“COVID taught us how much can be done from home,” Engskov told Home Health Care News. “I think it’s going to be done through technology, better clinical know-how and deep investment in talent and training. I think there’s a big opportunity to reposition the whole role of the carer in home health.”

Since 2019, Engskov has been president of Aegis Living. Bellevue, Washington-based Aegis operates a portfolio of 33 assisted living and memory care communities across Washington, California and Nevada.

Engskov earlier worked as executive vice president of business integration for Starbucks (Nasdaq: SBUX) and was assistant press secretary and personal aide to U.S. President Bill Clinton from 1993 to 2000.

Engskov now is moving on to become CEO of a startup, currently in stealth mode, focused on creating the next generation of home health, he told HHCN. He is scheduled to start his new position later this fall.

The startup is funded by ARCH Venture Partners, a venture capital firm that backs “disruptive science.” Co-founder and Managing Director Robert Nelsen has played a role in supporting and financing more than 30 companies that have reached valuations in excess of $1 billion, according to ARCH’s website.

Talent development and other workforce initiatives were a key priority for Engskov during his time with Aegis. Other Starbucks alumni joined the company after he became president, and bigger-picture, he believes that the senior living industry as a whole can do a better job of reaching millennials and other young workers.

Companies in the sector need to  “reposition” themselves with regard to recruitment strategies and labor-related operational approaches, he told HHCN in early 2020.

In leading a home health care startup, Engskov likely will be drawing on a skillset that he honed at Starbucks, which he said was a “small, entrepreneurial company” when he first joined. Engskov also has compared Aegis to Starbucks in the coffee company’s earlier days, saying that the senior living provider is a value-oriented business set to drive innovation in a sector poised for massive growth.

Engskov’s affiliation with ARCH began in March 2021, when he joined the board of a special purpose acquisition company (SPAC) sponsored by ARCH and General Catalyst. The SPAC — which priced a $500 million initial public offering and is called Revolution Healthcare Acquisition Corp. — is focused on making an acquisition in the digital health space.

And in August 2021, Engskov joined the board of Recuro Health, a Dallas-based personalized digital health provider. ARCH led a $15 million Series A round for Recuro.

Aegis CEO Dwayne Clark will be taking on the president title and taking a more active day-to-day role in the company, which provided the following statement to HHCN:

“Aegis Living is an employee-first company that takes exceptional pride in its culture and being a family-owned and operated business. Emerging from the pandemic more centered than ever on these core company values, Aegis Living Founder Dwayne Clark decided to step back into a day-to-day leadership role. Acting as Chairman, CEO and President, Dwayne is energized to nurture culture and operations as he once did when he founded Aegis nearly 25 years ago.”

The post Former Starbucks Exec, White House Official Engskov to Lead Home Health Care Startup appeared first on Home Health Care News.

A year in, that model has positioned Honor for further partnerships with large-scale organizations, and Eskaton has seen a revenue boost expanded into new markets. But the partnership did not get off to an auspicious start.

Sacramento, California-based Eskaton completed its transition to the Honor platform in Dec. 2018, and it didn’t take long for issues to emerge.

“By mid-January 2019, it became apparent we needed to address some of the issues we were experiencing,” Tom Bollum, executive director of Eskaton’s Live Well at Home business, told Senior Housing News. “We felt the issues were critical to our success.”

The story of how Honor responded sheds light on the latest iteration of the San Francisco-based company’s business model and approach to operations, which have gone through shifts since the startup first made a splash in the industry by raising $20 million in venture capital in 2015. Through subsequent rounds, funding has now exceeded $115 million.

The backstory behind Live Well and the evolution of the partnership with Honor also highlights the challenges and benefits for senior living providers as they add a home care component to their offerings.

Major pain points

About three years ago, Live Well at Home was serving a three-country area in and around Eskaton’s market stronghold of Sacramento. Trying to maintain a staff of 120 caregivers, Live Well was facing serious challenges.

“We were losing caregivers faster than we could hire them,” Bollum said.

With labor markets tight and caregivers in short supply, the dilemma will sound familiar to many senior living and care companies.

Live Well at Home tried several initiatives to address the problem, including starting a caregiver academy, a caregiver recognition program, and paying above market rates. Despite these efforts, the organization was still not seeing improvements.

The Live Well at Home situation was creating a drag on Eskaton as a whole. The majority of the nonprofit’s services were being provided in the Sacramento area, where Eskaton operates about 15 independent living, assisted living or continuum of care communities, as well as several affordable housing properties. The strategic vision in 2017 was to build up Eskaton’s presence in other California markets, but Live Well was not in a position to support that growth.

Meanwhile, Honor was already on Eskaton’s radar. In addition to its large chest of venture capital, Honor had attracted attention due to the pedigree of its founder, Seth Sternberg. His previous venture, Meebo, went on to be acquired by Google for a reported $100 million.

“We had Seth over to our corporate board several times to speak about strategy and his vision of home care,” Eskaton Chief Strategy Officer Sheri Peifer told SHN.

