If you run a homecare agency, you are probably grappling with caregiver retention and delivering quality care to your clients. These dual challenges are actually two sides of the same coin, as motivating and empowering caregivers to play an active role in their clients’ health can dramatically improve retention rates. At the same time, being proactive about your clients’ care can help avoid costly emergency room visits and hospital readmissions, while keeping clients and their families happy with the services your agency provides.

What Is Value-Based Care?

Value-based care (VBC) is a healthcare billing model that focuses on patient outcomes and a holistic approach to treatment. It is considered an alternative payment model as compared to fee-for-service (FFS) models, where payors pay for individual tasks. FFS billing models often lead to fragmented care in that they typically involve multiple, disparate services and treatments. VBC, on the other hand, focuses on the quality of care and the outcome, rather than the quantity of services.

VBC often emphasizes preventative care and early intervention to avoid hospital stays and ER visits. It enlists the help, feedback, and input of multiple healthcare providers, as well as the homecare aide, when applicable, to work together to provide a higher quality of overall care. VBC also takes into account the five social determinants of health (SDOH) and works to address and improve circumstances for patients when SDOH indicate potential problems or weaknesses.

Why Agencies Are Making the Shift to VBC

Homecare providers are in a unique position to make an impact with VBC, as they enable members to stay in their homes and out of hospitals. VBC models can reduce potentially avoidable complications, which often result in ER visits and hospital stays. For example, in the months after employing value-based care tools, one agency observed more than 1,150 clients and avoided an escalation in 90 of them, or 8% of all cases, according to an HHAeXchange study.

Additionally, VBC models help reduce healthcare costs for all involved, as they focus on decreasing costly or duplicative care and hospital readmissions.

Reducing costs can especially help improve access to healthcare in under-served communities, since individuals in these neighborhoods are the ones least likely to be able to afford multiple services and duplicative care. When medical practitioners work holistically, as a team, focused on outcomes, it can reduce the duration and expense of treatments.

How VBC Can Improve Confidence and Retention Rates for Caregivers

VBC is not just beneficial for patients and providers. When properly implemented, it can help caregivers feel more fulfilled on the job and therefore serve as a retention tool for agencies. When caregivers feel good about the work they’re doing, they’re less likely to look elsewhere for other jobs. With a 65.2% caregiver turnover rate, improving retention is crucial for agencies to be able to provide their clients with the best care and remain competitive and profitable in the field.

Recruiting, hiring, and training new caregivers after a worker leaves is costly and time-consuming. It costs, on average, $2,600 to replace a caregiverHome Care Pulse reports that caregiver turnover costs agencies an average of $171,600 annually. Plus, the need for home health and personal care aides is growing much faster than the national average, at a rate of 33% this decade, according to the Department of Labor Bureau of Statistics (BLS). There are close to 600,000 job openings each year, the BLS states.

With caregivers in such high demand, empowering them with the tools they need to be successful can reduce their stress and risk of burnout and ultimately improve retention rates.

Key Elements of VBC

VBC emphasizes caregivers taking a lead role in participants’ health outcomes by proactively pinpointing when a participant may need extra care and reporting their observations back to the agency.

Caregivers should look for changes in participants’ behavior as an early warning sign of potential health problems. Caregivers should always report changes to back to an agency administrator, nurse, or physician.

Some things to look for include any behavior that is different than usual, including needing more help, talking less, eating less, or being less active than normal. Agitation, confusion, anxiety, or fatigue and weakness are also warning signs that bear further investigation.

Caregivers should also watch for physical changes, such as increased pain, new pain, and changes in bowel movements, such as constipation or diarrhea.

Communication among the care team also plays an important part in achieving VBC. By giving aides the tools to recognize changes in a participant’s condition and encouraging them to communicate with the agency’s licensed nurse or supervisor, it increases their confidence and makes them feel like a partner in their clients’ care. Caregivers will also get to experience one of the more rewarding aspects of their job – seeing the results of helping clients stay well and live better lives.

Traditionally, many providers have underused homecare aides as a resource in their clients’ care. But with the appropriate tools and training, aides can play an important role on the frontlines of patient care. After all, a homecare aide is with a client every day and in the best position to notice and communicate changes in behavior, especially in situations where quick action and the appropriate response can improve health outcomes.

Tools and Best Practices to Empower Caregivers to Deliver VBC

Once caregivers know the warning signs of health problems, technology that simplifies the reporting and recording process can help streamline VBC and further empower caregivers.

HHAeXchange’s mobile app prompts caregivers to answer pre-defined questions about the client’s condition based on their diagnoses or other key factors, such as any noticeable changes in weight, or if they appear confused or shaky. Caregivers can also input additional observations and notes, such as the need for a prescription refill or a malfunctioning medical device.

Homecare agencies who employ digital VBC tools, like HHAeXchange’s Care Insights, have reported improved communication, more confidence identifying changes in their clients’ conditions, and improved involvement in their care. Agencies said that Care Insights makes it easier to report changes in their clients’ conditions, according to a recent survey.

In addition to making reporting easy for caregivers, Care Insights analyzes and tracks the data captured, giving agencies necessary insights into participants’ health. Alerts to changes in condition have been proven to help avoid escalations such as hospital stays and a need for emergency care.

The Role of Social Determinants of Health (SDOH) in VBC

VBC also takes into account SDOH in regard to patient care. The Care Insights tool helps homecare aides track SDOH with guided questions. In some cases, caregivers can help improve SDOH. For instance, a caregiver can make an attempt to prepare and serve healthy food to a patient struggling with poor nutrition, or encourage a participant who is not getting enough exercise to go for a walk. 


The combination of technology and personalized care when an agency employs VBC with the right tools can empower and inspire homecare aides. Improved retention rates, better outcomes, and reduced healthcare costs may seem like the holy grail of the homecare industry – but they are more attainable with VBC. It all starts with caregivers asking the right questions about their clients.

Key Takeaways:

  1. Homecare aides are untapped resources in ensuring value-based care.
  2. Improved patient care is driven by an empowered workforce.
  3. The challenges of capturing data on patient outcomes and caregiver retention can be resolved with the right technology.
  4. With the right tools and training, providers can improve communication, capture critical data, and boost caregiver satisfaction.

To learn more about how you can empower your caregivers and improve your agency’s quality of care, contact us.