Jeff Kang, CEO of WellBe Senior Medical, has been in healthcare for a long time. He was the first medical director of the Centers for Medicare and Medicaid Services (CMS), serving in that capacity from 1995 to 2022.
Since then, he has held leadership roles at Cigna (NYSE: CI), Walgreens Boots Alliance (Nasdaq: WBA) and ChenMed, a primary care practice for the elderly.
At WellBe, he still helps provide primary care for the elderly, but specifically at home. And, using his past experiences as a guiding light, he wants WellBe to be a “general contractor” for all home care for his patients.
“We are the prescriber, but also the navigator, the lawyer – the people who organize everything,” Kang told Home Health Care News.
In healthcare – but also in home care specifically – the ability to organize everything is becoming an area of great importance.
Moving care into the home is a goal for many health plans, providers and health systems today. But the ability to actually navigate this care and ensure that the patient is receiving the appropriate services at home is essential if these stakeholders are to deliver the cost savings and quality outcomes they believe home care can enable.
“I think that interest has always been there,” Kang said, referring specifically to home-based primary care. “I think the key really is that most groups wanted to do this on a pay-per-service basis. The challenge is that they become concerned about increased utilization. The difference is that we are prepared to do this on a full risk basis, with guaranteed earnings improvement from the start.”
Chicago-based WellBe provides home-based primary care services in six states: Georgia, Illinois, Ohio, Utah, West Virginia and Pennsylvania.
“I don’t think it’s the plan’s interest that has changed,” Kang continued. “I think it’s the providers that are willing to do this on a total risk basis rather than a per-service fee.”
Home primary care is an old idea with new legs, especially after the public health emergency prevented people – especially the elderly – from visiting physical facilities for health care.
Both home health care and personal care are also more popular than ever in modern history. There are also emerging models, such as hospital at home and SNF at home, which allow more severe patients to receive care in their preferred and comfortable environment.
All these things are great, in a vacuum. But Kang believes there needs to be a WellBe to ensure that all of these types of care are properly leveraged and available to patients.
“The thing is, everybody just wants to do their little play,” Kang said. “But nobody is really asking the patient to help them do that. There’s that general contractor role that is sorely lacking… and we have the power of the pen, we can write the order.”
WellBe’s model was created to care for patients throughout their care journeys, whether chronic care, acute care, palliative care, post-acute care or end-of-life care.
In certain markets, such as Chicago and Atlanta, the company partners with Aetna to provide home primary care services to thousands of patients.
Kang believes WellBe’s model is especially valuable to plans because they have a hard time getting all these services together for their members.
Take Medicare Advantage (MA) supplemental benefits, for example. These benefits exist so that the elderly have access to a larger set of services, but many are not used. When they are used, plans have difficulty keeping up with them.
“Health plans are adding all these supplemental benefits,” Kang said. “Sounds great on paper, but getting timely access to them and getting them all together is next to impossible.”
In terms of contracting with home health and palliative care providers, WellBe generally uses the health plan networks of both.
But within these networks, the company finds its preferred suppliers.
There are tradeoffs and tradeoffs to a full-risk model, of course. But when it comes to leveraging home healthcare, for example, the equation is simple. If a patient can benefit from home healthcare, WellBe will request these services.
“If we believe that putting a qualified nurse there – even before hospitalization – will improve outcomes and reduce costs, we can go ahead and place that order and then pay for it ourselves, all because we are at full risk,” Kang said.