Miriam Allred (00:11)
Hey everyone, welcome back to the Home Care Strategy Lab. I'm your host, Miriam Allred. It's great to be back with everyone. Hope you're having a great week. I am joined today in the lab by Steve Barlam, the CEO at JFS Care and also the immediate past president at ALCA, the Aging Life Care Association. Steve, the pleasure is all mine. Thank you for being here.

Steven Barlam (00:31)
What a treat. Thank you so much, Miriam.

Miriam Allred (00:34)
We have rubbed shoulders the last couple of years at conferences and I've talked to a couple of mutual connections over the last couple of weeks and so figured it is long overdue to interview you more formally. ⁓ you probably know as many if not more people in this industry than even I do. But for those that might be listening to this that don't know you, would you go ahead and introduce yourself briefly?

Steven Barlam (00:56)
Sure, sure. ⁓ I am a social worker. I graduated from Cal Berkeley and post-graduation, I went to work right away for a nonprofit organization, Jewish Family Service at the time. My whole career has been in care management and geriatric care management. I have been working for 41 years, unbelievable. ⁓

starting off in nonprofit after that starting a small boutique private practice in care management on the west side of Los Angeles. And then I was approached by Venture Capital and they wanted to create a model that would be high quantity and high quality. They felt that home care was a high quantity business but didn't always have

the most quality, highest quality, and they knew that care management was a very high quality business, but didn't really have a lot of the quantity that they needed to make it worthwhile their investment. So it intrigued me. I jumped aboard and I worked with a company that I helped co-found called LivHome for over 20 years.

⁓ grew that from one location to 17 locations in multiple states. And then I was approached by Jewish Family Service again six years ago saying, would you help us to create a model of care management led home care? And that was intriguing to me to come back to where I started and

I have been extremely happy in this journey.

Miriam Allred (02:54)
You strike me as one of a kind, Steve. Do you meet many other people that have had a journey even parallel to yours being in geriatric care management for this long?

Steven Barlam (03:02)
Now, now it's sort of an interesting,

it's an interesting journey. It's yeah.

Miriam Allred (03:09)
And you're a pioneer in that you have seen 40 years of care management and there aren't very many people that can say that. And also the integration of care management and home care, which is what we're going to talk about. But before we do talk a little bit more about Jewish Jewish Family Services, JFS care and that organization is unique in a lot of different ways, but just kind of high level the business model, the structure, whatever you'd like to share.

Steven Barlam (03:32)
Yeah, sure.

So JFS Care is a separate division of Jewish Family Service Los Angeles. We're a nonprofit organization and half of our client base that we serve are Holocaust survivors and through other grants and other programs of the neediest of the needy, while half of our clients are very high net worth individuals.

So it's an interesting mix ⁓ to be serving and we offer three distinct services. We offer traditional home care through a traditional home care model. ⁓ And we also provide geriatric care management, private geriatric care management. And lastly, we provide a thoughtful engagement program that's really focused on

marking times in meaningful ways for our clients and really focusing not just on the physical care, but the psychosocial, the social connectedness and engaging with our clients. So those are our three service lines. Yeah.

Miriam Allred (04:46)
I always like to ask what was the evolution of introducing those service lines? Was it care management, then home care, then this engagement, or did you launch with all three of them? What was kind of the order of operations of the three?

Steven Barlam (04:56)
Interesting.

So I came into the company and they were at about a $4 million run rate ⁓ of home care. And we've grown it two and a half times ⁓ in the last few years. And we added care management first. That was sort of my first charge because I realized the importance and I come from a model.

My, you know, the company that I helped co-found was this integrated model of care management and home care. So I'm a firm believer in how that can really work to the value of the clients ⁓ and the business. And then we most recently, this last year started the Thoughtful Engagement Program, which is based on a model out of Arizona, dear friend, Crystal Littlejohn.

⁓ her practice and we got a license to use that model and expand upon it. So we're doing that.

Miriam Allred (05:58)
Okay, yeah,

that's amazing. And that's really helpful. know, that's kind of maybe an odd question to pose to you, but it's really helpful because every home care company is at these different ⁓ junctures. it's do you add service lines? Do you add payer sources? Do you acquire companies? you sell? You know, there's all these milestones and companies kind of hit that fork in the road and they don't know which path to take. so you explaining the evolution of these service lines is even helpful at what size you were and at what point you considered these things.

Steven Barlam (06:07)
Mm-hmm.

Yeah, thank you.

Miriam Allred (06:29)
So I entered this industry six, seven years ago. I think many people are familiar with, Arosa. And there was kind of an evolution of what those companies, I believe, merged or acquired. Can you talk a little bit about the journey of what Livewell has since become?

