WelbeHealth’s Michael Le On The Future Of Innovative At-Home Care Models

In the broader at-home care space, Dr. Michael Le is considered an innovator.

As the co-founder and former chief medical officer of Landmark Health, he was integral in helping build a company that would eventually catch the eye of UnitedHealth Group’s (NYSE: UNH) Optum.

His impressive resume — which also includes time at Optum Home & Community Care and CareMore Health Plan — places him at the forefront of the movement bringing more care to the home and the community. It all started with, in Le’s words, the image of “the revered small-town doc with his black doctor’s bag doing house calls.”

Now, Le is on to his next chapter. Last month, he joined WelbeHealth as its chief medical officer.

WelbeHealth is a Program of All-Inclusive Care for the Elderly (PACE) operator that launched in 2015. The organization delivers services to its PACE members across California, including in the cities of Stockton, Modesto, Pasadena, Long Beach, Fresno and more.

Le is excited about the PACE model’s ability to improve health outcomes and lower costs through preventative care.

Home Health Care News recently caught up with Le for the latest episode of TALKS.

During the conversation, Le also touched on other care delivery models he finds interesting, and the importance of collaborations between PACE organizations and home-based care providers.

HHCN: I’m really excited that you could make it for TALKS because you’ve had such a distinguished career in health care, particularly around the home- and community-based setting. You were the CMO of Optum Home & Community Care, and before that, you helped build Landmark Health. Can you talk a little bit about these experiences?

Le: I’m very excited to share a bit of my experiences and also the WelbeHealth story. I was the co-founder and chief medical officer at Landmark, which we started about 10 years ago with the premise that the sickest and frailest population, they really struggled to get into the medical office, and they really needed around-the-clock care. Our solution at that time was to create a completely mobile physician-led interdisciplinary medical group that brought intensive house calls to patients 24/7, in the comfort of their homes.

Now, it’s very robust, and obviously, an expensive model with fully employed docs, nurse practitioners, psychiatrists, social workers, nurses, pharmacists, dieticians and navigators. We could only cover that cost through value-based contracting and taking total cost of care risk on the population, so that we could really staff and man the teams from day one to take care of the sickest patients. Fortunately, we had tremendous results and grew from just the four founders, and an idea, to being responsible for about 250,000 patients and about $2.5 billion in revenue across 20 states by 2021. By that time, we became the largest risk-bearing in-home medical care provider in the country.

Of course, that brings us up to the pandemic. Now, these very sick patients, they couldn’t even get into the offices. Our Landmark providers were able to go into the homes with full PPE to get them the care they needed, to help keep them out of ERs, which could potentially have been very deadly and catastrophic to them. That ability to care for patients in the homes at all times, and in all conditions, really got the attention of UnitedHealthcare and Optum, which then acquired Landmark in 2021 and used it as a platform for everything at home — naviHealth, Prospero, Optum at home, the institutional special needs, their in-home assessments program — all came under this platform. Happy to say it continued to grow to this year where now it’s about 16,000 employees covering almost a million patient lives across 39 states. I was the founding CMO for Optum, their home and community care. It’s great to see this growth and interest in bringing care to the home. I love the expansion nationally, but then I really felt much more at home in a smaller, nimble company where I could feel I could make even more difference.

I left Optum in March of this year for many different reasons, but especially the culture and the patient population we serve ended up here at WelbeHealth. Very happy to be here and just serving the most frail and complex patients and trying to give them the services that many times through their lives they probably have not received, but are in desperate need of.

You also led value-based care at CareMore Health Plan and Healthcare Partners, correct?

Le: Yes. I started my career at Healthcare Partners as a hospitalist, which was a capitated medical group here in Southern California. I worked in the ER and hospitals and witnessed the end result of this fragmentation and uncoordinated care that was failing our patients, and so it started to give me a picture of the gaps in the access to care and what needed to be done to help fill that.

I was there for 10 years and then was recruited to CareMore where I ran their high-risk programs, high-risk clinics, social SWAT team, case management, palliative care, hospice care, but also my pet program, the HouseCalls program, which was a bit of a model for the founding of Landmark. Both were premier organizations in the value-based care arena and really helped to mold a lot of my thinking on how to deliver innovative, high-quality, but really cost-effective care.

Thank you for walking us through your background a little bit there. We’ll get to WelbeHealth in just a second, but I am curious, did you always have this clear interest in home- and community-based care models, or did you gradually get into these areas?

