital adoption, one of the most felt effects of COVID-19 led to the utilization of digital applications at a much faster pace. The advent of remote health monitoring initiatives to effectively trace the virus route, monitor patient health through in home devices, telemedicine, would converge to reshape the utilization of hospitals and outpatient facilities. There is empirical evidence suggesting reduction in visits by 13.6% after evaluation of patient visit data in 58 hospitals in state of Maryland in the years of 2012 to 2021 [3].
It is critical for home care service organizations to add some value props their clients can associate while obtaining service. Although government programs, Medicaid and Medicare, state programs, Illinois Department on Aging, Illinois Department of Human Services, llinicare and health insurances Humana, Aetna, or Blue Cross Blue Shield, pretty much cover home care services and benefits, but what is important for Sahara is to offer a unique and customized service, and extremely high focus on customer service that caters to its maximum targeted populations in terms of care and quality. Catering to individualized care allows the member to feel valued. “Primary care for seniors should be purposeful, team-based and recognize the complexities that drive their health outcomes, according to Humana.” [4]. Thus, the concept of value-based care will continue to pave path for company growth.
According to data published by Humana’s 2023 value-based care report, in 2022, there was an increase between 3% to 11% in patient screenings in comparison to non-value-based care programs. Apart from that, it was reported that there was a reduction in patient admissions by 30.1%, contributing to a saving of 214,000 admissions, and a reduction of 12.7% in emergency visits, contributing to a saving of 146,000 visits [5]. Figure 1 shows the data collected between 2019 to 2022, reflecting on the reduction of hospitalizations and ER visits. Over the course of 10 years, value-based care can save the system high costs and increase patients’ health equity, allowing people to save more on premiums and maximize their health benefits.
Additional studies support the evidence of government programs contracting the private services to allow long term care and disability services and have seen an increase in the overall utilization. A comparative study conducted between fee-for-service and Virginia Medicaid beneficiaries confirmed that utilization of personal care increased by nearly 5%, and respite care increased by about 10% [6]. Figure 2 projects the needs of the general population aged 65 and above would increase over time in terms of support services.
Data Source: Humana Value Based Care Report, 2023.
Figure 1. Based on the outcomes and healthcare usage in 2022, showcased by Humana, a leading health insurance provider, reductions in the overall emergency visits and hospitalizations can be seen given their members were provided value-based care and support.
Data Source: Department of Health and Human Services published on brookings.edu.
Figure 2. Projected needs of the general population of age 65 and above would increase over time in terms of support services.
Apart from the studies referred to backing strong statistical evidence on home care services, there is a study published by [7] to highlight the problems associated with schedule flexibilities. The pain points associated with limited options for care providers’ pay scale increase have been discussed in detail and reforms need to be in place to revive their role in the system. During COVID-19, the immediate need to quickly adapt to the changing environment was a crucial part of the game, and home care services managers needed to be proactive on all levels of communication. A study conducted in Norway highlights the resilience-in-action by home care managers handled the pandemic successfully by staying on top of all information and involving their care staff in the decision-making process [8].
Various studies have also been published in addressing home care worker challenges. In addressing the capacity issues with resource allocation, a study conducted in Slovenia, [9] applied queueing models, that considered different performance measures and calculations to ensure appropriate levels of service and contribute to planning and capacity. A critical pain point is caregiver wages. The problem is that those are at the low end and may demotivate caregivers. An analysis conducted by [10], highlights the problem associated with the role itself by calling it a deinstitutionalized community. Since the role is limited to female chores such as washing, feeding, toileting, medication support, and basic nursing care, it falls in a low-wage category by disconnecting this role as part of the healthcare system. Effective training programs can integrate the caregiver’s role with the health system. Training caregivers must cover various aspects. A partnership must be built to understand the client’s needs, not only from a physical aspect but also from familiarity with their medical and health history. As emphasized by [11], a distinct skill set is needed to apply patient-centered care which will ease the client's transition from hospital to home care so the client can make informed decisions pertaining to their day-to-day health. Hiring multicultural staff can be extremely beneficial in the system to provide care in a culturally appropriate setting. Patient conversations can be meaningful when bilingual staff is hired. [12] performed a case study on a patient who brought in their daughter as an interpreter to understand the diagnosis and results. It eliminates the risks of any miscommunications.
