At a time when many home care providers are shutting the door on Medicare Advantage (MA), Avid Health at Home has managed to go the other way.
Avid Health at Home is a home care platform backed by Havencrest Capital. The company believes that demonstrating its value through data could be what puts it in the right positions with MA plans.
In the meantime, the company has also been bullish about forming partnerships with hospital systems, ACOs and other home-based care providers.
Avid Health at Home has also been active on the M&A front, completing multiple acquisitions last year.
Home Health Care News recently caught up with Avid Health at Home CEO Jennifer Lentz at the Capital + Strategy conference. During the conversation, she touched on the importance of payer diversification, reaching seniors who fall in the middle of home care affordability, MA and more.
Can you talk a little bit about the payment structure at Avid Health at Home?
We’re doing Medicaid, VA, government contract waiver programs, and private pay. And we’re probably close to about 50-50. Medicaid government and then private pay.
Given that Avid Health at Home is 50-50, can you talk about how important is payer diversification at your company?
It’s a priority. We spent a lot of time with our operators, looking at, ‘You’re about 85% Medicaid and 15% contract. Let’s talk about how we’re going to grow private-pay in your market. Let’s talk about where you can see some traction and different referral sources.’ Then we do the opposite in our heavy private-pay offices.
I think the demographics within each physical location can probably shape the payer mix, but VA is everywhere. We have a lot of opportunities with supplemental staffing, home health, hospice, assisted living facilities. We work really hard to make sure that we keep diversity. It’s a priority for us not to put all our eggs in one basket.
What are the biggest challenges in home-based care right now? How is your company navigating those?
I’ll answer this with a little bit more of a forward-thinking approach.
My struggle right now is that you are either wealthy enough to pay for care on your own or you’re on some sort of government payer.
How do we support the people who call us and don’t fall into either of those buckets? You get tons of that outreach — people looking for mom, dad, grandma, grandpa. We’re not seeing that type of access through Medicare Advantage, and as a non-certified provider, Medicare fee-for-service is, obviously, not part of the benefit.
How do we enable ourselves to support these people who can’t really afford our private-pay rates? We’re looking to really identify how we can show value in the Medicare savings. We’re leveraging our dual eligibles with our Medicaid cost, and we’re looking at our private-pay. We’re focusing, truly, on how we help avoid hospitalizations, how we help avoid falls, and more, so we can demonstrate to the Medicare partners — this is the value we add. I know we can be considered expensive because we’re not an episodic event or long-term care service and support, but how do we help you understand that we can benefit the health care continuum?
Can you speak about what the response has been to Avid Health at Home demonstrating that value?
It’s been a little eye opening from both sides of the table. Medicare Advantage plans are getting it now.
That said, I haven’t seen a tremendous amount of traction with getting those contracts fully executed, and getting into that space yet. I also don’t necessarily think our market share is high enough yet because we’re still pretty young, but it’s definitely being built into our core DNA to make sure that we can scale in those different avenues.
Aside from Medicare Advantage, is the company going after things like hospital partnerships or working with other providers?
I think the ACOs are another great opportunity to kind of show value, or demonstrate your ability to really care for somebody with a holistic approach. Communication and data points are critical, but we’re definitely seeing hospital systems talk to us. We do a lot with home health and hospice that are trying to take on risk for the bundled payment.
Our approach is helping people understand our value in a partnership. We’re getting more traction there, I just think Medicare Advantage is such a bear. It’s so big. We find local hospital system contracts much more attainable. I think leveraging that success and experience is going to help us get into the big market.
Are there other areas of home-based care that Avid Health at Home is making a strong effort to move into this year?
Yes, nursing and infusion. We operate in North Carolina, and they have the private duty nursing program, which is pretty robust. With our level of licensure in that state, we’re able to do LPN, RN, staffing, med management, and we can do infusion services. We have a little bit more of a clinical component to that. In Illinois, we’re doing more nursing services there as well.
When you’re looking at long-term needs, home health does a fantastic job of doing the post-acute, but we are the pre-acute. People have nursing needs, med needs and all kinds of things before and after they go into the hospital. We’re trying to round out our service delivery model to be inclusive of that.
In what ways is your company embracing technology to improve your business, either internally or for your customers?
Right now, our focus is making everything connect. From the moment we were created, it’s been all about how our systems integrate and how they talk. Every single thing is a data point, and everything has to be extracted, and everything has to be coded and created into something that is digestible. That’s been our first big tackle into tech — how do you make all your systems communicate, and then how do we extract whatever we need? Our CTO was fantastic at this.
Our caregivers all have apps, and they all chat and they have communication back to the office, which is great. I think the next wave is how do we incorporate the patient? How do we get their family members more involved? We have a patient portal, I don’t see high levels of engagement. I think it’s a lot for them, so how do we make it digestible for them? How do we talk to a daughter who lives in Michigan about what’s going on with mom at home in North Carolina? Those types of things are probably our next wave of how we would incorporate tech.
What are your company’s growth plans for the future?
We have two de novos, one in each state, launching this year, which I’m very excited about. There’s nothing like building something from the ground up. We have a pretty decent M&A pipeline that we’re really honing in on both within Illinois and North Carolina. We’re also, hopefully, expanding into a third state shortly.
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