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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 (00:00)
Hey everyone, welcome back to the Home Care Strategy Lab. I'm your host, Miriam Allred. It's great to be back with you. Hope everyone's having a great week. Today in the lab, I am joined by Daniel Stringer, the CEO at Total Care Connections based in Tempe, Arizona. Daniel, welcome to the show.
Daniel Stringer (00:15)
Awesome. Thanks, Miriam. Great to be here. Thanks for having me.
Miriam Allred (00:18)
I've been looking forward to this for a few months. You and I have talked, I don't know, over the last year or so and you're busy and you've got a lot going on, but I have genuinely been looking forward to this. So thanks for giving me the time.
Daniel Stringer (00:29)
Yeah, it's an honor to be here. I've been listening to your show and congrats to all of your success as well.
Miriam Allred (00:34)
Yeah, thank It was good to see you at Home Care Innovation Forum in California as well. So so that was a good time. let's go ahead and start with your introduction. for those that don't know you or your wife or your business, tell us a little bit about maybe your life kind of pre starting the business and then why you got into it and then we can talk a bit about your business model.
Daniel Stringer (00:54)
Okay, awesome. So my name is Daniel Stringer, and I started Total Care Connections just over 17 years ago. I was 22 years old at the time, and it was just coming off of the heels of the Great Recession of 2008, and I was trying to figure out how to survive, was really my goal in life at that young age. And started Total Care Connections down in Tucson, Arizona was our very first location, and then we've ex since expanded over the years. we've done
A couple of we've done four acquisitions in total. they were all like tuck-in type models, except for the first one we did in it was our third acquisition, but the first one that we did in Colorado, and that was our expansion into Colorado. that became our our kind of platform location for Colorado, and then we did a fourth acquisition in Colorado and tucked that in. So today we're in Tucson, Tempe, which is the greater Phoenix market, and then Colorado Springs, and we cover about seven counties in that.
Colorado Springs area, and then we have plans to continue expanding throughout both states. So that's where our current expansion plans are. Although we are open to acquisition opportunities in like adjacent states, and so we're looking, we're always looking at opportunities like that to expand, but that's our current footprint right now.
Miriam Allred (02:14)
Okay. And started as a non medical home care company and have since grown into a lot of different services and offerings, correct?
Daniel Stringer (02:22)
Yeah, so we actually started a hundred percent private pay.
that's all that we could wrap our heads around back then. And I actually started it with a business partner who I later bought out in 2015. So our first client that actually was paying was in the very beginning of 2009, down in Tucson. And then my wife and I got married in 2012. My wife is a nurse practitioner and she became our director of nursing and we actually started doing private pay nursing. So we weren't licensed as a home health agency even when we were doing the nursing.
As a private pay organization, we were able to do that. And that was something we I didn't realize we could do, but when I discovered that with the Department of Home Health, they said, you know, if this is private pay, we're not getting involved. So we were able to do that for several clients, and we continue to do that to this day. 2015, we then got our first VA contract. And this was before the Community Cares Act. We had to contract directly with the VA hospital. So it was a very difficult process to
It us years to like pound on that door until we could get that contract. And then that became like a huge part of our business down in Tucson.
Community Cares Act rolls around. 2016, we opened from scratch our Phoenix location, now headquartered in Tempe. And we were able to then take that VA contract and then that segued into the Tri-West, which is what most people are familiar with on the West Coast, for the VA. So we the we got the Tri-West contract, which now today allows us to provide VA services in all of our locations under Tri-West. And then in 2017, we
We got our first Medicaid contract. So in Arizona, it's an MCO state. So there are three managed care organizations or insurance companies that manage Medicaid funding for the state. And so it's very competitive to get a contract. And so we had tried prior to that, but had not had no success until 2017. We got our first one. We only had one MCO contract. And then that expanded to today. We have two.
Of the three MCOs in Arizona. and then in Colorado, when we acquired the agency there, it was private pay. That was in 2021. And that was 100% private pay. We added VA since we were already doing it. And then we were able to add Medicaid with our fourth acquisition, which was actually a Medicaid agency in Colorado, tucked all that together, and now we're private pay, VA, and Medicaid across the board. And then about a year and a half ago,
Actually, it's just about two years ago, we made the decision to expand into licensed skilled home health, but not doing episodic. So our model is specifically focused still on long-term care in the home, hourly shift type care in the home. But with our license and now Medicare accreditation. So we just got Medicare accredited in both Colorado and Arizona. We now have the ability to provide that long-term nursing care. Pay
By various payers, including the Federal Department of Labor, the Department of Developmentally Disabled in Arizona, we have a contract with now. TRICARE and TRI-WEST both have programs for this. There's workmen compensation programs that pay for private nursing in the home. And then Colorado Medicaid has many private duty nursing programs to provide nursing in the home.
now are you know both skilled and non-skilled and we're really going to be launching those new programs under that Medicare accreditation. Our plan is for those to really start to ramp up in the fourth quarter of this year and really steadily going, you know, starting next year.
Miriam Allred (06:16)
Fantastic. Great overview. I I know that might seem kind of like dry, but I think it's really good for people to see like this progression, you know, of a seventeen
Daniel Stringer (06:23)
Yeah.
Miriam Allred (06:23)
year old company started as private pay home care and now look at it today as just like a completely different but thriving organization. I'm always curious
Daniel Stringer (06:31)
Yeah.
Miriam Allred (06:32)
what percentage is private pay today VA versus Medicaid across the entire business?
Daniel Stringer (06:37)
Yeah.
It's a great question because it really kinda goes back to also some of the decisions we made along the way that we we didn't know then what impact that they would have. And something that
We've learned that I've learned and I think is true for all home care companies, especially just thinking about the future of home care, even today. If you're thinking about what do I need to do to pivot today or to diversify today, the thing that I've learned over the years is that without diversification, I don't know that we would have grown to where we are today. Like if we had just stayed private pay, I think one person could make the argument that no, if you s if you just hyper focused on private pay, you could
still be the same size and probably at better margins you know than you have. But
My experience has just showed me that by diversifying along the way, it's allowed us to be able to weather the ebbs and flows of home care. And it's also allowed us to be readily available for the shifts in the in the industry and the economy. I don't know, I'm not a I'm not a you know expert on the economy, but from my vantage point, just as having led this thing for 17 years and doing my own research, my
opinion is that, you know, as home care continues to evolve, the government has to continue to play more and more of a factor in this situation because the people we were providing care for almost 20 years ago, that demographic is shifting. We're moving into the baby boomer generation. And then we're gonna be, you know, seeing that kind of cap out in the over the next 20 years. But whether or not how much money they saved, how much they prepared for paying for this,
In the end, that group is going to change. Whether it grows or shrinks based upon demographic or geographical area, all of that can be kind of argued. But I think it's going to change. And I think that the government is just going to play more and more of an impact, like it or not, like it. You know, they're going to play more and more of an impact. And so for us, my my thought has been I just I want to make sure that as an organization, we're serving everybody. But the other reason why we did this is, you know, when I started the
Organization, it was like based out of survival. A lot of people have a home care starting story that's based in, well, I cared for my mom or I cared for my grandparent, and then I realized, wow, I love this, and I'm gonna start a home care company. And I wish I had that story, but I don't have that story.
