Things are different now than they were when Ben Bledsoe, the CEO of Consumer Direct Holdings (CDH), sat down with Home Health Care News to talk about his company going public.

The starkest difference is that his company is, well, not going public.

In September, it was announced that the special acquisition purpose company (SPAC) DTRT Health Acquisition Corp. (Nasdaq: DTRT) would be merging with Consumer Direct to form a $681 million company.

That deal is no more.

However, Consumer Direct maintains its status as one of the largest self-directed personal home care companies in the country.

Bledsoe spoke to HHCN in December about his rise at Consumer Direct, the misconceptions and value of self-directed care and what other goals he and the company have for the next few years.

Highlights of the conversation are below, edited for length and clarity.

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Can you give us some insight on what drew you to Consumer Direct in the first place, and chronicle your rise through the organization?

Ben Bledsoe: I returned from the Peace Corps, had just gotten married and my wife and I moved to Missoula, Montana for her to go to graduate school. I fell in with Consumer Direct Care Network as a caregiver.

I felt like it was something beneficial for the world, something where you can make a difference and caregiving really kind of stuck with me. It was one of those jobs that you relate to and look back on and say, “This was a really great time, a fun job and something that I felt great about.”

So I took on that caregiving job with Consumer Direct Care Network and then found myself being asked to come in and do some office work. I really took to the business side of it as well. I went back to school to finish a master’s degree while I was working and then from there, I moved to Arizona with Consumer Direct to help set up our Arizona operations.

Three years later, I moved from Tucson back to Missoula to start our quality improvement department and started taking on other pieces of the business. … Next thing you know, our owners decided that they wanted to take a step back and put a management team in place and they asked me to lead that team.

That was a decade ago now, so it was a pretty quick rise in the company. It’s something that again, I’m pretty proud of, but at the same time, seeing all the growth of that company from the bottom to the top, in and out, really just gives me a different viewpoint of who we are as a company and the culture of where we do work and how we can impact personal care as a whole.

Before we get further into the conversation, can you explain to our audience what Consumer Direct does as a company?

We are an in-home personal care provider. What that means is that we provide activities of daily living or instrumental activities of daily living to people with disabilities and the elderly. Things like helping someone get up in the morning, bathing, dressing, grooming, out into the community, anything helping people live the life they want.

Somebody just like you and I, the activities that we take for granted that get us up and out doing social things, and being part of our community, are things that we want to help people do every day.

It’s something that is hidden and maybe downplayed a little bit, but organizations like ours are there working with Medicaid and MCOs and others to make sure that we support people that need help every day to get out and into their community.

We do all models of personal care. Traditional personal care is what most people think of: a pool of caregivers that we’re going to send into people’s homes. We are the employer and we hire and fire and schedule and kind of control those groups of people.

Then there’s this other part called self-direction. We do traditional services at a smaller scale, but where we really made that name for ourselves is in the world of self-direction, or consumer-direction, hence the name of the company. Self-direction comes in a few different models as well, but essentially the philosophy here is that we want to put that control over the caregiver, that connection and that relationship with the client or their representative.

So there’s a managing employer in place, and whether they’re the legal employer or just the managing employer where we can act as the legal employer, but we put that philosophy of, “Hey, you’re the ones that know how to best direct this care. You get to recruit, hire, train and schedule the person that’s coming into your home.”

This idea of strangers coming into your house to do this very personal work that you have happen in personal care now is usually someone that you know or someone that you’ve recruited yourself. A neighbor, a friend, sometimes a relative, someone in that vein. We can be there to help as a company make sure that you meet all the requirements, both the worker and the client, and that you stay compliant with the different pieces that we put in. Things like fraud prevention measures.

That self-directed model, that’s really growing fast right now, and it is where we’ve made a name for ourselves. We can scale that in a different way. We can afford to pay caregivers a little bit more. It also saves some money for the payers as well. Really, when it boils down to it, we’re helping people with disabilities and the elderly get up in the morning, get out in their communities, get fed, get dressed and do the sort of daily life that we all want to have in our community.

What is the value of self-directed care?

