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As home-based care providers take on patients with increasingly complex needs, LifeCare Home Health and Hospice Family is weighing how to grow while maintaining consistent care across its local agencies.
That challenge helped drive CEO Dean Alverson’s decision to bring on Dr. Nasser Khan as president and chief operating officer. Khan joined LifeCare to help lead day-to-day operations as the company pursues acquisitions, invests in technology and expands its clinical capabilities.
LifeCare Home Health & Hospice provides Medicare-certified home health, hospice and private duty services through a family of local brands across Texas, Florida, Georgia, Nevada and Arizona.
But growth comes with trade-offs. Alverson said LifeCare may decline to enter certain markets or work with payers unwilling to reimburse for the level of care it provides. Meanwhile, both leaders are cautiously optimistic about the industry’s regulatory outlook, even as the enrollment moratorium restricts opportunities to open new locations.
On the latest episode of HHCN+ TALKS, Alverson and Khan discussed their approach to growth, rising patient acuity and what referral partners expect. They also shared how LifeCare is using AI to support intake, documentation and auditing — and why they see its value in supporting employees rather than simply reducing labor costs.
A replay of that TALKS episode for HHCN+ members is below, along with a transcript of the conversation. The transcript is lightly edited for style and clarity.
Dr. Khan, what drew you to LifeCare, and how your background has shaped the way that you’re going to be approaching your role?
Khan: It’s a problem that I’ve contemplated from the very beginning of my journey in healthcare, which is to say, when a patient leaves the acute care setting, what happens? Frequently we see, through dislocations or coordination that occur once the patient leaves the hospital, all this work that’s done to stabilize them is then quickly undone, and how frequently the patient ends up bouncing back. That’s not good for patients, that’s not good for families, that’s not good for society. And so, I’ve always thought it would be interesting to be on the ground floor and to see how to connect the dots.
When I looked at LifeCare specifically, a couple of things stood out for me. First and foremost our model: we’ve got very strong local agencies with real community roots, real brands in the community, that are backed by a larger parent entity that’s able to invest in systems, infrastructure, and people. I really do think healthcare is local, and despite the amount of consolidation we’ve seen across the industry over the past few decades, those with scale that do particularly well acknowledge in their DNA the local connections and relationships that are critical to being successful. I think that’s something that LifeCare has done really, really well.
Secondly, in any part of healthcare, but particularly in something like this complex post-acute setting, we rely on deep industry knowledge, expertise, and relationships, and so the opportunity to work with someone like Dean, who’s been in this industry a long time and has seen its evolutions, I think is an incredible opportunity to be able to tap into that expertise.
When I look at what we’re doing here at the end of the day, I draw upon a lot of what I’ve seen that’s worked elsewhere, whereas places like DaVita, or Acadia Healthcare, that operated across that care continuum, I think a lot about some of the things that you have to put in place to really scale, even hyper-scale, but also at the same time, not lose that DNA that I think is our special sauce at LifeCare. Ultimately, that’s the challenge that attracted me here.
Dean, do you want to weigh in about what made this the right time to bring Dr. Khan onboard and, what you’re hoping he’ll bring to LifeCare?
Alverson: We’ve been growing, and this was by design. We knew that at a certain scale it was not realistic or tenable for me to be able to continue to be the sole operator and the chief executive officer with an aggressive acquisition strategy, and all the regulatory changes that are taking place, such as the PPEO and hospice, for example.
We’re a clinically-driven company, and we wanted to demonstrate to the industry that we wanted to continue to be that, because quality of care is the most important thing to all of us. By bringing in a physician and someone who is an outstanding operator like Dr. Khan, it really sets us apart. The strain on the day-to-day operation and trying to stay at the highest level or standard of care is very difficult. Our peers would probably tell you that the compression of earnings and the opportunities that we’ve had over the years don’t exist today, and so everything we do has to be successful. If we don’t, we operate at a deficit.
I think there’s a tide moving as well. I worked in the hospital as a clinician, and I remember patients in ICU that we now serve in the home. These are patients that are on ventilators, they are very, very sick, and the acuity of the patient has gotten so much higher for what we do. So we must use technology, we must do better training, we must get better quality clinicians, we must have a higher level of clinical leadership, thus Dr. Khan is a logical choice. He came from Acadia, a $2 billion health system, to help us engineer some of that same quality that we’ve been very fortunate to have. But as we scale and get to that larger platform, it will be more difficult to manage.
