Transcript Generated by AI 00:00 Hey, Mark Parkinson here and welcome back to 00:03 Park Place. 00:04 Really appreciate you joining us. 00:06 One of the things that you know, I'm very excited about, 00:09 as you've seen in my post, is the group of contributors that we have 00:13 to Park Place. 00:13 We've really assembled, I think who's who group of folks that 00:17 know a heck of a lot about the sector are going to help us fulfill our mission, 00:22 which is your success. 00:23 We're trying to figure out ways to help you succeed. 00:27 And I'm super excited today to be joined by Anne Tomlinson, 00:31 who I've admired for 15 years, the whole 15 years that I've been back in 00:36 DC. 00:36 And I'm just so excited that Anne has agreed to contribute on a regular basis 00:40 to the Digest. 00:41 And Anne, it's really great to have you along in 00:43 this project. 00:43 Thank you so much. 00:45 Great. 00:45 Thank you for having me. 00:46 I appreciate it. 00:47 I'm excited about it. 00:49 Great. 00:49 Well, you've got a background. 00:51 It's kind of like my back or my first real job was on the on Capitol Hill. 00:54 And I know that you started out on Capitol Hill, 00:58 a lot of people in DC with that. 01:00 It's such a great base to have to kind of understand how things work up on the Hill. 01:06 But then like a lot of people, you left and joined the private sector 01:10 and when I met you, you spent 20 years were in kind of the 01:13 middle of a 20 year run at Avaler, which is one of the premier think tanks 01:18 at that time. 01:19 Tell us a little bit about the work that you did at Avalir. 01:22 Great, thank you. 01:24 So I joined Avalir when it was just two people. 01:29 I was one of the second people hired by Dan Mendelssohn and he had a vision even 01:34 then. 01:34 This was in 2000 that post acute and long term care were really important areas of 01:40 the healthcare set of all you know and all of healthier to be focusing on. 01:45 Like he really wanted to have a practice group at his firm that was leading in the 01:51 in thinking about how to deliver and pay for post acute care going forward and 01:57 long term care. 01:58 And so that was what I did. 01:59 I LED that kind of formation of that group and the growth of that group all 02:05 the way up and well through the enactment of the ACA when value based care became a 02:11 thing. 02:12 And and then even Dan and I shared also a passion for data and data analytics. 02:20 And so we launched are the first ever, you know, data analytics, 02:24 business intelligence solution to help post acute care providers understand the 02:30 flow of patients in their markets, in and out of hospitals and post acute 02:35 care organizations. 02:36 So I know that you became an expert on nursing homes, 02:39 on post acute care and nursing homes and AKA, 02:42 we retained you all the time to do studies for us to figure out what policy 02:46 positions we should be taking, how to defend the policy positions that 02:50 we were taking. 02:50 And you really became an expert in the whole nursing home world. 02:54 Talk, talk about the work that you've done with 02:56 nursing homes. 02:57 Yeah, they're sort of that's like I think of 03:00 nursing homes and in senior living operators as like my home base. 03:04 You know, when I, I have a, a much bigger firm now that does, 03:08 I was on my own for a while, but it's they do a lot of different 03:12 things that I don't. 03:13 I'm not expert in my expertise and kind of my home base are the skilled nursing 03:18 facility industry and senior living operators. 03:22 So then you left to have a Lyran form your own company. 03:25 I probably shouldn't say this. 03:26 I tried to hire you at ACA and you rejected me multiple times. 03:30 And I think that was quite wise because the the firm that you've created has done 03:33 extremely well. 03:34 Tell, tell us a little bit about what you've 03:36 created. 03:36 Yeah. 03:37 So I'm now the CEO of ATI Advisory, which did start out as just a myself 03:42 independently consulting, which I did out of Avalere with an eye 03:46 towards actually doing some research on my own about the experience of family 03:51 caregivers and founding A nonprofit organization that many people are 03:56 familiar with called daughterhood. org and supporting myself in independent 04:01 consulting in the process. 04:03 But you know, I think it was after 2015 when the policy 04:07 communities and the business community started to really, 04:11 I think kind of become a lot more aware of the population that needs post acute 04:17 and long term care and their contribution to high health care spending and the need 04:23 to make sure that value based care models and things like that take them into 04:28 account and more explicitly. 