LHC Group, Inc. (Nasdaq: LHCG) one of the two largest publicly traded and independent home health companies in the country, announced in May that U.S. Department of Health and Human Services (HHS) Chief Technology Officer Bruce Greenstein would be leaving his post to join LHC Group’s executive office.
Greenstein officially joined LHC Group in June, quickly earning his first promotion. He currently serves as executive vice president and chief strategy and innovation officer.
The role is an important one as LHC Group looks to the future, especially in regard to value-based contracting, accountable care organizations (ACOs), and alternative payment and delivery model strategies.
LHC Group’s services cover a wide range of health care needs for patients and families dealing with illness, injury or chronic conditions. The company’s 32,000 employees deliver home- and community-based services and facility-based care from more than 780 locations in communities in 36 states. As part of its business, LHC Group is the preferred in-home health care partner for 330 hospitals around the country.
HHCN caught up with Greenstein to discuss his move to LHC Group, his plans for the company and his overall thoughts on home health care.
This interview was edited for brevity and clarity.
HHCN: You have an interesting background. Before coming to Lafayette, Louisiana-based LHC Group, you held the position of chief technology officer for the U.S. Department of Health and Human Services. Can you walk me through that decision of leaving HHS to join LHC Group? That’s a big decision.
Greenstein: I’d flip it around. It was really about being pulled away from the government.
I was really enjoying my time in Washington, D.C. At Health and Human Services, at the beginning, it was based on how to help the department get organized around the most important tasks that needed to be addressed, such as the opioid epidemic, value-based care and other topics.
I had a great time doing that, but I’ve known LHC Group CEO Keith Myers for a long time, probably about eight or nine years. That relationship started when I was secretary of health for the State of Louisiana. Since that point, I kept track of what he was up to and the performance of the company in this area of health care — home health — that doesn’t get the same level of attention relative to other parts of the sector.
In a conversation with Keith, he asked the right questions about the future of home health and the future of health care in the home — and that was the trigger for me. I believe that this job is not about trying to improve the performance of a home health company. It’s trying to take these assets that LHC Group has and turn them into an overarching platform that provides health care in the home.
I also wanted to go back to the provider side of health care. I’ve been in everything from government and private equity to the health-plan side. It’s great to get back to the provider side where there’s a direct connection to patients and families. When you talk about improving quality, you do that by working with the people who actually provide the care.
LHC Group regularly talks about how we can deliver care in the home — not just as a discrete home health service, but health care in the home that keeps people there and out of the hospital. This, to me, is an incredible platform.
That was one of the major value props to coming here — helping to figure out how to organize the assets of the company and address what we see as the future of health care, in general. The future of health care is in the home.
You started in June and have already been promoted. As executive vice president and chief strategy and innovation officer, what do you have your sights set on in terms of goals?
I have a roster of objectives to fulfill.
I have an intense focus on a handful of items that will change this company in the market. I’m focused on areas that involve managed care, in a broad sense. I’m also focused on value-based contracting and purchasing.
While this may sound hyperbolic — and I mean this in a very specific way — our goal is to own the home.
That’s something we hear spun a few different ways, “owning the home.” Can you please dig into that and really explain what you mean?
When we think about owning the home, it’s the delivery of health care and social care services, whether it’s respite or personal care services. It could be supplies and durable medical equipment that gets to the home in a timely way. It’s also enabling services, such as transportation and nutrition.
It’s all of that resting on a very competent and user-friendly technology platform.
“Own the home” sounds like a trite saying, but it does have meaning. When Amazon started out, they were creating a platform. Books happened to be what they started with, selling them in a very dedicated way with superb service. They started adding from there. Now, I don’t think I can go a week without ordering things from Amazon, whether it’s household supplies or books, still.
The platform that they’ve created can seemingly deliver anything. When I think about a platform for LHC Group, we have many contracts where we’re in the home within just a few hours. We can deliver very rapid deployment into the home on behalf of Medicare Advantage plans, the federal government, Medicare, Medicaid.
We’ve developed this platform. Can we take this to the next step or five steps forward in a way that’s similar to what Amazon did with its platform? I believe the answer is yes.
