Market density and integration throughout the health care system are two main pillars for AccentCare, one of the biggest post-acute care companies in the country.
Dallas-based AccentCare provides home health, hospice, personal care and related services across more than 175 markets in 16 states. The company has grown rapidly in recent months, thanks to eight industry-shaping transactions since the start of 2018.
Currently backed by private equity firm Oak Hill Capital Partners, AccentCare is now the target of Advent International, which has invested more than $7 billion in 42 health care companies over the past three decades. Advent announced plans to acquire AccentCare on May 16.
Advent’s interest in AccentCare is an affirmation of the company’s density- and integration-driven business model, Chief Medical Officer Dr. Greg Sheff recently told Home Health Care News. A potential sale won’t drastically change AccentCare’s plans or impact its day-to-day operations, he said, but it will likely give the company more firepower to work with on the M&A front moving forward.
Highlights from HHCN’s conversation with Dr. Sheff are below, edited for length and clarity.
In addition to acquisition news and AccentCare’s business priorities, the CMO also highlighted some of the company’s innovative pilot programs, shared his thoughts on the Patient-Driven Groupings Model (PDGM) and described how home health fits into the Primary Cares First initiative recently unveiled by the U.S. Department of Health and Human Services (HSS).
HHCN: Can you tell me a little bit about yourself and your role with AccentCare?
Dr. Sheff: I’m a family physician. I began in leadership with primary care-focused multi-specialty group Austin Regional Clinic. From there, I moved on to become the senior physician executive at Seton Healthcare Family, which is an 11-hospital system, one of the large flagship Ascension markets.
It was around that time I started to get interested in post-acute care. As a practicing primary care physician, the reality is you don’t necessarily think about post-acute a lot. It sometimes feels so opaque and cut off. Your patients go into that trap door, and you just wait for them to pop out on the other side.
I’m talking about that lack of integration between post-acute and the rest of health care.
When I was at Seton and responsible for the total cost of care, I started caring a lot about post-acute. We’re all aware that it’s 17% of the Medicare spend but contributes to 73% of the all-cause regional variation in Medicare spend.
I became passionate about figuring out how to make post-acute care more integrated with other parts of the health care system. I came across AccentCare and was interested in the direction they were heading — making the home a robust and viable place for healing and recovery.
I joined AccentCare about four or five years ago. Today, I spend my time on our core clinical capabilities and driving our innovation efforts, plus our integration with physician groups and health systems.
Based on that primary care background, what are your thoughts on HHS’s recently announcement Primary Cares First initiative and how home health care fits in?
In general, primary care is being asked to be the quarterback and to be accountable for what happens to their patients. Getting the ability to extend care into the home becomes really relevant. Primary care providers need to understand what’s going on in the home and how they reach into the home to keep patients stable.
At AccentCare, we have a lot of work, a lot of programs focused on how we better integrate with outpatient practices. One of our goals is to become an extension of primary care physicians.
How have you seen the delivery of home health services change in the time you’ve been with AccentCare?
There’s a couple of things that are going on. Part of that is what we just talked about — how home health care integrates with the rest of health care. It’s no longer about “post-acute.” It’s about “pre-acute.”
And I’m saying “acute,” but the same holds true for skilled nursing facilities (SNFs) and in-patient rehab.
Home health is becoming less transactional. It’s no longer about, “How can I use home health to stabilize a patient after a discharge?” Now, it’s about, “How is the home a viable site of service?” Home health is all about extending partners’ reach — physician groups, health systems, managed care.
Nobody wakes up in the morning saying, “Boy, I hope I get to spend the day in a SNF.” You only go there because you’re scared or because it seems like the safest option. The home is the preferred setting for patients. It’s also, of course, the lowest-cost setting.
Part of taking care of complex patients in a more integrated fashion is on us and upping our game, bringing more medical capabilities into the home. We can’t do that alone. We need to build a continuum. Not just internally. Yes, we need to build a continuum between activities of daily living (ADL) support, skilled nursing and rehab, and palliative care and hospice. But all of that needs to be integrated with outpatient physicians, hospitals and so on.
The other thing I’d say — this is true for health care universally — is there’s a heavier focus on outcomes.
