Humana Enriches More Executives

Strange Tony,

Humana CEO Bruce Broussard sold company stock before Christmas as did thirteen other executives.  Broussard received $21.7 million for his shares.  Broussard's stock sale is 4.6 times more than the $4.7 million Kindred contributed to employee 401(k) retirement accounts in 2018.

Humana enriched former Homecare Homebase Chief Operating Officer Tom Maxwell when it announced it would buy specialty hospice pharmacy provider Enclara Healthcare.  Maxwell is an Enclara board member and owns healthcare consulting firm Maxwell Healthcare Associates.

Over a year ago Humana influenced the Kindred at Home board to go with Homecare Homebase.  Maxwell Health Associates assisted our hospice with its Homecare Homebase  go live.  Maxwell consultants ensured staff was not be paid fairly for hours worked or miles driven.

While valuable staff members were laid off Tom Maxwell made big money from Kindred at Home's conversion to Homecare Homebase.  He will make big money again when Humana closes the Enclara deal.

Two former Medicare Chiefs are directly involved with Humana/Kindred at Home or Enclara.  Obama Health Reformer Nancy Ann Deparle will profit handsomely in her role as founder of financial rapscallion Consonance Capital.  Bush II Medicare Chief Tom Scully owns a chunk of Kindred at Home via financial rapscallion Welsh, Carson, Anderson and Stowe.  He will make massive profits when Humana buys the rest of Kindred at Home from Humana at grossly inflated prices.  Broussard once worked for another Welsh Carson affiliate, U.S. Oncology and traded Concentra with WCAS as Humana's CEO.

Kindred Hospice workers toil under bad management and ineffective computer systems.  The spoils do not trickle down to the people doing the billable work.  Workers vote with their feet daily by leaving.  Executives have neither eyes to see or ears to hear.  They do have fingers to count their earthly gains which remain on this planet when they receive God's final judgement.

Anonymous

Toad Kicks Off "Gather Your Own Straw" Program

Strange Tony,

The day after Thanksgiving First Senior Regional Executive Vice President Toad introduced Kindred at Home's latest executive initiative to our hospice.  The mandatory meeting occurred on Black Friday.

FSREVP Toad:  "Our new program is based on a story from the Bible, one Kindred at Home executives and our investor dominated board discussed in a retreat.  As a group they asked 'How can we be more like that guy?'"

Employee #1: "Jesus?"

Toad: "Nope.  Think Old Testament.  Any guesses?

Employee #2:  "Moses?"

Toad:  "No."

Employee #2:  "David?"

Toad:  "Guys, it's the Pharaoh!  I'll read the verses that moved senior executives and our board of directors:"

Pharaoh gave this order to the slave drivers and overseers in charge of the people: ⁷ “You are no longer to supply the people with straw for making bricks; let them go and gather their own straw. ⁸ But require them to make the same number of bricks as before; don’t reduce the quota. They are lazy; that is why they are crying out, ‘Let us go and sacrifice to our God.’ ⁹ Make the work harder for the people so that they keep working and pay no attention to lies.”¹⁰ Then the slave drivers and the overseers went out and said to the people, “This is what Pharaoh says: ‘I will not give you any more straw. ¹¹ Go and get your own straw wherever you can find it, but your work will not be reduced at all.’” ¹² So the people scattered all over Egypt to gather stubble to use for straw. ¹³ The slave drivers kept pressing them, saying, “Complete the work required of you for each day, just as when you had straw.” ¹⁴ And Pharaoh’s slave drivers beat the Israelite overseers they had appointed, demanding, “Why haven’t you met your quota of bricks yesterday or today, as before?”

Employee #1:  "Since we don't use straw in caring for hospice patients what is it executives want from us?"

Toad:  "We want you to complete the work required of you each day.  We demand you meet productivity quotas established by top leadership.  Straw is symbolic of whatever barrier you face in getting your daily work completed."

Employee #2:  "How can you hold us to higher productivity standards after management eliminated key positions and gave us systems that hurt productivity?"

Toad:  "Straw!  You have to find your own.  It's your responsibility to figure it out.  The plan is to build institutional resilience from the ground up.  Employees are the bricks."

Employee #2:  "That makes no sense given the extra work management added.  We spend more time scheduling.  I have to wait for my work to be scheduled so I can actually do it.  I spend hours now entering my time and mileage in order to be paid correctly.  That usually doesn't happen so I spend hours figuring out how the company shorted me and how to resubmit time and mileage."

Toad:  "What you described is the work required of you every day.  Get 'er done."

Employee #3:  "There aren't enough hours in a day to do what the company expects."

Toad:  "Time is straw.  Straw is time.  Make your own."

Employee #4:  "Under Kindredlink it took me two hours to prepare for IDG.  Homecare Homebase increased that to a full eight hour day.  That's time eating, not time saving."

Toad:  "Homecare Homebase was a strategic decision made by our board of directors, the same people who admire and emulate Pharaoh.  Your personal inefficiency is very concerning.  I will make a note of it and ask your direct overseer (DO) to beat, (clears throat) verbally berate you."

Employee #4:  "Why did I open my mouth?"

Toad:  "Any more questions on this new exciting executive initiative?  Seeing none, I'd like to turn it over to the people in charge of ensuring this program is a success.  The Bible calls them slave drivers but executives call them Area VP's and DCO's."

Employee #1 (under their breath):  "We call them Mean Girls."

Mean Girl #1 (looking at Employee #1):  "Speak up if you have something to say..."

Employee #1 slinks down in their chair.

Mean Girl #1 (pause):  "Nothing?  Didn't think so.  (shifts gaze to whole group)  You guys must be so proud.  Your hospice is the first to pilot the "Gather Your Straw" program.  I am so honored FSREVP Toad selected one of my hospices to start this exciting effort.  Our fantastic Director of Clinical Operations is here to help you, so I will turn it over to her." 

