Transcript Generated by AI 00:00 Mark Parkinson back with Park Place, and today we begin our analysis of 00:05 Arizona. 00:06 And we've picked Arizona for a whole bunch of reasons. 00:10 Obviously, it's a very famous state for folks that 00:12 are going to retire. 00:14 It also happens to be a state where one of the very best state association execs 00:19 runs the organization. 00:21 And so we wanted to check in with Dave Voepel to start out our analysis of 00:25 Arizona and really kind of get the inside info on what's happening there. 00:29 You would think that there would be a gazillion nursing homes in Arizona. 00:33 It really turns out to not be the case. 00:35 Another surprising thing about Arizona is there is absolutely no certificate of 00:38 need. 00:39 Despite that, it doesn't appear that there's been a 00:42 massive build up in facilities and it's been probably the the deepest penetrated 00:46 managed care state in the country. 00:48 So there's a lot of really interesting things about it that we want to learn 00:52 about over over the series of interviews that we'll do. 00:55 So we're going to start out with Dave Voepel. 00:56 Dave Voepel's been the CEO of the Arizona Health Care Association for eight years. 01:00 Prior to that, he was a CEO in Illinois of the 01:03 association for 12 years. 01:05 He is highly respected, has served as the president of ASCHAE, 01:08 which means that he was the president of the group that represents all all of the 01:13 state association execs that put him on the AHCA board. 01:16 He was my boss for a while and he's a he's a really, really effective lobbyist, 01:21 but also a really fun person. 01:23 So, Dave, welcome to Park Place. 01:25 Hey, thanks, Mark. 01:26 I appreciate it. 01:28 Now, I I started talking a little bit about 01:30 how Arizona is not exactly what you would think when you think about the deep 01:34 penetration of retirees there. 01:35 Tell us about the provider mix there. 01:37 What? 01:38 How many buildings are there? 01:39 Sure. 01:40 Yeah. 01:40 We have for skilled nursing, we have 141 SNFs which for almost 8 01:45 million people seem small and that's because we're built on the home and 01:50 community based model. 01:51 So we're an HCBS state, which gives us about 3000 assisted living 01:57 facilities, communities throughout the state 1950 or 02:02 group homes and about 350 are 11 bed or more of which we call centers. 02:09 Those are, those are where our sweet spot is with 02:11 the skilled nursing and the assisted living centers. 02:14 I mean, that really is a very small number of 02:16 buildings. In Kansas, 02:18 You know, where I, I, we operated, there's 3 million people in over 300 02:22 buildings and you're telling us there's 141 SNFs. 02:25 That's, that's a remarkably small number. 02:27 It, it really is, it's in it. 02:29 And that comes from the fact that we were last to Medicaid. 02:32 We didn't show up to the Medicaid party until 1982 and we didn't start our Altex 02:37 program, our long term care program until 1989. 02:41 So it's pretty rare. 02:43 Now one of the things that's clear, and I'm not surprised with your 02:46 leadership there is that the sector is unified. 02:48 Just talk a little bit about that. 02:50 Yeah, that started before, way before me. 02:52 So the sector is very unified. 02:55 We have assisted living and skilled nursing facility members on our board. 02:59 We're being led by an assisted living person. 03:02 And we have in our leadership, like Chris Wooley will be our next 03:05 president. 03:06 He's with Avista Senior Living and he is assisted living. 03:09 So it's a, it's a really good mix and it's really, 03:12 it's really fun to be able to work between the two because they're 03:16 complementary and you have virtually every SNF provider as a member of the 03:20 association, right? 03:22 Yeah, that's the other thing. 03:23 Of the 141, we have 135 of those in our membership 03:27 and the other ones we still communicate with. 03:30 We have a, a program we call Disaster Ready, 03:33 which is an emergency preparedness program provided by a grant through HPP 03:37 funds and we communicate with all SNFs. 03:40 So we work across the board and, and with and with the Argentum and the 03:44 Leading Age affiliate as well. 03:45 So it's very collaborative. 03:47 Yeah. 03:47 They must be very, very small. 03:49 If there's only 6 that you don't have in your associate, that's fantastic. 03:53 Yeah. 03:53 The thing everybody knows about Arizona is it's been, 03:56 it's a managed care state and it's been a managed care state for a long time. 03:59 Talk, talk a little bit about that. 04:01 Yeah. 04:01 As I alluded to, we didn't come to managed care into into 04:05 this whole program until the 1980s and it started out as managed care. 04:09 So we've been managed care for what, 37 years or something like that. 04:13 So we understand managed care. 04:14 So when you talk about Medicare Advantage proliferation and you talk about some of 04:18 these things in other states, that's no big deal to us. 04:21 We know how to deal with it and the operators and the association have just 04:25 figured out how to make it work. 04:27 That's the key. 04:28 So I'll go back to that word. 04:30 You'll hear me use it a lot. 04:32 It's called collaboration and we collaborate and the association is set up 04:36 differently than most other associations where we get involved with claims, 04:41 claims management, reimbursement, provider assessment. 