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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 (00:55)
Welcome to the lab live at HCAOA with Carmen Perry, the VP of provider engagement at Paradigm Carmen, welcome to the show.
Carmen Perry (01:06)
Thank you, Miriam Thank you for having me.
Miriam Allred (01:08)
You are amazing. We have connected over the years. You know what I was actually thinking the first time that we met in person was in Tennessee at the Independent Home Care Alliance conference. I was speaking. I was like so young back then and knew nothing, but I was speaking and you were speaking and that was the first time I think we met and that was like five years ago. Wow. Do you remember that? Yes.
Carmen Perry (01:31)
I do. We're in Nashville. That's five years.
Miriam Allred (01:35)
That was small and that was a long time ago, but that was where we first met.
Carmen Perry (01:40)
Wow. Wow, we've known each other for a while.
Miriam Allred (01:43)
We've
known each other for a while. And now here we are, HCAOA 2025. Love that. Sitting on stage with the mics and we're going to go for it. Let's start with, I think a lot of people know you. You do a lot of public speaking, but I want to hear a little bit more about your background. What led you into healthcare, into home care, and then veterans care specifically is kind what you're known for. So give us the background.
Carmen Perry (01:51)
out.
So, you know, my first job in healthcare, I was working in a small beach town. I grew up in Santa Cruz in California, and it's a pretty small beach town, and we really have limited, you know, healthcare options just because it's small. And so my first job was at Santa Cruz Healthcare Center, and it was a skilled nursing facility.
In the facility, I did all the financial piece of it, but I got to interact with a lot of the patients and a lot of them were my friend's grandparents. Amazing. And so I'd take my break and I'd go talk to them. They'd tell me all these funny stories about my friends growing up. I just, loved, I loved the stories. I fell in love with working with older adults. And I quickly realized that when people go into facilities where it's necessary to have, it's not the ideal place to be.
And I learned about home care. And I'm like, well, if you can stay at home, who would come here? So I started working in home care. And we were talking a long time ago. I quickly realized that the biggest concern about home care was the cost of it. The majority of people that needed it couldn't afford it. There were limited funding options. And that was heartbreaking to me. It really was, because anyone, I mean, we all want to be in our own homes.
So of course, the older you get, you want to stay there. And I started learning about different funding options. And one of the ones I learned about was ⁓ aid and attendance for veterans. And I was talking to somebody about it, and they said, know, like, the majority of veterans don't even know that this funding is available to them. And I was like, you got to be kidding me. It's like free money. Like, we got to go tell them about this. And the owner of that company was like, you got to come work for me.
Miriam Allred (03:50)
I have no idea.
Carmen Perry (03:53)
Like you're like passionate about this. Like you should come do this. And I literally fell in love with educating people on what was available. Sorry. You're fine. Fell off. I got really excited about telling people about what was available. And it broke my heart a little bit because the more veterans you meet, the more you learn how much they don't know what that's available to them. And there's so much.
Miriam Allred (04:20)
How did
you go about educating yourself? Because it's kind of hairy. Like there's a lot of details. How did you go about your own education?
Carmen Perry (04:27)
You know, that's a really good question because I think a lot of people today, even now, ⁓ are desperate to get good information. There's a lot of bad information out there. And, you know, I really, I paid attention to the people that were actually getting help and I asked them, where did you go? Who got you help? How did you find out about, you know, legal assistance? How did you find out about free home care? How did you find out?
about food assistance. know, there's so many programs for veterans, but I made sure I connected with the people that were actually getting services.
Miriam Allred (05:02)
And what were those answers? What were they saying? Where were they turning to?
Carmen Perry (05:05)
So it varied.
⁓ There's a lot of organizations out there, and you have to be really careful because veterans is also a trigger word. And people say veteran just to get the attention, but they're not necessarily doing the best things for veterans. to me, I really aligned myself with the people that were operating ethically, but...
Also, we're actually getting people help. There's a lot of people out there will take information and sell that information, but they'll never actually get people help. And those organizations don't last very long, but they affect the trust that people have when you say, I'm out here to help a veteran. So the answers, they vary. I will say that one of the biggest issues I have noticed with veterans is they have a huge distrust of the VA. ⁓ They feel...
A lot of them feel that they were promised so much going in. You know, we're going to take care of you. We're going to provide health care. Your family's going be taken care of. And they feel like they get to that point of actually needing that assistance. And a lot of it falls flat. They feel like, you know, there are empty promises that never came to fruition. And it's very frustrating for them. So when you go to a veteran and say, hey, go to the VA for help, they're hesitant to do it.
Miriam Allred (06:26)
Is that like rooted in almost just customer service issue? They call in and someone's not receptive to them. Like that's maybe like the issue at the surface.
Carmen Perry (06:35)
That, and I think there's a lack of consistency. I think that a veteran can call the 1-800-number one day and get one answer. You call the next day get a different answer. there's no credibility there. You're like, which one was right? They don't know. And it's frustrating. You know, I tell home care owners this all the time. If you're this frustrated, how do you think they feel? They like signed up and volunteered.
to serve our country. And they stood up when most people didn't. You know, some people were just pulled into it. They didn't even volunteer. And then here they are saying, hey, help me. And they can't get it. I'm like, yes, we're frustrated on the provider side and on the care side. We're frustrated. But you got to put yourself in their shoes and really understand what they're trying to navigate. And then work with people that can actually help them navigate this to reduce the frustration for the veteran and for you.