Mean Girl #2 DCO:  "It's all about the employee experience which you now get to live 24 hours a day, seven days a week, although we only pay you for 40.  As of today all nurses are salaried and hourly employees are prohibited from submitting overtime.  If a employee submits overtime they will be disciplined for not using your time, straw, effectively.  That discipline could result in termination.  (Staff groan)

Toad:: "Gather Your Straw" puts you in charge of solving your own problems, so solve away."

Employee #3:  "Can we have our time here not count against our productivity measures?"

Toad:  "I'm afraid that's not possible.  Any meeting with an executive like myself is considered optimal use of your time by the company.  Remember the whole company is looking at this hospice.  You'd better perform.  Executives are counting on you."

Employee # 2 (spoken under their breath):  "for their giant paydays while we break our backs."

Toad:   "I would like to close with a prayer asking God's blessings for abundant admissions, census and margin.  Is a chaplain willing to do that?"

None volunteered so we exited the meeting room deflated and diminished.  It was the Blackest of Fridays.  We'll see how many more leave the toxic wasteland fouled by Humana/Curo.  The Bible says they will reap what they've sown  Lord, deliver us from evil.

Anonymous

Toad Returns to Head Up New Executive Initiative

Strange Tony,

I learned that former Vice President Toad has rejoined Kindred at Home to head up a new program.  He and the Mean Girls will be at our hospice site soon to kick it off.  I understand we are the pilot for this new executive program.

Toad left shortly after the buyout by Humana and two financial rapscallions.  At Mednax he helped trash a vibrant culture.  That makes him a perfect fit as Humana/Curo decimated our hospice over the last year.

I am curious what mendacity Toad and his Mean Girls will foist on our already stressed to the max site.  Lord, give us strength and peace in the coming maelstrom.

Anonymous

Humana CEO on Kindred at Home Q3 Earnings Call

Strange Tony,

Do you have any insights for me on what this guy is saying?  Humana CEO Bruce Broussard highlighted Kindred at Home in an Q3 earnings call on 11-17-19:

At the core of our strategy is interoperability, which facilitates our relationship with our provider partners, while simplifying the experience of our members. Recently Humana Pharmacy developed what we believe is the first clinical decision support fire integration in production between a payer and a provider via their clinical workflow. Our partner Signifyd Health is now using our OneMedList in connection with an in-home assessments, giving them the ability to confirm in real time member adherence to their medication and more proactively identify potential adverse drug interventions and drug disease conflicts.

During 2020 we will roll this same functionality to all Kindred at Home and other health care – health home health providers including integration with the new home care – home based system. The integration of technology like OneMedList with Kindred at Home is enabled by Humana's integration with the home care, home-based electronic medical record and practice management system. The integration allows the prescription drug information gathered by the Kindred at Home nurse to become part of the Humana record, ensuring a more comprehensive record and reducing the likelihood of medication errors.

This will accelerate our ability to proactively identify key clinical interventions while improving revenue capture and business and quality reporting.

The Kindred Hospice nurse has to re-enter the complete med list with every re-certification in Homecare Homebase.  As they are salaried and work 50-60 hour weeks the accuracy of the manually re-entered medlist may not be 100%.  That will be uploaded to Humana, who will begin to see the garbage in-garbage out nature of HCHB.  You can't have real time adherence to a medication the patient is no longer taking but remains in the system as a current medication.
 

...when we went into the Kindred investment, we went into it with the view that there would be reimbursement changes in there and those reimbursement changes would not only be rate impacted, but also just the way the business was going to the drivers of the business. And we are very excited about the changes of the reimbursement model, moving to a model that is going to reward more for nursing and reward more for chronic conditions as opposed to just therapy and be more oriented to less chronic conditions. 

So first just the structural changes there we find are very helpful for our member base and then advancing the downstream costs, such as admissions and readmissions in addition complications of particular conditions in total. The second thing is when we constructed the deal and did our forecast, we constructed the deal with knowing that there would be a transition both – that would require operational transition, and in addition, require us from a financial point of view. And so, when we did the deal on it and based on our valuations, we also assumed this particular transition there.

That is one of the reasons why you saw the organization invest in technology in 2019 to be able to prepare for these changes. And I think, if you were sitting in the board room of Kindred, you would also see a number of other changes both from competencies, clinical programs and so on and preparing for it. So I think – the both Kindred and Humana are very active in that evolution.

The third thing is on the just the financial side and I would say that it is incorporated in our outlook for 2020 and the years beyond that. But I do also want to highlight that in, when we were to exercise the put or call it is on the operating performance post that reimbursement change. So it does reflect in the other 60% that we purchased on. So, in summary, we're very excited about the changes as it structurally changes the economics to take on the conditions that we feel are most important for our members.

Secondarily, we have incorporated that in the transaction, both in the operating results that we see over the coming years. But then most importantly, as our – as we move to exercise in the put or call is, it will be reflected in the purchase price accordingly.

Humana will enrich Kindred at Home executives and two financial rapscallions when it buys the 60% of the company it does not own for a 10.5 to 11.5 multiple of EBITDA.  Kindred shareholders got a mere 8x multiple from Humana.

Broussard did not mention how Humana and the Kindred board keep ruining our once nationally recognized hospice.  Curo technology is a Trojan Horse.  Employees are under constant surveillance.  That's devolving.

Anonymous

Big Picture for Kindred at Home

Strange Tony,

Two web meetings addressed Kindred at Home's future under the ownership of Humana and two financial rapscallions, TPG and Welsh, Carson, Anderson and Stowe (WCAS).  The first occurred on November 5th when KAH President David Causby and Hospice President/Curo Health Services founder Larry Graham held a fireside web meeting for employees.

Larry Graham offered information on benefit improvements, saying the company would increase PTO, holiday, disability and HSA funding benefits, while holding health insurance premium increases to a minimum for staff.  Graham did not mention executives reduced most of those benefits for 2019, nor did he say how much of the prior cuts would be restored.  He said the company intended to offer great care by great clinicians.  I wondered when that would start.

David Causby encouraged employees to elect benefits for 2020, as they will not automatically carry forward.  He then said all hospice and home health sites within the company, 787 locations, are live on Homecare Homebase.  The conversion happened in nine waves with 40-50 sites per wave.

