Lifesprk CEO: Innovations Underway to Bring Tealwood Portfolio Into New Care, Payment Models

Announced earlier this year, the acquisition of Tealwood Senior Living by Lifesprk was an industry milestone.

Based in the Twin Cities metro area, Lifesprk specializes in providing value-based care largely through home- and community-based services. The company intends to bring more coordinated, integrated services to senior living residents by leveraging a mix of services and new payment models.

With the leadership of Bill Thomas of Green House, Eden Alternative and Minka fame, the integration of the Tealwood portfolio — numbering roughly 40 communities — is well underway, Lifesprk Founder and CEO Joel Theisen said during a recent appearance on SHN+ TALKS.


Operational innovations such as a “lodge model” are being conceptualized and operationalized, staff and residents are learning about new opportunities for integrated services to reduce care “bottlenecks,” and new payment streams are being introduced.

“We’ve been really active in bringing the payers to the party, if you will,” Theisen said. “We’re looking at bringing all those lives in those campuses to different value-based products.”

We are pleased to share the recording and this transcript of the SHN+ TALKS conversation with SHN+ members. Read on to learn about:

  • How Lifesprk is taking on “global risk” for older adult populations in new payment models, and the role senior living plays
  • Lifesprk’s plans to use the Tealwood platform as a test-bed for senior living innovations
  • Lifesprk’s ambitions to scale nationally and how senior living providers can become part of its networks

The following has been edited for clarity.

[00:01:54] Tim: Joel, can you start by sharing the company’s backstory and describing the business model a little bit?

[00:02:10] Joel: Yes, sounds good.

Like you said, Tim, I’m a nurse by background. As I was in the home health business back in the early ’90s, I saw the flaws in this acute/reactive service model and the fact that we don’t really look at people holistically across their life journey.

In ’96, I built a company that was a geriatric care management company with a private pay underbelly [and] scaled that to five locations across the country, but … I wanted to do something more important for all seniors and I wanted to really make a difference in the delivery system.

I left there and in 2004 started, as you said, Lifesprk. We raised family and friends money, not venture capital or not external capital. We really wanted to build something important. We started with the geriatric care management model, where we were serving seniors on a private pay basis out in the community because there was no other payer for it at the time. As things evolved, my interest was always in looking at the whole continuum and the whole life journey of seniors, and so we started working with hospital systems and helping them with narrow networks and helping them with discharge to home, discharge to TCUs [transitional care units].

We did a lot of consulting work and then we started consulting for the TCUs and helping them with readmission issues, transitional care models, all sorts of unique little bits and parts, all trying to, again, learn that journey. We were always searching for a way to pay for and really support wellness or wellbeing in a holistic care model.

What happened then with the ACA [Affordable Care Act], which was really awesome, was the fact that we opened up this whole value [based care] world to different types of providers. That’s when I really got excited, and Lifesprk invested deeply in technology and analytics, knowing that if we were ever going to play in the big leagues and change the delivery of services for seniors, we needed to really have efficacy and have provability.

Additionally, we opened a skilled home health company, we started our own medical practice because we also knew we needed attribution. We needed that medical model so we could acquire these populations from payers. We started our own medical plan, we added our own transportation company, we added hospice and palliative care, all with the idea of how do we arc towards creating a system, a real true system, and again, working with a lot of partners to differentiate and ultimately go after value-based contracting, where Lifesprk is today.

We built up a lot of parts and pieces of home health, private pay, palliative care, hospice, we were always interested in assisted living as well. We were doing contracted home care on record, so we were doing all the health care services inside of assisted living buildings for 13 years.

We always knew we wanted to do more, because we wanted to serve people where they are. Obviously, there’s a lot of seniors in senior campuses and so we had a lot of owners over the years approach us and want us to come in and bring out model inside. It became really compelling as we, three years ago, [were able] to get our first value-based contract, where Lifesprk is at global risk for a large population of Medicare Advantage seniors in the state of Minnesota.

We said, “Look, we’re going to be agnostic to payer.” Fee-for-service, government, Medicaid … That’s where Lifesprk is today.

The senior housing platform, [gives us] flexibility to take these communities and actually extend their walls, and really bring a whole different value prop around coordinated holistic, longitudinal services for seniors. That’s where we’re at now. We’re about a $60 million company. We have about 3,400 employees, and we’re starting to really get a lot of interest to continue to scale not only locally, but nationally.

[00:06:30] Tim: Talk to me a little bit more about the Tealwood acquisition, specifically. You mentioned that you’re already providing services in assisted living, but then to actually acquire an assisted living provider is a whole other step. When did you first connect with Tealwood and how did you know this was the right move to make?

[00:06:47] Joel: Yes, originally the owner started talking to us. Tealwood does a lot of property management. Then some of the owners started talking to us, and instead of making that cryptic and weird, I went right to Howie, who’s the CEO. He’s a great guy. We started having conversations about, “Look, this is what we’re doing, this is what we can add to the party.”

It was great because Howie has been in this business for a long, long time. He said, “Holy mackerel. You’re doing value-based. You’re actually getting value-based contracts and you’re doing the 365, 24/7 acute care, home care, hospital at home, all these innovative things?”

He’s like, “This is really cool. Let’s do this, let’s do this thing.” Howie leaned in.

He’s had a long career, him and his team. They’ve got a great culture. He, along with the owners, said, “This is a great idea, let’s put this thing together. Let’s make it happen.”

