November 20, 2024 • 40 mins
In this episode of NIC Chats, host Lisa McCracken welcomes Jim Lydiard, Chief Strategic Advisor for Pine Park Health, to discuss value-based care in senior living. Jim shares his journey from a personal connection with senior care to becoming a leader in healthcare innovation. The conversation delves into the complexities of value-based care, comparing ACO and Medicare Advantage models, and exploring the evolution of healthcare partnerships in senior living communities.
The episode offers valuable insights for senior living operators considering healthcare partnerships, including tips for assessing potential partners and the importance of organizational culture in successful implementations. Jim shares humbling experiences from his career, highlighting the challenges and lessons learned in implementing value-based care models. The discussion concludes with a look at emerging healthcare trends, including the concept of "health hospitality" and the growing focus on rural care and Medicaid innovation.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Lisa McCracken (00:03):
Hi, everyone.
Welcome to the NIC Chatspodcast series. My name is Lisa
McCracken. I'm the head ofresearch and analytics with
NIC. Super excited today tohave Jim Lydiard with us. Jim
may not be someone you know,but he's very familiar to us
and is well-versed in the topicwe're going to cover today. He
is the Chief Strategic Advisorfor Pine Park Health. Welcome,
(00:25):
Jim. Appreciate you joiningtoday.
Jim Lydiard (00:29):
Yeah, thanks for having me.
Lisa McCracken (00:30):
When I talked about your title, I would love
to hear a little bit more aboutyour background. I'm always
curious to hear where peoplegot to where they are. Before
we dive into everything thatyou know about the healthcare
space and value-based care andall that fun stuff, talk a
little bit about yourbackground and your journey to
where you are today.
Jim Lydiard (00:53):
Sure. Thanks again for having me. I would say I
unknowingly grew up in thespace, primarily as a consumer.
Early childhood memoriesinclude visiting an uncle who
was a quadriplegic in a nursinghome, visiting a grandmother
who began her experience insenior housing on the IL side
of a campus that had IL, AL,etc. She then eventually began
(01:16):
wandering as so many of ourolder adults and loved ones do,
she had advanced Alzheimer'sdementia and had to move to a
memory care community. Earlyfond memories include being a
child, going there with myfather. I sort of put those
thoughts in the back of my headfor many years and went about
school and college the way thatmany of us do. I also describe
(01:49):
myself a little as a failedphysician. My degrees are in
biology and chemistry. I'vetaken the MCATs twice but never
hit the apply button formedical school. Ultimately, I
ended up taking on a sort ofsales business development
position after school. It allstarted to come together for me
when, personally, things creptback into my world. I began
(02:12):
working for a company calledEvercare in 2007. My role there
was a blend of their hospicedivision and some of their ISN
nursing home division. Inparticular, I was living a
couple of days a week with mygrandparents, believe it or
not, commuting back and forththrough the state between my
(02:35):
home base and where mygrandparents lived because we
had two offices as well. What Ihad learned by living with my
grandparents at that time washow broken our healthcare
system was for seniors. Mygrandfather had advanced
(02:57):
Parkinson's, and my grandmotheron the other side of my family
had early-stage Alzheimer's.
Living with them for a coupleof days a week while working at
Evercare was glaring for me,and I really wanted to do
something about the brokenhealthcare system we found
ourselves in. While atEvercare, you sometimes stumble
into roles earlier in yourcareer and start to think, "I
(03:17):
can do more than make a livinghere." In 2010, I ended up
accepting a position withCareMore Health, which today is
an acquired subsidiary ofElance or Anthem Health Plan. A
(03:40):
t the time, that's really whenI began to do something about
the broken healthcare system. Ijoined CareMore back in 2010,
where we were launching variousspecial needs products
throughout the Southwest andultimately across the country.
I ended up spending 11 yearsthere, primarily supporting
their "Touch" program, whichwas their benefit plan and care
(04:02):
model specifically designed forseniors living in long-term
care and senior housingsettings. Since that time, I
spent 11 years there, and inthe last three or four years,
I've mostly been at privateequity or startup-type
companies, similarly supportinghomebound, home-limited
patients, and those living insenior housing or
hard-to-access, hard-to-engagepatient populations.
Lisa McCracken (04:36):
Fascinating background. I mean, obviously,
you were living it personallyand professionally too. I think
a lot of folks would stillagree that we've got a broken
system, but I like to thinktoday we're going to talk about
some glimmers of potentiallyshifting that broken system and
how we get there as anindustry. There's the provider
(04:58):
side of things, then there'sthe customer side, which is a
whole other conversation aroundthis. I do want to spend time
talking about value-based care,but I also acknowledge that for
a lot of people, it's a veryintimidating topic. Trying to
understand it can getcomplicated quickly. For
somebody like you, maybe not somuch, but for a lot of folks,
it's a challenge. We know we'vegot to understand this and take
(05:21):
a first step to get our armsaround it, but it can be
complicated. To the extent thatyou can, do a little bit of a
101 and level set theconversation. How do you define
value-based care as it relatesto the senior living sector?
What do we need to be thinkingabout and understanding?
Jim Lydiard (05:53):
I think at its core, value-based care is
merely a clinical and financialshift in focus—a focus from
volume to value. A focus onbest care, which organizations
define differently, but I thinkmeans timely, appropriate care
as opposed to simply more care.
Also, when a clinical modelgets further upstream and
(06:18):
builds trust with healthcarerecipients, patients, and
families—especially thepatients we serve in senior
housing—and you root your caremodel in informed consent and
educating patients and familiesalong the way, then care plans
can enact preventive care,usually at a more affordable
site of service, such as theapartment, community, or home
(06:38):
of these patients. Care plansare also able to limit and
avoid unnecessary treatment,futile care, and wasteful care.
This all leads tosavings—savings from what that
disease state historicallywould have expected a health
plan or Medicare to spend onthese sorts of members or
beneficiaries. Ultimately,those savings can be shared
amongst those involved increating that change. That’s a
(07:00):
clinical and financial overviewof how the shift in the care
model yields new ways to fundthis type of service and how
those newfound funds getdistributed.
Lisa McCracken (07:33):
Right. There is the financial component of it,
which I know often gets talkedabout on the operator side of
things, but then there arebetter ways to do it and best
practices. I know a number ofoperators that have gotten into
this space who have also saidthe reality is this type of
care and integrated models arejust a better way to do
business. We see occupancyimprovement, like the stay,
which I don't want to say hasnothing to do with the
(07:56):
value-based care side ofit—it’s a positive byproduct of
that model that can havefinancial returns across the
board.
Jim Lydiard (08:09):
I would argue to a degree, I think it has
everything to do with it.
That's just the nice part ofhow value-based care and senior
housing work in a veryaltruistic way. It's the value
that we collectively unlocktogether, and ultimately the
member and family benefit themost.
Lisa McCracken (08:27):
Right. I want to break down the value-based
care piece with a little morespecificity. I want to talk
about ACOs and MA versions ofvalue-based care. You've seen
both and experienced both. Doyou think one is particularly
more challenging than the otherin generating overall impact?
On top of that, if you're justentering into this, is there
(08:48):
one that's maybe a more naturalway to align? Again, because we
recognize value differently,there are different resource
allocations and levels ofsophistication in these models.
So compare and contrast the ACOand MA versions of value-based
care.
Jim Lydiard (09:08):
Great question.
And, like you, I get asked thisa lot. I would oversimplify it
and say that, in my experience,it's generally harder to build
scale and membership or growthe MA Medicare Advantage form
of value-based care. However,once you grow that population,
that cohort of patients andmembers, there are more levers
(09:30):
to impact success. In contrast,it may be simpler to build
scale and density on the ACOside, where the patient doesn't
have to make a plan change toamass the type of membership
needed to impact a value-basedcare model. However, there are
greater challenges to bend thecost curve in ACO care. In 15
(09:52):
years of supporting and leadingorganizations focused on this
space and these payer riskmodels, I've watched select
markets and MA regions begin toactually generate savings in
less than a year. I'd saythat's fast, but I've seen it.