He used the words "difficult" and "time consuming" before shifting to the expectation of seeing improved outcomes.  I expect those are financial because HCHB and all the Curo changes made our care much worse.  He expressed appreciation for all the "great work you do, despite distractions."   One regular distraction is the tremendous effort it takes in HCHB to be paid accurately for hours worked and miles driven.  Neither executive mentioned that feature.

Causby talked about November and a number of major events, National Hospice and Home Care month, Home Health Aide week, Veteran's Day and the company's annual marketing blitz "Home for the Holidays."  He spoke of key strategies and the need to grow the business beyond the 550,000 patients and families we serve per year.

David Causby talked about executives not living up to a communication plan and promised leadership communication on video in the future.  He wants to create a family atmosphere, recognized it's been a very hectic year that stressed staff in many ways.  He soft pedaled executives role in the carnage by saying we've "seen a lot of changes/challenges thrown at the organization."  Translation:  Aloof and absent executives have done a lot of tormenting of dedicated staff and destruction of quality hospice care.  .

Larry Graham shared his vision of 2020 being the year the company returns to organic growth.  Humana's 3rd quarter earnings reported referred to "slightly lower earnings from Kindred at Home operations."  Our hospice's daily census for Q3 was below last year, I believe due to the chaos the company imposed on our site.

Causby said the journey is far from over, that continued heavy lifting will be needed for eventual Humana ownership.  He reiterated the company is investing significantly in employee benefits.  That's because Kindred/Curo benefits are far below Humana's and there's great catching up to be done.  Humana knew this when they bought 40% of our company and then let Tweedledee Causby and Tweedledom Graham slash benefits for 2019.

Causby wants Kindred to be known for stellar clinical care and being innovative.  Management's priorities are to provide enhanced benefits and show appreciation.  The Curo way at our hospice has been the opposite of everything he stressed.  Humana et al delivered poor clinical care, rigidity under bad systems, benefit cuts and zero acknowledgement of hard work and high performance by dedicated staff (most of whom are now gone).

The dastardly duo ended with a dark future under Humana with artificial intelligence determining the level of care and what day that should be delivered.  The goal is to decrease hospitalizations for Humana's Medicare Advantage enrollees and decrease the live discharge rate for hospice.  That might mean only admitting patients who actually qualify for hospice.  The pressure to meet targets for admissions and average daily census had patients sneaking onto service that clearly did not qualify.  That pressure grew after Humana, TPG and WCAS bought us in July 2018.

Humana plans to have a predictive clinical modeling platform and operate integrated markets across the various organizations Humana owns.  The second web meeting occurred on November 7th.  Humana CEO Bruce Broussard addressed Kindred at Home's future in Humana's Q3 earnings call with Wall Street analysts.  I'll share those low-lights in another post.

Anonymous

Curo Makes Multiples for CEO

Strange Tony,

Think back to your hospice days.  Would you or any of your co-workers have found these words inspiring?

“You have very high multiples right now with the demographics that are trending; those multiples have to come down over time if you look at historical averages,” Larry Graham, founder and CEO of hospice and home health provider Curo Health Services said at Summit. “Private equity is very interested in the home care and hospice space which is driving up multiples at this point in time. I think the future changes to reimbursement, such as the [Medicare Advantage carve-in] will have an impact on multiples coming down.”  

Private equity are the financial rapscallions that partnered with Humana to buy Kindred at Home and Curo Health Services.  They crammed our hospice into Curo, and together they destroyed our level of service.

What Graham didn't say is he made big money under various financial rapscallions.  

Larry Graham co-founded Curo in April 2010 with GTCR, a Chicago based private equity firm.  He made huge profits from the next two sales of Curo Health Services to private equity owners.    Graham got a chunk of the $730 million Thomas H. Lee paid GTCR for Curo in 2015.  Three years later Curo's speculative debt rating went negative.  In July 2018 Graham got a portion of the $1.4 billion Humana, TPG Capital and WCAS paid Thomas H. Lee for Curo.

Graham partnered with financial rapscallions from day one with Curo.  His wealth is beyond what a normal person could spend in several lifetimes.  The rabid pursuit of more money does not make hospice better.  It makes it worse for employees, physicians, patients and families.

At the same conference Graham said "I am a firm believer in technology" and "the overall goal will be keeping patients out of the hospital."  Curo's technology cheats employees on paid time and mileage reimbursement.  The clinical portion of Homecare Homebase is garbage in-garbage out at our hospice as nurses don't have time to take the program's various rabbit trails. 

That's a nice stripped suit.  Over time Curo's technology may have CEO Graham switching suits to one with more white.

Anonymous

Humana CMO Shrank Our Hospice

Strange Tony,

Humana Chief Medical Officer William Shrank spoke with "Home Health Care News" about:

"Humana’s efforts surrounding social determinants of health, continuing health care trends and the ongoing alignment of the company’s in-home care operations."

Shrank failed to mention how Humana/Curo Health Services decimated our hospice by dramatically reducing staff, driving turnover through the roof and implementing garbage in-garbage out Homecare Homebase. 

Humana/Curo depersonalized our services by jettisoning or running off caring, experienced staff.  

"The future of being able to really care for vulnerable patients — ideally, in the home — is to coordinate all those resources. Coordinate them in terms of making sure everyone’s operating at the top of their license and focusing on their area of expertise, but more importantly that everyone’s working on a longitudinal patient medical record that allows them to communicate with each other."

Longitudinal record?  I didn't realize ten months of information was considered longitudinal.  Also there is nothing longitudinal about information that does not carry forward when hospice certification period ends and a new one begins.

Humana/Curo have harmed our hospice's ability to care for vulnerable patients.   They also harmed employees by not paying them fairly for hours worked and miles driven.  Humana has done nothing but hurt our hospice's care delivery.  Curo is a curse.

Anonymous

Humana Imposed Waste at Kindred Hospice

Strange Tony,

Humana led a study on healthcare waste while imposing the same on our hospice.  News reports indicated:

Researchers from Humana Inc. (HUM) and the University of Pittsburgh School of Medicine estimated the cost of waste in the United States (U.S.) health system. The study found that approximately 25 percent of health care spending can be characterized as waste – between $760 billion and $935 billion annually.