Miriam Allred (07:33)
Let's zoom out. already like getting right in, which I love, but let's zoom out. Like VA landscape. You have this really interesting position with Paradigm where you can see kind of across the country, like the landscape of VA. And I know that's a broad question, but like, what are you seeing? What's happening? Are there more providers than there's ever been? Is there more demand? Are we meeting that demand? Like, what are you seeing nationally?
Carmen Perry (07:36)
Yeah
You know, I like that you asked that question because I think, you know, there's such confusion. They go to the VA and they want to get credentialed. And they're like, why can't I get credentialed? Why, you know, I want to provide care to veterans. know veterans need help. And they're being told you're in an oversaturated area. So in your mind, you think, OK, there's too many providers in this area to provide care to veterans and I can't be accepted in.
Miriam Allred (08:17)
all the
veterans are getting care because there's so many providers.
Carmen Perry (08:20)
That's exactly where your mind goes, logically. But the reality is, everyone saw that increase in VA rates a couple years back. For years, we all know. For years, the VA was having a lot of issues credentialing people, paying people, processing claims. There was a lot of problems. So when they brought in TriWest and Optum to manage this, the third party administrators to manage the credentialing, manage the whole process,
They also reevaluated the rates and started paying some really good rates. They started paying on time. for providers that just weren't on that bandwagon at the time, now they're getting the memo that they're like, it's too late because, know, TriWest and Optum say, if we have this, you know, let's just say for example, we have hundred providers in this area, we don't need any more. But the reality is the hours right now are becoming, they're reevaluating the hours and reducing them.
So you're looking at having to staff two hour shifts on the drop of a referral. And not all providers can do that. They're not positioned financially to just say, OK, I can send one caregiver out here for two hours and across town for another two hours. It's just it's not financially feasible and it doesn't make fiscal sense, especially for a lot of the newer providers. it's even though there are a lot of providers in the system, the
challenge is finding providers that can adapt to those reduced hours for the long term. And a lot of providers are pulling away and saying, I can't do that. It's not making sense for me. So now you've got 100 providers, not the only handful of them can manage that kind of a schedule. there are some places where they're saturated, where the VA is now opening up and saying, hey, we need some more providers that can adapt and actually handle this, this kind of a schedule.
Miriam Allred (09:59)
you
Carmen Perry (10:11)
There also are ways around the oversaturated areas. know, veterans have a choice. They have a choice on who provides their care. And I think, you know, this is a hill I will die on. It does not matter if you are credentialed or not. If a veteran says, trust this provider and this is who I'm comfortable with, this is who's providing care to me, this is who I want, that's who they should get.
Miriam Allred (10:34)
choice.
Carmen Perry (10:35)
It should never
be a conversation that, you know, you're going to go with one of our providers that we're choosing for you. That's not the case. And I know that that's easier said than done in some cases, but it's law and it should be followed.
Miriam Allred (10:51)
Okay, and so there are some of these saturated markets, saturated states, where they say it's like closed, it's like no more. Is that like half the states, three quarters of the states? Like how many states are in that category? Ballpark.
Carmen Perry (11:07)
That is such a hard question to answer. don't even know. It's a good amount. And you know what I will say? It's not necessarily states because the only states that are absolutely shut is Texas and California, which, you know, it's kind of interesting because if you look at like ⁓ a United States map and you look at, you know, where home care agencies are highest concentrated, it's actually on the Eastern seaboard. Like that's majority of where they are. But
Miriam Allred (11:11)
But it's a good amount.
Okay.
Carmen Perry (11:36)
California and Texas have a very high amount of veterans that are accessing benefits. they have a lot of providers there too that got credentialed. I would say those are the biggest states that are just shut. Other states, they have regions, but they have pockets where they actually need providers. And I tell providers, like, if you cover those areas, you can get credentialed in those areas and care throughout the state.
Miriam Allred (11:50)
Okay.
Carmen Perry (12:05)
like focus on where they actually do need assistance. ⁓
Miriam Allred (12:09)
Because I say state, but every state has, can have multiple VAs that are all like geographic. And so it's not like state by state. It's really like VA office to VA office, which is more nuanced than that. And you were saying a minute ago, so even if they say they're closed or they're not taking new providers, there is a way in, which is going directly to the veteran. And you probably see that firsthand, these companies that want to get in, that go out and find the veterans themselves.
Carmen Perry (12:22)
Absolutely.
They
do. I, you know, you were talking about, know, myths. And that's where this goes for me. Because the biggest myth in this whole scheme is when I become credentialed, I'm going to get this onslaught of referrals. Like, the gates are going to open. Here come the veterans that I get to provide care for.