Also, I think um it frees up time. Dr. Khan has already taken so much off my plate, he has freed up so much time for me to really focus on strategic relationships, to start developing partnerships. Right now I’m very involved in growth. As a matter of fact, I was in three or four hospitals last week alone, and out with a couple of representatives, and I love that. I just haven’t had the opportunity to do so in quite some time because I didn’t have the support that Dr. Khan has brought in. As you guys know, he’s only been here for about 90 days, but you’d think he’d been here for five years. The guy knows the business so well, and he is such a blessing for us to have.
Dr. Khan, you’re getting to know the organization, what are you listening to from your clinical teams and operational leaders? And what’s on your priority list?
Khan: I think a couple of things. First and foremost, you always have to look in services and healthcare services where good people are working around the system instead of with the system, and really understand the workflows and what gets in the way of our caregivers and providers doing what they’re there to do, which is to take care of patients. I like to look at what can we do in order to make our clinicians feel comfortable and safe in what they’re doing and, particularly, in dealing with, as Dean alluded to, the higher level of complexity that we’re seeing in the outpatient setting.
And then, lastly, what do our referral partners have to say? And I would say that in sort of the broadest sense, not just of course, actual people in hospitals and outpatient setting physician practices, but also families, caregivers, and people that surround our patients in the broader ecosystem. Sometimes, you can get a little bit too close to the product if you will, and it’s important to step back and take the lens and perspectives of others so that you understand where there are opportunities to improve upon.
I think as that translates into where I am most focused and what my priorities are, obviously, first and foremost, in a services business, it begins and ends with your people—making sure that you retain people, that you’re monitoring for burnout, conscious of how to manage their workload so that you have that staffing flexibility to be able to address the needs of a of a rapidly-growing business, and making sure that we can get patients started in a timely fashion.
So, intake and access: when you get a call from a referral source, particularly perhaps as it relates to hospice and end-of-life care, there is an issue from the referral source side, of course, in a timely movement of patients across the care continuum, but also for patients and their families as well.
Consistency. So we talked about healthcare being local, and the value that I think all of our different, local entities and brands have that we don’t want to lose, at the same time, it’s important with scale that you bring some clinical consistency into place, and so structure, standards, training, again, that enables us to serve the increasingly clinically complex patients that we see.
Last, I would say is integration that occurs at the level of the different sites and geographies. And M&A has been a big part of the growth, as Dean alluded to, but also integration across service lines. We have the benefit of serving patients not only through our hospice service line, but also home health and private duty, and ultimately being able to manage patients across that care continuum and seamlessly between even our own service lines is what really makes us a more powerful, scaled asset.
Let’s go ahead and talk about growth. Dean, can you outline your growth goals, your to-do list? You talked about in-home primary care, could you expand on that a little bit?
Alverson: So there’s some natural synergies between service lines, home health, and hospice. We don’t look at our palliative care program as a pre-hospice program. Oftentimes, it’s used as a tool to just generate additional referrals for hospice. But we really focus on patients who have a life-threatening disease. It will take their life at some point, but they’re not really ready for end-of-life care. And so, we focus on the care of those patients for a longer period of time. Some of those patients could be in home health, they may go into hospice at some point, but we’re really focusing on more—and it’s probably symptomatic of what’s happening, as all of these patients and these payers are looking for solutions to healthcare. They have got to figure out, what’s a cost effective, but good outcome for everybody. And palliative care is really one of the unsung heroes in that battle, because of the care and the direction of care. It is a conduit to the acute care hospitals, as we’re seeing currently more and more interest from acute care and saying, “Hey, we’d like to partner with you on that type of care.”
But also, from a growth standpoint, how can we, as the patient population moves out of acute care or facility-based care, how can we raise our game a little bit? I remember a patient in ICU stage four decubitus. Back then, you would never ever send [that type of case] home. Today, we see these patients routinely. They’re on antibiotic therapy, they’re on wound therapy, they’ve got all of these complexities, they have comorbidities that are affecting the wound healing, all of the things that go along with that. So, we’re trying to look at it from, ‘what all would we have to provide in order for that patient to have all of their needs met and avoid a rehospitalization?’ Because we all would agree, the hospital is not the best place to receive care any longer. It’s too expensive, it’s cumbersome to navigate, and patients prefer to be at home. So I think that’s part of it, and how we start thinking about in-home primary care, because we want to manage those patients where they can stay in the home and not have to go back. Clinics are still filling the gap for today, but I think you’ll see more and more in-home primary in the future.
