In a period of about seven years, AccentCare Inc. has expanded its footprint from seven states to 31, thanks to strong organic growth and an aggressive M&A strategy.
With all of that growth has come massive change, according to the Dallas-based company’s longtime CEO, Steve Rodgers. But there was likely no bigger change in AccentCare’s history than its 2020 merger with Seasons Hospice & Palliative Care.
Having the right people in the right seats is a key to navigating changes for any business, Rodgers told Home Health Care News. Mavericks of change also don’t dwell on their setbacks, but rather, they learn from failure.
HHCN caught up with Rodgers to learn all about his approach to change as part of its 2021 “Changemakers” series. In addition to AccentCare’s ongoing evolution, the CEO also discussed the changes he’d like to see happen in home-based care, including the doing away with overly rigid and narrow benefits.
Highlights from the conversation are below, edited for length and clarity.
HHCN: Looking at all of the changes you’ve had to navigate, which changemaking efforts are you most proud of?
Rodgers: I’ve had the privilege of leading AccentCare for almost nine years. Going back over the last several, we have had a tremendous amount of change in this organization. Since 2016, we’ve done about 16 transactions. We’ve built an industry-leading shared services infrastructure. We’ve formed almost 30 joint ventures and strategic partnerships with large health systems and provider organizations. If I go back to 2014, we’ve expanded from seven states to 31.
But the thing that I’m most proud of, as I think about all that we’ve been through, is the way we’ve supported and grown the AccentCare culture through this time period. Through all that change, we found seats at the table for key leadership we brought in. They’ve made us a better organization. I think my proudest accomplishment or changemaking effort is that we’ve driven so much change without losing what I consider to be the soul of AccentCare. We haven’t lost focus on our mission. Our care for each other and for our patients is what we exist for. If you lose sight of that, all the other great things don’t really matter.
AccentCare last year executed a major merger with Seasons. Whenever there’s an acquisition or a merger of that scale, there are a lot of forces pushing and pulling against each other. What are the key ingredients to successful change?
It depends on the situation. But I’ll be frank, Seasons is, without a doubt, the most challenging integration we’ve ever had to go through. The reason is because they’re a great organization to begin with. It’s actually really hard to bring great organizations together.
Why is that?
You don’t want to buy or go out and bring together poorly run assets, because integrations are hard, right? Like AccentCare, Seasons has a proud and incredible culture. They’ve got great people, with a deep-seated view inside their business of why they’re there, doing what they do. With that in mind, it’s important through all this change to build the bonds with your people and the people you’re bringing in. As we run these businesses, it is all about the people.
Most of us are running very similar systems. We’re prescribed very specific patterns, whether it’s hospice or home health care, of what we need to be doing. How we execute is ultimately all about the people.
If you look at Seasons, we knew that CEO Todd Stern was a great leader and incredibly present across the organization. I knew my success with Seasons and getting them integrated was building a great relationship with Todd. That effort allowed us to form a joint vision of what we wanted the new organization to be, and then we drove our teams toward that particular vision.
Oftentimes, when you’re with other organizations, you’re maybe not always bringing over the leaders. In those cases, you have to get very hands on out there. But what we want to do is go in and learn from them. AccentCare has been able to bring great things into our organizations from almost all the acquisitions and efforts that we put together. We’re an incredible learning organization. That kind of mindset allows us to not only avoid doing harm to the organizations we’re bringing in, but engage them in a different way. We help show them how they can make an impact on the broader AccentCare organization.
Not all changemaking efforts work. What’s maybe one initiative or goal you’ve tried to fulfill, but failed at?
I’ve used this phrase a lot in the last year. Einstein has a quote of, “I have not failed. I have just found 10,000 ways that don’t work.” At AccentCare, we’re constantly finding ways that don’t work. Driving change is about having a vision — and having an unrelenting persistence to find success. In real change, you need to shut out the noise and take the heat on it.
Here’s a prime example: We’ve been on a mission since 2015 of creating a centralized intake and shared services capability. This has been a constant work in progress. Back in 2015, when we originally did it, it was poorly done. That resulted in not great service for our referral sources and a lot of frustration for our staff. Part of that was we didn’t have the right people on the point doing it. We didn’t take the time to get the right systems and technology in place around it. I know, because of that, we probably had people who quit.
For years, there was an overwhelming call to put centralized intake and some of these shared services capabilities back out in the field. But with that, I was very committed to a vision of what we could be. I knew if we wanted to be able to operate this business at scale, in a consistent manner over time, we had to make this work. So we found 10,000 ways central intake doesn’t work. But we have persisted.
Today, we’re using AI and smart technology to drive down the cost and errors of the intake process, and improve the timeliness of accepting referrals. On our home health care platform today, we have 100% visibility of all the referrals coming in on a real-time basis. We are reducing the cost it takes to accept them, and we’re setting high and consistent service standards that we look to meet across all our business partners out there. Again, there are numerous ways in which we’ve shut things down over time. But it’s about that kind of commitment to the vision and the persistence.
Whether you want to focus on home health, hospice or personal care services, what would you say are the biggest “winds of change” currently blowing across the home-based care landscape? And what’s it going to take for providers to thrive under that change?
