5 Growth Strategies From Clay Foutch of Home Matters Caregiving

00:00:03 Romi Gubes: Hello. Thank you for joining me on the Growth Operator Podcast. Super excited to dive into different aspects of the business with you. Obviously, you know, we have known each other for a while now. I know how well you operate your business. I saw it grow from the first line, which is super exciting and super inspiring. If you can start with just a quick introduction about yourself so our audience will get to know you and the business, and then we can dive right in.

00:00:26 Clayton Foutch: Yeah, well, I’m Clay Foutch. I founded Home Matters Caregiving with my wife, Kristina, in 2007. We’re based just outside of Portland, Oregon. We grew our business, and in 2020, we decided we would launch a franchise system based on our brand of care. Today, we operate in 17 states, and there are 45 Home Matters Caregiving owners across the US.

00:01:02 Romi Gubes: You know, it always gives me chills when you say that because I remember being at one of your first franchise conferences. The first was in Illinois, right?

00:01:10 Clayton Foutch: Orlando.

00:01:11 Romi Gubes: Orlando. Yeah, we met there. It was a small room with just a handful of owners. Yeah, some of them weren’t even owners yet. Right, right. And you told me, “Wait and see. We’ll grow exponentially. We’ll get to hundreds, and this room will get bigger.” Today, being at your last conference, it’s now a real, big conference with many owners who are hungry to grow and amazing people who are joining.

00:01:31 Clayton Foutch: Yeah, thanks. I think we’re still very much an emerging brand. But I think these are the good old days that we’re living right now because we’re really learning a lot from the people that join. We’re really learning a lot about the things we don’t know. Not knowing is a good place because it means you’re open to new ideas, and we’re very open to new ideas. It has been a lot of fun.

00:01:53 Romi Gubes: You know what? I feel like this humble approach you’re taking will follow you all along the journey. Even when you are a 1,000-franchisee network, you’ll say, “Yeah, we’re an emerging brand, we’re growing.”

00:02:04 Clayton Foutch: I like the seat on the bus. Our market is changing very quickly. So if you don’t think like an emerging brand, I think you’re going to have challenges. We’ve historically been the opposite of tech, which is my background in the beginning. Tech changes so quickly that you can’t take your foot off the gas; you have to constantly adapt. Our industry has historically been pretty similar. The way we ran business then was the way we run business now and the way we’re going to run business in the future, but it’s changing very quickly. So I think that mindset of thinking like an emerging brand and thinking like a startup is going to be an important part of how we grow. I’m 54 years old, Romi; I don’t have that long. I have to stay very focused right now.

00:02:51 Romi Gubes: You have a few years to nail it.

00:02:53 Clayton Foutch: Yeah, I have to get this right.

00:02:55 Romi Gubes: And I know one of the areas you’re more passionate about when it comes to growth is the combination. First of all, I know that you’re a blind believer that better care will lead to better business outcomes, and you’re preaching that in many different ways. One of the things you’ve done very successfully was to connect better care outcomes and how it impacts growth through referrals—different sorts of referrals. So if you can share a little bit about how you envision that? What did you do? What worked, and what didn’t?

00:03:22 Clayton Foutch: Yeah, well, I should probably start by saying my superpower is really in business development, relationship management, and connections. In 2010—16 years ago—I met two people that would prove to be really instrumental in the success of Home Matters Caregiving. I met my future CEO, Jeff. He launched Home Matters Caregiving in Phoenix, Arizona. I just started by trying to teach him. When you teach somebody how you’re doing something, it creates a white-hot spotlight on all the things that you actually don’t have documented very well. Jeff was the perfect person for me to work with back then. I also met our now COO, Heidi Rothwell, who became the administrator of our local agency. Her superpower is operational excellence. Jeff is really a finance guy, a good decision-maker, and very smart. So that’s a good balance in an office and for a brand.

00:05:14 Clayton Foutch: What I learned over these years was that solving problems for our referral partners was the way to grow our business and become important to all of the places that aging adults are passing through when they’re in either a crisis or a pinch point on decision-making. Better understanding that business helps us grow and serve that business as a referral partner.

00:05:37 Romi Gubes: If we’re looking at the numbers real quick before diving deeper, how much of your business today is coming from referrals?