At its founding, Honor’s model was to leverage a sophisticated tech platform to connect clients and caregivers more efficiently than a traditional home care company, and to use tech to also enhance the in-home care experience. It focused on private-pay, non-medical services such as assistance with activities of daily living.

That initial plan positioned Honor as a competitor to existing home care agencies, but the company has repositioned in the last few years. Shifts in employment law, challenges in client acquisition and other impediments sank some similar home care startups, but Honor responded by focusing more on building partnerships with existing home care providers.

The idea is that many home care agencies are struggling with recruitment, retention and scheduling. These are strengths of Honor, thanks to its scale, financial resources and technology. The tech facilitates more efficient workforce management in part because it captures a tremendous amount of data, which has led to scheduling practices that are effective but may seem counterintuitive.

So, Honor started to take over workforce management and other back-office responsibilities from some agencies. The idea is that this frees up the agency to focus on the provision of high-quality care, and the two organizations share in revenues. The exact parameters of these partnerships gave rise to some concern with the home care industry, but the Honor Care Network gained traction to the point where Honor was present in more than 600 cities and towns across California, Texas and New Mexico as of late 2018. Arizona, Ohio and Michigan have since been added.

After studying this model and going through several rounds of meetings with Honor, Eskaton’s leaders decided in the third quarter of 2018 to move ahead with a partnership. Bollum had high hopes that Honor would be able to solve “our major pain points” related to hiring, training and growing the pipeline of caregivers.

A learning curve

The initial transition of the Live Well workforce to the Honor platform went smoothly, with about 99% of caregivers making the transition. Although it took some explaining, the caregivers came to understand the advantages that Honor presented, including easier scheduling via the Honor app and the availability of more hours, Bollum said.

Honor has a “pretty formal” transition process that caregivers go through as they transition, involving onboarding, training and evaluation, Honor President Nita Sommers told SHN.

Meanwhile, Eskaton did eliminate some back-office positions that were redundant with what Honor was nor providing, leading to cost savings.

This initial transition was completed almost exactly one year ago. Then, the hard work began, as those critical issues swiftly popped up. These issues included:

— Having a more robust recruiting pipeline to have a bench of caregivers ready to staff new cases

— Better consistency of care from the beginning of a new client relationship

— Customer service issues related to care team availability when clients called with a need

Eskaton presented a particular need because the Live Well book of business included supplemental staffing for roughly 30 communities — operated by Eskaton as well as other providers — in the Sacramento area. This meant that workers had to be available at short-notice to pick up shifts.

Within 24 hours of these issues being brought to Honor’s attention, Sternberg and the management team were on their way to Sacramento. This responsiveness reassured Eskaton, as did the improvement plans that Honor presented.

Significantly, Honor committed to expediting a planned shift to a new management model. Previously, the company took a functional approach. This meant that certain staff members were responsible for overseeing particular functional areas across a wide variety of markets. In Sacramento, Honor accelerated a shift to a geographical-based model, meaning that there was now a dedicated team that would focus exclusively on this market.

“What that allows them to do is really customize, for example, recruiting approaches to unique aspects of the Sacramento market,” Sommers said. “It allows us to customize unique things we see on the wage and labor side, and it also allows us to really think about the individual partners we have in the market … how do their teams like to interact, and be able to work and interact with them in very tailored ways.”

Geographically focused teams are more knowledgeable about details that can make a big difference, such as how to pronounce the names of local facilities, Bollum pointed out. And then there are more significant market characteristics that make a major difference in being able to recruit and schedule staff effectively. In the Bay Area, for instance, caregivers may not want to drive across the bridge to work, even though a client would only be about two miles away, whereas in Sacramento it’s more commonplace to drive longer distances.

The shift to a geographically-based model included technological changes related to workflow, Sommers noted.

Within several weeks of that meeting between Honor and Eskaton leadership, Honor had started to make shifts on the ground to accelerate the new geographic model. Within about 30 days, improvements were seen.

“It makes me laugh because any strategic change or important initiative — at least in my experience in senior living — takes much longer than that,” Peifer said, adding that the speed of Honor’s response speaks to the company’s entrepreneurial spirit.

Now, a year in, the numbers paint a picture of success for the partnership. Live Well at Home’s top-line revenue is up 40%, whereas it had declined between 2017 and 2018, Bollum said. Eskaton is budgeting for 30% growth again for the next year.

Prior to the partnership, about 10% of available hours were not being staffed, but now the fulfillment rate is 99%.

Net promoter scores for both clients and care pros are also high, in the range of 60 to 70 out of 100, Sommers said. That is in line with some of the top-scoring companies nationally, such as JetBlue at 71 and Ritz-Carlton at 68, according to data from Satmetrix.

Also in the last year, Eskaton has expanded by taking on management of communities in new California markets: Stockton, in the Central Valley east of San Francisco; and Burlingame, an area just south of San Francisco International Airport.

The Honor partnership supported these expansions. Particularly in the case of Burlingame, this was a market that Honor already operated in, and so was able to bring valuable information and expertise to the table, including knowledge of pricing and effective recruitment methods.

