Miriam Allred (00:01)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. Today in the lab, I'm joined by Kevin Smith, the CEO of Best of Care based in the greater Boston, Massachusetts area. Kevin, welcome to the show.
Kevin Smith (00:15)
Thanks for having me, Miriam. Happy to be here.
Miriam Allred (00:18.864)
I feel like you were maybe one of the first guests that I interviewed on the Vision podcast probably five or six years ago. So full circle, we're back again. And naturally I wanted you as an early guest on this show. So a lot has happened in your business since the past five years. So that's really what I want to dig into today. So I'm excited to catch up and get into the decisions and acquisitions and really the changes that your business has undergone in the last several years.
Without further ado, let's just get right into it. I want you to start with your origin story and talk about the family business and your part in it all these years.
Kevin Smith (00:57)
Sure, so again, thanks for having me. It's nice to have a little full circle moment. I'm so happy for you to be launching this podcast and I'm really excited to be here and for you, honestly. yeah, to give you the quote unquote origin story, I really had no intentions of ever being involved in home care at all.
Miriam Allred (01:08.548)
Thank you.
Kevin Smith (01:22)
I did not know what I wanted to do, quite honestly. I grew up knowing that my father owned a home care agency, but like most kids, you really just have no clue what your parents do or what it all means. And then fast forward to me graduating from college and not having a job and not really knowing what I wanted to do or what I was going to do. you know, thankfully I...
talk to my dad and talk to him about maybe trying to work there just to see what it was all about. And here I am 18 years later and I've never left. And I have really sort of done all of the different things that you can do. I grew up there in many respects because when I started there, I learned on the fly. I learned by hiring people, by interviewing people.
by doing the payroll, by doing the billing. Occasionally when it was necessary I would go out and help out as a caregiver. I would go to the grocery store and get things that clients needed. And so I was trying to just do anything that I could to stay there. And I learned a lot about what I didn't really like.
about the job like most things you do them so that you can figure out what you don't like and what you do want to spend your time doing, what's meaningful to you. And I learned pretty quick that the communication, the thinking, the strategy, the ideas, those appealed and spoke to me far more than some of the more sort of task-based or operational requirements at a company.
Now, keep in mind, this was a much different profile of a company back then. In 2007, the company was still certainly mature for a home care agency. But we had maybe eight administrative staff and probably less than 100 caregivers and doing a little under $2 million in revenue. And so the company that I started working for back then was just something totally different than...
Kevin Smith (03:47)
than sort of what it has become today. So during that time, like I said, I did a bunch of different stuff and learned all sorts of ways and learned different things and ultimately had every job title. I became a vice president, a president, a COO, a CEO, and that kind of brings us up to date in terms of where I am today here in 2025.
Miriam Allred (04:14)
That was perfect. Let's unpack this business model. Like you said, 2007, you just kind of shared what the profile of the business was then. Here we are 2025, totally different size, shape, scope, unpack kind of the timeline and the evolution of the business model over the last decade or so.
Kevin Smith (04:33)
So again, when I joined that, the business that Best of Care was doing at the time was almost essentially and entirely Medicaid. We had sort of four, I think, contracts with state-funded entities here in Massachusetts, which are funded by Medicaid. And they're sort of quasi-governmental agency that purchases service from a network of providers.
and had a little bit of a private pay presence. And that was also back in the day where VNAs, regional and local VNAs had a much bigger presence and a much more impactful role in the continuum and the delivery of care. And oftentimes those VNAs would purchase a lot of staffing, a lot of home health aid service from companies like ours. And so
That was really it. And it was nuts and bolts kind of bread and butter home care service delivery. Short shifts. That was what was funded. And in pretty short order after working there, found myself more interested in the private pay business. Thinking about the opportunities that existed within it. Longer hours, 24-7.
more predictable staffing for our caregivers. But really what spoke to me most about it was like the, the relationshiping challenge that came along with it and building those relationships and those partnerships to the extent that I could find and convince people to, to work with me and that it was worth working with our company and finding my way as a representative and a face of the company that people could trust in and want to work with.
So that was then. In time, we added more services. we began adding more and more of a private pay business as I've alluded to, but then in 2018, excuse me, we launched a care management business. some of that was serendipitous, if I'm honest. I have to be honest because...
Kevin Smith (06:59)
Erin Lynch, who is the founder of our care management division, she was a home care scheduler at our company. She left, she took a job to be a nursing home administrator and then pitched an idea back to me while she was getting her masters in gerontology. And I had told her that I always had an open door. I really liked working with her and hoped that she would find her way back to us somehow. And she did with this idea.
And I am not a care manager. I'm a history major who happened to find his way into this family business that delivers home care services. within a couple of months of conversation, we agreed that she would launch this care management business through Best of Care. And we thought that it could be a unique way to speak to our existing audience of private pay clients and position this new service in front of them.
Kevin Smith (07:58)
And that was really sort of that first seedling of a diversification sort of mindset and strategy. And really the strategy came after we launched it. It was like, yeah, I'm willing to take a flyer on this. Go ahead, try it. You run it, you do everything. You are the care manager, I'm not. I'm gonna support it and I'm gonna message it and I'm gonna publicize it and hopefully we can gain some traction that way.