00:05:55 Clayton Foutch: We built our business exclusively on that model. From 2007 through early 2023, while we still ran our Beaverton-based agency, it was 100%. That was the only way we did business. That wasn’t a good decision; we would have been better served by diversifying revenue and doing some government-funded work. So I was wrong about that. We would have also benefited from doing more work with pay-per-lead, but we just didn’t have a good system for managing those leads. So rather than focus on what would be a good solution, I just said, “Let’s not do it.” We really were 100% referral-based. Today, what we teach is being about 80% private pay and family-funded, and about 20% government-funded. Of the 80% that is private, we really try to drive three-quarters of that from organic referral sources like skilled nursing, hospice, and senior housing advisors, and about 25% from community-based concierge care—working with independent living and assisted living communities.

00:07:07 Romi Gubes: So you’re saying, out of the 80%, how many are coming from a pay-per-lead concept?

00:07:11 Clayton Foutch: We try to keep that around 20%.

00:07:13 Romi Gubes: Okay, got it. And what is your advice at Home Matters University on how to start working with referrals and how to take your first steps into referrals? We know that it’s harder for the ones that are just starting to build their credibility in the marketplace and are not a huge name at the beginning, at least. What is your advice to them?

00:07:31 Clayton Foutch: Well, one is to understand that relationships and relational sales take time. You can’t shortcut history with someone, and you can’t shortcut experience in a market. You have to be patient; that’s number one. But you have to get the plane off the ground. Pay-per-lead is a very good way to build experience and history with your referral partners. We have processes and systems around how to become involved through education, through volunteerism, and through traditional business development activity. Those things have to be done, but that takes time, and you can’t rush it. Having a system and a process around leveraging leads, the acquisition of the lead, and then the management of the lead is vital. This is a good way to, in parallel, begin to generate care consultations, convert care consultations into new clients and hours, and ultimately serve the caregiving team with what your commitment is to them, which is hours.

00:09:12 Romi Gubes: Starting from building your repertoire and building your first portfolio is usually via pay-per-lead or something that is more immediate while you build your relationships with referrals. Do you have any recommendations in terms of priorities? Any specific type of referral that you recommend starting with?

00:09:30 Clayton Foutch: Well, yeah, that’s a good question. When you’re looking at organic referral partners, it’s really about understanding who is having a problem that you could help solve. I wouldn’t say necessarily that it should be hospice, a skilled nursing facility, a hospital, or a senior housing advisor or placement agent. It’s really about whether you can connect with a person to understand the situation they’re working within and the problems they’re facing. The more polished business development person understands the implication of that problem—like when that happens, how does it impact their business? In community-based settings like independent living communities, if you can connect with the executive director, the administrator, or the marketer, what is the situation there? What problems are they facing, and when they face them, how does it impact them? Once you understand that, then you can talk about where you might fit in to solve that problem.

00:10:55 Clayton Foutch: If you did that 100 times over the course of a week, a month, or a quarter, you could then take that 100 down to probably 15 or 20 where you feel like you have a good understanding of those things and you’ve introduced this idea of where you might fit in where you’re needed. Out of those 15 or 20, there might be 2 or 3 where it’s a perfect alignment—you’re the right person at the right time, and that’s where you’re going to start because you now know where you’re needed. None of this is my idea. This is an old strategy from Neil Rackham around 1985 called SPIN selling, but it really works. It works when you’re talking about strategic selling, and in a competitive market, strategic selling even with home care has proven to be a good model for us.

00:12:00 Romi Gubes: So what you’re basically saying is don’t just pop into the office of the executive director and say, “Hi, I know I’m the 10th agency that is visiting you today. I know that you don’t want to listen to me, but we provide compassionate care, trained caregivers,” and give her the general pitch. Rather, start with discovery, really understanding your market, and try to look for ones that you can really serve differently and in a different way than other agencies.

