Keith Myers has seen his fair share of change in Washington, D.C.
Since co-founding the business with his wife, Ginger, in 1994, Myers has helped lead LHC Group Inc. (Nasdaq: LHCG) through parts of five presidencies as chairman and CEO. A new administration with Joe Biden in the White House would make that six.
Although President Donald Trump has yet to formally concede due to his team’s ongoing legal challenges to the 2020 election, Myers’ roles at LHC Group and the Partnership for Quality Home Healthcare mean he must plan ahead for all outcomes. Since last year, he’s been working to make sure home health care maintains its rising position, regardless of the political landscape.
Home Health Care News sat down with Myers for an inside look at those policy efforts. In addition to the 2020 election, LHC Group’s top executive also touched on recent COVID-19 vaccine news, emerging post-acute care trends, the future of the Center for Medicare & Medicaid Innovation (CMMI) and more.
Highlights from HHCN’s conversation with Myers are below, edited for length and clarity.
HHCN: Looking back, what have the past four years meant for in-home care?
Myers: I think the data speaks for itself. Pre-COVID, we had a significant, measurable tailwind. Policy has been moving in our direction. I think that was influenced heavily by all the investments we’ve made in data-driven policy work in D.C., especially over the last decade.
When COVID happened, it took those tailwinds and put them on steroids.
We’re already going in the direction of shifting more care into the home. We’ve been able to bring that shift about thanks to the industry’s work, paired with the insights from Dobson DaVanzo & Associates and the others we’ve brought in as objective third parties. These groups have looked at the claims data, proving beyond a shadow of a doubt the efficacy of the home health benefit and our ability to create favorable outcomes at much lower costs.
Apart from demonstrating the value of home health care over the years, the industry has also been able to improve its standing with the U.S. Centers for Medicare & Medicaid Services (CMS). Providers have drastically lowered improper payments, for example.
I think back to the late 90s. There was a group of us — some of the original home health pioneers — who got together and decided to invest in data. We had the courage to invest in data to not only show where the opportunity was, but how we could improve. We looked at who the bad actors were.
Rather than the whole industry being viewed as problematic, we started holding those bad actors accountable. I think we gained a lot of credibility from that.
Those efforts helped CMS hone their skills on what to look at. They’re much more targeted now in their approaches, and I think that’s good for everyone.
Looking ahead, what are some of the things that might change? What could a potential Joe Biden administration mean for LHC Group and other in-home care providers?
Well, historically, Democrats have been more favorable to health care, generally. I think that is still true today. If we’re positioned with reliable data to give us a seat at the table going in, I think that’s important.
At the Partnership for Quality Home Healthcare, we started preparing for this potential outcome last year. LHC Group is represented by former U.S. Senator John Breaux, who is a former board member of ours. He’s still very active. I talk to Senator Breaux every other day.
We reached out and brought in former Senator Blanche Lincoln during the summer. We started orienting her specifically for this potential outcome. She’s at Lincoln Policy Group, as is Tom Scully, a former CMS administrator who also represents the Partnership. Another name is former U.S. Representative Joe Crowley. We’re working with him as well.
We have the right story. We have the right messengers, people who know President-Elect Biden and all the likely players who will be in his administration. I think we’ve positioned ourselves very well.
And we weren’t just planning for this outcome. We had strategies for both potential outcomes.
One of the things Biden has talked about is “Medicare at 60.” What would that mean for the home health industry?
The obvious impact is volume. Volume would be increased.
But I do believe we’re going to have a divided government, so I don’t expect to see anything too big happen. I don’t think we’re going to see anything transformative.
You’ve been in this business a long time. You and your wife, Ginger, started the business from your kitchen table. How disruptive is it when there’s an administration change?
It’s a great feeling to be able to say what I’m about to say — and mean it 100%. Today, I don’t think it’s that big of a deal. That’s because the data and the policy momentum are already on our side.
Back in the 1990s, we didn’t have much of a position. We just had, you know, some people who would support us. For me, that was folks like Senator Breaux and others. We were cobbling together data and support for home-based care, but we didn’t have overwhelming evidence gathered by independent, third-party experts like we do today.
This is going to be my sixth president. I’ve seen all the different political landscapes. I’ve seen a White House controlled by Democrats. I’ve seen Republicans having both the House and Senate. I’ve seen all the different combinations.
