HCBS PEAK 2014 2 Ben Unkle

Home & Community
Based Services
Peak Conference
J. Benjamin Unkle, Jr. – President & CEO
Daniel J. Nimon – President, WC at Home LLC
Joseph F. Belvedere – Chief Financial Officer
on Chesapeake Bay: Who Are We?
• 33 year-old Continuing Care
Retirement Community
• 441 IL; 96 AL; 95 Nursing Beds
Why did WCCB decide to start home
health, homecare and hospice?
• Quality of Care: Need to control clinical quality of care and
assure positive clinical outcomes for referrals to community
(both on and off campus) A new day: ensuring and proving
• Saw additional revenue growth opportunities and the ability to
diversify revenue stream without bricks & mortar
• Patients already here on campus and WCCB was “giving that
money” to outside HHA’s
• 15 -20 outside/community patients in short stay at NH & saw
opportunity to start home health with immediate volume.
Why did WCCB decide to start home
health, homecare and hospice?
• WCCB was already licensed to provide private
pay homecare services to residents on the
• $400K annual operating loss from services that
were being provided to ILU residents, much of it
without charge
Medication Management
Dressing Changes
Follow-up for all hospital and post acute discharges
ADL Care
How is that working for you?
On-campus services
• $400K losses converted to $150K positive income
in first full year.
• Residents happier to recover in their independent
living apartment from orthopedic surgery.
• More bed space for outside community patients
for rehab.
• Can offer community patients the chance to be
followed by our WC @ Home team.
• Readmission rates LOW: 13% vs. 17% national
Problems/Potential Lessons?
• Need good schedulers, training, coders, and
marketer for off-campus.
• This is NOT a business you can start by hiring one
administrator, hoping it was a good hire and not
watching it continually. Too much can go wrong.
• Highest barrier to entry is talent and knowledge.
• Retail brand risk in failure or poor quality.
• Earning the support of existing residents. WIFM?
Big Picture Strategy
• To provide home health & hospice services to residents
of Westminster-Canterbury on Chesapeake Bay (“Inside
the Gates”)
• To provide home health & hospice services to residents
of the Greater Hampton Roads area (“Beyond the
Gates in Hampton Roads”)
• To assist Faith-Based Non-Profit Organizations with
development and on-going operations of
independently owned home health & hospice services
(Partnerships – Behind the Scenes Support)
How can we touch more people?
(Good idea, but hard to start and
1. Invest in higher caliber talent than we alone can
afford & share talent through partnerships.
2. Leverage size for pricing and quality (value)
3. Bring and learn “best-practices” in a fragmented
4. Help other faith-based CCRCs stay strong and in
control of their campus/mission.
Options for Starting Home & Community
Based Services Program
Advisory Services
Certified Medicare Services
Here today and gone when
the rubber meets the road
Both partners motivated for
long-term success
Double to Triple the
start-up expenses
Higher cost of start-up / Need
to acquire expertise on staff
Lowest cost option for startup
Often Agencies are for sale for
a reason…Why?
No on-going support
Outsourced back-office allows
focus on core business /
healthcare side
Built-in bad habits / culture
Best practices on day one
Best practices on day one and
Chance of acquiring risky
No day-to-day operational
baggage with old license,
assistance or experience
including back Medicare issues
Often forgotten: Continuum
of Care management and
development expertise
What does WC at Home Offer to
Potential Partners?
• Initial Market and Feasibility Analysis
• Development of a Financial Pro-Forma & Cash Flow
Projections based on results of the Market Analysis
• Assistance with Initial Start-Up (policies, offices, etc)
• Selection of Administrator
• Guidance through State Licensure
• Guidance through CHAP Accreditation Process
• Guidance in obtaining a Medicare Provider Agreement
• IT/software selection & implementation
• On-going web-based access to specialized home
health & hospice clinical and financial software
What does WC at Home Offer to
Potential Partners?
• Development and mentoring for clinical staff
• Assistance in developing or strengthening current continuum
of care management strategies at CCRC
• Education of clinical and health information staff regarding
OASIS and proper coding to fully capture $$ from Episodes of
• Provide all billing services for Home Health, Homecare and
Hospice once operational.