And do you have specific goals for growth, however you quantify that, if you’re able to share those with us?
Alverson: I think we want to continue to grow and serve as many people as we can. We have a basic philosophy here and we have a very defined culture and value system. We believe that we can monetize great care. And by giving great care first, the benefits will come to us. And so, the focus is always on the clinical outcome of the patient. We do not focus on whether we are going to get paid or not get paid, those questions don’t come up.
We take a disproportionate share of indigent patients, as well, because, I will say CHRISTUS had a huge impact. Being over at CHRISTUS, which is a faith-based not-for-profit system, and how they address patients, really had an impact on how I want to address patients. The higher acuity patients are much more expensive to manage, and we’re going to have to manage that. So we may have to throttle certain services, but at the same time, scale matters. And as we get larger and make more investments, we’re able to do more things for our patients. We just started down some paths on our hospice program to provide additional services that we weren’t able to afford at sub-scale. That is going to be a game changer for patients at end-of-life. We want to not have that patient just go in and have someone hold their hand until they die. We want to enrich and enhance their lives and make the best of what time they have left.
And when you say you may have to pull back on some services, any specifics there that you’re considering?
Alverson: I think it’s, and maybe not services is the best word, but maybe geographies. Because one of the things that we understand very clearly is that not all payers are willing to pay for the services at the level that we provide. And that’s okay. If you don’t want to pay for that service, we may not be the best partner for you because better care costs more money. That’s just the bottom line. And where people ever got the notion that it was going to be cheaper to provide better care and have better outcomes, they were delusional, because that’s just not going to happen.
We’re not willing to compromise our care standards, and that puts us in a unique situation where we may have to say no to a geography, or no because of the MA penetration, or to an MA account, or even to a health system that’s not willing to be a partner with us. We have incredibly successful partnerships with health systems currently in high-acuity populations, and patients who don’t have the resources. But collectively, we’re able to get them resources and have a better outcome and lower rehospitalization rates in this higher-acuity population than our competitors in the same market. One example is, we’re at five or six percent rehospitalization. The market average is 15%. So, that says a lot about having that high level of quality, but we have to really trim it up and be very cautious about how we spend our money, so that we can maintain the same level of financial health for the business.
Dr. Khan, you talked about keeping clinical consistency top of mind as LifeCare pursues growth. Could you say more about what you’re keeping in mind as the organization is growing?
Khan: I think, building off what Dean was speaking to in terms of the growth strategy, of course, at the end of the day, our goal is to serve as many people as we can who have needs. But I think as we’re growing and maturing, one of the things you’re seeing is a migration from expanding what are point solutions to trying to think more comprehensively and holistically about how you can manage the post-acute care journey, if you will.
So there are discrete service lines where we offer hospice and home health and palliative care, and so forth, but really, at the end of the day, we’re talking about patients with chronic diseases that are traveling through a healthcare system, and we see ourselves down at the local level really being a node in that journey. And so when you build that sort of deep presence and trust and you’re interconnected with the patients and the providers, you’re able to understand what their unmet needs are, and to able to think and personalize what services you’re capable of offering, and then that’s how you start to pull into various adjacencies, be it in in-home primary care.
As Dean alluded to before, I think in order to do that successfully, you’ve got to keep a couple of things in mind. So, first and foremost, you are drawing upon a workforce that has to scale with you, and so you need systems in place in order to be able to recruit, retain, and provide continuous education and training to clinical staff. And a big part of that is ensuring that you’re maintaining and expanding competencies on people, particularly if you want to serve more complex patients with multiple different medical conditions.
I think there’s a logistics component. It is operations, right? And so, your ability to provide 24/7 care- sometimes patients in this world need care on holidays and weekends and in the middle of the night- means you need to be able to do that, and you’re doing that in their home, so that takes an incredible amount of coordination.