(10:16):
What I mean by generatingsavings in an MA world is that
care expenditures tend to be85% of the revenue you're
bringing in. Most of ourlisteners thinking about
Medicare Advantage haveprobably heard of the 85% rule.
Usually, anything better than85% MLR means that the product
itself has turned profitable.
Contrasting that with ACOexperiences, I've seen it take
a bit longer in ACOs to hityour stride. Usually, one to
(10:41):
two performance years is whenyou see reliable savings. But
again, it's quicker to grow andamass the membership on the ACO
side, where a plan changedoesn't have to take effect. My
favorite partnership pathoption, if you're a listener
wondering whether to do oneversus the other... Well, the
(11:12):
beauty of many of your marketsis that you might not have to
pick one or the other. You canoften look to a physician group
that partakes in bothsides—both MA risk agreements
as well as ACO-typearrangements. If you form your
opinion at the PCP group level,or the MSO level as it's
called, you can usually flex toboth tracks in a much easier
(11:35):
way. The adoption is easier.
Sometimes members are alreadyaffiliated with these physician
practices, so there's a simplerglide path to growing the
attribution on the ACO side andthe membership on the MA side.
Ultimately, that becomes thelinchpin for successive
outcomes.
Lisa McCracken (11:55):
I would observe that there's been a great
increase in some of thesepartnerships with physician
practices, even coming out ofthe pandemic. I don't have any
stats around that, but is thata correct read or not? I just
seem to be hearing more aboutsome of those partnerships and
alignments.
Jim Lydiard (12:12):
Yeah, I'd say you hear more about it today. Many
of your listeners wouldprobably say that mobile house
call physician practices havebeen serving this space
forever. But much like thesenior housing industry itself,
these practices have becomemore sophisticated as well.
Medicare has had a big role inadvancing more PCP-specific ACO
(12:36):
models and what CMMI has beenable to do. MA plans have also
gotten more sophisticated inhow they want to partner with
physician networks andphysician groups. I think it's
the perfect storm forinnovation, where most people
are seeing physician practicespotentially becoming the
captain of the team as itpertains to healthcare. They
are looking for ways to eithergive risk to those PCP groups,
(12:56):
as Medicare Advantage wouldsay, or give more
accountability towards thosePCP groups, as ACOs would
suggest. If those PCP groupsare doing their job, they are
often the ones that should beon the hook for rendering
savings or losses.
Lisa McCracken (13:26):
Right, it sounds like a natural
partnership. Do you have anyinsights in terms of if I'm a
senior living operator and I'vebeen approached by some
different physician groups onthat, what questions should I
be asking? Are there two orthree things I can do to assess
alignment and determine whomight be a good partner?
Recognizing this is probably acomplicated and in-depth
conversation, I'm sure you havesome insights into that.
Jim Lydiard (13:53):
Yeah. I think maybe a good stat to follow
here is there's just a lot ofnoise in the space. Yeah. I
think I saw a recent articlethat showed that ISNP plans,
(14:13):
which are again MedicareAdvantage products specifically
designed for folks that live insenior housing settings, have
risen from 40 products or so in2010 to like over 175 come
2025. So you're talking aboutbasically almost four times the
number of products that are outthere. And that's just on the
(14:33):
Medicare Advantage-specificside. The ACOs have also grown
immensely. If I was a communityoperator, there's probably a
few ways I'd start that.
That's, I think, what you'regetting at. Yeah. First and
foremost, these groups aren'thard to find. They're all
pushing for growth. What Ibelieve in wholeheartedly is
for these operators to justpause for a moment and make an
intentional decision to get indiscovery mode. T ake meetings
(15:00):
with several large groupslocally, regionally, and
potentially even nationally,because these groups have
timetables with CMS for whenthey can launch into these
markets. Or, if they're just anACO, they have performance
years with timetables on whento announce they're entering a
new market. Also, thesebuildings can easily
cross-reference theiroperational footprint with the
(15:21):
footprints of these plans orACOs. That is not a hard task
and can be done with a quickonline search. A discovery
phase also includes asking notjust what this ISNIP or ACO can
do for you, but asking yourresidents what they want and
what they want donedifferently. Ask your staff
what impact they’re lookingfor, and really immerse
yourself in kind of a truediscovery phase. What you're
(15:49):
ultimately trying to land on ishow your community or operation
can differentiate by laserfocusing on a healthcare
experience unlike any other.
Once you know your vision,you'll know what complements
you need. Phase two of this isall about finding that
complement. Differentiatingthese partnership options is
key. Ultimately, if buildingsare going into this for the
(16:10):
first time—meaning this isn't acase of "we tried this, it
didn’t work, we learned, andnow we're applying it with
partner two"—but rather you'regoing from zero to one, you
need to find a partner willingto create a glide path that
really includes and involvesyou in the foreseeable future.
Operators need to remember thathealthcare is a serious
business. And we've all talkedto these residents. Some of
(16:40):
these residents have had thesame health plan for 30 years.
Some of them have had the samePCP for 30 years. We shouldn't
take this lightly if we'regoing to ask these residents to
commit and align with a novelcare partnership you're
adopting, there's a massiveresponsibility we all have on
our hands. As such, thosepartnerships with ISNP plans,
ACOs, or general MA plans needto be well thought out. They
(17:03):
need to be prepared to endureand not feel flippant to the
end consumer, which means theresidents in your community. In
summary, a thorough discoveryphase, analyzing your gaps, and
interviewing partners to seewho will be the most malleable
to where you are in yourjourney and where you see this
going is essential. Usually,this means a roadmap of year
(17:25):
over year—here's how thepartnership could transform if
things are really winning andworking between us.
Lisa McCracken (17:35):
Right. I think all of those points underscore
the fact that this is acommitment you need to make,
and you need to have more thanjust a champion—champions
internally. This isn't just aquick initiative. This is
really about changing theculture of the organization,
and you've got a lot investedin this. It's about putting in
the time to do it right. Iwanted to talk a little bit
about how you've been in theindustry for a period of time.
(17:56):
You've talked about yourbackground. So, maybe where we
are today versus 10 or 15 yearsago—let's say 2010, when you
began selling value-based carein senior housing. What do you
see as some of the differencesin community operators today
versus then?
Jim Lydiard (18:20):
Yeah, good question. I'd say there are
differences on both sides ofthe coin. There are pros and
cons.
Lisa McCracken (18:28):
Probably
Jim Lydiard (18:29):
Pros and maybe opportunities for
improvement—there we go. On thepros side, when I would cold
call assisted livings back in2010, I would say, believe it
or not, only about 50% at bestwould acknowledge that they
were witnessing improvementopportunities in delivering
better onsite care. The other50% just believed the status of
(18:50):
healthcare in their buildingwas great.
Lisa McCracken (18:54):
Yeah.
Jim Lydiard (18:55):
When you break that down one layer deeper,
from the 50% that were seekingimprovement and acknowledged
there were areas to improve,only a small fraction
understood that value-basedcare was a means to do so. In
2010, a smaller percentageacknowledged the need for
(19:15):
healthcare improvement. By 2024or 2025, a much greater
percentage seems to recognizethis need and appears ready to
take action. The big pro is theknown participation in
healthcare, which is vitalgiven that these residents are
more frail, and wellnessstaffing remains pretty lean,
even compared to 2010. In termsof areas for improvement, while
it’s entirely possible thatbuildings were as overwhelmed
(19:38):
with day-to-day operations in2010 as they are now, it seems
more evident today. When youwalk into these buildings,
executive directors and healthand wellness directors are
often using a dozen to twodozen point solutions to run
their day-to-day business.