Again, I’ve been here for about nine years. We are now getting what we asked for. More than ever, health systems and managed care organizations are looking at home-based care as a needed solution to appropriately stabilize very sick patients and send them back into the community. I can’t go to a meeting now inside a large health system where an executive isn’t telling me of their need for a broader, more comprehensive set of services in the home. And they’re not thinking about it in the strict terms of “home health, hospice and personal care services.”
They could just have some extremely high-risk individuals who are maybe quite homebound. They need to be monitored. They need med reconciliation. They need stability in the home. With that, there are new entrants coming into this business. We have entities coming in on both ends of the scale. On the lower end, there are people who are willing to kind of come in and just do some of the telemonitoring activities. Then we have people, on the higher end of the scale, who are actually taking care of very complex patients, and partnering with hospitals and health systems to do these hospital-at-home programs.
As an industry and a business, we need to adapt to the changes that our customers — health systems, referral sources and patients — are calling for. I think the patients are looking for more of a continuous relationship. When I first got in this business, I used to say we care about our patients 60 days at a time. Because that was a “home health care episode,” right? But the reality is that our patients have a continuous need. They’re maybe going to be on service for over the next 15 years. Maybe that starts with them having some needs for personal attendant services. Then maybe they have periodic home health care needs, eventually hospice needs. In between that, they probably need meal services and food services.
There’s a broad spectrum of needs. If we, as an industry and business, don’t start to fill that gap, we will be disintermediated. Others will fill those gaps — and we’ll be left to pick up the pieces.
I’m very much a proponent of essentially expanding our service offerings. We have to look at how we can be more flexible, with our most valued resources being our caregivers out there. How can we deploy them in a much more flexible manner that goes beyond the benefit constraints that we’re put under right now?
How have you had to change as AccentCare has changed?
As the company has grown and become more successful, it’s gone through a lot of different stages. As a leader, I’ve had to continue to grow with the business. The reality is: I didn’t know what I didn’t know about home-based care when I first got into this nine years ago. I had to very much be a learning leader.
At the beginning stages, I had a vision for what I wanted AccentCare to be. But I was going to get nowhere if I didn’t get a core, base understanding of the business and how to make it successful. I’ve had to continue to adapt and change over time as the organization expands. I think one of the greatest challenges leaders of growing organizations face is keeping that hands-on influence you may have had when running a much smaller organization.
AccentCare was a $400 million organization when I first came on board, and you could pretty much still feel like you could touch everything within the business. I knew all the leaders in the field. I knew all the executive directors in the field. I knew them by name and could directly reach them whenever. As we’ve expanded to where we’re at today, with well in excess of 200 sites and operating in 29 states, the ability to actually stay in touch with your business and people gets tougher.
How do you see AccentCare continuing to change moving forward?
This isn’t just AccentCare. I think it’s the industry overall. I think there’s a real need for all of us to develop a very different level of relationship with the patient than we have today. I sometimes think about all the time and energy over the years, and all the homes we’ve gone into, and yet how little I still know about all the patients we take care of.
What do you mean by that?
Our successes in this business, the core foundation of it, will be making sure these patients are understanding their needs, that their extended caregiver family understands those needs, and that we’re able to appropriately convey all of that back to value-based care providers, health systems and physicians.
Why is it that every time I go in the home and touch the same patient, that we don’t already have a profile on that patient if we’ve been in there multiple times? We know the caregiving environment associated with it. We know the challenges they may have on food and food dependencies. We know all these things. As we’re working with the physicians on the care plans up front, we need to be better communicators, allowing us to deliver a better product in the end. In short, we have to become incredibly more intimate with the home environment and with the patients.
If you could snap your fingers and change one thing about how health care or senior care is delivered in the United States, what would that one thing be?
I would get rid of benefits. I think benefits are constraints in the system. We’re all hammered in by these rigid mechanisms and definitions. This is a big pie-in-the-sky idea, but it would make a ton of difference. I think the biggest frustrations for patients — and the biggest gaps in care — happen because of all the individually aligned benefit systems put together. We are very much prescribed in home health care exactly the services we can deliver and under what circumstances.
On the other side, how we take care of patients in their last year of life is too ill-defined today. The hospice benefit isn’t supposed to kick in until six months prior to end of life. We’re actually penalized as organizations if we extend that too far upstream and have live discharges of patients, even though we’ve helped them in so many ways during that time period.
We have to find ways to operate in a more fluid environment. This is where I’m a huge proponent of both value-based care and flexing benefits more under managed care. That allows us to focus in and treat the patient as an individual, concentrating on what their needs are.
Let’s just use the example of support with activities of daily living (ADLs). We all know in this business that ADL support is probably more critical for keeping a patient at home than all the skilled needs or rehabilitation services we could give them. Yet we are prohibited from providing those benefits today under the current home health care benefit. So many more patients could go directly out of the hospital and into the home, skipping the facility-based level of post-acute care.
There’s been a lot of tragic news in the past 15 to 16 months. But there have been some silver linings to the public health emergency as well. What do you think one positive, lasting change to come out of the pandemic is?
I think, in the end, it’s our appreciation for each other. It’s our appreciation for the time that we have together. I think we all took it for granted — our ability to actually get together and the connections that we’re able to have with each other.
Companies featured in this article:
