Community LTC, Golden Living, and Michael Yao

Abstract

We continue with our series exploring long-term care provider organizations that serve people in facility-based settings and home- and community-based settings. This month, we'll look at Golden Living through the eyes of its chief medical officer, Michael Yao, MD, CMD.Golden Living, headquartered in Plano, TX, is one of the largest providers of rehabilitation and skilled nursing care in the country, with just under 300 facilities in 21 states. This family of companies includes Golden LivingCenters, Aegis Therapies (third largest provider of therapy services in the United States), 360 Staffing, Ceres Purchasing Solutions (a purchasing, contract services company), and AseraCare Hospice. Golden LivingCenters alone serve more than 26,000 patients, with a collective staff of more than 40,000.Most of its services and individuals served are in facility-based settings, except for AseraCare and Aegis Therapies. Between 50% and 60% of its hospice services and its palliative medicine program, PRIME, are provided in the patient's home.Dr. Yao has been with Golden Living in a variety of roles for the past 10 years. For the past 2 years, he has served as chief medical officer for Golden Living and is responsible for overseeing and supporting the medical directors and attending physicians working within Golden Living Centers and AseraCare agencies. He also assists in the evaluation of leading-edge, evidence-based medical practices through the development and expansion of clinical specialty programs, according to the Golden Living website. Dr. Yao is board certified in family medicine and geriatric medicine, and has more than 20 years of experience in long-term care.Care Across the ContinuumThe rise of vertically connected organizations, such as accountable care organizations, is affecting service delivery across the health care industry. Fragmentation in health care delivery is well-known. There are more than 15,000 nursing facilities and approximately 16,000 licensed home health and hospice agencies in the United States, and that does not include private duty agencies and the vast amount of informal in-home caregivers. An emphasis on connection, coordination, and integration across providers is only natural and makes sense.So how does Golden Living balance the unique opportunities and challenges of facility-based care with community- or home-based care and services? For Dr. Yao, the health care delivery environment for facility-based and home-based care is similar. Whether you work in a skilled nursing facility or in home- and community-based services, the desired goal is the same: to deliver quality care to the patient over time. “If you're rounding on a patient in an SNF setting, you have to think about how care is delivered postdischarge,” Dr. Yao said. It is a growing challenge to view the patient holistically and over time. With the increasing number of hospitalists, SNF specialists, and office-only physicians, mitigating this challenge will become greater and take intentionality to overcome.Is there a different skill set for the attending physician who follows patients in a facility-based setting rather than in a home-based setting? Dr. Yao would say that it's not so much a matter of skill set as it is attitude. Home-based care requires the physician to be overtly intent on listening and paying attention to what on-site caregivers report. The physician has to listen closely to what visiting nurses and other staff identify because they see the patient more often than the physician. And that takes time, which is at a premium for physicians across the board. Although the importance and legitimacy of special providers like hospitalists and SNF specialists should not be overlooked, Dr. Yao's experience is that physicians who do the best with home-based care are those who also follow patients in their facility-based care as well.Golden Living anticipates growth in vertically integrated organizations, perhaps sooner in metropolitan areas than in rural settings. Increasingly, this includes not just provider networks but also insurance companies. Golden Living is actively participating in Centers for Medicare & Medicaid Services bundled payment projects, in which provider partnerships are key.Physicians as EmployeesA concurrent development is the changing nature of physician employment status. More and more, physicians are employees of provider networks, rather than being solely independent practitioners. At least conceptually, this should simplify the development process for vertically connected organizations because it streamlines the number of parties involved in the negotiations.Support and communication are essential parts of Golden Living's corporate strategy to prepare its physicians for the future. In addition to Dr. Yao being at the helm, four regional medical directors interface directly with facility medical directors, who, in turn, interface with local attending physicians. A dedicated newsletter targeted to medical directors and attending physicians covers topics that may range from facility operations to those of specific clinical focus, such as infection control and medication stewardship. Golden Living also actively encourages its physicians to pursue a medical director certification and promotes attendance at the annual AMDA conference.Golden Living will continue to explore ways that leverage technology to support physicians and other caregivers. Two things of growing importance to the company: centering dialog about quality of care and quality of life around metrics of care, and how to increase active involvement of