(20:07):
Turnover in these communitiesis usually around 100%
annually, from caregivers tomed techs to dining staff, and
all these buildings are stillrebounding from occupancy. The
big difference I see is thatoperators at the regional and
national levels have to bereally critical about what they
want to implement and how theyintend to implement change.
(20:28):
From a behavioral changemanagement perspective, you’re
deciding how much you thinkyour team at the local level is
prepared for. Otherwise, it’sjust going to result in a
series of sloppy launches. Thisdoesn’t just apply to
value-based care orhealthcare—it could be any
number of solutions an operatoris thinking of implementing.
(20:50):
For example, switching up theirEMR, changing their long-term
care pharmacy, and so on. Butyou’ve been in the industry for
a long time. What is yourperspective? You’ve seen a lot
from 2010 to 2025. What areyour thoughts on that?
Lisa McCracken (21:13):
I’m actually surprised when you said that
back in 2010, about 50%acknowledged that maybe there’s
a better way—that’s actuallyhigher than I would have
thought. I think back to 2010and value-based care and
smarter delivery of services.
Gosh, I’m not saying therewasn’t quality care and
services, but I think we’vecome a long way in terms of
understanding value-based care.
(21:33):
If you’re in the industry nowand you’ve never heard of
value-based care, I’d beshocked. Most people at least
have some semblance of what itis. I think there’s also an
acknowledgment that there’s abetter way. Another observation
I’d make is that there’s beenan evolution where much of the
care coordination washistorically focused on the
skilled nursing side. Now, Isee a clear acknowledgment of
the gains and opportunities inupstream initiatives, like
(21:54):
wellness and prevention, whichspan the continuum, starting
with independent livingresidents. We even see it
(22:15):
coming into active adultsettings a little bit with some
partnerships there. There’sreally opportunity across the
board. I see greaterreceptivity to it and interest
in learning, which is a goodthing. However, to your point,
I still think the system isbroken. Tech adoption has been
a good thing and has progressedsince 2010, but it’s mostly not
(22:37):
integrated. That lack ofintegration holds us back. It’s
so frustrating for the staffand everyone you hear about—how
many plug-and-play systemsexist, and yet they don’t talk
to each other. I think that’s asignificant barrier to fully
progressing on this value-basedcare journey.
Jim Lydiard (23:02):
Right. Well said.
Thank you.
Lisa McCracken (23:05):
Do you have an observation in terms of what’s
the one ingredient that mostoften equates to success in
launching some of thesehealthcare partnerships? Any
secret sauce?
Jim Lydiard (23:21):
Yeah. I love this question. I’m sure some
listeners would expect me tohave a real gem here, like the
right payer mix among theresident population, a well
fine-tuned, pre-establishednetwork of preferred healthcare
vendors already in thebuilding, or data and
analytical expertise, or a starED or health and wellness
(23:43):
director. Don’t get mewrong—all those things help.
They do. However, I wouldactually say success, in my
experience, has been rootedmuch deeper. I’ve typically
seen honesty and humblenessamong the buildings as the
prevailing factor. Will thisbuilding agree, implement with
intent, and see this thingthrough? I like buildings that
(24:05):
are willing to call out theirblind spots, ones that desire
change, maybe even ones thatare a little disruptive or
rebellious. What we are doingis making a monumental change
(24:29):
in how healthcare is delivered.
This brand of healthcare ishard. These residents, if you
just look at HCC scores, riskadjustment factors, and how
Medicare begins to add frailtycoefficients to this
population, are two to threetimes as frail as the
traditional Medicarebeneficiary. When you start to
deliver care to them, theyoften have an inherent distrust
(24:52):
in the American healthcaresystem. They already feel it’s
complicated, and sometimes theyfeel as though it has wronged
them. I love buildings that arehumble and honest, willing to
say, "Here’s what we need.
Here’s what we’re doing well,but here’s where our blind
spots are." Those are oftenreally good leading indicators
for success in my eyes.
Lisa McCracken (25:17):
Yeah. I would think that’s necessary because
the reality is you don’t get itexactly right from day one
either. You need to pivot, takea look at what’s working and
what’s not, and figure outwhere you need to evolve and
adjust along the way. Do youhave any stories from the
trenches, if you will—any ofthose humbling stories you’ve
seen over the years?
Jim Lydiard (25:41):
So yes, this is...
Lisa McCracken (25:42):
Without names, no names. Right.
Jim Lydiard (25:44):
Right. This is the part of the podcast where I
tell you how many times I’vefailed over the last 15 years
at this. In all honesty, thiswhole type of work is a series
of failures in a way. We justhope that we learn from those
and can apply them to the nextwin. I’ve got a couple of good
stories that come to mind whenyou ask for examples. The first
(26:05):
one was a lesson in realizingthat not all buildings really
want what’s best for residents.
Lisa McCracken (26:18):
Okay. You’ve got to elaborate on what you
mean by that, which I’m sureyou will.
Jim Lydiard (26:23):
I was probably part of the fastest program to
ever be terminated in a newmarket. Rewind back to 2015 or
so. My program was asked, aspart of a state-based RFP, to
launch in a new market. Thiswas after Anthem had acquired
(26:45):
CareMore, and one of the Anthemsubsidiary products in a new
state had just won a Medicaidbid. As part of that, we were
required by the state to launcha care model like ours in
nursing homes. We set out on anadventure, interviewing about a
dozen nursing homes that housedcustodial long-term care
patients who were now membersof this Medicaid health plan.
(27:08):
We ended up selecting three orfour buildings with a total of
about 180 residents who weremembers of this health plan. We
(27:37):
met with the ownership groupsof the four buildings—there
were one or two owners. We metwith the medical directors of
the buildings and rolled outhow we planned to jump in:
bringing in advanced practiceclinicians or nurse
practitioners, how our backoffice team would assist in
care coordination, and how we’dwork with the communities
already contracted for directadmit to SNFs when they needed
(27:59):
rehabilitation, and Part Bservices when they needed a
lighter version of that, and soon. The launch followed about
90 days of preparation afterreceiving the state’s approval.
We began care, but about 45days into it, we got a phone
call informing us that all fourbuildings had been sold to one
new owner-operator. The newowner-operator took a look at
(28:29):
our early data. Of the 180patients we’d served, they were
used to copious amounts of EDvisits and hospitalizations. We
had nipped that in the bud bybringing in more onsite primary
care and working much moretightly with both onsite and
near-site services. However,what we found with the new
operator group was that theirvested interest was in ensuring
they could send patientsreadily to the ED, enabling
(28:52):
them to turn on skilled daysand get a higher reimbursement
rate from the state. As aresult, we were asked to leave
just 60 days after our arrival,despite providing 60 days of
great care to 180 patientswithin a new clinical model. It
(29:18):
was a very humbling experience.
I remember one of my physicianmentors at the time, George
Fields, who’s now over atMolina, asking me, "Jim, would
you have done anythingdifferently? Would you have not
taken on this challenge andworked to make improvements for
these 180 members?" The answer,of course, was no. But that was
an extremely humblingexperience because we saw the
impact that was possible. Wesaw what we were building, and
(29:42):
yet this new ownership groupwas more focused on shifting
financial priorities than onproviding best-in-class care
for its custodial patients.
Lisa McCracken (29:58):
Well, it obviously reinforces the
importance of goal alignment.
Is everybody rowing in the samedirection and focused on the
right goals at the right time?
Jim Lydiard (30:08):
I've got one more that's, that's a real good
Lisa McCracken (30:10):
Okay. Sure.