Le: I actually have an interesting backstory to your question. I actually grew up in small town in Western Massachusetts and watched my dad, who is a primary care doc, do house calls when patients just couldn’t make it into his office. Really that vision of the revered small-town doc with his black doctor’s bag doing house calls was what attracted me to medicine in the first place. By the time I finished medical school and residency, I thought those Marcus Welby days of the house calls were long gone.

Again, I initially started work as a hospitalist, but as I kept seeing patients revolve back and forth in and out of the hospital, it just didn’t make sense. I thought, what the heck? Why don’t I just go see them in their homes? Obviously, it’s very eye-opening seeing patients in the home versus a 15-minute office appointment. You see the hoarding, the fall risk, the lack of social support, the empty fridges, and the true root causes of why they couldn’t stay out of the hospital. Then it makes sense you address those, and they become better.

Ever since then, it’s been my passion that instead of making a very sick and frail patient come to the system, let’s bring the system, the teams, the procedures to patients where they’re at in the comfort of their home and do it 24/7. Actually, just as a bit of a rewarding aside to me, Landmark ultimately expanded to Massachusetts, and we had three patients in that same small town that I grew up in. Very much coming back full circle for me to be able to provide that same care in the same communities I watched my dad serve just decades ago. That’s how I got into home and community care. That’s what keeps me here. That vision of bringing back that care from that golden era in some ways of medicine.

That has to be really cool getting to take it home. We’ve obviously seen home- and community-based care take on a bigger role in the broader health care continuum since 2020. What’s your take on that? I’m guessing that’s something you find exciting and long overdue.

Le: Absolutely, and so glad you asked about that. We’ve already seen a trend of so many services outside of health care being brought to the convenience of the home. The pandemic just accelerated that movement within health care. I think policymakers, the health care industries, cities, and communities across the country are realizing that we’re truly facing this rapidly growing elderly population — silver tsunami as they say. They don’t want to be treated in a nursing home. They want to reside in the comfort of their homes as independently as possible.

Remember, PACE has been around for a long time. It started in the 70s. I think there’s finally this appetite to invest in and dramatically scale community-based care at home for seniors. It’s certainly exciting to see, and I think it’s very much long overdue. I think we still have states without PACE programs, and that’s got to change. Thankfully, with robust support from the federal level and then drawing momentum of research and state and community commitments to PACE, we’re having this conversation at a really pivotal time.

I know that the vast majority of older adults want to age in place. Not only that, but we know that the care in the home is less costly than traditional nursing home care, and so the pandemic just accelerated all this. We’re happy to say that during the pandemic, the PACE programs and Welbe in particular had dramatic impacts in terms of saving lives, reducing mortality rates. We’re happy to be a leader and helping to drive some of those better outcomes for the sickest and frailest population.

Why WelbeHealth, and why did you want to work in the PACE space?

Le: In reality, I did have a lot of options and I wanted to be very selective in terms of what I wanted to do. As I mentioned before, I was searching for a smaller, more nimble growth organization that was really lined up with my passion for serving the most vulnerable and underserved populations.

I knew from my previous experiences just how crucially important culture and mission is to the success of organizations. I was aware of PACE long before, and quite frankly, I was a bit envious of all the additional services and resources that we just couldn’t provide through our traditional Medicare Advantage risk contracts like adult day services, dental, vision, meals, transportation, home health, physical therapy, all these things that I would’ve loved to provide for my patients previously, there are great resources in the PACE space.

Also, I knew some prior coworkers who had come to Welbe and talked to them and just became more intrigued the more that I learned. Really what sealed the deal was coming into these beautiful care centers and seeing such needing and deserving patients all being cared for by such passionate and mission-driven employees. The culture and the commitment was just so strong.

As I did more research, Welbe has shown some of the most impressive success during the pandemic in terms of their outcomes and really life-saving results for the PACE model. Welbe just had such a great reputation in the industry. Then, once I met the team and experienced the culture, it was not a difficult decision at all to bring my experiences here and join, and it just felt like home. It felt natural and comfortable.

You stepped into the CMO role in May. What are your short-term goals for WelbeHealth and what are some of your long-term goals for the organization?

Le: Let me start with the long-term vision first, and then I’ll get down to what I’m trying to look at in the short-term. Our ultimate long-term vision, it stretches even beyond PACE. It’s how do we redefine the health care service paradigm for seniors, just plain and simple. Right now, just nursing homes are serving a much larger percentage of the population than it actually needs to, and it’s not financially viable for many adults. As for nursing homes, the outcomes just are not as good in many instances.