Integrations with certain aspects of healthcare, such as pharmacy, can add value to Sahara’s business. As studies by Cigna indicate, the cost of drugs is rising, and it has been a challenge for plan sponsors to optimize utilization because of the high costs; the integration of pharmacy and medical benefits can lower costs and produce efficient outcomes [13]. Partnering with large pharma companies in terms of drug delivery and integration through automated systems can scale up the business model of smaller size companies.
An interesting study [14], highlights the closure of a long-term Illinois nursing home due to rising costs, inability to fill 84 beds, and substantial damage caused by flooding. In parallel to those issues, they experienced decreased funding by CMS, leading to less reimbursements and increased senior preference for home care; a comparison between nursing homes and home care services is yet more evidence of client preference for home care. Alongside the studies established, we must highlight the need to understand the ‘why’ aspect of implementing the change and the key detriments in the process. [15] presents two concepts of change to understand why a change is needed. The key indicators of the need for change are performance gaps and opportunity gaps.
Data Source: Sahara Home Care Services Data.
Figure 3. Sahara client growth in the last five-year period, as enrollment increased over the five-year period.
The utilization of technology is highly emphasized in-home care services to comply with the growing needs of the patient population and may play a significant role in reducing healthcare costs. The American Hospital Association lists crucial home care technologies that include At-Home Infusion, Virtual Clinical Exam Rooms, Digital Therapeutics, and Home Care Management Planforms [16]. Emphasis on measuring various kinds of metrics will be a huge help in understanding the overall performance. The perspective shared by [17] explains that performance metrics can be outdated and may not depict a true picture during analysis. Therefore, metrics pertaining to the current business models must be carefully assessed. Figure 3 shows the client growth of Sahara home care services as they incorporated new strategies during COVID-19.
Figure 4. A comparative analysis of increased yearly costs of a leading health insurance provider, HCSC, spanning between 2021, 2022, and 2023.
Data Source: https://www.hcsc.com/documents/hcsc-annual-report-2021.pdf.
Figure 5. Cost overview and key metrics of HCSC, a leading health insurance provider organization, published in 2021 report.
Data Source: https://www.hcsc.com/documents/hcsc-annual-report-2022.pdf.
Figure 6. Cost overview and key metrics of HCSC, a leading health insurance provider organization, published in 2022 report.
This research paper also covers the annual investment in costs and network growth of a leading health insurance provider, Health Care Service Corporation, HCSC (Figures 4-7) [18]-[20]. These figures were used to perform a comparative analysis to showcase the increasing needs within the communities and thus demand higher investments in specific areas, such as wellness programs, hospitals and providers.
As we explored risks associated with vulnerable populations, i.e., senior citizens and senior immigrant non-English speaking members, their barriers to access and understanding health care, and their impact on the overall system, one can easily see the benefits of having home care services in place that can alleviate hospital load, optional provider visits, by providing them the care and services, and an accessible system at the comfort of their home so they avoid the additional trips to hospitals. Home care services can open an array of options that can contribute to higher health equity for members. It ties to a value-based care system and changes that need to be implemented that can significantly reduce healthcare costs associated with admissions and emergency visits and act as a buffer to the ever-changing complex landscape of the healthcare system in the United States.
Data Source: https://www.hcsc.com/documents/hcsc-annual-report-2023.pdf.
Figure 7. Cost overview and key metrics of HCSC, a leading health insurance provider organization, published in 2023 report.
3. Methods
For this case study, interview sessions were conducted with leadership to discuss the deep insights on growth and expansion strategies. Additionally, quantitative analysis of membership growth throughout the last five years was carefully evaluated to understand the factors leading members to sign up for Sahara Home Care. This case study also refers to several qualitative studies published on the benefits of home care services and value-based care, home care challenges and solutions, benefits of having bilingual staff, government regulations, risks, utilization of technology, and their impact on healthcare costs and utilization.