04:45 Can't call it a tax here in Arizona. 04:46 We don't like taxes, so we got to call it an assessment. 04:49 So we have a supplement that goes along with it. 04:52 So we have all of these various dynamics and it's all based on the fact that we're 04:56 in the Wild West. 04:58 And so it's like we're not going to take anything from government. 05:01 We're going to tell government what to do. 05:03 And again, it goes back to collaboration. 05:05 So in order to do business in this state, you have to work with your managed care 05:09 company, which there are three on the Medicaid 05:12 side, and you have to work with the state 05:14 agencies and state government. 05:16 So let me just throw out a few key topics and you give me your kind of initial 05:21 thought on them. 05:22 Just general reimbursement in Arizona, if you're a good negotiator, 05:25 reimbursement's pretty good. 05:27 If you have specialty rates, reimbursement's pretty good. 05:30 If you don't like managed care, reimbursement's going to suck. 05:33 It's not going to be good because you're just not going to be able to get people 05:37 in your buildings. 05:39 So it's, it's not bad collaboration with the state 05:42 regulators. 05:44 It's very good. 05:44 We have a very good state agency. 05:48 The Department of Health does a very nice job. 05:51 It hasn't always been that way. 05:53 Different administrations. 05:54 It, it goes up and down, you know, same with the Medicaid agency. 05:59 It's up and down right now. 06:00 It's, it's pretty, pretty good. 06:02 It's the biggest thing is that they listen. 06:05 And so we come to this. 06:07 We took a page out of your playbook many years ago when you were at AHCA and 06:12 mainly said, hey, we want to be solutions oriented. 06:15 So we come in with solutions. 06:16 There's a problem, let's find a solution. 06:19 Your relationship with the governor and the state legislators, it's very good. 06:24 Yeah. 06:24 We have a state legislature that is all Republican for the most part, 06:27 and we have a governor that's Democrat. 06:29 And so, you know, there's, you have to play both sides of it, 06:32 in which case they both have their strengths and they both have their 06:36 weaknesses, and you have to get along with everybody. 06:38 Again, collaboration. 06:41 Dave, you come from a state that until recently 06:44 was one of the most divided among provider groups, which is Illinois, 06:48 and you're now running an association where you have one of the most united 06:53 groups in Arizona. 06:55 Just tell us a little bit about the difference in those situation. 06:58 Well, as you know, Illinois is a pay to play state. 07:02 You know, you've got to have the dollars to do it. 07:04 You got to have the pack to be able to do it. 07:05 You have to have all that good kind of stuff. 07:07 You have associations on top of associations in there in, in Illinois. 07:12 Arizona, we don't have that. 07:13 We have, we have 3 associations, but we all managed to do our own thing. 07:17 We talk weekly between the three of us. 07:19 So we try and work together and, and there are some differences, 07:23 but Illinois is so different. 07:25 It's very competitive. 07:27 Whereas Arizona, we're trying to find solutions and be 07:30 collaborative because that's the only way to exist here. 07:35 So you've been at this for a while. 07:37 How do you feel about the sector now and where do you see the future? 07:41 I feel great about the sector. 07:43 I think it's I think it's very good. 07:45 Arizona, I am a little worried on the 07:48 reimbursement side because we see a lot of cuts coming down due to HR1 07:53 on the federal side, I'm not sure with the Republican 07:56 Legislature, it's very tough to get increases through 08:00 on our Altex program. 08:02 Regulatory wise, we have a good relationship with the 08:06 regulators and we tend to be cooperative on that end. 08:10 So, so it's very it's it's, it's easy to sit down and have a good 08:14 discussion about it. 08:15 So I'm pretty high and pretty bullish on that in that area. 08:20 Well, Dave, thank you very much for spending time 08:22 with us today. 08:22 We really appreciate your input. 08:24 Yeah, it's been fun. 08:25 Love. 08:26 I love seeing this. 08:26 So this is great, Mark, and it's going to be fun. 08:29 Over the upcoming weeks, we'll have interviews with providers both 08:32 on the AL side and on the skilled because AL is so prominent in Arizona. 08:37 We'll hear from Mark Zimmet and Steven Littlehale, and by the time we get done, 08:40 I think I'll have a pretty good understanding of what it's like to 08:43 operate in the state. 08:44 And with leadership like Dave, it's it's pretty darn good. 08:48 Thank you all for your continued support of Park Place.
