Jeff Bevis Out at FirstLight: ‘I Still Have a Lot of Fuel in the Tank’

Home care veteran Jeff Bevis founded FirstLight Home Care with his son, Devin, toward the end of 2009. A decade later, his tenure as the franchise giant’s top executive has come to an end.

On Nov. 17, FirstLight’s board of directors informed Bevis that “they wanted to go in a different direction,” the former CEO told Home Health Care News. The decision was effective immediately.

“I had a surprise meeting with our board,” Bevis said. “And they decided they wanted to go a different way than what I would like to see, what I would have liked to continue.”

During his time as FirstLight’s CEO, Bevis helped lead the home care company through a long list of challenges, including the ongoing COVID-19 pandemic and a difficult labor landscape. At times, that leadership meant embracing emerging technologies while also refining new revenue streams such as Medicare Advantage (MA) and employee-assistance programs.

Other noteworthy initiatives that Bevis helped drive include FirstLight’s push to convert independent home care operators into its franchise system. The company’s first independent conversion came in September 2019.

A spokesperson for FirstLight confirmed the leadership change on Thursday.

“We are grateful for Jeff, as he led FirstLight through its first decade of growth,” the spokesperson told HHCN in an email. “We wish him well in his future endeavors. With a rapidly changing industry, FirstLight is positioned to move aggressively, seize pertinent opportunities and take the company to the next level.”

Currently, the Cincinnati, Ohio-based FirstLight has 120 owners operating across 200 territories in 38 states, with another 20 territories in development. Its three-year average growth rate is 74%, according to the 2020 Inc. 5000 list.

As of Thursday, FirstLight has not named a replacement for Bevis, who hopes to continue working in the home care space.

“I do have some non-compete limitations that are fairly narrow,” Bevis said. “But I’ve already had discussions with people contacting me from home care-technology [organizations] that do remote patient monitoring and telehealth — the types of services that are not home care-specific. I think I still have a lot of fuel in the tank.”

The franchiser is in the process of conducting a CEO search.

“We have a strong leadership team and interim management committee in place who are deeply committed to creating the best possible future for the company and our franchisees,” the spokesperson said. “We are committed to our culture of care and are positioned for significant growth as we head into the next decade and beyond.”

Looking back

Bevis and his son registered FirstLight in December 2009, then started franchising the following spring. Instead of following the normal template of opening a flagship location to showcase success prior to selling franchising rights, the co-founders dove right in, Bevis said.

“We started from scratch, as crazy as it sounds,” he recalled. “We just had an idea, a concept. We kind of broke the franchising rule of normally having an operating location first, which serves as your proof of concept.”

Devin Bevis remains in his FirstLight role of executive director of franchise services, according to the company’s website.

After setting up shop, FirstLight expanded to 19 locations in its first full year. Originally, the plan was to have a concentrated footprint in the Midwest, but that plan didn’t play out as expected.

“We thought we would have a Midwest footprint, but our first franchise was awarded in Florida,” Bevis said. “So that put that whole theory out the window.”

FirstLight grew steadily over the next five years, expanding to dozens of locations in several states. Last year, it even expanded into Canada.

Apart from its history of innovation and commitment to franchisee satisfaction, it’s that track record of growth that Bevis is particularly proud of.

“The growth has been solid from the 2010 start,” he said. “We didn’t have the weaknesses or the issues with peaks and valleys, which is what you typically see in some franchise systems. They’ll have like two to four years of fast growth, then a ton of closings because they were just trying to sell franchises as fast as possible.”

Prior to co-founding FirstLight, Bevis held an executive role at Comfort Keepers from about 2003 to 2007. After helping grow Comfort Keepers to about 600 units, he left when the organization changed ownership.

He formed FirstLight after doing international consulting work related to home care.

“I thought, you know, there’s really still more to be done in the home care space,” Bevis said. “I’ve been a caregiver four times in my life, so that continuing experience led me to feel like I could get back in the industry and make a difference.”