Steven Barlam (06:44)
Sure. So it was LivHome and LivHome ⁓ was founded back in 99 and basically on our last round of funding. And I served as the chief professional officer of that organization. So my responsibility was really focused on the care management side of the professional side of how do we integrate care management into the home care. ⁓

We got our last round of funding and it was through Bain Capital and Bain Capital introduced us to the folks at Arosa and they put us together and we were able to, they have done some remarkable things and I have learned some remarkable lessons from Ari Medoff who is, you know,

Pretty remarkable young man. And he has created a lovely company, Arosa. And it's, know, yeah.

Miriam Allred (07:53)
Yeah, great. A great story and a great

journey just for those, you know, that have probably heard of a Arosa but maybe haven't heard of LivHome and just kind of what what that's turned into. So that's helpful information. ⁓ Last thing I want you to introduce is ALCA, Aging Life Care Association. For those that aren't familiar with that association and what it is and who should be involved, give us give us the pitch.

Steven Barlam (08:15)
Sure. So the Aging Life Care Association is comprised of these like-minded professionals, primarily nurses, social workers, maybe gerontologists, ⁓ who are involved with the same tasks, the private care management or care management in general, which means that people are doing assessments, care plans, monitoring.

and overseeing the care while providing advocacy and support for family members and older adults. It's a gathering place. It's the professional association that has set the standards, that has set ⁓ codes of ethics, that is really about education through their conferences, their webinars, lots of different product lines to help support the professionals who are doing this kind of work.

I've been involved with the association since 1990 was my first conference. I was not one of the founders of that association. It had been around since I think 1988, maybe 87. But I was there in the early years and have been an active member, have been on their board, have been served as chair of their committees. I've been the president.

two different occasions in my life with the association. And it's a really remarkable place to help raise professionals up and to give them the support they need to do really good work out there.

Miriam Allred (09:53)
Is it a good place for all home care companies? Does it make sense for all home care companies to be a part of that, to inquire and learn about care management? Or is it best suited for companies that are doing that service?

Steven Barlam (10:05)
You know, there are opportunities for allied professionals and for others involved who aren't doing direct care management to get involved. Because I have to tell you, care managers are some of the most remarkable referral sources, especially for home care, as you could just imagine. And so having a really good relationship with care managers is critical to success.

And there's lots of different ways you can do it as you alluded to, like do you create your own? Do you buy? Do you just partner well with folks? And that's sort of what I hope we'll talk more about.

Miriam Allred (10:47)
Yeah, let's start with defining the terms because between you and I, people throw care management around loosely in home care. And I think that's the first place we need to start is making sure we're all using the same terminology internally in the industry and externally with families and clients and partners. And so you tell me define. Well, this is a loaded question, but define care management and then also share.

the terms that we're too loosely using in home care.

Steven Barlam (11:20)
So, you know, it drives me a little bonkers. Folks at my dear friends at Sunrise, for example, they call their CNAs care managers in all their communities. And that really drives me crazy. So we use the term case management, care management, life care management, ⁓ care coordination.

They can be used in multiple ways and it is confusing out there. That's why the Aging Life Care Association decided to change the terminology. And so for members who belong to ALCA, they are considered aging life care managers as opposed to just care managers out there. We needed to differentiate ourselves.

and to be able to say an aging life care manager abides by and agrees to the codes of ethics and the standards of practice set forth by the organization, that we all do certain tasks, the assessments, the care plans and the like. And it's so important. We also have certain

guidelines in terms of education or experience of who can be a member. So it's also different levels. In my world, since I'm in home care as well, we use the terminology home care management and life care management as differentiating between the work we do in the home care side of our business

with our assessments and developing care plans for our caregivers, because we use the same tasks or we do the same tasks and we use the same tools, right? And it gets mixed up. And so I think home care management makes sense. It's home care and it's the management of that home care that we do so well in the home care industry.

The life care management is a little bit more complex. If you think about it, Miriam, the situations that we walk into, a client who might have mental health issues, may have warring family ⁓ members who can't see eye to eye, who might have multiple medical conditions, might not be taking their medications as prescribed, who might not have

an estate plan in place, who might need to apply for public benefits. These are things above and beyond what a traditional home care company would deal with in their home care management. But it's what a life care manager does day in, day out. And so it's just being clear in terms of scope of practice.

⁓ And I have such great respect for my colleagues, fellow colleagues in the home care industry ⁓ who are doing care management and home care management. But it's, we have to be careful because you don't want to piss off the people who refer business to you, right?

Miriam Allred (14:55)
And we don't want

to confuse the families. I bring it back to there's so many reasons to define the terms, but to confuse the families if they go to one home care company that is offering home care management and another company offering aging life care management, but the family doesn't understand the differences, we're confusing them and then it's affecting both of us negatively.

