CareSphere ditched paper-based employee and patient onboarding processes for connected, automated workflows with Cognito Forms – resulting in 314% revenue growth and 93% faster employee onboarding.

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When the founders of CareSphere acquired the company in early 2020, they had ambitious plans to expand the company’s service area. However, they quickly recognized that significant growth wouldn’t be possible if they didn’t first address the operational challenges holding them back.

What began as a simple digital replacement for paper forms evolved into comprehensive workflow automations that supported the company’s explosive expansion.

Three years later, their transformation tells a remarkable story of resilience and innovation. Initially serving just 20 patients in two counties, CareSphere now provides care to over 1,200 patients throughout all 67 counties of Pennsylvania. Their workforce has grown to include 2,000 employees. All employees and patients are managed through streamlined digital workflows that have replaced the chaotic paper processes of the past.

In 2024, CareSphere was recognized as one of the fastest growing companies in the United States. They achieved an astounding 314% revenue growth over three years, now representing a complete reinvention of what’s possible in home healthcare operations.

The Challenge

“When we acquired CareSphere in 2020, everything was completely on paper. Paper charts and files for both employees and patients,” recalls Malky Neiman, the company’s Chief Human Resource Officer (CHRO) and co-founder.  That moment quickly brought a difficult reality into focus: the entire infrastructure was built on outdated, manual processes that couldn’t support the company’s long-term vision for growth.

On top of that, navigating compliance across multiple regulatory bodies — like the Department of Health (DOH), Department of Human Services (DHS), and the Office of Developmental Programs (ODP) — was becoming increasingly unmanageable without the right systems in place.

The founders envisioned expanding the home care agency statewide, offering services to a diverse client base, including adult, pediatric, and developmentally disabled clients. However, their barriers were clear. They needed to find a better way to manage their disconnected systems, time-consuming processes, and a complex regulatory landscape.

This defining moment solidified their challenge and made one thing extremely clear: growth was contingent upon fundamentally reimagining how they operated.

A paper-based past

Every process in the company required physical paperwork - from employee applications to patient assessments. Prospective employees had to travel to the office to complete paperwork, while patient files had to be stored in physical cabinets and folders.

• Why this matters: Collecting information via paper created major bottlenecks. Hiring and onboarding caregivers could take up to four weeks, meaning clients waited longer for care. Geographic expansion was also restricted, since everything depended on proximity to the office.

Compliance concerns

With services spanning multiple state-funded programs, CareSphere had to stay compliant with the unique requirements of each agency it worked with. Each department had its own set of rules for patient documentation, caregiver records, scheduling, and reporting.

• Why this matters: Keeping up with compliance was humanly impossible to do accurately and consistently at scale, especially with entirely paper-based systems. A single oversight could result in costly delays or gaps in service delivery. Without an automated, centralized solution, the company’s ability to grow while remaining compliant was at risk.

Manual, time-consuming processes

Staff were manually re-entering candidate data from paper forms into spreadsheets, tracking down missing information, and sending repeated emails to move processes forward.

• Why this matters: These repetitive tasks drained team bandwidth and introduced avoidable errors. Any meaningful growth would require significant increases in admin staff and office space – a costly and unsustainable model.

Why Cognito Forms?

Faced with the need to modernize their entire operation while maintaining strict regulatory compliance, the CareSphere team began searching for a digital solution that could meet their complex needs without requiring a team of developers. They discovered Cognito Forms and immediately saw its potential. Their decision to move forward with the platform ultimately came down to the powerful combination of flexibility, security, and ease of use. It empowered them to quickly build exactly what they needed, without coding experience.

Flexibility & ease of use

One of Cognito Forms’ most compelling advantages was its ability to support sophisticated workflows without requiring technical expertise.

• Complex conditional logic, validation rules, and multi-step workflows were all achievable without requiring coding experience.
• Comprehensive help documentation and responsive customer support guided them through any challenges along the way.
• The intuitive interface made it easy to start small and scale up over time, increasing the complexity of their forms as their needs evolved.

Seamless workflows & connected forms

CareSphere needed more than just forms. They needed a way to automate, connect, and streamline their workflows.