I think you need to have clear protocols and policies in place that help you with escalation, right? At the end of the day, you might have one caregiver in the home, they’ve got to be able to identify situations, involve risk stratification and triaging, and knowing when, “Hey, it’s time to escalate. I need to get a physician involved in care.” And the more that you’re able to do that and carefully do that, then you’re going to ultimately, you know, win the battle, which is to keep people cared for in their home and not in the acute care setting, and that’s how you’re going to create more satisfaction, that’s how you’re going to create more economic value.
I think the last piece I just mentioned, and I alluded to this earlier, underpinning all of this is making sure that you’re taking really good care of your workforce, you’re building a place that people want to come to and work for. You’re managing their caseloads, the acuity that they’re handling, and you are very much treating them as the customer as well. And so, I think that as a company as we scale, the better that we’re able to do that and deliver that value proposition to our employees, the stronger we will be in achieving our growth goals.
Dean, you also mentioned some regulatory changes that can impact growth. Could you illustrate what is impacting your growth goals and strategy?
Alverson: The obvious one, I think right now, is the moratorium. That’s limiting our ability to access communities that are underserved, that we know we need to provide services. Everybody deserves the level of care that we provide and if we’re not able to move into those geographies, then they’re going to be left to what’s there currently. And I think some competition’s a good thing for increasing and improving the quality of care.
The second aspect of it is payer-related. Acuity continues to rise, the cost of taking care of patients too. That level of compression, as Dr. Khan mentioned just a second ago, we really focus on taking care of our associates, and our clinical staff especially. We’ve made strategic investments in technology using AI for intake, and passive listening for documentation, none of which has returned an investment to the company. What it has done is enriched the lives of the caregivers, we’ve given them time back. We’ve eliminated home documentation and things like that. Those are values that we’re going to still exhibit in terms of our actions moving forward, because we care about our employees and we honestly believe that if those employees are happy and they’re cared for, they’ll care for our patients even better. So, that’s really important to us.
Some of the other limitations are pretty obvious. There are CONs in certain states. The whole landscape is going to change now due to the election, and so some states are going to tighten up, some are going to relax a little bit. But we’re getting more and more local regulatory influence, so that’s a good thing, because the moratorium is kind of a double-edged sword, right? Because it addresses some of the fraud issues and slows the process down so that we can kind of catch some of the bad actors out there, but at the same time, as I mentioned earlier, it limits the access to care and our ability to expand and serve more patients.
We’re coming at a time where the moratorium’s six-month mark should be lifting in the next few weeks, but no word yet from CMS. So, we are talking at a pretty pivotal time for the industry, would you say?
Alverson: Oh, I absolutely believe that’s the case. I was encouraged by some of the dialogue earlier this year from MedPAC, and some of the Alliance, and others’ interactions, and I’ve had some direct interaction with some of the congressional members. Thank goodness most of those guys are still here that can kind of carry forward some of the agenda to improve the quality of care. And they understand that if they can get back some of the dollars from all the fraud, then they could actually give us some benefit to be able to care for these patients at a higher level.
So, I’m encouraged. I typically am optimistic regardless, I always [see] the glass half full. But I would say cautiously optimistic, because, you know, we’ve seen some pretty heavy recommendations of cuts, especially in home health in the past, and there were some conversations earlier this year about whether they should cut hospice. And I think some level of reality is kind of setting in now, and saying, “Hey, you know what? These guys really are spending an incredible amount of resources to care for these patients. The good guys are doing some good things and have good outcomes. Maybe we shouldn’t punish these guys.” And so again, cautiously optimistic.
Dr. Khan, are you feeling cautiously optimistic?
Khan: I am. I mean, look, at the end of the day, you can’t argue with demographics, and the shifting, and the aging of the population. You can’t argue with migration that’s been underway for a decade or more from delivering care in expensive inpatient facilities towards outpatient, ultimately into the home of patients. And I think that on both sides of the aisle, that politicians, policymakers, regulators, understand that. I think that as there’s a little bit of this weeding out of bad actors as Dean was alluding to, and a recognition that the people that have been here all along doing good work need support that betters us all as a society.
With the moratorium, if that’s lifted, will that radically change your growth strategy?
Khan: Of course, I think the advantage of operating and having a deep footprint in a given geography is that you understand at a deep level where your patients are, where your caregivers are, what the needs of your referral sources are. And so you’re able to position accordingly, and at the end of the day, there is a great need for access, and so being able to grow through de novos allows you to pull that lever.