And, for Honor’s part, the experience with Eskaton helped build out capabilities that will make it easier to partner with larger, more sophisticated organizations going forward, Sommers said.

Other senior living organizations may be encouraged to partner with Honor based on the strong numbers that Eskaton is producing, particularly because the challenges that Live Well was experiencing prior to the partnership are commonplace.

“Senior living providers have ventured into the non-medical home care arena and found that it’s challenging, and finding that the workforce element is too difficult to achieve excellence on our own,” Peifer observed.

Still, some providers may be reluctant to give up any measure of control over their home care business, believing that they can create a differentiated product versus partnering with a group like Honor that may be working with several local senior living or home care competitors as well. In addition, they could be reluctant to give up any share of home care revenue.

Ultimately, each organization needs to weigh the pros and cons and honestly assess their own strengths and weaknesses, Peifer advised.

“We’re willing to get messy, we’re willing to think differently, and we have to evaluate and hitch ourselves to each other’s wagons,” she said. “My message would be evaluate what part of the market you want to be in, evaluate what you do extraordinarily well and what you don’t, and identify the right partner.”

The post Inside Honor’s New Management Model appeared first on Home Health Care News.

At the time, the major investment was billed as a way for Best Buy to augment its existing efforts in the health care space, while doubling down on its initiatives focused on the country’s aging population, including its “Assured Living” program.

That major investment is now starting to pay off for Best Buy.

“In health, we acquired a leading connected health services provider for aging consumers GreatCall and took a tangible step forward in our strategy to have seniors live longer in their homes with the help of technology,” Best Buy CEO Hubert Joly said Wednesday, recapping Q4 and full-year 2018 earnings on a call with investors and analysts. “Since we acquired the company in October, the integration has been seamless and the value creation opportunities we envision have begun to materialize.”

The Q4 earnings for Minneapolis-based Best Buy exceeded the expectations of Wall Street analysts, thanks to strong sales, particularly over the holidays.

The company has reported at least 3% sales growth every quarter for almost two years, CNN Business noted in a report published Wednesday.

GreatCall contributed to Best Buy’s financial success. For its domestic U.S. stores, revenue was down, largely due to location closures — but these declines were partially offset by 3% comparable sales gains and revenue from GreatCall, Joly noted.

Going forward, Best Buy intends to drive growth in its health business by expanding GreatCall’s devices and services.

“As children of aging parents, many of us would appreciate the potential power of our health monitoring service that enables seniors to live longer in their homes, while reducing related health care costs,” Joly said. “We’re currently in pilots with a number of managed care organizations. And over time, we believe this could become a material growth opportunity for us.”

In October, GreatCall announced it had signed a five-year deal with a Massachusetts health insurer to provide in-home, passive monitoring devices to its high-risk members.

In January, the company followed that announcement by revealing it had struck another partnership deal with insurer CNA, one of the largest U.S. commercial property and casualty insurance companies.

“We are constantly looking for ways to enrich lives through technology and help address the aging population who wish to age in place,” Bryan Fuhr, vice president of connected health for GreatCall, said following the announcement. “While the number of older adults continues to escalate, the growth of professional caregivers remains stagnant, putting a strain on these caregivers and the aging population as a whole.”

The GreatCall deal fits into Best Buy’s larger strategy.

The company wants to not only sell technology products but be a provider of consumer services and supports, including in a “consultative” role, Joly said Wednesday.

Such an approach could have an impact in the home-based care space if it means that a company with the size and scale of Best Buy is providing support for monitoring technology on the GreatCall platform.

The post Best Buy Reaps Benefits from $800 Million GreatCall Acquisition appeared first on Home Health Care News.

This was a key finding of “The State of Senior Living: An Industry Grappling with Autonomy,” a new report from architecture firm Perkins Eastman. The survey gathered responses from about 200 senior living industry professionals, mostly C-suite leaders with nonprofit providers. These providers offer a variety of different types of housing and services, such as standalone independent living and assisted living buildings, as well as continuing care retirement communities (CCRCs).

Perkins Eastman has been conducting the survey on a biennial basis since 2015, but this was the first year that it included questions related to industry disruption. Specifically, Perkins Eastman identified four disruptive forces and asked respondents to rank them.

“Aging in the community — decentralized care and services” ranked as the biggest source of disruption, with 83% of respondents saying this is very or extremely impactful. Technology — ranging from artificial intelligence to virtual reality and home automation — came in next, with 76% of respondents ranking this as very or extremely impactful.

The other two disruptors were “third act,” which refers to alternative definitions of retirement, and paradigm shifts related to climate, politics and finance.

The disruptive forces are intertwined, the report authors noted. For instance, technology will enable more aging in the community and decentralized care. Indeed, nearly 80% of respondents said that tech that allows people to be autonomous in their care, such as grocery delivery or wearable monitors, will be extremely or very impactful.

“The striking insight from this survey is the interest in alternatives and options that enable the individual to control their own destiny and chart their own path, whether by accessing services in the broader community or creating communities that provide more autonomy and self-directed control of their housing and health care needs,” the authors wrote.