Steven Barlam (15:00)
Right.

Right.

Right.

That's right. That's absolutely right. So it's really important to be clear on the language that you use and to be consistent and also to get feedback from others who are doing it in your community. You know, you just want to be clear how, you know, how should we be talking about the work that we do? And I have to tell you, I have been parts of so many discussions amongst

professionals of people at so many varying levels from hospital administration to community-based folks to home care, and nobody can agree to what's the right terminology. We've had weekends where these gatherings and convenings of professionals, and it's not an easy thing, but it's an important task.

Miriam Allred (16:15)
Okay, so a couple of questions. said your association, this association coined the term life care managers. When was that made official?

Steven Barlam (16:25)
⁓ good question. I would say at least six years ago, six to eight years ago, there was a big push within the organization for differentiation and clarity. And boy was there, it wasn't an easy, it was kind of a battle. Because there's the old, know, we had built so many years of brand equity.

Miriam Allred (16:33)
Okay.

Steven Barlam (16:51)
of finally people were recognizing what care management was. And then somebody is saying, it's not called care management anymore. It's now called aging life care services. So there were, you know, these heated debates within our association and within the professional community. But overall, we've come to a good place where the differentiation is not a bad thing.

Miriam Allred (17:20)
And when you defined it, did you also define clear scope for what life care management is? A minute ago, you illustrated an example of a client with all of these different facets of care needed. Is life care management clearly defined as to what it is and what it isn't, or there's still some edge cases?

Steven Barlam (17:32)
Yes.

I would say that we're on the road and it continues to evolve and we keep getting clearer over time, but we're not a hundred percent there. But if you go onto our website, the Aging Life Care Association website, aginglifecare.org, there is a definition for

what we define the scope of aging life care.

Miriam Allred (18:11)
Okay, and that's good answer because it's also up to every business. Like I kind of prefaced at the beginning, a lot of home care companies are doing home care management and they need to define what that is. And if they decide to branch into care management, they need to understand and clearly define what those two services are and aren't.

Steven Barlam (18:21)
Right.

Miriam Allred (18:32)
you know, we may talk about this in a few minutes, but just the monetization strategy around care management and billing that and what that looks like. If you have them clearly defined as two different service lines, they are very different in how they're billed and paid for and rolled out essentially. And so the distinction is important, but what you're saying at like an industry level, it's not clearly defined, but we're on our way there as an industry.

Steven Barlam (18:39)
All right.

Yes, that's a good way to put it.

Miriam Allred (18:58)
Okay, so a couple of things. What do home care providers need to understand from a business standpoint about care management? Thinking of like the practicality and when to introduce it and how to just differentiate service lines. If you're talking to this audience of home care owners, what do they need to understand from a business standpoint about care management?

Steven Barlam (19:22)
Okay, so first of all, I would say that probably the biggest gating factor that restricts or gets in the way of people being able to expand a care management business has to do with finding care managers. So the recruitment of care managers and how do you onboard them and how do you train them?

and how do you provide ongoing supervision so you can assure a certain level of quality, right? ⁓ It's easy to have a one-off. You identify one person in your community, they are eager, they wanna work with you, and you say, okay, I'm willing to take a chance on this, and you hire them. But if you haven't thought through what's the growth.

strategy and how are you going to get that next care manager and how are you going to that that can get in your way. And so I think about day in day out. Are there ways to use non-traditional folk as we realize that there are so many more older adults and people who could benefit from care management.

versus the amount of people who can provide care management, right? And so it's really figuring out how do you train up people in maybe some allied professions to be able to ensure that they're following certain protocols, certain standards of practice. So the first thing that I think you need to think about is your staff and talent. Where are you gonna get them?

⁓ How do you attract them? How do you retain them? Another piece is incentivizing from a business perspective. So there are so many professionals out there who do great work, great clinical work, but many social workers, many nurses aren't necessarily used to the business side of things. And so you're really looking for a hybrid

person or helping that professional along and helping them make peace with making money and generating and working in a for-profit arena because a lot have come from the helping fields, right? So it takes a certain mindset. Not all social workers make great care managers. Not all nurses make great care managers, but it takes a certain

drive a certain entrepreneurial spirit that you're looking for. So it's the recruitment. That's a critical piece. It's then looking at your market. does your market, there are many people that when you announce to your client base that your rates are $30, $35 an hour, $40, $45, the

the jaws drop, right? That it becomes like, it's a hard, not an easy sell. So can you imagine selling something that's at $150 an hour or $200 an hour or $250 an hour in some major cities, right? So you sort of need to make sure that you have the market for it in order to...

you know, be able to continue on a thriving business. So it's the market, it's the people. Those are the two critical factors. Are there other things that you had in mind with your question, Miriam?