PACE is rapidly growing right now, and long-term, we want Welbe to be leading that innovation and helping to drive PACE and deliver PACE to more and more patients in more and more communities. We’ve steadily grown over the past five years here in California, and we’re continuing that growth and looking to serve more cities and communities I think more broadly.

Now, in the short-term, I think I’m looking at the clinical model and really looking to see where we can optimize and standardize because I think there’s a lot of great things and great pockets that are going on, but how do we take all of the best practices at the different centers, drive towards that consistency of what we’ve established as those evidence-based best practices and really hold the programs accountable to the highest standards of clinical excellence and compliance and quality?

We’re really helping get all those sorts of tools to our providers so they can consistently provide the best-in-class care to our participants.

At the start of June, WelbeHealth announced that it was opening two new locations in Southern California. Talk a little bit about this, and does the company have further plans to expand its footprint?

Le: WelbeHealth already operates centers in Pasadena and Long Beach here in Southern California. We’re looking to open two new locations in Rosemead and North Hollywood in Los Angeles County. Both these locations are home to highly diverse populations, including thousands of seniors who would be eligible for PACE that currently don’t have a great wealth of provider options to choose from. We’re currently enrolling new members in Rosemead and North Hollywood and looking to start offering services come July 1st. I’m very involved in helping to launch those markets.

I also wanted to add that these new locations, as I walk in them, they’re so thoughtfully designed with contemporary spaces that really inspire an environment where our participants can just get mentally rejuvenated while receiving the highest quality medical care. They have featured outdoor social spaces, garden walls, hair salons, laundry rooms, really to get a bit of respite from some of the loneliness and the limited access to personal care that many lower-income individuals experience.

To really meet the needs of our participants, WelbeHealth has employed very multilingual staff across many, many positions and have culturally-appropriate meal menus, activities, and other services to really give the best service for our local communities. The reception’s just been tremendous. The communities have been so excited. I think it just really underscores just how underserved and how much pent-up demand there is for these PACE services.

While I think growth and expansion is exciting, clinical quality is really our first and foremost goal. There have been times in the past when WelbeHealth has intentionally held back on growth if we didn’t feel like all the components of the model were fully hired and trained, and to ensure that we’ve provided the best and highest quality care. Yes, absolutely excited to think about the potential growth, but quality and making sure that we deliver the best possible care is always the first cornerstone.

It’s not just WelbeHealth that’s expanding, the PACE concept is beginning to expand into more markets as well. What do you expect this space, this market to look like in five years, for example? Will there be PACE in every city, every state?

Le: There absolutely should be. PACE should be in every state. It’s a model that works. The data really supports this. We just need to invest in it, commit to it, and really embark on a very broad-based public educational campaign, so that more and more seniors and their caregivers know that this is an option for them. The program’s been around since the 70s and currently it serves about 60,000 people nationally today. The growth for many decades has been slow, but I really do sense that we’re at a bit of an inflection point. It’s starting to change in a major way, and there’s this exponential momentum to grow, and especially in states like California.

In California alone, the number of PACE centers has more than doubled in the past five years and enrollment has tripled. The pandemic, like I said, has certainly accelerated a lot of this growth, but we want to maintain it. We want to be able to nurture it and continue to build on it. WelbeHealth is certainly considering opportunities to serve more seniors in California and beyond because I think there’s so much need and the need out there is so immense. We remain very active in California, as does the National PACE Association, to try to continue to be leaders in advocating for the expansion of PACE.

I would hope that five years from now, PACE or PACE-like models would be almost considered the standard of care for a very sick and frail individuals with significant functional challenges, as the solution to help them remain as safe and as independent as possible in the comfort of their homes surrounded by their loved ones.

Speaking of keeping seniors safe, one of the things that put PACE on the map as a care model was its ability to keep seniors alive and safe during the height of the pandemic, especially compared to nursing homes. WelbeHealth was a big part of this conversation. The National PACE COVID-19 death rate was 3.8%, compared to 11.8% in nursing homes and WelbeHealth’s COVID-19 death rate was 2.4%. Can you talk about some of the care delivery advantages of the PACE model?

Le: Obviously those are results that we’re super proud of. First, I’d say that PACE improves health outcomes. There’s a 24% lower hospitalization rate amongst PACE members compared to dually eligible beneficiaries who receive their care in nursing homes. People receiving care through PACE programs are also less likely to be readmitted to the hospital or suffer emergency room visits. All of this significantly reduces the likelihood of being admitted to a nursing home and all the complications that arise from being in a health care setting unnecessarily.