Miriam Allred (09:06)
Yeah.
Daniel Stringer (09:08)
My story was I was a young kid who was trying to figure out how to be an entrepreneur in a really bad economic time. And I wanted to I wanted to solve people's needs through whatever I could figure out what to do.
And not just their wants. So this idea was if it's solving a need, then if the economy crashes again, aka COVID, then maybe my business will survive. And so, because
Miriam Allred (09:35)
Yeah.
Daniel Stringer (09:37)
I had a small business prior to starting this and it tanked. It was a recruiting
Miriam Allred (09:41)
Mm-hmm.
Daniel Stringer (09:42)
company, and I was doing headhunting for banks and mortgage companies. Well, mortgage companies suffered the most in 2008. So that thing really suffered. And so
So I wanted to solve a need. And so then I discovered home care. And you know, long story short, I was like, this is a great business opportunity. Well, that was me 22. As I've grown, my why has changed.
Miriam Allred (10:07)
Mm-hmm.
Daniel Stringer (10:08)
And
You know, I'm a Christian. I have always felt like I I've always been w been I've been somebody that's wanted to give, wanted to be philanthropic, but I've always kind of compartmentalized that. Like we have the business, and then I do giving at church and nonprofits and whatever. And as time progressed, I started to really see now this is like our business is much more than just a for profit business. And even though we are still a for-profit company, there's a lot of venues within this business where we can meet the
the my why of serving our community and serving vulnerable people, many of which are our caregivers and many of which are our clients. So when we shifted to Medicaid,
And looking at those margins, I it was it wasn't like, well, let's just figure out how we can make money off this. It was also solving this desire to say, well, as
Miriam Allred (10:57)
Mm.
Daniel Stringer (10:58)
a company, we want to serve the the least of these. We want to serve people in our community who are poor, who can't get access to care. But we want to do it at high quality levels. So whereas instead of saying, well, we're just gonna have this like carved-out bare bones service model for Medicaid, we wanted to say, How can
we still provide them with the great customer service, the care management, the coordination, like everything that we would give the private pay client. And we won't treat people any differently. So it really it became a part of our why and not just a business decision to gonna go into Medicaid.
Miriam Allred (11:33)
Yeah. And we're gonna talk about that. Like your your spirit of like giving and how you take care of your clients and your families and your employees. I wanna go back to my original question because I think it's interesting.
Daniel Stringer (11:42)
Sorry.
Miriam Allred (11:43)
No, that's okay. The the the percentage breakdown of those payer sources.
Daniel Stringer (11:47)
yes.
Miriam Allred (11:48)
I I think people are just interested to know that of like, yeah, are you still heavily private pay? But yeah, where is VA at and where's
Medicaid at?
Daniel Stringer (11:55)
No, that's great.
So no, our our private pay is now about twenty-five percent of the total company. So today, you know, it's August 2026, recording this. You know, we're at 17,000 hours a week across our three locations. And about twenty-five percent is private pay, about thirty percent is VA, and the rest is Medicaid. So the Medicaid
Miriam Allred (12:21)
Okay.
Daniel Stringer (12:22)
has become the largest bucket.
Miriam Allred (12:24)
So a very healthy mix of the three, you know. I just ask these things because still like a lot of people that start private pay oftentimes still have maybe fifty to seventy-five percent as private pay, and then they layer in maybe a twenty-five percent or thirty percent of another payer, but yours is very, very much changed and you really have kind of like a healthy mix of all three.
Daniel Stringer (12:40)
Yes. Yes.
Miriam Allred (12:43)
and 17,000 hours, I did want to ask kind of like census, like how many employees you have to date.
Daniel Stringer (12:48)
Yeah. So actively working, we have a thousand employees on any given pay period. and then we have it as any home care agency does, we have a lot of PRN staff that are coming and going. And so we have a total like active census of employees of about 1,300. But then we'll see about a thousand that are actually getting paid at every pay period. and then on the client side, we're actually at about a thousand clients now across all the locations in a given month.
That are built.
Miriam Allred (13:18)
Okay. Okay.
Awesome. Awesome. I've gotten all of the kind of like demographic questions out of you because I just like to set that stage. But what I want
Daniel Stringer (13:24)
Yeah, for sure.
Miriam Allred (13:25)
to talk about that you have told me is like your passion is really like become workforce development. Like that's something that you're focused on. That's something you've developed specific programs for over the years. And so that's what I want to talk about. and there's a couple that you have told me about maternity and paternity leave, some of these employee relief fund and grants, and also
self-insured healthcare. And so I want to talk
Daniel Stringer (13:47)
Yeah.
Miriam Allred (13:47)
about kind of the what and why of these programs. I said to you before the call, like home care is so saturated and getting so competitive, and recruiting caregivers is like still the biggest challenge, and maybe more so now than ever. And so it's programs like this and benefits like these that are really starting to set the best agencies apart. And you're an example
Daniel Stringer (14:08)
Mm-hmm.
Miriam Allred (14:09)
of that. And so I guess my first question before we get into the programs, why are
Are you passionate about workforce development? And when recently or long ago, when did you start to become like really intentional about your focus on it?
Daniel Stringer (14:24)
Yeah, no, I appreciate that. you know, we
So I would say, you know, five, six years ago, we really started to think about this probably a lot because our in the industry itself and the payers within the industry across the country really started to hone in on workforce development. COVID really shed a lot of light on this. And so this became a buzzword: workforce development. And what I started to see, and I think what is really kind of taken place amongst a lot of operators is that.
buzzword has also become
almost annoying to hear because people hear, we need to do workforce development. And it's like, what does that actually mean? and
Miriam Allred (15:09)
Mm.
Daniel Stringer (15:09)
what are we actually doing? And a lot of times that just equates to are we just pumping more money, giving more money to indeed. We're just trying to hire more people on the front end of the funnel. And so going back to kind of my why as well and what how that has shifted, I started to have really recognized that our caregivers are the same people that oftentimes show up to their church and
And need some benevolence, or show up to a food bank and need f food, you know, or they're on government assistance at the same time that they're working here. And so I just re recognize that our mission field is right in front of us. They're the people that work here. So, how as an organization do we start to look at the programs that we have in place as being, even though there are expenses that we have to expense within the organization, mentally.
I started looking at them as these are ways that we're giving, though. You know, we're giving things that we don't have to give as a company, but it's it's a legitimate way for us to actually develop our workforce, actually retain them, and meet the real needs and not just not just have this kind of
Hopeful intent to meet their needs, which I think so many organizations have. We we want to do these things, but at the end of the day, we end up only doing maybe what we just have to do. And so, and we kind of rely ultimately on government regulation before anything, we do anything more than what we have to do. but but for me, the the switch that flipped was: well, as leaders, if there's any part of us as leaders, and there is for me, but just speaking to your
Audience that wants to not just make money but also wants to be able to give money. And we think, well, let's give money to these nonprofit organizations. I would just challenge everybody to think we our own organization is a place where we can fulfill some philanthropic motivations because our team members are right in front of us and they have a lot of these needs that maybe these other nonprofits are actually solving. So when that flip switch flipped for me, it made me realize let's look at this differently and let's not.