00:12:22 Clayton Foutch: Right. And while we’ve been around for 19 years and our franchise organization has been around for five, we were born into this next chapter, which is a new era: AI. In the old days, researching a skilled nursing facility meant looking through state records and the last audit. Now, in the parking lot, you just go to Claude and say, “What was their last CMS score or rating? What were the results of the last audit?” You get a summary of their last audit right in the parking lot. So you know some of the pain points, you know some of the challenges they’re facing, and you know what CMS says about them. At the same time, what does the public say about them? What is their Google Review score? What is the consensus of the people who took the time to leave a review? Knowing that gives you a foundation of their situation, no matter what they say. If you can mix that into a conversation based on what you know—mentioning other skilled nursing facilities that have had similar challenges and what their processes were around corrective actions—it makes the conversation more meaningful and creates the potential for collaboration.

00:14:15 Clayton Foutch: But sales is a game. If you’re a baseball fan like me, you think of great hitters, right? The best hitters, seven out of ten times, leave that battle between the pitcher and them and go back to the dugout having lost. Those are the best. This means that you have to have a mindset that seven out of ten times, this probably won’t work out, but the three times it does, we want to be prepared for. A little bit of preparation goes a long way to quickly identify those three out of ten that potentially could be a good fit and where it could be the right time.

00:15:12 Romi Gubes: Let’s take it a step lower just to give some concrete examples from the field. Let’s run a quick simulation here. You have an independent living community that you collected all kinds of business intelligence on from the web. You spoke to their Executive Director, and you understand the main problem is occupancy, right? They are around a 70% occupancy rate. Obviously, this is not a good place to be, and this is their main focus. How can they create a waitlist, and how can they retain their clients for longer? Because this is a leaking bucket that they’re trying to solve. You’re coming into the executive director’s office; what does your pitch sound like?

00:15:47 Clayton Foutch: Let’s take a step further back because I’m imagining that there’s someone listening to this at some point in the future and they say, “Well, how did you get to the executive director?” Because that’s a hard meeting to get. This is not one where you just stop in. Let’s take a step back. The easiest appointment in our industry to get is at an independent living, assisted living, memory care, or skilled nursing community. The way we get that meeting is we call their marketer—their business development person. We first identify ourselves as a home care company. We never want to express anything other than we are a home care company, and I’d like to do a tour of your community because we have many clients and we talk to many families that aren’t a good fit for home care, and we want to know where to refer them. We will get 99 out of 100 tours scheduled if we take that approach.

00:16:53 Clayton Foutch: A tour is an important part of learning about the situation at this community. What are some situational observations that we would see on a tour? We would see and learn how many apartments by care type—independent, assisted, or memory care—are occupied. If they have 100 independent apartments and they’re at 65% occupancy, they have 35 open apartments. We now understand that situation. As we’re walking and talking, we might learn that the assisted living side is full—65 apartments at 100% occupancy—and they have 15 memory care beds at 100% occupancy. So we can ask, “Linda, as the marketer, what is your strategy around filling the independent living apartments, and does that create a challenge for you in your business?” They would explain, “Yeah, we have to report out every day, and we’re investing in more leads.” We learn that how they solve that problem is driving more traffic into the community.

00:18:18 Clayton Foutch: What are some other situational things that we would learn? We would learn what the amenities are. Do they have a home health organization here for their residents? Do they have an onsite physician group? Do they have a new chef who was a former Michelin chef? These are all situational details. Do they have a stable management team, or do they have a lot of turnover in management? All situational questions lead to understanding why that is a problem and what the implication of that problem is. When you’re talking to a marketing person and they share that the implication of low census is pressure, stress, and performance improvement, and you’ve learned what their strategy is, you begin to formulate ideas during this walk. You see different apartment types, get to know people, and bump into the wellness center or their onsite home care company. Where might we fit in?

00:19:43 Clayton Foutch: Well, I know a lot of senior housing placement advisors, so I start to think that maybe I could host an event here and invite all of my advisor network to do a tour—maybe a happy hour. If I could get 15 people here who have a network of families they’re talking to, that might help this organization. Along that tour, eventually, we meet the executive director. Now I know a lot of things about the situation, the problem, and the implication, and I can correlate that to their goals. When I get a minute with them, I want to take what I’ve learned and request five minutes to share an idea or two. That begins the conversation. Then you’re back to an at-bat, and seven out of ten times, that executive director will say it’s not the right timing or you’re not the right person, and you’re back to the dugout. But three out of ten times, that person leans in and says, “I’m interested in one good idea because I’m five minutes before my next call, and I am under a tremendous amount of pressure to solve this occupancy problem.”