Miriam Allred (23:20)
Well, I want to ask about the career path of these care managers because you just mentioned that nurses can become care managers, social workers can become care managers. Is there a traditional professional path for care managers or it's more ambiguous?

Steven Barlam (23:29)
Mm-hmm.

I think we get at people who don't do well in traditional settings, who get bored working in a hospital doing certain stressful tasks under the gun, who don't get the opportunity to develop the relationships on an ongoing basis. Because care management

in its true form, you can work with a client. We have clients that we have worked with for two, three years. So, you know, length of stay, it's a pretty sweet thing from a business model perspective of client retention can be magnificent. And it feeds the soul of many care managers who are able to really make a difference and

you know, spend the time and connect with somebody and see them over a period of time versus one-off transactions like a discharge planner might have or a nurse might have in a medical setting.

Miriam Allred (24:45)
So you were talking about recruiting care managers and we're going to kind of jump between, you know, adopting care management into your organization and also partnering with care management. But I think a question that's relevant to both is where are these care managers? that it sounded like you were implying that some of them are just like independently out there doing this work on their own or charging for it or not for charging for it, but then they're also care management companies. So some of them are employed, but

Steven Barlam (24:52)
Go for it.

Miriam Allred (25:14)
Are those kind of the two primary places that you find care managers or just self-employed out there doing the work and then working for care management companies or are there other buckets or arenas that they're in?

Steven Barlam (25:22)
There's other venues.

So we work with, when I'm looking for a care manager, I want to make sure it's really about tapping into people who have a certain level of expertise around the population. And so people are paying us top dollar for, expert advice. So where do you find those folks in assisted living in?

skilled nursing, and we have gotten a couple of folks from occupational therapy, from hospice, from home health agencies, from hospital settings, from, you those are, I would say, probably our best sources. ⁓ I recruit a lot of folks right out of school who

have had experience prior to going to school doing all kinds of things. And I find some of the best care managers are people, you know, who have been in retail, who have done, you know, who just have interesting experiences, have gone back to school and we can leverage their life experiences. And it's the onboarding of them and the training which is critical.

to ensure that they're following certain standards and doing things in the appropriate way.

Miriam Allred (26:53)
On that training component, is that something that the ALCA Association provides or when you talk about training, how do you train these people accordingly? And is there some sort of certificate or license for life care managers?

Steven Barlam (27:06)
There are probably, for life care managers for the Aging Life Care Association, they recognize three different certification bodies. One being NACM, one being the CCM that is administered through CMSA ⁓ allied group, and one through NASW, through the National Association of Social Workers.

So there are different certification bodies and yeah.

Miriam Allred (27:39)
helpful too

in that when we talk about partnering with life care managers, you want to know who the good actors are and who the bad actors are. I know that's like a harsh way of putting it, but there's a lot of people out there saying that they do care management and so that's why I'm asking about these certifications and training. If you're going to hire them, there's a process, but also if you're going to go partner with them, you want to make sure you're working with the professionals out there that are certified and have gone through the right training and processes.

Steven Barlam (27:47)
Right.

Right.

And then through ALCA, through the Aging Life Care Association, at national conferences, they offer startups and like boot camps to help folks who are just starting out, giving them full day training sessions on how to start their practice and some of the clinical issues, the marketing support and the like, ⁓ as well as they have

products that they sell in terms of training to help onboard staff in a consistent fashion.

Miriam Allred (28:39)
Okay, let's talk about kind of the nuts and bolts for a minute. ⁓ You cited the cost and cost is already a primary concern for most families when they're considering care. And so if you come in and offer a service that's double or triple what they're even anticipating, you know, there's that like whiplash shock factor. Talk about how you at JFS care bill for care management and how you approach families with

this service.

Steven Barlam (29:06)
That's a great, great question. So I just got off a call literally prior to this where somebody was calling in and they were looking for home care. So I just happened to pick up the call and basically the person was looking for their mother and was looking for just a few hours, but she said, and this was the trigger. I'm not sure how I'm ever going to get my mom to accept the care. Like the need was there, but she was stuck.

And so often we talk to families who they get the value of home care, right? But when it comes to trying to implement it, things sometimes get stuck. So it was an easy sell for me. And I truly meant it, you know, a sell in the most genuine way of helping to solve the problem was

to talk to this client by saying, if we could get a professional out to eyeball the situation, to understand what's the stumbling blocks, and then to strategize with you as the daughter and your siblings to let you know what your options are and how can we best get the care in place? Would it be worth it to you to invest an hour or two hours of my time at this rate?