Miriam Allred (12:59)
This is just gonna go
up,
Carmen Perry (13:01)
I'm going get these incredible rates. It's going to be wonderful. It's the biggest lie ever told in home care. I don't know who started it. The reality is when it comes to providing care, if you keep the veteran at the focus and they're the center of trying to provide care, you're going to get referrals from the VA. That is a reality. If they know that you're out there providing care and you are making sure that veteran is getting all of their needs met,
Miriam Allred (13:08)
I don't know They need to stop.
Carmen Perry (13:31)
They're going to... That information does circulate at the case manager level. They're like, this agency, they take the referral, they take the authorization, they get a caregiver out there pretty quickly, they're billing on time, they're communicating with me. They're telling me what's going on with the veteran. And that's a big deal to them because case managers are disconnected from the veteran.
And they're responsible for that care. They're responsible to know what's going on day to day in that veteran's life. And they don't have eyes. They're remote employees. They don't have eyes on that veteran. They're making a call and they're getting as much information as they can if the veteran answers the phone. So I tell providers, when you get the opportunity to take care of a veteran, you want to communicate with that case manager as much as you can about what's going on with that veteran.
because that's going to give them the tools they need to reauthorize care and communicate that up the chain and say, home care is working. This veteran was able to thrive in their space because of this program. And that fulfills a lot of needs. That opens the doors for more funding for more veterans to get care. So I tell providers, you're not going to get that onslaught of referrals. However,
you open up that line of communication with that case manager and you create a trust and a transparency, you're going to get more referrals. I always say, communicate the good, the bad, the ugly.
Miriam Allred (14:58)
Yeah, I think it's, it's similar to in private pay, you have all these referral sources. This case manager, it's another person that you have to build a real trustworthy relationship with, drive value to them, ensure that that client receives exceptional care, and then that trust just snowballs. And so it's not a, you get credentialed and then referrals are pouring out from the heavens. It's like, have to do, that's when the work really starts getting that first referral, building that trust, ensuring great care, and then getting the next referral and the next and the next.
And yeah, where does that myth come from? That you get credentialed and all of a sudden, I don't know where that started or what's behind that, why people think that way.
Carmen Perry (15:27)
Exactly. Exactly.
out. Tell me. I'd love to talk to that person. It's so crazy to me. And it's, it's, it's everyone thinks it. So I'm really curious. I like, I like being able to tell them that forget about the referrals, forget about the VA, focus on the veteran and go into your community. And I tell everyone, if you take nothing else from what I say, take this. Educate and advocate. That's what you need to do.
You need to educate your community on what's available to veterans, what you yourself are bringing to the table to take care of your veteran community in your area. Become that go-to person. Become that person that they trust. And they can say, okay, if I go here and I talk to, know, Miriam, she's going to tell me what I can get or where I can go to get the help I need. And I can trust it because it's going to work.
Miriam Allred (16:30)
What are some of the organizations, events in a community? And I know this area specific, but what are some of the events, partners, resources that someone could tap into to get in front of veterans in a community?
Carmen Perry (16:45)
So I recommend three. ⁓ I really recommend connecting with your local VFW. While VFW is not necessarily the largest group out there, it is the oldest. VFW, Veterans of Foreign Wars. They operate in post. They're national. ⁓ You could go in any day of the week and meet a veteran that served overseas in there. ⁓
Miriam Allred (17:01)
VFW.
Carmen Perry (17:14)
I like that group because it's also a place where veterans go to feel connected and that camaraderie and feel like someone understands what they've been through. There's a lot of resources they offer at the VFW. ⁓ There's also the American Legion. ⁓ Now, they are not the oldest, because the VFW is, but they're the largest group that has a lot of influence on veteran operations in the United States and on policy for veterans.
They also operate in post and again a lot of resources you can get there. There's Wounded Warrior, which is the newest organization I recommend. They started after 9-11 and really focused on a lot of the veterans that served in the Gulf Wars and they're coming back wounded from their service.
What I like about those three organizations is you can go there and you can get assistance with applications. You can get assistance with trusted resources. They won't send you anywhere wrong or, you know, that hasn't been fully vetted. ⁓ But you can go to any of those resources at any point and get assistance. So even if you, as like a home care provider, don't really know what to do or how to walk someone through an application, go to any of those in your local community. Like I said, American Legion, VFW, all operate in post.
They're in every county. There's gonna be one near you. And you can go there and actually connect with veterans. And even if the veterans that are in those posts when you go there don't need your help, I guarantee you they know someone at home that's not there that does need your help. So I tell providers to align themselves with trusted places like that.
Miriam Allred (18:51)
And boom, there they are. three. You're you know, your stuff that was right off the cuff. You didn't even like skip a beat. Let's talk a little bit about credentialing. That's kind of like the, you know, like the technical aspect of getting started here. That's obviously something that Paradigm helps with. And I hear time and time again, like Paradigm, we basically showed up, they did all the work and that's amazing. So there's almost like this black box of like what credentialing is because you guys take on a lot of that responsibility. Walk through just like the key points of the credentialing process.
Carmen Perry (19:20)
You know, it's first, obviously, identifying if they're even accepting applications. think a lot of people, there's a lot of guesswork there because they don't know, like, am I in a saturated area? Am I not? You know, who knows? So just having that knowledge and us being able to kind of do that front end work for them is helpful.