AccentCare has been very active on the acquisition front over the past couple of years. From what I understand, that’s partly to build density and overlap in target markets. Why is that important?
We’ve done eight acquisitions since January 2018 in multiple markets: Texas, Florida and Massachusetts among them. We’ve actually entered five new states through these acquisitions overall.
Density is key for us. Broadly, our ultimate goal is to add value — more value through clinical outcomes and efficiency. Our goal isn’t to hang a shingle on every corner, but to be relevant in the markets we’re in.
If we want to make a change in outcomes, we need to have a seat at the table. We need size to be relevant to care delivery partners and payers. Density helps drive operational efficiencies like drive time. The more efficiencies we have, the more margin we have, meaning we can continue to invest in the market.
In terms of payers, managed care is very important to us. The industry spent a lot of time running away from managed care. As Medicare Advantage (MA) continues to grow, it’s critical we’re able to serve those patients. To be a good partner to physician groups and health systems, we can’t just take care of some of their patients.
AccentCare has done eight acquisitions since the start of 2018. Most recently, however, news came out that AccentCare was actually being acquired. What’s your take on that?
When we’re making an acquisition of a home health or hospice agency, we’re working on, “How do we bring them into our operating platform? How do we use our processes with them?”
The partnership with Advent is a confirmation of our strategy and the path we’re on. It’s changing the financial, private equity-backing behind the scenes. From a day-to-day perspective, it’s business as usual.
We’ve had a great experience with Oak Hill Capital Partners, our previous PE sponsor. We’re excited to go to the next level with Advent. This positions us to continue expanding into new service areas. This isn’t getting taken over. Management is intact and committed. It’s an endorsement.
You’re going to see us ramping up what we’re doing — not ramping down. From a PE cycle, it was just time. This is a very natural transition.
What’s the role of CMO in today’s post-acute care company?
My role is simply to help us understand how we deliver the best results for patients.
Part of that is figuring out how our core home health, personal care and hospice function in an integrated fashion. Part of that is looking for new services that we need. One of the acquisitions we did this year, for example, included a mobile physician group.
A lot of it is staying in tune with the rest of health care. The home is a critical place to take care of patients, but the services we provide don’t form the epicenter of health care.
Also tied into my role is figuring out payment issues. Right now, there’s the home health payment reform associated with PDGM. But I’m even just talking about pushing toward value-based contracts, bundled payments and capitation.
How has AccentCare performed under CMS’s nine-state Value-Based Purchasing Model (VBPM)?
We’ve done well. I don’t have the numbers offhand, but we’re very happy with our results.
But that’s a small step. It’s still incentivizing providers the same way, just with a little carrot-and-stick motivation. That’s opposed to something like, “This is what you have to spend on home care. These are the outcomes we demand with that. Go figure out the best way to do it.”
Do you think PDGM will better align reimbursement with patient characteristics like CMS says it will?
PDGM is complicated. There’s a lot of good in it. At a high level, it does put more value on caring for medically complex patients, which is the right thing to do. At AccentCare, we think we’re very well-positioned for that.
The direction that PDGM is trying to move the industry is right. But the devil is always in the details. There are plenty of implementation areas we don’t agree with. The biggest one is the aggressive assumptions around behavioral adjustments. We very much support efforts to correct those flaws prior to Jan. 1.
There’s what CMS is trying to accomplish, then there’s what CMS is actually doing. There’s a little bit of a disconnect there.
How else is AccentCare working to stand out in this increasingly competitive market?
A lot of our focus is on being dense and relevant in the markets we’re in. A lot of it is on partnerships with other health care providers and payers. We’re pushing the envelope on what can be done in the home with several different pilot programs.
We have a program with a large oncology practice that’s getting some great results. Their 60-day admission rate was cut in half for their patients.
We have an acute care-at-home program we’ve developed with one of our joint venture partners, UC San Diego Health. That’s focused on taking patients that are potential admissions from the ER home. A program with them had a 94% hospital-avoidance rate.
We’re also doing things with video visits. We have a wound care program with a technology partner, Synzi. We’re getting great clinical and efficiency results out of that.
In hospice, we’ve had a bridge program for a long time.
We’ve also done some stuff with personal care, giving those individuals advanced care partner training, providing an advanced understanding of the disease process of the clients they’re caring for.