AccentCare CEO: To Avoid Extinction, Home Health ‘Dinosaurs’ Must Embrace New Services

The chief executive officer of any business must balance immediate priorities with future aspirations. That’s particularly true for home-based care CEOs, whose organizations are starting to draw the attention of Amazon (Nasdaq: AMZN), CVS Health (NYSE: CVS) and other potential disruptors.

At Dallas-based AccentCare Inc., this balancing act means doubling down on recruitment and retention efforts, while exploring new expansion opportunities in terms of its geographic footprint and portfolio of services.

“We’ve got to continue to look at product-line expansions within the industry,” AccentCare CEO Steve Rodgers told Home Health Care News during a recent HHCN+ TALKS conversation. “I would predict that the people that are in this business five to seven years from now, the biggest product may not be the Medicare-certified home care product.”

HHCN is pleased to share the recording and transcript of our HHCN+ TALKS conversation with Rodgers. Read on to learn more about:

– What AccentCare is doing to combat the staffing challenges plaguing nearly all health care providers

– How the home-based care giant is creating a new identify after successfully completing multiple integrations, including its industry-shaping merger with Seasons Hospice & Palliative care

– Why Rodgers believes home health companies exclusively focused on traditional service offerings will become “dinosaurs” in the not-too-distant future

The below has been edited for length and clarity.

[00:00:00] Bob Holly: Good afternoon, everyone. Welcome to this episode of HHCN+ TALKS. I’m Bob Holly, the managing editor of Home Health Care News and Hospice News. If you’re tuning into TALKS for the first time, this is our fairly recently launched interview series, where HHCN connects with some of home-based care’s biggest names and most innovative thinkers. I’m thrilled to welcome somebody today who certainly fits that description in AccentCare CEO Steve Rodgers. Steve, thank you so much for joining us.

[00:00:33] Steve Rodgers: Yes. Thanks, Bob. It’s always great to spend some time with you. I’m excited to be here today.

[00:00:38] Holly: Well, we are glad to have you. Before we get started, a quick note for all of our viewers. I have a long list of questions that I plan to ask Steve, but we’re also accepting questions from the audience. If you did want to ask about AccentCare’s plans or what it’s seeing in the home health space in 2022, chat your thoughts via the question function in Zoom. If we see any good ones, I’ll make sure to call them out.

OK, Steve, to get started: How are you? How’s everything going at AccentCare?

[00:01:18] Rodgers: It’s good. I’m just very excited, Bob. I’m excited about AccentCare, the team we put together here. Even though it’s been a very difficult time period over the course of the last couple years, it’s been a very exciting time to be in this home-based care space, with everything it’s meant to us. I’m excited to share more of those insights with you as we go forward.

But the last couple years have been tough, I think for a lot of us across the board. We’re going to have some great war stories. I think that all of us are going to be very proud to have actually navigated and been through this time period. It’ll be something that I think when we get to the other side of this, people will look back and not believe exactly how we used to do things versus the way we’re doing things now. It’s a very exciting time for ourselves in the industry.

[00:02:11] Holly: I think most of our viewers, they’re probably familiar with AccentCare. But just in case there are a few folks learning about the home health industry for the first time or they’re fairly new to the market, could you give a basic overview of the AccentCare business?

[00:02:28] Rodgers: AccentCare, we operate in 32 states today. We offer three principal lines of business. There’s Medicare-certified home care. We’re about the fifth-largest Medicare-certified home care player in the country. We offer hospice services, which once again, we’re about the fifth-largest there. We’re one of the larger personal care businesses. We do both Medicaid as well as private pay.

We really focus on the continuum of care and trying to develop intimate relationships with our patients. We tend to operate in large Medicare MSAs, looking to have that full continuum. We anchor into big partnerships – like here in Texas and in the Dallas area with Baylor Scott & White. We have a number of these partnerships across the country that are formal, financially aligned joint ventures that allow us to actually be part of the continuum of care for these large partners.

