Miriam Allred (00:01.02)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. I hope everyone is having a great week. It's great to be back in the lab. Today I'm joined by Greg Bean, the Vice President of Revenue Cycle Management at AxisCare Greg, I think you know more about VA billing than anyone else in the industry. You might have to prove me wrong on that, but I am excited to...
Pick your brain on all things VA billing. It's such a hot topic and you're an expert when it comes to this lane. And so we're going to dive in and talk about ways to streamline VA billing and also increase those VA billable hours. So before we jump into the topic, talk to us about your background. I know you've been on a lot of stages. A lot of people know you and have heard you speak.
So share maybe the things that people love to hear most about you and your background, and then also sprinkle in maybe a couple of personal things that people don't know about you.
Greg Bean (00:59.3)
Well, thanks for having me first and foremost. So, you know, I think one of the driving forces behind all of this for me is I joined the Navy at the ripe old age of 17. So, you know, I grew up on a ranch in Northern Idaho. My folks had a ranch and I decided to jump off and join the Navy at 17. Following that, I spent several years working in the acute care setting, trauma, emergency nursing, acute care.
And then a friend of mine said, hey, let's start a home care company. And then look, here we are 30 years later, working through all of these environments. You know, I think one of the driving forces behind all of this for me and what makes it a huge piece for me is, you know, I look back at my grandfather and both of his brothers were in the first European conflict. In fact, captured and was a prisoner of war in Stalag 13.
So if there's any Hogan's Heroes fans out there, he was in the real style, like 13. It wasn't quite like in the movies. My dad then was a part in the Navy and his brother and my other uncle on my mom's side. My brother was Army, my sister was Air Force. I was obviously Navy. My son-in-law was a Marine. And so now I see even my son's active duty serving in the Air Force. So the military, the VA, the world is a passion for me, but it's also a lifestyle.
Miriam Allred (02:25.6)
Wow. And you have, like you just said, you've been in this in and around the military and home care for 30 years. I don't know that we need to go that far back, but I want to preface this conversation with the changes you've seen in the VA, maybe the last 10 years in home care. A lot has happened just in the last 10 years. Can you just share from your perspective some of the changes that have happened when it comes to the VA and home care over the last maybe decade or so?
Greg Bean (02:55.7)
Yeah, I think one of the big things in home care from my own personal thought process around what's changed, what hasn't changed, what's better, worse and so on is in the home care space, so many people aren't aware that they have a benefit. And it isn't something that the VA puts out there. They say, hey guys, that you can be getting services or girls, you can be getting service, men, women, whatever it might be. It's not something that's published by the VA.
It's not pushed by the VA. And when we look at the total number of veterans in the United States with over 20 million, and we think about the fact that in today's world, only 175,000 veterans are getting home care. So when you think about that, that less than 1 % of our veteran population is getting care, it really becomes a paramount objective and an expectation of home care companies
to actually go out and educate veterans and then help them to get services. So one of the things that I've seen is there's been a massive push the past few years for home care. 10 years ago, the VA didn't pay well. It wasn't a great service. I mean, it was a great service to the veterans, but it wasn't a great service for home care companies. the pay was low, the issues were problems and so on. And so they had waiting lists of veterans to get care from home care companies.
Now home care companies are observing this not only as a need in their community with their veteran population, but also as an opportunity to grow their business. So now we see agencies actually standing in line to provide care for the veterans. So it's come full circle from veterans not having enough service to people standing in line saying we need to go out and educate people so they can actually receive benefits and care.
Miriam Allred (04:42.1)
I don't know if this is a naive question, but why do you think the VA isn't more public and vocal about the benefit? it something political? Is it just like a lack of marketing function? Why aren't they more vocal?