• Continued monitoring of clinical performance improvement
to assure positive clinical outcomes
STEP 1: Initial Market and Feasibility Analysis
Current Medicare SNF usage
Current Home Health competition in market
Home Health and Hospice referrals from hospitals
Home Health usage in market
Provider reputation in market
Provider ability to strengthen management of
continuum for referral development
• You can use this whether you hire us or not
STEP 2: Financial Pro-Forma
& Cash Flow Projection
• Utilize Market Analysis to develop a 5 year
pro-forma operating budget
– Referral assumptions to create volume/revenue
– Expenses based on your data and our formulas
– Cash Flow Analysis: initial investment and cash
generation over 5 years
• Presentation to your Leadership Team: a
candid assessment of win/win potential
Step 3: Initial Start-Up Assistance
• Provide operational & clinical assistance and
expertise for:
– Recruitment of Administrator and Health
Information Coordinator – Required start-up staff
– Assist CCRC and/or Administrator with initial office
selection and set-up of IT & software
– Policy and procedure development
STEP 4: Licensure, Accreditation
and Medicare Provider Agreement
Assistance in obtaining state licensure
CHAP (Deemed Status) Accreditation readiness
CHAP Survey assistance and guidance
Guidance with Fiscal Intermediary
Assistance with CMS initial home health application
and guidance through the process
• Obtaining Medicare Provider Agreement and billing
Step 5: Information Technology and
On-Going Software Support
• Recommend initial and on-going hardware needs
• Provide discounted volume based pricing for
software & licenses
• Coordination and installation/configuration of
• Train staff on use of software
• Assign WC at Home staff as primary liaison for
any software “Help” issues that may be
Step 6: Continuum of Care
Management Strategies
• Identify current Continuum of Care systems
• Develop and/or assist CCRC Team in enhancing a
strong continuum of care management strategy
– Identify Medicare SNF, assisted living and independent
living referrals
– Develop and/or provide education to Continuum of
Care Committee RE: home health eligibility
– Assist CCRC with Part B Out Patient issues
– Negotiate pricing with current rehab services provider
and/or assist with selection of home health rehab
Step 7: Billing & Coding Services
• Quality Assurance Audits to assure Medicare
• Provide training for all staff on completion of
OASIS documentation
• Review of OASIS coding to assure proper
reimbursement levels for each Episode of Care
• Serve as conduit for submission of all billing to
third parties (Medicare, commercial
Step 8: On-Going Advisory Services
• Routine on-site consultative meetings with Home
Health staff
– Administrator coaching
– Clinical and Operations Support
• Monthly Advisory Conference Calls
– Clinical Care Review
– Operations Review
– Financial Review
• External review and quarterly reporting on
quality measures, clinical indicators and financial
results to CCRC executive leadership
Timeline Summary
• WC at Home recommends an initial Home
Health start-up followed by Hospice
– Months 1 to 3 - Recruit and train Administrator,
develop policies/procedures, begin enhancement
of management continuum strategies
– Months 4 to 6 – Prepare and receive state
licensure, deploy software and train
– Months 6 to 9 – Prepare for CHAP accreditation
– Months 10 to 12 – Obtain accreditation and
Medicare Provider Agreement
How’s that working for you and for
your partners? Recent Partner
Case Study: Partner
An Agency owned by
two faith-based
• Purchased from a
“Mom & Pop” provider
in 2007
• History of unstable onsite leadership – Focus
problem for CCRC’s
• Not capturing internal
Recent Partner - Services
• Retained to analyze whether agency should even
continue in home health Medicare program
• Based on feasibility study, WC at Home was
contracted to provide:
– Assistance with development of a strong continuum
management program on each campus
– clinical expertise and billing services
– IT infrastructure and software
– Interim leadership
How’s that working for your partner?
• Tripled the episodes/cases.
• Positive margins for its owners.
• Clients are happy.
Offers over 100 years of combined
healthcare experience with our senior
leadership team
Dan Nimon
Serves as President of WC
at Home, LLC. Dan has 27 years of
health care operations
experience and excels in
reimbursement and continuum
management. He has been
involved in the start-up and
operations of 3 separate home
health organizations in
Waterville, Maine,
Lynchburg, VA, and Virginia
Beach, VA.
Joe Belvedere
CFO. Joe has
10 + years of multi – site
home health financial management
in addition to 25 +
years of corporate financial
management experience. Joe was
responsible for 7 owned
home health & hospice offices and
4 affiliated organizations
with operating revenues in excess
of $40 million annually.
Sally Huston, RN, MSN
Sally serves as Sr. Director
of Clinical Services and Operations.
Sally is an RN with 30+ years of
healthcare management
experience, having most
recently served as Corp. V/P of
Clinical Services for the past
10 years with the same
organization as Joe Belvedere.
Sally has also been a consultant for
CHAP and is very experienced with
home health & hospice standards.
Heather Elsner
Heather serves as Director
of Health Information and
Reimbursement. Heather
has 10 + years
experience with home
health coding and billing,
having served as the
Corporate QA Coordinator
for Senior Independence in
Ohio prior to joining the staff of
WC at Home. Heather is a
Certified Healthcare Billing Coder.
The Future???
• Who believes the cost/price affordability
squeeze will go away?
• Who believes we will not have to demonstrate
provable quality outcomes?
• Who believes that procedure-based health
care payments are coming back?
• Who worries about keeping overall margins
healthy to stay in control of our missions and
So, what are we going to do about it?
• Hunker down and ignore it all?
• Trust our high service levels and the niceness
of our staff will justify higher and higher fees?
• Look for BOTH new revenues and economies?
• Remember, every year we make new lifetime
promises to a new set of older adults.
• They are depending on us to stay in control
and deliver what they bought!
at Home, LLC

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