Secondly, I think PACE participants receive better preventative care with the capitated model that PACE has, and it really aligns the incentives to provide very preventive care and to be as innovative and efficient as possible with patient care. With respect to hearing, vision, depression, and palliative screenings, we do all that and provide nutrition, flu shots, vaccinations — all these things to really catch things early and prevent all the downstream complications.

Also, because the model is so high-touch and there’s so many different team members seeing the participants, any one of them can identify, ‘Oh, something’s a little bit off,’ and then we can investigate and we can treat conditions early and prevent exacerbations and complications downstream. Also, I think that there’s a lot of caregiver satisfaction. It’s so hard being a caregiver for a loved one who has a lot of dependencies. We found that 96% of family members are satisfied with the support that they received through PACE and 97.5% of caregivers would recommend PACE to someone in a similar situation. We are this 24/7 lifeline for caregivers, and it significantly reduces that burden and burnout that they experience.

Another one is that PACE participants are less likely to suffer depression. Studies have shown that 27% of new PACE enrollees when screened scored as depressed on initial assessments before enrollment. Now, fast forward nine months and 80% of those individuals no longer report being depressed, likely because they’re receiving the care that they may have never had in the community before and we’ve reduced a lot of the stressors that they have.

I’d say lastly, the participant satisfaction is tremendous. Participants rated their satisfaction with PACE as 4.1 out of 5. We know that in health care the satisfaction can be very low. This is tremendous. The disenrollment rate for PACE is 5% less than the Medicare Advantage plans. This is even more impressive when you consider that our population, a large majority, is Medicaid eligible and there’s much more churn in the Medicaid population compared to the MA. I think being able to have that high retention and that very high-touch model and being especially there when you need it for them is so important.

My view is essentially what we’re providing for our patients, it’s concierge-level care, but not for those who can afford it, but it’s actually those patients who really have the least resources and actually really need this model the most.

You’re obviously the CMO and this is more of a business question, but what do the financials around PACE look like? How stable is the reimbursement environment, and are PACE operators struggling to stay afloat like nursing homes or home health agencies, or other senior care organizations?

Le: Happy to delve into a non-clinical question there. First, I’ll just say that PACE overall delivers exceptional outcomes at a lower cost to seniors, and that’s part of the reason it’s exciting to see the model scale. In addition to bringing these tremendous patient care outcomes, costs have been impressively lower. PACE saves around $10,000 per patient, per year, according to a 2022 study from the Bipartisan Policy Center. PACE organizations, overall, save the government and taxpayers an estimated hundred million dollars.

That said, the programs have been, in the past, limited in terms of their growth due to the capital necessary to build out these centers and deliver the comprehensive services. It costs millions and millions of dollars to open a PACE center. I think at WelbeHealth, we’re a bit unique, and I think we’ve been fortunate that as a public benefit company, we’re navigating this challenge with a business approach that ensures that we have the capital necessary to really deliver on the mission.

I’ll also say that having come from a lot of organizations that have been investor-backed, we’re fortunate to have investors that are very much mission-aligned to what we do and they’re playing a long game. They understand that it takes time to really change the trajectory and the cost of care, and it takes time to transform health care delivery in communities. They’re all in on very thoughtful investments in terms of the infrastructure, the teams, the technology to really scale the model and drive lasting long-term results many years down the road and not just what quarterly financials look like.

These investments I think have allowed us to be creative and really develop innovative systems, technologies, and processes that are dedicated and laser-focused on the PACE space and the PACE model, as opposed to if we were part of a bigger system where we’d have to compromise or where we might be just a bit smaller afterthought as part of a larger system, but we are able to make these investments in exactly to what we need in exactly what the PACE space needs.

In your view, how does the PACE model fit into the broader shift towards value-based care?

Le: I feel very strongly about this. The health care providers and organizations should be assessed based upon the quality of the care that they deliver and their health outcomes. The model of getting paid per nursing home bed that you fill, heads in beds, or the volume of services provided is a totally broken fee-for-service system. I think that most people are starting to recognize that. The industry is recognizing that, but change is always a bit slower than common sense and the recognition of it.

I think the pandemic really did shine that spotlight on the need for – and really the benefit of – at-home services for older adults. Also, more importantly, our population is growing older and there’s this growing recognition amongst the government industry leaders that we need to scale solutions that are targeted specifically for their needs. One size does not fit all, and we need to really curate models that are tailored to the specific needs and challenges of the older population.

