Post-Acute Care in the Post Health Care Reform Era: Increasing Relevance, Responsibility and Risk

An Interview with Benjamin Breier, President and Chief Executive Officer

Sea changes are occurring in every aspect of health care. The post-acute sector is certainly no exception. We spoke with Kindred Healthcare CEO Mr. Benjamin Breier to get his take on how Kindred and post-acute care at large are navigating and even leading these changes.

PULSE: The theme for our conference is The Innovation Game: The Race between Entrants and Incumbents. As one of the larger, more seasoned organizations in the space, what are your thoughts about how incumbents are innovating the post-acute care sector?

BEN BREIER: One of the things that we really see happening is that many of them are starting to expand and diversify their service lines. They are doing this in order to become strong partners to payers, to health systems and to physician groups, to all of our referral sources. A lot of post-acute companies are getting into multiple lines of business.

Incumbents are also testing what I would call new value- based purchasing models. In order to do that kind of testing they have to invest in technology, a lot of technology that both helps with the analytics but also helps to improve patient care. This helps to move information from one setting to another, or multiple settings, and at the end operate more efficiently.

PULSE: In what ways is Kindred an entrant, or in what ways would you like Kindred to be an entrant?

BREIER: Looking at the evolution of our company over the last couple of years, we actually have become an entrant in multiple different lines of business. For example, we did not have much capacity in the home health and hospice space inside of healthcare delivery. So, last year we went out and acquired the largest home health and hospice provider in the country in Gentiva in order to become an entrant into that market.

We now have the base of businesses that we want to be in. What we are now trying to do is take this diverse set of businesses and figure out how to operate them more collaboratively, not just up and down the verticals that they are reimbursed and regulated, but on more of a horizontal way, in an integrated and Continue the Care fashion.

By delivering integrated post-acute care, not just in a nursing center, but from an LTACH to an IRF, to home health, to hospice, to all of the things that we are involved in, we are acting as an entrant. We are trying to be an entrant into the coordinated care population health management universe. And that’s not specifically in going out to acquire a business, but it’s in taking all of our businesses that we’ve been incumbents in for so many years and really reworking them into a new value proposition.

PULSE: What entrants are you seeing that are making the biggest impact in the post-acute care sector?

BREIER: There are a lot of companies that call themselves quote, unquote, “care coordinators” or “navigators.” These third- party information-driven companies are trying to leverage themselves into the post- acute space as a new entrant as someone who can talk to insurance companies and referral sources and say if you use our information or our algorithms, we can help you manage costs more efficiently by putting your patients or your residents into the lowest cost setting. We’re seeing a lot of that in the post-acute space.

I would point out that they don’t actually own any of the provider networks. They don’t actually provide any of the care. And if you look back over the last 20 years of healthcare, there’s been a lot of these navigator type companies that have come, that have flashed, and then gone. We’ll see if any of these survive in the long haul.

PULSE: What are the major influences or pressures that you are experiencing from other stakeholders in healthcare that are driving you to innovate?

BREIER: There’s a lot of discussion and new policy and new reimbursement around reducing readmissions back to hospitals and certainly within a 90-day episode. Our Kindred care settings are really proving to be a strong partner to hospitals and health systems because of the work we’ve done around our low re-hospitalization rates. One of the great values that we drive is in our ability to keep pushing patients into lower acuity settings, drive readmission rates lower and get people returned home faster. One of the ways that we’re doing this is by implementing lots of technology in new ways across our continuum to reduce average lengths of stay, to reduce some of the friction costs in and around healthcare, and to get people home faster and keep them home.

In addition to that we’ve developed what I would call a comprehensive patient care centered model that really allows us to consistently improve our quality and our clinical outcomes in order to be the strong solution.

PULSE: As value networks develop, whether in response to ACOs, bundled payments, integrated delivery networks or other factors, how is Kindred seeking to position itself in a way that allows them to stay competitive?

BREIER: Over the last number of years Kindred has developed lots of relationships and partnerships with some of the nation’s premiere hospital and health systems and other healthcare organizations to establish a comprehensive and coordinated care network. Kindred has been at the forefront really in testing new payment and new delivery models. We’re currently participating in some of CMS’s innovation center supported models, including things like our bundled payment demonstration. In 2014 we became an owner and a strategic partner in the Silver State Medicare Shared Savings Program ACO, which covers the lives of almost 20,000 Medicare patients in Southern Nevada.

We’re also implementing innovative care models that seem to be having a positive impact in preventing hospital readmissions, improving clinical outcomes and getting people home faster.

PULSE: What are the biggest threats or challenges for post- acute care providers, and which component or components of the post-acute care spectrum face the most risk?

BREIER: There’s a lot of opportunity but there are certainly a lot of risks in what we do. First, just from a policy perspective, we spend a lot of time in Washington talking to policymakers about the kind of care that we provide, and we find ourselves caught up in the wash of things like budget discussions and policy debates, sometimes really having nothing to do with healthcare delivery at all.

But sometimes policymakers, in an effort to come up with short-term financial solutions, use the Medicare program to help pay for punting the football down the road. Having said that, this last budget that was just passed raised some of the domestic spending caps and essentially gives us some clarity through 2017. But when we think about the regulatory and the reimbursement side of the world, there are certainly lots and lots of risks involved there.

On the other hand, just from a payment perspective, we certainly keep our eye out on what’s happening in and around private enterprise. The consolidation that’s occurring on the managed care side of the world is continuing to drive payer power. We certainly worry in the post-acute world about whether or not we will get commoditized and be forced to take prices well below what we think it costs to deliver quality of care.

That’s why we have at Kindred continued to focus on scaling our own company. We think size and scale and innovation help us meet some of the changes and some of the challenges that we see, both in the public and the private sector.


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Benjamin A. Breier

President and Chief Executive Officer at Kindred Healthcare, Inc.

Benjamin A. Breier is the President and Chief Executive Officer of Kindred Healthcare, Inc., one of the largest providers of healthcare services in the United States. Mr. Breier has served as President of Kindred since 2012 and was named Chief Operating Officer in August 2010. Mr. Breier previously served as Executive Vice President and President of Kindred Healthcare’s Hospital Division from March 2008 to August 2010 and as President of Kindred’s Rehabilitation Division from August 2005 to March 2008.

Prior to joining Kindred, Mr. Breier served as Concentra, Inc.’s Senior Vice President of Operations and Vice President of Operations. Before joining Concentra, Mr. Breier served as Director of Operations at Premier Practice Management, Inc. He joined Premier as Chief Operating Officer in January 1997 and became Chief Executive Officer in June 1998. Premier Practice Management was a subsidiary of Premier, Inc., the largest hospital group purchasing alliance in the United States.

Mr. Breier received his bachelor’s in economics from the Wharton School of Business at The University of Pennsylvania and holds an MBA and MHA from the University of Miami, (Fla.)

Mr. Breier currently serves on the Board of Directors of Kindred Healthcare, and the Federation of American Hospitals. Mr. Breier is a member of the Business Roundtable and the Wall Street Journal CEO Council.

In August 2015, Modern Healthcare magazine named Mr. Breier one of the 100 Most Influential People in Healthcare and in September 2010, Mr. Breier was also named by Modern Healthcare magazine to the 2010 “Up & Comers” list, which recognizes rising young leaders aged 40 and under who are making a difference in healthcare. In March 2015, Louisville Business First named Mr. Breier the Health Care Leader of the Year.

Christian PeñaComment