‘So much potential ahead of us’

There’s a lot to like about home care and where the industry is headed, Bevis said, but there are still plenty of frustrations. One of the biggest for him is how home care remains somewhat on the outside of health care looking in, even after proving its mettle during the COVID-19 pandemic.

“There’s still the ongoing perception of home care being the [odd man out],’” Bevis said.

Another point of frustration has been how home care agencies have had to fight for every inch of ground gained with third-party payers. Bevis hopes that will change as more Medicare Advantage (MA) plans embrace in-home care and social determinants of health as part of their supplemental-benefit design.

Overall, at least 920 plans are participating in the “Special Supplemental Benefits for the Chronically Ill” MA pathway in 2021, an ATI Advisory analysis of Centers for Medicare & Medicaid Services (CMS) data shows. Broadly, that pathway allows MA plans to offer benefits focused on anything that helps chronically ill individuals stay in their homes and out of the hospital.

“Back in 2003, we were saying, ‘Oh, gosh. Wouldn’t it be great if CMS recognized the benefits of home care?’” Bevis said. “Now we have at least a little bit of that, with CMS sticking its toe in the water with supplemental benefits. I think that’s going to speed up.”

On top of payer-related challenges, the home care industry must find ways to better navigate the labor landscape, he added, especially as agencies compete with higher-paying employers in less demanding job sectors.

Standing behind consistent industry quality standards will also be important moving forward.

“Home care has so much potential ahead of us,” Bevis said. “I think a big part of the future will be industry standards, trying to get more [operators] to accept or adopt quality standards.”

Although Bevis is leaving FirstLight, he’ll remain a minority equity holder, he noted.

“I certainly wish the brand all the best,” Bevis said.

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How a unique patient identifier gets health plans closer to interoperability

Health plans have been fighting against inaccurate member data, incomplete member profiles and duplicate records for years. Without a watertight way to keep track of patient identities so health data is reliably linked and accessible across multiple services, payers can’t always be confident that the record in front of them matches the member they have in mind.

The pandemic has brought this into sharp focus: positive COVID-19 test results aren’t always following members from service to service, and as the vaccination program rolls out, knowing who has had the disease and who has been vaccinated could be difficult to monitor.

As health data expands exponentially and the need to share and connect member records becomes more urgent and complicated, the challenges facing health plans will only grow. Could a unique patient identifier (UPI) be the answer?

4 member matching challenges that health plans could solve with a UPI

1. The healthcare ecosystem lacks 21st Century Cures Act data coordination

The lack of integrated systems to transfer member data securely contributes to safety issues, payment delays and potential audits and fines. Over a third of denied claims for health systems result from inaccurate patient information, costing them  at least $6 billion per year. While this would seem not to impact the payer, the inability to properly link claims to members could lead to an inability to understand the risk represented by the members being covered. Or worse, an inability to anticipate and monitor trends in members health and provide proactive healthcare options.

A unique patient identifier can connect the dots between different parts of the healthcare ecosystem so duplicate and incomplete member data can be detected and eliminated. With a more complete picture of who a member is, health plans can make decisions based on accurate information and exchange data safely and securely. There’s a far lower risk of acting without knowing about recent treatment or test results, or communicating using the wrong address (or even to the wrong member).

2. Healthcare providers have outgrown traditional matching tools

With the volume and variability of health data to be matched, traditional matching tools are no longer fit for purpose. For example, an enterprise master patient index (EMPI), which links all versions of a patient’s record across several facilities, may seem reliable. However, by relying on a single source of demographic data, EMPIs likely replicate errors and outdated information, and may combine records for patients who share certain demographic information (for example, if two patients have similar names and the same date of birth).

Instead, payers should consider a matching solution that combines member roster information with comprehensive third-party reference data. Member records are matched using referential and probabilistic matching, and connected using a UPI. This gives health plans a more complete picture of their members, built on reliable health, credit, and consumer data sources, and allows all parties to understand the person at the center of it all.

3. Discrepancies in member data make care coordination impossible

Members may use different names or nicknames, their address may change, and they may even share a Social Security Number (SSN) with someone else. How can health plans help to coordinate care if they’re not sure they’re tracking the right member?

A single electronic health record (EHR) can follow the member throughout their healthcare journey with a UPI, so health plans can be confident that the person on the phone or in the office matches the record on screen. They can monitor and respond to gaps in care, allowing them to better coordinate care for better patient health, improved member engagement and money-saving operational efficiencies.

4. Members present to multiple facilities, inhibiting care plan tracking

How can health plans reliably track medication adherence, especially when members present to multiple locations? Is there really a gap in care, or did the member just attend a different facility? And if members go to different pharmacies, how can a pharmacist be sure the prescription is going to the right person? All of this can create risks to patient safety and increased costs for payers.

A UPI can help. Experian Health has teamed up with the National Council for Prescription Drug Programs (NCPDP), which sets standards for pharmacy services to exchange electronic healthcare data. A framework has been built for a UPI-based patient matching solution that the entire US healthcare network can use. Not only will this improve patient safety, it’ll minimize staff time spent on reconciling incorrect records, thus boosting financial performance too.

When it comes to mismatched records, prevention is better than cure. With a Universal Identity Manager, health plans can have confidence in the accuracy and security of the data they’re using and sharing, promote patient safety, and improve staff productivity.

Contact us to learn more.

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Home Health Therapy Utilization Increased Under PDGM, New Data Suggests

The Patient-Driven Groupings Model (PDGM) has finally been around long enough for there to be some legitimate and meaningful data.

The COVID-19 crisis has obscured some of the numbers, but the home health world is finally gaining a clearer picture on what kind of impact the new payment model has had since its Jan. 1, 2020, implementation.

One of the major revelations, industry insiders noted during a Tuesday webinar hosted by BlackTree Healthcare Consulting, is that therapy utilization has not suffered nearly as much as originally anticipated.

“I think one of the myths as we headed into PDGM was that therapy utilization was dead,” BlackTree Managing Director Nick Seabrook said. “And that is clearly not the case. We’re still providing therapy at a high amount — almost half the visits under PDGM are still therapy visits.”

King of Prussia, Pennsylvania-based BlackTree Healthcare Consulting provides billing, OASIS and other support services to home health and hospice agencies, as well as skilled nursing facilities (SNFs). 

The data that the consulting firm dove into during its Tuesday webinar came from January 2020 through October 2020.

Overall, therapy visits actually increased slightly on 30-day claims billed during that span, jumping from 3.39 therapy visits per episode in 2018 to 3.56 therapy visits per episode in 2020.

PDGM wasn’t the only factor expected to drive therapy utilization down in 2020. Some experts believed the COVID-19 pandemic and restrictions around “non-essential services” would similarly lead to therapy cuts, especially for home health patients residing in assisted living communities and other long-term care facilities.

Encompass Health Corp. (NYSE: EHC) even opted to restructure its therapy workforce’s compensation in Q2 2020 due to COVID-19 disruption.

But based on the data available right now, utilization decreases did not happen on an industry-wide scale. In fact, there was a bigger decrease in non-therapy utilization than there was in therapy utilization. 

“The percentage of therapy visits compared to the overall visits actually went up in Year 1,” Seabrook said. “[Exactly] 45.9% of visits under [the prospective payment system] were therapy. Under Year 1, that was 46.8% of visits.” 

“That was one of the more shocking stats that we uncovered from the data analysis,” he added.

At the beginning of the public health emergency, this outcome looked highly unlikely. As agencies were adjusting to PDGM amid the COVID-19 crisis, it looked like there could be dire consequences.

“We probably saw a lot more effects of … the COVID crisis than we did with the inception of PDGM,” Diana Kornetti, president of the American Physical Therapy Association’s (APTA) home health section, told Home Health Care News in July. “That was like the double whammy, like the other shoe landing.”

Yet later on, there were anecdotal reports from therapists that suggested things may not be as bleak as they were presented earlier in the year.

For instance, many therapists gained power back in some areas to set visits strictly based on how the patient presented themselves in person, Dr. Monique Caruth, the CEO of Fyzio4u Rehab Staffing Group, said on a recent webinar hosted by HHCN.

“At the beginning of the year with PDGM, we were being questioned when we put visits at twice per week for four weeks, for instance, or three times per week for four weeks,” said Caruth, who is a therapist herself. “We had clinical managers sending back messages saying, ‘We have to be careful because of PDGM.’ And then COVID hit. Then it went back to giving the therapist control of determining frequency.”

COVID-19’s effect on home health made it hard to distinguish what PDGM did to therapy utilization overall. Even with more data to consider, it’s still tough to tell what the effects of either were on utilization.

But the data presented during the BlackTree webinar did seem to paint a much brighter picture than expected. And it’s possible that the public health emergency threw a wrench in the plans of agencies that had planned to reduce utilization across the board in 2020.

“I think it becomes a crisis mode [reaction], and then a standard is set that we’re going to do one visit in person and then one telehealth visit during COVID, for instance,” Cindy Krafft, the owner and founder of Kornetti & Krafft Health Care Solutions, said on the HHCN webinar. “And we know that patient care does not work well as a one-size-fits-all. I think, sometimes as therapists, we dig in our heels about what we think our frequency should be, just because it’s what we’ve always done, too.”

LUPA struggles

Low-Utilization Payment Adjustments (LUPAs) were a major pain point for providers early in 2020, and the data presented by BlackTree showed that it continued to be a struggle.

“I think one of the immediate impacts that COVID had was a huge spike — depending on region — in those LUPA numbers,” Seabrook said. “And one of the questions that we had was if we were going to start to see this number normalize and see a big trend going downwards.”

The overall number for LUPAs through October was at 8.9%. CMS was expecting a LUPA rate at around 7% in 2020, internally believing home health providers would find ways to briing that number even lower.

“Well, the opposite happened,” Seabrook said. “Now again, some of that impact is going to be due to COVID.”

LUPA numbers varied based on a lot of different factors — region, types of patient and periods, among others. But broadly speaking, LUPAs are still something providers were having a tough time managing through October.

“I think one of the main takeaways is that … this is probably an area that we’re still trying to wrap our arms around as an industry, in terms of how we can best manage these patients and best manage these LUPA thresholds,” Seabrook said.

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Top Home Health Trends for 2021

“Nobody knows what the future holds” has been one of the biggest lessons learned during the COVID-19 emergency.

But even as the home health industry plays its part in responding to new infection spikes across parts of the country, it has never been more important to stay ahead of the curve. To remain competitive in coming months and beyond, agencies must identify the key trends that will help or hurt their businesses.

Yes, the coronavirus will continue to shape home-based care in 2021, especially when it comes to technology adoption, policy and outside investment. The Patient-Driven Groupings Model (PDGM) will likewise come back into the spotlight.

Each January, Home Health Care News tries to predict some of the top trends for the coming 12 months. That task may never be more complicated than it is right now.

Investment in home-based care will reach new heights.

This prediction probably goes without saying, but investment in home health care will reach new heights in 2021, with interest driven by private and public payers alike.

Prior to 2020, home health operators spent years trying to explain the value of their services to private payers and Medicare Advantage (MA) plans. Despite those outreach efforts, most providers have still struggled with non-competitive rates and strict limits around utilization.

But to keep high-risk populations healthy, payers had to increasingly turn to home health care during the COVID-19 emergency, giving providers an improved bargaining position. In one success story, for example, LHC Group Inc. (Nasdaq: LHCG) was able to grow its non-Medicare episodic admissions by about 35% in 2020, with the majority of those admissions coming at a Medicare-equivalent rate.

“Last year, we had been more engaged with our payers than ever before,” LHC Group President Joshua Proffitt noted at a recent investor conference.

In a November survey of 76 health plan executives from CareCentrix and KRC Research, 97% of respondents said they believed more care at home is better for both their organizations and their members. A similarly high percentage said they believed treating members at home is more cost effective than facility-based care.

