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For other home-based care providers, the Minnesota-based Lifespark can offer lessons in taking on risk to get to the “apex-predator level,” as its CEO Joel Theisen would say. At the same time, the company is also looking outward to learn from others as it gets ready for a nationwide expansion.
That’s why the provider – which offers home health, home care, hospice, primary care, senior living and other services – brought on a handful of advisers recently.
One of which is Paul Mastrapa, who formerly helmed Help at Home, Option Care and Walgreens Boots Alliance’s (Nasdaq: WBA) infusion services division.
Mastrapa and Theisen spent time laying out what they believed to be the best way forward for home-based care providers to Home Health Care News just the other week.
As a follow up, HHCN spoke with those two again to dig deeper on an episode of HHCN+ TALKS. The recording and highlights of the conversation with Theisen and Mastrapa are below.
Read on to learn more about:
– How Lifespark is planning to take on nearly $500 million in upside and downside risk, and how other providers can get there
– What Mastrapa has learned from all of his stops, where he is now in his career and how he wants to make an impact next
– How Lifespark plans to expand outside of Minnesota and take its holistic and risk-based approach to the rest of the country
Andrew Donlan: Hello everyone and welcome to another edition of HHCN+ Talks. We are welcoming two people on this panel today and we’re very excited about this one. We have Joel Theisen, the CEO of Lifespark and Paul Mastrapa, who is a home-based care veteran now joining Lifespark as an adviser. I wrote something up on these two last week and I’m really excited to follow up with you guys today. First of all, welcome. Joel, would you mind just first giving a background of yourself in case some of the audience doesn’t know?
Joel Theisen: My name is Joel Theisen and I’m actually a nurse by training. I’ve been in senior services for about 30 years now. I cut my teeth in home health back in the early ’90s when I built a venture-backed startup, actually with Paul. Then, in 2004, I started Lifespark. I’ve been doing that for the last 18 years and building something that I really look forward to talking about with you today.
Donlan: Before we move on to Paul, could you give a brief overview of Lifespark?
Theisen: Lifespark is really kind of unique. We have what we call a complete senior health model and there are three main components to that. We have a single point of contact for the seniors that we serve in global risk, which is what we call a life manager. Then we have geriatric medicine where we have geriatric MDs and nurse practitioners that serve these populations, as well as transition managers. We also have a really deep commitment to data and analytics to really enable that proactive, predictive, prescriptive model.
Historically, and as the company has evolved over the last 18 years to get there, we have a large-scale home health care company with about a $30 million home care company. We have a $10 million hospice company, a $10 million private-duty company, a large property management portfolio where we manage 37 assisted living and three skilled nursing facilities. We have a transportation company and a lot of other assets that make up our ecosystem, but the goal for it really is around that global risk, Lifespark COMPLETE model.
Donlan: Paul, would you mind giving us a background on all of your experiences as well, all the way up to obviously joining Lifespark?
Paul Mastrapa: I come from a health care family and decided to go into the business. My father was a physician. At a certain point in my business career, you realize you need to specialize in something, you’ve got to build a brand. To me, that raises the question about, “Well, what are you passionate about?” Health care came back around full circle for me in the early ‘90s. I knew that’s where I wanted to be. I’m passionate about helping people, I love the mission and what we do within health care.
I knew that I wanted to be in services, and early on I said, “Where am I going to play in this crazy marketplace?” I knew the home was going to be the future, both with technology and with consumer preference, etcetera. I started to launch my first health care experience at a very small company called Option Care, which was based out of the Chicago area. It was an early pioneer in home infusion therapy in a very fragmented market and was growing extremely quickly. Option Care has been a very strong thread throughout my career. I spent 18 years at Option Care. When I joined, it was a $40 million business. When I left back in 2018, it was a $2 billion business. We really saw an industry grow, mature, consolidate and then really expand in a lot of new areas.
I’ve spent over 30 years in alternate-site health care services. I’ve touched on a lot of home infusion, home health, hospice, private duty, DME. I was the CEO of Option Care when we spun it out of Walgreens and then left that into 2017.
In 2018 I joined Help at Home as the CEO. Help at Home is the largest Medicaid homecare provider in the country and I was excited about two things: the inherent growth in home care services for the Medicaid population, but more importantly, the ability and opportunity to provide value-based services to some of the hardest to reach, highest-risk people in the health care system. We have 50,000 clients across the 11 states that we serve.