Data Analysis
We obtained data for display in Figure 1 from Humana, a health insurance provider. The data obtained for outcomes and healthcare usage of value-based care through data published on the Humana website indicates a reduction in hospitalizations and ER visits between 2019 to 2022, given the value-based programs offered to its beneficiaries.
In Figure 2, data was also obtained from the Department of Health and Human Services, highlighting the investment of adult services through various channels and an increased need for long-term care solutions.
In Figure 3, data figures were obtained from the Sahara Home Care Organization. The initial figures for 2019 showed slowed growth. However, there was a surge in client enrollment due to the increasing need for home care services. Table 1 has recorded data set of Sahara clients enrolled in their program over a five-year period:
Table 1. Sahara client growth data collected in the last five-year period.
|
Clients Serviced |
Percentage Increase |
2019 |
1900 |
10% |
2020 |
3800 |
50% |
2021 |
3800 |
50% |
2022 |
4560 |
20% |
2023 |
4924.8 |
8% |
In Figure 4, a comparative analysis can be observed in the overall healthcare cost spent by Health Care Service Corporation (HCSC), Illinois annual report. Based on the annual report published on the public site, a comparative analysis has been performed and one can conclude the increase in yearly medical costs and hospital network and provider growth indicate a rise in healthcare needs. Table 2 shows the overall costs of a leading health care insurance company, Health Care Service Corporation and is a comparative analysis is showcased in Figure 4.
Table 2. Medical Costs, Provider Network and Hospital Network Growth recorded by health insurance provider, HCSC.
|
Medical Costs
Administered |
Provider Network
Growth |
Hospital Network
Growth |
Year |
|
|
|
2021 |
80 billion |
305,710 |
9285 |
2022 |
102.3 million |
406,388 |
9246 |
2023 |
108.5 billion |
416,000 |
10,000 |
From Figures 5-7, we can review the cost overview and key metrics of HCSC over a three-year period, depicting growth in specific areas, signifying heavy investments in the evolving health ecosystem.
4. Results
Since this is a case review and no experiments have been conducted, an emphasis on the impact of home care services on health systems. Based on the current home care market condition, suggestions were made to the Sahara Home Care Services. This research refers to several studies conducted in the past and the data backs the need to have homecare services as they have a positive impact on the existing healthcare system to improve healthcare efficiency and allow services to benefit a diverse population, specifically ages 65 and above.
5. Discussion
This case study aims to study Sahara Homecare Services and its impacts on the healthcare system. Factors such as growing aging, increasing migrant population, and pandemic trigger a ripple effect within the healthcare upstream system. Existing research supports the benefits of home care services. The journal article reflects on issues, complexities, and sustainable solutions.
6. Analysis
Based on the complexities of the current market and healthcare system, Sahara Home Care Services has made a solid mark in the Illinois market. However, as markets evolve, the team needs to follow a sustainability plan, such as investing in employee retention, expanding to other states, and adding additional services to maintain its competitive advantage.
7. Current Challenges at Sahara
As much as home care services benefit the health system, there are certain challenges tied to home care services. The challenges that existed back in the day when Sahara originally took off were related to financial constraints due to state process involvement. As Mr. Rana highlighted, the payment system was not the most efficient one, and it took longer wait times for payments to clear out. Some of the earlier challenges also relate to clients’ trust issues. Back in the day, there were not many South Asian community home care centers, and people were aware of just one home care service that mainly focused on serving residents in Cook County and DuPage County. Sahara, however, served four different counties, which was yet another challenge. With a large span of coverage area, there were worker capacity challenges. The team lacked the bandwidth to support the vast areas the Sahara signed up for. Eventually, as expansion grew and the locations increased in those counties, they could retain caregivers who would be able to support seniors in those areas.
The challenges today still exist with the workforce. The main factor is that caregivers are not given the highest wage and are close to the minimal wage. This can be a drawback for people opting to go into the field. The schedules are also very haphazard, so it can be difficult to procure a workforce for the home care industry. The hours that caregivers go in to support the clients can be very exhausting as the hours are not fixed and are based on client availability. There are other markets that allow caregivers to earn at a similar scale but have the flexibility of their own schedule. Therefore, there is a challenge to retain work.