Preferences of aging baby boomers appear to be driving this disruption. Nearly 70% of respondents said that the ability to stay at home and access services would be the most important consideration for boomers as they look for supportive housing.

Still, that number is down somewhat from the 2017 version of the survey, when 75% of respondents said that this would be the boomers’ No. 1 priority.

Home health care providers, payers and managed care organizations are all driving the trend of decentralized services delivered in people’s homes. For instance, insurance giant Humana (NYSE: HUM) has been outspoken about its strategy to “own the home” — that is, the company intends to manage and pay for more at-home services for older adults, to drive down costs while improving consumer satisfaction and health outcomes. This strategy underpinned Humana acquiring a 40% stake in Kindred at Home, the nation’s largest home health provider.

The post Senior Living Providers Expect Disruption from Increase in At-Home Services appeared first on Home Health Care News.

In leading Homewatch CareGivers through this period of change, Smith has drawn on skills honed across several industries, including retail, technology and education. She is focused on building scalable systems and positioning Homewatch CareGivers’ franchises for success as the home care landscape changes. Medicare Advantage is one area where Smith sees opportunities. She’s also aware that with an “irrational market” at the moment, private equity money is flooding the sector and raising the stakes in an already hyper-competitive business, she said during a recent interview for Home Health Care News’ Disrupt podcast.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Below are some highlights of Smith’s comments, edited for length and clarity:

HHCN: Can you talk about your early career?

Smith: I actually started my career when I was 9 years old, believe it or not. I was working in a mailing room in Phoenix. I wanted to get my mom a Christmas present, but I didn’t have any money … So I wandered and found this job making 75 cents an hour, and ended up cutting my teeth as a capitalist early on.

I made my way more to traditional retail. I worked for a company that was eventually acquired by The Sunglass Hut … retail was fantastic for me. Retail and food service are something that I wish everybody would take a part in early in their career. It really deepened my roots in customer service and process management. It’s a significant and healthy dose of humility, I believe, for those who are working in those industries, and being part of those service sectors and grounded in the service of others I think really helps people be more patient and understanding.

Then I had stints in technology, the home furnishings industry and the international travel and tourism industry. My early career was classic for Gen X. I’d stay for a few years … help an organization build value, make contributions, but I always needed change and growth in my youth, and I got that. It was the basis for an adaptability, if you will. Working in a broad variety of industries helped me develop what I refer to as intellectual adaptability, to bring all of that experience forward as I advanced in my career.

And you went on to the education sector, with Alta Colleges and The Princeton Review?

Alta Colleges was proprietary education. So, similar to the University of Phoenix, but smaller. That’s where I began managing the shared services. We had about 5,000 employees, so in addition to managing online and on-the-ground educational institutions, I managed the shared services, human resources, purchasing, real estate for about 5,000 employees and 3,500 units across the country.

… The Princeton Review is one of the great education brands … they provided college education test preparation to over 100,000 students in 14 countries at that time … I had an an employee base of about 10,000 employees delivering services to students across that broad geography. It helped hone my focus on scalable systems and building commercial value, because The Princeton Review was a publicly traded company. That was my first time moving into that domain.

How did you make the leap into home care in 2015?

A recruiter found me. Interestingly enough, I’d never heard of the sector. I certainly knew about home health care, but like many people in society, I didn’t know about home care. My brother and I were taking care of our 82-year-old mother at that time, both of us living remotely, and we were really desperate for the services of home care. I didn’t know there were companies that could help with activities of daily living … she was falling and we were anxious … the recruiter introduced me to the [Sauer] family — it was family ownership at that time — I learned more about the fundamentals of the industry.

Where was the company when you came on board? Was PE ownership already in the cards?

If I can take you back to 2015, the family had been in the business for 40 years. Paul Sauer was really one of the founders of the industry, in my mind. And when they asked me to join, they were not thinking about an exit. They were thinking about scaling, building scalable systems, and really moving the business to that next phrase of growth.

I was the first person who joined in the leadership capacity outside of the family. Once I got in here and took a look at the hyper-competitive model and the capitalization that was going to be needed for us to really compete, and the fact that the founder was a little bit later in the stage of his career here, it really made a lot of sense to exit the family. They were willing to invest, but investment brings risk, and it just didn’t make a lot of sense. So, we went through an exit and we set the record multiple for the industry, which is a wonderful piece of validation for the family and, I think, a big, important recognition of the type of brand equity that they had built over the years. Becoming CEO was the next logical step in my career here at Homewatch CareGivers.

What was the multiple, can you tell me?

No, I can’t share it with you, but I can tell you that we have actually sold twice in one year, if you can imagine it. The market is a little bit irrational right now, but our network pro forma has been outstanding. Our first private equity owner was PNC Riverarch Capital, and we were part of the Authority Brands concept. It really has been a great experience. Now, we’re owned by Apax Partners, which is the 14th-largest private equity firm in the world. They own great consumer brands such as Cole Haan and Tommy Hilfiger. So we’re very excited about this next wave of growth for us.

It seems like such a momentous change to go from being family-owned to going through two private equity sales. I imagine you’ve been managing through a lot of change.