And she absolutely said, let's go for it. So it's how you approach it. And it's not for everybody. So I'm going to just take a quick aside. And I hope this will make sense, is that in my former company, there we had care managers that we were paying.

Right. And they were salaried and we had full time care managers and people would call in to LivHome wanting home care. We were a top dollar. And when we introduced the care management, they said, no, thank you. So were we going to walk away from the home care dollars because they refused to pay for the care management? Absolutely not.

So we figured out how do we involve our care managers? And there are some clients who will engage and there will be some clients who won't. And for those who don't want to pay for the full care management, is there another service that we can offer them to offer and ensure the quality, maybe at a lower level employee, more the home care management? And for those who do engage,

and who are willing to pay, we can provide and be able to charge for it in order to cover the costs. There are some businesses out there that make it invisible and don't charge for the care management and just charge a premium for their home care because they can deliver a much higher level of service. And it becomes like a concierge service where you get this great

white glove service by a professional and they're doing great care management service.

Miriam Allred (32:32)
Hmm.

Steven Barlam (32:34)
So there are different approaches and you have to figure out for your business what makes sense and for your marketplace what makes sense and what is the competition out there because if it's full of competition, do you want to start off competing or is there another way to get your competition to be your referral source? It's an interesting thing that I've always thought about in home care.

Miriam Allred (32:59)
Mm-hmm.

Steven Barlam (33:03)
My biggest competitor is the families who are doing it on their own, who are providing the care. And so my biggest challenge is how do I turn my competition into my consumer? And that's a really cool thing. And in the same way, how do you turn the care manager into your referrer?

Miriam Allred (33:18)
Mm.

Steven Barlam (33:32)
That's the coolest part. So.

Miriam Allred (33:35)
Yeah, I think of that word like frenemies we're really on the same team doing the same work. It's just a matter of defining who does what and how we work together and where there's upside for all parties.

Steven Barlam (33:38)
Yeah, exactly. Keep them.

Exactly, exactly.

Miriam Allred (33:52)
So, wow, okay, a lot of questions. It's interesting to hear you talk through this. You've been doing this for a long time, but it sounds like even your thinking has evolved. But what I pick up is standard practice is meeting people where they are. You said you just answered the phone to a family and you listen and learn and hear what their needs are. And you keep an open mind as to what service you're gonna lead with. It might be home care, it might be care management, it might be something else, but...

Steven Barlam (34:01)
completely.

Miriam Allred (34:19)
It's really just dictated by what the family needs. And then you are armed with kind of like your tool belt of services and you can pick one and lead with one. And then the others can follow or be bolted on later down the road.

Steven Barlam (34:32)
It has to be all about creating value for your client base. And the more services you have in your quiver that you can pull out and use, the better and the power to you. So you don't have to use all of it for everybody. But if you can do, if you can find the right combination, it's magical. It's really quite remarkable.

Miriam Allred (34:59)
Staying in the nuts and bolts for a little bit longer, talk about structuring the hours and the time of a care manager because that's part of the hang up. You know, we'll talk about the pros and cons of each of these models. Part of the hang up with doing it internally is the complexity of managing the structure and the schedule of the care manager. Can you talk about how you structure their schedules?

Steven Barlam (35:02)
Yes, please.

Right?

Sure. So I am lucky enough as we have grown to have a director of care management and that director of care management is really responsible for the onboarding, the oversight, the supervision and reviewing on a weekly basis how people are doing. I remember at LivHome that we have created a, it was,

a newsletter for our care managers to hold them accountable. And it really laid out exactly everybody, all of our team members, and we had over 30 care managers, and how much they were billing that week, how many hours, and everybody could see everybody else's. It was all about transparency and accountability. And that was a critical piece to

when you talk about nuts and bolts, it's really setting what are the proper guidelines. And I'm not sure this is the right venue to speak specifically because it will be different for, you know, depending on your company, but it's really consulting with somebody. I know there are many people out there who consult around care, you know, developing care management in your business, and it's well worth a few hours of their time.

⁓ to be able to set up the right mechanism and the right numbers that will make sense for your company, especially over time.

Miriam Allred (36:59)
So talk about a client example specifically, you know, for example, the family that just called in that initial assessment or that even like life care management assessment, you know, you bill probably an hour or two for that initial visit, but then the ongoing care management, those might be 15 minute increments or 30 minute increments or 60 minute increments. you know what does that look like over the lifespan of a client?

Steven Barlam (37:11)
Mm-hmm.

Yeah. So how do we, yeah.