Another ongoing problem that can lead to ambiguity is negative migration. Many people are shifting outside of Illinois, which is shrinking the market size. In relevance to this issue, a challenge is to find a balance of enough workers within the market size. An area with a bigger market can have fewer available caregivers, and an area with a smaller market may have a higher number of candidates willing to work. As a matter of fact, the numbers in terms of maintaining a steady workforce have certainly declined over the years. As Sahara studies the market on a periodic basis to open locations, this will be a challenge in business decisions.
There is also an increased competition in the market. Initially, when Sahara was established, there was one other competitor; however, they have around twenty vendors in the area, which accounts for at least four times higher than when they started. Within this growing industry, Sahara has to continue to explore ways to maintain its momentum in being a pioneer in-home care services.
Reimbursements that kick in from states have very long wait times and, unfortunately, happen to continue to date. During COVID-19, this was extremely difficult, and state-mandated compulsory services were to be provided to the clients. Although COVID-19 did have an impact on Sahara in terms of safety protocols, and mandating certain services per state guidelines, Sahara did implement digital tools ahead to survive during the pandemic. Nevertheless, the plans to prepare for extreme conditions in terms of health crisis must be instilled to adapt to the changing needs in the healthcare environment, which calls for ample equipment, staffing, government funding, client stipends, and various benefits to be able to deliver access to health care through their portal.
Within the home care industry, the options to add specific services or lines of business are highly regulated, and thus, approvals and licenses take longer wait times to evaluate. Therefore, one can conclude that the scope of home care services can be limited in terms of expansion and growth. The lack of integration with hospitals, pharmaceutical industries, and various entities can be a drawback for home care service organizations.
Strategies
So how is Sahara becoming a value-based leader? The one factor called out by Sahara leadership is the high customer satisfaction rates of their clients. The team continues to strive to make its services better and more accessible and focuses on its performance metrics. The value they drive is high satisfaction rates. They work extremely hard to maintain and retain their clients. Rana and his team took great joy in explaining that if ever there is a situation when any of the clients are struggling to lose their plans or need financial support, they will offer other plans or continue to support in different ways regardless of the coverage. This humane act makes them the most preferred home care service.
Sahara has some key strategies that play a significant role in its success. From early on, Sahara saw the missing component of a standardized process. This was partly due to limited businesses offering to South Asian community needs. They established proper workflow, requiring forms as such at the state of the art level. Their team meets with potential clients through interviews and conducting screenings, by either visiting homes or their preferred qualifications. The outreach program is incredible. They provide all the details necessary to support the clients during enrollment. They provide bilingual services and have staff members go over the benefit plans and thus have a two-way communication path between caregivers, administrative staff members, and clients. Once the screenings are successfully completed, the application can be sent through various Managed Care Organizations both at the county and state levels and is reviewed and approved per their designated program. These forms have been effective that state has used them as models to demonstrate to other home care service providers to use them. They have a lot of compliances along with other agencies, but they fulfill them in an exceptional way, marking as an industry standard, and that sets them apart.
The first thing covered by the Sahara team was the preparation of the healthcare crisis. Yes, COVID-19 taught the industry how to go into survival mode. During COVID-19, they had an IT infrastructure in place that allowed staff members to log in and work from home. This was one of the successful methods in terms of utilizing the technology and was implemented a year prior to the pandemic. They were mainly focused on Personal Protective Equipment (PPE) and usage of masks, gloves, and sanitizers. They also stocked up adequate inventory for caregiver usage to ensure that it does not face shortages. They have PPE, masks, sanitizers, gloves, and effective inventory management for equipment. Their process is to have caregivers forecast their equipment needs and pickup from the warehouse as needed. The company has allocated budgets for the basic healthcare non-medical equipment. As part of training, Sahara has also built a solid training system for their caregivers. They provide simulation training, safety training, and technical training.
Initially, a problem they faced in their diverse staff was that some of the migrant workers struggled utilizing technology. In the beginning, the workers were not required to clock in visit verification and thus this led to zero transparency over caregiver hours. However, seeing the disruptions in scheduling and lack of effective utilizations by his caregivers, they implemented a customizable software that was user friendly and utilized for update reminders. Although there was trouble in the utilization of those tools, as caregivers were not used to technology and preferred manual processes, they were frequently trained to learn the usage. With delays in background checks, the company sorted the solution by engaging employees in compliance training. Apart from the interactive on-the-job training and recognition programs, they also run assistance programs, such as community activity drives, for caregivers as a means to support caregiver families.