Let’s hope that’s a moreconstructive lesson learned
because, quite frankly, that’sdisheartening to hear. But it
reinforces, as I said, theimportance of alignment.
Jim Lydiard (30:23):
Well, you’re asking for humbling stories.
Lisa McCracken (30:26):
Yeah .
Jim Lydiard (30:26):
On many podcasts, we just listen to the wins, but
the hard reality is there are alot of misses along the way
too. This next miss, which willprobably end a little more
lighthearted, is a lesson inhow healthcare doesn’t have to
be so complex. Sometimes thesimplest solutions are the
right solutions. I rememberyears ago enrolling a member at
(30:49):
a memory care facility. Thiswas a low-income memory care
community, one of thosecottage-like setups with 10
residents in six or sevencottages on one campus of care.
I remember this one patientvividly—he was a younger
patient of ours, and thebuilding took a chance on our
referral to them. We referredthis member to the building.
(31:27):
The member moved in, andshortly thereafter, the member
experienced an unavoidablehospitalization due to some
complex interactions withpharmacy needs. The member
spent four or five days in theinpatient hospital setting and
then returned to the building.
Not even 30 minutes after themember arrived, I got a phone
call from the executivedirector of the community. They
(31:51):
said, "Jim, you’ve got to helpus. Mike just got dropped back
off, and we’re going to have tosend him back out." I asked,
"Oh no, how can I help? What’sgoing on? Do we need to send a
clinician out?" The executivedirector, in the most
matter-of-fact way possible,said, "Unless you can get Mike
(32:12):
underwear, we’re sending himback out." I had to pause for a
moment, and my first thoughtwas, "Where’s the nearest
Walmart?" My second thoughtwas, "If I’m ever in a pinch
(32:34):
and not feeling great, should Icall my insurance agent for
something like this?"Nonetheless, I found myself in
line at Walmart buyingunderwear because,
unfortunately, the hospital haddischarged this patient in a
hospital gown and nothing more.
The patient returned to thispoor memory care community,
surrounded by peers andresidents, without any clothes.
(32:54):
All the data science,technology, and clinical
treatment plans in the worldcouldn’t have prepared me for
this return-to-acute-avoidanceissue. It was a humbling
experience—a reminder thatsometimes it’s not about cool
population health data scienceor technology. It’s about
humanism. This guy just neededsome clothing, and the
community wouldn’t send himout. Here we are, years later,
(33:15):
and let’s hope Mike is stilldoing well there.
Lisa McCracken (33:27):
Yeah. Well, it shows the importance of some of
the basics and transitions ofcare, right?
Jim Lydiard (33:33):
Right. And you can edit as much of this out as you
prefer.
Lisa McCracken (33:36):
Oh, I think we’ll leave that one in. It
keeps people engaged. I’m surethe listeners are hooked now.
All right, let’s wrap upbecause we’re coming up to our
time here. I’d love to hearyour thoughts on what other
healthcare trends you have youreye on at the moment. Are there
any that relate to ourlisteners in healthcare and
housing or the intersectionbetween the two?
Jim Lydiard (33:56):
Yes. I’d like to attempt to coin a phrase today.
I think we’re entering into aworld where, previously, there
was healthcare and then therewere these communities more
commonly known as hospitality.
I think we’re entering a worldwhere "health hospitality" is
going to be a thing. And what Isee in the...
Lisa McCracken (34:17):
Not heard that one before. I'm gonna remember
that. Health hospitality, youhave to tell me how to spell
how to spell it then. But goahead,
Jim Lydiard (34:24):
I think the big overarching trends right now
include rural care, which seemsto be a significant focus. Many
companies are starting in thisspace, investing in it, and
selling within it. It’s a bigchallenge for most health plans
and the government, not justregarding healthcare
expenditures but also access tocare for aging populations.
(34:46):
Medicaid is another big themeright now and is, in a way,
having its heyday. Since 2007,we’ve seen a lot of investment
and health plan innovation inMedicare Advantage to support
the space. I feel that samelevel of investment and
innovation is either alreadyhere or on its way for
(35:07):
Medicaid. We’re going to see asignificant expansion of that
as eligibility increases stateby state. I also like solutions
around care navigation,particularly navigation
performed by lay, nonclinicalpeople. Candidly speaking, I
think I’d be a great carenavigator myself. I know enough
about different topics—notdeeply like a clinician—but
enough to help guide a senioror someone with lower health
literacy to better understandand access healthcare
(35:27):
opportunities. Lastly, I thinkbehavioral health is another
key area of focus.
Lisa McCracken (36:00):
Definitely , that was gonna be one on my
list.
Jim Lydiard (36:01):
Yeah, it’s definitely on the rise because
it has gone from beingsomething relatively taboo just
a few years ago to now beingsomething everybody talks about
and feels comfortablediscussing. Generally speaking,
I’m fascinated by the harderproblems in healthcare, the
tougher solutions, and thewinding roads. I think all of
those have a place in seniorhousing or hospitality.
Lisa McCracken (36:28):
Hospitality.
Yeah, that’s a very good one,and we’ll remember that. Like I
said, I’ve got to figure outhow to spell it, but I get what
you’re saying, and I think...
Jim Lydiard (36:37):
Yeah. But again, you’re in tune with all
this—housing, finance, markets.
What are you seeing upside in?
Lisa McCracken (36:43):
Yeah, well, definitely. Behavioral health
and mental health are areas Iwas going to mention. Outside
of cognitive impairment anddementia in Alzheimer’s, I
think these are issues thatoperators are dealing with
every day. The question is,what are the opportunities to
bring forth more solutions andstrategic partnerships on that
front? Quite frankly, it’salready a bit of a crisis. It’s
(37:03):
talked about more now than inthe past, but there’s still
much to address. You mentionedcare navigation, and I think
there’s huge opportunity there.
Even within the senior livingsetting, there’s significant
potential for population healthmanagement in general and for
helping residents and theirfamily members better navigate
the system. With carenavigation, thinking through
(37:39):
the business model isessential. You’ve seen
different organizations bringforth various services and
platforms on thatfront—sometimes they work, and
sometimes not so much. What Imentioned earlier about
upstream initiatives isexciting. It’s great to see
organizations and the sectorpivot from the "sick care"
model to a "WellCare" model andrecognize the opportunity to
make a meaningful impact onresidents across the spectrum.
(37:59):
Those are the things I thinkabout, and I see great
opportunity there. One finalquick question: By 2030, all
Medicare beneficiaries aresupposed to be in a value-based
care arrangement. Is that goingto happen? Yes? No? Is that
aspirational, or do you thinkit’s realistic?
Jim Lydiard (38:34):
I don’t think it’s going to happen—not because of
the Medicare Advantage side ofthat number. I think we’ve seen
what Medicare expected, withmore than 50% of the population
now choosing a MedicareAdvantage plan, which they deem
credible for that stat. I thinkthe issue lies more on the ACO
side. Despite CMMI’s attemptswith not just launching
(38:55):
PCP-related ACOs but alsospecialty-related ACOs—for
oncology, renal care,cardiovascular, and even
pulmonology—we’re not seeing asmuch adoption on the Medicare
side. I think over the next fewyears, we can significantly
close that gap, but my guess isthat by 2030, we’ll still be at
best around 75% to 80% of theway there. That will still be
(39:17):
meaningful. As long as everyonestarts to become more
accountable—through ACOs andrisk populations—the whole goal
of value-based care, which isto bend the cost curve, should
still start to materialize inthe way we intended,
particularly over metrics likeGDP.
Lisa McCracken (39:57):
Right, I agree.