04:30 And so our business grew, my business grew and I made the decision 04:36 to hire people and now we're at 49 people that I know. 04:40 It's crazy, I know. 04:42 So you know, and I and we are, you know, the way I like to describe what we do and 04:47 who we are. 04:48 And, and I'm not really the least expert of 04:51 all of the people at ATI, many, many, many things, but very, 04:55 at a very high level, what we do is we work with both the 04:59 government leaders and business leaders in healthcare. 05:02 And I like to say we work and I think a lot of consulting firms use this phrase. 05:07 So, you know, solving the hardest problems in 05:09 healthcare, we're getting the toughest problems in 05:11 healthcare. 05:12 I think for us though, it is a real differentiator in that. 05:16 And that because of my background working with this, 05:19 with the nursing home industry and the people that I hired and attracted 05:23 overtime is that we have AI think of much deeper expertise and understanding of the 05:28 populations have chronic care needs and long term care needs, dual eligibles. 05:33 You know, these more vulnerable and high cost and 05:36 high need populations is really our area of differentiation and expertise. 05:41 And so we kind of wrap that with the usual, you know, data analytics, 05:46 research capabilities, financial, you know, modeling and, 05:50 and things like that. 05:52 And that, you know, data analytics really is a, 05:55 a huge component of what we do. 05:59 But, but that's, you know, we work with states, 06:02 we work with managed care organizations, we work with providers, 06:05 we work with trade associations, we work with foundations. 06:08 And we're always bringing that lens on the chronic care populations. 06:12 And, and I think a lot of awareness about what 06:15 nursing facilities contribute to the value of the care that's being delivered 06:19 to them. 06:20 Great. 06:21 Well, we're really going to rely on you, Anne, 06:23 a lot to help us figure out what providers need to be doing to get ready 06:27 for the future, to succeed in the, in the current environment, 06:30 but also get ready for the future. 06:31 And one thing that's very clear about the future is that CMS, 06:35 whether it's been under a Democratic or Republican administration, 06:40 they just keep talking about value based care and saying, 06:43 and it looks like this is holding true even with Trump winning that every 06:48 healthcare providers going to be in a value based care plan by the year 2030, 06:53 like 100%. 06:54 So do you see the same level of commitment across administrations? 06:58 And do you think this is really going to happen? 07:00 What what are your thoughts on that? 07:01 Yes, actually I would. 07:03 It's from what I've seen so far, this administration, 07:07 I would argue is even more aggressive and more committed to kind of propelling 07:14 value based care forward than even the previous administration. 07:18 And in the ways that we're seeing that already are in things like more models 07:25 being already either, you know, retained from the previous administration 07:31 or or created that are requiring the participation of providers in certain 07:37 markets. 07:38 So there's what we call, we call those mandatory models. 07:41 So there are more already more mandatory models and an explicit, you know, 07:47 explicit statements that they expect to do more of those. 07:52 And I think, you know, a fairly ambitious strategic plan which 07:57 that they put out in May CMMI, which by the way, interestingly, 08:02 I thought for the very first time I've ever seen this out of CMS would be very 08:08 explicitly mentioned function, functional decline, caregiving, 08:13 all of the things that are relevant to the work that the nursing home industry 08:19 does and touches. 08:20 So I think they, I think there's leadership there that 08:23 really understands our population and is interested in the high cost and the high 08:27 need populations. 08:28 And they're going to be doing more mandatory models. 08:30 And they seem, you know, pretty oriented towards giving, 08:34 even giving providers who are leading these models, 08:37 tools that are more similar to medic, Medicare Advantage plans, you know, 08:42 the ability to really, you know, authorize services in advance, you know, 08:47 monitor utilization. 08:48 So they're they're very, very serious. 08:51 And they're serious about putting more risk and more authority and control in 08:55 the hands of providers. 