After more than two decades in the hospital space, David Meyer has stepped into the ring of post-acute as chief growth and innovation officer for Alivia Care.
Alivia Care came into existence in 2020 when Community Hospice & Palliative Care, now an affiliate, formed a larger company with a wider range of services. The Florida-based nonprofit has since expanded into Georgia and established itself in the home health and PACE arenas.
Meyer came to health care via the I.T. department of the largest health system in Jacksonville, right around the time of the “Y2K debacle,” he told Hospice News. In time, he worked his way into the strategy team and came up those ranks. Eventually, he moved on to become chief strategy and marketing officer at Ascension St. Vincent’s Health System.
Through those years, Meyer oversaw or participated in the acquisition and construction of new hospitals, including cancer and heart centers, and helped to build large-scale medical staff from scratch.
By joining Alivia about six months ago, he began “chapter two” of his career, moving in the same direction as the health care system itself — towards the home and community.
Alivia CareAs chief growth and innovation officer, how do you define “growth” and “innovation”?
I have spent 25 years on the acute side, and now in post-acute in order for me to truly understand the lever for growth, I’m really taking a deep dive and understanding the industry. I’m really immersing myself in the key challenges that are facing post-acute and specifically hospice care.
So if you look at the trajectory of growth for hospice, what was really fascinating to me, honestly, was the low utilization of hospice across the country of those that are eligible for hospice care, about 50% [among Medicare decedents]. There were excess deaths coming out of the pandemic, and those will likely be fewer over the next few years. But if you can move the needle on utilization, that is one lever to grow.
The other thing is the shift from traditional Medicare to value-based care. Let’s just assume that the [value-based insurance design (VBID) demonstration] will become mainstream at some point in the future, that’s clearly going to have reimbursement pressures for hospices throughout the country. With increasing costs, the math isn’t working out. So I think another key growth lever for us is to be successful in value-based care and really putting the patient and the patient’s family at the center of what we’re trying to achieve.
We’re very optimistic and bullish on developing a product and network that will be attractive to payers and providers that would want to participate in that. Now, there are a lot of capabilities, like data stack capabilities, etc., and building your network in order to get there.
The other is, I really had the opportunity to spend time in our PACE program, and it’s awesome. It just seems to be a really cool way to improve how people live with advanced chronic illnesses. It’s just a really cool model, and I’m really bullish on the future of PACE programs. We’re seeing a trajectory of our growth as well with our PACE program in the Jacksonville market.
How do you think that your career in facility-based care can kind of inform your approach to this home- and community-based environment?
One thing that I know is that facility-based care is likely unsustainable because it’s so costly. It’s not going away. The acuity levels of hospitals will continue to grow, but this movement towards hospital-at-home and at-home urgent care has its challenges. How do you scale those types of models and all the remote monitoring capabilities that will be required? That’s a significant lift.
But if you can start small and begin to advance with new technologies and AI, I do believe it has the opportunity to become scalable. The amount of dollars spent on Medicare is unsustainable, so something has to change. The studies that I’ve read thus far about hospital-at-home say it’s decreased the overall cost by 15%, which is significant to [the U.S. Centers for Medicare & Medicaid Services (CMS)].
Alivia provides a much larger continuum of services beyond hospice. How do you balance your resources when it comes to growth across business lines?
We haven’t had significant struggles with the balancing act, if you will. I think the leadership team is all on board that we need to diversify our revenue streams for the reasons that I mentioned. The hospice economic model is becoming more and more challenging.
We do operate a home health agency in The Villages in Florida. We have hospice affiliates. We are providing [Managed Service Organization] services for two hospice programs in Southeast Georgia, and then our PACE program. They’re not capital-intensive. So in terms of dollar resources, it’s really kind of the [full-time employee] support that we have built into Alivia.
You’re in a certificate-of-need (CON) state with a large senior population living in markets where a lot of hospices and other health care providers want to grow. That looks to me like a very complex environment in which to compete. Do you think that’s a fair assessment? And, if so, what are some of the complexities that you’re keeping in mind as you move forward?
I do think you’re right that it is complex. And it’s increasingly becoming more complex.
We kind of refer to them as “substitute competition,” but we’re seeing what would be traditional referral sources for us investing in their own palliative care and hospice-type programs. So we’re very mindful of that, developing unique ways for us to control our referral sources as necessary.
What are some of the unique aspects of growing as a nonprofit in the Florida marketplace?
I think for us it’s how we differentiate ourselves. That’s one of the things that really surprised me when I came to Alivia and [its affiliate] Community Hospice & Palliative Care was the number of unfunded services and programs that we offer. I think that is truly differentiated, and not only with the other not-for-profits, but with the for-profit hospice organizations throughout our market and throughout the State of Florida, as well.
The other thing was the amount of support that we provide to the family members. It’s awesome. The patient obviously is at the center and forefront of what we do, but also the family as well. We have a lot of support mechanisms and programs in place just to support the family members.
Do you foresee any new affiliations developing in 2023, and if so, do you expect some of those to be hospices?
I don’t see any new hospice affiliations in the next 12 months. We are growing our [Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH)] program. As I mentioned, we do expect our PACE program to continue with its volume growth and our home health agency under Alivia Cares.
Can you tell me a little more about the opportunity you see with ACO REACH?
It’s a really cool model for those that have a chronic illness or advanced illness. It’s a really unique way to devote more adequate resources to that population. We can reach over 1,000 individuals in our market.
I don’t think we’re anywhere near that right now because it’s such a new program, but we are pretty bullish and confident that the ACO REACH model will be successful in improving the health outcomes for those individuals.
Where do you see the greatest opportunities for innovation beyond value-based payment models?
It’s the need to optimize the workflow and operations across our enterprise — because of the staffing shortages — the utilization of AI and advanced technologies to fill in for some of these vacant positions.
Strategically investing in advanced technologies to optimize and improve the work environment is critical to our success and also to the economic model of hospice care.
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