75% to 80% is nothing to beashamed of—that’s significant
progress, for sure. Well, JimLydiard, we appreciate your
time with us today. Jim Lydiardserves as the Chief Strategic
Advisor at Pine Park Health. Heis also a very loyal NIC
volunteer and heads up ourPartnering for Health focus
area committee. We acknowledgeyour constant support of the
NIC stakeholders and yourservice to the industry. Thank
(40:19):
you for being with us heretoday. Thank you, everyone, for
listening to another NIC Chatspodcast. You can access this
podcast and others on ourwebsite at www.nic.org. Thank
you so much.
Jim Lydiard (40:38):
Thank y ou.
Hi, everyone.
Welcome to the NIC Chatspodcast series. My name is Lisa
McCracken. I'm the head ofresearch and analytics with
NIC. Super excited today tohave Jim Lydiard with us. Jim
may not be someone you know,but he's very familiar to us
and is well-versed in the topicwe're going to cover today. He
is the Chief Strategic Advisorfor Pine Park Health. Welcome,
(00:25):
Jim. Appreciate you joiningtoday.
Jim Lydiard (00:29):
Yeah, thanks for having me.
Lisa McCracken (00:30):
When I talked about your title, I would love
to hear a little bit more aboutyour background. I'm always
curious to hear where peoplegot to where they are. Before
we dive into everything thatyou know about the healthcare
space and value-based care andall that fun stuff, talk a
little bit about yourbackground and your journey to
where you are today.
Jim Lydiard (00:53):
Sure. Thanks again for having me. I would say I
unknowingly grew up in thespace, primarily as a consumer.
Early childhood memoriesinclude visiting an uncle who
was a quadriplegic in a nursinghome, visiting a grandmother
who began her experience insenior housing on the IL side
of a campus that had IL, AL,etc. She then eventually began
(01:16):
wandering as so many of ourolder adults and loved ones do,
she had advanced Alzheimer'sdementia and had to move to a
memory care community. Earlyfond memories include being a
child, going there with myfather. I sort of put those
thoughts in the back of my headfor many years and went about
school and college the way thatmany of us do. I also describe
(01:49):
myself a little as a failedphysician. My degrees are in
biology and chemistry. I'vetaken the MCATs twice but never
hit the apply button formedical school. Ultimately, I
ended up taking on a sort ofsales business development
position after school. It allstarted to come together for me
when, personally, things creptback into my world. I began
(02:12):
working for a company calledEvercare in 2007. My role there
was a blend of their hospicedivision and some of their ISN
nursing home division. Inparticular, I was living a
couple of days a week with mygrandparents, believe it or
not, commuting back and forththrough the state between my
(02:35):
home base and where mygrandparents lived because we
had two offices as well. What Ihad learned by living with my
grandparents at that time washow broken our healthcare
system was for seniors. Mygrandfather had advanced
(02:57):
Parkinson's, and my grandmotheron the other side of my family
had early-stage Alzheimer's.
Living with them for a coupleof days a week while working at
Evercare was glaring for me,and I really wanted to do
something about the brokenhealthcare system we found
ourselves in. While atEvercare, you sometimes stumble
into roles earlier in yourcareer and start to think, "I
(03:17):
can do more than make a livinghere." In 2010, I ended up
accepting a position withCareMore Health, which today is
an acquired subsidiary ofElance or Anthem Health Plan. A
(03:40):
t the time, that's really whenI began to do something about
the broken healthcare system. Ijoined CareMore back in 2010,
where we were launching variousspecial needs products
throughout the Southwest andultimately across the country.
I ended up spending 11 yearsthere, primarily supporting
their "Touch" program, whichwas their benefit plan and care
(04:02):
model specifically designed forseniors living in long-term
care and senior housingsettings. Since that time, I
spent 11 years there, and inthe last three or four years,
I've mostly been at privateequity or startup-type
companies, similarly supportinghomebound, home-limited
patients, and those living insenior housing or
hard-to-access, hard-to-engagepatient populations.
Lisa McCracken (04:36):
Fascinating background. I mean, obviously,
you were living it personallyand professionally too. I think
a lot of folks would stillagree that we've got a broken
system, but I like to thinktoday we're going to talk about
some glimmers of potentiallyshifting that broken system and
how we get there as anindustry. There's the provider
(04:58):
side of things, then there'sthe customer side, which is a
whole other conversation aroundthis. I do want to spend time
talking about value-based care,but I also acknowledge that for
a lot of people, it's a veryintimidating topic. Trying to
understand it can getcomplicated quickly. For
somebody like you, maybe not somuch, but for a lot of folks,
it's a challenge. We know we'vegot to understand this and take
(05:21):
a first step to get our armsaround it, but it can be
complicated. To the extent thatyou can, do a little bit of a
101 and level set theconversation. How do you define
value-based care as it relatesto the senior living sector?
What do we need to be thinkingabout and understanding?
Jim Lydiard (05:53):
I think at its core, value-based care is
merely a clinical and financialshift in focus—a focus from
volume to value. A focus onbest care, which organizations
define differently, but I thinkmeans timely, appropriate care
as opposed to simply more care.
Also, when a clinical modelgets further upstream and
(06:18):
builds trust with healthcarerecipients, patients, and
families—especially thepatients we serve in senior
housing—and you root your caremodel in informed consent and
educating patients and familiesalong the way, then care plans
can enact preventive care,usually at a more affordable
site of service, such as theapartment, community, or home
(06:38):
of these patients. Care plansare also able to limit and
avoid unnecessary treatment,futile care, and wasteful care.
This all leads tosavings—savings from what that
disease state historicallywould have expected a health
plan or Medicare to spend onthese sorts of members or
beneficiaries. Ultimately,those savings can be shared
amongst those involved increating that change. That’s a
(07:00):
clinical and financial overviewof how the shift in the care
model yields new ways to fundthis type of service and how
those newfound funds getdistributed.
Lisa McCracken (07:33):
Right. There is the financial component of it,
which I know often gets talkedabout on the operator side of
things, but then there arebetter ways to do it and best
practices. I know a number ofoperators that have gotten into
this space who have also saidthe reality is this type of
care and integrated models arejust a better way to do
business. We see occupancyimprovement, like the stay,
which I don't want to say hasnothing to do with the
(07:56):
value-based care side ofit—it’s a positive byproduct of
that model that can havefinancial returns across the
board.
Jim Lydiard (08:09):
I would argue to a degree, I think it has
everything to do with it.
That's just the nice part ofhow value-based care and senior
housing work in a veryaltruistic way. It's the value
that we collectively unlocktogether, and ultimately the
member and family benefit themost.
Lisa McCracken (08:27):
Right. I want to break down the value-based
care piece with a little morespecificity. I want to talk
about ACOs and MA versions ofvalue-based care. You've seen
both and experienced both. Doyou think one is particularly
more challenging than the otherin generating overall impact?
On top of that, if you're justentering into this, is there
(08:48):
one that's maybe a more naturalway to align? Again, because we
recognize value differently,there are different resource
allocations and levels ofsophistication in these models.
So compare and contrast the ACOand MA versions of value-based
care.
Jim Lydiard (09:08):
Great question.
And, like you, I get asked thisa lot. I would oversimplify it
and say that, in my experience,it's generally harder to build
scale and membership or growthe MA Medicare Advantage form
of value-based care. However,once you grow that population,
that cohort of patients andmembers, there are more levers
(09:30):
to impact success. In contrast,it may be simpler to build
scale and density on the ACOside, where the patient doesn't
have to make a plan change toamass the type of membership
needed to impact a value-basedcare model. However, there are
greater challenges to bend thecost curve in ACO care. In 15
(09:52):
years of supporting and leadingorganizations focused on this
space and these payer riskmodels, I've watched select
markets and MA regions begin toactually generate savings in
less than a year. I'd saythat's fast, but I've seen it.
(10:16):
What I mean by generatingsavings in an MA world is that
care expenditures tend to be85% of the revenue you're
bringing in. Most of ourlisteners thinking about
Medicare Advantage haveprobably heard of the 85% rule.