Greg Bean (04:55.07)
No, I think it's genuinely budget related. I hate to say that. I hate to go down that path. But the reality is, that it's never been a law or a requirement that they provide this benefit back to our veterans. So each VA regional medical center has had their own idea of how much of this care they wanted to support. So you'd have one hospital saying they'll give a veteran four hours a week of care.
and others saying they're going to give them 40 hours a week depending upon what they've individualized their budgets and created in from a budgetary standpoint. So it's been budgetary. It's been driven by the local environment of each regional medical center and not a big push by the VA on a national level. know, one of the things that happened with the Dole Act in this last year is it actually codified the Homemaker Home Health Aid program into law. So now,
it's not a matter of whether the VA hospital wants to support this service or can support the service. It's actually mandated. So it does allow for us to really help veterans to understand they can get the benefit, but then also they're mandated to provide the care to our veterans. So it's changed drastically that way.
Miriam Allred (06:03.6)
And like you said, it puts the burden on the home care agencies, but also it's the opportunity for them to position themselves as the one to kind of solve the puzzle and be that resource for these veterans.
Greg Bean (06:16.5)
So I think that's been the biggest shift is home care companies are understanding they need to go out and educate the community and be a part of this industry and environment. It's not something that they've focused on or been a focal part into home care. It's predominantly around private duty, private pay.
personal services, things along that line. And they're saying, wait a minute, we have this massive population of 20 million veterans with over 10 million over the age of 65. We should be supporting them and getting benefits and care and supporting them back in the community. I think it's been a huge focal point of the industry over the past few years and it's really enhanced the amount of people getting care.
Miriam Allred (07:01.1)
We'll talk more about that education piece, because that's a key part of the puzzle is how do you get out in front of these people? How do you produce resources, marketing material that attracts them and helps them understand the benefit? A couple more questions before we jump in. Just the supply of home care companies has gone up substantially in the last decade. And like you mentioned, also the demand for VA coverage and VA services to be covered.
Are there, is it realistic for smaller home care companies to still be contracted by the VA or has that ship sailed in some states and most states? Like are there still opportunities or has it been saturated heavily the last few years?
Greg Bean (07:45.7)
I think one of the things if I was looking at that as a home care company is where are the areas saturated? If you were in a very saturated market where there's a great deal of home care companies already providing services back across the VA, you're going to be very challenged to get into network. The networks are managed by two different platforms, one being TriWest and the other being Optum. They don't actually decide who gets into network. It's actually decided by the VA that way.
They're the credentialing bodies, but the VA hospitals themselves say, hey, we don't need any more providers or we need more providers. So your remote areas of the country are still in need and even remote areas around your rural area. even you and I would use, I'll throw like an Atlanta out there. Atlanta proper Fulton County might not need assistance, but there's surrounding counties all the way around Atlanta that might.
So as you look to, there's still a massive need. There's still a huge veteran population. So I would encourage all agencies to get enrolled, to work towards enrollment, and to work towards providing services back to veterans and educating them back into the community. Because if you were to ask somebody in your neighborhood, do you know a veteran could benefit from free care, free home care? I don't think anybody can say they don't know a veteran who could benefit from free home care.
Miriam Allred (09:07.7)
Mm-hmm. And I'm glad you mentioned that rural piece. This is really top of mind for me because I recently interviewed the founders of ClearPath Home Care in rural Texas and they were saying when they started their business, they were almost 100 % private pay. 12 years later when they sold their business, they were almost 85 % VA because of the demand for VA services in rural Texas and their rural market. And so I think you're exactly right. More concentration.
less demand and maybe the metros but there's still lot of opportunities in the more rural parts of the country.
Greg Bean (09:40.6)
Well, and you start, if you start looking at the number of veterans and where they retire and where they spend their lives and where they are as we scatter across the country, you you may not see as large of a veteran retirement in inner city Los Angeles or inner city Atlanta, as you might see in some of the surrounding areas where you see people retiring, retirement age as they move into the more rural areas and communities to allow for themselves for retirement purposes. I think it's a big piece of what we do in this country as we try to sprawl and spread out a little bit as we retire.