I ran that from 2018 to 2021 and then transitioned into doing board and advisory work. I’m working with three different companies and exploring a couple of additional ones, all within the health care realm. One of which is Lifespark. I’m thrilled to be partnering with Joel and the mission. It speaks not just to my passion and my heart, but also shared history.
Donlan: Before we get into the shared history, when you’re looking at these companies that you want to work with at this stage of your career, Paul, what exactly are you looking for? I assume there are some red flags that keep you away from certain companies, and there are other ones where there’s a reason why you’re interested in joining the board or joining as an adviser. Can you break down what your thought process is?
Mastrapa: From an ownership structure, I’ve been in senior roles in public entities. I’ve been in the divisions of large private companies. Now I’ve done a fair amount of private equity and I’ve really, really enjoyed the private equity experience. There’s nothing like bringing a lot of smart people to the table with a focus on investment and capital to really create an exciting opportunity. I’ve tended to focus now on working with private equity-backed businesses.
What I’m looking for is, one: where my background and experiences can help and can be some value-add. A board member could mean a lot of different things. I’m not interested in just showing up to a quarterly meeting and pontificating on various things. I want to be involved. Typically, with a smaller company you have that opportunity to really help in a variety of ways.
I’m looking for a way that I can add value. I’m frankly looking for areas where I can learn some things as well. One of the boards I’m on is an infusion business, but it’s in a little bit of a different niche that is helping me expand some of my perspectives. Lifespark is one of those that’s helping me to expand on some of things that are not quite in the exact sweet spot of my experience — but I’m bringing a lot to the table from that experience with investors and a management team that I like.
It’s about fun and making a difference in helping these businesses. I’ve been lucky to be involved in a startup all the way through to working closely with a Fortune 40. I love the creation experience of working with companies because there’s just nothing like it.
Donlan: I imagine joining Lifespark at this time is particularly exciting just because – we’ll talk about the model and why you do love the model – but also because of the expansion opportunities that are there. Before we move into that, again, last time I talked to both of you, I was a little bit surprised to know that you had worked together before. Do you guys want to quickly explain that? Because I think it’s a cool story that you’ve ended up again together later on down the road.
Theisen: Paul and I had a really good relationship because we both are hard chargers. We both saw the future and we’re always positive about things. Paul and I built a good relationship there.
As time went on, I decided that I was going to leave and go off and build something different, something new because I wasn’t happy with the way that home care was providing services to these folks. When I did, I called Paul and I said, “Hey, Paul, you got some ideas?” Paul’s background was in finance and he obviously has connected to a lot of different vehicles in the past that I hadn’t done. When Paul and I started to talk about the ideas of how to do geriatric services or senior care services differently, Paul’s like, “Hey, man, I like that idea, let’s get together.”
Paul and I spent a bunch of months together writing a business plan and finishing it off and eventually raised $8.5 million to do our first deal. I moved on the scene and out to California where Paul was living. Him and I started a company called AdvoLife in 1996. That’s how we got together. We’ve been compadres in the market, we were together for about three years and then Paul went on to Option Care.
I stayed at AdvoLife for a little longer and scaled it a little bit more. Paul stayed on the board and then we broke apart for probably 15 years or so.
Donlan: What services were you providing there, Paul?
Mastrapa: At the time, what we saw in home health was all of these point solutions, but [providers] not really solving the problem. When you’re an operator in these businesses, you really see the same clients cycle over and over again. They go into the health care system, they have an acute event, go into the health care system, and then off they go. They get the services to help them get back on their feet, but it’s not really solving the problem.
The impetus for the idea came from the Medicare Home Health change from cost reimbursement to, ultimately, the perspective pay system back in the late ’90s. The old system was geared toward providing a lot of custodial care. That was going to move much more to a skill-based model as a new Medicare reimbursement system came into play. A lot of seniors that were getting home care under a Medicare umbrella were going to need services. They were going to either have to pay privately or go into a skilled setting.
We said, “Let’s put together something that really solves the problem.” We introduced the geriatric care manager. That’s what we call the Life Advocate. That’s where the name comes from. Your advocate for living at home was a little bit of the branding and then personal care was a base, but it was supporting medical interventions, transportation, meal delivery, home medical modification, socialization.
