Advocacy Investments Paying Off For Bayada

May 06, 2023

There's a good argument to be made that one of the biggest successes in the history of Bayada Home Health Care came from a pre-dinner conversation in a parking lot 14 years ago.

It was 2009, and Dave Totaro had just been hired by the company's founder, Mark Baiada, as Bayada's first chief marketing officer.

"About six months into the new job, I had a conversation with Mark about our company's creed, which states that our clients come first," Totaro told Home Health Care News. "He said to me, ‘We spend a lot of time nurturing our patients, but our biggest client is the government. They fund about 70% of what we do between Medicare and Medicaid, and we really don't have anyone that is actually developing relationships with them.’ Walking to dinner that night, I told him, ‘Well I could do that.’"

Over a decade later, Bayada has — in Totaro's eyes — one of the strongest government affairs teams in the home-based care industry.

The Moorestown, New Jersey-based Bayada is a provider of home health, hospice and home- and community-based services. It has over 360 locations across 23 states and six other countries.

Totaro was admittedly in over his head at first, but the story of how Bayada invested in advocacy for home care and home health shows the bigger picture on how advocating for the work that is being done by agencies across the country can be an effective and lucrative strategy for providers of all sizes.

As the CEO of Home Care Association of America (HCAOA), Vicki Hoak argues that health care is politics.

"I say that all the time because so many people are averse to getting involved in advocacy, but if you are a health care provider, you have got to pay attention to advocacy," Hoak told HHCN. "Everything our agencies live by — regulations on how they’re licensed, Medicaid, Medicare, everything starts with an elected official. So we have to recognize as health care providers that we must be engaged in advocacy."

In order to get the most exposure possible in front of lawmakers, stakeholders and other decision-makers on Capitol Hill and elsewhere, it's imperative that agencies communicate with elected officials, she said.

Standing on the sidelines as the demand for in-home care rises is simply not a good business decision.

Before joining Bayada, Totaro held a number of different roles in other companies, one that involved assisting the government affairs team. Essentially, he learned how to build a brand through advocacy.

"A lot of what you do is you’re building a brand," he said. "You have a message, and you have to consistently deliver it to an audience and try to meet certain expectations. One of the things that we did at Bayada that no one else has done, even since then, is that we recognized that advocacy — or all politics — is local."

In the early days of Totaro's advocacy work at Bayada, he hired two team members whose full-time job was to advocate on behalf of the company's in-home care models in New Jersey and Pennsylvania, two of its largest markets.

"We started small and focused primarily on those two markets," he said. "Then, we started to have success. The first year, when Chris Christie was the Governor of New Jersey, one of the first things that he tried to do was to cut the personal care rate significantly. We fought that, and, while we didn't get an incremental revenue increase, we were able to fight and avoid the cut."

Coming to the realization that taking a boots-on-the-ground approach would lead to actual change ushered in a new era of advocacy for Bayada.

Soon after, the company delegated a full-time advocacy staffer for North Carolina, Totaro became the chief government affairs officer, and the results started to pay off almost immediately.

"We noticed that every time we added another person to our advocacy team, our return on investment actually increased faster than the cost increase," Totaro said. "The more feet on the ground we had, the faster our ROI started to rise."

For agencies and providers that have not yet started any kind of advocacy for their work or the industry, Hoak had one simple piece of advice.

"Don't wait another day," she said. "There's an educating aspect that goes along with advocacy. I look at them synonymously, especially when it comes to our sector. We have an identity crisis in the personal care home care space because people don't quite understand us. We don't have national standards like home health or other sectors. We’re in a long-term care crisis, and we know, moving ahead, we’ve got to do whatever we can to get people to plan for their long-term care needs."

Totaro started to notice a real difference in the true ROI for Bayada around 2015.

It was then when all 360 of the company's offices participated in its advocacy program.

"We created what was called the ambassador program, and we asked for a representative from each one of our service offices throughout the country who had a passion for getting involved in government advocacy," he said. "This was a volunteer position — in addition to their regular job — to be an ambassador for us at the local level. Their role is to form relationships with not only local legislators and state legislators but also the federal legislators in the district when they’re at home."

Earlier on in Bayada's advocacy efforts, Totaro said that the ROI was 7-to-1, meaning that for every dollar the company invested in its advocacy efforts, it would get back $7 in revenue.

"The incremental revenues that we generated in that year were 7 times what the expenses were," he said. "We track it every year. As of 2022, we’re at 24-to-1."

Bayada saw a huge spike during the pandemic on that ROI as the federal government aided agencies with funding, but Totaro still credits his advocacy teams for being opportunistic in seeking out those funds. That's something not many agencies were equipped to do because they may not have had those relationships in place.

Of the 24 states Bayada operates in, 13 of them have dedicated staff members for advocacy alone. In those states, Medicaid reimbursement rates increased by 23% since 2013 for Bayada. In states that don't, rates increased by 7%.

Even in states that have partial advocacy teams — usually a social media and public affairs team member — rates increased by 15%.

That is a welcoming sign for agencies that might not have the resources to build full-time advocacy teams. Sizeable investments aren't necessary to see a sizable return on investment.

"It means that you don't have to have a full program like we have," Totaro said. "As long as you are there, you are active and you’re raising your voice, you’re going to get heard."

The same kind of investments are being made on a national scale as well, Hoak said.

"We invest in not only a lobbyist in Washington, D.C., plus our staff, we also invest in state lobbyists in 10 states," Hoak said. "That's unusual for a national trade association, but we do that because we do see a return on that investment. It's just as important to monitor and to promote good legislation for increasing access as it is to watch what's going on in our industry."

Bayada Home Health Care, HCAOA

Patrick Filbin is a reporter for HHCN. Prior to joining Aging Media Network, he was a reporter with the Chattanooga Times Free Press and a features reporter for the Gillette News Record in Wyoming.