I have directly experienced Humana's wasteful management at our hospice.  Our complex payroll function within Homecare Homebase wastes numerous hours for employees wishing to be paid accurately for their work.

Every pay period the system does what used to be called a time and motion study.  Each employee must account for their time down to the minute.  Because the system won't allow you to start the next segment with the previous segment's ending time, an employee loses that minute.  At the end of the day the system could've robbed an employee of ten to fifteen minutes of actual worked time.

The robbery gets worse when Homecare Homebase's mileage reimbursement system only automatically pays for the trip to see the patient.  For an employee to be paid for their return trip to the office they must manually enter that into the mileage system.

Management did not train staff on the time or mileage system under Homecare Homebase and many employees were shorted as a result.  Five months after going live management offered to bring someone in to train staff on both functions.  Staff agreed that would be helpful.  It hasn't happened to date and I doubt it will.

Humana believes Kindred at Home will help reduce waste in its Medicare Advantage population.  My experience is they imposed significant waste.  It used to take 10-15 minutes to input worked hours.  It now takes two hours per pay period.  That's just to roll the dice and see if management will approve the submissions for payment.  More time is needed to study the check and find discrepancies (if shorted).

Homecare Homebase is a nightmare in complexity for employees wanting to be paid fairly for hours worked and miles driven.  I do not understand how hours worked in a just closed pay period can not be paid and added to a month that has long gone by.  That happened frequently at our hospice.

Another bureaucratic time waster is scheduling every visit.  This works fine for Home Health but makes no sense for hospice.  On call and regular staff wasted hours waiting for management to add the visit and push an assignment.   This also happened with our nurse practitioners needing to do face-to-face visits.  We look bad when a nurse practitioner travels to do a face-to-face visit in a facility and there is no visit note for them to complete.  It becomes a paper visit or a redo.  

Humana's study on administrative waste applies to our hospice.  It's ironic that Humana imposed the wasteful system after buying our hospice in July 2018.   Forgive them Lord, they know not what they do.  Or do they?  Lord, forgive them anyway.

Anonymous

Kindred at Home/Curo's Hospice Staffing Model

Strange Tony,

Last August I gathered comments on Curo Health's hospice staffing model.  Their words ended up as accurate predictions for changes at our hospice over the last year.   Over 50% of staff left, voluntarily or involuntarily.

A former executive shared Curo's staffing model.  It is sparse and not capable of delivering good customer service, at least that has been my experience.

Kindred at Home home health locations are undergoing the same decimation process as our hospice.  They are converting to Homecare Homebase which was supposed to save our hospice lots of work.  It did not.  Homecare Homebase added significant busy work and it underpaid my co-workers for time worked and miles driven.

My vision was to work for a company that could accurately pay employees and staffed for outstanding customer service.  That is not Kindred at Home/Curo Health Services under the ownership of Humana and two financial rapscallions.  That is a tragic development.

Anonymous

Curo's Sick Model and Bad Technology

Strange Tony,

I'm afraid our hospice is terminal from severe management disease.  It began a year ago when Humana purchased our hospice and placed us under Curo Health Service CEO Larry Graham. What they've done together to our site is a crying shame.

Executives knew the plan and the corresponding carnage it would cause.  Step One:  They handcuffed a few people they thought critical to the company's success with retention bonuses.  Step Two:  Once these people were strapped down the firings began.  The terminations haven't stopped.  In an employee update call executives referred to their mendacious plans as a "bumpy year for employees."

Nothing about their plan respected teamwork, once a hallmark of our hospice.  In our heyday everyone mattered.  There were experienced people with time and patience to shepherd new employees.  People were trained to do the job.  No more.

Step Three:  Leave few to no standard bearers.  The few that remain hate what Humana/Curo has done to our hospice.  Curo management has a unique inability to listen.  Step Four:  Label those speaking out as "negative" and deride them for sharing their employee experience.   Ignore that these people were recently the "go to" people for their discipline.

Secure leaders would view what was shared as feedback.  Staff know and have experienced consequences of ongoing management greed and callousness. We just can't honestly share our experiences with anyone up the chain without retaliation.

Executive greed cut nearly everything in the last year, health insurance benefits, holiday pay, staffing, space, color printer, employee appreciation day, floating holiday, post it notes, cellphones, IPADS, computers, employee going away parties and parking spaces.  We just learned some pinhead in Mooresville wants us to pay for parking.  Shaming the Future Together - Curo and Kindred at Home.

They use spreadsheets to underpay staff for miles driven and hours worked.  Loss of pay is compounded by mean girl management, which can viciously cut a hospice heart.  I pray God return to them tenfold what they have foisted on others.

Anonymous

Kindred at Home/Curo Health Employees Tell Friends to Stay Away

Strange Tony,

Management's obsession with measures, big data and artificial intelligence only apply to their greedy priorities.  One year ago Humana bought Curo Health Services, a collection of regional hospices established by financial rapscallions in 2010.   Humana placed Kindred at Home's hospice division under Curo's "innovative" management.  In the last year Curo decimated our once great hospice.

Glassdoor collects data from employees about their experience.  One can look at three companies on Glassdoor to get a feel for Humana's Home portfolio, Kindred at Home, Kindred Hospice and Curo Health Services.  As Curo management has been innovative in the ways they've tortured our hospice let's start there.

Less than half of Curo's employees support its leadership, believe in its future and would recommend a friend work alongside them:

Roughly a third of Kindred at Home employees would recommend the company to a friend (35%) and have a positive business outlook (36%).

Leadership leaves Kindred at Home and Curo employees uninspired, which can be seen in Curo's overall rating trend from employees:

I did not see one regional executive visit our office from July 2018 to July 2019.  Feedback, like excrement, only goes one way, downhill.

Homecare Homebase's garbage in-garbage out hospice system has been a time killer for staff, both clinical and office.   

The company's answer to overworked nurses was to make them salaried.  Humana/Curo Executives get an A in Abusive Management 600, a course required by our 60% financial rapscallion owners.  Abuse leads to no hope.

Yet employees know who is responsible.

Each graph peaked as Humana bought Kindred at Home and Curo Health Services.  Employees experienced harm after these deals and the ratings slide began.

The company has a consistent artificial response to those raising issues of no raises, horrible management and declining quality care. 

Employees may be the heart in that we keep pumping but the company has shown us no love.   How long will workers stay under executive disdain, hollow phrases and false embraces?

Anonymous

Kindred Barely Mentioned in Earnings Call

Strange Tony,

Humana held its Q2 earnings call and Kindred got but a few mentions.  Most of those are below:

In the home through our minority investment in Kindred at Home, we are piloting value-based care models in multiple markets and continue to see encouraging results from a standalone financial perspective for Kindred at Home, and from the standpoint of delivering improved clinical outcomes for our members. To usher in the next wave of integration, Humana and Kindred at Home have invested in an interdisciplinary team of clinicians responsible for taking the best practices gleaned from pilot markets and applying those learnings across Kindred’s broad geographic footprint.

... healthcare services is performing above expectations and we increased our adjusted EBITDA guidance for the full year by approximately $40 million ...  Our home business, including Kindred at Home, is performing well.  

....having new distribution channels that we’ve created, whether it’s Kindred or a PIPC or other areas where we can engage our members in different ways, that’s why we continue to invest those channels and in the technology that supports it so we can continue to manage our medical costs.   

All of our costs are estimated, and so it’s important to identify these early warning systems that can allow us to identify the issues and then create the clinical programs and the customer engagement platform, and frankly the analytics to be able to identify who needs the intervention. We continue to invest in that. We’re nowhere near where we need to be.  

I would say that the outperformance is pretty balanced across the board...  Where we’re seeing, I’d say, greater percentage outperformance is on the Kindred side.   ... the Kindred team is really executing on the business plan.

Humana's 40% interest in Kindred's earnings grew 300% from Q1.  Historically the first six months delivered stronger hospice volumes and revenues than the latter half of the year.  

Humana/Curo operated our Kindred Hospice as a cost center that needs massive ongoing cuts.  So far dramatic reductions in service levels have not translated to reduced patient census.  They have hurt billing.  At one point our hospice had $750,000 in unbilled care.  That's been cut in half.   

Before Humana/Curo foisted cumbersome Homecare Homebase on our hospice our unbilled revenue rarely reached $75,000.  That was under higher volumes.  

Humana and partner financial rapscallions milk our hospice at the expense of quality clinical care.  We're nowhere where we used to be. 

Anonymous

Under Chief Consumer Officer Humana/Curo Consumes our Hospice

Strange Tony,

Humana's Chief Consumer Officer Jody Bilney will leave the company at the end of 2019.  She recently offered:

“What I do know is consumers. I understand how people make decisions. I understand how well-run companies are well run; the importance of corporate culture and governance; and the importance of employee engagement. Those are (all) transferable skills that are relevant across industries.”

Humana transferred none of those skills to Curo Health Services after last year's buyout.  Humana teamed with Curo to consume our once great hospice with repeated, intrusive cuts.  Together they destroyed our customer service levels, trashed our high quality hospice culture and drove away scores of employees/medical directors.

Curo is well run for one consumer, its financial rapscallion owners.  Curo was created from a primordial mix of greed, leverage and political connections.

Bilney's boss CEO Bruce Broussard prioritized bad technology and high interest expenses over customer service.  It placed no emphasis on Kindred at Home employees.  If Bilney knows anything about KAH she realizes the ash heap our company has become.

Consumed by financial rapscallions, Kindred at Home is now managed by an accountant.  I would say things can't get any worse but Humana keeps upping the scale.

Humana's Bruce Broussard, WCAS Tom Scully (former Medicare Chief) and TPG's Dr. Mansukani (former Kindred Board member) can make things much worse for the average KAH employee.  We are but ants they step on because they do not see us.

Workers are units of production, many replaceable by machine learning and artificial intelligence.  I'm not sure what AI can do with Homecare Homebase's "garbage in-garbage out" software.  I can predict it will lead to huge paybacks/refunds to Medicare as the system does not help nurses show decline and continuing hospice eligibility.  That is if the system bills Medicare in the first place.

Humana consumed our hospice and its Chief Consumer Officer.   Bilney will leave Humana a multi-millionaire.  Most of us left with the clothes on our back after years of hard work with no raises.  That's employee abandonment, a disheartening form of disengagement.

Anonymous

Humana Home Division Led by Accountant: Bad Sign

Strange Tony,

Humana announced the promotion of a finance person to lead its home operations:

Humana Inc. (HUM), one of the nation’s leading health and well-being companies, announced the promotion of Susan Diamond to Segment President, Home Business.

Humana’s Home Solutions Business aligns Humana’s home care elements into a single operating unit, continuing to recognize the strategic importance of home care in bringing to life an integrated care delivery model that meets consumers where they want to be, in the more comfortable, accessible and lower cost setting of their home. In her new role, Susan will lead Humana At Home as well as our home nursing and in-home assessment operations. In addition, she will lead Home Operations, our transition management office with Kindred at Home.

Diamond joined Humana in 2006 as a strategic advisor focused on investment and acquisition opportunities before moving into strategic, financial and operational leadership positions for Humana’s Medicare and corporate finance organizations.  

This bodes unwell for dedicated hospice professionals within Kindred at Home.  A bean counter is in charge, one that has no clue about hospice.

In between sits ethically challenged Larry Graham, and corporate cutthroat David Causby.  They have plans for Kindred at Home, drastically cutting costs to fund our $3 billion in debt and saving Humana money on its Medicare Advantage business.

That's not the mission of hospice. 

Anonymous

Carnage at Our Hospice: One Year After Buyout

Strange Tony,

Our hospice is unrecognizable on the one year anniversary of our latest buyout.  We went from time efficient technology that met Medicare regulations to garbage in-garbage out Homecare Homebase.

An important element of Healthcare Services also is Kindred, and it's important that we invest in Kindred for the long term. And so for example, implementing Homecare Homebase, while an expense for 2019, it's a decision that the Kindred board made recently because we thought it would position us better for the future and enable us, as Humana, to attain the clinical outcomes and the clinical measures that we're striving to do.  So we thought that was a smart investment to make.--Humana CFO Brian Kane

Additionally, Kindred at Home has selected Homecare Homebase as the electronic medical record and practice management system for both home health and hospice. And we’ll begin implementing this system in 2019. This will accelerate our ability to proactively identify key clinical interventions while improving revenue capture and business and quality reporting.--Humana CEO Bruce Broussard

Humana made an investment in Homecare Homebase as part of its big data, artificial intelligence plans.  Who knew big data and AI were a euphemism for not paying employees for hours worked and miles driven?

On the clinical side Homecare Homebase is a time eater for nurses who say the system does a poor job of documenting decline and how the patient continues to meet hospice eligibility.  The system can't do anything without orders and scheduling.  Home health is scheduled.  Hospice happens.

Few experienced hospice nurses remain.  Some recall Kindred's effort to predict a patient's decline and death.  The predictive service index score was so inaccurate clinicians stopped looking at it.  On-call staff laughed at it and said, "that number is worthless." 

Who trashed our hospice?  It's been a group effort led by financial rapscallions who own 60% of our company and Humana, which owns the other 40%.  Kindred at Home executives will have a lottery level payday when Humana acquires the other 60%.

Kindred at Home President David Causby and Hospice President Larry Graham foisted Curo's bad technology and miserly staffing models on our once great hospice.  This wobbly platform harmed customer service levels.  Dedicated hospice professionals could not get the attention of anyone in the company.  Their issues and concerns went unheard despite repeated requests. 

Humana considers the home a whole new ecosystem, a distribution platform that no other insurer has today.  Kindred at Home provides the opportunity for Humana to bring integrated technology into the home.  Humana plans to use big data/AI to personalize care for those it insures.  I don't believe it after seeing how executives used our hospice data.

Data showed an employee drove too much, therefore management cut the mileage reimbursement rate (lower than the rate paid to other employees) as an incentive for the high mileage employee to pay Kindred at Home for a company car.  Translation:  The company (which gave patient assignments) no longer wanted to pay staff mileage to drive to fulfill those assignments.

Data showed our hospice had too much square footage, too many computers, too many phones, too many parking spaces and too many bathrooms.  The aforementioned areas were cut 50 to 75%.  They did add cameras to spy on the few employees left.

Data showed it cheaper to take away company provided cell phones so employees could pick up and pay for that personal expense (over $800 pay cut in my case).  Staff who desire a clear boundary between work and personal phones are unreasonable and not team players.  Company apps for employee personal phones have tracking/monitoring capabilities.

Humana's data mining has proven harmful and offensive to Kindred at Home employees.  If someone wants to personalize my care then talk to me.  Ask me about my dreams, my desires, my gifts, my faith and my heart. 

Data mining already produced impersonal decisions that benefit our greedy owners.  Heartless artificial intelligence will reduce hospice headcount past the point of no return.  When that happens, when the Kindred/Curo combination becomes the least preferred hospice provider, God will strike Broussard, Kane, Causby, Graham and our 60% owners where it hurts the most, in their pocketbooks.

Recall that as a 40% owner in a highly leveraged business in Kindred, there's a lot of debt impacts there that get consolidated below the EBITDA line.-- Humana CFO Bryan Kane

Retribution will come for the harm executives have done to our once great hospice.  They are responsible for the deep drop in customer care and destroying teamwork at our site.  It may be in this life or when executives meet their maker. They will atone for their grievous sins.

Anonymous

Moody's Reveals KAH Executive Selfish Greed

Strange Tony,

Moody's issued an update to its rating of Gentiva (Kindred at Home) debt.  It noted improvements from a financial standpoint that lessens investor worry for holding Gentiva debt. 

Moody's Investors Service ("Moody's") upgraded Gentiva Health Services, Inc.'s (dba Kindred at Home, or KAH) Corporate Family Rating (CFR) to B1 from B2

While Gentiva's debt rating improved it is still considered junk.  Kindred at Home plans to spend $487 million to replace $475 of second lien term loan.  Financial rapscallions charge deal fees for such debt exchanges.  It's one of the ways they rob funds from companies they own.

The upgrade of the CFR follows the successful separation from Kindred Healthcare, Inc. and merger with Curo Health Services, LLC in July 2018. KAH has performed well since completing these transactions, and is ahead of plan with respect to realizing benefits of cost saving initiatives. As a result, the company has deleveraged meaningfully over the last year and generated over $100 million of free cash flow since the separation. Additionally, the proposed refinancing transaction will modestly reduce leverage and result in about $18 million in annual interest expense savings. 

My hospice coworkers helped generate Kindred at Home's over $100 million of free cash flow since July 2, 2018.  $77 million of KAH cash will be used to give WCAS and TPG Capital another payday (more deal fees).

A hospice coworker informed me that her first raise in years was a mere 12 cents.  That's a wage increase of $249.60 per year before taxes.  I know how hard she works and the love she shares with patients.

Kindred at Home offers a miserly 1% retirement benefit according to Fidelity.  It's 401(k) match declined under Gentiva from 3%.

This decrease prepared us for Humana's cutting two holidays for 2019 and reducing holiday pay.   It's clear none to a mere pittance of the $18 million in interest expense savings will go to employees.

Earnings before Interest, Taxes, Depreciation and Amortization (EBITDA) soared over the last twelve months according to Moody's.

Moody's recognizes that adjusted debt/EBITDA has declined from 7.5x at the time of the separation transaction, to 6.3x for the twelve months ended 3/31/2019. Moody's believes that adjusted debt/EBITDA will decline to the mid-5.0x range by the end of 2019.

Gentiva/KAHDebt did not change during the period.  That means EBITDA soared 19%.  Moody's understands income statements and balance sheets but has no clue when company cuts turn into poor care and bad customer service, eventually eroding revenue.

The stable outlook reflects Moody's view that the company will continue to de-lever as it realizes continued cost saving benefits, while maintaining very good liquidity and solid growth. 

Moody's also does not know when company technology robs employees of pay for hours worked and miles driven.  Homecare Homebase is complex and cumbersome on the clinical side but even worse for payroll and expense reimbursement.  Fellow employees were shorted pay and mileage during the period cited by Moody's.  Management and corporate have ignored employee concerns.  It's called wage theft.

Moody's expects Gentiva/Kindred at Home to have "organic revenue growth and further realization of cost savings."  I believe cost savings have harmed customer service and further cuts will harm revenue at our hospice site.  Customer service is already far below our historical standards.  How far will our hospice shrink to fund a giant executive payday (based on a multiple of EBITDA)? 

Shrink, Shrank, Shrunk.

Anonymous (from KAH/Gentiva with its unstable, greedy executives, clearly unwilling to share)

Executive Fireside Chat: Hot Air

Strange Tony,

Kindred at Home CEO David Causby and Hospice President Larry Graham spoke to employees via audio.  I asked my hospice co-workers about the company update.  They said:

• It had no meat, no substance.  It sounded like a political speech
• They talked about how great things are going and how management is doing great
• There was nothing for me in their talk
• The talk of excellence and making a great company is nonsense, given what they've done to our hospice, harming our service levels and quality of care

CEO David Causby said he achieved very strong financial results for the company by growing ADC (average daily census) and instituting very strong cost controls.

I believe my coworkers busted their backsides to serve our hospice patients while severely handicapped by a garbage-in/garbage-out Homecare Homebase (HCHB) and Curo's unreliable technology.  We waived goodbye to five co-workers who'd worked hard to serve our patients.  Local management promised merit raises during Q1 but they never arrived.

Causby talked about spreading the Homecare Homebase virus throughout the company.  It is infecting 15 home health sites with plans to make it epidemic at all 360 home health locations.  Causby said it would help with administrative and clinical operations.  Somehow he believes it will help with employee retention and recruitment.

Hospice President Larry Graham is of the same delusion.  He stated HCHB would "enhance the work-life balance of clinical staff and lead the industry in compliance and clinical excellence.

A nurse case manager in Florida wrote this on Indeed three days ago.  "The charting will take over your life. You spend all day in the field seeing patients then have to go home and spend hours charting. There was no real training on the documentation either, you just learn as you go. Every form requires an additional form which ultimately requires an addendum.. it’s never ending. On your days off you are expected to catch up on charting and are getting phone calls, texts and emails. It’s non stop." 

Two days ago a North Carolina nurse wrote about her Kindred at Home employment.  "NO ONE tells you that you will work from home the moment you get home until you fall asleep charting, wake up and chart more. There is no work life balance."

CEO Causby touched on benefits, that have only deteriorated under his watch, and our long promised merit raises.  The company administered a benefit survey that asked about benefit trade offs and possible new benefits, most of which were nonsense, like maid or handyman.  

Hospice President Larry Graham mentioned "enhanced benefits" in his talk but those words made no sense to my hospice coworkers.  In the real world Causby and Graham took away our Employee Appreciation Day and Floating holiday for 2019.  

David Causby said he wanted to "improve the benefit structure for all of our employees."  If Causby, Graham, Humana CEO Bruce Broussard and our 60% financial rapscallion owners meant that then employees would have equity stakes in Kindred at Home and something other than a pittance for a retirement match.  These executives are well aware of Kindred's miserly benefits package vs. Humana's.    

Long promised merit raises remain a distant vision.  Causby said executives are "looking at salary structure and plan to address merits in upcoming months for our company."  Apparently raises remain under the vise grip  of strong cost controls.

Graham dangled a golden future with Humana as our employer where executives would go above and beyond for patients and staff.  Through redesigning for excellence opportunities will be created for employees.

Causby tempered Graham's lofty future by informing us executives did the heavy lifting in standing up our company up over the last ten months.  He noted this transitional year had the company fully implementing HCHB in hospice which caused "a lot of stressful times."  Causby said "hopefully there will be more opportunities within the organization for individuals to grow, but it wouldn't be right of me to say this is not going to be a bumpy year.  I hope all of you can stay with us as go through this transition."  Causby and Graham bumped five co-workers out the door via the Curo model.

Causby said Kindred at Home is a good company that wants to be great.  "It starts with employees, feedback to us and how we can get better."  Here's one answer.  It starts with real relationship. 
Quit bullshitting us.

Anonymous

Humana Execs Toy with Kindred

Strange Tony.

Humana hosted its Q1 earnings call last week.  Humana President Bruce Broussard did not mention Kindred at Home directly in his opening remarks but CFO Brian Kane did.

Healthcare Services is performing in line with expectations, and our adjusted EBITDA guidance remains unchanged for the full year at $1 billion to $1.05 billion. Our home business, including both Kindred at Home and Humana At Home, is outperforming our initial expectations primarily reflecting higher-than-anticipated volume and increased deal synergies relative to expectations.

My hospice coworkers helped deliver those higher than expected volumes and we directly bore the brunt of increased deal synergies with the loss of experienced staff.

As it relates to Healthcare Services, we are seeing really nice performance in our Kindred business, in our Humana At Home businesses. Homecare Homebase is being implemented. That's going well. We're committed to getting on Homecare Homebase. That's one of the investments, as you point out, that we made this year. We think that will create a better clinical model ultimately for us as we continue to integrate with Humana. 

Homecare Homebase has made delivering higher volumes problematic with its overly complex, home health oriented clinical side.  It's business operations side made it difficult for employees to be paid for the full amount of time they work and miles they drive.  

Kindred at Home Hospice President Larry Graham told employees they rolled out Homecare Homebase "to enhance the work-life balance of clinical staff and lead the industry in compliance and clinical excellence."

Enhanced work-life balance means staff are free to document from home and not be paid for it.  The only place for nurses to document continued hospice eligibility is in the narrative.  Some nurses added a qualifier to address Homecare Homebase's garbage in-garbage out clinical rabbit trails.