00:21:05 Romi Gubes: You’re saying you’re coming armed to the ED, you press specifically on their pain points, and you’re tethering some kind of elevator pitch to address those pain points on the spot. I think that’s a very high bar.

00:21:16 Clayton Foutch: Well, yeah, but believe me, if I can figure this out, then anyone can figure this out. The truth is, when you’re in a community-based setting, this is an apartment complex for 85-year-olds—it’s Melrose Place for 85-year-olds. Understanding occupancy is everything. It doesn’t take much imagination to say, “Where would a home care company fit in, and how might we help?” One, we can help by getting more eyeballs on them. An easy example would be asking, “Would you like to co-sponsor a series of events? I have a good network of senior housing advisors, home health and hospice organizations, and so on. We could host some events here, and I could drive traffic.” That’s something I could do to bring value, and that’s an easy “yes” if the timing is right and that person thinks you might be the right person.

00:22:24 Clayton Foutch: What’s more challenging and what might be the next phase is usually identifying the bigger challenge: “How do I retain my residents? How do I create an environment where my residents have an improved length of stay?” What triggers move-outs? Is it overall satisfaction? Is it a clinical incident? Is it food, management turnover, or culture? And if you can learn that—voice, you have to edit this out, boy, it’s totally fine. I was just kidding. You have to lighten this up a little bit. You start to get serious, and I’m like, we shouldn’t be too serious. No, not too serious. But if you think about the other half of the challenge they have, which is move-ins and move-outs, understanding that is harder to start with when you’re just meeting an executive director. So we always talk about that as phase two. Phase one is more eyeballs; they’re proud of their community, their geography, their amenities, and their services, and then you can grow from there to talk about what reasons are on the Pareto chart for why residents move out. That takes some trust for that person to share, but this is relational, not transactional. There’s no rush; you get there when the relationship evolves into that.

00:24:56 Romi Gubes: One of the things I’m interested in—I spend a lot of time in the field with those business development guys, driving through the different communities in their marketplace, going from one to another. One thing I found interesting is that when I ask, “What is your desired outcome?” I’m getting completely different answers from different reps, or I’m getting silence because they’re not sure what they’re aiming for. So I’m interested to hear, when you’re approaching an IL, what is your Holy Grail? What is the best outcome and success you can imagine?

00:25:31 Clayton Foutch: Well, first of all, I’m not surprised by that because a lot of people who do business development, outreach, or marketing—which I never refer to as outreach or marketing; we are business development people, we are hunters—view their job as building relationships with people who are influencing aging adults so that we can get referrals and new clients to serve our customer, which is the caregiver.

00:26:01 Romi Gubes: Would you agree that it’s somewhat similar to strategic alliances or partnership relationships?

00:26:05 Clayton Foutch: 100%, yeah. When I go to an IL, I want to spend a minute in the car to prep. What does the community say about this place? I want to go on Claude and type in this community. What do I quickly learn about who the executive director is? I might grab a LinkedIn page. I don’t want to overanalyze because seven out of ten times I’m going to walk in and walk right back out to the dugout, but I want to know a little bit about the people I might run into and the community I’m approaching. The desired outcome is that I’m about to meet one of those three out of ten people who has a problem and is directly feeling the implication of it. What they need is a partner like me who can bring eyes to this organization and be a service provider to this community—meaning we can be a vetted partner housed inside this community where we are the preferred partner for all of those independent living residents who need a little bit of help in order to age in place. That’s the desired outcome.

00:27:18 Romi Gubes: What does it mean to be the best preferred vendor?