Usually, anything better than85% MLR means that the product
itself has turned profitable.
Contrasting that with ACOexperiences, I've seen it take
a bit longer in ACOs to hityour stride. Usually, one to
(10:41):
two performance years is whenyou see reliable savings. But
again, it's quicker to grow andamass the membership on the ACO
side, where a plan changedoesn't have to take effect. My
favorite partnership pathoption, if you're a listener
wondering whether to do oneversus the other... Well, the
(11:12):
beauty of many of your marketsis that you might not have to
pick one or the other. You canoften look to a physician group
that partakes in bothsides—both MA risk agreements
as well as ACO-typearrangements. If you form your
opinion at the PCP group level,or the MSO level as it's
called, you can usually flex toboth tracks in a much easier
(11:35):
way. The adoption is easier.
Sometimes members are alreadyaffiliated with these physician
practices, so there's a simplerglide path to growing the
attribution on the ACO side andthe membership on the MA side.
Ultimately, that becomes thelinchpin for successive
outcomes.
Lisa McCracken (11:55):
I would observe that there's been a great
increase in some of thesepartnerships with physician
practices, even coming out ofthe pandemic. I don't have any
stats around that, but is thata correct read or not? I just
seem to be hearing more aboutsome of those partnerships and
alignments.
Jim Lydiard (12:12):
Yeah, I'd say you hear more about it today. Many
of your listeners wouldprobably say that mobile house
call physician practices havebeen serving this space
forever. But much like thesenior housing industry itself,
these practices have becomemore sophisticated as well.
Medicare has had a big role inadvancing more PCP-specific ACO
(12:36):
models and what CMMI has beenable to do. MA plans have also
gotten more sophisticated inhow they want to partner with
physician networks andphysician groups. I think it's
the perfect storm forinnovation, where most people
are seeing physician practicespotentially becoming the
captain of the team as itpertains to healthcare. They
are looking for ways to eithergive risk to those PCP groups,
(12:56):
as Medicare Advantage wouldsay, or give more
accountability towards thosePCP groups, as ACOs would
suggest. If those PCP groupsare doing their job, they are
often the ones that should beon the hook for rendering
savings or losses.
Lisa McCracken (13:26):
Right, it sounds like a natural
partnership. Do you have anyinsights in terms of if I'm a
senior living operator and I'vebeen approached by some
different physician groups onthat, what questions should I
be asking? Are there two orthree things I can do to assess
alignment and determine whomight be a good partner?
Recognizing this is probably acomplicated and in-depth
conversation, I'm sure you havesome insights into that.
Jim Lydiard (13:53):
Yeah. I think maybe a good stat to follow
here is there's just a lot ofnoise in the space. Yeah. I
think I saw a recent articlethat showed that ISNP plans,
(14:13):
which are again MedicareAdvantage products specifically
designed for folks that live insenior housing settings, have
risen from 40 products or so in2010 to like over 175 come
2025. So you're talking aboutbasically almost four times the
number of products that are outthere. And that's just on the
(14:33):
Medicare Advantage-specificside. The ACOs have also grown
immensely. If I was a communityoperator, there's probably a
few ways I'd start that.
That's, I think, what you'regetting at. Yeah. First and
foremost, these groups aren'thard to find. They're all
pushing for growth. What Ibelieve in wholeheartedly is
for these operators to justpause for a moment and make an
intentional decision to get indiscovery mode. T ake meetings
(15:00):
with several large groupslocally, regionally, and
potentially even nationally,because these groups have
timetables with CMS for whenthey can launch into these
markets. Or, if they're just anACO, they have performance
years with timetables on whento announce they're entering a
new market. Also, thesebuildings can easily
cross-reference theiroperational footprint with the
(15:21):
footprints of these plans orACOs. That is not a hard task
and can be done with a quickonline search. A discovery
phase also includes asking notjust what this ISNIP or ACO can
do for you, but asking yourresidents what they want and
what they want donedifferently. Ask your staff
what impact they’re lookingfor, and really immerse
yourself in kind of a truediscovery phase. What you're
(15:49):
ultimately trying to land on ishow your community or operation
can differentiate by laserfocusing on a healthcare
experience unlike any other.
Once you know your vision,you'll know what complements
you need. Phase two of this isall about finding that
complement. Differentiatingthese partnership options is
key. Ultimately, if buildingsare going into this for the
(16:10):
first time—meaning this isn't acase of "we tried this, it
didn’t work, we learned, andnow we're applying it with
partner two"—but rather you'regoing from zero to one, you
need to find a partner willingto create a glide path that
really includes and involvesyou in the foreseeable future.
Operators need to remember thathealthcare is a serious
business. And we've all talkedto these residents. Some of
(16:40):
these residents have had thesame health plan for 30 years.
Some of them have had the samePCP for 30 years. We shouldn't
take this lightly if we'regoing to ask these residents to
commit and align with a novelcare partnership you're
adopting, there's a massiveresponsibility we all have on
our hands. As such, thosepartnerships with ISNP plans,
ACOs, or general MA plans needto be well thought out. They
(17:03):
need to be prepared to endureand not feel flippant to the
end consumer, which means theresidents in your community. In
summary, a thorough discoveryphase, analyzing your gaps, and
interviewing partners to seewho will be the most malleable
to where you are in yourjourney and where you see this
going is essential. Usually,this means a roadmap of year
(17:25):
over year—here's how thepartnership could transform if
things are really winning andworking between us.
Lisa McCracken (17:35):
Right. I think all of those points underscore
the fact that this is acommitment you need to make,
and you need to have more thanjust a champion—champions
internally. This isn't just aquick initiative. This is
really about changing theculture of the organization,
and you've got a lot investedin this. It's about putting in
the time to do it right. Iwanted to talk a little bit
about how you've been in theindustry for a period of time.
(17:56):
You've talked about yourbackground. So, maybe where we
are today versus 10 or 15 yearsago—let's say 2010, when you
began selling value-based carein senior housing. What do you
see as some of the differencesin community operators today
versus then?
Jim Lydiard (18:20):
Yeah, good question. I'd say there are
differences on both sides ofthe coin. There are pros and
cons.
Lisa McCracken (18:28):
Probably
Jim Lydiard (18:29):
Pros and maybe opportunities for
improvement—there we go. On thepros side, when I would cold
call assisted livings back in2010, I would say, believe it
or not, only about 50% at bestwould acknowledge that they
were witnessing improvementopportunities in delivering
better onsite care. The other50% just believed the status of
(18:50):
healthcare in their buildingwas great.
Lisa McCracken (18:54):
Yeah.
Jim Lydiard (18:55):
When you break that down one layer deeper,
from the 50% that were seekingimprovement and acknowledged
there were areas to improve,only a small fraction
understood that value-basedcare was a means to do so. In
2010, a smaller percentageacknowledged the need for
(19:15):
healthcare improvement. By 2024or 2025, a much greater
percentage seems to recognizethis need and appears ready to
take action. The big pro is theknown participation in
healthcare, which is vitalgiven that these residents are
more frail, and wellnessstaffing remains pretty lean,
even compared to 2010. In termsof areas for improvement, while
it’s entirely possible thatbuildings were as overwhelmed
(19:38):
with day-to-day operations in2010 as they are now, it seems
more evident today. When youwalk into these buildings,
executive directors and healthand wellness directors are
often using a dozen to twodozen point solutions to run
their day-to-day business.
(20:07):
Turnover in these communitiesis usually around 100%
annually, from caregivers tomed techs to dining staff, and
all these buildings are stillrebounding from occupancy. The
big difference I see is thatoperators at the regional and
national levels have to bereally critical about what they
want to implement and how theyintend to implement change.