08:58 So when you, when you think about the sniffs and, 09:00 and where we fit into the whole world and they're headed towards value based care 09:04 with everybody, what does that mean for the sniffs? 09:06 I mean, I, I've heard some people speculate that CMS 09:10 could require everybody to be in an ISNAP or require everybody to have an ACO 09:14 program or something like that. 09:18 Where do you see this headed? 09:20 Yeah, I, I think that I wouldn't, I don't know that I would see CMMI 09:25 requiring that every, you know, requiring a model of some kind touching 09:31 every single Medicare beneficiary. 09:34 However, I think one of the populations that they 09:38 are very interested in are dual eligibles. 09:41 And just to take a quick side track for a minute, you know, 09:45 nursing home long stay populations are, you know, a high, very, 09:50 very high percentage of them are, you know, duly eligible for both programs. 09:55 And kind of once somebody gets a nursing home, you know, 09:58 their care is effectively integrated by the nursing home. 10:02 And certainly even more so under some of the ISNIPS models and some of the ECO 10:07 models that are happening for that long stay population in nursing homes, 10:11 which I think you and I are in agreement has been one of the most exciting and 10:16 promising innovations in our space. 10:18 But at the same time, states, state governments, 10:21 governors and CMS are looking at the dual eligible population more broadly. 10:28 They don't think, oh, dual eligible, that's there's nursing homes and there's 10:31 everyone else. 10:32 They just think duals and they think we're, you know, 10:34 for 20 years we've been trying to find a way to get these duals into these managed 10:39 care programs so that, you know, we don't have to worry anymore about them 10:42 navigating these, you know, all of its inefficiency that happens when 10:46 they're in two different programs. 10:48 We want to integrate these programs for duals. 10:50 We can't we've, but we've struggled to do it because we 10:53 can't make them sign up for managed care. 10:56 But I think there are even more now than ever interest in maybe we can't make them 11:01 sign up for managed care, but we could make sure that they are 11:05 attributed. 11:06 Every single dual eligible is attributed to an ACO because that's a little bit 11:11 less of a, you know, a forcible event. 11:14 You know, you're, you're sort of saying to the physician 11:18 groups and the hospitals and the managed care plans, you know, 11:22 all of these dual eligible are up for grabs in terms of managing them. 11:28 So for providers getting ready for this, and we'll have multiple discussions with 11:33 you in the future of this. 11:35 I think what your messaging is today is this ain't going away just because Trump 11:39 has come in. 11:39 If anything, it's, it may become even bigger. 11:43 You need to develop a value based care strategy because this is, 11:46 this is really going to happen. 11:48 It really is. 11:49 And I, I, I feel like it's hard to be credible on 11:51 this because as a consultant, I feel like, do you feel this way? 11:54 I feel like I've been saying for to that since, you know, I don't know, 11:58 10-15 years this is really happening. 12:01 OK guys, get ready. 12:02 But we have seen cycles, we've seen the payment Model 3 and we've 12:07 seen the ISNIP and the AC OS. 12:10 You know, we there has been this, if you really look, 12:13 you can see there has been this steady March and now we're we're not marching 12:17 anymore. 12:18 We're probably getting ready to get into the race. 12:21 And I really, it is happening, I think. 12:24 Yeah, there's that quote that saying that 12:26 change from year to year in anything is slow, but over a 10 year. 12:29 Is pretty damn fast. 12:31 And if you think back 10 years ago, I mean, 12:33 how ACOs at this level weren't anywhere near where they were at. 12:36 Providers were just starting to think about creating ice snips. 12:39 They hadn't really done it. 12:41 So there have been dramatic changes over the last 10 years and you would think 12:45 that with this hyper focus that the Trump administration has on all of this, 12:49 the next 10 years is going to be even more dramatic. 12:51 So, and we're so thrilled that you're along 12:53 for the ride to help us figure this all out. 12:56 Hopefully over the next 10 years. 12:57 I hope I have that much time left and that and if we're just really glad you're 13:01 part of Park Place. 13:03 Thanks everybody for tuning into Park Place and we appreciate your support of 13:07 this website.
