LHC Group’s Bruce Greenstein: It’s Time to ‘Re-Engineer’ Post-Acute Care

LHC Group (Nasdaq: LHCG) is one of the biggest home health providers in the country — and a company that has been a fixture in the home-based care business for more than two decades.

During that time, the Lafayette, Louisiana-based home health giant’s business model has stayed largely the same: land joint venture partnerships with leading hospitals. To date, the provider has 76 JV partnerships with 355 hospitals nationwide.

But lately, LHC Group has taken things to a whole new level, landing bigger partners with a more bullish approach than ever before — and acquiring innovative companies in the process.

Executive Vice President and Chief Strategy and Innovation Officer Bruce Greenstein shared the key to the company’s “maniacal” JV execution — along with its “best kept secret” — in a recent appearance on the Disrupt podcast from Home Health Care News.

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During HHCN’s conversation with Greenstein, the LHC Group exec also offered listeners insight into the company’s recent explosion in ACO involvement — and how others can follow in its footsteps. Additionally, Greenstein outlined why widespread industry disruption won’t happen unless reimbursement lets it.

Below are highlights from HHCN’s conversation with Greenstein, edited for length and clarity.

HHCN: LHC Group has already had a busy 2019 when it comes to JV activity. You announced two partnerships with hospital systems earlier this year — Unity Health in January and Geisinger soon after. How are those JVs going, and what can we expect for the rest of the year?

Greenstein: Unity and Geisinger [are] really big.

It’s not anything different than we’ve been doing all along. We have 76 JV partnerships that involve 355 hospitals. For us, it’s the way that we go to market and the way that we do business.

Geisinger is recognized as one of the most innovative and forward-thinking health systems. It’s their brand and our brand that have come together to think about what the possibilities are to manage and maintain health in the home for their patients, many of whom are managed in a capitated payment environment.

They have a real reason to think about how to have pre-acute care or manage their post-acute much further than just a 30- or 60-day window. We think — far more than readmissions — [we can] really manage those patients and their comorbidities into the home and staying into the home with them for a while. We’re really excited about building out new and innovative programs with Geisinger.

The second part is about the pipeline. I can’t talk about the details, but I can say the pipeline is very busy, and I think we’ll have some “Aha!” moments for people who will be watching. We’re very excited about continuing to partner across all of our three major lines of business — home health, hospice and, on the Medicaid side, home- and community-based services.

We have a strategy of co-location, which allows us to be able to provide those different types of care, from our more than 780 locations across the country.

So keep watching.

The Centers for Medicare & Medicaid Services recently announced a new voluntary risk-based Primary Cares Initiative designed to reward physicians for keeping patients at home and away from hospitals. What do you think it means for home-based care providers?

This should be one of the most exciting announcements from CMS in a while. It introduces what seems like an attractive level of risk for primary care physicians.

Why does this matter for us in the home care industry?

We know if you look at national health care expenditures where the highest spending occurs, [it’s] in institutions — typically hospitals.

Overwhelmingly, hospitalizations are appropriate, but there’s still a lot of institutional uses of care that are inappropriate. That would be an unnecessary cost.

That’s where us as an industry comes in.

We need the vision. We need to have some way for primary care physicians and their practices to consume this enlightened way of using post-acute services.

Then, we have to come up with enhanced models so we’ll be able to share in the savings that will be created for the primary care physicians in Primary Cares First.

With that, I think we’ll build that financial alignment, we’ll create organizational alignment, and we might be able to offer additional services and benefits in the form of telemedicine, telemonitoring, more disease management within the episodes. And we might even see longer episodes to keep patients from going into the hospital after they get discharged from a traditional episode.

It’s time to start thinking about ways we could reengineer post-acute care. As the leaders in home health, I think we need to get together and really map out what that looks like — and present the vision instead of having it presented to us.

Going back to LHC Group’s JV strategy. Earlier this year, CEO Keith Myers said LHC Group is more bullish on its JV strategy that ever before because it’s continuously improving the process. What goes into that?