Research has shown that PACE is one of the very highly effective solutions that we have at our disposal to meet the needs of the 77,000 aging baby boomers that we have in our country. Over the last several years, the Biden administration has taken steps to really pick up where the Obama administration left off, essentially, which is continuing to invest further into PACE. The home-based care models are more efficient and very cost-effective at keeping the elderly patients healthier and happier than institutional care settings. I think the value-based approach is exactly what PACE was built upon.

What are some of the main ways PACE providers should be collaborating with home-based care organizations to help keep seniors healthy? Are there natural collaborations for Medicare-certified home health agencies, or private pay home care providers? What’s your view on this?

Le: I’m excited to be a bit of a liaison between PACE and some of the home-based care experiences I’ve had in the past. PACE certainly does have some elements of home care, but we need to expand it more. Especially when I think about times when we’re launching new markets or when our membership is small in the early days of markets, you could actually burn out providers just with the call burning and things like that of having to be on call or do urgent visits and other things like that.

I see that there’s ways of collaborating with home health or care providers. Especially in that way of, can we partner so that maybe for after-hours, or maybe for weekend coverage, if we need someone seen and we need services delivered, we can partner with those entities to provide that around-the-clock care? Or, procedures that can really help to stabilize some of the patients in place so they don’t have to end up in urgent cares or ERs or hospitals?

When you first joined WelbeHealth, you said: “Revolutionizing how we care for the most vulnerable in our diverse communities is what inspires and motivates me.” What are some of the ways the company is working to innovate PACE care delivery models?

Le: WelbeHealth’s purpose and values really define us. That’s why last June, Welbe amended our certificate of formation and became the first, and the only, public benefits company in PACE, formalizing this commitment to weighing the interest of all stakeholders, including our providers, including participants, including employees alongside with our shareholders. Changing the company status really means holding ourselves to a higher standard of transparency and accountability. That really resonated with me. The health care system has given consumers too many reasons to distrust and be skeptical of it.

We really do believe that PACE programs should set this very high standard for clinical care and compliance excellence. We’ve been intentional about prioritizing both as we continue to expand and really consider some of the future opportunities. We’re very motivated in terms of being able to improve the care of the most vulnerable, really helping to create opportunities and jobs where team members who are passionate can find that outlet to be able to do their mission-driven work.

It’s about really being able to enrich and improve the health care delivery system in the communities that we’re touching, really to help our patients live longer with much higher quality of life and great satisfaction.

Again, looking at your background, you have such a great understanding of home- and community-based care trends. Apart from PACE, is there a care delivery model that you find fascinating, and why?

Le: Yes, as a former hospitalist, I’ll say that I’ve always closely followed hospital at home. I think it provides great services for the patients that actually qualify for the services and whom they touch. It too, similar to PACE, has had challenges in scaling and growing, but I do think that it’s starting to change and gaining momentum in terms of growing and expanding also.

From a problem-solving brain, there’s a lot of logistical and operational challenges and issues that I’m very intrigued by in terms of how you solve some of these challenges to get the care to patients. You can certainly see a lot of the similarities and parallels between hospital at home and PACE. I think we’ve definitely started on that upward trend of growth and momentum. Because I’m a big fan of the model, I’m hoping that hospital at home also has that inflection point.

I’ll also say that, just very excited to see home health becoming much more of a key vertical in integrated delivery systems. Optum had already purchased LHC while I was there and now the news of them making a bid for Amedisys, it just really shows just how much interest there is, and frankly, acknowledgment of the important role that home health is going to be playing in the value-based arena in the future. Certainly exciting for the home health industry, and I’ll be watching very eagerly to see how it all plays out.

Yes, that is certainly some big news, and HHCN will also be watching and covering, so look out for that coverage. Before we wrap up this episode of TALKS, I wanted to ask what else is important to bring up? What else do you want to say or talk about?

Le: We’ve covered so much, and I think in closing, I just want to underscore just how exciting this moment really is for those of us who are really invested in PACE and are in terms of reinventing the nursing home industry. PACE has unprecedented political and industry support right now like never before, and companies like WelbeHealth are charting a genuinely new and effective approach to very high-needs markets for delivering holistic care to seniors facing complex medical, social, behavioral challenges.

Looking ahead, I’m just very excited to see PACE grow nationally and for Welbe to continue to be a driving leader and advocate for that path forward.