Fast Forward with John M. Kunysz, CEO of Intrepid USA Healthcare Services

As CEO of Intrepid USA Healthcare Services, John M. Kunysz, is responsible for leading the organization’s ongoing growth initiatives, with an emphasis on delivering personalized patient and family-centered care. Under Kunysz’s leadership, Intrepid USA was named the 12th largest provider of home health care services in the country.

Through the Fast Forward series, Kunysz shares insight into the tools, technologies and practices that are reshaping home health and home care as we know it. In addition, he provides perspective on the shift to the patient-as-payer model and a more concierge-style continuum of care.

HHCN: Tell me about the path that led you to your current role.

Kunysz: My health care career started out in the payer world. I worked on the payer side in operations roles, then I got more involved with acute care service providers, offering transcription, health information management, patient financial services and revenue-cycle support.

My heavy concentration on patient experience through revenue-cycle services and patient fintech ended up exposing me to a private equity firm that recruited me to help with Intrepid in 2018.

At the time, there was a migration toward the patient-as-payer model and the concierge, family medical home care continuum. More procedures were done at home instead of the acute care setting, and it created an interesting opportunity. I transitioned from acute care to physician practice, then into the post-acute arena.

Where do you see yourself and your company three years from now?

When it comes to health care at home, we’ll be partnering with more out-of-hospital surgery centers. Patients will only need to travel to large hospital facilities if they have a critical need for neuro or cardio beds that can’t be provided in an outpatient setting.

Right now, we’re about 80% Medicare. I think over the next three to five years, we’re going to see a radical shift in our payer mix, which will probably be somewhere between 30% and maybe 40% Medicare — much less than what it is now. Much larger percentages of our patient populations will have direct contracts with payers to provide care for them in a comprehensive setting, helping to control costs.

What do you think will be the most significant challenge for your company during that time?

I think the biggest challenge will be continuing to attract, motivate and retain incredibly scarce talent — one of the challenges our industry faces as a whole. Traditionally, the top talent went to work in the large acute care health systems and in the big hospitals. If they couldn’t quite cut it there, they would end up in the physician practice arena.

If you weren’t qualified to make it in either of those settings, you’d get hired into long-term care, post-acute care or assisted living. That’s shifting now. We’re seeing a lot more talented resources spending their careers in health care, bringing those talents and skills to the post-acute world. The way I see it, we’re running a hospital with 7,000 beds in 17 states and a couple thousand care team members, and that’s a much more complex and challenging clinical environment than a single location.

Continuing to attract, motivate and retain that key talent is going to be our challenge, because working in post-acute and home health care is still not nearly as sexy as working as a barista at Starbucks, or as a genius at the Apple store.

What is the greatest source of health care disruption that you see coming in the next three years?

I think we’re going to see the growth of the patient-as-payer model, with families taking more financial responsibility for their health care costs. I see us moving away from traditional models of placing aging parents or relatives in congregate care facilities, with better ways to care for them at home. The tremendous growth of the aging baby boomer generation is also at a point where their care needs are beginning to overwhelm the level of staff resources.

What do you see as the most exciting economic, financial or bottom-line opportunity over the next three years?

I’m most excited about working directly with payers and family members to create alternative care models. Our entire health care system has been built around an episodic payer model, but moving forward, we will be focused on aging in place. We can work with payers to provide very cost-effective models, enabling a migration from the episodic payer methodology and mindset to an accountable aging-in-place model.

If you look at our business and health care services in general, we’ve been planning systems around the manufacturing and production process for years. They’re called MRP systems, which stands for materials requirements planning. We have not done a good job of that in the home health care business.

It’s almost like there are physician preference cards for the different surgical needs and devices. Patients should have preference cards, and care team members should have preference cards, too. Why are we asking someone who’s terrified of dogs to go into a home with dogs, or someone who is allergic to cats to go into a home with cats?

We can change the way in which our staff is paired with people who have similar interests. Then, you’ll have care team support as a more fulfilling job experience.

In addition to the MRP staffing-patient alignment interest, patient monitoring and remote patient monitoring will also create a better patient experience. Using room imaging and scanning technology allows us to keep our patients safer by interacting more effectively with them in their homes.

Beyond technology, everybody knows that people want to age in place. What do you think will be the greatest social influence in the home-based care industry over the next three years?

In health care, as you get into the aging population, you need an incredibly integrated and seamless methodology to incorporate care input. The patient may not be telling you the truth. They don’t want to have their keys taken away. They don’t want to lose their independence. Sometimes their spouse or significant other may be enabling them and not necessarily telling the truth. You need to incorporate input from other family members to understand the full patient picture.

I want to move toward a holistic aging-in-place type of program with better patient and family engagement communication tools. Because when you think about it, we know more about our Chewy dog food or Amazon order than we do about the care visit with our loved one.

What consumer product or consumer service do you think will have the greatest impact on home-based care providers over the next three years?

I think the ability to use in-home patient monitoring and patient communications technology, coupled up with what I call “patient contact centers,” will make a significant impact on home-based care providers. We plan to create patient contact centers staffed with people trained to deal with social determinants of health and engage patients in a way that’s different. Patients will share things with us that they won’t necessarily tell their family or close friends.

They’ll be a little more candid and open. I’m excited about that, but also about finding ways to do remote patient monitoring in the home, particularly around medication compliance and/or health risks, like we talked about. You’re seeing imaging and management that can determine whether or not a patient is someplace they shouldn’t be, in a position on the floor that they shouldn’t be, if they haven’t moved or if they haven’t taken their medication — we can contact them to follow up on any of this.

Complete this sentence: Three years from now, I hope care delivery will be …

More personalized and delivered in a concierge, family medical home care experience.

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