The reason Keith Myers feels so bullish about it is we have a demonstrated track record. We’ve had two decades of figuring out how to best provide care and services to our hospital partners in a way that’s mutually advantageous.

In some cases, the speed to care can reduce a day from the length of stay in the hospital, which can equate to savings on the DRG side. Having capabilities in the home so quickly could maybe give a family that option of going home instead of going to a skilled nursing facility [SNF].

Without rapid deployment of care services, going home instead of a SNF wasn’t an option before.

We’ve seen in our relationships with Ochsner [Health System] a 58% reduction of the utilization of SNFs. That’s a large amount of savings when a good portion of those patients are part of a full-capitated risk population.

Many other hospitals are just now recognizing that they have rehospitalization problems that can be solved in the home, [or] that they have an overutilization of SNF length of stay. They can address that with really strategic and properly used home health.

Let’s talk about the backup headquarters you recently added in Louisville, Kentucky — something made possible by the Almost Family merger. Why was creating this second location important to you guys?

Think about where our company was founded and where we operate today: Lafayette, Louisiana. [It] has the best people, culture, food you can imagine, but it also seems to be a magnet for storms coming off the gulf and hurricanes.

Now, we have space and duplication on the IT side, so we can run the company from Louisville if we had to move out of our current location for any other reason.

Another benefit from that merger: In 2018, LHC Group really revved up its ACO involvement. In fact, you doubled the number of ACOs you’re involved with. What’s 2019 look like for ACO activity?

It’s one of the best kept secrets around.

Part of the Almost Family umbrella included Imperium Health, the ACO management company.

Since the acquisition, we’ve made large increases in both the investment [into the business], as well as the total number of Medicare patients covered.

We’re at about 460,000 attributed lives across 30 different ACOs. We have stretch from the East Coast all the way, fairly far, across the country.

It gives us both insight and experience into managing risk, being deep inside physician practices and employed physician practices, both independent and part of health systems. We understand Medicare claims data in a deep way.

For our ACO management, we really are paying attention to what’s happening across the entire patient journey. We’re interested in working with physicians to figure out how we help them manage a large patient population. How [can] we focus on those that have extraordinarily high cost and those that have very little cost but need to have preventative care on an ongoing basis?

We get to build our acumen in areas we typically don’t participate in as a company. It’s given us great insights into what drives costs, how to use claims data as predictive modeling, how to build algorithms and how to identify patients where we can provide more care in the home.

That’s really made us more effective as a company because part of what we’re doing both within the ACOs and with our JV partners is essentially creating high-performing networks of post-acute care providers.

The idea is to make one-stop shopping for primary care clinics and health systems to find post-acute partners.

A lot of providers want to be involved in ACOs. What advice would you have for home-based care providers hoping to do that?

This is one of those areas where I feel like we’re always competitive. We’re always trying to win more market share by having the best quality product.

But I also feel like this is where I want to work with my colleagues from other companies to make the value proposition to ACOs and other risk-oriented payment arrangements to just show the value of home health as a way to manage the total cost of care for patients [and] give patients higher satisfaction.

What needs to be done is to use the publicly available data to create the value proposition to quantify your offer to the ACOs.

We want ACOs to think about home health being the answer and something that you can substitute in for SNF stays or hospital readmissions.

The home health industry has to make its value proposition far clearer and more compelling.

Finally, because this podcast is called Disrupt, how do you define disruption in the home health industry?

The term “disrupt” is probably one of the most overused terms in business and in health care. Somehow, we think that if we can use an iPad to do a doctor visit,we’re creating disruption. So let me be a little more dialed back on the way that I think about disruption.

I think disruption has to be providing a service in a different way — and getting compensated for it. It has to work. It has to do something.

When we think about telemedicine, we’ve had the capability of doing telemedicine for probably two decades — but there have been very few willing to pay for it.

The biggest disruption we can do is use existing technology, but get paid in a creative way that really creates value.

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