Not
just look at these as expenses, but as investments and as giving to our own team. And so that's what really it started to change for me and realize that workforce development needs to not be about necessarily just creating new more caregivers or making caregivers aware that there are jobs, because that's being done widely. We need to be thinking about workforce development as how are we going far and above what we absolutely have to do as organizations to take care of these team members. But then as
We'll get into in this call, you know, how do you do that? Because it's not that simple. It's easy to say, it's not that simple to do.
Miriam Allred (17:59)
Exactly.
And also offering things that are relevant and useful. You know, we see a lot of agencies try a lot of different things and and then they have this bad taste in their mouth of like, we tried this thing and nobody used it. And it's like, okay, don't give up there. And so we'll talk
Daniel Stringer (18:10)
Yeah. Right.
Miriam Allred (18:12)
about that kind of towards the end of like why these things and how did you identify that they were the right things. But let's let's talk about the program. So I want to start with the maternity, paternity leave, you know, like that's not like a novel concept to anyone, but the way that you've structured it is unique and also offering all all the way to not just your office team.
but to your caregivers is also I think unique. And so talk about what the program's called and just kind of like the high level like overview of your program and how you've built it specifically.
Daniel Stringer (18:39)
So as a back background, for ten years didn't provide any paid leave for for pregnancy disability leave or maternity leave or paternity leave, which would be traditionally for dads. really, because it didn't seem conceivable that we could possibly afford that. Obviously, we're not billing anyone for those hours, so if we were just to pay them out, it would be on top of any other paid leave that we offer.
But what we when when Roe v Wade was overturned at the Supreme Court level, my wife and I, we sat down and we we felt a little bit of conviction around this topic. And just to be transparent with your audience, I'm pro-life. You know, I I bel I wanna protect life from the womb to the tomb. And that really conveys all the way to the business that we're in in the in the in the sense that we're caring for disabled people, we are caring for some people whose quality of life is very low. And so at but at the end of the day, we value all
all
life. and that's just our philosophy on on the topic. But the conviction when Roe v Wade was overturned was
We have a lot of opinions in our society and everybody has an opinion and everybody should is entitled to that. and I have no qualms with, you know, that conversation around this topic. I know it's a hot topic and I don't mean to go into it on your show, but what I want to just set the stage
Miriam Allred (19:57)
That's fine.
Daniel Stringer (19:59)
with is the conviction that we had was, sure, we have our opinion, we're pro-life. But what are we doing about it versus just having the opinion or trying to let our opinion be known if if we were even doing that, which we weren't which I haven't done that since I was young.
Miriam Allred (20:15)
Mm-hmm.
Daniel Stringer (20:15)
And so I'm trying to stay out of the political fray
these days. but anyways, so what are we doing about it? And so what the conviction that I had was, you know what, the reality is, one of the real challenges in our society for moms and dads to be able to bring children into this world, which also includes taking other children in from bad situations like foster care and adoption.
Our society, we we need our communities around us to be able to be support systems to enable people to do that effectively. And one of the great challenges of our society is that if you're a mom who or a soon-to-be mom who doesn't have a great support system and then doesn't have any kind of type of paid leave and then doesn't have much savings, then your plan to bring that child into the world is often missing a lot of keys. And so we realize, you know, if
If we're truly pro-life, this is an opportunity for us to say to our team members who are gonna bring children into this world and say, listen, we'll be there for you when that occurs. And so with some type of a paid leave program. So what we put in place was paid pregnancy disability leave. we call it that just so that we can not have any discrimination element with relation to genders. So at the end of the day, if you can become pregnant, then and you give
Birth, then you are eligible for six weeks of paid leave. The way that we do it is that we base it upon the average hours that you've worked. I think it's over the past six months that you've worked here. We take those average hours, and that's how we know how much leave you are eligible for. So if you worked 40 hours a week, then you're eligible for 40 hours a week for six weeks. If you work 20 hours a week, then you're eligible for 20 hours a week. So that allows us to keep that fair
based upon how much work you know you're performing or how much is your normal schedule.
then we added paid parental leave, which allows for our dads to qualify. It also allows for parents to qualify if they foster a child or they adopt a child, and that's two weeks of leave. It can be added to the paid pregnancy disability leave. So specifically for our moms who give birth, they can then be eligible for the full eight weeks of leave.
Miriam Allred (22:41)
Okay. Fantastic. it sounds like you and your wife kind of like made this decision. I'd imagine you you dealt with this leading up to, you know, Roe v Wade and all of that. Like it's always been a conversation. You've always had employees that have had children and, you know, you've navigated
Daniel Stringer (22:55)
Yes.
Miriam Allred (22:55)
that, but you guys kind of made this decision. When you announce this program to your workforce, what was the response? You know, were people surprised? Were the caregivers excited? Like
What was just kind
Daniel Stringer (23:06)
Yeah.
Miriam Allred (23:07)
of like the response to it?
Daniel Stringer (23:09)
Yeah, I mean the response was was great. I mean it it was basically like there is no company, you know, in our industry that's paying for this and offering it. And so I think there was twofold. One, just a sense of
Pride from our team to say, wow, we can we can be a part of an organization that's committing to this. And then for those team members who maybe were anticipating potentially either getting pregnant or already pregnant, you know, it really it really gave them that sense that we were behind them and that we and that we heard them, even though they didn't say anything, but we heard them and we see them as an organization. And so, you know, I think that.
that really just communicated value across the board. And it really has it's been in place now since Roe v Wade overturned and I'm forgetting on when that day was, but it's been several years. Since then, you know, we have had many, many moms and dads take advantage of the program. But even beyond that, just from like a recruiting tool and a referral source conversation, it it's it just really, it's a great
talking point in that moment because people are like, I've never heard of this. It's actually rare in general. If you just look it regardless of our industry, it's rare in general. Typically it's gonna be like a really big company that might have that in the US. but most, you know, most companies in the US don't. Now in Colorado, and there are some states that are doing this, but in Colorado they now have a family leave state funded program.
But it doesn't cover all of their wages. And so when Colorado put that in place, well, now as a company, we have to pay taxes into that program. It's actually interesting to see the difference because we're in two states. Colorado's state taxes from the employer side are significantly more than in Arizona. Arizona does not have anything. Colorado now has this program. So we're paying into this program. So what we do in Colorado is we cover the difference. So
Miriam Allred (25:20)
Mm.
Daniel Stringer (25:20)
when the caregiver is eligible and then qualifies or any
employee in the company. And then they're also getting some state funding now because they've just given birth. Then we will come in and cover the difference so they still get the hundred percent of their average hours for the next six to eight weeks.
Miriam Allred (25:36)
Okay. From a cost
perspective, w you knew like how many employees you have. Maybe historically you could kind of calculate or estimate how many people would take advantage of this. From a cost perspective, were you able to anticipate what you thought it would be or has it been more or less for as like of a business expense than what you thought?
Daniel Stringer (25:53)
that's a great question. I would say it hasn't been i it it wasn't like anything massive. You know, at the end of the day, when we we were kind of like trying to guess like, okay, if 5% of our team has a baby in a given year, you know, then we're gonna be doing this, you know, dozens of times in the year. and so we thought, okay, well, what what would that equate to mathematically and did the rough math. The way that I
processed it though was yes this is a business expense it's gonna eat away at EBITDA it's gonna eat away at profit at the end of the day these are paid wages but
With that dollar amount, would I be comfortable as just a person who owns this company? Would I be comfortable with that amount of money? Would I have given that amount of money to an organization in the g in the same year? And for me, the answer was yes. It wasn't gonna be so much money that I'm like, well, I'm not even giving that much money to anyone, you know? And so
Miriam Allred (26:48)
Mm, mhm.