There are many moving parts and a lot of changes to be handled by a small organization. As an effective leadership trait, Rana and his team have always been ahead of the game. They had it already in place to train workers well on compliance and check procedures accordingly to mitigate risks. They have a fair advantage of government announcements and access to notifications early on. Their team is looped in at least six months in advance as part of pre-hearing prior to policy changes to make the necessary adjustments to their business operations. Sahara’s strategies in adapting to changes and weaving business needs led them a long way. Those organizations who were satisfied in their comfort zones could not survive the competition and swept them off. It is vital for organizations to review all aspects of business and understand the reasons for implementing change.
A key strategy that worked well in their interest is their ability to perform proper compliance. By maintaining well documented information, custom software utilization and IT tools, and building electronic versions, they pioneered the system and built trust and excellent rapport with the state Department of Health. This positively impacted their position in the market to the point that they are able to provide valuable feedback to lawmakers. A key benefit is that they play a critical role in shaping home care service policies and regulations. Rana and his team are content with the current relations they have built upon as they participate and speak on various issues backed by solid data. An interesting example signifying the impact of this relationship goes back to a pandemic time, when, in fact, the state took in their inputs and experiences of the problems and risks their clients and caregivers were facing.
Sahara has its key operation managers and directors who conduct inspections, adapt processes, and continuously introspect and evaluate their successes and failures. The level of management is not centralized in a hierarchy where decisions flow from the top down. Their management style is very inclusive in terms of giving team members the ability to express their innovative ideas geared toward process improvements. Those continuous improvement sessions help the organization streamline its processes based on empirical evidence to support its operations. Based on the interaction with leadership, the key ingredient in their success recipe was that people did not have many options with their home care service providers. Rana had envisioned serving its clients with the respect that they deserved. He knew that the offering to its clients must be generous, and due to the limited options available at that time, he had to have a plan that stood out for the community, and that was only through its excellent customer service. This was a single major factor that stood out drastically and transformed the business as the client’s first choice.
Another successful approach Sahara continues to conduct thorough market studies through outreach in the area and consensus data. Based on some of the challenges highlighted due to negative migration and worker recruitment issues, they are moving away from saturated areas and catering to all ethnicities. This turned out to be a game-changer for them. Their market penetration occurs through periodic market studies based on a variety of factors, such as population and demand within a specific area.
Currently, they have about twelve offices throughout Illinois. One of their strategies is to set up offices in locations that have a higher senior population and youngsters. Based on the consensus data they review; they finalize their selection between 1-3 suburbs and assess the staffing availability. In addition to that, they spend some time in the areas to review locations, engage in client outreach, and finally contact realtors to proceed with the selected locations. In terms of growth, they have grown their membership over the years. However, there was a boost in the last few years where membership has almost doubled. Figure 3 displays the growth assessment. Table 1 and Figure 3 reflect on Sahara’s client growth. During 2019, the growth was only about 10%. However, post-pandemic, business has nearly doubled. This was in part due to other competitors being shut down while Sahara received 20% to 25% growth and market share.
8. Recommendations
Based on the overall analysis of the challenges and strategies that Sahara continues to apply, several options can be explored. The fact that it is just based in Illinois can be a big pain point in terms of market recognition. If they have the right programs for their clients, they should explore advancing to additional states. If not all, at least regional states and nearby states can be an option to gradually expand. From a population perspective, it is understandable that most migration occurs in big cities due to the availability of work and attraction for businesses.
Another option Sahara can look into is expanding its services to children with disability. This can play a significant impact in the community as families need a helping hand and support for children with special needs. With a growing number of cases of special needs, a line of service catering to the specific child’s needs can increase their membership growth and provide them with solid momentum on the ground. Market studies in remote areas can be a big boost to people who have to drive farther distances to reach the hospitals; in cities with limited hospitals and outpatient facilities, this can lead to capacity issues, and thus, the increased Sahara locations can be a buffer.