You’re exactly right. It’s probably one of the more significant transitions that I’ve led, is to go from a 40-year-old family business to one owned by the 14th-largest private equity firm in the world. But what I find helps is that you anchor into your organizational values and mission.

We’ve been fortunate in that our values are the same values as our private equity owners. As people ask me often, what is it like working for private equity, well, not all private equity is created equal. So we have gotten folks that want to drive value for every constituent that touches our business, which is part of my focus and key values … So when you look at finding a private equity firm, when we dealt with change, all of our conversations have been about, number one, we have great franchise owners and they were excited to see the family exit, to see that they did so well, because at some point they will sell, and they’re trading on the same brand equity, strong fundamentals. So, people have been very optimistic.

So, now the conversation changes to what does this mean to me, how is this going to benefit me in my local market? And so, leading through that change has not only been about the values but showing them point-by-point over the last year how their businesses have been benefited by the change in ownership and recapitalization. And it doesn’t hurt that our growth right now is outpacing the industry. As a results-focused executive, we don’t do everything perfectly, but right now I think we’re performing strongly under our new ownership, and I think our franchise owners are a big reason why.

There’s been so much private equity investment in home care over the last few years, what’s behind that?

At a high level, this is a perfect industry for private equity ownership, in my opinion, and there’s only a couple brands left that are not private-equity owned. It’s hyper-competitive, it’s hyper-local, you really need a strong capital base to be able to compete. You’re competing not only for clients and referral sources but you’re competing for caregivers … for home care companies, we have to formalize our footing within the continuum of care and that takes investment, that takes leverage, and so I do believe it’s a perfect space for private equity. Especially when you see those fundamentals of 10,000 people turning 65 years of age every single day.

… Typically, a private equity hold will be anywhere from three to seven years. This was a shorter hold for us but the results were there, our owner was able to exit because there are just a lot of money in the marketplace right now, and private equity going to that market is a little bit irrational. Private equity needs to invest. They need strong investment in strong sectors with strong executive officers, that will eventually lead to their exit. So, it is unusual to have a one-year hold, but it makes sense in conjunction with the marketplace, the industry and our results. But I won’t mind it that Apax holds onto us for a few more years. It’s a lot to go through due diligence twice in one year.

I spoke with you soon after the announcement that Medicare Advantage would be allowed to cover non-skilled, in-home care starting in 2019. You were bullish on the MA opportunity then, are you still?

It’s an exciting time. I’m still bullish … it was and still is an important policy recognition of home care. I spoke at your Summit in Chicago alongside the executives of Amedisys and Humana, and all of us were speaking about how instrumental home care has been and is becoming, and the importance of reducing hospital re-admits … we’re the eyes and ears of the home when family members are not there, and reducing those hospital re-admits is really one of the great opportunities around home care.

So I felt and I still feel that the opportunity around Medicare Advantage is a big policy recognition of this, and I’m really excited about what it’s going to bring to our sector. As you know, there’s just a little bit of guidance trickling out, and we’re still waiting to hear from everybody. Anthem was one of the first out and shared some of the services that will be covered, but we’re still waiting on rates, for example.

As a word of pause, I was disheartened to hear that one [insurance] provider may require folks in our sector to be Medicare-certified, even though CMS is not requiring that. I was really disheartened to hear that that may come along with one of the providers. So I would caution and hope everybody recognizes that home care is somewhat unencumbered by deep regulatory requirements. Let’s keep us there. It’s very important for our innovation, for us to be adaptable to the needs of family members, and to weave in alongside home care or hospice partners, so my hope is that there will not be limitations to keep most home care players out there from joining. But … this is the right direction, and I think a couple years from now, we will see home care really having a stronger footing within the continuum, and I expect, as rates roll out, it’s going to bring dramatic changes to our sector.

The post Homewatch CareGivers Harnesses Private Equity Capital to Shine in Hyper-Competitive Market appeared first on Home Health Care News.

In September, the Trump Administration put forward a proposal that would change the so-called “public charge rule.” This change would broaden the criteria that officials take into account when considering whether an immigrant should be granted entry to the country or given a green card.

Specifically, if immigrants utilize programs such as Medicaid or the Supplemental Nutrition Assistance Program (SNAP), they could be considered at high risk of becoming a “public charge” — dependent on the government to get by — and denied entry or permanent legal resident status. Critics of the proposal say that green card candidates will likely forgo medical care to avoid appearing on Medicaid rolls, endangering themselves and their children and driving costs up for the health care system, due to a spike in emergency room visits.

About 30% of home care workers are not natural-born U.S. citizens, and about the same percentage rely on Medicaid and SNAP, NAHC pointed out in its Dec. 10 letter commenting on the proposal.

“Barring immigrants on the basis of public assistance will only exacerbate an already prevalent workforce shortage leaving many employers unable to care for patients in need,” NAHC wrote. “This will cause patients to seek out more costly institutional settings for the same care they could have received in their home.”

In total, the proposed rule lists 15 factors that the Department of Homeland Security would start evaluating to determine whether an immigrant is likely to become a public charge. In addition to use of Medicaid and other public assistance programs, the factors include employment history, age and English fluency. Only those who have a household income above a certain threshold — nearly $41,200 for a couple with no children — will be exempt from the public charge evaluation.