We really wanted to take a whole-person approach to help seniors remain independent in their own homes. It also comes from the focus that the home is the best place for seniors to be, but all private pay.
There was no funding mechanism for this. We knew how to connect to the population when they had the crisis. The whole idea was to keep them at home. At the time we introduced an early stage of video conferencing to try for both clinical intervention and social intervention. It was very cutting edge, I think.
Theisen: We were also watching PACE. A lot of people know PACE today. It was emerging then. There was some capitation in the late ’90s. These things go in big cycles, these payment reforms. Capitation tried to happen a bit. There was disease management that was getting some energy.
Paul and I were playing on those themes of, “Hey, this could go capitation. This could get more PACE-like.” We really wanted a lifelong relationship and really that holistic relationship and that was really the precursor to it.
If you remember, we went through a period of time when long-term care insurance was going to solve a lot of the problems for seniors. That was going to be a big boom, and viaticals. We were watching lots of trends then and some of them cycle back through as you get older in life. It’s funny to see them come back.
We were trying to really harvest the value that we were creating in that longitudinal holistic approach. Ultimately, the investors wanted us to roll up the private duty industry and it was just something I didn’t really want to do. It was just more of the same stuff.
Mastrapa: When I was looking at Help at Home and really deciding if that’s where I wanted to be in my next career option, the term “social determinants of health” came in and I’m like, “What the hell is that?” Then it really brought back some of my other life experiences.
Well, it’s all that other stuff other than your physical health that makes you sick. It’s like, “Well, duh.” We knew that 20 years ago. You know that when you’re in the home and you’re actually seeing people and their families and what they’re dealing with day in and day out.
I think the marketplace has grown up substantially since that time. Now there’s an appreciation for the value it creates and there’s funding support to do some new, innovative things. But all that experience was really a precursor to a lot of things that I’ve done in my career, and clearly what Joel has built here at Lifespark.
Donlan: I covered a survey on social determinants of health yesterday, and I refer to it as a buzz term that had recently come about, but there are companies that recognized this a long time ago, including yours. That’s why I thought this was such a good impetus for the conversation because you all were together back then, you’re together now, and you still have the same mission, the same perspective. Things have evolved, no doubt, but you’re still coming at it from the same place to a certain extent.
In the article I wrote about the two of you last week, I mentioned PACE as another option for home-based care providers who are looking to get more into risk-based models. I do want to get into that because I think it’s interesting, especially with the home health proposed rule and the negative cuts there and all that as a backdrop, Joel, four years ago, you decided to take on global risk. Can you give background to the audience on why you decided to do that and how you did that?
Theisen: The why is, I think, self-evident. I’ve had a whole career of being commoditized, if you will, and being on a fee-for-service mentality. It’s never allowed us to really deliver what was necessary to these folks because it’s all based on volume and not on value.
When the Affordable Care Act was introduced, and then out of that spun Medicare Advantage, and out of that spun CMMI, which then spawned out a bunch of demonstration projects and opportunities, that allowed me to start to really think about, “Boy, this is the shot. Value-based is coming, and it’s really going to stick this time.”
I went all in on the health plan — having our own medical doctors and nurse practitioners. I bet on all that before we even had a contract in hand, but four years ago was the first time when we actually secured that contract.
We secured a full upside downside global risk contract. That really allowed us to deliver on this model and not be penny wise and pound foolish, but really smart longitudinally for these folks.
I think it’s the only model in my mind. I think everybody should be at-risk because I think everybody should be accountable to the health of these individuals that we serve. Not to their own bottom lines, not to their own business case or their piece or their fragment of the experience, but really global risks.
That was the why, and again, we were able to get into a contract with a health plan and a health system in a three-way relationship where we were able to take about $60 million of upside-downside risk. From a home and community standpoint, I don’t think anybody’s done that in the country.
This is where we burned the boats or we said, “Look, we’re all in on this, and either we’re going to make a great company, or we’re going put a nail in our head,” because all the history that you heard of Paul and I when we do these things, this isn’t about money for me. I like money, don’t get me wrong, but it’s about doing the right thing for those that have trusted us all these years.
You can’t claim ignorance. When you know the right thing to do is to serve these people in a thoughtful, holistic way and deliver on not only medical but on their psychosocial, that’s really it.