Daniel Stringer (26:49)
if it got a little out of control or if it was like the max of what we anticipated, in my mind, it was like, but this is still within the thresholds of what I would be willing to give to a good cause.
And this is a good cause. And so let's let it ride, see what happens. And I don't have the exact dollars to share with you in terms of how much money we've spent on this program, but just anecdotally, it hasn't been like the max of what I would have anticipated. And and so the so I think for any organization that's listening to this going, man, I don't even know how to quantify it. At the end of the day, it's you wouldn't even there if unless there's a government regulation in your state that I'm unaware of.
You wouldn't have to start with six or eight weeks. I mean, you could start with anything, test
Miriam Allred (27:32)
Mm.
Daniel Stringer (27:32)
it, see what the usage is, and you can always expand something. It's harder to carve something back than it is to expand
Miriam Allred (27:39)
Mm-hmm.
Daniel Stringer (27:39)
it, but you can start with a week. You could do anything, and it just conveys value to that employee saying, Hey, when you face this moment in your life, which is a wonderful moment, you know, we want to be there for you in some way, even if it's a small way, we're gonna be there for you in some way. And then you could see.
Like how does this end up hitting the bottom line and can we expand it from there?
Miriam Allred (28:03)
Yeah, and we
talk a lot about recruitment and retention. And it's hard to quantify like dollar for dollar the impact that this has had on your recruitment, on your retention. But we know the cost to acquire and retain caregivers. And so honestly, like if you really think about it, like this all balances out. Because if these employees, if they have children, stay with you and then continue to work for you for months or years, the value that that brings back to the business is massive rather than going out and recruiting more workforce.
Daniel Stringer (28:31)
Yeah. And then when you when you hear the stories, you know, when when somebody, you know, then
lets us know that they're so thankful that they have paid leave where they work and they were able to, you know, give birth and and then come back to work, you know, a couple of months later and not have this huge disruption in their financial world. That for me, like speaks to my heart side of me, you know, where it's like, maybe this doesn't look right to a private equity company. Like we're not private equity backed. And I don't want to do that because I want us
To be able to stay mission focused. Private equity company would be like, there's a lot of room to cut in this business. So, but you know, for me, it touches my heart. And I'm like, that's that's really what life becomes about. When you get out of survival mode when I was 22 in 2009, it's like, well, then what is life about as a business owner, as an entrepreneur? And it becomes so much more than the bottom line. My hope is it would be that way for all of us as leaders. and so then that becomes like it's
It's like a different type of currency. When you realize you can have an impact in people's lives, that impact that it has on you is real value, maybe not dollar value, but it's real value.
Miriam Allred (29:47)
Yeah.
And I love that you still have that mentality of like the impact that this has on one. Like you have taken care of thousands upon thousands of families and clients and caregivers at this point. But I I have personally have like that same belief of like, even if you just change like one person's life, like
Daniel Stringer (30:01)
Yeah.
Miriam Allred (30:02)
that is what life is all about is like impacting one person. You're doing that at scale, but you still have this mindset of like, even if we just help one mother go through this and it saves her and helps her and blesses her, like
then it's all worth it. And again,
Daniel Stringer (30:16)
Yeah.
Miriam Allred (30:17)
like you're able to do that at scale, but like keeping the mentality of like if this even impacts one person in the way that we anticipated it to, then it's worth it.
Daniel Stringer (30:24)
Yeah.
I agree. And it really, it really gets you back to your why. Because I I'm sure there's a lot of your listeners who, and I've gone through these days, when you're running a home care company, it can really wear you out wear you down. And they're gonna be really difficult moments and days. and getting back to your why and having these moments where you can go out on a limb and take a risk, but it's not a risk in the business sense of I'm trying to make more. It's a risk like I'm just gonna try to help more. But it brings
you back to you know this there's so much more reason why we're in this business than it is just to preserve the bottom line and that gives you more gas in your tank to
Miriam Allred (31:04)
Mm.
Daniel Stringer (31:04)
keep leading and keep building and and to and have a more reasons to get up every morning and do what we do.
Miriam Allred (31:10)
Yeah, gives
you the endurance to with withstand the lows because there are a lot of lows, but also a lot of highs.
Daniel Stringer (31:13)
Yeah. Yeah. Right.
Miriam Allred (31:16)
this is great, Daniel. Let's keep going. I want to talk about these other two programs because you've learned a
Daniel Stringer (31:19)
Yeah.
Miriam Allred (31:20)
lot. let's talk about the employee relief funds and grants. I've heard of variations of this with different agencies, but I want to hear how, how and why kind of you've built something in house. It's not government subsidized. There's no kind of like outside money, I don't believe, but you guys have built and allocated money for these this kind of like employee relief funds. So explain.
What that is.
Daniel Stringer (31:40)
Yeah.
So prior to we so we launched this at the very end of 2023. So we're going on it's just over two and a half years or so. Prior to that, we had kind of that same thinking that that that spurred our paid pregnancy disability leave programs, which was you know, how do we how do we become aware and how can we have the opportunity as an organization to help people when they face crisis? So, you know, it whether or not it's their house burned down, which has happened.
Actually, multiple times
to team members.
Miriam Allred (32:12)
This is wow.
Daniel Stringer (32:14)
not multiple times to one person, but multiple times and multiple people. Literally, their houses are burned down. you know, how do we deal with a situation where somebody's in a domestic violence situation and they're like, I can't stay at my house, and now we're becoming aware of it. That's one thing that that a lot of people that aren't in home care, but everybody that's listening that is in home care understands is that we have a very unique relationship with our caregivers and our team in that.
That we are oftentimes, I tell my team, I'm like, a lot of times you have a business, you know, scheduler or coordinator hat on, and then next thing you know, you're a personal counselor and you're just walking people through
Miriam Allred (32:50)
Therapist. Yeah.
Daniel Stringer (32:51)
life. That's probably true of that really any employer, not just home care, but we have that in home care. And and so we're made aware of issues, but then we're like, wow, you know, I hope that works out. And you just feel like I wish I could do something, and then you're like, maybe we can do something, or maybe you know, so
But then the problem is is like we you get a larger organization and then who can make the decision as to who can get something and when somebody doesn't get something, you know? So it becomes like a complicated problem to solve when you start to really think about it.
And so we started though with just this idea like, hey, to all of our team, all of our schedulers, coordinators, everybody, if you become aware of a really difficult crisis that a caregiver shares with you, pass it on to us at the leadership team level. We will we just want to know about it. And if we can do something to help them, then we want the opportunity to. So it was very very broad, like we had no system in place. And we started to get a few things here and there, and we were able to like.
Pay someone's rent one time who was avoiding an eviction and a few different things took place. But we thought, you know, this is not scalable. It also isn't fair in the sense that there's no formal way for somebody to like ask for help and there's no there's no there's no a system that our team can just follow. So it's very ambiguous. So I started researching and I discovered that the IRS has already put in place a structure for which this
Can be done in a legal way and in a way that also has already guardrails in place. So we don't need to reinvent the wheel and come up with an employee relief fund out of thin air. So when I discovered that, I realized there's also administrators or companies that actually put together these employee relief funds for companies and they administer the grants on behalf of the company. And so I started going down that rabbit hole and learning about all the different
options and we ended up working with a company called Canary, who we still work with to this day. Canary is a for-profit company, but they're very like missional focused, they're very affordable as I've seen
comparison to other companies out there in the way that they charge us as an organization to administer our fund. So in late 2023 we we signed on and we created our own fund. So it's a nonprofit 501c3 arm of the organization. It sits completely outside off the books of Total Care Connections. The money is held in trust.
And as an organization, we donate money into the fund to keep it solvent. That donation is recorded as a charitable contribution in the same way as if we donated to any other nonprofit organization. The money sits in trust, and then Canary has a team of grant administrators. And they're able to follow IRS guidelines as it relates to who qualifies for a grant and what documents.
Documentation has to be submitted by the employee in order to prove that they have this hardship. So it creates controls for waste, fraud, and abuse, which is just an unfortunate reality that we have to have those controls in place to ensure that the fund is remains integrous, has integrity, and that we don't have anybody potentially trying to get a grant when it's just not valid. And so we have those controls in place because the IRS already kind of created this.
Thing about it is the guidelines that the IRS put in place are very broad. So someone who's facing a financial hardship crisis that could be related to their car, that's probably that is the number one request that we get. So somebody has their car break down, and this is what takes place amongst individuals on the lower end of the socio and economic scale across this country. They call it the poverty cycle. If you are living paycheck to paycheck and you probably
Drive
an older vehicle and you you have you live in a place that probably has deferred maintenance or needs needs things or is eventually going to need something in order to keep running, like an air conditioner or something like that. But let's take the car. So your car breaks down, you now can't get to work, so you don't go to work. So then you can't get paid. So now you can't pay to repair the car, but you now you can't even pay your rent, and the cycle unravels. And some and a lot of people in this country are one
Emergency like this away from their life unraveling. And so by recognizing this, and again going back to our why and just our the giving motivations that we have as an organization and just as owners, this totally aligned with what we wanted to be able to give give to in a systematic way where our team members felt like this was fair. The great thing about it is because we have a third-party administrator that we're paying to administer the grants.
We are not even privy to who is getting the grants. So our team members know that their information is confidential. We don't have to be made aware of their situation, right? If it's very private or maybe there's something going on that they just don't want their boss to know about, it doesn't have to be the case. They can go straight to the employee relief fund, they submit their request, that administrator requests documentation, and if it meets the guidelines, they're able to then get
the grant. So I can keep going unless you have follow up questions.
Okay.
Miriam Allred (38:35)
Yeah, handful a handful of questions. you're
kind of in indirectly answering some, but I want to ask a few more. So that that was gonna be my first question of do the employees still typically come to your team and then you send them to Canary, or are you finding more often than than not they go straight to the fund when they have the issues?
Daniel Stringer (38:52)
It's a good question. So it's both. They'll come to us, and then our team has the they're empowered now with something. So when someone comes to them and says, my gosh, this literally happened like three weeks ago. We had a caregiver walk into our office, and I was sitting here and she was out there in the lobby, and I overheard it, and she said that her house had burned out. So, like going back to that example, I'm like, again, because this has happened multiple times. And yeah, our team was able to come and give her the emotional support and say, I'm so sorry this happened.
to you, my gosh, and do all of those things. But then instead of saying well good luck was able to say, make sure you apply for a grant. Now our grant sizes max out at $1,000 per employee per year. So every year it it renews and they can apply for another $1,000. So obviously a thousand dollars is not going to put our house back together. So we're not solving and we don't intend to solve the full problem, right? And we can't because that's just economically it wouldn't it wouldn't work.
But what we do want to do is be able to just be a part of the solution. So we have a website, it's called totalcare.grantcircles.org. It's built by Canary, but it's our website. It it on the back end it gives us all the reporting as to where the money's going, what exactly it's paying for, how much money has gone out. but then on the front side, it's where the caregivers and our team members actually apply. And so that's what we give them to then go and try to apply for a grant.
Miriam Allred (40:19)
Okay, fantastic. That you're yeah, you're answering all the questions, which is great, which I was gonna ask like how much you contribute and is it the same amount month the same amount month over month because it's tricky to anticipate how many people will tap into this over the course of a year. So you probably just over the years kind of like allocated an amount. And then as needs arise,
Daniel Stringer (40:37)
Yeah, so that's a great
Miriam Allred (40:39)
I'm guessing you can contribute more.
Daniel Stringer (40:41)
Yeah, so what we do is we just keep it funded and it'll ebb and flow. So we'll we'll sometimes need to put more money into it. if there's like a natural disaster taking place in that particular area, then we've seen where there's a bunch of grant requests. And then so then we just have to put more money into it. So from like a budgeting perspective, we've just again kind of put this in our mental framework as this is this is all charitable. Yes, it's a
Write off because it's a donation to a legitimate nonprofit, our own nonprofit. We're able to also demonstrate transparently that there's no conflict of interest because we do not choose, as even me, the owner, I don't have any decision-making power as to who gets a grant and who doesn't get a grant. So there's no favoritism happening. And it allows for us to be able to have integrity, you know, in that way. But we just have to kind of ride those ebbs and flows. And because
It's just mentally a charitable thing, But I'll give you some real numbers. I mean, in the last two and a half years, 264 grants have been awarded, and it's just over $200,000. And again, we're running at about a thousand people working actively every pay period. So, you know, you could kind of do the rough math and figure out: okay, how could this be pared down?
But you don't have to do $1,000. You know, you could start with $500 or something less per year and then again just see how it scales. but it's just another great vehicle to meet the needs. Again, these people, our caregivers, oftentimes are on the lower end of the socioeconomic scale. Our caregivers don't make minimum wage, but
Minimum wage is like below is well below the poverty level at this point in all in in all states. And so at the end of the day, even if you make a good income, you can still be struggling. And so we wanted to be able to meet people's needs in this way, you know, when they face certain financial hardships. And again, going back to some of the examples, I mean, we're looking at car repairs. We've helped people get out of domestic violence situations, pay medical bills that they weren't able to afford, and then natural disaster.
type situations where you know they they need something repaired because it was destroyed in a flood or something like that.
Miriam Allred (43:02)
And I love what you said of being a part of the solution. Economically, you can't be the solution because there are too many crises with this demographic of employees with this workforce. But you want to be a part of the solution because you're right. A caregiver calls in in crisis. Most agencies say, I am so sorry. I wish we could help. Let us know how we can help. But it's like that satisfies no one. And so being a part of the solution on and offering some sort of tangible support is absolutely better than not. And you
You kind of were just answering this, like, because it's an IRS program and they've established the guidelines, I'm guessing they know that this is typically relevant to a specific workforce. And so they've factored all of that in. But I was gonna ask, like, have you heard feedback from employees that said, like, hey, this was my scenario and I got declined? It sounds like they cover all of like the most common scenario. So that probably doesn't happen. But I was just curious, like
Because the guidelines are established by someone outside of home care, does it still feel like relevant and applicable and the guidelines make sense for your workforce?
Daniel Stringer (44:01)
Yeah, no, it's it's it's very applicable, I feel. Like for example, and I invite any of your listeners, they can go to totalcare.grantcircles.org and just on that page, they have to log in. They can go to the FAQ section and it covers all the things that we cover and it aligns with, the IRS guidelines. So it really does cover all your major things. and so w but we do have people that are declined. But the number one reason, and I'm just looking at the data right now, the number one reason why it's
Declined is insufficient documentation. So this protects protects the employer as well. Because at the end of the day, somebody may say that this is going on, I have this problem, but you're you're busy running a company, like to now turn over and say, okay, well, now I need to determine the validity of the requests. And now I need to get receipts and I need to know that you actually can't afford this, you know.
That's a whole separate job. And so we were just really happy to discover that there are organizations like Canary that this is their business and this is what they do for organizations like us. And so they're able to then ensure that this is done in a systematic way where employees do have to submit the data, the documentation that their request is legitimate. And so that is that's the number one reason why they're declined, is just not having enough documents.
Documentation or not responding, the two top reasons are not responding to the documentation request at all or not providing enough documentation. So that protects us as an organization. And it also protects it's not just the organization funding it, but thinking about we're a big team and the whole team is funding this. You know, like this is a commitment of the company. So when we can speak to our team members and they're a part of, you know, building an organization that's funding this thing, we have integrity on both sides because the fund is protecting.
Protected and it has
Miriam Allred (45:54)
Mm-hmm.
Daniel Stringer (45:54)
integrity, and we're not just it's not getting rated, I guess, you know, with with
Miriam Allred (45:59)
Mm.
Daniel Stringer (45:59)
requests that are not substantiated. And so what's really cool is that we're now, and this is just happening in the last six months, we've been doing these programs for years now, but now just in the last six months, the payers.
at the Medicaid level and specifically the Medicaid level right now, are now talking with us about wow, these programs are the types of things that Medicaid at the federal level and the state level wants.
To be happening within the home and community-based services. So what's really cool is now we have a seat at these tables, and specifically me, I'm able to sit down with the leaders of these managed care organizations and have conversations now about how does this become more of a systematic
at least priority of the health plans. But how then how do we like rising tide lifts all boats? How do how how can all agencies start to do these types of things? Because this is actually what we this is what real workforce development is. And
Miriam Allred (47:05)
Mm.
Daniel Stringer (47:06)
this is what actually putting money into it looks like. These are at least real examples. And so it's also giving us now opportunity that I didn't anticipate at the payer level to have a better, stronger relationship and potentially
a values-based relationship and contract with these payers. So that's just now starting to happen, which is really exciting because it just is it feels very validating, you know, that the payers are saying, well, this is what this is the type of stuff we want to fund. And they're not like
Miriam Allred (47:36)
That's really
Daniel Stringer (47:37)
funding it directly right now, but there's they're giving me these positive intents around it.
Miriam Allred (47:41)
Yeah,
that's really, really cool. Because we talk about this at like a macro scale. When we talk about workforce development of caregivers across
Daniel Stringer (47:47)
Yeah.
Miriam Allred (47:48)
the entire country, it's the same answer. I wish we could help them. I wish there was something we
Daniel Stringer (47:52)
Yes.
Miriam Allred (47:52)
can do, but there's nothing we can literally do. It's like we can literally do something. And at like, you know, kind of like your micro scale and the macro scale, like these are the types of programs and initiatives that we need help administering and that we need to start
Daniel Stringer (48:03)
Yeah.
Miriam Allred (48:04)
offering to really start chipping away at the larger workforce problems that we have.
Daniel Stringer (48:08)
Yeah.
Yeah.
Miriam Allred (48:09)
fantastic, fantastic, Daniel. This is awesome. I want to ask you about one more if you've got it in the
Daniel Stringer (48:14)
Call.
Miriam Allred (48:14)
tank here, which is health insurance. And I've actually talked about this r a bit recently. I don't know if you've heard of the company Vitable, but I interviewed them recently and just talking about like health care plans for home care, because
Daniel Stringer (48:26)
Mm-hmm.
Miriam Allred (48:26)
there's a lot of options out there, but that this is a common one where you hear agencies say, like, we offered something, no one took advantage of it, therefore we we dialed it back, and now we offer nothing. And so there's just like a lot of
misconceptions and kind of like bad
Daniel Stringer (48:39)
Yeah.
Miriam Allred (48:39)
blood out there, but you have done something unique offering self insured healthcare. So talk about talk about kind of like the history of like what you offered and then why
Daniel Stringer (48:47)
Yeah.
Miriam Allred (48:48)
you've gone down this new route.
Daniel Stringer (48:50)
Yeah, so we started offering health insurance to all of our caregivers when the Affordable Care Act came into place because we we were over a hundred employees, full-time employees. And so we started off with, you know, probably what what you would find to be typical in home care industry. I don't even remember the exact plans, but we had just general of ACA compliant plans. and then we added dental envision. And so that has evolved over the years, but what took place
Last year, and this probably hit a lot of the listeners, was just the absolute insane rise in cost. So we received a renewal from United Healthcare, which was our provider for health insurance, of 76% more premium than the current year. So almost doubling. And that was just
I mean we were like, this is insane. This is catastrophic. You know, we we have, of our and to get to give your listeners an idea, of our, a thousand people, we still only have sixty people on that have chosen the health, major health. And then we have like 300 people on Vision and Dental, who choose just that. So
But even at the 60 people, doubling our cost was hundreds of thousands of dollars to have the same healthcare that we just that we have right now. And so we were like, this is insane. And so, A, either some somehow as a company we're absorbing this and then trying to do that at scale as we continue to grow that number. And two, or two, you know, then the employees have to s see some type of an increase to what we're asking them to pay. So we started, and I could go down a rabbit hole.
Of everything I've learned about the health insurance industry, but I won't do that. We could say that for a different podcast.
Miriam Allred (50:36)
Mm-hmm.
Daniel Stringer (50:37)
But after learning a lot about it, I realized that there is an opportunity at our size to go to become self-insured through a captive. So what that basically means is that we are self-insuring all of the claims that come through from our employees up to a certain dollar amount. We have a cap of, I believe.
I believe it's $40,000 per year per employee. And then there's an aggregate cap. So our captive insurance, which layers on top of this, is what we pay premiums for now, is just covering it if it exceeds those numbers.
So obviously, those are big numbers, and you know, when you hear them, you're like, well, how does that make any sense? Well, at the end of day, the whole idea of insurance is that it's a group of people paying into a big pot. Not everybody needs $40,000 of healthcare every year. A few people might, and then everybody else just needs prescriptions. So, long story short, we realized that we could become self-insured. We were able to keep our costs to the employee flat. So everybody entered 2026 without any.
Increase, even though we had a 76% increase quote from United Healthcare, by switching to this, we were able to now as a company, we did have to come up with more money at the end of the day. we did have an increase, significant increase, but not just having a self-insured plan was the reason we did this. We also realized that a number of our employees, and I think this is probably true for any of your listeners.