Given that the median annual income for home care workers was $15,100 in 2017, most of these individuals will fail to meet the threshold, NAHC pointed out. And, in part, wages are so low in home care because Medicaid rates for these services are low, preventing agencies from paying their workers more. So, the new rule could create a vicious cycle.

“… The very programs that are considered in determining whether an immigrant is a ‘public charge’ are the reason why these crucial home care workers may qualify for that public support,” the letter states.

NAHC is far from the only organization to comment on this potential rule change. More than 210,000 comments came in during the 60-day comment period for the proposed rule, which ended on Monday, Vox reported. Now, the Department of Homeland Security will consider these comments and issue a final version of the rule, probably within months.

Written by Tim Mullaney

The post NAHC: ‘Public Charge’ Immigration Proposal Would Hurt Home Care Workforce appeared first on Home Health Care News.

Late last month, Bloomberg reported that Land & Buildings had put forward this plan to Brookdale’s management. Brentwood, Tennessee-based Brookdale is the nation’s largest senior living community owner and operator, and is also one of the largest home health providers. Its share price has eroded since its nearly $3 billion acquisition of rival Emeritus Corp. in 2015, and the company has been in the midst of an operational turnaround for the last year.

In Monday’s letter, Stamford, Connecticut-based investment management firm Land & Buildings described that meeting with members of Brookdale’s board of directors and management regarding ways to unlock the company’s real estate value.

“The discussion was productive, and several interesting perspectives surfaced,” Land & Buildings Founder and CIO Jonathan Litt wrote. “We left the conversation with a strong conviction that structural and tax issues involved in such a path can be overcome.”

Litt called on Brookdale to adopt an arrangement sometimes known as an “OpCo/PropCo,” in which the senior living company would create a REIT election for its properties and a separate public company for its management business. Many other companies have undertaken similar REIT conversions in the past, including Marriott’s (NYSE:MAR) split from Host Hotels (NYSE: HST) and Vici Properties’ (NYSE: VICI) spin-off from Caesars Entertainment (Nasdaq: CZR) in 2017. On the senior housing side, one relatively recent example is The Ensign Group spinning-off CareTrust REIT in 2014.

Under Litt’s plan, the Brookdale operating company would consist of the manager and the company’s ancillary services. The REIT, meanwhile, would likely operate under a REIT Investment Diversification and Empowerment Act (RIDEA) structure, and could bring in other senior living operators in addition to Brookdale. The new REIT would also own the “highest quality, most ideally-located” properties in the company’s current portfolio, allowing it to maintain a deleveraged balance sheet.

“Fellow shareholders, we urge you to reach out to management and the board to voice your opinions about the potential strategic options Brookdale may pursue with respect to its real estate,” Litt wrote.

Bringing in additional operators to take over some Brookdale buildings could address one critique of this plan, which is that a spin-off REIT would have an undiversified portfolio. It’s a point that Dana Hambly, an analyst with Stephens, made to Senior Housing News last month, after rumors of this plan first surfaced in the press.

“I am not sure what the potential tax bill to shareholders would be if BKD tried an OpCo/PropCo, but I’m guessing it complicates this strategy,” Hambly told SHN last month. “Also, one would have to consider the value of the OpCo. It would likely have an onerous capital structure and rent expense consuming most or all of cash flow. This would clearly hurt the OpCo valuation, and I’d think that it would also negatively impact the REIT (OpCo) valuation as it would have a single, struggling tenant.”

But Litt is confident in the plan’s merits. Overall, the OpCo/PropCo split could generate approximately $1 per share of recurring cash flow, and position the company to grow in 2020 and beyond, Litt wrote in Monday’s letter. A Brookdale REIT could also possibly trade at double the current BKD share price, he said, citing the fact that some other health care REITs trade in mid- to high-teen AFFO multiples.

“Improving the operations at Brookdale remains key to enhancing value, and we are highly encouraged that Brookdale reached out to us and leading real estate advisors to explore ways to maximize value for all shareholders,” Litt wrote.

Brookdale didn’t weigh in on the specifics of Litt’s plan in a statement emailed to SHN.

“We welcome feedback from all shareholders, but as a matter of policy, do not comment on individual interactions,” the statement read. “In a short period of time, Brookdale’s leadership team has made significant business and operational improvements at the company to deliver long-term value to stockholders. We are executing our turnaround strategy to drive operational improvements and position Brookdale for long-term success, and we will continue to carefully evaluate options for increasing shareholder value.”

The positive tone is somewhat a change for Litt, who in September vented his frustration that Brookdale’s management was only doing “the bare minimum to appease shareholders.” In the past, the Land & Buildings founder and activist investor has urged Brookdale to unlock its real estate value through sales. And he’s not the only one with this idea, as Macquarie Investment Management in November also wrote an open letter to Brookdale shareholders calling on the company to consider selling its owned assets.

Written by Tim Regan

The post Brookdale Shareholder Puts Forward Plan to Split Up Company appeared first on Home Health Care News.