It’s not rocket science, but that’s what global risk and value-based care allows people to do. I didn’t want to see the same continual back 20, 30 years ago. Home health is great, but it doesn’t have the opportunity to harvest the value it creates. It doesn’t have the ability to really create this true delivery system that seniors need and want.
Donlan: From a financial and clinical standpoint, how have things gone since then?
Theisen: They’ve gone great. We’ve tripled, quadrupled down. We just kept betting the farm. We bet the farm every three weeks at Lifespark, so we keep going into this deeper and deeper.
We moved from that original contract where it was a Medicare Advantage contract – upside, downside – where now we have I-SNP contracts, we have a dual-eligible contract. We have an ACO strategy going into 2023. We have an MSSP ACO.
We want to be agnostic to payers. We want to serve people in risk products across all lives. It doesn’t matter if they’re rich, poor, they’re rural, they’re local, they’re metro. That’s what Lifespark’s been doing is building out the ecosystem and the infrastructure in a very scalable way with heavy tech and analytics capabilities to be able to deliver this product all over the country.
We went from about 6,000 clients that we had under global risk to about 30,000 to 35,000 seniors in a global risk contract. Not just one contract, not just I-SNPs. These are in MA, they’re in ACO Reach, they’re in ACO MSSP and we’re super excited about it. I couldn’t be more happy with what the team’s done and what the market’s done to appreciate the home and community-based platform we’ve built.
Donlan: Paul, what is your background with risk-based contracting? I know you’re very in on it as Joel is, but can you explain where you’re coming at this from the experiences that you’ve had at your previous stops?
Mastrapa: Over a decade ago, mainly in my Option Care days, the movement was starting to shift more towards value-based care. Risk-based contracting is a structural way to build a value-based relationship.
What I saw within the infusion therapy industry as I really grew up and scaled that business nationally is that you move from a small part of ancillary medical spend to then moving more into a strategic part of the health system relationship.
Within that framework, we were treating some of the most expensive people in health care with a lot of specialty medications. There was an opportunity to leverage our point of care in that business within a value-based relationship.
For example, IVIg is used for a lot of autoimmune-related conditions. It’s a very, very expensive therapy that’s used quite a bit off-label and with a limited amount of monitoring by physicians around the efficacy of the drug. Well, we’re administering this drug on a routine basis, every four or six weeks, depending on the dosage, the therapy or the disease state.
Our nurses could actually monitor response to therapy which either could mean an increase in dosage, a reduction in dosage or moving to a different therapy for efficacy reasons.
That’s a value-based opportunity. If you’re actually intervened with a health plan, you start looking at, “Okay, how do we get paid for an intervention? We have to invest in technology,” et cetera.
There’s lots of examples of drug-based therapy that we actually entered into to change that dynamic.
Site-of-care is a big issue with infusion therapy. Typically, a lot of these specialty drugs are administered in a hospital outpatient setting, a physician’s office or at home. We would actually partner with a health plan, pull their data, help them understand where their spend is and then put together initiatives — both push and pull strategies — in order to drive utilization into the lowest and most effective cost site-of-care.
Within that, you’d structure a value-based relationship. We did rehospitalization guarantees and all sorts of other things. You’re constantly dancing around the edges because there’s still that fee-for-service environment that’s around you. It helps to deepen your relationships when you understand the broader perspective of the health plan and view them as a partner as opposed to, “How do I just keep doing more of X, Y, and Z to make more money?”
Until you actually grab the whole risk, it’s really difficult, because it’s tail wagging the dog to some extent. Some of my most frustrating incidents or experiences were when we would work with very large health plans and show a nearly nine-figure, well into eight-figure savings opportunity on some of these very expensive drugs, and their first go-to would be, “Well, if I’m going to give you all this volume, what kind of a rate cut are you going to give me?”
When you’re in that mindset, it’s hard to break through.
Donlan: A lot of home-based care entities are intrigued by the idea of value-based care. They want to get into it and maybe they even have a little bit, but it’s just a one-off partnership. Why is that not good enough, Paul? Why do you need to really deepen your relationships and also take more of the full risk in order to really be involved with this space?
Mastrapa: You can’t do it part-time. What people don’t understand is that you can’t just flip a switch and become a value-based care provider.
