Juniper Communities Founder and CEO Lynne Katzmann has combined a background in public policy with entrepreneurial acumen to become a senior living changemaker, creating an influential operating model and leading the industry in new directions.
When she founded Juniper in 1988, Katzmann had a goal to shape public policy through her work at the company. Today, she is succeeding. Juniper’s Connect4Life model — developed in response to the Affordable Care Act — has become a template for how senior living can benefit from and contribute to changes in the U.S. health care system.
Connect4Life positioned Juniper well for further policy shifts, including new Medicare Advantage flexibilities that could make this insurance product a senior living payment source. Katzmann has teamed up with other senior living providers to create The Perennial Consortium, which is in the process of bringing its own Medicare Advantage plans to market.
Bloomfield, New Jersey-based Juniper currently has a portfolio of 21 communities in four states. Katzmann spoke about how she stepped out of her comfort zone as the company grew and innovated, early and painful efforts to create eco-friendly buildings, and why senior living needs to change or risk disruption from the likes of Amazon or Apple.
What are some changemaking efforts that you’re especially proud of?
When I started Juniper, I did so with the belief that we would be a small to mid-size company that would innovate as a way to shape public policy. So, in other words, to show that you could make people’s lives better by doing things differently and that other people could follow suit.
We have been involved in a whole host of changes over the years, many of which I’m proud of.
We have only constructed a couple of buildings, [but] we built them to the most advanced environmental sustainability standards of the time … Environmental sustainability, to many people at the time, was recycling. To us, it was far more than that. It has been just a part of everything we’ve done, but nobody knows about it.
The next thing we did was, we built a memory care building. That design was a small house model, before people talked about small houses. I’m really proud of that. Those buildings still are around today. They’re full.
The third example is Connect4Life.
Can you describe how you came up with Connect4Life?
I have a Ph.D. in health economics and policy … So when the Affordable Care Act was legislated [in 2010], I wanted to learn about it.
The law called for data to be shared and called for interoperability. [It] called for people to have EHRs, and to share that data. The only people that were really funded for that were hospital systems and doctors. And skilled nursing, which we had quite a bit of at the time, was, in the law, supposed to be up and running and fully functional by January 1, 2013.
We decided that we would implement in 2011, because we wanted to be ready and fully functioning by the end of 2012. We also made the decision, albeit it not one that was regulated by the ACA, to include our assisted living communities in that rollout.
I think that was probably an assumption that was premature, but frankly, it’s been one of the best decisions we inadvertently made.
By the end of 2012, we had an integrated electronic operating model. So what that means is, not just on the care side, but we used [the tech platform’s] general ledger system, their CRM (marketing system), and all of the other pieces that made up a basic operating system for a senior housing environment, including a SNF and AL. And that was pretty revolutionary. We’d always collected data, and we began to be able to use data to drive decisions.
The second thing which came out of the Affordable Care Act was the whole play in readmission penalties. That meant hospitals, in order to make money, needed to be able to understand what happened when someone left the hospital. They were now responsible for that, and that would change how people worked together.
I was asked to speak at a panel with Susan Dentzer, who was my hero. She was doing all this health policy work that I had followed for years. I thought, “I get to be at the big person’s table, and she’s a woman, and I’m going to learn so much from her.” The topic was care transitions.
I had no idea what care transitions was, so I learned … What we in senior housing did at Juniper was exactly what care transitions, and the Affordable Care Act, were calling for. We did assessments, we monitored people for changing condition, we did care plans, we monitored those care plans. We were required to give information when people left our community, and we were required to coordinate their care once they returned from whatever other setting they had been in.
People loved the green packets. We became the go-to company for admissions or for transfers.
We said, “We’re going to have our own care transitions program. We have an electronic operating system. We can push a couple of buttons and get real-time information every time one of our residents leaves our community, so let’s do that, but let’s package it.” We put together Juniper-green plastic envelopes that said, “Your health information from Juniper Village.” Every time someone left our community, whether it was to see a doctor, a specialist, a hospital, or for testing, they went out with their health information with them, and we became really well known for our green packets.
People loved the green packets. We became the go-to company for admissions or for transfers because [those providers] knew we had data, and they knew we would protect them from readmissions. But more importantly, we were able to give them information to avoid duplication of service and to better organize the transition of care.