So I would say that our average client spends about four hours a month on average. We have some clients who we are serving 10 hours a month, and we have some clients that we'll see every other month. So it really varies all over the place. But the truth of the matter is we want to set it up from the get-go with the family.

becomes really easy for me to have the conversation with someone and saying, you know what I'd like to recommend that I come out twice a month every other week, because a lot can go on if I'm just coming out once a month. And the value that I add to you is I'm laying my professional eyes on the situation and I'm helping you to...

pick up on any changes so we can step in and we can intervene before it becomes a crisis, before it's costly, before it's traumatic, before the problems can emerge. And usually I can get families to agree to the twice a month. And then if there are other issues that come up, medical appointments, pouring meds, phone calls,

reviewing emails, things like that, that adds to it and that's where it grows from there. But people at the front end don't know what it is. So if you try to sell too much of it, it becomes frightening. So I try to start where they're at and help people understand it's not that scary. And let's start small in small steps.

Miriam Allred (39:16)
Mm.

Steven Barlam (39:20)
And as they trust you and see the value, they want more and they want more.

Miriam Allred (39:25)
And that actually lends itself to what we talked about earlier, is care management. Life care management isn't totally clearly defined, but that's actually advantageous because every family's care management needs vary. And so you have to kind of identify with them what care management looks like for their specific needs.

Steven Barlam (39:37)
my god, yeah.

Exactly. It's painting the picture. And so from my perspective, it's really about a couple of things that we do really well. It's about figuring out what people want and what they need. And there's often a delta between those two. And a really good care manager figures out how to bring those closer together. Because families contact us and it's always or generally

about risk and making the person safer. And the older adult, it's not about safety per se, but it's about control. And it's about having some agency in one's life to be able to make decisions and not be told what to do. So it's creating the balance between the two and care managers are really good about that.

Miriam Allred (40:44)
When we talk about payers, is all life care management private pay or do any other payer sources, government payer sources, LTC, will any of them pay for life care management?

Steven Barlam (40:58)
Okay, interesting question. So I'd say long-term care insurance, there are some policies that pay for aging life care services, for care management services. For the most part, it's out of pocket. However, there are newer, I mean, as you think about the future, as you think about, you know, new...

funding sources, we as a nonprofit organization got funding through a grant to be able to offer care management services for homeless individuals and recently homeless individuals. So for two and a half years, we were funded to provide care management services for that. There are hospital systems who realize for readmission issues,

or for folks who haven't been successful in applying for public benefits, but they're eligible, that there are hospital systems who are willing to pay private care managers to get involved and to share the risk a bit with them. And there are interesting models out there. The VA has contracts with some care managers.

to provide care management for ⁓ vets. ⁓ Also the GUIDE program, for dementia care through CMS and Medicare services are starting to pay for that. So we're seeing like the beginning steps and that's really exciting. But in today's market, the real focus is the private pay market for

aging life care services. And if you think about it, we have such a fragmented system right now and people are living longer and it's more confusing how to get services and the like. There is a huge market out there.

Miriam Allred (43:07)
From a revenue standpoint for both JFS care and a lot of home care and care management companies that you interface with, from a revenue standpoint, what's kind of a traditional breakdown of revenue care management to home care? If you can share what that is for JFS care and or is there kind of a standard or a ballpark across the industry or is it very greatly?

Steven Barlam (43:29)
Yeah,

it varies greatly from speaking with friends and colleagues. I have friends and colleagues where care management is a huge piece. For us, it's a smaller piece, but it's a value added and it attracts more business to home care. So we do it and it definitely generates revenue and it pays for itself and is profitable.

But it also leads to, new referrals because we offer a wider range of service. So it's well worth it.

Miriam Allred (44:07)
Yeah, I was just curious You have a bigger ⁓ pulse on home care and care management. And I'm always intrigued by what service lends itself to other services. You know, there's no one way to build a home care company. There's no one way to structure your services. But, you know, is care management the carrot to get to home care or is home care the carrot to get to care management? They all fit together in different ways, but it's really up to the agency.

to establish what their formula is and how their services fit together.

Steven Barlam (44:38)
Exactly. And there are different ways. There are agencies that start off as care management businesses that add home care. And there are businesses that start off as home care and add care management. When we started LivHome, we started a care management business that was adding home care. And we found that so much easier ⁓ to stay true to the core of care management.

without compromising some of the things that sometimes are compromised.

Miriam Allred (45:13)
So let's talk about, say you're a home care company right now, you've been in this position, but think from the lens of a lot of people listening to this, that currently are home care companies that are partnered with care managers out in their community. What factors would you consider as a home care CEO of a, I don't know, $5 to $8 million home care company right now with the infrastructure and the ability to add care management?

Steven Barlam (45:20)
Right. Yes.

Perfect.

