Lifesprk CEO Joel Theisen ‘Betting the Farm’ on Medicare Advantage, Value-Based Care

When CEO Joel Theisen began Minnesota-based Lifesprk more than a decade ago, he started out with about $500,000 and a handful of employees. Theisen has turned his diverse home-based care company into a roughly $35 million business since then, while simultaneously launching a joint venture with one of the largest health systems in the country.

Pursing value-based care arrangements and going after emerging Medicare Advantage (MA) opportunities will be keys to Lifesprk’s success moving forward, according to Theisen. Home Health Care News caught up with the CEO to learn more about those plans during a recent conversation on its podcast, Disrupt.

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During HHCN’s discussion with Lifesprk’s leader, Theisen also offered listeners insight into his company’s philosophy on building an integrated care delivery system with a longitudinal approach.

Additionally, Theisen explained why it could be disastrous for home-based care providers to “stay in their own lanes.”

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

HHCN: We’re going to talk about both Lifesprk and Homespire, your joint venture with Intermountain. Let’s start with Lifesprk. Can you tell our listeners a little bit about your company?

Theisen: Lifesprk was started in 2004.

This is my third company. I started with a company that my in-laws built from scratch and took public in the 80s. That was a skilled home care and hospice company. I then did a venture-backed startup around whole-person care in California for seven years. I built that up to five locations across the country.

Lifesprk is kind of my Holy Grail. This one we bootstrapped, starting with three employees and half a million dollars. Today, we have about 650 employees.

We started with a geriatric care management, private-pay model. We’ve added campus home care services in memory care, then a skilled home care component. We’ve also added a transitions-of-care model and navigation services. Most recently, we added primary care services.

We’re about a $35 million operation. We have the freedom to create our future going forward.

What about Homespire, the JV with Intermountain in Utah formed in May 2018?

Intermountain really came to us. They were searching for more community-based expertise and a senior strategy. As they were doing that, they wanted to bring in a geriatric care management, private-pay component to their ecosystem. They did not have those services in-house, though they had home health, hospice and many other offerings in their $10 billion system.

Intermountain was looking from East Coast to West Coast for best-in-breed partners. They found out about Lifesprk and came to town. We were fortunate enough to get the nod.

In our negotiations, I was really bullish on, yes, being their geriatric care management and private-pay partner — but I also made it clear I wanted to help out in redesigning a new delivery system around seniors. Intermountain loved that idea.

A lot of home care providers would like to have this kind of relationship with a major health system. How did you build this connection? 

Intermountain was really interested in the data we were collecting, which was important to them as an integrated payer-provider network. Many people may not know this, but Intermountain owns its own health plan, SelectHealth.

Beyond that — demonstrating low re-hospitalization and ER rates, keepage — we were willing to put skin in the game. That sense of collaboration made them comfortable with us. We didn’t just want to come in and be a preferred-provider partner.

It was more: “How do we own this entity together, using our best collective knowledge and resources to better the design?”

The other thing was our focus on social determinants of health. We do a lot around scoring social determinants of health for our customers. That was important to Intermountain. It was different, as not many providers are doing that. 

Intermountain has lots of metrics and data they can get. What was alluring to them — and what other providers should be doing now, in my opinion, to win deals with health systems and payers — is making sure they can track and create value around social determinants. Bringing that to the party opens a lot of doors.

Not long ago, Lifesprk announced it was expanding its home-based primary care offering. What does that expansion look like — and why do that in the first place? I should point out, too, you brought in Bill Thomas to help.

In all my years, what I’ve learned working in all types of home- and community-based services is that — if you want to get into the major leagues — client attribution is based on primary care.

From a payer perspective, for us to change the game and be able to serve all types of people, you really need to have access to, partner with or have your own primary care service delivery. And it has to be integrated. 

Geriatrics has a very unique place in primary care. It’s a specialty. There are not a lot of geriatricians out there. We felt it was important strategically for us to design, implement and deliver a fully integrated, person-centered medical and social determinants model. That’s why we did it.