Once we realized we had a care transitions program, we realized that we had these other ancillary services on site. We had rehab, we had pharmacy. We said, “Well, what happens if they became part of this integrated network?”
It meant that the same provider had to provide care on a regular basis. They had to have regular hours and they had to be on site. And more importantly, they had to enter certain data into our electronic system, and then utilize that system so that they could communicate with the other providers and see what else was happening around a resident.
We formed a circle of post-acute providers around a resident, and we then added primary care, which was the missing piece. Primary care is interesting because it is the glue on the post-acute side, but it’s also the gatekeeper to the acute piece.
We began to see that we were having some pretty good results: that people were living longer, they were happier, the number of people who were transferred out due to health conditions was reduced, and we said, “We got something here, let’s package it [as Connect4Life], just like we packaged care transitions.”
Can you elaborate on those good results?
We had Anne [Tumlinson] do the research, and she first looked at utilization, and we spent probably a good half a year pulling data out of our system and comparing it to the Medicare data set that she had access to at Johns Hopkins.
The results far exceeded anything we ever thought possible. With the very large reduction in hospitalizations and readmissions, we said, “Okay, we’ve got a program that really could be something. And what we’ve done is doable by anyone in our industry, and because we believe in being a model for public policy, let’s package it and share it.”
I was not one to get out and speak to people. I just wanted to be at home with my little garden, cooking food for the whole neighborhood, doing the things that I love. And [my team] said, “No, Lynne. We’re at a point in who we are as a company that you need to get out. You need to tell people what we’re doing because we want to be recognized for our work.”
I went out and started talking. It enabled us to really come full circle on our original goal to be a model for public policy.
We then hired Anne again to monetize the value of the savings from [our reduced utilization], and those numbers came back so amazingly large that we said, “If we’re saving the government $10 billion to $15 billion a year, wouldn’t it be cool if senior housing captured some of those dollars so we could do more for the people who need our services but can’t afford to pay for it?”
And that led to another changemaking effort, to create The Perennial Consortium with other senior living providers, to launch a Medicare Advantage plan?
After more research, it became clear that the only way to do that was to control the health care dollar, and the only vehicle available to do that at this point in time for a senior housing provider was to become a SNP, a special needs plan through Medicare Advantage. That was the genesis of the whole Perennial Consortium.
How is it different to lead change through The Perennial Consortium versus through Juniper?
I am an entrepreneur, and I am in an enviable position to own a controlling interest in entities that control the decisions that Juniper makes. I know that, and my investors know that. None of us abuses our privileges, but it has provided me with an ability to think big, in ways that perhaps other people may not be able to do.
So, being an entrepreneur, and choosing to do something that scales across the industry is a new learning experience … For me, the greatest challenge is building a collaborative of CEOs and leaders to innovate collectively. I think it’s a great opportunity for new learning, and I’m doing it, and I couldn’t be luckier to have the partners I have, because they are wonderful human beings and incredible business people, with experience, with acumen, with intelligence, and above all, heart.
Tell me about a changemaking effort that didn’t go well?
The reason we got into environmental sustainability is because one of the people that’s worked with us for almost 30 years, Richard Ottens, said, “Lynne, you’re all about doing better things for people, and we take care of older adults, and we provide better quality of care and service. What about the environment? The environment creates health; we need to be responsible for the environment.”
[Richard and I] spent days in architects’ offices, picking out every piece of hardware, researching low-VOC carpets, all simple things that would make a huge difference in the life of the building and of the people who lived there. It took an enormous amount of time. We fought with the architects who said “yes” but didn’t do [what they promised], and with the construction company who also said “yes” to get our business, but who were really not interested in being the leader at that point in time.
To be a certified LEED building, you had to hire a consultant who would come in and verify the work of the construction manager. And when they came in, we learned that many things weren’t done properly: things as simple as the right light fixtures, the dehumidification system was in but not hooked up. It went on and on and on. We decided not to pay the final bill for the contractor until they fixed it.
They refused to fix it, we went to arbitration, and after spending an enormous amount of additional money, we lost … We thought we would win, and we lost. At that point in time, my faith in the construction industry, and my faith in myself and my ability to work in that environment was … I questioned it.