That being said, a moratorium implies that things are frozen, and that’s not the case. Of course, you know, there’s M&A, but being able to more deeply serve the existing referral base that you have, I think is an important lever. I think also, really doing that work to build out your infrastructure, to build out the quality and the consistency of the product and service, so to speak, so that when the moratorium is lifted, you’re really able to take off.
Dean alluded to this, but just the way in the last couple of months, some cases the last couple of days and weeks, that we’ve been able to really advance what we can do with technology. From, you mentioned, ambient AI to support documentation for our caregivers and to give them leverage through, most recently, our ability to deploy a home-brewed agentic AI system to be able to look at really multifocal data points across the enterprise, and to understand where we’re meeting our goals and where we’re not, and to be really hyper-focused on ensuring that we’re bringing the best of LifeCare to the patient’s bedside.
Alverson: I think I would really just be echoing what Dr. Khan said. I think that we have an obligation to ensure the safety of our all of our patients, and anything that might jeopardize that, we have to get involved in that discussion. I believe strongly that we are growing really well organically. It’s been a tough year, I think, for some smaller companies, and there are fewer than there were when we started this year, and some of which we’ve been able to pick up some of their patient loads and help out a little bit. I think that probably is not going to go away anytime soon. I think the economic pressures with cuts and the compression on earnings for some of these smaller companies related to the cost of provision of provision of care is going to continue to rise. We don’t know, with the changes that are taking place, what the economy is going to do at this point, but we have to be thinking about innovation every single day today. And if you’re not doing it, you’re already behind.
And I think, as Dr. Khan said, we’re already making very strategic investments. We will be making more, and it’s been very helpful and beneficial. It hasn’t demonstrated the cost savings that we need, but it has improved some of the performance levels that we need to see as well. So it kind of does have some value, but it is not producing value, where you hear some of the sales guys — and this is where I get a little out there — they oversell sometimes. It’s going to save us hundreds of thousands of dollars, and so forth, I don’t know that that’s going to be the case. I think that the level of care that we have to raise our standards to is going to cost, and it might offset some of those dollars, but I don’t think it’s going to save a lot.
How is LifeCare approaching this tidal wave of AI and technology tools?
Khan: There’s a lot every day; you turn the page to a new day, and there’s a new solution out there, and so it’s the paradox of abundant choice, so to speak, which I think you’re alluding to. So I think we have to we have a framework for how to approach it, and first and foremost, it’s thinking about what the patient needs and what our providers need, and then sort of seeing if there’s technology that can help solve it, versus technology looking for a problem to solve.
And as far as sort of a high-level framework for how to think about it, I like to think about using technology in particular and the standardization that comes with that to focus on things that affect safety, that affect compliance, and back-office operations, while making sure that care itself is hyper-personal, if you will, and it’s oriented on making sure that those relationships are preserved and are kept strong, and that’s a little bit of the difference.
So, things like flowing through intake from a portal, or things like dealing with scheduling, things like documentation, charting, auditing, those are excellent candidates for technology, but some of the brass tacks, human aspects of the conversations, as Dean was alluding to, that occur between someone on a sales team and a referral source, or certainly the interactions between the caregivers, family members, and patients, those are fundamentally human, and although there’s a litany of technology solutions for that, that’s not necessarily where our strategic focus has been thus far.
What are you seeing in terms of ROI, and do you expect that to change in the future?
Khan: Yeah, it’s really interesting. Things are changing so fast I’m certainly learning, and I think we all are. I think the ongoing assumption with a lot of the software solutions, AI-driven or not, is that they would be able to deliver a high level of automation that would create certain human-driven manual tasks as potentially redundant, right? And so the fear that the software is going to eliminate jobs as a mechanism to cost savings.
In our experience, we haven’t seen that as much as Dean referenced. I would say that it’s augmenting people’s jobs, and that still ultimately creates value. So, like we referenced the ambient AI solution, and its impact is that it allows the provider to do what they’re there to do, which is to fully engage with the patient. It takes what is the least satisfying aspect of the job, which is the documentation, and it shifts the focus to the caregiving.