physicians in quality assurance and performance improvement.The transition from primary care physician and educator to a 100% administrative role has been a significant change for Dr. Yao. The challenges are many: working daily to improve care and systems of care in the face of reimbursement, regulation, and increasingly complex care issues. However, Dr. Yao said, “In the end, it still comes down to quality of care and having a heart for the populations we serve.” Surely Dr. Yao, his work, and his leadership at Golden Living, are a great example for others to model and admire.Michael Yao, MD, CMDView Large Image Figure ViewerDownload Hi-res image Download (PPT) We continue with our series exploring long-term care provider organizations that serve people in facility-based settings and home- and community-based settings. This month, we'll look at Golden Living through the eyes of its chief medical officer, Michael Yao, MD, CMD. Golden Living, headquartered in Plano, TX, is one of the largest providers of rehabilitation and skilled nursing care in the country, with just under 300 facilities in 21 states. This family of companies includes Golden LivingCenters, Aegis Therapies (third largest provider of therapy services in the United States), 360 Staffing, Ceres Purchasing Solutions (a purchasing, contract services company), and AseraCare Hospice. Golden LivingCenters alone serve more than 26,000 patients, with a collective staff of more than 40,000. Most of its services and individuals served are in facility-based settings, except for AseraCare and Aegis Therapies. Between 50% and 60% of its hospice services and its palliative medicine program, PRIME, are provided in the patient's home. Dr. Yao has been with Golden Living in a variety of roles for the past 10 years. For the past 2 years, he has served as chief medical officer for Golden Living and is responsible for overseeing and supporting the medical directors and attending physicians working within Golden Living Centers and AseraCare agencies. He also assists in the evaluation of leading-edge, evidence-based medical practices through the development and expansion of clinical specialty programs, according to the Golden Living website. Dr. Yao is board certified in family medicine and geriatric medicine, and has more than 20 years of experience in long-term care. Care Across the ContinuumThe rise of vertically connected organizations, such as accountable care organizations, is affecting service delivery across the health care industry. Fragmentation in health care delivery is well-known. There are more than 15,000 nursing facilities and approximately 16,000 licensed home health and hospice agencies in the United States, and that does not include private duty agencies and the vast amount of informal in-home caregivers. An emphasis on connection, coordination, and integration across providers is only natural and makes sense.So how does Golden Living balance the unique opportunities and challenges of facility-based care with community- or home-based care and services? For Dr. Yao, the health care delivery environment for facility-based and home-based care is similar. Whether you work in a skilled nursing facility or in home- and community-based services, the desired goal is the same: to deliver quality care to the patient over time. “If you're rounding on a patient in an SNF setting, you have to think about how care is delivered postdischarge,” Dr. Yao said. It is a growing challenge to view the patient holistically and over time. With the increasing number of hospitalists, SNF specialists, and office-only physicians, mitigating this challenge will become greater and take intentionality to overcome.Is there a different skill set for the attending physician who follows patients in a facility-based setting rather than in a home-based setting? Dr. Yao would say that it's not so much a matter of skill set as it is attitude. Home-based care requires the physician to be overtly intent on listening and paying attention to what on-site caregivers report. The physician has to listen closely to what visiting nurses and other staff identify because they see the patient more often than the physician. And that takes time, which is at a premium for physicians across the board. Although the importance and legitimacy of special providers like hospitalists and SNF specialists should not be overlooked, Dr. Yao's experience is that physicians who do the best with home-based care are those who also follow patients in their facility-based care as well.Golden Living anticipates growth in vertically integrated organizations, perhaps sooner in metropolitan areas than in rural settings. Increasingly, this includes not just provider networks but also insurance companies. Golden Living is actively participating in Centers for Medicare & Medicaid Services bundled payment projects, in which provider partnerships are key. The rise of vertically connected organizations, such as accountable care organizations, is affecting service delivery across the health care industry. Fragmentation in health care delivery is well-known. There are more than 15,000 nursing facilities and approximately 16,000 licensed home health and hospice agencies in the United States, and that does not include private duty agencies and the vast amount of informal in-home caregivers. An emphasis on connection, coordination, and integration across providers is only natural and makes sense. So how does Golden Living balance the unique opportunities and challenges of facility-based care with community- or home-based care and services? For Dr. Yao, the health care delivery environment for facility-based