There are a ton of different parts of value, depending on where you are in this network and in this community. The biggest value of self-direction is in the control that you give to someone receiving services. That’s in a client who wants to be more involved and more engaged in those day-to-day services or supplements that they’ve assigned as the representative. It could be a mom or it could be another friend organizing that care, playing the role of the employer.

When you have someone that’s more engaged in those services, they get to make all those choices and live the life that they want to live. They need to do it on their own terms. You bring that engagement into play and it improves customer satisfaction, it improves longevity, keeps you up to speed with technology, and adds a number of different values to keep those people in place.

It also is a lower cost to taxpayers, you and I, for being good stewards of the Medicaid dollar. We do primarily Medicaid services.

Finally, because of that lower overhead for us as a company where someone in the home is serving as that managing employer, it’s much more scalable. We can also pass on some of those cost savings to caregivers. The low-wage worker, that very important job of being the person who actually does the hands-on work, we can usually afford to pay caregivers a little bit more and reward them for the important work that they do.

What do you think are some of the misconceptions about self-directed home care in the larger home care industry? And do you expect self-directed care to continue to grow in popularity as people get a better understanding of it?

I think most of the misconceptions, and the one that we battle back on in most cases is there is a perception that self-direction comes with an escalated amount of fraud in our services. There’s no evidence to back that up. And in most cases, what people are thinking of when they think about fraud is a caregiver who is logging out 15 minutes later or logging in 15 minutes earlier. Those are the kinds of things that people start to look at and point their fingers at here and there.

Again, these are low-wage workers that are living paycheck to paycheck, and if we can put in controls for that, we will. There have been some new tools come into play like electronic visit verification that started to eliminate that as well.

Bigger fraud, I would argue, is more on those systemic levels. We’ve seen agencies that are just bad players. That’s no different whether it’s in traditional personal care or self-directed home care. There’s no real evidence in either place, and we are very aware of this perception.

We developed our own fraud prevention program that’s been in place for nearly a decade now. We’ve had caregivers who have decided not to work with us because they see some of our materials and they realize that we take it seriously. We have tight connections with the Office of Inspector General (OIG) in nearly every state we’re in. We operate a toll-free number and a number of different fraud prevention techniques. We have our own fraud prevention video that we developed. That’s the one that we battle against the most.

On the second part of your question, do I think self-direction will grow? I am 100% certain that self-direction will continue to grow. It’s been growing at a faster rate than traditional personal care. As a whole, personal care is going to grow.

We have an aging population in the U.S. We have emerging needs and a gap in income that exists in the country as well. The eligibility for those services that are meant for people with disabilities, the elderly and people that are low income, we know that eligibility will be up there.

Below that, we have the self-directed world that’s grown in popularity and is taking up a larger piece of that market share of personal care. We see that over and over again. I can point to it on many of the charts and KPIs that I look at, of all the models and services we provide, self-directed care has the higher customer satisfaction scores every single time.

That, I really believe, comes back to the engagement of the client and the connection between caregivers and clients as well.

Finally, the growth comes down to the workforce. Self-direction opens up a new doorway for that workforce. In this model, you have people that typically wouldn’t do this work in a different model of service, but they’ll do it for someone that they know. Self-direction opens that door and brings those people in the workforce. You can staff it, and you can do the work, whereas a traditional agency may have a hard time recruiting at the rates that they’re paying. And again, it involves strangers coming into homes. So yes, self-direction is going to grow.

Can you give us the background on how this DTRT, SPAC deal came together?

DTRT Health Acquisition Corp. is a special purpose acquisition company, a SPAC. They were formed with the specific purpose of finding a high growth health care company that they could assist to take public. The CEO of DTRT Health Acquisition Corp., Mark Heaney, was the previous CEO of Addus Home Care. It’s a pretty small community of home care providers, so we know each other. I’ve known Mark for many years. He also is very familiar with some of our founders and we have a lot of respect for Mark.

He approached our founders and our partners and talked about this deal and what we could do. We could see that at some point, we were going to need some help with our ambition, appetite and our continued growth.

Why was now the right time for Consumer Direct to go public?

