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Is there a single right way to run a home care agency? We sure don’t think so. That’s why we’re interviewing home care leaders across the industry and asking them tough questions about the strategies, operations, and decisions behind their success. Join host Miriam Allred, veteran home care podcaster known for Home Care U and Vision: The Home Care Leaders’ Podcast, as she puts high-growth home care agencies under the microscope to see what works, what doesn’t, and why. Get ready to listen, learn, and build the winning formula for your own success. In the Home Care Strategy Lab, you are the scientist.
Miriam Allred (00:07)
Michelle, welcome to the lab live at HCAOA.
Michelle Cone (00:11)
This is an exciting time to be here. Look at this room out here. It's wonderful.
Miriam Allred (00:17)
And here we are on stage with the mics under the lights. What a fun experience.
Michelle Cone (00:21)
This is an experience and you have been quite popular.
Miriam Allred (00:24)
Apparently, they keep telling me that but you were on my short list of people to have on the stage here. We have connected a lot over the years but not super recently and so I thought I want to spend time with Michelle. So thank you. Michelle Cohn with Home Well Care Services. You live here in Texas.
Michelle Cone (00:39)
I do. This was a drive and not a flight for me, which was absolutely fantastic. Maybe two and a half hours to get right here to Reunion Center of Dallas. It takes a little bit of time. ⁓ But yeah, it wasn't bad. So I get to drive home and avoid the airports and all the chaos, which is nice. Wonderful. I told my husband I'm not sure if he'll be home before I am, but it'll be around five or six.
Miriam Allred (00:45)
many hours.
Pool side with the dogs. Yes. I love your photo.
Michelle Cone (01:11)
You know I can't get a good night's sleep unless I have a chihuahua sleeping next to me, so...
Miriam Allred (01:16)
My goodness, you're so sweet. Michelle, you have been in home care for a hot minute. And I want to ask you about what you've learned and the question specifically around what has paid off? What investment have you kind of poured your time in, your business in that has taken the longest to pay off but has been worth it?
Michelle Cone (01:35)
I want to take a little spin and say, from a personal growth perspective, learning to lead with patience and learning to play the long game. ⁓ know, working to not look for the short wins and the immediate gratification, but at the long-term strategy. And I think that early on in my career, that was difficult, especially because I started out when I started out in home care many, many moons ago.
was a scheduling coordinator first, but marketing and sales has always been the background that I've played within early on. And of course, if you're in sales, instant gratification is what you want to see. So learning even in following a sales process that it may take months to build a relationship to earn the trust, to make sure that I'm listening to the needs of the person I'm visiting with, whether it's a client, whether it's a referral source, whether it's a partner.
⁓ And then how can we, whatever company or organization I may be working with, be able to meet that need, to offer some peace of mind, to provide some solution. And that is not a quick process, especially in home care. You know, at Homewell, our tagline is trusted care, true compassion. And that trusted care takes a minute. know, clients and families are trusting their loved ones ⁓ with us. Referral source and partners are trusting their
relationships and their reputation ⁓ with these families on placing these folks with you. So understanding that when it comes to leading and ⁓ while instant gratification is nice, the long game and the patience is what I've been working with over the 27 years that I've been in home care. And I think I'm finally in my 50s and figuring that out. So it's not easy.
Miriam Allred (03:32)
Patience is such an important leadership quality and it sounds like you've been putting in the work. How do you practice patience? How do you get better at patience? Tell us what you've learned, like what that self-discovery has looked like.
Michelle Cone (03:44)
Sure. Well, much of it has been necessity, right? Understanding especially when it comes to leadership, ⁓ you know, we are playing a long game, right? We ⁓ are the visionaries in our company. And whether it comes from, it relates to data or outcomes or satisfaction or new partnerships or launching new franchisees,
It takes a while to see the results and the outcome from any of those measures that we're looking at. ⁓ And so I think early on in my career, one of the things that was a challenge for me is if something wasn't working in two or three weeks, let's scrap it and burn it to the ground and build something else new. And it's not enough time in many instances for whatever initiative you're working on.
to actually show whether it's working or not, or is it, and there's certain tweaks or modifications or adaptions that you can make without having to scrap the whole project. And there's a lot of work and time that goes into a new program or a new initiative or a new partnership. And of course, the data that you need to collect and then be able to look at it over time and slice and dice and source and see what makes sense for you. So I think it was...
