Twenty weeks at Champs Home Care
Real engagements are confidential, so here is one told on a fictional agency — week by week, person by person, the way it actually goes. If you run a home-care operation, you will recognize every desk in this story. The names and numbers are invented; nothing else is.
The signing
The first meeting wasn't a pitch. Ari Fleisher, the administrator, had one real question, and it wasn't about price: "You worked with agencies before. How do I know our playbook doesn't end up in Williamsburg?" Fair question — in this industry everyone knows everyone, and half the office has a cousin at a competitor.
So before we saw a single number, Champs had our signature on a mutual NDA and a non-compete. What we learn inside their walls stays theirs. We volunteered it; nobody had to ask twice. Then the practical part: an executive sponsor (Ari), working read-only access to HHAeXchange reporting and the billing exports, and a date. The clock didn't start until the logins actually worked — six days later.
The onboarding: a morning with Ari
Not the CEO. That's deliberate. Mendy Gross built the agency and can tell you its story for hours — but Ari runs Tuesday. So the first real session was three hours in Ari's office with the door closed, learning the business the way a new senior hire would, and writing down every term like we'd never heard it.
- The language: MLTC, auth, EVV, split shift, live-in vs. hourly, "the portal" (which meant three different portals depending on who said it).
- The metrics they live by: missed-visit rate, EVV compliance %, days-to-bill, denial rate, aide churn — and which MLTC plan is strict about which.
- The team map: who actually does what, which is not what the org chart says. Two people "help out" with billing who aren't in billing.
- Where it hurts, in Ari's words: "Intake is drowning, billing is a black box until the 15th, and I find out about missed visits from the plan before I find out from us."
A chair next to every desk
Then two weeks of sitting with each person while they worked — not interviewing them in a conference room, sitting next to them, watching the actual clicks. People tell a stranger with a notebook what they'd never write in a survey. Here's what the floor taught us, person by person:
Chana Schnell
New cases arrive from five MLTC portals and a fax line. Chana re-types each referral into HHAeXchange, then again into the intake tracking sheet, then calls the family. Rush hours are worst: referrals sit while she re-keys the morning's batch. Her whiteboard note says it all: "CHECK PORTALS AGAIN 2PM."
Rivky Stern
Runs 520 aides off HHAeXchange plus a WhatsApp group per neighborhood. The 7–9am scramble is daily ritual: an aide calls out, Rivky broadcasts, calls down her mental list, then fixes the EVV exceptions the shuffle created. She is brilliant at it. That's the problem — it lives in her head.
Sarah Halpern
Bills five plans through HHAeXchange, then re-keys everything into QuickBooks by hand — line by line, every remittance. Denials land in a spreadsheet she calls "the graveyard": auth mismatches and EVV gaps she refiles when she can find the time, which is never. She hasn't looked at the aging report in a month. Nobody has.
Dovid Berkowitz
Keeps 520 aides compliant: in-services, physicals, I-9s, registry checks. His system is a color-coded spreadsheet and patience. Every week ~14 documents come due; every one is a phone-call chase. When a plan audits a chart, the office stops while Dovid pulls paper.
Eli Mandel
Owner of the ~30 Google Sheets that hold the agency together — census, referrals, cars, keys, the Monday report. Every Monday morning he assembles numbers from HHAeXchange, the sheets, and Sarah's notes into the report Mendy reads. It takes him half a day, and it's already stale by lunch.
By the end of week 3 the Dwell Map had seven points on it, priced. The labor alone: ≈ $126K a year of skilled people doing re-entry and chasing. The bigger number was hiding in Sarah's graveyard — a 6.8% denial rate, mostly auth and EVV mismatches that better plumbing would prevent.
The technology deep dive
Then we stopped talking to people and started reading systems and invoices. The question for every tool: keep it, replace it, or build the thin layer that should have existed all along. Champs did not need new software to buy. It needed its software to talk.
| System | What it does at Champs | ≈ Cost/yr | Verdict | Why |
|---|---|---|---|---|
| HHAeXchange | EVV, authorizations, scheduling, MLTC billing — the system of record | $34K | KEEP + INTEGRATE | It's the required rail to the MLTC plans. The problem was never HHAX — it's everything typed into and out of it by hand. |
| Viventium | Payroll for 520 aides | $16K | KEEP + INTEGRATE | Good at its job. Hours already flow from EVV; leave it alone. |
| QuickBooks | The books | $2K | KEEP + BRIDGE | Sarah's 60% is the swivel chair between HHAX and QBO. Build the bridge; keep the books. |
| Fax + payer portals | How referrals and auths arrive | $2K | BUILD INTAKE LAYER | Digital intake: referrals parsed, validated, entered into HHAX, exceptions to Chana for review instead of retyping. |
| ~30 Google Sheets | Census, trackers, compliance, the Monday report | $0 | REPLACE | Replace with one governed ops layer fed by the real systems. Eli's Monday report becomes a page that's always current. |
| WhatsApp groups | How Rivky actually reaches aides | $0 | KEEP — FOR PEOPLE | Don't fight what works. Coverage broadcasts get generated and logged automatically; humans keep the conversation. |
The digest, the Gameplan — and finally, the CEO
Then a few quiet days with everything we'd heard and measured, turning it into one document: the map, the baseline, the audit above, a phased plan, and the Number. Week 6 was the first time we sat with Mendy Gross — and that's exactly why the meeting worked. We walked in speaking MLTC and missed-visit rate, carrying a map his own people had already confirmed was true. No beginner questions on the owner's time.
- Phase 1 (90 days): digital referral intake → HHAX; the HHAX↔QuickBooks bridge; denial-prevention checks before claims go out.
- Phase 2: the coverage engine for Rivky (ranked aide suggestions + auto-logged broadcasts); the compliance radar for Dovid (30/60/90-day document alerts, self-serve uploads).
- Phase 3: retire the 30 sheets into one live ops view; Eli's Monday report becomes a permanent, current page.
Labor redirected (~$126K), denials prevented and recovered (the bulk of the rest), overtime trimmed at the margins — every line traced to the baseline, assumptions stated. Mendy's question was the right one: "And if I stop after this document?" Then you keep the map, the audit, and the plan, and you've spent $25K learning exactly where your $24M operation leaks. He signed the build twelve days later, audit fee credited in full.
The build, one Friday at a time
Week 9: digital intake went live. Chana stopped retyping and started reviewing an exception queue; same-day referral response went from "usually" to "always" — and she now checks portals zero times a day, because the portals come to her. Week 14: the HHAX↔QuickBooks bridge shipped after holding its gates two straight weeks (96%+ clean match rate). Week 18: denial-prevention checks live — claims with auth or EVV mismatches get flagged before they go out the door, not thirty days after.
Every Friday, working software on live data in front of Ari's team. Around week 12 Ari stopped attending. That's what trust looks like on a calendar.
And Sarah? With the re-keying gone, she finally opened the aging report — and spent the quarter working the graveyard instead of feeding it. Denials fell from 6.8% toward 4%, and a billing manager earning $75K started doing $75K work. Nobody was replaced. Everybody was promoted by their own job.
The operation, on a heartbeat
Hypercare ended, managed began: everything monitored, exceptions to humans, and one page a month to Ari and Mendy. This is month three's Pulse:
You know a Chana. You probably know three
The people here are invented; the desks are not. The audit writes this story about your operation — with your names, your systems, and your real numbers.