That’s according to a Nov. 20 note from Leerink analysts; the note was issued after a Wall Street Journal report that Humana and Walgreens are in talks and could take equity stakes in each other.

On Wednesday night, Walgreens Executive Vice Chairman and CEO Stefano Pessina said that the two companies are indeed in negotiations, Forbes reported.

Last June, Humana and Walgreens began piloting senior-focused health clinics located in Walgreens stores in Kansas City, Missouri. Now, the companies are considering how to expand this initiative, including through a joint venture, a commercial agreement, or some other type of partnership, Pessina said Wednesday at the Forbes Healthcare Summit in New York City.

The Kansas City pilot involves Humana employees stationed inside the Walgreens stores to help Humana’s Medicare Advantage members and other seniors in accessing a range of services.

“Closer integration would allow seniors to enjoy primary care in store in addition to the broad array of HUM ex-store services, and drives foot traffic for broader WBA merchandise,” the Leerink analysts wrote in their Nov. 20 note.

Humana’s broader services include home health care through Kindred at Home; the insurance giant acquired a 40% ownership stake in Kindred at Home in early 2018. More recently — at the Morgan Stanley Healthcare Conference in September — Humana CFO Brian Kane said that there are opportunities to integrate Kindred at Home more closely with the Walgreens initiatives.

Ultimately, it is seniors’ homes — not pharmacies — where Humana is most focused, and services in Walgreens or other community locations would be designed to support seniors’ ability to age in place in their own homes, Leerink believes.

“While HUM has been piloting these retail clinics, the strategic commitment remains focused on the home as a care setting for seniors,” the firm’s note states.

It’s a point that Humana Chief Medical Officer Roy A. Beveridge has repeatedly emphasized in speaking with Home Health Care News.

“You have to go where the member or the patient is,” he told HHCN earlier this month. “Patients spend 98% to 99% of their time in their homes, so for us to believe that we can help someone in their health and not be where they are most of the time doesn’t make any sense.”

A closer relationship between Walgreens and Humana could also help the companies compete with rivals Aetna (NYSE: AET) and CVS Health (NYSE: CVS). On Wednesday, pharmacy company CVS completed its nearly $70 billion acquisition of insurer Aetna. As a result of the deal, CVS reportedly plans to focus more store space on health care as opposed to retail.

A complete acquisition is not likely to occur between Walgreens and Humana, however.

“Today, the multiples of the insurance companies are much higher than our multiples,” Pessina said at the Forbes event. “We should have bought it four years ago when our multiple was higher than their multiple.”

Written by Tim Mullaney

The post Humana Could Create ‘End-to-End’ Senior Care with Walgreens, Kindred at Home appeared first on Home Health Care News.

Greenbaum is also eyeing Medicare Advantage (MA) opportunities, and ComForCare recently forged a partnership with Kindred at Home, which is partially owned by MA giant Humana (NYSE: HUM).

As he tackles these priorities and others — including technology initiatives and workforce challenges — Greenbaum taps into his entrepreneurial instincts. Previously, he was founder and CEO of printing and marketing services company PostNet, which grew to a 660-unit franchise system under his leadership.

Today, ComForCare encompasses nearly 200 independently owned and operated locations in the U.S. and Canada, and the goal is to double the size of the company within three to five years, Greenbaum said during his recent appearance on the Disrupt podcast from Home Health Care News.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Below are some highlights of Greenbaum’s comments, edited for length and clarity:

Why did the ComForCare opportunity appeal to you, when you were thinking about taking the CEO position?

My initial reaction was, oh wow, this is an industry that I don’t know very well. I think what attracted me and why I’m here is, first of all, this company is owned by an organization called The Riverside Company, which is a private equity firm that is highly respected in franchising, highly respected in private equity. [It’s a] very values-driven, very entrepreneurial organization run by two entrepreneurial founders. So that was interesting to me. Some of my dear friends had done business with The Riverside Company for years, one of them being Dina Dwyer-Owens with The Dwyer Group, a very successful franchise organization developed with the support of the Riverside team.

The other thing that was appealing was the idea of working in an industry that really makes a difference. All my career, I’ve cared deeply about being part of a business that adds value, that gives back, that creates opportunity.

The third piece of it was Riverside’s vision was to build a multi-brand platform of companies servicing aging adults along the continuum of care. The idea of adding that kind of value throughout the point in time when someone enters the need for care and in later stages of their life, that whole idea of giving back … really was attractive to me.

You said 2018 would be a learning year for you … what have you learned?

My gosh, it’s like drinking through two fire hoses.

It was clear to me that this was a fairly complex business and industry, between the home care we provide and the private-duty nursing, and there are state-specific requirements, all sorts of needs to adhere to best practices and standards of care … in how we bring someone into our care and the development of the care plan, through the execution of that care plan.

I’ve learned, as I’ve operated among a number of competitors in the industry now, that differentiation is the key. It’s absolutely critical to help clients and caregivers understand what’s unique or different about us, and how that support of the continuum of care adds to the value proposition.