In our experience, the highest risk has been when one party controls both the House and Senate, never mind who’s in the White House. But listen, I think we have a favorable landscape right now. Yes, we have some Senate races that still make things very tight. But Democrats in the House are seeing their numbers go the wrong way, so it’s unlikely they’ll do anything way out there.
And Biden is largely considered a moderate, someone who works across the aisle, much like Senator Breaux did.
CMMI has tested out a number of alternative payment models over the past four years. Overall, it has launched 54 since its formation, with officials often citing the Home Health Value-Based Purchasing Model as one of the most successful. How has LHC Group performed under that?
We’ve performed well in the nine initial states where we’ve had the opportunity.
There’s also the Comprehensive Care for Joint Replacement (CJR) model. We’ve done significant work there with Ochsner and had great success. That has informed a lot of our strategies around skilled nursing facility (SNF) diversion and other efforts to move patients downstream.
I would also point to our broader and deeper experience with accountable care organizations (ACOs). We’re very proud of that. We’ve really come a long way with ACOs. I’d say the two biggest levers we’re pulling in that regard are preventative measures and care management on the front end, then, when patients do need care, leveraging home health care to the greatest extent possible.
Would you support a nationwide expansion of the Home Health Value-Based Purchasing Model?
Yes. The details are always important, but given a choice between strict fee-for-service versus some sort of value-based purchasing, we’re always going to take the value-based option.
What do you think a Biden administration would mean for value-based care? Would it be more of the same — or would there be a drastic difference?
I haven’t seen any evidence or indicators where I’d say “drastically different.” I think Democrats tend to lean into provider-based care. They’re not as much in favor of Medicare Advantage as Republican administrations, in my view.
I’m a big believer that providers should have — if not full control — a more meaningful stake in the risk pool. I think some of the CMMI demonstrations support that. You get the best of both worlds when providers have that seat at the table. You get lower costs and quality outcomes.
Earlier this week, Biden’s transition team unveiled members of its COVID-19 task force. It includes Atul Gawande, a former FDA commissioner and several others, but no in-home care experts. What are your thoughts on that?
I think we’ve learned over the years that there are a lot of ways to influence the process without having somebody officially named to a particular position. We know this through our experience with the Medicare Payment Advisory Commission (MedPAC).
I think there are more people favorable to home-based care policy than one might think. But, sure, we’d love to have somebody on the task force who’s directly involved with the home health industry.
If you had to look in your crystal ball right now, what’s one prediction for home health, hospice and personal care moving forward?
I think care in the home, across the board, is going to be the “ask” of patients. It’s also going to be the very first inclination of referral sources.
In the past, home-based care hasn’t been an afterthought, but it wasn’t always at the top of the list. Let’s take SNFs, for example. In the past, if a patient qualified for SNF, then they would typically get referred to SNF. Referral sources would automatically think it was the safest route for them, from a risk perspective.
But now, they see the risks associated with going to an in-patient setting. I’ve seen patients, families and referral sources acknowledging that risk more than ever. They’re saying, “You can be cared for at home, if that’s what you want to do.”
That conversation is happening with discharge planners and referral sources everywhere. It’s happening at a level that we weren’t seeing pre-COVID. I don’t think we’re going to go backwards on that. It’s a new normal.
Pfizer and Moderna came out and said they’re very close on COVID-19 vaccines. Once those are ready to distribute, what role should home health providers play?
Well, it’s almost not fair for me to answer that. Of course I think home health workers should play a role. And we’re all familiar with the phrase “social distancing” now. What better place to bring the vaccine to people than in their homes? Why would you bring everyone to a centralized location for a vaccine?
I think our front-line workers and the people they care for, including the elderly, should also be among the first to receive a vaccine. I’d like to hear arguments against that.
What has you excited about 2021?
There’s a lot to be excited about. Having been in the industry as long as I have been, I don’t know if 20 years ago I really believed I would see the day with this much opportunity.
I couldn’t see it from where we were back then. We were just fighting for survival. To see this opportunity intersect with our preparation as an industry and our ability as individual providers to care for patients downstream, it’s incredible. It’s what dreams are made of.
I couldn’t be more excited for or proud of our industry. It puts some pep in my step and makes me want to keep doing this for a really long time.