LeadingAge Magazine · March/April 2013 • Volume 03 • Number 02

The Well-Rounded Provider: Excellence Marries Reinvention to Thrive in Changing Environments

March 03, 2013 | by Debra Wood, R.N.

The latest in our series on long-established providers that are changing to create the future of aging services.

Changing demographics and health care reform are offering opportunities and challenges to organizations willing to reinvent themselves while remaining focused on their history, mission and values.

“We are looking at doing a better job of what we do,” says David Perdue, board of trustees chairman of A.G. Rhodes Health & Rehab in Atlanta, GA. “We will continue to strive for excellence within the existing walls.”

CenterLight Health System in the Bronx, NY, formerly the Beth Abraham Family of Health Services, continues on a similar quality path within its historic “walls.” But its officials expect more care will take place at home and are rapidly expanding its community-based and managed-care offerings. Of the more than 14,000 people CenterLight serves, for example, only 1,200 reside in nursing homes.

“We are a provider, an insurer, and we did it by realizing we had all of these skills and evolved to where we are today,” says Michael R. Potack, CenterLight board chairman. “We see caring for people in the broader context of the deinstitutionalization of the elderly.”

A.G. Rhodes has served its community for more than a century, starting in 1897 as the six-bed Hospital of the Atlanta Circle of the King’s Daughters and Sons to care for patients suffering from incurable diseases. With the building in disrepair, officials approached Atlanta businessman Amos G. Rhodes about making a donation to repair the roof. Instead of putting money in the dilapidated structure, the furniture entrepreneur provided land and funds for a new building, completed in 1904 and still used by the renamed A.G. Rhodes Health & Rehab.

Rhodes’ great, great grandson, Perdue, now serves as chairman, following in the footsteps of his father, grandfather and a great uncle before him.

“The chairman has always been a family member of A.G. Rhodes,” says Albert Blackwelder, CEO of A.G. Rhodes Health & Rehab. “This continuity has enabled the organization to remain true to its mission for 110 years.”

In years past, the male board of trustees oversaw finances and strategic planning and the female board of managers made hands-on decisions, signing checks, taking curtains home for laundering, and hiring and firing nurses. Now the trustees have grown, become more diversified, and taken on fiduciary and operational responsibilities. The managers remain involved, consulting with staff about activities and other resident-care issues.

In the late 1960s, the trustees engaged a for-profit management company, and the organization expanded to 415 beds at three skilled nursing and sub-acute and outpatient rehabilitation facilities. At the end of 40 years, the trustees re-evaluated the direction of A.G. Rhodes and realized a need to focus on the future.

The trustees consulted with Kathy Bremer at BoardWalk Consulting in Atlanta, who assisted in completing an analysis of the organization. The board considered three options. The organization could sell or lease the homes and use the profits for charitable good or run the facilities.

The board ranked what mattered most, Bremer says. Superior care for patients and families and superior care in the long-term ranked highest. That led to the decision to become internally managed.

“During our strategic planning, we considered our options for the future and were able to finally identify and understand the true monetary value of our charity,” Perdue says. “Because of our history of good management and nonprofit status, we have been able to provide a tangibly higher level of care. We realized the long-term value of our focus on people and mission, rather than profit or bottom line. We also recognized the great value in our focus on the ‘family,’ be it family of residents, staff or generations of volunteers.”

While A.G. Rhodes has changed, the board and leadership remain committed to taking care of not only its residents but also its employees. The organization employs rehabilitative therapists and does not contract out those services. A.G. Rhodes tends to pay more than its competitors and offers benefits, including paid retirement. Many staff members have worked at the facility for more than a decade. Some nursing assistants have cared for residents for more than 40 years.

“They do this not because it’s a job, but a calling,” says Blackwelder.

Deke Cateau, administrator at the Atlanta campus, credits the investment in people and their longevity with the organization for A.G. Rhodes’ success.

“The family-oriented leadership in our Board of Managers and Board of Trustees trickles down,” Cateau says. “Employees feel they are part of the A.G. Rhodes family. We are a community.”

For the past decade, sub-acute rehab has gained prominence in the patient mix, and A.G. Rhodes has forged ahead with inventive rehab programs, including Wii-based movement therapy; a rehab pool, with an underwater treadmill and lift equipment; and a therapeutic garden, with raised planters and a stocked pond. Patients plant and harvest vegetables. They also can practice with adaptive devices to adjust to walking on different levels of surfaces.

A.G. Rhodes leaders continue to be innovative and are willing to try new things.

“We have a drive to stay relevant and not become a dinosaur,” Cateau says.

Committed to operating the facilities, A.G. Rhodes’ board realizes the organization must continue to evolve to thrive in today’s health-care environment. Perdue expects the new governance structure will increase the opportunities for alliances with other entities.

“We have to align ourselves with hospitals and health systems and with whatever forces are pulling together in the post-acute continuum,” Blackwelder says. “We are also looking to differentiate ourselves by our not-for-profit status. And we have to be ready to accept payment through accountable care organizations (ACOs). We have to firm up these relationships now.”