Managed care plans and joint ventures are two avenues that LHC Group has taken as part of its business strategy. How do those fit into this discussion?
Let’s start with managed care plans.
New models require new models. Medicare Advantage is a new model of financing and organization health care, but it’s not a new model for delivering health care. Medicare Advantage players want to provide care in the most efficient and effective way. They want to see the best outcomes, and they want to spend the least amount of money. What that means is paying less for the same commodity services.
We’re a human capital company and produce services given by very competent people. If we think we’re just going to succeed in the world of managed care — MA specifically — by producing the same service we’re been providing since the 90s, that’s not the recipe for success on its own.
Again, new models require new models.
We’re working with a number of MA plans and next-gen ACOs. There’s the consolidation in the payer market, but also the decentralization of risk, which is kind of a big thing to think about, but it’s something that’s happening under our feet.
We work with several large — both our joint venture partners and non-JV partners — health systems that are taking full-cap risk from both Medicare Advantage plans and, in some cases, commercial plans. They want to buy services that don’t necessarily have the discrete moniker of the Medicare home health benefit.
They’re interested in delivering health care in the home to help their patients. We’re designing new models, and we’re engaged in either delivering that today and in some large health systems that are innovative we’re producing new products today that don’t fit conveniently in the Medicare description of benefits.
That’s to satisfy the MA plans’ objective of high-quality, efficient care, but also to help patients thrive in their home.
HHCN has connected with LHC Group’s Keith Myers previously in talking about how home health, as an industry, is shifting from a post-acute label to a pre-acute one. During our recent HHCN Summit, we had a lot of people talk about how there are conflicting and contradictory signs from the government in that regard, however. As part of this shift, MA plans are instrumental. What’s your take on this high-level point?
I agree. But the bottom line is we deliver health care in the home. Trying to force that in a bucket of “post-acute” or “pre-acute” really doesn’t matter. It’s about looking at and developing models that are effective from both sides.
PDGM. New payment models. There’s so much we can discuss. What else is important to highlight about your role or where the industry is heading?
I just want to stress how health care is moving into the home. Look at hospital-at-home or SNF-at-home programs, for example. We’re seeing the downward shift to more cost-effective settings.
In terms of PDGM, it’s a once-in-a-generation shift that the federal government is looking at doing without spending enough time testing the ideas. It was rejected in a similar form last year. I look at how CMS overhauled SNF payments. It took them eight or nine years to make a change that’s similar to what they’re trying to do in one year in the home health industry.
I think it will have negative consequences on the industry. I would tell them to pull the rule back and spend more time in their planning and deliberation process.
Let’s not jump into something that’s unproven.
At the same time, CMS has an NPRM out — I think comments are closed — for the ACO rule. We applaud CMS for moving ahead in the ACO world to put risk in the provider’s hands and give the maximum amount of flexibility.
We believe that CMS is looking at doing post-acute care bundles. We’re very pleased with that. We see post-acute bundles as a way to provide patients with more flexibility, better care settings and a deeper, enriching experience in the post-acute setting, where they can get care in the home and have it for a longer period of time.
From your position, what are your top three challenges moving into 2019?
Oh, gosh. I would say myopic payers that are not interested in new models, but just want to do something like grouping all their providers and taking 5% of payments away, thinking that’s called highly effective health care. We want to help educate this part of the market that “value” is more than just taking a discount.
No. 2, we want to give the total post-acute bundle more attention. We think home health and post-acute care tends to not be the headline issue in Washington, D.C. We’d like to see that it is.
Lastly, changing quickly is hard. Changing is hard in general. We need to have a clear destination and clear vision as an industry so companies can change how they organize themselves and address new market opportunities.
You’ve mentioned a few things that you’re excited about. Anything else you’re eager to see that’s going on in the home health space?
As I’ve said again and again, health care moving into the home. That gets me excited. And we’re very well positioned to take advantage of that as we build out this platform. I’m bullish about LHC Group’s performance.
The home health industry is a big part of the future of health care.
Written by Robert Holly