We talked pre-COVID, we were getting some momentum, and then COVID happened, and obviously, that shut down our talks for a while. As it started to stabilize a little bit, we got a deal done.

The real rationale was, Howie and team are really committed to changing the [resident] experience. He saw that this could be a good legacy for him and his team to make it better for seniors and those that serve them.

[00:08:17] Tim: Related to that, Howie told me that the combination of Lifesprk and Tealwood could help reduce bottlenecks in caring services. Can you talk a little bit about what those bottlenecks are and how you think you can resolve them?

[00:08:34] Joel: … What he was talking about was really that fragmented continuum that we’ve all dealt with our entire careers, right? Lifesprk is bringing primary care, geriatric expertise on-site for all these folks who will all have access if they want it. Obviously it’s their choice.

That also then translates to the technology connection with telehealth, telepresence, and our electronic life record, which is a much larger [platform] than just a medical record.

Then ultimately, that reduces those bottlenecks in clients having to go to the ER and having to go out of the system and end up in TCUs and all the different stuff that happens, because of services that are coordinated at the point of care or the point of service.

[00:09:56] Tim: The acquisition was announced very recently. I don’t know how much has changed or what could have been implemented on the ground, but I know Bill Thomas of Green House fame is involved in operationalizing this model. How’s it going so far?

[00:10:18] Joel: It’s an acquisition, it’s an integration, and you’re bringing on 40 properties, three SNFs. We thought, holy mackerel, this is going to be a big lift and it’s going to be challenging, but we were really committed to the culture and the team and the people, and having Howie and his team … behind it, we just all pushed together and made it very transparent and open. Right now, [the focus] is just to make sure all the employees really feel a part of this new momentum.

There’s a lot of education, there’s a lot of training, and so all that’s going fantastic. We haven’t lost any staff. Everyone’s really bullish. They’re really excited about the future and that’s a testament to Howie and his team and the cultures that we equally bring to this and the deference and diligence that we did to set it up.

Where we’re at on that side is really good, and then to your point about Bill Thomas, he’s working with us basically 100% of the time now on helping us as well as others, helping us envision some new modeling, some new really interesting ways to create reciprocity in our sites, create this, what we’re calling the lodge model.

That’s going really well too. Our owners are loving it because we’re already improving some metrics in not only occupancy but in satisfaction and some other areas.

Then on top of it, we’ve been really active in bringing the payers to the party, if you will. We’re looking at bringing all those lives in those campuses to different value-based products. We not only do the same thing, but we actually can look at both sides of their wallet, if you will. We’re looking at the private pay piece, and they’re doing that already, but how do we subsidize and how do we support using Medicaid Advantage to help with reducing costs on copays and additional expenses and pharmacy, et cetera.

Hopefully, over time, our plan is to really help bring a different population to campus living that doesn’t have to be private pay. We think we can subsidize it with some of the dollars that are available if we’re really good at reducing acute care events.

[00:12:45] Tim: When you say you want to bring in a population that isn’t private pay, are you envisioning that even their rent would not be paid out of pocket?

[00:12:54] Joel: It’s a bold statement, but we’re going to make bold statements.

I think at first it will be more subsidies, Tim. I think there’s an opportunity for us to subsidize for people that [rent] expense, no different than food, or a PACE-like model. We have to start looking at these things differently, because we know we have a ton of seniors that are not able to be cared for well in our current system, and we’re spending 3.5 trillion dollars on healthcare, and we have to bring this hospitality/home environment connected to the government paid assets, and do better for them and make it connected.

I think to start with, it’ll be subsidized. I think over time, I think we’ll see if we can create enough value and create enough lift on total cost of care, I’d love to put that money right back in housing.

[00:13:52] Tim: You mentioned that Bill is helping with the concept of reciprocity. Can you describe what reciprocity means?

[00:14:01] Joel: … What this is really trying to do is really create more reciprocity in the communities for the seniors and their families, so they can actually serve and help each other more, where they can actually find creative ways to create value for one another.

We’re looking at things like care banking … different ways to create reciprocity, so give a little take a little, right? It becomes truly more of a community that feels connected in a genuine humanistic way. That’s some of the work that we’re doing around this reciprocity. How do we support and bring value and bring services to people that aren’t paid for it all the time, are not all professional? How do we help each other? How do these people help each other in these care settings and in these life settings?

External community members as well, bringing in not only caregivers but people in the community, [so] that we can get a vested interest and more of an intergenerational concept rolling. I know a lot of people have done that in different ways in senior housing, but we’re looking at that as well and doing it in some unique ways.

[00:15:47] Tim: You mentioned the “lodge” concept. Is that a physical structure that’s the lodge or is it a metaphorical lodge, what does that refer to?

[00:15:57] Joel: Yes. It’s a little bit of a long history, I’ll try to make this quick, but it goes back to The Elks Lodge and all these different organizations that created value to communities, and that were involved in this idea of reciprocity and support. It is more metaphorical … It’s really trying to extend those walls and not make it this, “put them up on the hill, seniors are all isolated,” and call it good and safe and efficacious.

I think it’s more about how do we really look at bringing in the local community team, this housing asset to the community and really bring wisdom, care, support into that community and out of that community. It becomes not a real estate block. It’s more … a place where people thrive, and there’s a lot of great wisdom and value in the senior populations that we need to export into these larger communities.