As more private payers invest in home health care, “total cost of care” will become the most important metric for providers to track.

From a public perspective, federal and state-level policymakers will also aggressively search for new ways to invest in home- and community-based care. That could simply mean allocating more money for home health agencies as part of the annual payment update, but it could also mean updating post-acute care policies to shift more patients away from skilled nursing facilities (SNFs).

“The tragic devastation wrought by the coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” CMS Administrator Seema Verma said in a September announcement. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”

Along with payers, private equity groups will maintain their laser-sharp focus on home health investments in 2021.

There will be a turf war over the home.

More money flowing into home-based care and a brighter spotlight will naturally breed more competition. As a result, traditional home health agencies will need to find their footing in a new, more crowded ecosystem.

The hospital-at-home model is a good example of this idea.

In response to acute care capacity challenges, the U.S. Centers for Medicare & Medicaid Services (CMS) launched a new hospital-at-home waiver in late 2020, granting hospitals “unprecedented” flexibility to care for patients in the home setting.

As of Jan. 13, there were at least 80 hospital participants in the initiative. 

To work, hospital-at-home programs require hands-on care and other services, including remote patient monitoring. In many ways, the concept adds to what home health agencies already do, especially those with a history of caring for high-acuity populations.

The same could be said for emerging SNF-at-home programs.

Moving forward, home health operators will need to make sure they’re not being overshadowed by specialized hospital-at-home or SNF-at-home models. Cindy Krafft, owner and founder of Kornetti & Krafft Health Care Solutions, said it best during a recent HHCN webinar.

“I’m not a fan of ‘hospital at home’ or ‘SNF at home’ as a designation or evolution,” Krafft said. “I think home care is home care, and it doesn’t need to be ‘another setting came to your house.’ We’re already there. As we look at what other models can do for managing different types of patients, I think we’ve already shown what we can do.”

It’s not just hospital-at-home and SNF-at-home models. Seemingly countless home-focused health care startups are popping up, too, with in-home urgent care models particularly gaining lots of attention.

Home health operators have fought long and hard to “own the home.” In 2021, they’ll need to fight for that ownership.

Patient-acuity levels will continue rising, forcing agencies to become more specialized.

There is a common misconception that home health agencies only treat younger patients in relatively stable, good condition. That hasn’t been true for a long time.

First of all, individuals who utilize home health services are older than the broader universe of Medicare patients. Roughly one out of every four home health patients is over the age of 85, while just 10.9% of the overall Medicare population is over that age, according to the 2020 Home Health Chartbook.

At the same time, nearly half of all home health users suffer from five or more chronic conditions, such as asthma, arthritis, diabetes or heart disease. Just 22.4% of all Medicare beneficiaries suffer from that many chronic conditions all at once.

Home health users are additionally more likely to live alone and have two or more functional limitations.

These and other statistics reflect the high-acuity profile of most home health patients. In the wake of the COVID-19 pandemic and hospitals rushing individuals back home to preserve capacity, that profile is only growing more acute — and that’s a boon for providers.

“Where I see the most acceleration going forward is in higher-acuity home care,” Susan Diamond, home care business president at Humana Inc. (NYSE: HUM), told HHCN in December. “Physicians are starting to embrace the delivery of hospital-level and skilled nursing care in the home. In the past, physicians were more inclined to refer a patient to a facility setting.”

To keep up with rising acuity, home health agencies will need to become even more specialized, with dedicated programs addressing respiratory health, wound care, heart health and more.

Fortunately, PDGM gave many operators a head start.

Policymakers will take a sledgehammer to the traditional home health benefit.

The home health benefit under Medicare has been as rigid as a slab of concrete. But health care thought leaders are starting to chip away at that block in recognition of home health providers’ versatile capabilities.

At one time, home health care was a service people received after leaving the hospital or another institutional care setting. Today, home health agencies regularly help their patients stay out of the hospital or a SNF in the first place.