That's 2018. I'll pause there and see if you want me to keep going sort of with the timeline and services and things like that or if you want to go, yeah.
Miriam Allred (08:36)
One question of, yeah, that's great. One question about care management. It's kind of a gray area a little bit. Sometimes home care businesses are doing a version of care management and they don't know it or they don't know what to call it. Was that happening? And was it a whole like paradigm shift once you tacked on this new service line?
Kevin Smith (08:56)
Yeah, and honestly we're still trying to think about how to talk about it. I've never seen an industry or a service that defies a simple elevator pitch or like a pithy sentence that can just be sort of like tangibly digested by the listener or the audience the way that care management does. And the way that we tried to explain it,
to our existing clients was.
Leave home care alone. They know what home care is because they're already paying us for it, right? Let's explain to them how we can sort of enhance that experience by adding a new layer of support by a super professional person who has the local resources, knowledge, and skill to be able to manage that person's care needs into the horizon. So.
We gave all sorts of examples to the geographically distant adult children, for example, right? That's the great hypothetical. The son and daughter who live in California and mom and dad are on Cape Cod. What are you gonna do when they go to the doctor? You want someone who can be a reliable narrator and someone who can document, transcribe, communicate that information, and then communicate it effectively back to the family.
You want someone who can do that on an ongoing basis, on an as needed basis, in perpetuity to make sure that so and so feels safe. And already I've just wasted what? A minute 38 of air on this pod trying to say that. So there you go, proof positive that it's still kind of like work in progress. But that's what we started doing was like, rather than try to explain it to the world, let's just start by explaining it.
Miriam Allred (10:40)
Okay.
Kevin Smith (10:55.981)
to the people who are already working with us. And so we gained a little traction in doing so. But it's still sometimes elusive in terms of trying to come up with the best possible way to describe that service. It's almost like you have to say what it isn't. It's one of those things and land on it that way.
Miriam Allred (11:19)
It's good to hear you describe this though, because as we go through this conversation, every time you tack on a new service line, this process restarts. Best of Care is no longer just home care, it's home care plus care management. And we're going to go through all of these other layers that you've added on. so, you know, adding on another service is adding on another revenue stream, but it's basically re positioning the company. And that's both an internal and an external effort that takes a lot of time and effort and communication and
struggling to kind of figure that out. And I think care management is a really good example of that process. So that's why I wanted to hear you talk through that. But let's keep going on the timeline. So this was 2018, you bring in care management organically with Erin. That took some time because your next move isn't until 2022 with moving mentors. So talk about the next acquisition and the reasoning there.
Kevin Smith (12:15)
Yes, so in 2022 we acquired a nearly three decade old, very well established, really sort of like one of the first in the industry, move management companies called Moving Mentor. And at the time when we started looking at Moving Mentor, again, I didn't know much about move management, but.
when I started to learn about it by speaking to the principal of that company, Barbara Perman, who is one of the really, really early pioneer figures in the move management industry, it gave me a great sense of trust knowing that someone who's been around for that long and established for that long has been able to build relationships with payers and partners to the extent that they understood what a move management could do for them. That's what gave me peace of mind and the diligence.
And, but what I saw, at least through my own sort of lens and perspective was, move management at its core allowed individuals into the homes and lives of often older adults who are going through this transitional period or moment in their life, mostly based around a move. And usually when that's happening,
it's motivated or driven by something that could be crisis, could be health, it could be preference or anything else. But the sort of like middle of the Venn diagram between home care and move management is we're in someone's home who is in a moment of vulnerability in their life. And that's where both services kick in. Now in home care, for all of our home care listeners, we know that to be
Friday at five o'clock when you get the discharge who needs 24 seven and mom can't go home until we have it. Can you help us? That's our version of the crisis. Move management, their version when they're in the home is either we need to declutter, we need to right size and downsize and readjust the floor plan so that someone can stay here safely or we need to move them out of this home so they can be safe in the next place. And so what I saw was that sort of overlapping moment and I said,
Kevin Smith (14:37)
Well, if we have a move management business and they are in the homes of people and they can be sort of educated around what the light bulb is for a home care intervention. And if our home care team can be educated for what a move management intervention might look like, you know, maybe we're scratching at something here and the existing private pay market that we were already serving seemed to allow for that.
In other words, it seemed like there might be some interest among that audience to say, well, yeah, we are getting home care, but maybe mom or dad could also use this so that they could move more safely around the home. Best of Care at the time was also working very hard to establish new relationships with independent living communities to deliver home care. Those communities by nature, by their very nature, have a lot of move-ins and a lot of move-outs.
So there was another piece of overlap there. Maybe we can take those partnerships with those communities at a new resource where we safeguard their moves in or out because nothing's more important to those places than occupancy. So some of these sort of things started to materialize and coalesce in our mind. And that's what led us to that acquisition. It was also the geography of it all where Movie Mentor had some
really key and long standing relationships that they worked hard to build and maintain in the western part of Massachusetts where Best of Care was very interested in gaining new market share for its home care business. And so we kind of chicken or egged it, know, whichever way you want to look at it. And that's what led us out there. And so we are a couple of years into it now and now we're working to try and scale that business in a way that
follows our home care business, follows our independent living partnerships, assists our care managers, and just fits in nicely into this holistic model that we're trying to build up.