00:27:22 Clayton Foutch: It means that we have an office inside their community, that there’s a space with Home Matters Caregiving signage and a price sheet. I have a manager on site who oversees the care that’s being delivered—essentially an administrator overseeing this care. This is why it’s important to understand the situation, because as an owner, you have to know that there are top tier-one type communities, tier-two, tier-three, and tier-four. You have to know who you’re targeting and who is a good fit for your brand and what you’re trying to accomplish. The most successful businesses—if you think of companies like Nordstrom, Walmart, and Dollar General—are three very successful organizations that do it three completely different ways, and we have to know what we are and who we are. Then you have to find partners aligned with that. You don’t want to cast your line into a community that you’re not a good fit for or that isn’t a good fit for you. But when you’re casting your line into ponds where there are good prospects, that three out of ten is going to be good for you. We want to be vetted, we want to have alignment with that management team, we want to be on site, and we want the residents to know we are another service that this community has invested in. We’re investing in the residents, and we’re now a part of this community. That’s relational, and that takes time. You can’t rush that, but this is definitely not a transactional deal.

00:29:18 Romi Gubes: I know that for the Beaverton office, your flagship office, you were the one running that for a while. Just recently, you introduced business development reps who will lead that effort. Can you speak to me a little bit about what qualities you’re looking for in such a job, and also how you build an incentive plan connected to desired outcomes?

00:29:39 Clayton Foutch: Well, this is the toughest person to hire. Business development people are artists, and artists have different ways of expressing themselves. You can’t take a sculptor and say, “I want to show you watercolors; this is how we do it, we are a watercolor company.” You have to find somebody who has the characteristics you’re looking for and someone who is open to the belief that art plus science really creates the best outcome. Then you, the owner or whoever is managing, have to be disciplined to remember they are an artist. You can’t teach or train work ethic; you need somebody who has a good motor and works hard. Number two, they have to really care. That is also something you can’t teach—not just caring about success and criteria, but caring about the team they work with, caring about the community of caregivers counting on them to deliver results, and ultimately caring about the business. Again, this is a relational sale, so this is not a transactional person. You have to get to know them and be patient, so this is a position you hire very slowly.

00:32:14 Romi Gubes: You said you don’t have time, right? You said you have just a few years to—

00:32:17 Clayton Foutch: Yeah, but that’s why I work in parallel every day. Every time I meet people, I’m always thinking, “That could be a special person.” You meet people in all walks of life, and if I have a superpower, I think I have a couple, but one of them is I can spot the winners. I can spot the people with the right heart and the right intention. It’s why I’m with you, honestly. You’re a one percenter—you’re smart, you’re hungry, and you’re humble.

00:32:41 Romi Gubes: Thank you.

00:32:42 Clayton Foutch: When you meet special people like that, you try to figure out how to stay in their orbit—how to navigate to be around them or how to attract them to our orbit. I hope we opened this talking about Kristina. Well, guess what happened when I met her in school? I could see very quickly that she’s one of the one percenters. When I met Jeff, there was no question; this was one of the smartest, most sincere, and genuine people I would ever meet. How does a guy like him and a girl like me get together? I want to figure this out. It’s the same with Heidi. When you meet special people, you should always be looking for them, no matter where you’re at or what you’re doing.

00:33:23 Clayton Foutch: If you’re the owner of an agency and you’re listening to this, people often say a lot of these networking events are no good because it’s the same people. I say, “No, you’re missing the point.” Networking events are very important to our business. Number one, the networking event is typically at a place you should be at—a community, the VFW, or a senior center. You should be there as the owner. Number two, if there are 25 people or 100 people, I guarantee you that 1, 2, or 5 of those people are potential partners, and these are more at-bats. If there are five people who could potentially influence our business and I get a chance, that’s one or two people I can foster a relationship with. So that’s the second reason it’s important to go. The third reason is you should be looking at every single person in the room because if there are 100 people, by definition, one of them is a one percenter, and your job is to find them. It doesn’t matter if they’re in operations, compliance, business development, if they’re the owner, a caregiver, a CNA, or a nurse—you should be trying to find that person because you want to surround yourself with people who are better than you.

00:34:44 Romi Gubes: In another podcast we had, I heard one of the owners saying that he and his entire team always go out with business cards in their pockets because his message to everyone is “always be hiring.” Even if you’re in Chick-fil-A and the cashier is amazing and constantly remembers your order, give her a business card and invite her for an interview at the agency.