It was an inevitable, right? It absolutely is something that I needed to learn over my career, but I've also had wonderful mentors throughout the years. And I would say that many of the leaders that have really stood out to me, one of their core values and behaviors and characteristics that I have always admired has been their patience and their ability to slow down and process and look at the situation, the business holistically and look long-term.
down the road, long game, what makes sense now, but what makes sense six months from now, a year from now, three years from now. ⁓ And that's, think, also been something that I've really appreciated being in home care. ⁓ Typically, the journey of a client isn't a quick one, right? Now, there are...
senses of urgency and there is chaos and there is crisis 100 percent, but typically there were different situations that led to that. So these folks, while they need support now, it's something that they have needed for quite some time and you have to understand that when we meet them where they are, they're still processing that they may need that support, that they may need that help. They're still
cautious about giving up their independence, even though what we do in home care is offer them independence and allow them that autonomy to age in place within the familiarity of their own home. So I think there's so many different facets that I can pull from, either from a local level or from a 30,000 foot view, where patience is integral for any decision making that you're involved in at the local level or at the leadership level.
Miriam Allred (06:50)
The connection that I'm making, I like the word that you're using, which is processing. Home care is very reactive. There is a lot of urgency. There is a lot of chaos. so oftentimes we don't have patients because there's no time for patients. It's all happening in real time. But I like that word processing. Last night at dinner, someone was talking about a leader that they had that would always say every single, you know, big strategic decision, I need to sleep on it. I need to sleep on it. That was like her.
her rule of thumb for processing was, I'm gonna sleep on it. And I think that's so simple, but it's just giving yourself the time and the space to process and not be so reactive all the time. And that's patience and that's how you work on it is giving yourself the time and the space to process. And everyone and everything around you will benefit from that extra time to process.
Michelle Cone (07:40)
Well, you can look at the situation with a clear head, right? Because I have been very guilty of being reactionary ⁓ because I want to solve the problem immediately. It's because I want to help and I want to be valuable. And in doing so, you need to be patient and you need to step back and take a look at the situation from a 360 view to make sure that the decision that you're going to make, the recommendation, whatever, is aligned with all of the initiatives and the goals of the organizations.
and of the organization, but ⁓ also, you you want to make sure that you're tapping into processes and workflows. If something bubbles up and you don't have a clear path or a process for it, define it.
write it down, make sure it's repeatable, because I can almost guarantee it's gonna bubble up again, right? You wanna be able to plug into that process and that workflow to make it easier. And I think that that also supports the patients, right? The sense of urgency comes from the, no, what am I going to do? And I think when you have clear processes, clear workflows, clear procedures, and everyone is aligned, it helps with that a little bit. It calms the nerves and the need to be reactive or that.
push to be reactive, even though you know you shouldn't, but you just have this pull to make, to solve for the problem, to take a look back and let your processes, your workflows, and your team plug into what you've developed. And oftentimes you'll see that that challenge or concern has been mitigated by the time you take that break and you maybe come back tomorrow with a clear head and you've thought openly and intentionally about it and a completely different perspective.
Miriam Allred (09:21)
And the second part of what you said is like playing the long game. And I think home care is a long game for a lot of different reasons. How is that a mindset? You know, it's kind in my mind, it feels like a mindset, thinking short term, but also thinking long term and leaders have to balance that balance the urgency balance the short term with the long term. How have you done that? Or how are you helping other maybe franchisees leaders balance that short game and that long game?
Michelle Cone (09:49)
I think you have your short goals, your long-term initiatives, and then also you want to make sure that you have clear expectations and what is the plan of execution. So I think with all of that really supports what that long game looks like because I mean...
many agency owners that we see out with us today, they know what they want to accomplish by the end of the month, by the end of the quarter, but then what does that look like for the end of 2026? What does your business look like in 2030? I'm in franchising, so we're in a marriage for 10 years, right? And so we are playing the short game and the long game. We want satisfaction, we want results, we want to make sure that we're providing them with support and engagement so that they can help.
people in their communities and employ really wonderful people and build strong teams. ⁓ While also looking at where do you want to be in the end of 24 months, 36 months. You know, we've got owners that want to build a legacy and pass the business to their children. We have some that want to build an asset and sell some day. We have others that are empire builders and
Once they establish one territory, boy, they're hungry for the next. So I think it's the expectations of what are the goals and what are the long-term initiatives and what are the short-term steps that we can then move towards to achieve those long-term goals and those outcomes.
Miriam Allred (11:09)
put you on the spot personally. Okay. What are you thinking about for yourself? You know, when you think, yeah, playing the long game, you've been at this for a lot of years, you personally have accomplished a lot. Thank you. What's next for you? Like, what's top of mind? What's the long game for you? Like, where do you want to take yourself maybe the next couple of years?