Miriam Allred (19:36)
Is that listed publicly? How do you find that out? have to call the VA office.
Carmen Perry (19:40)
We have to call and find out.
No, VA actually won't know. You've got to work with Tri-West and Optum. That's all been kind of capitated over to them. Absolutely. They're the ones responsible for it now. They're the ones who got those contracts. So they manage it all and they tell you whether we're accepting applications or not.
Miriam Allred (19:49)
They are the ones that safeguard that information.
Carmen Perry (20:01)
⁓ You know, there's those few exceptions. There's the exception, you know, if you're in an area where it's saturated, but you cover an area that's not saturated, you know, under that same VA, that's an exception. There's veterans that choose that they want the care through you. That's an exception. But really, it's understanding. The thing about Paradigm is that they're going to have the latest knowledge. They have really positioned themselves to keep up to date with everything that's going on. So you can trust what's coming from them. And if you need...
if you have questions or you need to understand, can I get credentialed or can I not? It's a good place to start. It's a great place to start. They take the guesswork out of it. It's like, we want home care providers to focus on what they do best, which is providing that care to the veterans. Once they get that veteran and they get in through that door, that job becomes 10 times more hard. So we want them to focus on that and like, do with the rest.
Miriam Allred (20:53)
take on the rest.
So first you need that answer and then the application process. Talk a little bit about application process.
Carmen Perry (21:03)
You know, that I don't really feel is the difficult part. I think once you, you you have to have your NPI, which, you know, the majority of providers have, not all, but that's not a hard thing to do, is getting an NPI. It's like getting an EIN. You you apply for it, you get it. That number is the identifying number. That's the number you use for billing, but you need to make sure you have an NPI. ⁓
you're going to have to make sure that you have all your business licenses. so it's going to be state specific because each state has different requirements. Like California and New York are highly home care regulated states. So there's going to be a higher requirement for the application process in those areas. But there are states that don't even require licenses. it's state specific. It's whatever is required in your state. ⁓ And again, when you get to that point in providing care, it's also state specific where they have RN assessments that are required. Not all do, but some do.
Miriam Allred (21:38)
state.
Carmen Perry (21:56)
It's really abiding by your home care state law. So it's also being aware of what's going on in your state. Some people just buy a home care agency they don't really know. So in some cases, we're having to educate them on what's needed. ⁓ But yeah, the application process isn't difficult.
Miriam Allred (22:13)
It's just making sure you're credible and like a legitimate business in the state. And then you submit that application and then the processing time and like the approval time that vary widely from like what to what though, a couple of weeks to a couple of months or.
Carmen Perry (22:22)
⁓ It really does.
God.
We're talking about once the application's You submit it. Oh, OK. Oh, my God. When they're waiting for credentialing, because that could go,
Miriam Allred (22:35)
Well, yeah, you tell me both. Tell me both.
Carmen Perry (22:38)
So when they're in a saturated area and you call Optum and say you want to get on their waiting list, ⁓ and I say Optum, could be either Tri-West or Optum. ⁓ If you're in a saturated area and they are not taking new providers, that wait time could go multiple years.
Miriam Allred (22:55)
Is there any transparency into the list? There's There's not, right? There's not. not like, you're 16, and then next year you're 15. Absolutely not. There's not, OK. Because they don't have to.
Carmen Perry (22:57)
There's no.
No, no, there's not. That makes it very frustrating again for a provider who's like, just want, I got veterans, I want to provide care, you know, it makes it very difficult.
Miriam Allred (23:15)
And
Paradigm doesn't have any insight into that either. Well, you have relationships at TriWest and Optum.
Carmen Perry (23:20)
And we work really hard at trying to keep an open communication with them so we understand what's going on and if anything's changing in any area. We really advocate for the provider because we understand the end user. We understand the more we advocate for providers to provide that care, more veterans are getting care. And I do appreciate that viewpoint because I think a lot of companies don't really consider that
what we do, the more we do it, who's getting more care, who's benefiting from this. And I love that that's how we approach things. I've always been that way, especially with veterans, because how do you not love your veterans? They have the best story. But I feel like if home care providers also go in with that vein, OK, whatever I'm doing at the end of the day, this man needs help or this woman needs help, and I'm going to do whatever I can to help them, you're going to be able to help them. You'll figure it out.
very, very hard to be a home care provider. Like, I have so much respect for how they operate their business. Like, you're going into someone's home and saying, I'm going to help you stay here. And like, that's the coolest thing ever.
Miriam Allred (24:31)
I was just saying that as I sat down to lunch, like you're in good company because this, industry is tough and we're all just trauma bonding at this conference. Your pain tolerance, there's just one problem after the next, but we just get better at managing the problems. So the second part of that question is the application process. How long typically can that application process take?
Carmen Perry (24:44)
100 %
So
if everything's ready to go, I mean, you're looking that that could take anywhere from a couple weeks to a couple months. And like I said, you're on the other end waiting to get even the application to credential. You're looking at anywhere from a couple months to a couple years.
Miriam Allred (25:05)
Okay, so and the application the only what would be the reasons that your application doesn't get accepted?
