Value-based care is a hot topic in the industry and Alan Fairbanks brings an operator’s voice to the table as he joins Serviam Care Network as President to lead the initiative.

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Listen to Alan on BTG Ep. 88.

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Welcome to season six of Bridge The Gap, a podcast dedicated to informing, educating, and influencing the future of housing and services for seniors. Powered by sponsors Accushield, Aline, ProCare HR, Hamilton CapTel, Service Master, Patriot Angels, The Bridge Group Construction and Solinity. And produced by Solinity Marketing.

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Lucas 00:52

Welcome to Bridge the Gap podcast, this Senior Living podcast with Josh and Lucas. A great topic on today centered around value-based care and the value-based movement that's coming into the industry. We want to welcome our guest today, Alan Fairbanks, the president at Serviam Care Network. Welcome to the show.

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Alan 1:10

Thank you. Great to be here.

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Lucas 1:12

Alan, it's great to see you again. Actually, we had the opportunity to meet you a number of years back. I believe it was the NHI symposium in Nashville. We had a great time and a great time hanging out and getting to know you a little bit better. It's great to see you back. You recently transitioned over as President at Serviam. Please update us on that transition and kind of what some of your initiatives and goals are before we jump into the value-based movement.

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Alan 1:39

I made the decision to transition into Serviam. I've been doing a lot of work for Serviam. As many of you probably know, Bickford was one of the founding members of the Bickford was one of the founding members of the Serbian Care Network. And I've been doing this for 35 years now. And what I've come to realize is, as an industry, we're really at a significant crossroads right now with what's available to us when you think about value-based care and some of the initiatives in and around value-based care. And what I felt was for me to really have a more meaningful impact on this industry and to be a voice for operators, this was an opportunity that I just couldn't pass up and had to to really lean into and felt like it was my opportunity to give back to the industry. At the end of the day, an industry that I love dearly and care a lot about. And ultimately from the operator standpoint, giving a voice for operators as it relates to value-based care was ultimately why I chose to make the decision to transition into Serviam Care Network.

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Josh 2:49

Well, this is exciting and I'm really excited not only for our listeners, but for myself to talk to you a little bit because this is brand new. There has been a ton of conversation, value-based care, the hot topic over really the last year or two. We've had some of these conversations on our network, but our audience represents the industry well in that we have the largest operators listening all the way down to the "mom and pops" throughout the industry. The smaller operators that have from one community on up. And value-based care is something that I think we're all trying to wrap our heads around of how we position our teams, our communities, our services, to be in that movement. And so if you could frame for us just a little bit about value-based care and what some of the goals for you are early on, maybe in this first year or two with the Serbian Care Network.

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Alan 3:53

You're right, you cannot go to a conference today, right? And have 75% of the conference being discussed as value-based care. So it is certainly a hot topic, everyone's talking about it, but what I feel happens is everyone's talking about it, but no one's really talking about it from the frame of an operator. And as an operator, how do I access value-based care? What does it mean and what is my opportunity as it relates to value-based care? So one of the things, first and foremost, is helping operators understand what value-based care means. And for me, ultimately, to break it down in its simplest terms, it's, as an operator, I have a mechanism and a way to begin to get paid for the outcomes that I'm producing. If I do a really good job as an operator and taking care of seniors in their home in a proactive way, doing a good job with decreasing hospitalizations, decreasing ER visits, and creating value for the healthcare system as a whole, and the spending that goes on in the healthcare system, then I, as an operator, ought to be able to get paid for that work that I'm doing.

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Alan 5:11

And ultimately, that's what I believe the value-based care is - is a way and a mechanism for us as operators to get paid for the work that we're already doing and the outcomes that we're producing. So for me, the biggest opportunity and way to do that is to produce and have a platform that operators can step into, can lean into that creates these outcomes, and then an on-ramp for senior living operators to be able to enter into that. And ultimately, as I said, get paid for the work that we're doing. And that's what we're creating at Serviam Care Network, is that on-ramp, that vehicle for individual operators. If you're an operator of one community and one location, or if you're an operator of multiple communities, we have a platform and a mechanism for you to be able to enter into value-based care and access some of the benefits that value-based care creates for us as operators.

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Josh 6:09

Alan, that seems very encouraging because everything you just said, I would say 99.99% of the operators that I talk to, regardless of the size of their community, you can, even hear Lucas, the senior living fan, he can't get away from his phone. I mean, it's just nonsense.

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Alan 6:29

That's somebody calling in right now asking a question about value-based care. I didn't know this was a dial-in show.

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Lucas 6:34

It's already happening. It's coming.

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Josh 6:36

I mean, I can't take this guy anywhere, but this is extremely encouraging. I know for our listeners, it's encouraging to me because like I was saying, probably the majority, the vast majority of the people listening right now are saying, Hey, you know what? That sounds like me. I've been working for years. I've been focusing on reducing hospital admissions. I've been working on quality outcomes. We're kind of already in that business. But in an industry that's been getting crunched and taking some hard knocks, you're saying we're already in a good position and providing a lot of these services. What we have to figure out is what are the steps to actually monetize this? What are the steps to actually get paid for what we're already doing? If I'm hearing you correctly, there's a way to do that and part of what you're creating is a platform for that. Can you tell us a little bit more of what are some steps that you take to get to that point?