[00:17:19] Tim: We’ve got a question from the audience … you have multiple parts of the continuum, do you think pure-play senior living operators need to be nervous about all this movement toward home care versus communal living? Do they need to start expanding into the home?

[00:17:52] Joel: That’s a great question. I’ve been hearing that too in the market. A lot of people are going in that direction.

What I believe about that is, you don’t just start your own home care, but you need to start integrating these parts and pieces and these silos. If you guys have read Atul Gawande’s book Being Mortal, these silos, fragmentation, we use different words, but I do believe that the integration of these different parts to create this continuum and create this longitudinal holistic approach is absolutely critical, not just for the experience of the senior, but as we think about payment reform and payment opportunity to create efficacious population health metrics. You need to have partners.

We always say isolation is fatal. We have a ton of partners. We do have some of our own continuum pieces in Minnesota. The reason why we’ve done that quite frankly is because we’re trying to create the workflow, the data flow, interoperability of those assets because we’re going to start scaling them in about 12 to 24 months nationally. We won’t scale home care … there’s things that we won’t scale. We’re going to find best-in-breed partners in those markets to bring together with data and analytics.

With medical groups, we’ll bring together that full continuum so we can tee it up on reducing costs and improving life experience over time. I don’t think you need to buy them; you can buy them, you can own them, that’s fine, but I think it’s really more important that you start to think about the connection and the use case of these populations over time … more longitudinally.

[00:19:41] Tim: You say you’re about to scale nationally, but maybe not scale the home care piece you own. Can you elaborate on that a little bit, about what you are going to take to a national stage?

[00:19:54] Joel: Yes … What we’re going to scale is this trusting relationship concept, where we are agnostic to environment. We have people in the home, we have people in [senior] housing, we have people in long-term care, we’ll take anybody anywhere and we’re agnostic to pay — we will take still private pay, we’ll take government pay, we’ll take value-based pay. Most of all, we’re trying to move towards value-based pay. As we scale, we’ll scale our geriatric care coordination, which we call life care management.

This connection to the client and the family, which is really, really critical, as we all know … We’re going to take that [national], we’re going to take the nurse practitioners and physicians that are geriatric experts, not just primary care docs that take care of young kids and middle-aged people with problems, but really focused on geriatric expertise, we’re going to take that. We’re going to take our data and technology and what we call our electronic life record, which is the aggregation of all the payment data, all the medical data, all the third-party data, all the bot data on social determinants, and then all of our first-party data so we can actually really build out the opportunity to understand what’s driving the needle on value, what’s driving the needle on experience for these populations.

And then the last part is what I was talking about, building out this network of all these service providers. It’s a high performance, not a narrow network, but a high-performance network of who are the right hospitals, who are the best TCUs, who are the best health care companies. We’re going to aggregate those providers into this new delivery system that’s all built for value-based and that’s what we’ll scale.

[00:22:11] Tim: How does payment work in that system? You go to a market and go to the big Medicare Advantage players there and say, contract with us, we’ll provide this for you, give us the capitated rate, or something like that?

[00:22:26] Joel: Yes. There’s different ways, but in a sense, we’re going to the payer side because we just think the other parts are broken too much, so they don’t really want to really get into value-based care, mostly. A lot of them say they do, but they don’t, because they have one foot in the canoe and … they are fee for service drunkards. They can’t get out of that because they have too much invested in hard assets.

Really, we are looking to work with mostly payers or .. the government continues to evolve around direct contracting. Contracting where you can bypass a payer and go directly to CMS.

We’re actually one of 53 providers in the nation that has a DCE provider acceptance. We’re going to start our own plan if you will, where we can aggregate and go at full risk over time on our own population.

[00:23:25] Tim: In that DCE program, can you do that regardless of the market across the country, or are you specifically allowed to do that in particular places?

[00:23:35] Joel: Yes. That’s a great question. It’s evolving and there’s actually new models, with the new administration, coming out right now. They put a hold on the DCE, other models like it, but there’s some new stuff coming out. I think it’s going to continue to evolve because as we know, everybody knows that health care is out of control and the costs are out of control and we need to do something about it. The government continues to open up new options for people that are willing to truly do it better and take risks.

[00:24:05] Tim: If I’m a senior living provider and Lifesprk comes into my market and starts to work with the payers, et cetera, and you’re looking to create one of these high-performance networks, are you looking at senior living as a piece of those networks, and if so, what are the characteristics of a senior living provider that would be part of that network?

[00:24:33] Joel: I’m really glad you asked that question, Tim because just to be clear, like in Minnesota, that’s where we started, we have relationships, multiple different nonprofit and for-profit skilled nursing, as well as housing, assisted living [partners]. Absolutely. Yes, the answer is yes. We probably won’t even scale our property management in a new market because that’s not our game, right? There’s great people that do that really well, and so we’ll bring them to value-based opportunities, because right now, everybody [in senior living] just thinks of their business case around out of pocket, unless you have [Medicaid] waiver programs, which some people do out there, but the majority is this whole private pay mentality.

We can bring that government opportunity and that population health platform, and again, do a lot of the things that now, with technology and with advanced practice, we can do. The answer is yes.

I bet you we have 10 if not more senior housing partners that are going to be part of this new ecosystem. They want in. They want access to those value-based dollars that they just haven’t had access to and they want better outcomes. They want to have integrated [services] and care coordination. They want a seamless experience and they want differentiation. I’m all about partnerships and working with as many senior housing folks as we can in the future and … driving a whole different value proposition that hasn’t been delivered in the market yet.