Carmen Perry (25:13)
So, it's funny you ask that. I just ran into this the other day because when you have a bunch of numbers you're submitting to get credentialed, if your numbers aren't necessarily like maybe your MPI is associated with your old office address, you moved your offices, or if there's just something that they're researching and it's not connecting, that could be an issue. It's funny since I've been working with veterans, I always say I've learned to...
dot every I cross every T, because you do one thing wrong on a VA application. mean, they're, they're, they're, they're, it's very damaging to them getting care. You've got to be really clear about your paperwork. It's funny. It's made me really good at registration for my kids' You know what I mean? Because I'm like, I know how to do this. But, um, no.
Miriam Allred (26:03)
It's kind
of like screening these companies, like how closely are they paying attention to these details because when it gets to the actual care, we need them to be paying close attention to every single detail. It's making me think of like the screening process for caregivers, like this extensive screening process. It's just so that you can ensure quality on the other side. I think that's how the VA approaches it as well. It's like we want to ensure the best companies are getting these VA referrals.
Carmen Perry (26:15)
Hopefully.
Absolutely.
We're talking about care for veterans. We want to make sure they're getting the best possible care. Someone that can fill out an application. That qualifies.
Miriam Allred (26:37)
So,
so after the application, after the credentialing, after the credentialing, after the application, we were talking earlier about getting that first referral. They don't just hand those referrals out. That's where the real work actually starts. Do you encourage a lot of providers probably to build a relationship with the case manager and or go out and find the veterans themselves? Like what, what path do you recommend? Both paths.
Carmen Perry (27:02)
I do, but I say this, because in some situations, you're going to get a referral right away. In some situations, they're like, because you're closest to the veteran. They use their internal system, and they pull up, okay, veteran Smith lives here. We've got a 25-mile radius. These are all the providers in the area. This is the one we're going to go with. So if your NPI is attached to that address and it's within the closest one to the veteran,
you're going to get that referral. So some people do get a referral. An onslaught? No. One or two? Yes. ⁓ I tell everybody that's your invitation to open up communication with that caseworker and really establish who you are going to be as a provider to them. Are you going to be the go-to? Are you going to be someone they can trust? I, again, was saying earlier about communication, know, realistically, if something goes wrong in home care, because we always say it's not if, it's when.
If something goes wrong, you need to be the first one on the phone with that caseworker. You need to be the first one communicating the issue. You need to tell them what happened. You need to tell them how you solved the problem and how you're going to prevent it from happening again. That is going to create the trust you need for that way they know, okay, if I send it there, if something goes wrong, at least I know they'll take care of it, or I know who to contact to get it taken care of. That's going to really create a trust with them. And you need to do that. If they don't know who you are,
The only way to establish that is by creating that relationship with them. You can't go in there and bring them cookies and you can't just talk to them for no reason. They're busy. They're overworked. They don't want to just talk to you. They do get the opportunity to learn who you are through the care you provide. That's it. So be that provider that gives them the information before they come looking for you. Don't let a family member be the first phone call when something goes wrong, because that's going to break their heart. don't want...
providers that can, they can trust and that they know are taking care of the veterans. Be that.
Miriam Allred (29:02)
and then they give you that first referral and you treat that like gold. Like it is a prized jewel because what you do with that first referral matters. And then the additional work starts, which is the care plan and the assessment and the authorization and the reauthorization. Like there's a lot of logistics to these cases. ⁓ What are, guess, just some of like the common pitfalls when the care actually starts? Again, there's a lot of these like technical.
logistical nuances for a VA case. What are some of the pitfalls that providers might fall into? What are the mistakes they might make with that first referral that you've seen?
Carmen Perry (29:37)
That is a really good question because I think when people are new to the VA, they get so excited. They're just like, I got a veteran, let's go. And it's like, okay, hold on, wait, fuck the brain. Compliance issue, let's focus. Like, no, overtime, remember that. you know, some people think like, especially let's go with California, because I'm a California girl. In California, there's a lot of laws around overtime. You can't pay overtime with... ⁓
Miriam Allred (29:47)
Like gear up.
Carmen Perry (30:05)
veterans benefits, but in California, you work over eight hours, that's time and a half. So you have to really be aware of your state laws, but also the VA compliance requirements. And, you know, not being in compliance with the VA could actually get you to lose your credentialing with the VA for good. So you have to be aware of what's required and operate within those laws and within their compliance requirements to
stay on board. I mentioned overtime, but there's holidays. We're not playing time and a half on holidays either. Not over billing, because they're going to authorize you a certain amount of units per client, a certain amount of hours. And what kind of trips some providers up is their weeks go from Monday to Sunday, but the weeks for the VA go from Saturday to Sunday, or Sunday to Saturday, sorry.
And so when you think about it, you're billing within your hours on the weeks that you operate, but you're not operating in the same weeks that the VA operates. And that is something that's so simple that can be easy. So I do think it's important to inform yourself, educate yourself, know what the requirements are, know how, like just make sure that you're doing everything right, because you don't want to lose your credential. You work so hard and sometimes wait so long to get it.