It often changes your whole approach of how you go to market, how you train your people, your operating model, your technology investment, your processes. It really affects everything, so if you’re trying to throw a very modestly impactful value-based relationship with the payer, but your heart and soul is not into it, they’re going to see through that and it’s not going to go anywhere.
You get some credit for even just having the dialogue, but if you’re really not committed to it, it’s going to be hard to be successful. That is the difference to me. It’s not a contract, it’s a philosophy in a way of operating and a culture in your organization that you really have to own.
Theisen: You have to go back to the client experience. We can talk about our businesses and about how we make money — and that all matters — but if you don’t really look at the root cause analysis of why these problems are caused, then you’re able to service them over time and get to that proactive, predictive, prescriptive capabilities.
This hyper-fragmentation is happening in the market now because everybody wants to try to take a shot at a point solution and get paid for it. That creates huge inefficiencies. It creates a huge cost, which we’re seeing in 20% GDP in health care, but most importantly, we’ve taken humanity out of health.
The client experience is horrible when you have all these different people coming in and out of your life over time. Home health is in the right place to build from. Community is where it needs to be. It could be community-assisted living, it could be community home care.
[There’s] a great opportunity for all the clinicians in the world that want to do this work. All the people that hopefully see the value with your mom or dad. You want them to have a consistent, trusted relationship with people that are helping them through their journey, through their whole life, especially in the end of life.
I think that’s the missing link. We’ve trapped up the health system in all these bits and parts and everybody is taking a swing at it and trying to monetize it.
As Paul said, until you make that real commitment of “Look, we’re all in” kind of thing, we’re going to really be at risk for hospitalizations, TCU stays, drug costs. That’s when you really start to back up and say, “Whoa, what are we doing here?”
I think the health system does a horrible job at looking at the big picture and seeing the forest through the trees.
Donlan: Joel, you obviously have capabilities that allow you to go all in on this. What makes you different? Why are you able to take on all this risk? I assume that’s a lot to do with all the capabilities you have, all the service lines you have. Did you have that in mind when you were creating Lifespark that you eventually wanted to have those capabilities, so you could go all in on risk, or is that something that you built up over time as you approached that four year mark where you did go global risk?
Theisen: Lifespark’s always been focused on building a lifelong, longitudinal, holistic approach through some sort of payment reform. It wasn’t like we were doing home services in a lot of different parts and pieces that, “Hey, Eureka, we can go into global risks now.”
We’ve been architecting this company from when I started. It has been a journey to get to this place where we are right now, where the opportunity is massive. Obviously, it’s happened, and I couldn’t be more happy for it.
It’s been intentional from the very beginning because it’s really hard. It’s sophisticated work to tie all this together in a meaningful way. Quite frankly, there’s still a lot of adoption curve. A lot of people are violently opposing these types of things, these types of opportunities, because the old guard is hanging on to fee-for-service. Why would people want to change when they’re making a ton of money?
It goes back to that client again. I think there’s a lot of pressure. There’s the money machine. There’s lots of stuff in the legislature at the policy level right now that people are pressing. “Do these value-based things work? Is it going too fast? Should we slow down? Should we go back to fee-for-service? Should we go back to ACO architecture?”
There’s lots of noise, but what’s not noisy for me is that when you look at the eyes of the clients that we serve, and you see when you get to serve them across the continuum with thoughtful, proactive, predictive services, it’s amazing.
That’s why I do what I do. That’s the opportunity that’s there. I know that a lot of folks can’t just jump there. Like Paul said, it’s not easy, but there are a lot of opportunities to now start to partner around these opportunities.
Donlan: Joel because you’ve taken all these risks, it opens up opportunities moving forward. For instance, becoming a DCE with the federal government and also ACO Reach. Can you explain how that came about and what you’re doing there?
Theisen: We always look at it like agnostic to payer, but the payer matters. Whoever holds the risk, whoever has the highest apex predator level of risk, is really the payers. The government’s just a payer.
Obviously, the government sells those contracts for MA to a health plan and then the health plan disseminates a provider network. It’s the same kind of thing. At the government level, you’re cutting out the plan and going directly to the government.
That was the intent that CMI put out originally, the DCE opportunity. Now it’s changed the language, just to try and have more diversity, inclusion, and equity into the program. Which is great.
Those came about because the government wanted to give independent physician groups opportunities to take risk at different levels instead of just having the little health systems take it.