[00:26:22] Tim: I guess going back to having your own senior living platform in the former Tealwood, now Lifesprk buildings, is part of the vision there that they will be the arena in which you can push the envelope fastest and furthest with how senior living can be brought into these networks, so then you can go to other senior living providers and say, “Look what we have done.”

[00:26:47] Joel: Yes, absolutely. We use the word efficacy, but yeah, Tim, that’s exactly why we did it, because we’ve had a lot of opportunities over the years to get into real estate and get into senior housing. As you can imagine, we’ve always been on the cutting edge of a lot of different things. I’ve always been working with the senior housing folks, but we just felt it would really be important to figure out the true integration and do some things differently around how we understand workflow and how we understand data and how we use data and how we get into the different EMRs.

It is really a learning lab, and that’s how we look at it. It’s great. Obviously, we love being a part of it, having full property management, doing some other things differently with Bill Thomas in the lodges and some different value creation there, but the real impetus was to create that learning lab and get us moving towards more value-based opportunities for senior housing across the board, not just Lifesprk, but really, like I said, all these other partners that I can’t wait to bring along. This is our chance now in the world. I’ve been doing this for 30 years.

I love everything. I love home health, I love senior housing, I love all the different places where people are really truly connected in a real way to the populations. Not these transactional models. I hate that. I think senior housing and home health and adult day and wherever there’s this trusting understanding and relationship, that’s where I want those folks to win.

[00:28:31] Tim: From a financial perspective, are there advantages that you see or upside that you see that you’ll be able to achieve in the Lifesprk senior living platform that a mere partner of Lifesprk on the senior living side wouldn’t be able to necessarily achieve?

[00:28:57] Joel: I’d say one thing that is really interesting, and again, I wouldn’t say I’m a deep expert in senior housing, but I’ve been around it for a long time and what I do know is, a lot of times, when we think about losing any clients to an acute event, they go in the ambulance, they may come back, they may not come back. If they come back, they come back with multiple different providers, and they have all these different providers coming in and out of your buildings.

I think from the standpoint of truly looking at the metrics around life enrichment or frailty, and truly extending the best capacity of people’s life longer, that’s a real benefit to length of stay. You don’t have clients that aren’t paying for services when they’re in an acute care event or in a TCU for 30 or 60 days. So you might get the real estate side, but you don’t get the care side.

I think just from the economic perspective, I think some of the ways that we can provide acute care in these settings and make it seamless really supports and benefits the NOI, which is important. It benefits the stability of the population of not moving out to a higher level of care or to, who knows, to death early. I think there’s benefits on that side from an income and an application standpoint.

I think the other thing is because we’re so big on data and analytics, for us and for others, we’re learning some really unbelievable things around what really matters and what really drives not only acute care spend but happiness and purpose and identity. There’s some really cool stuff when you really are focused on listening and learning about your population that you just wouldn’t normally get.

I think there’s obviously some people on this phone call that probably do that really well, better than others, but it can get pretty deep and it’s pretty amazing. I’m even learning stuff every day on the analytics and metrics and outcomes that are being produced by the differentiation of what we’re producing.

[00:31:18] Tim: What do you consider to be the competitive set for Lifesprk. I’m curious if there are other organizations similar to Lifesprk either in the Twin Cities market or elsewhere around the country. It seems to me like we do see various value-based care plays but certainly I can’t think of another company like Lifesprk that has, for instance, done an acquisition in senior living.

[00:31:43] Joel: There’s a lot of companies that are doing what I would call point solutions, Tim.

Point solution meaning there’s lots of companies, obviously, that have a medical practice that comes to their buildings. That’s obviously been done all over the country. There’s lots of groups that go out and follow clients from either the health system or from an independent physician group, where they’ll provide some benefit, and that’s good. They’re not really working deeply with the housing enterprise. There’s no creative value for each. There’s one business model that the primary care is providing or the geriatric service and then the housing is still just doing what the housing is doing.

It’s not integrated from the medical standpoint, like acute care, home, hospital-at-home, really looking at medical expertise for geriatrics and geriatricians and NPs, there’s a bunch of companies out there doing that stuff, but they’re not really integrated. On that end, there’s just not a lot going on.

I think that’s where Lifesprk is very different in our approach and where we come from. We don’t come from a medical model. We come from a social determinant or psychosocial model.

As it relates to the nation, again, there’s these point solutions that are doing transitions care management. They might have a transitions program or a care management program, or companies are integrating home health, they’re integrating hospitals, they’re integrating palliative care. There’s parts of the ecosystem that people are integrating, but mostly they’re driven off of a point solution for a unique or new payment methodology. What Lifesprk has done that no one’s done is we’re going at global risk. We’re taking full global risk for these populations. What I mean by full global risk is … with Medicare Advantage, [the government is] just basically selling their contract, if you will, to Humana, Aetna, Blue Cross, whoever in your market, the big payers. And then the payers are going at risk for that. Lifesprk is actually going side by side and saying, “We’ll take risk on hospital stays. We’ll take risk on primary care, specialty care, TCU, home care, everything.” I don’t know of anybody that’s taking global risk like Lifesprk. That’s what really differentiates us because we’re about that longitudinal holistic approach versus the what’s my bit play, what’s my point solution play.