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Alan 7:31

Let me backup a little bit because I think what actually has happened and why this is becoming so accessible and so available to us today really goes back to Covid and all the crap that we went through as an industry, right? As it relates to Covid. And I think coming on the backside of Covid, what that has ultimately created is a willingness for operators to collaborate and cooperate and work together in such a way that I've never seen again in the 35 years that I've been doing this. I think operators are more and more willing to lean in and work together in a collaborative way, much more so than they ever have post Covid. And I think that certainly is a positive. I think that's been something that's been needed in this industry for a long, long time. So ultimately, when you think about that platform, what we're creating is a strategy that is focused in regional markets, in individual states of creating an alliance, an alliance of operators that are working together.

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Alan 8:41

We at Serviam will hold that alliance. We will go and get in relationship with the payers and on behalf of those individual communities, those individual communities will work with us as the alliance. They'll contract with the alliance. We will go out and we will find those payers. We will hold that risk, both upside and downside risk when you talk about value-based care and getting in relationship with those payers to give access to that risk for those individual communities. Because when you think about value-based care, some of the real benefits come when you know you're producing the outcomes and then you're able to go at risk for some of those dollars. If you're an individual community, you don't have the capital, you don't have the access to be able to go and get in relationship with payers because payers aren't interested in single communities. So what we are creating is an opportunity to create scale and density with multiple communities in individual locations, individual regions, which will get the payer's attention. And then on behalf of those individual communities, we as the alliance will get in relationship with payers and then share in those funds with those individual communities as they produce outcomes. We think that's a model that can be replicated, multiple locations, over and over again. To me, it's the best way for individual and small operators to access value-based care, because at the end of the day, scale and density is what is what's going to drive so much of this. And many of us as operators don't have the ability to do that because we just don't have the size. We're giving the opportunity for that with our alliance strategy for individual operators to be able to access value-based care.

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Josh 10:30

Well, that is exciting. And I'm sitting here putting my small operator hat on and I'm thinking, so you're telling me there's a chance. And so we have an opportunity in front of us, but I'm also now thinking, "Gosh, I bet there's a checklist. I bet there's some criteria that right now I can go and look at my team and say, 'This is what we need to get in place in our operations, in our community to make sure that we're ready to join a network like this.'" Is there any kind of cheat sheet you can give us to make sure we're ready for this?

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Alan 11:08

The biggest thing is the data and understanding the data that you need to have as it relates to hospitalizations, ER visits, reduction in falls, length of stay, all of those things are extremely important to payers. And when you think about a checklist, that's the beauty also of what we as an alliance will bring to those individual operators. We're not just going to say, "You're a member of the alliance." We're going to have individuals working locally as Serviam Care network employees in those local regions to help come along beside those operators. We'll help you understand, we'll give you technology to operate in a value-based care world with an operating system that does that. We'll be side by side with you teaching you how to operate that system to make sure that we're producing the outcome. Because what we want to make sure that we do and what's extremely important in any value-based care relationship is the outcomes. And I'm not willing to take the chance that, "Hey, it is just going to be okay. Join the alliance and let's hope for the best." We're going to come along beside those operators. We're going to have an operating system that's going to help them navigate the value-based care world. We'll be right side by side with them, teaching them that so we know we're going to get the outcomes because the last thing you want to do as an operator, as an alliance is go at risk without a known outcome that you're going to be producing. So we want to know we get the outcomes, make sure we're getting those outcomes, and then you step and move into partial risk step and move into full risk with Medicare dollars, which is where I think the true value is. There's a lot of things going on out there about care coordination fees and shared savings, and those are a great way to enter into the value-based care space. In my opinion, before it really becomes meaningful, you have to be able to get access to the risk and be willing to enter into a risk type of relationship before it really gets truly meaningful from an economic standpoint. And at the end of the day, who truly benefits from value-based care is the resident, because that's where the outcomes are coming, is through improved care, improved proactive care, and we're moving into more of a well care system, a healthcare system, getting out of the sick care system that we're living in today.

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Lucas 13:33

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Josh 13:49

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Josh 14:10

It seems to me with all the conversation, the energy, what you guys are doing, what the industry's talking about, this is a train that's kind of already leaving the station, maybe it's already left the station. As a community leader, you need to be thinking about getting on board with it. Is this the future of senior housing and you're going to have to be a senior living operator to be part of that? Or is this something where this is going to kind of divide the industry from those that are in value-based care and those that aren't? Do you have anything in your crystal ball that would give some indication of that?