As far as the issues related to caregiver shortages and lower wages, this is a common pain point and needs a major revamp of the process. The company must think through ways how they can provide caregivers the avenues to find career growth, pursue this field as their passion, and offer incentives and benefit packages that will keep them motivated. A recommendation would be for Sahara to partner with training institutions that offer caregivers to enroll in additional phlebotomy, EKG, or medical training besides the regular safety, vitals, and CPR training. This will allow Sahara caregivers to be multi-faceted and empowered and encourage them to look into plenty of options within the healthcare industry.
Another problem tied to the workforce is the flexibility. Sahara must keep a quota to hire on-call caregivers to relieve the caregivers scheduled on regular shifts. Studies indicate that when lunch breaks are fixed, caregivers have a higher probability of delaying service or working overtime [7]. Performance metrics can be another great measure to give an overview of how the organization is performing. Although they have high customer preference based on the growth and membership data shared, a deeper analysis and assessment can be meaningful to the organization. Sahara must continue to cover a variety of areas to measure their wins and identify opportunities for improvement.
As far as the issues are concerned with delays in payment reimbursements, states should implement and revise their cycles to ensure that their process does not cause a disorder in the flow. Although delays can occur with reimbursements, and verifications may take time, the need for process improvement is viable to sustain operations fluently. To that point, specific cycle times need to be reviewed and must be voiced by Sahara to the lawmakers and government entities owning this process.
Mergers, acquisitions, and integrations are the means for any business to grow. Although government programs authorize senior home care services, Sahara must work its way to scale up and integrate with different industries, for example, prescription drug delivery options. Suppose a client requires an immediate prescription and needs assistance in drug delivery. In that case, Sahara can look into integrating with clients’ medical providers through automated systems and securely access data to benefit them and add extra layers. They must conduct studies to understand the supply and demand and operationalize their business via new ventures.
Lastly, Sahara must invest in information technology to build integrative systems or adapt to newer technologies to streamline business operations. Though a heavy initial investment, the company can go a long way in establishing quality systems through automation. A client running low on certain drugs can be notified by the caregiver to the client’s medical doctor to trigger a response through automation tools and have the drug handy when needed. Although Sahara’s Enterprise Resource Planning (ERP) system maintains high standards, it must look to advance from a growth perspective.
9. Conclusions
An in-depth analysis has been performed to review the impacts of home care services on the utilization of hospitals and emergency departments. Factors such as age (65 and above), location, accessibility to healthcare programs and benefits, healthcare literacy, shortage of caregivers, payment issues through reimbursements, high medical costs, and emergency planning are all harbingers of the quality of our health system and heavily impact the roadmaps to effective healthcare. Value-based options and the ability to change are key factors of growth in the healthcare business. As decision makers in any health field, we must understand the risks associated with overburdened health systems that may seep through holes impacting healthcare economics. Statistical studies on various benefits of home care services conclude that they leave a positive impact by changing the quality of life for the elderly population.
As depicted, the growing aging population also calls for an increased number of home care service centers [21]. One may argue that home care services will never replace the care provided by a medical doctor or in a hospital. The claim is not to cover the medical needs of elderly patients. Of course, when patients are ill, they will be seen by the doctors. The idea is to recognize symptoms and apply the best methods to allow seniors to manage care.
Apart from that, Sahara is a solid example that started off as a small organization serving to bridge gaps. They saw a lack of standardized processes and lack of health awareness within the local community and hence contributed their bit in establishing the small firm and leading their business to the next level. Surely, they disrupted the market back in the day and are headed in the right direction in terms of gaining market value and staying in a competitive industry. However, they must look into expansion strategies, the addition of new services, and enhance their caregiver programs and operations to differentiate in the market.
Change is inevitable, as mentioned many times. Due to policy changes by lawmakers, healthcare businesses may be affected. The fundamental part of growth comes from reinventing processes gradually. After all, continuous inspection and adaptation are key to growth. Sahara has great potential to be an industry leader and is slowly making its way through its strategies but it must incorporate the recommendations along the way to sustain itself and be the leader in a highly competitive and rough industry.