• Lookup Fields enabled multiple forms to work together seamlessly. This keeps their data synced and reduces duplicate data.
• Prefilled fields save employees time during onboarding and documentation, while keeping data consistent.
• The Zapier integration instantly connected form data to systems like Google Sheets, Office 365, Twilio, and other internal processes.
• The Cognito Forms API enabled real-time syncing with their Electronic Medical Record (EMR), closing the loop on patient and caregiver records.

Enterprise-grade security & compliance

Serving patients across multiple state-funded programs meant navigating a web of strict (and sometimes outdated) regulatory requirements. Compliance wasn’t optional, and neither was security, especially when handling sensitive patient information.

Cognito Forms gave CareSphere the tools to build compliance into their processes, while keeping all data protected and secure.

• HIPAA-compliance ensured all patient and caregiver information was stored and transmitted securely.
• Cognito Forms offered handwritten electronic signatures that were accepted by agencies still expecting traditional “pen-on-paper” signatures. This enabled them to meet regulations without sacrificing convenience.
• Validation rules enforcing compliance meant forms couldn’t be submitted if anything was missing or incorrect, reducing errors and incomplete files.
• Custom error messages guided staff step-by-step to complete documentation properly, keeping everyone aligned with agency standards.

The Solution & Implementation

Despite having no technical background, Neiman leveraged Cognito Forms’ intuitive interface to start digitizing workflows one form at a time. What started as simple digital applications quickly evolved into robust, interconnected forms and Workflows that automated entire business processes across departments.

She carefully mapped each Workflow, connecting patient care plans to caregiver timesheets, interview schedules to onboarding, and compliance protocols to automatic validation rules. The result wasn’t just a collection of digital forms: “Cognito Forms has become the backbone for managing the entire organization,” reports Neiman.

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Employee lifecycle management

Neiman created a three-part automated system to manage the employee lifecycle for their caregivers:

Lead management

• Job site applicants automatically feed into their recruiting form via Webhooks.
• Recruiters schedule interviews using Lookup Fields that pull from available time slots.
• Interviewers document their feedback directly in the recruiting form.
• Once approved, Zapier prefills the applicant’s details into the official employment application and sends this new form in an email to candidates.

Application processing

• Applicants securely submit all required documentation by filling out the form, attaching documents, and electronically signing.
• The HR team reviews submissions with custom statuses to track progress.
• Missing documents trigger automatic email reminders via Zapier.
• Conditional logic ensures the proper completion of forms, including I-9 compliance.
• Once applications are complete, their automated Workflow triggers Zapier to send new hires an email with their orientation details.

Employee management

• New hires trigger Zapier and Cognito Forms API actions for account creation in their EMR, employee portal, and payroll systems.
• Ongoing updates – like PTO requests, availability changes, or incident reports – are linked to each employee’s profile using Lookup Fields.
• Termination Workflows automatically revoke employees’ access to all forms and patient data.

Patient care coordination

Similarly, they built a comprehensive system for managing the full patient journey, from inquiry to ongoing care.

Lead management

• Website inquiries create patient leads automatically.
• Eligibility verification is tracked using custom Workflows.
• Intake assessments are completed directly in the patient’s profile form.

Case assignment

• Their team tracks each patient’s authorized hours in a Repeating Section on their patient profile form.
• New patient cases are automatically available and added to the Lookup Field, enabling caregivers to select the case from a scheduling form.
• Alternatively, caregivers can express interest in specific times, locations, or case types, and the Lookup Fields suggest appropriate cases for them.
• Contracts are generated automatically once caregiver and patient matches are confirmed.

Ongoing care management

• Employee timesheets are validated against their assigned care plans to ensure accuracy.
• Patient preferences, hospitalizations, discharge requirements, and other key information are centrally tracked in a patient profile form using Lookup Fields.
• Custom errors and form validation are built into all forms, enforcing regulatory compliance of each patient’s documentation.

Implementation approach

CareSphere’s implementation followed a gradual, progressive approach.  As Neiman puts it: “Getting to this point came gradually. With time, I did more and more because I realized how much more we could do. Now we’re running an entire system directly on Cognito Forms.”