[00:34:13] Tim: We have seen some of those insurers who play largely in Medicare Advantage, Humana is the specific one I’m thinking of, they acquired Kindred’s home care business. We’ve heard a lot of chatter about other insurance companies acquiring providers in the home care space or post-acute, or theoretically, even senior living. Do you expect that to happen?

[00:34:37] Joel: Yes, I do.

I think it’s going to happen for sure. It’s already happening. It’s happening behind closed doors. There’s a lot of people that are making plays and starting to make plays, and once they understand it, it’s a gain. It’s just learning everybody’s new ecosystems and what’s driving it is —- unfortunately or fortunately, it’s how we want to look at the world —- money, money, money, right?

… People are looking at where they can access the dollars differently and where they can create population aggregation differently and that’s where senior housing is so strong.

I love senior housing because you might have 10,000 seniors or 5,000 seniors in a market, and so those seniors are a unique asset. Senior housing providers have a unique value that they don’t even really know about because what the payers are looking at is, “Hey, if I can get my hands on those 5,000 or 10,000 seniors and control the total cost of care, have access to the Medicare Medicaid dollars, boy, there’s a whole different value proposition here.”

… I think you’re going to see what Humana did times 10, times 20, times 30. I already know it because I know a lot of these private equity firms, I know a lot of the different plans and payers, and they’re thinking about it for sure, or doing stuff. Some of them are thinking about it, it’s not easy. It’s not easy to make this integration and make this pivot, but the ones that get it right are going to be in a really great spot.

[00:36:27] Tim: I think senior living has the additional complication of the real estate piece being such a value driver. Can you talk a little bit about how you see that playing a role? I’m imagining, what if Humana acquire as a senior living provider company, but not the real estate, and now REITs or private equity are suddenly working with a huge insurer instead of the regional operator who they might have in the past? Do you see scenarios like that coming to pass?

[00:36:58] Joel: Yes, that’s a good one. I think those are the things we’re going to definitely contemplate. I think that’s reality. I think when these payers understand again, how to access these providers and these populations in new ways, those scenarios are going to happen. I think that there’s obviously areas where it could become problematic and there’s areas where it can become really awesome.

I’m more optimistic. I think our world needs change. I think our senior population needs change. I think our reimbursement needs to change. I think the way we serve these folks across the continuum needs to change. I believe we need to be bullish and we need to be leading those conversations and leading those opportunities instead of just letting them passively dictate terms to us and how we operate. I think it’s just getting on your game.

The best thing that all the senior housing [providers have], in my opinion, is you have the trust [of residents] … you really know these people more than anyone else … The hospitals don’t know [them]. The primary care clinics don’t know [them]. Payers don’t know [them]. Who knows [them] is you.

I think that’s where the opportunity and the value is, and we just have to make sure we understand that and leverage that to create better experiences for those that we serve with better economics, better overall value, for those that serve. We all know that this is a tough market with recruiting and retention. People are just frustrated with productivity and not enough staff or in the medical side, and not being able to really provide a true relationship and experience.

What Lifesprk is doing and why we’re doing what we’re doing philosophically in Minnesota, we have people running through our company right now. We’ve hired 400 people in the last like six months, 400 professionals. They’re coming out of all these other networks because they want something different. They want to be able to really provide a different model, a more holistic and more thoughtful model. I think that plays into it too.

[00:39:05] Tim: I want you to talk a little bit more about the role of data here. I’m specifically interested in how, as you’re doing integration with the Tealwood platform, you’re starting to be able to bring all the residents in those 40 communities into Lifesprk’s data systems, since it seems like that drives so much of the type of care and services that differentiate the model.

[00:39:40] Joel: … Let’s just use a specific example like a campus setting. We can go in and obviously develop the rapport and the trust with the client and the family.

Then what we are able to do with our models, we’re able to start to pull information and data from the medical records, from the health system that they use or have used. We can start pulling data into this data lake around all their claims history from the payer.

If we can get them on a Medicare managed care [plan], or if they’re on a Medicare Advantage product that we can service, we can start to see this more longitudinal play, where we have all the medical data. We have all the claims data. We know Mrs. Smith spent $60,000 on acute care last year, or she spent $10,000 on a SNF stay last year … You just start to put together some intelligence and know more than just what’s being told.

Then what we do is we start getting our own first party [data]. We have a holistic model where everyone that we work with, we discover what’s important to them. It’s not an assessment, but we really look at purpose, passion, identity, social supports, what is their network? Obviously, a lot of us have those types of things, but we put all that data into this cauldron, if you will, on each individual client.

On top of all that data, then we’re buying data from companies out there that you might’ve heard of like Carrot Health or Social Determinant of Health, it’s a company actually, where they actually are acquiring large amounts of data to understand more macro populations and macro economics around these populations. We’re putting, again, all that data, packing as much information as we can about these residents and families, as we can.

Then we do this first party where we’re actually asking where the holes are, and what they really care about, what they really want. That’s really what makes up what we call our electronic life record. Then we’re also pulling in all the EMR data. We have five EMRs at Lifesprk. We have one for medical, one for home health, [etc].

We’re pulling all that data in where we can, bidirectionally we’re pulling all that data in, and we’re able to then start to get … predictive, predictive analytics. Given the information that we have, we can get predictive.

“What should we do? Based on this amount of data on this person, what are the best practices that we can start to deploy way ahead of the event, way ahead of a problem, way ahead of social isolation or depression?” We’re starting to learn.