According to the most recent data on Medicare discharge patterns, roughly one-third of home health episodes are preceded by an institutional stay. That means two-thirds of all home health episodes — the vast majority — come from the community.

Home health care isn’t just becoming more “pre-acute.” As previously noted, it’s also becoming “more acute” — and an important cog in the hospital-at-home and SNF-at-home machines.

In 2020, the Medicare Payment Advisory Commission (MedPAC) started to reimagine the home health benefit to reflect this wider spectrum.

“I think one of the interesting challenges of home health is that it seems to be evolving into multiple types of care,” MedPAC commissioner Amol Navathe, co-director of the Healthcare Transformation Institute at the University of Pennsylvania’s School of Medicine, said at a December meeting. “We’ve heard already that there are developments in hospital-at-home, how many of the [alternative payment models] models like bundled payments are starting to shift patients from SNF to home health, which perhaps means that the acuity of patients in the home health care setting is also evolving, to some extent.”

With more attention on in-home care than ever before, policymakers will look to take a sledge hammer to the existing rigid home health benefit.

It may not happen in 2021, but soon the home health benefit will look very, very different. 

The age of telehealth will finally begin.

“I don’t think that the telehealth toothpaste is going back into the tube.”

“Telehealth visits are powerful tools that can help keep our patients and our employees safe.”

“We need Congress to amend Medicare law to directly authorize fair payment for the delivery of telehealth services under the home health benefit.”

These are just a few of the quotes HHCN gathered in 2020 touting the value of telehealth and virtual visits.

Despite the tragedy and devastation brought on by the coronavirus, the public health emergency accelerated the pace of home health innovation by a decade. To preserve personal protective equipment (PPE) and minimize exposure risks, operators across the industry have turned to telehealth with resounding success.

LHC Group, for example, went from about 176,000 telehealth and virtual visits in the first quarter of 2020 to more than 261,000 in Q2. The Los Angeles-based American Homecare Health Services used telehealth to help grow its patient census by about 10% while operating in one of the biggest COVID-19 hotspots in the country.

For the most part, this home health shift has been financed out of agencies’ own pockets. As things still stand as of January 2021, Congress has not yet given CMS the green light to directly reimburse for in-home virtual care.

But that may soon happen.

In October, U.S. Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.) introduced the Home Health Emergency Access to Telehealth (HEAT) Act, a bipartisan bill to provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during the COVID-19 pandemic and future public health emergencies. A companion bill was also introduced in the House.

While neither piece of legislation has made it out of committee, this kind of common-sense issue is the perfect bridge for a deeply divided government. In light of the recent Washington, D.C., turmoil, lawmakers will want to quickly show American voters that they can still work together — and there’s no better, nonpartisan way to do that than by passing the HEAT Act.

Once that happens, it will be arguably the most important domino to fall in ushering in a new age of telehealth.

That ‘historic’ M&A activity we predicted for 2020? It’s still coming.

Two years ago, home health M&A experts believed the implementation of PDGM and changes to Requests for Anticipated Payment (RAPs) would lead to a “historic” number of transactions. Smaller agencies wouldn’t be able to survive all the cash-flow disruptions coming at one time, they speculated.

Well, that wave of deals never really materialized. New operational flexibilities, government stimulus money and other COVID-19 lifelines created a “sugar high” for some of the operators that may have otherwise sought to exit the market.

Now, 2021 will be the year that 2020 was supposed to be, Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow told HHCN in December.

“The disruption from the implementation of PDGM and impact from the reduction (and in 2021 the full elimination) of the RAP was largely mitigated by Cares Act funds that helped to support the broader health care space,” Kusserow said. “Once the Public Health Emergency is over and there is no more Cares Act or additional government support, the impact that we thought we would see in 2020 will play out in 2021 – fewer players with more market share.

There have already been signs of that playing out as the industry has stabilized from COVID-19’s impact.

Overall, the fourth quarter of 2020 saw at least 17 deals for home health assets, data from M&A advisory firm Mertz Taggart shows. That’s the most home health deals in a single quarter since Q3 of 2018.

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