[00:03:31] Holly: The home health market itself is made up of 11,000-plus individual agencies. Then even the largest providers, still, their market share is 6%, 7%, maybe even less in some cases. It’s a very, very fragmented market with a lot of different players. How is AccentCare different from your market peers, in your view? What are your biggest differences?

[00:03:55] Rodgers: I think we’ve tried to do a few different things. Early on in my career, I was an executive with General Electric Company, there during the Jack Welch years. I’ve adopted a lot of his mantras and tried to put them into the AccentCare business.

I think first is, we do want to operate with size, scale and density in the marketplaces that we operate in. We’re very focused on larger urban marketplaces. We anchor, like I said before, into these partnerships within those markets, then look to offer a continuum of care across them. This is all then supported by one of the industry-leading technology platforms across the board, where we haven’t only brought in the common-type EMR platforms. But we’ve also built a lot of AI and intelligence inside our systems, as well as a very robust “care flow platform.” That really allows us, in a shared-services infrastructure, to create a more consistent experience for the patients and referral sources.

That’s how we like to distinguish ourselves – in size, scale and density. Our average metro area has about a $65 million operating business within it, and that allows us to bring in other support services. Things we see as critical these days, such as recruiting capabilities, plus other support and onboarding capabilities, to really beef up our operations in those particular markets.

[00:05:29] Holly: I’m just thinking back to the past couple of years, and you and I have connected quite a bit. I think in the fall of 2020, we talked about a new post-acute care JV with Fairview. A couple months after that, we talked about the big merger with Seasons. Most recently, we talked about the organization-wide branding strategy – bringing all your different brands under the AccentCare name. In your opinion, what business milestones stand out most over the past couple of years – and why?

[00:06:04] Rodgers: First off, I just think this Seasons acquisition has been transformational to the organization. It’s been transformational in a number of different ways. One, it fully filled out our hospice line of business. But I think Seasons as an organization, too, is another one of these organizations that is very well suited for the modern environment. I’m talking about what they’ve done with everything around learning, training, education and things like that. If you look back, we brought Seasons in and closed that transaction at the end of 2020 or the beginning of 2021 there.

We integrated the leadership teams by the end of February. What that allowed us to do is, we then quickly pivoted as an organization to essentially building a new vision of what we wanted to be. A new purpose and vision, I think, for the company. By the middle of last year, we were able to bring together over a hundred senior leaders from across the organization and begin this “reimagining process” inside of AccentCare.

That allowed us to actually, by the fall of this last year, have a new purpose and vision for the organization, one that then fed into the branding and the branding mechanisms across the board. If you look at this last year, 2021 was essentially a transformational year for AccentCare, where we brought in not only Seasons, but several other organizations. We ended up doing four integrations. We brought together about five EMR systems. So it was important for us to, as we left 2021 and moved into 2022, exit with one brand, one organization focused on the continuum of care and this “reimagining care” concept.

[00:08:03] Holly: Personally, I recently started getting more involved in Hospice News. I have trouble integrating myself into two different newsrooms. I can’t really imagine integrating four different providers and five different EMRs at the same time. Circling back to that branding initiative, I know a lot of providers like to be a “house of brands,” so to speak. Tell me a little bit more about the strategic rationale to bringing everything together under one name.

[00:08:38] Rodgers: I think all these markets are evolving. It is time for us to move to national brands, I think, across the board. There were two principal reasons why we ended up doing this. One is that we needed to be simpler and easier to use for our patients and our referral sources. In a Houston marketplace, it made no sense for us to have a Seasons brand and to have a Texas Home Health brand (that was down there at the time, an AccentCare company).

We did a lot of research around this. Our referral sources and our customers really preferred to have everything under one name. It’s not just about one name. It’s about one set of processes in the way that you think about it. The second piece associated with it is, essentially, we did it for our employees. When I say that, one of the pieces of feedback we got was branding creates individual fiefdoms within the organization.