00:35:05 Clayton Foutch: 100%. I remember you and me visiting D.C. a few weeks ago and hearing this lady speak. I think both of us realized she’s a one percenter, and immediately we were like, “Yeah, we have to talk to her.” Great people emerge, and duds emerge. That’s okay. A lot of people think I’m a dud, so that’s okay; it’s about perception. What most of us miss is that it’s our job to remain perceptive and aware, and to be intentional about meeting people, finding them, and navigating into their orbit. How could I help them in whatever capacity I can? What skills do I have that could help them in any way? That naturally brings me into their orbit and gives me a chance to learn from them. In some cases, we end up working together, we become friends, or they become a mentor.

00:36:12 Clayton Foutch: You mentioned this idea that someone else shared. For the folks who are listening to this one day, there’s another organization that’s really good at this that often has a bad connotation—if connotation isn’t the right word, edit that out. There’s a group that does multi-level marketing (MLM). What multi-level marketers are very good at—and I encourage anyone listening to this to pay attention to that industry—is that they are trained to master their 30-second elevator pitch and master introducing themselves to everyone because your job is to find the three out of ten. It doesn’t matter where you’re at—Chick-fil-A, the grocery store, the car wash, or the dog park. You’re talking to everyone about this thing you’re really excited about. The truth is, I’m really excited about what we’re doing at Home Matters Caregiving, and I want to share this with people. You can learn a lot from that industry about how they do that and why it’s so effective, and then figure out how to incorporate that into meeting new people on a tour or at a dog park.

00:38:30 Romi Gubes: That’s super exciting. I think people often put that on the back burner or don’t invest enough time, but this is our main responsibility as leaders: to think about the manpower and the people we’re bringing on board because this is the make-or-break of our business; it’s not anything else. Going back to my other question that you won’t get away from: how are you incentivizing the business development rep so it will be connected directly to the outcomes?

00:38:57 Clayton Foutch: I think there are two or three ways to do it, but in general, compensation typically consists of some amount of base salary and some amount of incentive or variable income tied to growth. When you find the right person who understands their job is to grow hours so that we can serve our customer—this professional caregiver we’ve made commitments to—then going from 500 hours to 1,000 hours ties the success of the agency to the efforts of this person. Every incremental hour is part of their variable, typically on tiers: if we get to X by Y date, it means this; if we get to Y by Z date, it’s this plus an accelerator. If you have a good business development person who has the right work ethic, the right intention, cares, and will take their form of artistry and apply the basics of the science—number of visits, number of impressions—then you can align on what their total compensation should look like at plan to meet local market standards and their expectations.

00:40:24 Clayton Foutch: A good business development person is the only person on your team who pays for themselves. Investing in this takes some patience. For non-business development types, it may create some anxiety because they might make more than you, the owner—it’s very possible they’re going to make more than you that year. But if you invest in them and they’re the right person, and you have good metrics and key performance indicators that you’re tracking, this is the only person on your team who, at the end of the year, has paid for themselves. Very important.

00:41:21 Romi Gubes: Yeah, definitely. I think the main consideration would be: can I find the right person to handle this super strategic task for me as an owner, someone else who will know how to do it well enough for my business to grow? Because the sunk cost is huge. If you’re investing in someone who is not delivering, you didn’t just lose their salary; you remain stagnant in your business, so it’s a huge risk if not done right. Now I want to shift gears. We spoke about referrals a little bit, specifically about different providers. Now I want to shift gears to speak about payers because I know this is something you’re also very passionate about and have had some success and lessons learned with. Can you speak to me a little bit about that? We can start specifically with PACE. I know that you had a recent effective journey with them.

00:42:15 Clayton Foutch: Yeah, I’ll start by saying that from 2007 through 2023, we didn’t do any government-funded work. Why not? Number one, it looked confusing to me, so that was probably enough for me to just not do it. Number two, the reimbursement rates made me think, “Jeez, I have a limited number of caregiving team members; why would I deploy them on less than our rack rates?”—our standard billing rate. That was reason number two that I said we’ll just stick with our traditional referral private pay clients and traditional referral partners. Number three, I didn’t really understand how it worked. I say all that to then say I couldn’t have been more wrong, genuinely. This is an important part of serving our community. When you think of the people we serve through private pay, family-funded care, these are the wealthiest people in our community who can have us come into their home for concierge 1-to-1 care. These are the five percenters.