Miriam Allred (31:12)
Easy trip up though.
Carmen Perry (31:30)
You just want to make sure you get to keep it. You want to keep providing care to veterans. educate yourself.
Miriam Allred (31:34)
A few minutes ago you were talking about how maybe nationwide the VA is like reducing hours. What's going on?
Carmen Perry (31:41)
Yeah, that's, you know, one of the things I think about a lot, and I think right now is one of my biggest concerns for providers, is that across the country, this is not happening in one area or two areas. This is like a nationwide issue where I'm seeing a reduction in hours, ⁓ where a veteran that will say getting 40 hours is now getting 20 hours. Like, they're getting cut significantly. ⁓ I'm also seeing a reduction in authorization, so...
while they're bringing on lot of new veterans, a lot of veterans that have been on the services for a long time are not getting reauthorized for new hours, which concerns me a lot because when you are used to getting home cared as a veteran and you're in your home and you know, okay, I'm holding on for one more day and my caregiver is coming, and then the VA is like, you know what, we're not authorizing these services anymore, that can be life-changing for somebody.
Miriam Allred (32:36)
So who is behind this? What's behind this? Is this Tri-West Optum? Is this the local VA? Is this the national VA? Who is the...
Carmen Perry (32:43)
So the local VA's are the ones who authorize the hours. one of the things I'm seeing, I mean, this is something that also concerns me, is that home care providers are required to put care notes in to submit their billing. And instead of actually using that opportunity to say, hey, I'm noticing a decline in Mr. Smith or the veteran. ⁓
I'm noticing they're having a hard time walking, they're needing more assistance with bathing, they're unable to stand at the stove and cook their meals. Instead of communicating that, they're using a checkbox, help the veterans check. This is what I did. They're not getting specific. The care notes actually tell a story. So when it comes time to actually review that, renew that authorization, they're like, well, I've got a checkbox for the last two years of care.
Miriam Allred (33:36)
Wow.
Carmen Perry (33:37)
Do
they really need this help anymore? Maybe not. So I implore providers to take that opportunity to communicate what's going on with the veterans. Really, what are you actually doing for them? Tell a story as to how you're assisting them with their ADLs. ⁓ Another thing I think is a little concerning is that with the reduction of hours, instead of...
Instead of veterans being able to go and talk to their doctor about what's going on, they're getting phone calls from their case managers. And they're calling them, you know, the caregiver's there, they're having a wonderful day, we went out to lunch, we walked to the beach, you know, they're having a wonderful day and they're saying things are great. I'm going, I'm doing fine. Instead of describing like their worst day, they're getting, they're describing their best day.
You know, where some days they may have sundown or they may, you know, they may be having days where they can't get out of bed or they're unable to eat because of nausea or they're dizzy and they're not describing that day. They're telling the case manager, you know, how wonderful things are and the case manager is all like, you don't need a home care provider. You're great.
Miriam Allred (34:51)
This is super interesting. The incentives, it's like the way that the caregiver describes what's happening in the home. They want to see progress, they want to see outcomes, but it's almost like at the expense of the veterans. I haven't heard this described this way, but it's making a lot of sense.
Carmen Perry (35:10)
We tell providers to let the veterans know they're going to get a call. They're going to get asked, how are things going? And they should be honest about how things are going. But don't describe your best day.
Miriam Allred (35:23)
Yeah,
okay, super interesting. So the reduction in hours, and just to make sure I understand, like you're seeing this across the board, like this isn't in certain like regions, it's really like nationwide. And you said that the local VAs ⁓ aren't responsible for the hours, but I am correct in thinking there's like a national VA, like this all rolls up to the national level, correct?
Carmen Perry (35:34)
which is nationwide 100 % it is.
It
does. It does. But each VA has their own budget. And each budget has a capitated amount for CCN, Community Care Network. And everyone pretty much blows through those budgets because the care need is so high. I mean, everyone talks about it, right? the silver tsunami is coming. It's coming. And I'm like, no, no, no. It's here. We've got more people that need care than we have people that can provide for it. We've got more people that need care than they can afford it.
Miriam Allred (36:08)
here yesterday.
Carmen Perry (36:17)
We're living. The silver tsunami, which you guys think is coming, we're living it. ⁓ But the reality is with the VA, it's the same situation. They've got a budget. They've got a certain amount set aside, and we're blowing through that. We've got veterans every day that need care, and you think about the small percentage that are actually getting care, there's so many more out there that don't even know it's available. So there's still a need, and they are already out of money.
So they're doing what they can to try to navigate that world that they're in. There's so much uncertainty for them as well with budgets. I I'm definitely shut down. They don't know.
Miriam Allred (36:58)
But that's where some of my confusion around this lies. When I talk to these home care providers that do a lot of VA, everyone that I talk to, say, there's more veterans out there. There's so much demand. There's so much need. But then that's where I get confused. When I hear closed states, I'm like, what? That doesn't mean that state is mastered and every single veteran is getting care. it's just so interesting when I hear these comments. It's slightly confusing. Who's making all of these decisions when there's still veterans that need care? Why are we?
putting these restrictions on these companies.