Miriam Allred (45:42)
What would be the factors that you would consider to consider rather than partnering, actually bringing care management in-house?

Steven Barlam (45:49)
So I would want to think about how many referrals are currently coming in from existing care managers, because the moment you start providing care management, you're going to see a change and care managers are going to feel skittish of referring to you. So if you have really good relationships, it's just a big consideration. The other is

Again, the recruitment and like how easy will it be to attract and do you have a pool of people that you can draw upon sometimes people have internal staff that can convert over. To a care manager position to start with. So it's really thinking about that piece it's also having little focus groups with

referral sources, other referral sources, attorneys, fiduciaries, other folks, and asking them when you need care management, like how happy are you with the existing array in your community? And you will find pretty clearly there will be, are certain communities where it wouldn't make sense to offer it on your own. But there are others where

God, we need another solution out here and what a great opportunity, but it's really important to do the due diligence and to check like any good business plan is you want to know what your competition is like and you want to know your marketplace, can they afford and the pricing, you know, the pricing that you would intend.

Miriam Allred (47:34)
Yeah, all great factors for them to consider. You're in the LA area, which is one of the largest metro cities in this country. Do you have a sense of how many care management companies exist in your market?

Steven Barlam (47:50)
Not enough. Yeah, isn't that interesting? There are, I have colleagues in the community. may have 20 to 25 and we could use more.

Miriam Allred (47:51)
Not enough.

Wow, that's see, that's very interesting when you talk about market research and looking hard at your own market as their saturation. If a market like LA isn't saturated, I'd imagine there's a lot of opportunity in most areas then.

Steven Barlam (48:21)
Yes,

yeah, yeah. Although in some communities, they're completely saturated or, you know, I think about New York, I think about Boston area, I think about Chicago, and we used to have operations in all those areas and they were a bit more saturated. LA, for whatever reason, you know, was not as saturated and thank goodness in a way.

Miriam Allred (48:49)
Is it common for there to be a few big key players? Is that how care management operates or is it very fragmented and there's just a surplus of them?

Steven Barlam (49:00)
Very

fragmented. It's very fragmented. There are organizations, some really interesting players out there that are consolidators or who are doing things private labeled ⁓ to be able to offer bigger, larger services through network models, through private labeled models.

And that's really interesting. I've seen a lot of that back in the nineties and early 2000, then they sort of disappeared for a while and they're reemerging. And we'll see if they'll be successful this time around. I think that it, it's a lot about timing and are people sophisticated enough?

to be able to accept, use, purchase services and we keep evolving and I'm convinced that you know the market is ready for that.

Miriam Allred (50:09)
Okay, this might be a totally moot point, but you providing home care and care management. Is there any way in which it makes sense to still partner with them even though you offer that service?

Steven Barlam (50:22)
we absolutely. So, and we tell folks we'd be shooting ourselves in the foot if we ever tried to steal away your care management business, right? Even though we do care management and we do home care, if you refer to our home care, we will, we understand what your needs are thoroughly because we're an insider. We get it.

and we will serve you extremely well. And we get referrals for the home care side from independent care managers. And we refer out when we're at capacity or for clients that just aren't a good match for us. So we figure out how to play nice, nice, right? In our sphere and it works for us.

Miriam Allred (51:17)
Okay, I'm glad I asked that then because that's exactly right. Care managers can refer you home care business even though they know you're a care management company. If you provide really good home care, they want to refer to you regardless.

Steven Barlam (51:29)
Right?

Exactly. Now some are a bit skittish because they're fearful that a family will want to do like we just got ⁓ a call that we lost. And the reason that we lost it is because our competition also does physical therapy, occupational therapy, home health services and home care. And this

family who is a physician felt more comfortable with going for the full comprehensive solution. We just don't offer that. And so there are people who are fearful because we offer more things that families might be more inclined to go with us. But again, we tell folks it would be suicide for us to try to try to steal away your clients.

Miriam Allred (52:24)
Hmm.

Steven Barlam (52:28)
⁓ If you're making a referral to us, we want more referrals from you, like we'd be stupid to do that. So there have been many times we have tried to convince families and are successful. Stay with your care manager, please. ⁓ It just makes sense.

Miriam Allred (52:34)
Mm-hmm. Yeah.

So in your opinion, home care and care management, is there always room for both to play nicely in that every home care company needs to understand what care management is and seek it out either internally or externally? Like the two just go hand in hand together nicely always. Is that your opinion?

Steven Barlam (53:08)
Interesting. I would say 95 % of the time. But there are some times that care managers can be pain in the butts for a home care agency. We're one more contact that you need to make. We're somebody who is telling the family, you know, whispering in their ear, right?