The reason why they have, well, one of the reasons they have health insurance is they have very high cost prescription drugs, which would be class D drugs on the drug list. You have A, B, C, and D. D is the most expensive drugs that you can buy. And people with chronic illnesses need these drugs. Well, what takes place, and what I didn't understand until going down this rabbit hole, was that those employees typically are maxing out every year their out-of-pocket deductible and out-of-pocket max. Because the
Deductible or the co-payment on the drug is typically hundreds of dollars a month. So their drug costs thousands of dollars a month and they're paying a few hundred dollars a month, and at the end of the year, they're gonna max out their out-of-pocket max. So it's very expensive for them to have these drugs, even with health insurance.
With going self-insured, we were able to bring in a vendor. We now have our all of our own vendors. So we have our own prescription benefits manager negotiating drug prices. We, you know, we have our own lab program. So you can get all of your labs and MRIs and anything like that at a very, very low cost. These are types of savings that a major health insurance company does not.
Provide for. They just don't. So you don't have access to a lot of time. I mean, nobody knows what anything costs. If you go
Miriam Allred (53:34)
Mm-hmm.
Daniel Stringer (53:35)
to a doctor and say, how much does it cost for an MRI? They're I have no clue. You don't know until after you've gotten the MRI, and now you're in debt. And so
Miriam Allred (53:41)
Mm.
Daniel Stringer (53:42)
what by being self-insured, now we've created transparency in pricing, but we fight for the employees. So our employees now that were on all of these very high-cost prescription drugs, we have a program called Sharx, S-H-A-R-X, that is
Sourcing these drugs through Canada and through government programs that we were had no idea existed for people who are on the lower economic, socioeconomic scale, are able to qualify for some government programs that I didn't know existed. United Healthcare doesn't do anything about this. But Sharx goes in and gets them qualified. So the next thing you know, they're now being able to manage their chronic illness for 10% of the cost that they were with United Healthcare. And sometimes, because of their income level,
It's free now. And so they were spending five, six, seven hundred dollars a month just to live. And now they're paying 50 bucks or nothing. And so that was something that I got really excited about. I was like, yeah, we're gonna end up either way, whatever we do as a company, we're gonna be spending a lot more money on health insurance. But if at the end of the day we can create more cost savings for the employees on like prescription drugs and labs and going to get an MRI and whatever you need, like on those levels, then
Then wow, let's do it. And so that's what got us passionate about it was not just like saving money on that month-to-month premium, but being able to see real cost savings for these individual needs that our people have and getting more granular with how do we approach them.
Miriam Allred (55:14)
Okay, so who you
sound very educated on this. Obviously you've done a lot of the research and been heavily
Daniel Stringer (55:19)
Yeah.
Miriam Allred (55:19)
involved. Do you or someone on your team manage all of this? Because when you take away someone like United, you know, granted you still have to do all the work and like figure it out, but like have you do you have an employee designated to managing all of this? Because it's a lot.
Daniel Stringer (55:33)
Yeah, it's a great question. So we do have one benefits specialist on our HR team that only does benefits. But it's not that our team member has to adjudicate all these claims and like decide if we're paying for this or not. What we do with with the captive, we have we still have a TPA. So every insurance company has a TPA, which is the per which is the arm of their company that manages claims, paying claims, negotiating claims down, saying, yeah, we're not paying $50,000 for time.
And all at the hospital, we're paying five dollars, you know, doing all of that for you. So we, as a part of this program, we have our TPA, and the TPA is called Auxient, A-U-X-I-E-N-T, and they manage all the claims. So claims go to Auxient they decide how they negotiate it all down. We then we then rent a network. So Aetna rents their network to us. So all of our team members, in terms of when they
They go, well, what insurance do I have? Like, I've never heard of this. For that in their mind, it on their insurance card, it says Aetna on the back.
So as long as they're in the Aetna network, then they get Aetna pricing, Aetna claims, everything seems normal to them. So there's been no disruption to our team members going, I've never heard of Auxient and none of my healthcare providers know what this is. They just see Aetna and then they're able to process it. So in that, on that side of things, it's very much the same as having United Healthcare. The difference is that when we're paying each month, our cost can vary because if we have low claims coming in, we just pay.
Claims. We're not paying the same exact premium every month to United Healthcare. Now we're paying a lower premium to cover the overage insurance. And then we're paying actual claims, but we will see an invoice that says, This person, this is the only downside. We see you know this detail. This person needed to go, you know, get an MRI. This was the cost. And you're like, okay. And we just literally pay that bill.
Miriam Allred (57:36)
Okay. To me, it
sounded sounds like administratively like a lot more work on you, but maybe it was just like the initial setup and learning and kind of like the learning
Daniel Stringer (57:44)
Yeah.
Miriam Allred (57:45)
curve. But now that it's all in place, there's not that much of an administrative burden. Is that accurate? Okay.
Daniel Stringer (57:50)
Correct. Yeah, really
there's not. It's it's it's not that big of a lift at all. It's very similar to as if we were still with United Healthcare. It's just the way that we pay claims, the way that we receive data. We have transparency now. We know what we're paying for. When you pay United Healthcare, who knows? Did they did they spend that money or they just kept it? You know?
Miriam Allred (58:08)
Yeah.
Daniel Stringer (58:09)
and so now we see exactly where the money's going.
Miriam Allred (58:12)
Okay. when you rolled this out, did you have more employees enroll into this? Was this more attractive to people or did your numbers kind of stay the same?
Daniel Stringer (58:22)
We saw a little bump in enrollment, but it wasn't it but I also was was I was concerned that people would go, What? I've never heard of this, you know? And they would think, This is is this even real? And so and then and that they would go, Well, I don't know if my doctor takes these plans, you know, and stuff like that. So that was my concern. But we had no hiccups because once people understood that you're on the Aetna network, which is a national name, then all they had to do, and they can go on the Aetna website, not not like the Auxient website.
They can go on Aetna website and look to see if their doctor's there, just like as if we had Aetna. so it was very streamlined. And so there's been no hiccups and no issues for anybody that I'm aware of. Like nobody's brought anything up to me from our HR team, like, wow, we didn't anticipate this huge problem. so it's been really smooth. And there's one other program that we now have as a part of this little package of of self-insuring, but we have these different vendors, right? we have the TPA.
We have the overage insurance coverage. You know, we have Auxient which is managing our claims. We have Sharx, which is negotiating our drug prices. And then we have a program that's very specific to procedures. And so, like I mentioned earlier, no one knows what anything costs. So when you're like, I need to go get a colonoscopy, which I'm gonna do this month for the first time, I'm 40 this year. I'll let you know how it goes.
Miriam Allred (59:45)
T I, I'm just kidding.
Daniel Stringer (59:50)
but you're like, well, how much does that cost?
know and at the end of the day nobody tells you so this program we have if you go through this this vendor they have pre-negotiated like the lowest price that they can get across the country in your market of what these things cost and this this includes like daily regular procedures like that and it goes to like I need a knee replacement surgery they've negotiated the price and so if you go through our vendor then we will actually as a health plan you will as the employee you will not be charged a copay
For going to the vendor because we've negotiated such a low price that instead of you saying to you, well, you now need to pay a copay, which might be a lot, you know, for a procedure like that, you now need don't need to pay anything because you've saved the plan so much more by going through our vendor that now
Miriam Allred (1:00:38)
Mm.
Daniel Stringer (1:00:39)
you can go get your knee replaced for free for no cost.
