In some ways, home health care is still in its teen years, according to AccentCare CEO Steve Rodgers. Providers are making significant strides propping up home-based care as an essential component of the broader health care continuum, but they still have a ways to go.
On this front, The Dallas-based AccentCare wants to lead by example. To do so, it’s moving the needle by establishing partnerships with health systems and implementing a range of innovative pilots.
“I think a number of organizations, not just us, are leaning into the challenges of the industry — and are distinguishing themselves,” Rodgers recently told Home Health Care News. “I think that’s good for all of us when we do it together.”
HHCN caught up with Rodgers to discuss AccentCare’s growth strategy and how he’s positioning the company to be a Centers for Medicare & Medicaid Services (CMS) partner. During the conversation, Rodgers also discussed why he believes seizing managed care opportunities will help the home health industry “grow up.”
For background, AccentCare has shot up on LexisNexis’s ranking of largest home health providers. In 2019, AccentCare checked in at No. 5, with 1.63% of the national market share. In 2017, the company was LexisNexis’s 11th-largest home health provider in the U.S., with 0.81% of the national market share.
Currently, AccentCare has more than 170 locations. Its service lines include skilled home health and personal care services, along with hospice care, private-duty nursing and care management.
Below are the highlights from HHCN’s conversation with Rodgers, edited for length and clarity.
HHCN: AccentCare took a step forward in terms of market share and scale from 2017 to 2019. What have been the keys to that growth?
Rodgers: We’ve been executing on a strategy since 2014 and have been fairly consistent. We’re not an organization that likes to spread ourselves out. We tend to be very geographically focused. We try and build size and density within the marketplaces we end up operating in. Unlike some of our competitors, we’re very focused on urban marketplaces, and it takes a different skill set to conquer urban marketplaces.
As we look at these marketplaces, we look at how we’re going to grow with them. Everything from our joint ventures — like with Baylor Scott & White Health and UCLA — to how we develop other strategic relationships with referral sources. We’ve done that and executed well on that. Within these strategic markets, we end up driving over a 20% growth rate. On top of that, we’ve selectively picked up high-quality assets to enter new marketplaces.
I think part of the secret sauce is we go in very much focused on improving the quality of care.
You can see in all the marketplaces we’ve ended up in, we were able to significantly improve the star ratings and the patient experiences over time. That puts you at the top of the list with hospitals and physician groups.
What were some operational highlights and challenges from last year?
Managing growth is incredibly difficult. In fact, I would say that the ability to improve the quality of your operations while bringing on management and leadership is one of the biggest challenges.
We had a lot of integration last year. We had Accolade, which we bought back in 2018 in north Texas. We had Steward Home Care and Hospice, and we had numerous other assets come into the mix. This means getting them operationally integrated and acclimated, which takes a lot of resources. Each of those represents challenges, because you have to engage the leadership teams and the management teams in the right way.
On existing marketplaces, it’s actually been continuing to essentially move toward an operationally effective, efficient model in our shared services strategy.
We’ve been essentially bringing up recruiting and hiring hubs — getting the bugs out of how we effectively hire and onboard.
In May, HHCN reported that Oak Hill was selling AccentCare to Advent International. Can you share any updates on that and what it means for AccentCare moving forward?
Yes. Advent is one of the top private equity firms in the country. They purchased us, and we closed on a transaction with them in June of 2019. They have been great partners, we have been at the table with them since before the transaction. They have essentially allowed us to take the company to the next level. They’ve been working with us on getting our shared services infrastructure and IT infrastructure up to the next level. They’ve been great in thinking through all the different pieces we need to execute on, to double, then triple this business over the course of the next several years.
I’d say 2019 was a transitional year as we did this, but it came at a great time. The reality is, last year, all of us were very much heads down preparing for the Patient-Driven Groupings Model (PDGM). But we don’t feel like we missed out on anything strategically, because the home health care M&A marketplace slowed down quite a bit. Nobody wanted to take the risk while the industry was going through this reimbursement change. It was a good time for us to bring a new partner on, start to rebuild our five-year strategic plan inside the organization, and then come out the gate for 2020 with a clear strategy on where to take the business.
HHCN has usually reported on AccentCare as the strategic buyer. What does AccentCare look for in acquisitions?
The quality of the people, because we’re not buying assets to essentially dismantle. We’re buying assets to build on. The most important thing for us is having really great people. If the company has great people and is taking great care of patients, we can work with them on their systems. We can work with them on the retail sales strategies. We can work with them on the other things. But we want to build on top of the organizations we bring in. If you look at almost all the acquisitions we have, we’ve kept the leadership teams in place. Those leadership teams have actually taken those businesses to the next level. We’re not an arrogant organization, we are a learning organization.
AccentCare does more than just home health or hospice. Is there a particular post-acute segment you see as more attractive in 2020?
We’re continuing to build on both our home health and hospice platforms. We want to have a continuum of care within the geographic areas that we service. We want to have everything from home health to hospice — and the personal care assistance businesses. If we see a quality asset within a targeted geographic area, we’ll go after it and then look to fill out the continuum around that. We are a disciplined organization, meaning we basically have identified very specific geographic areas we want to be in. We’ve got a very specific strategy on how we want to migrate into those geographic areas and we pretty well stick to our playbook.
In early 2018, you told HHCN it’s time for home health to “grow up” in order to seize opportunities presented by evolving payment systems and managed care. Has the industry grown up?
I’d say we’re in our teen years. I think a number of organizations, not just us, are leaning into the challenges of the industry and are distinguishing themselves. I think that’s good for all of us when we do it together. Many of our competitors are much more engaged with managed care than they were years ago. I’m very proud of the way the industry faced fraud and abuse initiatives. I think that the way the industry faced PDGM and actively work with CMS on that was outstanding. I think the industry is growing up, but we’ve got some ways to go. I don’t think we’re at the product that the market needs. There’s a lot more we can do.
Also in 2018, you said Medicare Advantage and Medicaid made up more than 35% of your total business. Has that changed at all?
We continue to grow that book of business. We now have in place risk programs and value-based programs. We operate in large geographic metropolitan areas, and within those areas upwards of 50% of the populations are now on Medicare Advantage. I think in many of those areas, our book of business is beginning to mirror those marketplaces — and we’re doing it in a profitable manner.
We have continued to execute a very aggressive managed care strategy, including taking full risk for home health care. We want to be partners with managed care. We want to be partners with CMS on tackling the significant issues of taking care of these vulnerable populations in the home.
What have been the pillars of AccentCare’s PDGM strategy?
We worked on PDGM for close to a year. If I had to step back and talk about pillars, the first is great data and analytics to understand where some of the issues were going to be and identifying where we saw opportunities to improve care.
The second is looking at our operational infrastructure. One of the advantages we had was to leverage our shared services infrastructure. One of the keys to PDGM is having quicker visibility around the patient at the start of episodes, and being able to track and staff. Leveraging the operational capabilities was critical for us.
Last is a very aggressive training and monitoring program for our staff.