We’ve got 25 data scientists and data analysts at Lifesprk that that’s all they’re doing is building black box algorithms and data aggregation and data connection to this insight engine, which ultimately will drive where we get to these predictive and prescriptive capabilities that no one’s really cared about in the past, no one’s really done. That’s what’s really unique and interesting. We’re pulling a whole bunch of stuff together that hasn’t been done before.

[00:43:09] Tim: Another question from an attendee, can you talk about the role of skilled nursing in all of this? I know that there were a couple of skilled nursing facilities involved in the Tealwood acquisition. How do you see skilled nursing fitting in as things evolve?

[00:43:23] Joel: Yes, I love it. It’s part of that continuum. We love TCUs … I know a lot of people are really down on TCUs and SNFs. If I have an enemy out there it’s an acute care setting. I think that’s where — we have to take people out of the acute care setting. I think there’s a portion of them that can go direct admits to TCUs and direct admits to skilled nursing facilities with the right service capabilities and model.

Absolutely there’s a place [for SNFs]. I think it’s really important that we have to think about the redesign. We have to, again, get access to the payment. We’re working with a number of different TCUs and actually conglomerations of different TCUs and SNFs in the Twin Cities markets, back to that high-performance network, because these are places that people, they obviously transition through. What we’re really focused on doing is, and we’re already starting to do this, is when people are having troubles in senior housing or in their home care setting we’re actually making direct admits to these institutions without all the three-day hospital stays and all that crap.

We’re actually changing the methodology and changing the thinking around, what’s the least restrictive environment, what’s the most cost-effective environment to create a safe, efficacious, service plan for these folks. Ultimately getting them back as quickly as we can to their home setting or their residential home. That’s how we see it. Absolutely a big proponent of leveraging and really working with skilled nursing.

[00:45:05] Tim: You mentioned that you have to keep in mind the redesign. Do you mean how the physical plant of SNFs or TCUs?

[00:45:13] Joel: There’s definitely things that can be done differently in the physical plant side. It’s more really just in flipping people’s minds from having 90-day stays and getting paid, how they get paid, to really thinking about how do we create value. How do we incorporate and integrate a delivery system that really understands? Again, back to this big data you asked me about, because that cascade, all the data from the TCUs, we’re getting bidirectional data now.

We share all the information. Everything that we’ve built that I’ve just talked about is something that the TCU has access to. We have their access, we have their data, we’re sharing data, and obviously, that creates an integration and the trusted relationship and the medical practice stays connected … Most of the SNFs that we use on our high-performance network … it’s one continuum, one family, throughout.

[00:46:11] Tim: I’m curious about this legislation that just got introduced called Choose Home. For anyone’s who’s listening who doesn’t know, it’s creating an add-on payment for home health providers. Certain patients who’d otherwise be eligible for nursing home care following a hospital stay would be eligible now to receive that care in the home. Do you have thoughts on that legislation, Joel?

[00:46:33] Joel: You know what my thoughts are probably going to be.


I love it. I love anything that’s going to push the opportunities for providers to get access to dollars to do something better for those that we serve. This is all about the clients. It’s all about creating a better experience, but we have to think longitudinally, we have to think holistically. I love Choose Home … there are just parts that I don’t like about it, [but] it’s directionally, directionally correct.

I know we’re going to see more of it. We’re going to see more of it, because the old way is unattainable. We’re spending, again, $3.5 trillion on healthcare, senior populations are getting just crushed, we just have to redesign, and that’s why we’re on this call together. That’s why I’m on this call, because I want to work with people like you guys out there and figure this out and not just be letting these things happen.

One of the quotes I love is, “The best way to predict your future is create it.” Again, we can’t be passive. Because what happens when we’re passive in these environments is we get the tail ends, we get the last place at the trough and that’s not where we need to be, we need to be at the front.

[00:47:56] Tim: On Choose Home, we saw pushback from AHCA and NCAL, the association for nursing homes and some assisted living providers. They’re obviously concerned about losing some of their patient population, but I’m wondering specifically on the private pay side, if you have thoughts about what the implications of Choose Home could be? I’m wondering if an assisted living provider, if my resident leaves and goes to the hospital for a procedure, they’re coming back to me faster if I have the capability to provide that care they need in my setting.

[00:48:36] Joel: I’m with you, yes. I agree and I think it’s an opportunity … I think the assisted living provider, when we say Choose Home, that’s their home. What are we talking about here? Their [senior] housing, that’s their home, why isn’t that money trailing to help them, wherever that is. I think that we just need to keep pushing for the right packages to support people in wanting to do the right thing for those that we serve.

… To what you were saying, we have to have the right service capabilities, not just smoke and mirrors … we need to [create a] delivery system that ultimately creates better services, better experience, obviously better life [for older adults].

As we all know, you win economically when you do the right things programmatically. We know when we do the right thing by our residents we’ll create a better brand. We’ll create better move-ins, it’s just a little bit more of a time commitment.

[00:50:12] Tim: I guess, to the point you made earlier about home care, I don’t know how much Choose Home would actually affect assisted living. I don’t know what the percentage of residents are that would be eligible to now come back to assisted living faster [after a hospital stay], or independent living. To the extent that there is that patient population, might be even more important to have either your own [home health company] or a close, trusted partner on the home health side that can provide that skilled care [in assisted living]? Is that fair to say?