The other thing I would tell you is, I’ve been impacted and impressed by the franchisees. The quality of folks in this organization.

Is the goal still to double the size of the company within three to five years?

It absolutely is. In fact, subsequently we’ve acquired a brand called CarePatrol that’s in the placement services business. They have 150 franchisees. Our combined organization is around 350 … our goal was to acquire and develop an organization of seven to 10 brands. We continue to pursue opportunities, grow organically and I think it’s a very realistic goal.

You spoke about differentiation … I think one way ComForCare is starting to differentiate itself through building that family of brands. I think last time we spoke about it, you made the comparison with what The Dwyer Group did with all different types of home service businesses all under the same umbrella.

We will be very soon [announcing] a new name for the platform company that will service all of the brands … we’re excited about that. I had shared with you before that we’re working in the home care space, which we love, and now in the placement services space. We’re also looking at private duty and home health, we’re expanding our own private duty nursing program within ComForCare. We’re looking at businesses in the area of home repairs and modifications to allow people to safely age in their homes, we’re looking at hospice and palliative care businesses, and businesses that will functionally support seniors and aging adults at every stage and need in their lives.

Having a suite of services, with products and services for any need and every need [seniors] may have, that is the key differentiator. And having the technology to understand the customer or client profile and their needs, and know what to offer them, when and how, and making sure we’re not just selling services to people but adding value, making it easier for them, or more effective or meaningful for them, to live their lives. That we not only think is a differentiator, but we think will be a big value-add for our clients.

Building that platform of brands is one way to grow, but so are partnerships. One partnership that was recently announced is with Kindred at Home. What does that entail?

It’s a mutual referral base partnership. There are only three partners they’ve selected to work with, and at the end of the day, I think it demonstrates our commitment to provide a comprehensive approach to that transition of care that I think is critical to us. They’re one of many organizations that we’re looking to partner with. Again, so that we’re able to provide this very consistent — non-disruptive to the client — level of care.

Kindred at Home is partially owned by Humana, a big Medicare Advantage provider. With MA plans now being allowed to offer non-skilled in-home care, what do you make of the MA opportunity?

I think we’re like everybody right now … we’re paying attention, monitoring how we would pursue this and how it would be implemented in the organization. There are only a few [insurance] providers right now that I’m aware of that are offering home care as a supplemental benefit and that’s only in select areas. Like a lot folks, we’re in a wait-and-see situation, to basically see as other [insurance] providers come forward, if they’ll be offering more substantial plans during the October 2019 enrollment period … just wanting to make sure that we enter that opportunity at the right time in the right way when it becomes available.

You must feel good about how the partnership with Kindred at Home positions you with Humana as they are thinking about what they want do with this benefit?

That is 100% true, absolutely. A lot of us in the industry are laying groundwork to take real advantage of that opportunity and to provide a great value-added service to clients as it unfolds. Of course. We’re going to prepare for it. In the meantime, we’re offering a great solution for both organizations.

Listen to the complete episode of Disrupt with Steve Greenbaum:

Written by Tim Mullaney

The post Disrupt—ComForCare CEO Pursues Multi-Brand Growth Strategy, Medicare Advantage Opportunities appeared first on Home Health Care News.

For about a year, home-based palliative care has been a mandated benefit in California’s Medicaid program, Medi-Cal. Most Medi-Cal beneficiaries are enrolled in managed care plans that contract with agencies that provide these palliative care services, according to a Next Avenue report published Tuesday by Forbes.

“California is truly leading in this regard,” Stacie Sinclair, senior policy manager for the Center to Advance Palliative Care, told Next Avenue, which is a PBS website.

Palliative care provider ResolutionCare, which serves clients in rural northern California, is featured in the article. About 145 of the company’s clients, representing roughly two-thirds of its total customer base, are on Medi-Cal. Many of these people are in their 50s or 60s and are not initially familiar with palliative care, ResolutionCare founder Michael Fratkin told Next Avenue.

California mandates in-home palliative care for people with four conditions: congestive heart failure, chronic obstructive pulmonary disease, end-stage liver disease and late-stage cancers. But ResolutionCare’s services go beyond comfort care and symptom management, given that many of its Medi-Cal customers are facing homelessness, addiction, mental illness, food insecurity and other issues, in addition to serious illness, according to Fratkin. Care varies from brief check-ins for some patients to 30 hours of weekly contact.

Net costs of the palliative care benefit are not yet known, Next Avenue reported, although there is reason to believe that it is saving the health care system money. For instance, a Medicare Advantage plan based in the San Diego area has achieved significant savings related to care for people with dementia and cancer.

If California’s Medicaid model is successful, it could help pave the way for Medicare to offer a palliative care benefit — an outcome that Fratkin would like to see.

In other parts of the country, providers are seeking ways to offer more palliative care without Medicare reimbursement or significant coverage from private insurance. Louisville-based Hosparus Health, for instance, is investing $1 million a year in a palliative care program, aiming to demonstrate the value of this type of care.

Written by Tim Mullaney

The post Why California is a Hotbed for In-Home Palliative Care appeared first on Home Health Care News.