Carmen Perry (37:30)
It doesn't
make sense. It doesn't make sense. And that's why I really do encourage providers to not hear closed. Forget that. Again, go out there. Educate your community because I guarantee you there are veterans in your community that have no idea they could get care in their home. And they're struggling every day. They think, ⁓ I don't need home care until I can't get out of my bed. They don't realize the little things that are so hard for them could become so much easier and really give them longevity.
and safety in their homes, just the little things. Like I tell a lot of providers, when you go to these veteran organizations I told you to go to, American Legion, VFW, when you go there, don't talk about like the high acuity care you provide. Don't talk about, know, ⁓ we're doing, you know, bed bound transfers. No, don't talk about that. Talk about the little things you do. Talk about how like you can go and prepare meals for a whole week and put it in the refrigerator for someone who can't.
you know, make a meal for themselves anymore. know, think about, like, the lighthouse keeping you do and how someone can't even hold their arm to push a vacuum cleaner, but how they'd really like their house mopped and vacuumed, you know. Like, think about the basic skills, because those are the things that people in those organizations that are sitting there talking to their friends, those are the things they don't realize they could actually get help with that would actually help them live longer in their home safely.
Miriam Allred (38:55)
Really well said, Carmen. Just so many good nuggets that people need to hear. We're talking a lot about the present state of VA. I want you to let your mind go towards future state. What are you all at Paradigm talking about and thinking about going into 2026 or the next couple of years? What trends are you seeing that's going to forecast where the VA is headed the next couple of years?
Carmen Perry (39:16)
You know, one thing I would say that I've been really seeing an increasing number about that I think providers should be aware of is local VA's really increasing their like extra level of credentialing. So when you get credentialed through VA or through TriWest and through Optum, that's the credentialing process. That should be it. You're in. But I'm noticing kind of an uptick in
Well, now that you're credentialed there, now when you have to go through an orientation at our local VA, and until you do that, you can't provide care to veterans. Or we have a preferred screening that we're going to do before you can provide care to veterans. Or just another extra hoop or an extra layer. And I'm seeing it. mean.
Yes, that's been going on for a while. I'm seeing an uptick in that. And I think providers should be aware of that. Like, okay, don't just necessarily celebrate when you get that credentialing. We need to do a deep dive on what's happening at your local VA to get you through whatever they're trying to throw at you now.
Miriam Allred (40:17)
remind me is the credentialing indefinite? You get credentialed and it's indefinite or there's a recredentialing?
Carmen Perry (40:24)
Every three years, there's a recredentialing. And really, you want to start that process like 90 days before that credentialing is up and expired because it's, again, another process. You know, if you don't get your recredentialing done in time and you continue to provide care to veterans that you're authorized to provide care for, you could actually lose your credentialing. They could choose not to pay you and not let you recredential. Because who knows what they could do. So the reality is...
Pay attention to when you got credentialed and make sure 90 days in advance you're getting all your stuff together for your application and you're ready to go when the time comes up so that they have at, I mean, 60 days at the minimum, get your stuff together and get it into your third-party administrator.
Miriam Allred (41:13)
And you were mentioning like they're putting up these new hoops to jump through. Is that likely them just trying to weed out the bad? Like there's bad actors out there. don't know.
Carmen Perry (41:24)
You know, I don't know. That's a very good question. ⁓ I hate to believe that. I hate to believe that there's, you know, providers out there providing care to our veterans that aren't operating ethically, but you never know. I really don't understand why they're doing it because it used to be like a hit and miss. Like maybe I heard about it once or twice across the country. I'm hearing now about it almost every day. It's really increased and I don't know if it's their way of, you know, finding their favorite.
Miriam Allred (41:46)
That's so interesting.
Carmen Perry (41:52)
I don't know if it's their way of really trying to just streamline who they're working with and who can actually take the cases, who's going to communicate with them effectively, who's going to provide the best care. I really like to think that's what it is.
Miriam Allred (42:08)
Okay,
yeah, super interesting. Any other trends coming to mind or things that you're hearing or keeping your, keeping the pulse on?
Carmen Perry (42:15)
You know, again, with just the reduction in hours, I would really advocate that providers are communicating the care they're providing 100 % to the VA so that those hours are not getting reduced or eliminated. I think that's something that they need to an eye out for, especially as they see reauthorizations are coming up. Start checking those care notes. Make sure those care notes are not just a checkbox. Make sure they're telling that story.
Miriam Allred (42:42)
Talk about a good use case for AI. In my mind, I'm just picturing the care notes that get submitted to the VA, and I can see all those checkboxes. It's not telling the story. It's not the picture. It's not accurate. It's literally checkboxes. That's totally open to interpretation. It is. And the worst way. And so we need the details. We need the storytelling to make sure everything's accurate. The VA can make better decisions. I agree. Let's talk about Paradigm. OK.
Carmen Perry (43:05)
Thank
Miriam Allred (43:08)
Tell me about Paradigm. I think most people know what you all do, but give us the high level, like kind of sales pitch of what you do. And honestly, while you're working there, like you haven't been there for too long. And so what drew you to Paradigm? You know...