And that's been really, really cool as well, because now people are able to go and get that procedure, whereas they thought, wow, I thought I would this would be like extremely expensive or I would max out my out of pocket. Now I'm paying nothing.
Miriam Allred (1:00:54)
Yeah. Okay. One little like kind of sidebar question here. You mentioned the numbers of how many people are utilizing this in your in your company. The numbers are small for a company of your size. What are the rest of your employees doing? And do you do you lose sleep over what they're doing and ways to help more of your employees when it comes to health insurance?
Daniel Stringer (1:01:14)
Yes, and that's actually a great segue because I wasn't I didn't even tell you about this but we're just about to launch a new program. It's a Section 125 program, which is a it's a program designed to have a no net cost to the employee. it does not replace major medical.
But what it does do is it provides them with without having any actual cost to the employee, it provides them with unlimited use of telehealth for not just urgent care. That's how how telehealth has become known for like urgent care. Like I need to get a pr antibiotic. But you can have primary care through this company. It's called Procurio, is the vendor. so you can see a primary care physician and have that regular doctor.
Urgent care type visits, sick visits, and then also mental health. And you can see a counselor, and it's all no copay. So the employees will have access to this. So people who have our major health plan and just want this added on can have it. And then all of our employees who have not taken the major health plan, because A, most likely, these are the main reasons. One, they are on Medicaid. That's the reality of a lot of caregivers.
So they already have Medicaid health and it's free to them. So paying paying for our plan, even though we try to keep the cost down, it's still more than zero. and then they have a spouse who has health insurance. That's a lot of them. So I don't actually think that a lot of our employees are completely uninsured. I don't know because they don't they're not always gonna share that information. But my assumption is that most of our employees have something happening, they're they're insured in some way. But when we discovered the Section 125 plan,
where we can allow, we can we can provide them with that 100% telehealth, you know, no co-payment. And then it also gives them a prescription card, which has pre-negotiated pricing on 1200 generic prescriptions. So the vast majority of what people need on any given year, inhalers, antibiotics, you know, anything low-cost painkillers, things like that, they can go in and get these drugs for sometimes zero dollars or like five dollars.
And so for the vast majority of the prescription needs, other than those individuals I mentioned that have very high cost prescriptions, but like the vast majority, with this program, it's gonna have zero net cost to our employees, and now they'll be able to see a doctor anytime they want for mental health, primary care, sick visits, and get the vast majority of prescriptions pretty much covered or five bucks. And that will be available to a hundred percent of our staff and there will be no net cost to them. So they would just have to say to themselves, I already am covered by something
Miriam Allred (1:04:00)
Mm.
Daniel Stringer (1:04:00)
else. I literally have no need.
In order to not take it because there's no there's no cost. So that's what we're doing to expand currently our health plan. And then we've added things like we now offer the short-term disability, long-term disability, life insurance, accidental death insurance. and there's a few other like small carve-outs that we've now like packed into our plan that those are all voluntary as well. So we do have, like I mentioned, like 300 people on dental and vision and a lot of those other insurances that.
otherwise they wouldn't be able to to get. So it provides them with a mechanism to get those types of benefits as well.
Miriam Allred (1:04:40)
Yeah,
back to what you said earlier, like just being a part of the solution. You know, we can't solve everything for everyone, but
Daniel Stringer (1:04:46)
Yeah.
Miriam Allred (1:04:47)
every day that these caregivers call out because they're sick or their child is sick, like that adds up. And so just creating opportunities and solutions and being part of like the long term solution,
Fantastic, Daniel. Like you have thought through it sounds like almost everything, but I just love like the innovative forward thinking approach and also like you're not complacent. You know, this is twenty twenty six. If we have this conversation a couple more years, you will come to new realizations of what these what
Daniel Stringer (1:05:12)
Yeah.
Miriam Allred (1:05:13)
this workforce needs. You know, it's ever evolving. But to me, you are like keeping up with the times and doing the most that you can and also keeping an open mind, like what you might need down the road too.
Daniel Stringer (1:05:24)
Yeah, no, I appreciate that. It's awesome.
Miriam Allred (1:05:26)
last question here, just in closing, think of all of these home care owners listening to this. They probably just heard all of this and they're like, wow, where do I start? You know, you talk to
Daniel Stringer (1:05:33)
Yeah.
Miriam Allred (1:05:33)
other home care owners in your market and at conferences and things, like you know what these people are thinking and how and and what they're struggling with. If you had to encourage them, in a direction of where they should start with offering their employees something, what would you recommend to like most people?
Daniel Stringer (1:05:51)
Yeah, that's a great question. You know, I mean, first off, I would just challenge, you know, everybody's thinking a little bit in that sometimes we look at these things as expenses and not necessarily looking at them as ways to give back. I think most of everyone listening here has a piece of them and a part of their financial world outside the business, you know, where they're inclined to give, right? Just philanthropically or charitably. So start thinking about you know your your business a little differently in that way because then.
It starts to open your mind to look at this not just as an expense but as a way to give. But then secondly, I would just encourage everyone and feel free to reach out to me. I'm an open book and I'm happy to share all the vendors and all the people we use. You know, so you can just cut to the chase and learn about how you can put something like this in place. But you know, start small, you know. So if you're gonna do at some thinking about some paid leave for maternity or paternity, think starting small. if you want to do some type of an employee grant program, start smaller.
you know, and see what the costs end up actually being. I think a lot of times we have this all or nothing thought. Like if
Miriam Allred (1:06:59)
Mm-hmm.
Daniel Stringer (1:06:59)
I can't do it all, then I'm not gonna do it at all. At all, you know, and so I kind of said at all twice. And
Miriam Allred (1:07:05)
Yeah.
Daniel Stringer (1:07:05)
so at the end of the day we just want to think about, you know, taking one step forward. I always think about doing the next right thing. we can't solve the whole world's problems, but we can do something and seeing where that grows and evolves
It allows for you to be a part of that journey if you just say yes and make one step in the right direction. So I'm I'm happy to talk with anybody that's interested in any of these things and and I'm happy to talk to people who've thought of other ways, to develop workforce and collaborate with those people because I'm really just excited to be a part of that conversation.
Miriam Allred (1:07:39)
Yeah, fantastic,
Daniel. This has been so, so good. I will hopefully get a list from you of all these vendors and I can at least include it in the show notes that people can reference there. It's gonna be like a beefy show notes, but you've you've cited
Daniel Stringer (1:07:45)
Yeah. Absolutely. Great.
Miriam Allred (1:07:50)
a lot of vendors and that's a great place for people to get started. Also, people can go to totalcareconnections.com. I didn't say that this at the start, but fantastic website. If anyone wants to look
Daniel Stringer (1:07:59)
thank you.
Miriam Allred (1:07:59)
at like a really good home care website, Total Care Connections like is one of the best websites I've seen.
Thank you so much, Daniel. This has been great. There's something for everyone in this episode. And more than anything, just like full circle back to it's competitive out there. And if a company's applying at your company and another company and they see the benefits and just like the culture that you've created, like hands down, they're gonna come to you over anybody else. And so I just everyone's talking about differentiation and competition and where this industry and where the market's headed. And it's like these are the types of programs that are gonna make the difference and really change and shape the future of home care. So
Daniel, thank you so much. Fantastic conversation.
Daniel Stringer (1:08:36)
Awesome.
Thanks, Miriam.