The exchange of electronic data will be key in ACOs, and in that regard A.G. Rhodes is ahead of the game, having had electronic health records for a decade. Interconnectivity still must take place.

A.G. Rhodes has worked with Emory University, with faculty serving as medical directors, but Blackwelder said those relationships must be hard-wired. At its Cobb facility, a hospitalist from WellStar Medical Group will become medical director and a nurse practitioner will work full time at Rhodes’ campus.

“They are working the strategic plan and looking at constant improvement, constant innovation and being on the cutting edge with partnerships, technology and the care they are offering,” Bremer says. “It’s a new day that reflects the value and mission of what has always mattered to that institution.”

CenterLight began serving older adults in 1920 at Beth Abraham Nursing Home and has evolved with the changing health-care environment, seizing opportunities and staying ahead of the curve.

“We were going with the flow and then decided to go faster than the flow,” Potack says.

Potack credits CenterLight’s success with staying aware of the organization’s surroundings, strengths and changes in the health care marketplace, and then following trends. The 15 board members bring different expertise and each serves on one or two committees. The full board focuses on strategy, and once the board makes a decision, he says, management is free to implement.

The board decided last year to bring all of its entities under a common name. The organization had grown organically and through acquisitions. But none of those organization’s names had recognition beyond the local community, so it came up with a unifying name—CenterLight Health System—and began a rebranding program.

“The CenterLight name reflects our core philosophy—to keep patients at the center of all we do and to be a guiding force in what is often an overwhelming health-care delivery system,” says Mike Fassler, president and CEO and a nearly 30-year employee of the organization.

“By uniting our services under a common brand, we can demonstrate our ability to provide a full spectrum of long-term care services, which is important for competitive reasons given the current market landscape in New York State,” Fassler says. “In addition, we are streamlining our internal processes, core business functions and technology platforms to create an enterprise approach to operations. From a clinical perspective, this allows us to continually measure and enhance the quality of care our patients receive because we can rely on evidence-based data and proven outcomes.”

CenterLight not only delivers patient-centered care, it also pays for those services as a managed health plan.

“That aligns the incentives,” says Joseph M. Healy Jr., CenterLight senior vice president/chief operating officer for managed care. “If we do a good job of keeping them healthy and safe in their homes and communities, it’s good for them. And, it’s also good for business from an insurance perspective.”

CenterLight began its Program of All-Inclusive Care for the Elderly (PACE) in 1985 and soon grew it to one of the largest PACEs in the country. PACE involves managing risk, so CenterLight expanded on its knowledge and experience with that program to branch into offering managed long-term care plans. It now covers more than 11,000 members and continues to grow.

Although CenterLight set a strategic goal to expand in the managed-care marketplace, the state’s decision to redesign its Medicaid program and transition fee-for-service recipients into managed-care plans offered the opportunity to swiftly ramp up enrollment.

Healy indicates in 2010, CenterLight aimed to double enrollment in three to four years but has accomplished that within two years and is now in the process of tripling its initial enrollment. Overall, CenterLight’s membership grew 48% in 2011 and 54% in 2012.

Potack estimates about 150,000 people in the New York metropolitan area are eligible for programs. About half are affiliated with a managed-care plan, and the other half will affiliate with an organization within the next 12 to15 months due to Medicaid reform and mandatory enrollment.

Members range from needing basic services and socialization to others who require live-in help. Rates are set on an average, and CenterLight has developed tools to ground care plans in accepted standards and evidence-based principles. It reassesses the plans every six months and whenever a significant change occurs in the member’s life.

“We need to ensure we are providing everything a patient needs but not beyond that,” Healy says. “We have to focus on the patient and figuring out how to minimize back office costs to make sure we can survive within the cost pressures and that more dollars go to the care of the patients.”

CenterLight uses its size to negotiate purchasing discounts and enjoys economies of scale associated with administrative expenses. Care teams also work collaboratively across the organization. Managed-care members may be enrolled in CenterLight’s adult day program or reside in or receive sub-acute care in one of its nursing homes.

“We’ve been working across business units to figure out better ways to provide better care, more cost effectively,” Healy said. “If we think differently, oftentimes we can come up with new and better ways to do things.”

Clinicians also collaborate with other providers in the community and allow members to stay with an existing physician or home-care agency, while CenterLight develops new relationships, which has grown its referral base and improved care continuity.

“We can provide services that support and complement the physician’s practice and help ensure patients have a greater chance of following the physician’s recommendations,” Healy says.

Potack predicts organizations joining the managed-care movement will move to the front of the pack and must champion the cause of coordinating care and assuming risk. If not, outside insurers will seek out the low-cost provider and turn residential long-term care into a commodity, a difficult spot in which to operate successfully. Therefore, he says, long-term care organizations must push forward to become a major player and assume the financial risk.

“Anyone getting in the way of this is stepping in front of an 80 mile per hour locomotive,” Potack concludes. “That’s where the future is. The push for that to happen is dramatic. It’s critical you are ahead of the curve on this.”