(20:28):
From a behavioral changemanagement perspective, you’re
deciding how much you thinkyour team at the local level is
prepared for. Otherwise, it’sjust going to result in a
series of sloppy launches. Thisdoesn’t just apply to
value-based care orhealthcare—it could be any
number of solutions an operatoris thinking of implementing.
(20:50):
For example, switching up theirEMR, changing their long-term
care pharmacy, and so on. Butyou’ve been in the industry for
a long time. What is yourperspective? You’ve seen a lot
from 2010 to 2025. What areyour thoughts on that?
Lisa McCracken (21:13):
I’m actually surprised when you said that
back in 2010, about 50%acknowledged that maybe there’s
a better way—that’s actuallyhigher than I would have
thought. I think back to 2010and value-based care and
smarter delivery of services.
Gosh, I’m not saying therewasn’t quality care and
services, but I think we’vecome a long way in terms of
understanding value-based care.
(21:33):
If you’re in the industry nowand you’ve never heard of
value-based care, I’d beshocked. Most people at least
have some semblance of what itis. I think there’s also an
acknowledgment that there’s abetter way. Another observation
I’d make is that there’s beenan evolution where much of the
care coordination washistorically focused on the
skilled nursing side. Now, Isee a clear acknowledgment of
the gains and opportunities inupstream initiatives, like
(21:54):
wellness and prevention, whichspan the continuum, starting
with independent livingresidents. We even see it
(22:15):
coming into active adultsettings a little bit with some
partnerships there. There’sreally opportunity across the
board. I see greaterreceptivity to it and interest
in learning, which is a goodthing. However, to your point,
I still think the system isbroken. Tech adoption has been
a good thing and has progressedsince 2010, but it’s mostly not
(22:37):
integrated. That lack ofintegration holds us back. It’s
so frustrating for the staffand everyone you hear about—how
many plug-and-play systemsexist, and yet they don’t talk
to each other. I think that’s asignificant barrier to fully
progressing on this value-basedcare journey.
Jim Lydiard (23:02):
Right. Well said.
Thank you.
Lisa McCracken (23:05):
Do you have an observation in terms of what’s
the one ingredient that mostoften equates to success in
launching some of thesehealthcare partnerships? Any
secret sauce?
Jim Lydiard (23:21):
Yeah. I love this question. I’m sure some
listeners would expect me tohave a real gem here, like the
right payer mix among theresident population, a well
fine-tuned, pre-establishednetwork of preferred healthcare
vendors already in thebuilding, or data and
analytical expertise, or a starED or health and wellness
(23:43):
director. Don’t get mewrong—all those things help.
They do. However, I wouldactually say success, in my
experience, has been rootedmuch deeper. I’ve typically
seen honesty and humblenessamong the buildings as the
prevailing factor. Will thisbuilding agree, implement with
intent, and see this thingthrough? I like buildings that
(24:05):
are willing to call out theirblind spots, ones that desire
change, maybe even ones thatare a little disruptive or
rebellious. What we are doingis making a monumental change
(24:29):
in how healthcare is delivered.
This brand of healthcare ishard. These residents, if you
just look at HCC scores, riskadjustment factors, and how
Medicare begins to add frailtycoefficients to this
population, are two to threetimes as frail as the
traditional Medicarebeneficiary. When you start to
deliver care to them, theyoften have an inherent distrust
(24:52):
in the American healthcaresystem. They already feel it’s
complicated, and sometimes theyfeel as though it has wronged
them. I love buildings that arehumble and honest, willing to
say, "Here’s what we need.
Here’s what we’re doing well,but here’s where our blind
spots are." Those are oftenreally good leading indicators
for success in my eyes.
Lisa McCracken (25:17):
Yeah. I would think that’s necessary because
the reality is you don’t get itexactly right from day one
either. You need to pivot, takea look at what’s working and
what’s not, and figure outwhere you need to evolve and
adjust along the way. Do youhave any stories from the
trenches, if you will—any ofthose humbling stories you’ve
seen over the years?
Jim Lydiard (25:41):
So yes, this is...
Lisa McCracken (25:42):
Without names, no names. Right.
Jim Lydiard (25:44):
Right. This is the part of the podcast where I
tell you how many times I’vefailed over the last 15 years
at this. In all honesty, thiswhole type of work is a series
of failures in a way. We justhope that we learn from those
and can apply them to the nextwin. I’ve got a couple of good
stories that come to mind whenyou ask for examples. The first
(26:05):
one was a lesson in realizingthat not all buildings really
want what’s best for residents.
Lisa McCracken (26:18):
Okay. You’ve got to elaborate on what you
mean by that, which I’m sureyou will.
Jim Lydiard (26:23):
I was probably part of the fastest program to
ever be terminated in a newmarket. Rewind back to 2015 or
so. My program was asked, aspart of a state-based RFP, to
launch in a new market. Thiswas after Anthem had acquired
(26:45):
CareMore, and one of the Anthemsubsidiary products in a new
state had just won a Medicaidbid. As part of that, we were
required by the state to launcha care model like ours in
nursing homes. We set out on anadventure, interviewing about a
dozen nursing homes that housedcustodial long-term care
patients who were now membersof this Medicaid health plan.
(27:08):
We ended up selecting three orfour buildings with a total of
about 180 residents who weremembers of this health plan. We
(27:37):
met with the ownership groupsof the four buildings—there
were one or two owners. We metwith the medical directors of
the buildings and rolled outhow we planned to jump in:
bringing in advanced practiceclinicians or nurse
practitioners, how our backoffice team would assist in
care coordination, and how we’dwork with the communities
already contracted for directadmit to SNFs when they needed
(27:59):
rehabilitation, and Part Bservices when they needed a
lighter version of that, and soon. The launch followed about
90 days of preparation afterreceiving the state’s approval.
We began care, but about 45days into it, we got a phone
call informing us that all fourbuildings had been sold to one
new owner-operator. The newowner-operator took a look at
(28:29):
our early data. Of the 180patients we’d served, they were
used to copious amounts of EDvisits and hospitalizations. We
had nipped that in the bud bybringing in more onsite primary
care and working much moretightly with both onsite and
near-site services. However,what we found with the new
operator group was that theirvested interest was in ensuring
they could send patientsreadily to the ED, enabling
(28:52):
them to turn on skilled daysand get a higher reimbursement
rate from the state. As aresult, we were asked to leave
just 60 days after our arrival,despite providing 60 days of
great care to 180 patientswithin a new clinical model. It
(29:18):
was a very humbling experience.
I remember one of my physicianmentors at the time, George
Fields, who’s now over atMolina, asking me, "Jim, would
you have done anythingdifferently? Would you have not
taken on this challenge andworked to make improvements for
these 180 members?" The answer,of course, was no. But that was
an extremely humblingexperience because we saw the
impact that was possible. Wesaw what we were building, and
(29:42):
yet this new ownership groupwas more focused on shifting
financial priorities than onproviding best-in-class care
for its custodial patients.
Lisa McCracken (29:58):
Well, it obviously reinforces the
importance of goal alignment.
Is everybody rowing in the samedirection and focused on the
right goals at the right time?
Jim Lydiard (30:08):
I've got one more that's, that's a real good
Lisa McCracken (30:10):
Okay. Sure.
Let’s hope that’s a moreconstructive lesson learned
because, quite frankly, that’sdisheartening to hear. But it
reinforces, as I said, theimportance of alignment.
Jim Lydiard (30:23):
Well, you’re asking for humbling stories.
Lisa McCracken (30:26):
Yeah .
