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