We would find employees saying, “I’m a Seasons employee.” Or, “I’m a Texas Home Health employee.” Maybe, “I’m a Guardian employee.” If we want to create a unified organization focused on one vision and one purpose of reimagining care, then it is very important for us – as an organization – to unify under one brand. Those were the major two reasons that we drove toward one brand.

[00:10:03] Holly: We touched on the branding initiative. We touched on the Seasons merger and some of the integration work that you’ve done. Of course, the other topic we’ve talked a lot about over the past couple of years has been COVID – the public health emergency. In what ways, as we’re talking here on Feb. 8, is AccentCare still being affected by the pandemic?

[00:10:28] Rodgers: I think the No. 1 way is – I continue to wake up in the morning and spend a big part of everyday worrying about our people. We, as an industry and as a provider of care in home health care, have pushed the limits on our people. We keep coming back to the well. We worked through two COVID waves last year. They evolved into another COVID wave this year. Over time, it’s had a lot of stressful impact on our people.

We operate in an industry where the people who are delivering this care are oftentimes disconnected from us in the marketplace, meaning that they are individually operating in their cars every day, they’re not going into the office every day, and they’re dealing with a lot of stress. Over time, we’ve had to find new and better ways to be able to connect with our people out in the field and better support them. One of the things we all have to continue to think about is essentially how we’re supporting our people out there – and that’s probably the major thing that I see right now in terms of COVID.

Obviously these vaccine mandates have played into that. We are well on the way and feel very confident. We have done tremendously well as an organization through this. But all the resources that have gone into managing the various mandates that come down, that takes a little bit of energy out of the organization.

All these things have continued to change the organization in different ways. I was down in Austin, Texas, last week, sitting down with a bunch of people, having lunch actually with people in our agency. Already, we’re talking about what it was like at the beginning of the COVID waves. That started hitting us – how different we are as an organization right now from when we were back in March 2020.

[00:12:50] Holly: I feel like talking to providers back in March 2020, everything was a new crisis. Today, we certainly still have challenges, but the processes for handling crises are more so in place. Whatever comes up, providers know how to respond.

[00:13:12] Rodgers: That’s right. Our emergency-response capabilities. For instance, we’ve got a very mature emergency-response management team now in place that can quickly get out across the country.

And in Texas, we may get a dusting of snow that makes traveling into the office difficult. I don’t even have to blink or think much to, “Let’s just close the office or the corporate offices on Thursday and Friday.” Because we’re all still connected virtually. We’re able to work together without an issue. The pandemic has made us more adaptable not only in those situations. Whether it’s wildfires in California, hurricanes coming through Florida or South Texas, or something else, we know how to better respond to them.

[00:14:07] Holly: Whether it is the ability to quickly pivot to virtual or something else, what have been some of the things that have surprised you most about this whole saga?

[00:14:20] Rodgers: Surprised me most? You can talk at the most macro levels. I would’ve never figured we’d have this ability to use virtual technology the way that we do today. Even this studio or our ability to quickly adapt by using Cisco, WebEx or Zoom.

If you look back two and a half years ago to now, it’s like breathing for us.

I would have never really predicted the significant shift we’ve seen to care in the home. What this has done for the industry, I think it has accelerated our business model by three to five years. I saw some graphs not too long ago suggesting we’re now – both with volume and complexity – very equivalent with what’s being taken care of in the skilled nursing facilities (SNFs). I think that is another.

The third thing I’d say is just the resilience we’ve had, both as a country and as an industry. It’s only in times like this that you actually get to test that resilience and build the muscles around it.

I think even the home care industry and the health care sector, despite all the pain and loss, has risen to the challenge. Once we adapted as an industry and a business model, we were able to rise above the hardship and continue to operate.