And so that’s going to manifest into a more robust encounter. It’s going to manifest into things like satisfaction scores, which, by the way, are tied, like in the case of home health and VBP, to alternative payment models. It’s going to manifest positive feedback, through families, or to referral sources, that’s going to lead to growth via more referrals. So, it’s creating economic value, it’s not just returning an investment in terms of actual labor reduction, or cost savings, in that regard.
And then if you travel that down, and you think of some of the other back-office functions, like for example, helping with auditing and chart review. Well, from a business continuity standpoint, the ability to mitigate an adverse survey outcomes, or other related tail risks, is massively valuable for an enterprise. It’s just a different way of doing that ROI calculation.
Dean, what would you like to add about the technology strategy at LifeCare?
Alverson: I totally support what Dr. Khan said. In addition to that, we are seeing maybe a little bit of a competitive advantage in some respects. So, the ability to say yes, and to really be able to know that the patient coming your way is someone you can take care of. Because the worst thing you can do is say yes, and then turn around and say, “I can’t take this patient,” right? And so, our intake augmentation with AI has been very helpful, because we can say yes in a matter of minutes now, when it used to take us 30 or 40 minutes, especially on complicated patients.
The bar is going to continue to get raised. We have to be the easy button. Discharge planners in the hospital want to get rid of the patient as quickly as they can, so they can get to the next patient. And so, if they’re having to fool around and call three or four different providers, that is not helping them. So, they’re looking for one solution, someone who says yes, and when they say yes, they know they’re going to take the patient. So, AI’s been really helpful in that respect. It hasn’t necessarily increased the volume for us, the way I thought it would, and should. But, I think we’ll get there, because it’s building confidence with the health system that they finally say, “You know what? We’ve seen enough evidence now to say this is a provider that we need.”
I think the interoperability or bidirectional information is really critical. That’s the next step, where payers and health systems are going to say, “Well, listen, we just sent you 20 patients. We need to identify that.” Now we’re using AI to help us identify the benefit and create reports, and do some other things that allow us to communicate more effectively with our health partners and our payer partners, to be able to say, “Here’s the evidence that you’re looking for, that demonstrates the quality of care and the financial benefit,” because we can quantify a lot of that. So, those are areas that I think will emerge. To Dr. Khan’s point, over time we’ll see an ROI that’s much easier to quantify.
But we have improved, just in the last couple of months, our key indicators in such a way that the level of granularity that we have through AI allows us to really pick apart very specific cases and look at them retrospectively. The auditing process alone enables us to look at an audit and look for trends, so that we can have some actionable result pretty quickly. Those things are really critical.
Now, it hasn’t reduced the number of people, because there’s a learning curve, and there’s a confidence curve as well, knowing that the AI is actually going to, if you set it up properly, do what you ask it to do. We just had a comparison with two different systems, and one picked up something and the other didn’t. And it was something very critical that Medicare picks up 100% of the time. So, if you’re using the other technology, you have risk. And if you use the newer technology or the different technology, then you won’t have as much risk, because it is something that we know a 100% of the time Medicare picks up, if they’re doing audits. So, being very informed is critical, if you’re going to invest in technology, to make sure it’s a good fit for you, because one size does not fit all.
What are you seeing, what are the trends in terms of patient acuity, and how is LifeCare addressing that trend?
Alverson: I think we’re seeing much higher-acuity patients, and those patients have to be dealt with differently than what we’ve done in the past, because we’re being measured every single day. The gate fees are, how quickly you say yes, what is your rehospitalization rates? I mean, the usual things that I think we’re all seeing, especially on the home health side. And that if you can’t prove that your performance is better in that population, you’re not, first of all, going to get that population.
Now, there could be some benefit to taking that higher-acuity population in terms of reimbursement, but if you don’t have economic guardrails on it, you can spend a lot of money, and you can end up with a visit per episode going crazy. So it’s not one lever or two, it’s multiple levers on every single patient. So, as we start to look at that, it’s getting and networking with your payer partners and your health partners to make sure that the data that they have available is coming your way, as well, because if we miss a couple of comorbidities, it’s going to change the financial performance of that patient. So, that’s been very helpful to us.
We want to deepen our clinical expertise. I just had a conversation with a neurologist, and I was shocked at what I learned about how the evolution of brain injuries is evolving really quickly, and those types of patients who are going to need specialized care. And over time, that care is going to change dramatically because the disease state itself is going to change dramatically.