Their gradual approach included four distinct phases:

• Replace basic processes with simple digital forms
• Add Workflow as you become more familiar with the platform
• Use Lookup Fields to connect related forms and centralize data
• Set up integrations with other systems through Zapier or the Cognito Forms API

Results & Impact

Since implementing Cognito Forms, CareSphere has transformed its operations with remarkable results.

314% revenue growth without staffing increases

CareSphere experienced a 314% growth in revenue over three years, which earned them recognition as one of the fastest growing companies in the United States. They achieved this amount of growth without requiring any proportional increases in administrative staff. Their office staff can process significantly more applications per person because they eliminated manual document handling with their automations.

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93% reduction in application processing time

Their updated hiring process reduced caregiver onboarding time from an average of 4 weeks to 2 days – a 93% time reduction. They were able to do this by eliminating manual data entry throughout the process. Additionally, staff are no longer required to check on and manually activate new employees in other systems. Built-in automations activate new employees in these systems based on the completion of steps in the Workflow.

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Improved regulatory compliance

“We haven’t been cited for regulatory compliance since we implemented Cognito Forms because our processes just run the way they’re meant to now,” shares Neiman. CareSphere strengthened its compliance by building error-proof Workflows that embed documentation requirements directly into each form. Regulatory expectations are now met consistently through smarter systems, without requiring extra effort. Daily operations now seamlessly align with the strict standards of agencies like DOH, DHS, and ODP.

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Improved patient & employee experiences

The digital transformation has also enhanced the experience for both staff and patients. Caregivers love being able to easily submit care reports, timesheets, and PTO requests from anywhere on any device. Patients save time with the ability to complete paperwork from the comfort of their own home.  Additionally, office staff have a complete view of each patient and caregiver with centralized information and connected forms. Together, these improvements have made CareSphere more agile, more responsive, and better equipped to deliver exceptional care at scale.

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Best Practices Learned

CareSphere’s transformation with Cognito Forms wasn’t just about technology — it was about building sustainable systems with a strategic approach. Along the way, their team developed key best practices for digital transformation in healthcare:

• Start simple and build gradually: Neiman advises, “Anyone can do it, even if you start slow. It really came gradually for us. It’s as simple as adding a field, labelling it, then adding validation. It’s that easy to start.” CareSphere began with basic forms and gradually layered in more complexity as their comfort and confidence grew. This incremental approach made adoption manageable and effective – even for a non-technical team.
• Use integrations for maximum efficiency: Integrating Cognito Forms with tools like Zapier, their EMR, and payroll systems helped eliminate manual or duplicate data entry. This resulted in faster workflows, fewer errors, and time saved across departments.
• Enforce compliance from the start: With custom errors and validation logic, CareSphere embedded compliance checks directly into each form. This proactive strategy helped prevent documentation errors at the source, rather than reacting after the fact.
• Iterate based on feedback: Every audit, new regulation, and internal challenge became an opportunity to improve. CareSphere continuously refines its forms and processes to keep operations resilient and compliant.

Up Next: Charting New Territory

Having transformed their core operations, CareSphere continues pushing the boundaries of what’s possible with Cognito Forms. Just recently, they launched their new “Office Lifecycle” form & Workflow—bringing the same patient and employee management automations to their internal office operations.

This latest innovation tracks employee performance against KPIs pulled directly from job descriptions, manages PTO with direct payroll integration, and provides managers with real-time visibility into team performance. “It’s just going to continue to evolve,” explains Neiman.

Unlock Your Growth Potential

Is your home healthcare agency buried in paperwork or struggling to keep up with complex compliance demands? With Cognito Forms, you can build secure, automated workflows that seamlessly integrate with your existing processes – without writing a single line of code or hiring expensive developers.

Join CareSphere and hundreds of other healthcare organizations that have transformed their processes, improved compliance, and accelerated growth. From managing employee applications to patient documentation and beyond, your path to a smarter, more scalable operation starts with creating secure, professional forms in minutes.