[00:50:40] Joel: I think so … again, like I said, it has some imperfectness to it, but that’s why I’m a global spend guy, I’m a total cost of care guy. There’s a lot of fancy fandango when it comes to ISNPs or the dual populations, there’s different platforms. I’m trying to knock some of that friction out and just say, “Look, total cost of care, let’s figure out global risks. Let’s figure out how to really serve these people over their lifetime and do it the right way.”

I always say as a joke, if we could give people lollipops and reduce cost of care, I’ll give them lollipops all day. We have to think differently about what creates the value, what lowers the acute care burn.

[00:51:39] Tim: I know you just acquired Tealwood so maybe it’s way premature for me to ask this question, but I’m wondering if you have plans to further grow the Lifesprk Senior Living platform through other acquisitions or even building new communities?

[00:51:55] Joel: Honestly, we’re getting bombarded by nationals and locals to bring this model with them … we were asked to come in as a partner in a lot of them. As far as our own property management in Minnesota and beyond, our owners are aggressive builders. They’ll build up two or three or four campuses a year, right now in our local market.

There’s some other folks that have come to us and wanted us to do property management. We’re trying to say, “Hey, look, we don’t have to do your property management but let us just do this wrapper, do this wrapper on value-based and bring that to you.” Unless your provider’s really bad, or your property manager is really bad.


I guess the answer to your question, squarely, I’m sure we’ll grow. We grow, we just grow naturally, but we’re not going to seek out trying to take over property management from other providers. That’s just not our game, what we want to do is aggregate those populations and get at value-based, population health, whatever you want to call it, but we want to get global risk and bring all our home and community-based providers the opportunity to think about how we serve people differently.

[00:53:09] Tim: The ownership groups who you’re working with already, as they build new communities, will those not necessarily then take on the Lifesprk Senior Living brand, or it will be case by case?

[00:53:19] Joel: Those we are all taking on. We already just took on four and we actually own a little bit of the real estate, [we’ve] taken on a minority interest in the real estate, because they want us to be invested and all that. There will be some for sure. Definitely, there’ll be some. I’m just saying, I just want to make it clear that it’s not our strategy, it’s not our core strategy.

Our core strategy is to aggregate through these other folks that are doing it well. Again, it’s not everybody, we don’t want to partner with everybody. We want to partner with the people that want to really work. It takes some risks to be in a value-based relationship, look at these folks longitudinally and holistically, not just improve the NOI, and let’s just create the most simple little model we can that doesn’t really create a lot of value.

No, that stuff we’re not interested in. We’re really interested in having people that want to change the whole continuum around how these folks experience not only their life services but also their health care.

[00:54:24] Tim: Narrowing in on the Lifesprk Senior Living platform specifically, what do you think is the biggest challenge that you face to realize the vision you have for it and make it a success?

[00:54:34] Joel: That’s a great question. I feel pretty good right now, Tim, maybe it’s just because I’m in that honeymoon period.


I’ve been having a lot of great people like Bill Thomas and others that are helping in designing, and we’re doing some really cool stuff. We’ve got great operators, and Howie, his team is great. The biggest challenge is still the pandemic, and with some of these weird things obviously popping off, that’s a bit of a challenge.

I think what always is a challenge is something new, adopting this new approach. I think as it relates to us specifically, we want to get these families and these clients really bought into, “Hey, let’s make sure you get into a value-based model.” That takes engagement, it takes a little bit of salesmanship if you will.

That’s a challenge. Because in a sense, if we don’t get them tied to a value-based payer or product, then we can’t really bring the whole house as far as what we really want to bring, telehealth, technology, data, life experience, the ELR, all the stuff that we want to do then is more problematic, because we’re not getting reimbursed for it. We just want to harvest the value.

I think the challenge is to make sure that we do a really good job so that people understand the benefit of the new way we can deliver not only housing but services in an integrated way. That will be a challenge.

[00:56:12] Tim: That makes sense. I’m curious too, coming out of COVID, everyone is trying to recover occupancy. How is the Tealwood platform in terms of census?

[00:56:21] Joel: It’s solid. Don’t get me wrong, there’s a few, as we all know, with like 40 properties, there’s a few that are struggling for different reasons. Quite frankly, some of them that are struggling were either new builds or recent builds that were in right at the front of COVID, or they had a really hard hit — some with higher memory care census got really hard hit and there was some loss.

Our metrics every week we’re plus, plus, plus. Right now, we’re seeing this continual build to really solid, solid occupancy rates and [we are] not having any concerns, our owners are thinking it’s awesome. We’re bringing a lot more omnichannel marketing. We’re doing some unique things that weren’t done before … We’re actually bringing a little bit more power there.

Then because of our big network, because of all the clients that we do have, home- and community-based [providers] … we have the ability to positively at least influence where those folks move, and so that’s helping our housing as well. So, helping each other. Home care, home health helping housing, housing helping home health … so it’s this population that’s bigger, that’s creating more opportunities.

[00:57:51] Tim: Looking at Lifesprk as a larger organization, what are your top priorities for the next year or so? Is it the national expansion that you mentioned earlier? Are there other goals that you’ve got in the near term?

[00:58:03] Joel: A lot of it’s based on, again, this efficacy. Proving that providing longitudal holistic services for seniors regardless of where they live, regardless of the disease, regardless of the payer, that we can really make a big difference in their lives.