They’re now able to see and predict things that we, first of all, couldn’t even identify. If you think back about the NFL, and the head injuries when it first started, is that nobody could figure out what was going on, until a doctor, I think from Nairobi, said, “Hey, you know, that’s not a natural function to have your head beat up against something everyday. Something’s got to be tied to this.” And then, they started looking into it.
We’re getting that information today, and we know that patients who have multiple head injuries are 50% more likely to have early-stage Alzheimer’s or dementia. And so, as we take those patients, especially in the palliative care or chronic care states, and move them forward, it’s going to be more difficult to manage them, it’s going to be more complicated, it’s going to be more expensive, and it’s going to take longer, because as medicine gets better, patients live longer, and the cost actually goes up. So, again, we’ve got to align the economics with the quality of care that we’re designing and not assume that there’s some magic bullet out there, because it just isn’t.
And then, a more unified operational model. If we don’t have good standards, the deviation, the outliers, are going to kill you. But if we can get that operating model in place, and that’s both actual operations and clinical pathways and care pathways, and it’s economic. It’s kind of like pay for what you get. There are these train stations of care, right, where patients are going through, and they’re stopping at these stations, but you’ve got to align the economics of that at each of those train stops, in order to be able to manage the care of the patient.
Ultimately, you can start to look out into the future and say, “There is a way to reduce that care, but it’s going to be at station three, not at station six.” And we’re evolving with that. AI is actually helping with that, by identifying where the gaps are, and if this had occurred three years ago, the cost today would’ve been less, in terms of taking care of the patient, the outcome would’ve been better. So, I think it’s a lot more of that to come, and I’m really excited about that, because that is one of the things I think in healthcare that’s becoming exponentially better, and more transparent to us in terms of caring for patients.
What do you see as necessary to meet this trend of rising acuity?
Khan: To frame it, I mean it’s been remarkable to me to see the migration of complexity from inpatient to outpatient, and as I look at what our nurses managed today, that not that long ago would have been managed in a hospital or a skilled nursing facility, you see patients that will typically have multiple chronic conditions in play, from heart failure and COPD to diabetes or end-stage renal disease, complex medication regimens, typically 10 or more drugs that are changing whether in the inpatient stay or upon discharge that are only getting more complex with interactions that need to be considered and managed.
We see patients that are on IV therapies, they’ve got complex wounds. Then the other piece, speaking of CTE and brain injury, is just the cognitive issues and then behavioral health issues, and handling that has been a particular additional accelerant of the complexity we see in the home. And what does that mean for us, and for the operating model, and for the caregivers? It puts an incredible premium on clinical judgment.
And if you think about care delivered in the home, at any one time, there could be one licensed person in the home that’s there observing the patient. So, your ability to spot deterioration of the clinical course of that patient early, and then to know when it is appropriate and how to escalate it, is going to be the difference-maker. And that takes training, that takes backup and redundancies, that takes protocols, and a clear line between the in-home caregiver and, and potentially the physician as well.
A lot of the things that we’ve been thinking about and investing in are there to do just that, to sort of keep up with this rising tide of complexity that we see inside the home. And it’s also, wearing that innovation hat that Dean referenced, it starts to help you to have a vision or a point of view on, what are the additional, whether it’s formal services or maybe it’s just as simple as competencies and capabilities, “Do I need to have to be able to deploy in order to be successful here?”
Maybe the last piece I would just highlight is again the role of technology. It is allowing us increasingly to be able to more effectively orsuccessfully risk-stratify patients, so from the very beginning and looking at the information we have at intake and adding our assessment and our systems are able to give a risk score or indication that’s going to help us think through how we schedule and deploy caregivers to the home with the ultimate goal of reducing readmissions. It’s almost this idea of mass personalization or mass customization. How do you take care of people at scale in their home in a remote-like setting and be able to personalize and customize it in such a way that’s tailored to their level of acuity allows you to maximize the efficiency of the deployment of your caregiver resource and then achieve the ultimate outcome of interest, which is to keep people out of the hospital and cared for successfully in the home.
What do referral partners want right now, and what are you doing to meet those desires?
Khan: Speed is going to be table stakes here. I think it comes down to three things. One, a clear, reliable and quick yes or no. Can I take this patient, and when? It’s one thing to say something; it’s another thing to follow through. So once we accept the patient, how fast can we start care and deploy resources? Not only our own caregivers but also pharmacy and DME and supplies that have to come into the home as well. There’s a coordination effort that goes on the provider’s side.