It also creates the path for us around payment reform to go directly to payers and actually be a delivery system that’s an alternative to what I call the “sick care system.”

Many of these aging clients we know have multiple chronic conditions and co-morbidities that get in the way of their lives. For us to be successful, we need to keep those at bay so we can focus on purpose, passion, identify, family and community-building.

Any thoughts on the Primary Cares First Initiative from the Centers for Medicare & Medicaid Services (CMS)? That’s the recently announced initiative from CMS that would create five new value-based payment models for primary care. Seems like Lifesprk would be well-positioned.

My quick reaction is that I love it. I love the opportunity to put community-based providers in a position to really create a different business model and experience for people they serve.

What we’re doing currently obviously isn’t working. About 19% of GDP is from health care. We have high re-hospitalization rates, high ER admissions. We’re not creating great outcomes across the board.

I think things like this are very important. I’m more excited now about where health care is headed — including changes to Medicare Advantage — than I’ve ever been.

Everything is opening up for home-based care providers. The government is saying, “You guys are closest to the customer. You guys are the ones in front of them most of the time, being in their homes or lives.”

Let’s dive into Medicare Advantage. You were a panelist at our Capital + Strategy Forum in Washington, D.C. During that event, you said something along the lines of betting everything you’ve got on MA. Do you still feel that way?

Yes. Luckily, I’m consistent. Every day I feel more committed to that idea.

To improve health care and the patient experience overall, we’re going to have to “break” how it’s traditionally delivered. MA is a major disruption opportunity, and I’d rather run our company into the ground going after the full integration of a longitudinal model than provide more transactional, episodic services.

That’s just not solving people’s real issues or delivering the value they need.

I’m pretty passionate about a lot of things. With this, I’m still all-in and actively betting the farm — not just on Medicare Advantage, but any value-based opportunity recognizing triple aim, quadruple aim … population health.

And you mentioned Bill Thomas earlier. He’s committed to that as well. He’s not just an optic for Lifesprk. He’s an active, engaged partner in designing and leading our delivery system.

Also during Cap + Strat, there was this discussion about whether home care providers should stay in their lane. You were against that idea. In fact, you’ve said in the past that isolation is fatal for home care providers.

I think those lanes are riddled with cement barriers along the way.

In skilled home care, for example, you have an episode and deliver services for, say, two weeks. As soon as you deal with patients’ symptom management or get them to a reasonable rehabilitation state, you discharge them. You cross your fingers and hope they don’t fail — or that you see them back. You sometimes don’t even know what happens to them.

You don’t get to go back into root-cause analysis to understand, “Why did they have the fall? Why did they have the exacerbated CHF?” The myopic view of staying in your own lane does not create a solution.

We have to be generalists. People in the private-pay home care, hospice, palliative care, assisted living — we all have the opportunity to build this trust, in a sense, and be general contractors for people longitudinally.

Care today is so fragmented, which isn’t in anybody’s best interest. Staying alone is a recipe for failure.

From a monetary standpoint, isolation is also fatal because — if you do stay in your lane — I believe providers are going to continue to be marginalized. There’s going to be margin compression, for example, with the Patient-Driven Groupings Model (PDGM) in skilled home health care. Margins continue to be compressed. Hospice will even get compressed a little bit.

There are very thin margins. People complain there’s not enough money, especially in Medicaid and some of these other [streams] where there’s not enough to truly innovate. It’s not sustainable.

There are billions of dollars being spent on health care, but a lot of it is going into acute care’s bricks and sticks. I think we need to take some of that money from acute care by working together and creating a proactive approach to health care.

We simply can’t be afraid to work together.

What other challenges are on the horizon for at-home care providers?

It, of course, depends on whether we’re talking about skilled home health care or private-pay home care. In general, one of the big ones is the workforce. There’s so much we have to do, but resources are so thin.

We need to build a better environment across the continuum of training, career development. People need to want to come into our industry. They can’t want to run to acute care.

Our world has to be attractive, viable and meaningful for people.

Another challenge is regulation. We keep piling on more and more regulation. We make it hard for providers sometimes.

And, again, margin compression is a challenge.

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