We were a part of that originally. We were one of the first ones that won the bid, but we deferred it. Now, going into next year, we’re actually using a convener so we’re not our own ACO, but we are doing ACO REACH through a convener.
There’s a lot of conveners out there now and we’re doing that because it’s best suited to our business case right now. We are in that model and we’re also in an ACO MSSP model.
Those are great models and they’re great models to explore that will continue to evolve. I think they’ll continue to change as time goes on with new administrations and new learnings on how to make them better.
I love the fact that they’re happening and that they’re being put to market for people to ideate on and to deliver on and to make better because I think that’s where you can see the opportunity for providers to serve people in an entirely new and different way.
Donlan: Paul, you’re joining this company when there’s expansion considerations and you have a lot of experience with companies that expanded. What do you see right now in Lifespark? How do you expand it without losing any of the magic that was created over the last 18 years?
Mastrapa: Joel and I have stayed close over the years and have talked a lot about both of our experiences to date. We both have different experiences. Mine have been a lot of inorganic growth as well as a lot of organic growth in a variety of different settings.
I’ve lived through a lot of experiences and know what it takes to scale businesses and experienced a lot of those pitfalls. Lightspark is at a fascinating inflection point. They’ve built the components of a true value-based care entity, a full risk-bearing entity. Actually taking those and now expanding them, not only within its core market but actually in new markets, there’s a lot of things to learn in that experience. From the structural investments that you need to make, the cultural items, things that Joel knows very well.
I think what you learn over time in running businesses is you can never have too many thought partners.
The fact that Joel was putting together this advisory board with great people was fascinating because I just love hearing different perspectives. For me, it is too important of a time right now to take what Joel has spent his whole life building, the impact that this can have, that it’s already having in Minnesota, that it can have in multiple markets, to not want to do this, right?
You want this to be as good and as successful as possible.
The cultural component of this is incredible. It’s the fourth part of the quadruple aim. It’s the employee part of this experience. It’s not me delivering this care or Joel directly delivering this care. There are a lot of people under him that are coming together to actually deliver on this vision.
The technology investments are tremendous if you’re going to be taking risks. You need to know where you’re going and you need to have roadmaps.
Those are going to continue to grow, evolve, expand and require more investment. Thankfully, or disappointingly, the opportunity is so big that you can actually generate those things.
Joel has 17 years of experience in Minnesota. Now, Lifespark is going to be a little bit of a new entity when you go into a new market. New markets are going to be very important as well.
Taking a business from one market to multiple markets — and to a substantially much higher level of risk — is going to be really fun. A fun ride for me, but one that’s going to require a lot of work.
Donlan: Joel, what’s next for Lifespark? Can you break it down as simply as you can? What is next? What are you going to do? I’m sure you don’t have all the answers, but what do you envision the future looking like?
Theisen: We’re actually working really hard on two sets of scale. We’re actually working to build a rural capability. A lot of people stay in metro. Rural is not easy. The rural aspect of Lifespark is really important to us because we want to serve all seniors everywhere. I can’t speak to it yet right now, but we do have an LOI for a new market outside of Minnesota.
We’re not going to just go and plant a bunch of flags. A lot of companies get really excited and they scale all over the place. They spread their assets all over the place, and then they’re like, “Holy crap, that was messy.” We’re being a little more intentional.
We absolutely have to get out of Minnesota, but we also have a lot inside of Minnesota so we’re going to open up Minnesota to be in the whole state and focus on rural areas.
Then we’re also going to get into one or two new markets here in the next 12 to 24 months and not go crazy, but really learn.
I think it’s a continuation of learning and global risk. There is a lot of risk in global risk, so I think it’s making sure we really got it down. We’ve got some great efficacy. We’re working with a great payer partner in Minnesota who’s given us a lot of information and data.
It’s really about building a movement. That’s what Lifespark’s about. We’re about building a movement and partnering.
When we go into a new market, we’re not going to start another home care company or another hospice company or another housing company. We’re going to bring population health assets or global risk assets, but we’re going to look for partners. We’re going to partner, partner, partner, and be that gooey layer that brings these really cool assets together to be able to deliver on global risk contracting.
That’s what’s next for Lifespark: build those partnerships and figure out how to do that, not with our own assets but with everybody else’s.
That’s a big opportunity. It’s how the company will become “the” company in senior services, not a company in senior services. That’s what I’m excited about.