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Alan 14:48

As an operator, you are going to be doing value-based care by the year 2030, whether you know it or not. Whether you're going to actively participate in it and get paid for those outcomes or whether you're just going to be a bystander because every one of the physicians that you're going to be working with in your community is going to be in a value-based care system. CMS has drawn a line in the sand and they've done this in the past, but I I believe they're serious about it this time that every single physician that works with a Medicare resident by the year 2030 will be in a value-based care relationship. So when I look at that, when I think about that as an operator and as an industry, we just as well embrace this and find a way for it to benefit us all, both economically, but again, ultimately at the end of the day, it's going to benefit the residents because you're going to be in a value-based care relationship, whether you know it or not, in every one of your senior living communities.

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Josh 15:44

So for the types of communities that would be eligible or probably the best candidate for this, obviously our industry, when we say senior living, the first question I always ask is, "What kind of product, what kind of services are you delivering?" So we've got the independent types of communities with a lot of flavors there, some coordination of services, some not so much. Assisted living all the way through your memory care communities. Does this stop on the acuity spectrum of independent living communities are not going to be part of this and this is just for assisted living memory care and above? Or is there an opportunity to get involved in this at every level?

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Alan 16:24

There is absolutely an opportunity to get involved in this at every level. When you think about a payer, they're probably going to be most attractive actually to the independent living because they would rather get "access" to those individuals earlier in the process, right? To be able to help to navigate their care and create savings early in the process. So if you're a CCRC, if you're a 28 apartment assisted living or everything in between, value-based care is something that is available and is an opportunity for all of us in this industry.

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Josh 17:00

Probably my last question, I got to give Lucas some space here because I know he's itching over there.

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Alan 17:05

He's still on the phone, man.

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Josh 17:07

Yeah, he's taking calls right now. We'll get back to him. From the time that, say I'm an operator, I hear this and I'm like, "I've got to get involved." What is kind of your timeline from let's get involved, let's get part of a network like this, and to the time that you actually start experiencing, let's say, payment for services, what does that look like? Is that months? Is that years? What are the process milestones?

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Alan 17:38

We're creating alliance strategies in specific states and in those specific states as an operator, we're creating opportunities for you to enter into an alliance day one. What we're going to provide is technology. We're going to provide preventive technology to help provide and create outcomes at no cost to the provider. And we're going to monitor that, watch that for a year, look at what those outcomes are. And then by year two is when you can start to expect to receive payments for the outcomes that you're producing. And then by year three and four, when we move into more and more risk, those payments will increase significantly over a period of time. But it's a stair step approach. You don't just flip a light switch, "Oh, I'm doing value-based care." It's more of a dimmer. I mean, you step in, you enter into it, you begin to monitor your outcomes, monitor your data, what you're producing, what you're doing from an outcome perspective, and then you move into maybe some partial risk, a little bit more risk, and then you can move into full risk.

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Alan 18:41

Now there's opportunities and value-based care for you to, as an operator, if you never want to get into the risk world, you can certainly do that. I mean, you can live in shared savings, you can live in care coordination fees, but my belief is that's accessing just the very tip of the iceberg of what value-based care could be available to you if you stay in that space. The shared savings gets harder and harder and harder every year, and those dollars are going to shrink. And the care coordination fees aren't really significant, in my opinion, to begin to move the needle from a revenue standpoint in individual communities. So what we're offering is that opportunity to get access to upside risk without ever being exposed to any downside risk and contributing capital to be an owner of a special needs planner to that effect. So I think what we're offering is a great entry level for communities to be able to access some of the great benefits of value-based care without some of those downside risks that are associated with it.

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Josh 19:46

Wow. Lucas, today seems like the day our listeners are hearing this message, they got to get started. You're in communities of every size and shape, every day of your life, all over the country. I can see you running with a flag down the hallways, just telling people they got to get on board with this.

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Lucas 20:06

I definitely will be. I'll be in a conversation with somebody. I'll say, "Hey, have you talked about value-based care? I just had a great conversation with Alan. You should check out our show." Fun fact. So this episode is actually 288, so 288 for our flagship weekly show. Alan, was on episode 88, 200 episodes ago. So I don't know how that coincidence really lines up with the math. But a fun fact for our listeners, I know that this is a conversation we have just scratched the surface and I know our listeners are going to want to connect. We will make sure, Alan, that we connect your information in the show notes. Our listeners can also go to btgvoice.com. They can download this episode if you want to read the transcript and take this to your teams, that's also available at btgvoice.com. Connect with us on LinkedIn. We'd love to hear your comments about this topic and how it's affecting your day-to-day operations. Alan, thank you so much for spending time with us today.

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Alan 21:05

You bet. It's been great. I'm all about creating value for operators on an operator at heart, and that's why I am doing this and that's why I'm going to continue to do this, is to be the voice of an operator in this value-based care space because I think that's what this industry truly, truly needs is an operator's perspective of value-based care.

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Lucas 21:24

Excellent way to end the show today, and thanks to our listeners for listening to another great episode of Bridge The Gap.

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21:30

Thanks for listening to Bridge The Gap podcast with Josh and Lucas. Connect with the BTG network team and use your voice to influence the industry by connecting with us at btgvoice.com.