Carmen Perry (43:21)
It's interesting. I have known about Paradigm for years. And we've co-presented for years because I love talking about veterans. They got my heart. ⁓ And I really do like the fact that Paradigm approaches what they do with, if we can help somebody, they can take care of our veterans or our older adults better. So I love that that's how they really approach their business model, patient-centric.
But ultimately, Paradigm is doing that revenue cycle management. They're managing all of that back office end of VA and third party billing. And it really takes the guesswork out of it. Like you literally do not have to even think, okay, this re-authorization is coming up, I got to take care of this, or I got to my re-credentialing done, or I got to go take care of this paperwork, or I've got to request for more information, or whatever it may be, I got a denial on my billing. What do I do with that?
There's so many questions when it comes to the VA. I like that Paradigm focuses on making that part of it a note. Like, you don't have to think about it. They just take care
Miriam Allred (44:24)
care of it.
That's what I hear from providers. When I ask them billing questions and they say they're working with Paradigm, they're like, Paradigm does that. Paradigm does that. And I'm like, wow, they do everything for you. Like, they can literally just focus on all like the front end, on the care, but you will take off all the weight on the back end.
Carmen Perry (44:41)
That's a really big deal for a provider. A lot of providers get into this and they're like, look, I want to take care of people. They don't want to think about that paperwork. That's a lot of paperwork. And like I said, with the VA, it's like the dotting of the T or the I and the crossing of the T. You've got to get that right. Having that not be something you have to worry about, it's an added benefit. It really does create a value in a business, I think.
Miriam Allred (45:07)
And there's no margin for error. There shouldn't ever be, but in private pay, maybe there's a little wiggle room, and people are patient and flexible. But in the VA, there is no margin for error, and so it has to be perfect every time.
Carmen Perry (45:18)
Yeah, and I came here because I have a huge respect for the way that Paradigm's positioned themselves. I think that when you are looking for information, say you're not working with Paradigm, but you're just trying to understand how to navigate the VA, like Paradigm doesn't gatekeep that information. They released this vault earlier this year, and I've had multiple providers who don't work with Paradigm yet, but they've come up to me and said,
When I have a question, I go to that vault. It's been really helpful. I feel like they come with the latest knowledge, and they've positioned themselves as a trusted resource. And everyone talks about, you're the VA lady. I mean, everyone calls me that. And it's OK. I'll take that. But I feel like even when I have questions, I would go to Paradigm. I love that they have really given themselves that corner of the market when it comes to who you can trust for information.
Miriam Allred (46:03)
Take that.
because we talked about that at the beginning, where you went years ago to get your information. There's a lot of bad information out there, but also it's muddy. You hit CMS's website, you hit some of these government websites, and I am just like deer in the headlights. I don't know how to make sense of any of this. I read that VA vault and I'm like, I think I could do this. It's so simple and straightforward and has all the answers that you need.
Carmen Perry (46:36)
I love that too, that vault. It's like easily digested. Like it's, okay, this is saying it how I would, I need to understand it. You know, I work with this group, this group called National Aging in Place Council. And the reason I fell in love with this group is because it's the only senior care organization in the country that...
vets, its members. You have to pass a background check. Your business has to operate with ethical standards. I mean, they hold all of their members just to a higher level in this aging in place space, like in the older adult community. And for me, I, you you were talking about where to go to get, you know, the answers. I feel like anyone in this organization, anyone in that membership, I can refer anyone to because I know they're going to be taken care of. And that's scary in this because just as much as veterans is...
you know, a trigger word, you know, seniors. Another trigger word. People say, I do this or I do that. And, you know, you don't know if they're operating okay and ethically and, you know, just in the right frame of mind and they're gonna take care of somebody. And so I love, like, learning about different groups that are actually, like, background checking and making sure that someone's operating the way they should. And I feel like Paradigm does.
Like they operate the way they should. And it's important in this industry to make sure you're working with people like... And I think, you know, I tell everyone, you know, when we tell them to grow their senior network, when you're a home care provider, you need a referral network. And we tell them, okay, go out and meet these people, meet home health, meet hospice, like meet an elder law attorney, you get your referral group together. I tell everybody, do your homework.
Miriam Allred (47:57)
Better take it.
Carmen Perry (48:17)
read the reviews because you are who you hang out with. That's just your reality. Whoever you hang out with, you're going to be associated with. You want to make sure that they're operating at the best possible level and Paradigm does that.
Miriam Allred (48:29)
And Carmen you are the VA lady I say lean in and own that girlfriend You are the VA lady and you are busy but for those listening to this that are not connected with you Make sure they get connected with you because you're busy. What's the best way for people to get in contact with you? What's your preference? LinkedIn we're linkedin girls
Carmen Perry (48:45)
Find me on LinkedIn.
I can't believe
it's been five years.
Miriam Allred (48:51)
Five years. That's crazy. Thank you so much for joining me, Carmen. This has been a ton of fun. You're a natural. There's a reason why they put you in the hot seat, but wow, you are good at this, and this has been so fun. So thank you for joining me live at HCAOA.
Carmen Perry (49:02)
Thank you, Miriam.
you