Ultimately, and this is a piece that we’re really hyper-focused on, is closing the loop. Somebody has entrusted you with grabbing the baton and taking care of their patient, and so it’s important for us to be able to stay in tight communication, whether it’s the referral source or the physician, to keep abreast of whether care has started, if there are any changes in status, and so forth. At the end of the day those basics of really good service are critical in order to be effective.
Alverson: Dr. Khan covered most of it. It is quick to yes, and the yes means yes. It is better communications. And then the proof of results. They’re looking for their patient populations, and they’re looking for very specific outcomes that were designed, not by chance. They don’t want you just reporting: ‘This is what happened to the patient.’ They set a standard and then they want you to deliver information that suggests that that standard is being met.
I think we’re going to see more of that than we ever have before because that was a common theme and it is something that we already have a great deal of with our current health system partners and payer partners.
A little tip: don’t just use their information. Make sure you go back and look at yours, because the way they pull data may put you in a bucket with people that you shouldn’t be in. In one instance, we realized that we were in a higher-acuity population and they were comparing that higher-acuity population with the general population and saying, ‘Well, your numbers are worse.’ Let’s go take a look at that because, if you isolate it, and they said, ‘Oh, we’re sorry, our bad.’
But that’s shame on us too, right? For not being able to separate those patient populations because they’re very, very different, and the expectations very different.
Looking at Lifecare’s broader strategy, where do you see the strongest opportunities in the next chapter of home-based care? And what are you going to do differently to pursue them?
Alverson: The strongest opportunity is clinical retention. It’s been a challenge for the industry for some time now, but it’s also a great opportunity.
There’s an initiative to fund nurses’ entire tuition. I just heard that, and I thought that was a fantastic effort on the government’s part. Anything that I do with the government is always qualified with optimistic encouragement. I think it’s a good start because it is about numbers, but it also is about quality. What I’ve seen and heard recently is that the quality is not there. The industry is growing at 7%, 8%, and so the opportunity to serve more patients is there.
I think the use of technology is going to be critical for us to better serve patients in the future, and to actually make it easier on not just the clinicians but everybody in the organization.
I don’t think it’s going to alleviate a lot of FTEs anytime soon, but I do think it’ll make the quality of life better and I think global retention will be better from that.
And, diversification. I mentioned in-home primary care as a possibility for us. We may want to do some more of that. We’re partnered now with some in-home primary care groups and it’s worked very well. We may want to do it ourselves. I know there are some other companies out there that are already in that business and that space and continuing to grow it. I think there are lots of opportunities, but the most important thing is consistent quality across the continuum.
It’s kind of like going to McDonald’s. You know when you go to McDonald’s you’re going to get a hamburger; it’s going to taste the same no matter what McDonald’s. Every location has to have a standard, and that standard has to be met so that everybody gets the same high-level quality of care.
And I assume that’s important as you’re considering acquisitions?
Alverson: It’s very challenging because it’s culture first. Quality of care, we can engineer some of that, but the culture we don’t own. We set the standard, but we don’t own it, the employees actually own the culture. They can decide whether they’re going to do it or not do it. But if we don’t take the time to invest in making sure it’s a good fit, we can actually do damage to our business.
Khan: There is an incredible opportunity here to improve care for our patients and, broadly speaking, improve the quality of care in our healthcare system to do so in a way that creates greater satisfaction, that delivers higher outcomes. And that can cost less.
It’s not an opportunity problem that exists in abundance. The opportunity really goes back to the basics and I think Dean hit it well. At the end of the day, we’re not in the drug or device manufacturing business. Our intellectual property is our people. The greatest opportunity is to be able to attract and retain excellent, like-minded clinicians that are really committed to the mission and vision of what we’re here to do. And [for them] to make this a place that they want to stay, a place where they tell their peers to come to and to work. That’s going to allow us to deliver consistency. I like the McDonald’s analogy. When you walk in, you know how the hamburger’s going to taste. You know what you’re going to expect. It is the experience that you yourself, as a patient — and all of us some day are likely to have some complex care needs — would very proudly refer a family member or close friend to. If we’re able to execute that [then] the opportunity is unlimited.
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