and home-based care is similar. Whether you work in a skilled nursing facility or in home- and community-based services, the desired goal is the same: to deliver quality care to the patient over time. “If you're rounding on a patient in an SNF setting, you have to think about how care is delivered postdischarge,” Dr. Yao said. It is a growing challenge to view the patient holistically and over time. With the increasing number of hospitalists, SNF specialists, and office-only physicians, mitigating this challenge will become greater and take intentionality to overcome. Is there a different skill set for the attending physician who follows patients in a facility-based setting rather than in a home-based setting? Dr. Yao would say that it's not so much a matter of skill set as it is attitude. Home-based care requires the physician to be overtly intent on listening and paying attention to what on-site caregivers report. The physician has to listen closely to what visiting nurses and other staff identify because they see the patient more often than the physician. And that takes time, which is at a premium for physicians across the board. Although the importance and legitimacy of special providers like hospitalists and SNF specialists should not be overlooked, Dr. Yao's experience is that physicians who do the best with home-based care are those who also follow patients in their facility-based care as well. Golden Living anticipates growth in vertically integrated organizations, perhaps sooner in metropolitan areas than in rural settings. Increasingly, this includes not just provider networks but also insurance companies. Golden Living is actively participating in Centers for Medicare & Medicaid Services bundled payment projects, in which provider partnerships are key. Physicians as EmployeesA concurrent development is the changing nature of physician employment status. More and more, physicians are employees of provider networks, rather than being solely independent practitioners. At least conceptually, this should simplify the development process for vertically connected organizations because it streamlines the number of parties involved in the negotiations.Support and communication are essential parts of Golden Living's corporate strategy to prepare its physicians for the future. In addition to Dr. Yao being at the helm, four regional medical directors interface directly with facility medical directors, who, in turn, interface with local attending physicians. A dedicated newsletter targeted to medical directors and attending physicians covers topics that may range from facility operations to those of specific clinical focus, such as infection control and medication stewardship. Golden Living also actively encourages its physicians to pursue a medical director certification and promotes attendance at the annual AMDA conference.Golden Living will continue to explore ways that leverage technology to support physicians and other caregivers. Two things of growing importance to the company: centering dialog about quality of care and quality of life around metrics of care, and how to increase active involvement of physicians in quality assurance and performance improvement.The transition from primary care physician and educator to a 100% administrative role has been a significant change for Dr. Yao. The challenges are many: working daily to improve care and systems of care in the face of reimbursement, regulation, and increasingly complex care issues. However, Dr. Yao said, “In the end, it still comes down to quality of care and having a heart for the populations we serve.” Surely Dr. Yao, his work, and his leadership at Golden Living, are a great example for others to model and admire. A concurrent development is the changing nature of physician employment status. More and more, physicians are employees of provider networks, rather than being solely independent practitioners. At least conceptually, this should simplify the development process for vertically connected organizations because it streamlines the number of parties involved in the negotiations. Support and communication are essential parts of Golden Living's corporate strategy to prepare its physicians for the future. In addition to Dr. Yao being at the helm, four regional medical directors interface directly with facility medical directors, who, in turn, interface with local attending physicians. A dedicated newsletter targeted to medical directors and attending physicians covers topics that may range from facility operations to those of specific clinical focus, such as infection control and medication stewardship. Golden Living also actively encourages its physicians to pursue a medical director certification and promotes attendance at the annual AMDA conference. Golden Living will continue to explore ways that leverage technology to support physicians and other caregivers. Two things of growing importance to the company: centering dialog about quality of care and quality of life around metrics of care, and how to increase active involvement of physicians in quality assurance and performance improvement. The transition from primary care physician and educator to a 100% administrative role has been a significant change for Dr. Yao. The challenges are many: working daily to improve care and systems of care in the face of reimbursement, regulation, and increasingly complex care issues. However, Dr. Yao said, “In the end, it still comes down to quality of care and having a heart for the populations we serve.” Surely Dr. Yao, his work, and his leadership at Golden Living, are a great example for others to model and admire.