Michelle Cone (11:27)
I would say that as I'm getting older, I'm entering my mid-50s now, that it's all about making a difference and leaving the world better than I found it. And I love home care. I've been in the healthcare industry for, gosh, I'm coming up on 30 years. It's been a minute. And I want to make sure that I'm getting involved, that I am educating anyone and everyone on the value of home care, that we exist.
this is what we can provide, this is the solutions that we can offer, whether that's readmission prevention, whether it's cost savings for payers, whether it's patient satisfaction, whatever that looks like, we are an instrumental puzzle piece that oftentimes has been missing from many of the conversations. And I think that's what motivates me is we've been building to where home care is now.
for a couple of decades, me personally. So, I mean, I was sitting with some home care executives for lunch yesterday and we're all talking about, we're seasoned, right? And we were all talking about the time is now. Like we have been working and building for this and we feel like, thank goodness we're still in this industry where we can see where home care is going to go in the next few years because the ecosystem around us is really changing. Home care at its core has not. The great quality care,
⁓ the flexibility, the peace of mind that we provide, that has not changed. But the world around us is swirling. So whether it's VA opportunities, it's Medicaid, it's CMS innovation models, it's partnership opportunities, all of these are bubbling up now and we're prepared for them. So I think that's the fun part is I did the work, we've done the work, and now we get to see the beauty of others recognizing the value in home care.
⁓ As the aging population continues to move towards 2030 and beyond, and the demand is just increasing on a day by day basis. So I plan on staying where I'm at, doing what I'm doing. I love my team. I love our executive team. I love our franchise system. This has been my first experience in franchising and I have been able to absorb so much from the team and I have really come to...
recognize and appreciate the beauty of the franchising model. Because it was a little foreign to me early on. I didn't quite understand why we couldn't do this and we couldn't do that. And it's because the franchising model is very different and it's very unique, but it's also very valuable. And I think for the right person, it can be a game changer. ⁓ And so I've seen all these wonderful owners that have been able to come into our system and...
see them achieve whatever level of success and what success is to them, that's very, very rewarding. You know, we are providing care to over 6,000, 7,000, 8,000, we're on the way to 10,000 clients a day. And that brings me tremendous satisfaction because that is more of an impact than I could have ever made at a local level as just me, myself and I.
out there trying to educate or connect or advocate. When you're able to pull folks together, that's where you see some great opportunity.
Miriam Allred (14:49)
A minute ago, the beauty of where you sit is you can be on the ground level with these home care companies, but you can also kind of sit and see at that 30,000 foot. You talk about all the opportunities in home care is the word that's coming to mind is like cresting. It's like we're coming so far and it's like, not like, don't know if we're going to crest. We don't like necessarily want to like peak, but we're kind of like on the rise in a really good way. And you just mentioned, you know, some of these like payer mix opportunities.
What are you focused on or looking at for 2026 with your franchisees? What are you guys kind of dialed into as initiatives or programs or things that you want to hit the gas on next year?
Michelle Cone (15:25)
So we've built the infrastructure and now it's just implementation and plugging in, right? So all of the programs, many of the partnerships that we've had in place, we have built the infrastructure and the architecture to support the growth. And I think that that's what we're really excited about now is whether it's our internal team or whether it's opportunities externally with what we're seeing with additional payers.
I personally am very excited about the CMS Innovation Model of the Guide Program. I think it's going to be the first of many that we're going to see down the road, but I think this goes back to the fact that home care is necessary. And if we're going to work to prevent falls, prevent ED visits, prevent ⁓ hospitalizations or readmissions, we really have to understand the needs of the clients and the families and
build intentional programs around them and capture the data over time and be able to prove that to these payers. And I have noticed the past couple of days, even at HCAOA, that's one of the things that's been called out and I've appreciated it. It's that we have done a pretty cruddy job of capturing the data to provide to partners and to payers. And then we expect Medicare Advantage plans or anyone else to be very excited about working with us. Well, we don't have the
the data and the proof to provide to them. So under these wonderful models, I'm hoping that we're going to continue to see, know under the guide model, we're partnered with Pocket RN in their first year, 24 to 25, July to July, they are seeing 30 % reduction in hospitalizations and emergency room visits.
And that's something that is irrefutable. You can put dollars behind that. You can go and speak to payers about opening up and expanding access to home care because at the end of the day, we're making a huge difference on saving Medicare dollars, saving, ⁓ you know, making sure that we're being good stewards of that money.
Miriam Allred (17:21)
We want to strike this balance though. Home care is not hospice, is not home health. And the more that we move towards diversification, we don't want to lose the essence of what home care is. It's personal. How do we strike that balance? Again, we want to be seen as a part of this continuum. We want to be seen as a sophisticated part of the puzzle, but we also don't want to lose the essence of what we are. Do you think we can strike that balance?
Michelle Cone (17:36)
It's personal.
I think we can and I think it depends on the audience and what lens we're looking through, right? Because we have many different stakeholders. ⁓ We have the clients, we have the families, we have referral sources, we have payers and we have everyone in between. So I think you have to be able to meet them where they are and give them the information that they need. For instance, you know, we talk a lot as an industry about ADLs, right? Bathing, dressing, toileting, transportation, that's all wonderful. But I think we really need to start to speak.
about how we impact the major, the healthcare continuum at large by providing the personal care support. So I think instead of hammering, yes, we do those ADLs, it's more of a what in providing supportive tasks.