Humana made $39 million in Q1 from its complex holdings in Kindred at Home.  My hospice coworkers received nothing from executives for their efforts.  President David Causby has long advocated not giving employees raises and turning a tin ear to their voices.

Hospice President Larry Graham knows his customer is Humana and its financial rapscallion partners.  Since its founding Curo has been owned by financial rapscallions.

Here's how Causby and Graham have impacted a key work-life measure, whether an employee would recommend their employer to a friend.  Less than half of Kindred/Curo employees would recommend a friend work for the company.  That's a stinging management rebuke.

Humana President Bruce Broussard did address Kindred with one Wall Street analyst.  

We have invested in Kindred based on a reimbursement change that would have some impact on lowering the impact from a therapy. But in addition, we see a great opportunity in being able to assist us in what our core business, and that is really driving down the cost of care through preventing hospital admissions.

Kindred at Home is a toy for Humana executives and Kindred at Home's abysmal duo, David Causby and Larry Graham.  As a result my hospice co-workers have much to bear.

Anonymous

We Can Give the Heart of Hospice Away

StrangeTony,

My heart grieves for the way my hospice coworkers have turned on their brethren after the Humana buyout.  Not long ago we stood united against sick, unethical management.  When management attacked we would surround a coworker with support and encouragement.  That has changed.

Fear set in after five coworkers received pink slips.  Longtime employees must believe the favor they curry with ignorant, arrogant managers will give them the upper hand in the next round of reductions.  It won't. 

Our management doesn't know the heart of hospice and cannot discern its beat.  But staff who've lived it, some for decades, know. 

Former hospice disciples turned Judas against dedicated coworkers.  Those who once surrounded peers in support have jointed management jackals in taunting "the weak." 

Management's insider club offers cruel words and dismissive jokes to the scorned. Mean Girls Management can't take the heart of hospice from us.  But we can give it away and I'm afraid that is happening. 

This is my prayer at this time:

Lord, protect us from evil imposed by those pretending to lead us to greener pastures.  Soften all of our hearts so that we may appreciate one another.  Provide us a mirror so we can see what is in our eyes, in our hearts when we speak ill of the other.  Even the scales so all people can be seen for the good they do, not just the favored few.

Lord, show our leaders that the pasture is for all, not an exclusive reward for being in authority.  Catch the victims of management cruelty should they plummet.  Hold them closely in your palm so they may rest and be renewed in mind, body and spirit.  Guide them to the next opportunity to do your will in this difficult world. In Christ's name we pray.  Amen

Wishing the peace that passeth all understanding to you and yours,

Anonymous

Stand Against Management's Selfish Wind

Anonymous,

I retired from hospice at the right time.  Corporate toxicity was bad enough my last several years.  The poem below gave me solace during stressful times caused by executive whimsy, mendacity and greed.  I share it with you in the hope it serves as a balm.

The Oak Tree
by Johnny Ray Ryder Jr

A mighty wind blew night and day
It stole the oak tree's leaves away
Then snapped its boughs and pulled its bark
Until the oak was tired and stark
But still the oak tree held its ground
While other trees fell all around
The weary wind gave up and spoke.
How can you still be standing Oak?
The oak tree said, I know that you
Can break each branch of mine in two
Carry every leaf away
Shake my limbs, and make me sway
But I have roots stretched in the earth
Growing stronger since my birth
You'll never touch them, for you see
They are the deepest part of me
Until today, I wasn't sure
Of just how much I could endure
But now I've found, with thanks to you
I'm stronger than I ever knew

Distorted executive priorities and inhumane behavior are the damaging wind which feels unceasing.  Sick leadership eventually collapses from the unnecessary weight it imposes on others.  Stand strong until that day.  Listen for the voice of God for his peace and mercy are always available.  Rest in his palm when the burdens seem too great.

Strange Tony

Margin Matters Over Customer Service

Strange Tony,

Customer service at our hospice continues to deteriorate.  Regional VP's and local management are well aware of the numerous ways our care is coming up short.  Their response is not the corporate tagline, "Our Care Matters."  Bone cutting staffing models, garbage-in/garbage-out technology and robust financial margins are more important.  To their credit our hospice staff have hung in there thus far.

Humana, despite making the home one of its top five strategies, considers Kindred at Home a management distraction.  While they don't care enough to pay attention our hospice is breaking under the weight of layers of aloof and disturbing management.

Cracks are growing in the dike.  I'm not sure how much longer staff can hold back the abusive tide.  Humana/Curo's cookie cutter mantra is growth.  Our hospice is to grow by shrinking. Staff, holidays, health care coverage and mileage reimbursement are all smaller.  What will the company shrink next?  Kindred at Home is synonymous with widespread management malpractice.  The chaos continues.

Anonymous

Kindred at Home to Enrich Humana Investors

Strange Tony,

Humana's top five accomplishments at its annual Investor Day include "forming the nation's largest home health and hospice operator" via Kindred at Home/Curo Health Services.  Home Health is also one of the five most impactful areas of influence on health care utlization.

Home health is one of Humana's national platforms

The home health opportunity warranted a whole slide during Investor Day.

After splashing Kindred at Home as a key strategy/influencer/opportunity Humana cited the area as a "management distraction" which needed to be reduced.   Huh? 

Without full ownership there is no pressure for Humana to align pay and benefits across the company.  Kindred at Home employees continue to receive short shrift from executives across our ownership spectrum.

Humana's financial measures have grown substantially according to several slides, yet wages only increased 1.3%.  That did not keep up with inflation of 1.7%.  Kindred at Home has been a notorious miser in giving wage increases.  Management promised our nurses raises earlier this year.  They have not arrived yet.

This is all to enrich Kindred at Home executives, the two financial rapscallions and Humana's executive team.

Trend bender Kindred at Home is to make Humana's Medicare Advantage plans more profitable.  Our new technology is a huge barrier to serving patients and their families.  It also is a disaster for documenting continued Medicare hospice eligibility according to our nurses.  Humana's Investor Day made it clear our hospice is here to serve the greedy.

Anonymous