00:44:09 Clayton Foutch: These are the ones who, quite frankly, don’t look like anything I knew growing up or what 95% of us know. These are huge dollars they’re spending every month to have this 1-to-1 care brought into their home. I always equate it to gym memberships, right? Some of us go to a gym and it’s a dollar a week, and it’s a tiny, over-packed gym, but we can afford it. Then some of us go to a better gym that costs more, or a club with a juice bar and massage services. The further you go up, the higher the cost is and the narrower the market becomes for potential people who can afford it. Some people even have the funds to say, “No, I’m going to bring a personal trainer to me for 1-to-1 sessions.” That represents the people we’re serving with private pay, family-funded care.

00:45:07 Clayton Foutch: The PACE program that you brought up has been in my market for 40 years. I’ve driven by PACE—I think there are 11 different PACE centers in the Portland metro market—driven by them a thousand times, and I was never inquisitive or curious enough to go in. Matter of fact, I knew many of the people who worked for PACE associated with our largest hospital system; some of them are very good friends, and I never connected the dots on why this could be very important to our organization. When I finally did, what I realized was that my people—my family’s history—look a lot more like PACE participants than they do the clients I serve for 1-to-1 private care. The more I learned about the situation PACE was in, the problems they face, and the implications of those problems, the more I realized I wanted to find a way to fit in, show them where I’m needed, and help them serve this economically and medically fragile group of people who look like my family.

00:46:42 Romi Gubes: It became more of a mission that you were excited about personally, and this is how it started, which is very similar to everything you do, right? You need to be very connected to the mission. So how was your approach to getting in there? How did you think about serving them in the best way possible?

00:47:18 Clayton Foutch: We began using Sensi in the summer of 2022. Now we’re in 2023, a year into using this, and I was convinced that using technology—this high-tech way of getting insights into changing conditions along with high-touch care—was the cleanest path to truly driving data-driven outcomes. PACE is a capitated service, meaning they have a fixed amount of dollars per participant per month. If we could avoid any percentage of hospitalizations and emergency room visits, we could have a huge impact on the participants they serve and their overall satisfaction because they would avoid incidents that lead to a hospital or ER visit. What was the process like? Painful. For any of my folks out there, luckily, when we got to the plate and got sent back to the dugout, we just kept coming back to the plate with different ways to talk through objections and find the right person or wait for the timing to be right. Because this became a passion- and mission-focused initiative, I was pretty determined to share this vision of improving data-driven care outcomes with someone who had the influence to allow us to try. After about one year—

00:49:23 Clayton Foutch: One year of those at-bats is a long time for a guy my age to keep going at this. But after one year, we did start a pilot where we could demonstrate the balance of home care plus technology and begin to measure. But even then, when you get the answer and the outcome you’re looking for, you have to understand that you’re still selling. When I was in high school, my goal was to go to a dance with a girl. Job one is to get into the dance. But once you’re in, you’re still not dancing with anyone yet. Job two is you have to be able to dance with someone, but you can’t get to step two until you get invited in. This was the same way: we are now a vetted, approved partner capable of using home care and our standard of care using audio-based technology. We were in, but nothing happened initially, so we had to grow organically from the inside, which is much easier. We currently serve fewer than 50 participants, but we’ve grown from zero, and we are now about 19 months into the program.

00:50:52 Clayton Foutch: We’ve been able to document much-improved outcomes to the tune of a 30% reduced hospitalization rate and north of a 30% reduced emergency room visit rate. This is not only very measurable, but hospitalizations have a clear dollar amount attached to them. When a participant is hospitalized, it costs on average X, and an ER visit costs on average Y, and that data is readily available. So you can begin to apply the improved care outcome, which aligns with the PACE mission. They’re innovative and care-driven. This idea of an interdisciplinary team deploys a concierge brand of care to the rest of us—it’s not just for the five percenters, but what we all want is this concierge type of care, and PACE participants get that, and we get to be a part of it. If we can tie in better outcomes, this is a win for the participant and a win for PACE because any capitated dollars that are not spent unnecessarily stay in the program, meaning more services and more participants can be served. And it’s a win for the agency.

00:52:31 Clayton Foutch: We think we haven’t even begun to scratch the surface. If there’s anyone from PACE listening to this, find me; I have a lot of ideas on ways we could help more participants and more PACE programs. I love this.