Jim Lydiard (30:26):
On many podcasts, we just listen to the wins, but
the hard reality is there are alot of misses along the way
too. This next miss, which willprobably end a little more
lighthearted, is a lesson inhow healthcare doesn’t have to
be so complex. Sometimes thesimplest solutions are the
right solutions. I rememberyears ago enrolling a member at
(30:49):
a memory care facility. Thiswas a low-income memory care
community, one of thosecottage-like setups with 10
residents in six or sevencottages on one campus of care.
I remember this one patientvividly—he was a younger
patient of ours, and thebuilding took a chance on our
referral to them. We referredthis member to the building.
(31:27):
The member moved in, andshortly thereafter, the member
experienced an unavoidablehospitalization due to some
complex interactions withpharmacy needs. The member
spent four or five days in theinpatient hospital setting and
then returned to the building.
Not even 30 minutes after themember arrived, I got a phone
call from the executivedirector of the community. They
(31:51):
said, "Jim, you’ve got to helpus. Mike just got dropped back
off, and we’re going to have tosend him back out." I asked,
"Oh no, how can I help? What’sgoing on? Do we need to send a
clinician out?" The executivedirector, in the most
matter-of-fact way possible,said, "Unless you can get Mike
(32:12):
underwear, we’re sending himback out." I had to pause for a
moment, and my first thoughtwas, "Where’s the nearest
Walmart?" My second thoughtwas, "If I’m ever in a pinch
(32:34):
and not feeling great, should Icall my insurance agent for
something like this?"Nonetheless, I found myself in
line at Walmart buyingunderwear because,
unfortunately, the hospital haddischarged this patient in a
hospital gown and nothing more.
The patient returned to thispoor memory care community,
surrounded by peers andresidents, without any clothes.
(32:54):
All the data science,technology, and clinical
treatment plans in the worldcouldn’t have prepared me for
this return-to-acute-avoidanceissue. It was a humbling
experience—a reminder thatsometimes it’s not about cool
population health data scienceor technology. It’s about
humanism. This guy just neededsome clothing, and the
community wouldn’t send himout. Here we are, years later,
(33:15):
and let’s hope Mike is stilldoing well there.
Lisa McCracken (33:27):
Yeah. Well, it shows the importance of some of
the basics and transitions ofcare, right?
Jim Lydiard (33:33):
Right. And you can edit as much of this out as you
prefer.
Lisa McCracken (33:36):
Oh, I think we’ll leave that one in. It
keeps people engaged. I’m surethe listeners are hooked now.
All right, let’s wrap upbecause we’re coming up to our
time here. I’d love to hearyour thoughts on what other
healthcare trends you have youreye on at the moment. Are there
any that relate to ourlisteners in healthcare and
housing or the intersectionbetween the two?
Jim Lydiard (33:56):
Yes. I’d like to attempt to coin a phrase today.
I think we’re entering into aworld where, previously, there
was healthcare and then therewere these communities more
commonly known as hospitality.
I think we’re entering a worldwhere "health hospitality" is
going to be a thing. And what Isee in the...
Lisa McCracken (34:17):
Not heard that one before. I'm gonna remember
that. Health hospitality, youhave to tell me how to spell
how to spell it then. But goahead,
Jim Lydiard (34:24):
I think the big overarching trends right now
include rural care, which seemsto be a significant focus. Many
companies are starting in thisspace, investing in it, and
selling within it. It’s a bigchallenge for most health plans
and the government, not justregarding healthcare
expenditures but also access tocare for aging populations.
(34:46):
Medicaid is another big themeright now and is, in a way,
having its heyday. Since 2007,we’ve seen a lot of investment
and health plan innovation inMedicare Advantage to support
the space. I feel that samelevel of investment and
innovation is either alreadyhere or on its way for
(35:07):
Medicaid. We’re going to see asignificant expansion of that
as eligibility increases stateby state. I also like solutions
around care navigation,particularly navigation
performed by lay, nonclinicalpeople. Candidly speaking, I
think I’d be a great carenavigator myself. I know enough
about different topics—notdeeply like a clinician—but
enough to help guide a senioror someone with lower health
literacy to better understandand access healthcare
(35:27):
opportunities. Lastly, I thinkbehavioral health is another
key area of focus.
Lisa McCracken (36:00):
Definitely , that was gonna be one on my
list.
Jim Lydiard (36:01):
Yeah, it’s definitely on the rise because
it has gone from beingsomething relatively taboo just
a few years ago to now beingsomething everybody talks about
and feels comfortablediscussing. Generally speaking,
I’m fascinated by the harderproblems in healthcare, the
tougher solutions, and thewinding roads. I think all of
those have a place in seniorhousing or hospitality.
Lisa McCracken (36:28):
Hospitality.
Yeah, that’s a very good one,and we’ll remember that. Like I
said, I’ve got to figure outhow to spell it, but I get what
you’re saying, and I think...
Jim Lydiard (36:37):
Yeah. But again, you’re in tune with all
this—housing, finance, markets.
What are you seeing upside in?
Lisa McCracken (36:43):
Yeah, well, definitely. Behavioral health
and mental health are areas Iwas going to mention. Outside
of cognitive impairment anddementia in Alzheimer’s, I
think these are issues thatoperators are dealing with
every day. The question is,what are the opportunities to
bring forth more solutions andstrategic partnerships on that
front? Quite frankly, it’salready a bit of a crisis. It’s
(37:03):
talked about more now than inthe past, but there’s still
much to address. You mentionedcare navigation, and I think
there’s huge opportunity there.
Even within the senior livingsetting, there’s significant
potential for population healthmanagement in general and for
helping residents and theirfamily members better navigate
the system. With carenavigation, thinking through
(37:39):
the business model isessential. You’ve seen
different organizations bringforth various services and
platforms on thatfront—sometimes they work, and
sometimes not so much. What Imentioned earlier about
upstream initiatives isexciting. It’s great to see
organizations and the sectorpivot from the "sick care"
model to a "WellCare" model andrecognize the opportunity to
make a meaningful impact onresidents across the spectrum.
(37:59):
Those are the things I thinkabout, and I see great
opportunity there. One finalquick question: By 2030, all
Medicare beneficiaries aresupposed to be in a value-based
care arrangement. Is that goingto happen? Yes? No? Is that
aspirational, or do you thinkit’s realistic?
Jim Lydiard (38:34):
I don’t think it’s going to happen—not because of
the Medicare Advantage side ofthat number. I think we’ve seen
what Medicare expected, withmore than 50% of the population
now choosing a MedicareAdvantage plan, which they deem
credible for that stat. I thinkthe issue lies more on the ACO
side. Despite CMMI’s attemptswith not just launching
(38:55):
PCP-related ACOs but alsospecialty-related ACOs—for
oncology, renal care,cardiovascular, and even
pulmonology—we’re not seeing asmuch adoption on the Medicare
side. I think over the next fewyears, we can significantly
close that gap, but my guess isthat by 2030, we’ll still be at
best around 75% to 80% of theway there. That will still be
(39:17):
meaningful. As long as everyonestarts to become more
accountable—through ACOs andrisk populations—the whole goal
of value-based care, which isto bend the cost curve, should
still start to materialize inthe way we intended,
particularly over metrics likeGDP.
Lisa McCracken (39:57):
Right, I agree.
75% to 80% is nothing to beashamed of—that’s significant
progress, for sure. Well, JimLydiard, we appreciate your
time with us today. Jim Lydiardserves as the Chief Strategic
Advisor at Pine Park Health. Heis also a very loyal NIC
volunteer and heads up ourPartnering for Health focus
area committee. We acknowledgeyour constant support of the
NIC stakeholders and yourservice to the industry. Thank
(40:19):
you for being with us heretoday. Thank you, everyone, for
listening to another NIC Chatspodcast. You can access this
podcast and others on ourwebsite at www.nic.org. Thank
you so much.
Jim Lydiard (40:38):
Thank y ou.
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