And it sometimes is inconvenient or we can make it a little bit more difficult by having a care manager involved. So there are some home care companies who prefer to ignore care managers and just, you know, I don't want to bother with them. They get enough business from other sources. So that's just an interesting, but that's a small, small.

Overall, care managers can be the very best referral sources. my God. From my perspective, there are three things. If somebody lives in my area, can afford my services, and has the right need, like that's gold, right? And care managers have so many of those people.

They have the people living in my area who have the right need, who can afford service. Like, my goodness, if I devote just a little time to that care manager, it's good business sense.

Miriam Allred (54:48)
Two high level questions, Steve, as we wrap up here. You have been in this space for 40 years. I want to know, are you satisfied with the present state of care management or is there a lot left to be desired?

Steven Barlam (55:04)
There's a lot left to be desired. I am amazed at how far we have come and there have been some changes and some great changes along the road. But as I hear the clock ticking louder, as I come to the 40 years or so that I've been in the field,

I see that there is so much more that can be done and I'm excited because I've seen some of the changes recently. ⁓ Some of the changes with technology, with AI, with documentation, with platforms that you can share information with greater ease. I see there are changes. One important change is

not necessarily doing for the client. know, care managers come in, we assess, we figure out a plan, we intervene, we make recommendations, but there's not enough of us to serve all these clients that are coming down the road. And so there has to be a shift of how do we help families become the care manager? How do we help? And so there's this whole

movement within care management around how do we educate, how do we coach in a different way than doing for. And that I think is a great opportunity for that next generation because there's just not going to be enough of us to meet the need.

Miriam Allred (56:37)
Hmm.

Hmm.

Yeah, I think you're answering what was going to be my next question, is where is all? No, that's great. Where is all of this heading and where do you want it to head? know, like you say, demand wise, it might need to head in the direction that you just illustrated, which is we educate and coach and train up people to do this work. If you could set the standard and five years from now or 10 years from now, what do you want care management to look like? And maybe from the home care lens specifically, what

Steven Barlam (56:54)
sorry.

Mm-hmm.

Miriam Allred (57:20)
What should the standard be in the industry for care management?

Steven Barlam (57:28)
I think it's all about quality. It's all about, it has to be about meeting the clients where they're at. So there will always be the places for the boutique players, the home care players, the care management players that are high quality, really magnificent. And they are in parallel with the larger systems.

that will provide care coordination, care management to help folks really just to be more efficient, to be more effective in the work. I heard this interesting quote and it was related to AI. Okay, and you know, lot of people...

are so fearful of AI, like how is it going to replace me and all that kind of stuff. And it was really about the quote had something to the effect of you shouldn't be so concerned with AI replacing you, but you should be more concerned with your colleagues who are using AI well, because they're going to be the ones who are going to replace you.

And so in the same way, we can't be so fearful about technology and some of these changes that are coming down the pike, we need to embrace them, but do it in a wise way. Because if we don't, it's gonna leave us in the dust. And so in the same way, I would say to all of my colleagues as leaders in the home care arena,

It's really, you can't ignore care management, embrace it. Whether you partner with us, whether you buy us, whether you create, just don't ignore because if you ignore, you're going to be left behind. And that would be the worst thing in the world. So it's how do you leverage that?

Miriam Allred (59:36)
Yeah, really,

really great comments. I think of the words like differentiation, innovation and efficiency. And this this industry, it's it's more crowded and complex than it ever has been. But in a good way, it's pushing all of us to think differently, to work harder, work smarter. And there's just so much access to tools and resources and information. But it's what do do with that? And are you doing a little bit better than, you know, the guy next door?

Steven Barlam (1:00:02)
Yeah, that's it.

Miriam Allred (1:00:04)
Steve, know we've bopped around here to different topics, so thank you for bearing with me, but a lot of really, a lot of good questions, a lot of good answers, and a lot of good insights. Again, every home care company comes up on these junctures of what should they do and where should they go next? And the more that I learn about care management, the more that I surround myself with companies like yourself that do both, I'm developing this like personal bias that I think there's a lot of value in care management and it's...

Steven Barlam (1:00:07)
We sure have. This has been fun.

Miriam Allred (1:00:31)
and it's what families need in a lot of ways. so defining it, understanding it, partnering with it, like you said, building it or buying it, I think there's room for all of it, but I think it's just another really good opportunity that every home care company should have on the table and consider at some point.

Steven Barlam (1:00:49)
Thank you. I would agree.

Miriam Allred (1:00:51)
So thank you so much for joining me in the lab, Steve. We will wrap here, and I'll look forward to more conversations with you in the future.

Steven Barlam (1:00:58)
Thank you so much, Miriam. What a pleasure.