What does that do to the larger ecosystem? Right? So we are keeping folks at home. We are increasing patient satisfaction. We are making sure that people are aging in place at home as they so choose. But also many folks want to ⁓ take advantage of the hospice benefit at home versus a facility placement. Right? Home health. We collaborate very well with home health. So I think continuing to look at, I used to call it the three-legged stool a long time ago. It was
basically non-medical, skilled, and hospice. And now you're seeing ⁓ kind of personal care pull apart from companionship only. You're also seeing kind of diversification from palliative care, right, that is now pre-hospice. ⁓ So there's all these different opportunities that are bubbling up and we just need to be ready to speak to them. And even in hospice and palliative care, do you have a program or an offering that's going to meet the needs of those patients in that referral source?
Home care in general, placing a caregiver in the home and providing personal care support, that's fantastic. But what are you doing to collaborate with the team, the interdisciplinary team, making sure your care team is coordinating with their care team, that the caregivers are speaking to the care managers and they're communicating any change of condition to outside partners so that they can get ahead of that. So painting more of a picture to hospice and home health of how we are in addition to of what you're doing.
We may be a non-medical component, but we are your eyes and ears when you're limited by what Medicare will or will not allow you to do.
Miriam Allred (20:08)
We drive solutions that match. And
you and I are both like sales and marketing professionals by nature. And it's all about positioning and messaging. It is. In home care, we know what we do and what we do well and the outcomes that we provide. But now it's like that storytelling and that positioning and helping people understand that the ADLs on paper are solutions. Saving lives, changing lives. Like we are the change makers. And so I think it's, I think we're getting there. It's really just positioning and messaging.
and conveying the value and the quality of home care. And we're getting better.
Michelle Cone (20:41)
We are, but you hit the nail on the head. We are not great at storytelling, right? And I think that we see, I think that that is oftentimes ⁓ highlighting the silos between the operations team and the sales and marketing team. If the operations team is not providing success stories and outcomes to sales and marketing, what are they selling and what are they messaging in your community? And I talked to many ⁓ agencies, even outside of Homewell.
Where it's like, you know, our care team doesn't really interact that much with our sales and marketing team. And I consider that table stakes. ⁓ I need those stories to be shared. I need those outcomes to be shared for fuel for the sales and marketing team, ⁓ boots on the ground or in print to make sure that you're getting that message out there to the people that need to hear it.
Miriam Allred (21:33)
Michelle, the future is bright for home care. is wonderful. we get to be a part of it. I know. I really just feel like the next couple of years, there's just this turning tide, and we've come such a long way, and it's only going to get better from here.
Michelle Cone (21:36)
So excited. So lucky.
only
going to get better. And I'm blessed to be a part of it. We have got fantastic folks that are in this space, no matter what agency or brand you choose. ⁓ These people care. We want to make a difference. ⁓ You know, we were talking, I was talking with some leaders yesterday, we're all in this together. And when we come together and we mind share and we share best practices and we take that back to our locations, we're helping more people. ⁓ Your session with the caregivers.
yesterday was phenomenal. One of the best sessions, if not the best session that I attended and I take notes and attend all of them that I can. But there's actionable strategies that we're going to be able to take back coming directly from those caregivers. But it was also validation of a lot of the things that we're doing right. The handwritten cards that came up a few times yesterday. We've been talking about CEOs and owners taking the moment to write a personal card and put it in the mail and mail it.
We had caregivers yesterday saying that they have kept some of those cards from former ⁓ leaders and agency owners 10, 15 years. So some of the old tried and true methods still work and we aren't doing enough of those things because we are chasing the shiny gift card, right, to just toss their way. And they crave more than that. And so hearing from them directly in formats like this where you're hosting a wonderful breakout and we can listen.
to them directly. I hope everyone was taking notes because there was some really great feedback that, again, was validating, but I think there's opportunities there as well. And most of it is just treating them with respect and calling them after problematic shift and ask them how they're doing, recognizing that their work is hard work.
appreciating them, but not just when you need a shift filled. So really enjoyed coming to the conference and all of the sessions, but I want to give you kudos because that was wonderful. It was emotional, had some tears in my eyes, yes, it was absolutely a fantastic panel. Thank you.
Miriam Allred (23:44)
Thanks, Michelle. It's my pleasure. I just love being here and I love doing this. And I think we can agree that we love home care because the people agree that people here are the salt of the earth. are as good as they. That's why I love being here. So thank you so much for joining me live. A lot of great little nuggets that I just took from this conversation. So thank you so much.
Michelle Cone (23:55)
It's a relationship business.
You're wonderful. Thank you so much, Miriam. I appreciate it.
you