Our data and analytics teams are working really hard with our payers and with our teams to make sure that we’re able to have demonstrable results. That obviously fuels the opportunity for us to get into more value-based contracts.

Just starting 2022, by the way, we’ve got a whole bunch of new contracts that we have laid out, which is awesome for us. Again, because we want to serve all seniors, we want to serve the duals … The big priority is to prove efficacy with this new approach. It can be scalable and be something that happens in a macro way.

For instance, historically in all of our services — home [care] or senior housing or whatever — we get one client at a time, one client at a time, one client a time with value-based [care]. We’re taking a contract, we’re taking on 5,000 seniors at a time, 10,000 seniors at a time. That gives it a big platform to play with and a whole bunch of opportunities to make sure they get the right services at the right time in the right place. That’s what we’re focused on next, as far as strategy. It’s culture, talent, technology and the platform built for efficacy.

[00:59:39] Tim: I think that the data capabilities you have seem really impressive. I think you used the word data lake. I think that’s the same phrase that Amazon just used as they were announcing their own health care data platform and the way that they’re growing that.

What do you think about Amazon, specifically, or the big tech companies that are getting more involved in the health care space and trying to make plays that are taking advantage of the move toward more value-based care? I don’t know that I have a more articulate way of phrasing that question, but I think in senior living, specifically, some people see it as a threat and some people see it as an opportunity and some people just don’t know what to make of it at all.

[01:00:29] Joel: That’s a great question. I don’t take a ton of time focused on the Amazons … I guess, I would say this it’s interesting, because we do work with Salesforce. Salesforce is a $44 billion tech platform company. We use their architecture. We use parts of them and they’re big. They work with Amazons, they work with the Googles, and the big [health systems], Kaiser Permanente, and we’re getting a lot of positives from them. They think Lifesprk has a data platform and a data model that’s outstripped anybody in the country. That gives us a lot of confidence that we’re going in the right direction, and we’re going at it more deeply and more thoughtfully than anyone else.

What I would say is, it didn’t happen overnight. We’re close to the residents, we’re close to the clients, we’re close to the members, we understand. Amazon, they’re really smart and they have a lot to say about it and they have a lot to learn and they have really smart data and technology, but it’s also about the service and the care and the experience.

I’m fine with them coming in. Because I think mostly what they’re coming into [is] a lot of commercial populations and health care in total and the old guard of this acute care. The reason why they are is because there’s such an opportunity — back to what we talked about before, payment, there’s so much money that’s being wasted, that they’re saying, “Hey, man, we can do better, because we can figure anything out.” That kind of thing.

They’re not so much the threat, I think, especially for a long time, for senior housing, in my opinion. In fact, I think they can be potentially a benefit, if we think about it, and we work [the right way]. Again, lead the conversation and not let them define how we play in their ecosystem. What is their ecosystem? What are they doing? I think it behooves us to move with them and get out front, but I’m not afraid of them at all.

I think it just shows that the market needs to shift, and I think that all the providers on this call today need to be really thinking about data and analytics. Because if you can’t show your story … If you don’t have data and analytics, which is the science of proving that you can do something more than just fill [beds], I don’t think that there’s as much advantage. You can still win there, but I don’t think there is as much advantage going forward in the future.

Long answer to your broad question there, I think it shows that there’s a lot of interest, there’s a lot of opportunity. Otherwise, Amazon wouldn’t touch it. I think it’s good. I like being disrupted. I like disruption.

[01:03:25] Tim: Any last thoughts you have for the audience or any topics that we haven’t talked about that you wanted to address?

[01:03:36] Joel: No, other than I would just say, look, I really appreciate the opportunity to talk with you, Tim, today and with whoever’s on the phone. I think this is our time. I think if you’re ever going to disrupt or if you’re going to change your methodology or model, now is the time. There’s great opportunities for those organizations that are willing to understand and learn what the health care side looks like. There’s a great opportunity because of the trust and the relationship you have with families and these clients … you want to put yourself in the front seat.

I would just really obviously, hopefully, push and in some way inspire folks out there to move now. It doesn’t have to be tomorrow, but in the next year or two, I think that this disruption, it’s not “maybe it will happen.” It is going to happen, and I think those opportunities, if you understand the market and if you understand the payment side of it, can be really advantageous to the seniors that you’re serving, the families that you serve and the employees that you have.

[01:04:56] Tim: If I can interrupt you on the partner, I realized I missed a question from an audience member, from Bob Kramer actually, who I know you’ve had some dialogue with. If you don’t mind taking one more question, I’ll share Bob’s with you, which is, “ How will you structure the relationship with the senior living operator to share the financial returns on the health care dollar with them?”

[01:05:17] Joel: That’s an awesome question. That is a really great question. We’re in that right now, Bob, we’re working on some really interesting contracts. Because there’s a lot to go into that around safe harbors and pay for referrals and all sorts of stuff, but we are working on those contracts as we speak. It’s really cool and I would be happy to take that offline, but we’re working with some really hotshot lawyers and some different people that have done a lot of value-based work at the highest levels.

We’re absolutely committed to making sure there is a financial opportunity … on that network side, especially. That’s critical. It has to be everyone wins. I love that question. It’s three people working on it right now, figuring that out. Not perfect answer, but it’s absolutely critical and we are fully committed to that share.

[01:06:16] Tim: Excellent. Joel, it’s always fascinating to talk to you, so thanks for doing TALKS. I look forward to continuing the conversation.

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