We had just finished this large implementation in the state of Washington. We have grown pretty steadily for years and years. Every year was bigger than the last. With this latest Washington implementation, it more than doubled our company. I’m really proud of what this team did to implement that work and at the same time, keep all the other programs we had going.

Even before that, we had implemented some work in Virginia. Around that time, there was a moment where we thought, “Well, we’re getting a lot of accolades for the work that we’re doing, having caregivers and clients, by and large, be close to 100% satisfied, but there are still a few things we can improve on.”

Considering that growth, it was time for us to look at how we can put together a more strategic and longer-term plan. We see innovation coming into the space and some real possibilities with technology and our own internal systems that we’ve brought in for customized for our own uses. I think there’s just a ton of activity that convinced us that this is the time for us.

At the same time, we have some aging founders that are wondering what their succession plan is. For me, I look at it and say being a public company is really a benefit for when we go out there and try to bid on new business.

We have state agencies and MCOs that can look at us and could see that transparency that they always want to have about how compliant we’re being, about our financial status, about our stability, about our leadership. Those kinds of things – I think – will help us grow even further in the community.

Looking ahead, where do you want the company to be in, say, three years or five years?

We have our own internal strategic plan and those things change on an annual basis. A lot of that has to do with growth. We want to keep those same great things – the things that have made us a great company – in place and keep moving them and improving them.

In the end, I believe we’ll continue to grow. Self-direction feels like it has a never-ending horizon in front of it. There are tons of opportunities ahead of us for multiple states and from lots of managed care organizations.

Several different stakeholder partnerships that we’re really excited about are coming up. Leading this industry has really been a target for us. We looked at some of our larger competitors and we looked up to them for a long time. Seeing them, learning from them and seeing where we are now. I think we’ve been a leader for quite some time, and, in this case, we want to be the leader in self-direction.

I think we are right on track and continue to be a little bit more of that acknowledged leader. The ones that others look up to are the kind of places that we want to go to. We’re super proud of where we are today. I can’t imagine what this team is going to be able to accomplish in the next three to five years.

Zooming out a little bit. Whether it’s in self-directed care specifically or home care at large, what do you think are one or two problems that need to be fixed in the near-term future?

Within our industry, number one has to do with the workforce. Caregivers do physically, emotionally and mentally challenging work. I did this work myself. It is very hard, but it’s extraordinarily important.

Having them do this hard work and then being asked to take on new pieces of technology, or delegated tasks, all these sorts of things that we’re asking people to do in their homes. That’s great.

But in the end, these are folks that are making wages that are now verging on poverty wages. We’re below or competing with fast food and retail. That’s nothing against fast food or retail, but this is work that is a little more integral to someone’s day-to-day life.

I’ve really been happy with seeing different states and MCOs addressing the issue of rates. Rates that are paid to agencies like us, therefore become larger wages for caregivers.

In the U.S., as a whole, there’s an issue with seeing this as a career, seeing it as a valuable part of a care team, seeing it as something to celebrate and work to celebrate. That’s a problem I see within our industry: trying to make sure that you secure that workforce and that those grassroots people receive the respect and the benefits that they should.

That’s my No. 1: trying to push for the respect of caregivers in the world.

Do you have any predictions for home care over the next couple of years?

I do believe self-direction is growing. It’s creeping up into this place where it is seen as a solution for lots of these challenges that we are facing home care, and maybe even health care as a whole.

Self-direction affords that low-cost possibility for payers. We can fill in with more services, have more people receive those services, or perhaps pay caregivers a little more to fill that gap in the workforce that we know we’re running up against.

As a solution, I think self-direction creates a different scale. When you can put some of those tasks on people in their homes, it just changes the game. I think that that’s a great possibility for them.

For health care as a whole, I think personal care has a bigger role to play. The idea that caregivers can be a bigger part of that care team, helping bring information in and helping us even drive more toward better outcomes or helping identify how we can do value-based purchasing in-home care. There are a lot of questions out there that I think home care, and, again, specifically, self-direction, can start to open up in the world.

There’s a lot that we can do with these services. I think we’re underrated for the value that we can bring as an agency. Those caregivers can do work to improve the lives of the people that they’re serving. We can also improve the work that we do as an agency, that an MCO may do, that a state may do.