00:52:48 Romi Gubes: I’m listening to you, and as an entrepreneur myself and a builder, we’re always unsatisfied with the cadence, right? We always want things to be faster. I’m sure that if you collect all the lessons learned, there might be a way to shrink it from 19 months to maybe 16 or 15 months. But working with payers by nature will take longer than a pay-per-lead motion or other motions that might be shorter or easier. What I’m hearing from you that I appreciate so much is your strategic thinking about the business and how you build a moat as time goes by because those long-term relationships and efforts compound. It takes time to get them off the ground and get the motion going, and the probability of success can be low initially, but when it is successful, this is what can really build an empire later on.

00:53:50 Romi Gubes: Reflecting on our entire conversation, you spoke about short-term wins like pay-per-lead, community, and word of mouth. Then there are other provider referral sources that take more time, but not as long as government payers, representing the midterm strategy. Finally, you have the long-term strategy, which involves payers. I think that’s incredible. Thank you for letting Sensi AI be a part of that journey. I learned a lot from you, and it’s super exciting to see the business grow. Is there anything else I didn’t ask that you want to add?

00:54:33 Clayton Foutch: I think you have to have a realistic outlook on how much time you have. Listen, if you say, “I need to turn this thing into something meaningful dollar-wise and I have six months,” my advice to you is to find a penny stock and push all in, and if you win, you’ve done it. But if you’re building something, then you have to have a timeline you’re working within—five years or ten years—so that you can be patient and learn as you go. I hear a lot of owners talk about hiring people or hiring consultants. I’m not bashing the consulting industry, but you have to know this: you have to do the heavy lifting. You have to pick it up, you have to put it down, you have to hear from the caregiving community how well you’re serving them, and you have to hear from clients, family members, and referral partners.

00:55:54 Clayton Foutch: Then you have to have a humble part of you that listens to that and says, “I can be better. I can learn something from that mistake. I’m going to go say I’m sorry, learn from that, and implement those changes for all the other caregivers, clients, family members, and referral partners.” This doesn’t happen overnight. Too often, we overestimate what we can do in a very short period of time, but worse, we underestimate how much we could accomplish over a long period of time. That balance is really important, and you need people around you to remind you of that. I have three key people who help remind me of that because I get impatient too.

00:56:45 Clayton Foutch: For owners, you also have to decide who you are. As I said, Dollar General is a great business; they make a lot of money and serve large parts of the United States. Walmart is actually the most successful retail business, serving another segment of the population better than anyone. Then Nordstrom serves another part of our population very well. You have to decide who you are, build a business around that, and your “why” story has to reflect that. I grew up as a Dollar General person—that’s the world I knew, and that’s my family. I admire the Nordstrom people and want to be a Nordstrom person, but I’ll never forget what it means to be poor or what it means when things are scarce. That sense of insecurity can be a powerful thing for an entrepreneur.

00:57:51 Clayton Foutch: I encourage those who have come out of that place to not forget it because that is who your caregivers most often identify as. That is what government-funded veterans, PACE participants, and Medicaid recipients look like. The reality is that represents the majority of us. If you know that about who you are, it’s much easier to navigate your ship and create a business that reflects who you truly are. That’s where genuineness comes from, because it is genuine; that is who we are.

00:58:32 Romi Gubes: I think it’s good news and bad news to the people listening to us because you’re saying it’s not advice or specific education you need—it’s who you are, how you’re approaching that journey, the questions you’re asking, where you decide to focus your time, and how customer-obsessed you are. It’s more about the actions you’re taking, your mindset, and your focus rather than some missing know-how.

00:58:59 Clayton Foutch: I think so, but a lot of entrepreneurs have something like that in them to begin with—that’s the DNA of people like you, me, and the people listening. There are lots of great resources: go listen to Simon Sinek, go listen to Tony Robbins, go listen to all these really smart people who have figured out who they are and how they did it. Then surround yourself with people who are honest with you, and don’t be ashamed or afraid to be vulnerable. I should have said that.

00:59:38 Romi Gubes: Thank you, Clay.

00:59:39 Clayton Foutch: Thank you, Romi. I enjoyed it very much.