[00:17:03] Holly: I did want to dig further into the staffing component because that’s the No. 1 thing everybody wants to talk about. What is AccentCare doing right now to keep your clinicians, to keep the folks going into the home? And what have been some of your biggest staffing lessons learned from 2020 and 2021?

[00:18:00] Rodgers: There has always been significant levels of turnover in the home-based care market. We’ve struggled with actually attracting and bringing in the level of talent that we need – and getting them trained.

What COVID has done is exacerbate. It continues to exacerbate. It magnifies all the little problems that you have and makes them very, very big problems. That’s where we’re at right now. Staffing and labor is a very, very big problem for health care overall – and home care, especially.

The principles that I think we continue to try to push forward? What have I seen make a difference in situations like this? The first is leadership matters. Who you have leading your people out in the field everyday matters.

The second is connectivity matters. The business processes and systems, but also the personal ways in which we’re connecting with each other. Especially when it comes to nurses in the field, if we want to keep them, we’re doing very simple things like telling ourselves, “You need to make sure that you call every nurse every month, and that you’re connecting with those nurses and actually hearing them.” And not just the nurses, but the other clinical staff, too. Connectivity matters.

Then underneath this, to support all the people out in the field – culture matters. You need to create an environment that people want to work in, where they feel valued as individuals, where they can make a difference.

So all of those things matter. Then they translate down to the individual actions that we all have to take. Those are some of the things in which we’re thinking about it.

Now, I will tell you that the tools and the techniques that we have to operate on as a business are evolving very much in this environment. Because none of us have operated in the type of inflationary environment that we have today, with quite the level of competition that we have. What you used to think about on a monthly or quarterly basis has really almost moved to daily and weekly. How many people am I actually recruiting into the organization? Or how good of a job are we actually doing in essentially being able to move them through our recruiting processes? How are we doing between when we close them and actually when they show up for work?

All those things are things that now you need to be acutely aware of and on top of, on an ongoing basis. As an industry, we collectively have more referrals coming in and more business coming in than we can fill. Our ability to actually grow as a business and continue to thrive as a business, it’s all going to be encapsulated in the leadership, the connectivity, the culture we create, then all these little actions that we’re driving.

[00:21:55] Holly: I want to circle back to one of the first comments you just made: Leadership matters. I couldn’t agree more. And something that I’m a little bit concerned about that I’ve heard some talk amongst providers about is leadership burnout. You actually have a lot of managers leaving the industry. I’m definitely not saying this is the case at AccentCare specifically, but I’ve heard from other providers who are worried about experienced nurses and clinical managers leaving the field, then having younger, less-experienced folks stepping up. Is that “brain drain” something that’s top of mind for you?

[00:22:36] Rodgers: I think our clinical leaders have gone under a tremendous amount of stress over the course of the last 24 months. I think that as an industry – and I’m talking health care overall, and home care in particular – we haven’t done enough to train and basically support them in adapting to the stress, to the environment. I think there are and should be a lot more things that we’re doing. I would tell you that, generally speaking, at our executive level across our organization, it’s a fairly stable workforce right now.

I think when you get down at the next level into some of the clinical-supervisory work, is where you’re seeing a little bit more churn. That’s partly because I think there’s probably step-up opportunities for them in places like managed care and elsewhere, where it’s a little bit easier job for them without all the stresses that they end up having.

The other thing that I think exacerbates the issue within the home care industry is the incredible regulatory burden that’s put on top of us. A lot of supervisory work in our industry goes into regulatory oversight work, which is not very fulfilling work. What we’ve continued to try to do is pull out that more specialized work from the supervisory work. Because what we find is, when we can get our nurses, our clinical leaders with a passion for patient care, just focused on supporting our clinicians in the field, that it can become a very fulfilling process. It’s all the other things – the vaccine mandates, the regulatory oversight, all the other things that we put on top of them that essentially cause the burnout out there.