We realized maybe this wasn’t the best place for us to be. We’ve been very successful at buying local, under-managed properties, and so we went back to our core competency. To this day, the buildings that we designed and built are the best we own and operate.
There’s a part of me that would love to design some new buildings now, and I think my team would love to as well. We would probably need a really simpatico design and construction partner to do that. We haven’t found that. What I would be totally open to, is working with a company where that was their core competency, and we can bring to the table what we do well, which is managing, creating a culture, and programming in an environment.
Do you thrive on change or consider yourself more cautious?
Change is fundamental to who I am.
Every changemaker has different things that motivate them: I love to learn, and my greatest strength is to be able to learn a lot of different things and be able to see how they might relate differently. It’s like putting together a group of puzzle pieces in a different way to have a very different picture at the end, a different outcome. That’s my strength. I probably couldn’t design anything from the ground up that wasn’t informed by something I had seen or learned.
For me, change is what makes a vibrant life, what keeps me invested, what makes me happy, what keeps me willing to be on a plane three-quarters of my time.
How do you time a change, so that you’re ahead of the curve but not too far ahead of the market?
I think those are really, really great questions. I never think about them.
Other people bring them to my attention at Juniper … I believe the team understands that I’m likely to come up with some new idea that may not make sense today, but they trust me enough that they’re willing to work with me. That means challenge, that means test. And that, I deeply value.
What we’re trying to do now at Juniper is to take our learning, which has evolved and happened over time, and try to package it in such a way that we can help other people participate in the changes that are happening in the industry more easily.
Do you think the industry is changing quickly enough?
It has no choice.
Our consumer is changing at every level. The Greatest Generation took what we had, the Silent Generation isn’t so sure, [but] will take it when they absolutely need it. The boomers will not. And so when you’re faced with consumers who don’t want to buy what you offer, you have to change.
I really believe that if people don’t get off the mark soon, we’re going to be disrupted by Apple or Amazon.
Technology, it’s here. And I believe people know that technology is here to stay, whether it’s Alexa, or a sensor, or ambient technology that picks up data, or AI, or any of those — data is here. It is the new way we look at our world and communicate within our world.
I think that the combination of several of those factors, consumer change being one, technology being another, the labor force changing being another, I think all of those things say we cannot face the world in the same way we did before.
Now, what pace you take and what constraints you work under are all different.
I really believe that if people don’t get off the mark soon, we’re going to be disrupted by Apple or Amazon. What Amazon’s doing with Berkshire Hathaway and JPMorgan Chase is, they’re putting together their own model for health care of the future. Atul Guwunde has better words than I do, but [believes the] same thing: Bring [health care] down to the lowest level, maintain your lifestyle, manage your lifestyle, and don’t use all the expensive stuff. He talks about end of life. He is the head of [Amazon’s effort], and they put all their money behind him. So, it’s happening.
[Clive Christensen says] an industry is ripe for disruptive innovation when things become too expensive and inaccessible for the common person, and we’re just about there. We’re certainly there in health care in general, and we’re quickly moving there in our industry.
He said that those preconditions make it right for people to either come in in a big way and disrupt, or to reorganize the pieces of the puzzle — my words, not his — to create a new model which serves more people at a cheaper cost. That’s what Connect4Life does.
Do you have a vision for what will appeal to the boomers?
[If the question is], “What do you see happening for senior housing in the future?” in my mind, it is integration. But it’s not just integration of health care and housing. It’s far more than that.
You have to integrate technology with human touch. High-tech, high-touch. You need to think about how to integrate lifestyle management services with housing, and also with care management.
Lastly, in terms of an experience in programming, you need to integrate your community with the greater community surrounding it, so that when people come to your building, it’s not a segregated environment, but rather an integrated environment made up of people of different ages, with different interests, doing different things in your site.
When you talk about it, it doesn’t sound like much, but when you think about what it takes to truly accomplish that, it’s a shifting of the paradigm of how we do things.
So, a simple word, not so easy to do. It requires a mindset shift, it requires the willingness to butt heads with regulators and financial sources, it requires the ability to manage change.