[00:24:47] Holly: I know I can’t keep you on HHCN+ TALKS all day, so I want to look ahead a little bit before we go. What key themes do you see shaping home health care in 2022?

[00:25:14] Rodgers: When I came into this industry 10 years ago, people looked at me sideways and said, “Why are you coming into this industry? And what are you doing?” I came out of Optum, and now there is a proliferation of interest. If you look at just over the course of the last month, CVS Health’s Karen Lynch said she was very interested in the home. UnitedHealthcare and its CEO continue to express their interest.

Over the course of last year, we had Humana integrate the Kindred acquisition. Just today, there was a press release about Amazon not only moving into the home, but actually bringing up more pilots around both telehealth as well as in-person care, more on the commercial populations right now. You are seeing a proliferation of services into the home. I think the business we’re in and how people think about the home is going to change significantly over the course of the next five years, as both the technology as well as the continued interest pushes into it. The reason is because it doesn’t take much to have a significant impact on the cost of care by how we execute in the home today.

If you could just reduce five SNF days through your medication reconciliation, reduce 10% of the pharmacy spend and basically avoid one ER visit, that would reduce about 8% of the cost of care for a senior in a year. That’s just what I’d call scraping the edges of what is possible within the industry. When you talk about the magnitude of the dollars and the opportunity, people are going to look at this business very differently. I think we, as an industry, who’ve been traditionally in this, we’ll become these dinosaurs if we choose not to adapt to that.

We’ve got to continue to look at product-line expansions within the industry. I would predict that the people that are in this business five to seven years from now, the biggest product may not be the Medicare-certified home care product. It could be chronic care management products. It could be the way you’re supporting telehealth in the home. I think these businesses that have just stuck with the core products out there, they’ll have an increasingly difficult time surviving.

Meanwhile, managed care is going to want to contract with fewer players – and they’re going to be looking for the higher-value players. In the not-too-distant future, the Medicare Advantage plans out there will probably have in excess of 50% of the addressable Medicare population out there. You’ll have a huge chunk of the other populations in direct contract, ACOs, other things like value-based arrangements. They’re going to be looking for those other services. The core home care services are going to continue to shrink, so we have got to adapt.

[00:28:48] Holly: CVS, Walgreens, United, Humana, Amazon. There are all of these major players looking to disrupt care in the home. Is now the time to really plant the flag in the ground and say, “This is my turf?”

[00:29:15] Rodgers: I think our advantage is our experience. As an industry and a business, we’ve been doing this. All of us wake up every day thinking about it. We touch over 200,000 patients every year. We’ve got these armies of clinicians that are out there. We understand the difficulty in operating in these environments. I do believe that we as a business, AccentCare, have to be thinking about it. I know many of our other national competitors are very much thinking about it. I know Amedisys, for example, made the acquisition of Contessa Health, very much thinking about how they have to expand services.

You always get into the position of the current-day economics versus the future. It’s those trade-offs that you have to make. I think all of us have to start making those bets on the future, while we continue to create the cash flows and the operations underneath the existing business. I think over time, it’s about our reach – how many homes are we in? How many products are we pulling through those over time?

[00:30:23] Holly: I think my last question for you is: What has you most excited about 2022 for AccentCare? Maybe give us a sneak peek of what’s to come.

[00:30:40] Rodgers: We went through a lot last year. The business came out very strong. I’m really hoping that the pandemic starts to wane a little bit for us, so we can have a sustained time period of focusing on the core blocking and tackling issues of the business. What I’m most excited about is essentially then pivoting to that. We’ve got a very focused set of plans to really fulfill that purpose of reimagining care, building out the continuum in a number of marketplaces.

We’ve got a number of de novo opportunities within hospice, home health and personal care services. We’re doing a very significant expansion of our private-pay personal care platform that we think is a linchpin at actually creating the continuity of care for our patients across the board. We’re continuing to build the technology platforms that create a better patient and a better referral source experience.