Despite A Major Entrance Into New York, Help At Home Is Not Done Expanding

Rich Tinsely, formerly of Stoneridge Partners, wasn’t looking to get back into the provider side of things.

But he is now, as the chief development officer for one of the biggest at-home care organizations in the country, Help At Home.

Tinsley has over two decades of experience in the home-based care space, and was happy in his former role.

But when Help At Home leaders approached him about joining their team, several factors played into his decision to come on board.

For the latest episode of Disrupt, HHCN sat down with Tinsley to chat about why he decided to join Help At Home, the company’s growth strategy and why he’s bullish on the future of its payer sources.

HHCN: Why did you want to go to the provider side again, and why Help at Home specifically?

Tinsley: I wasn’t looking to go back to the provider side. I had a really nice career. When you look at the spectrum of all home care businesses, Help At Home is in the home longer. We keep our clients years, not weeks or months. We have an insight for our clients that no one else has.

We’re in the home long-term, so that was always very appealing to me. Then when I met the management team and they gave me their proposal, told me what they wanted to do, where they wanted to grow the business, it was very appealing to me.

A lot of the senior team that I’m a part of come from a payer background. We have a similar philosophy of how we want to go after growth and how to impact the industry. It’s not always a rate conversation, it’s the wellbeing of the clients. Long term, I think a company like ours is best positioned to have the biggest impact on the overall health care costs and keeping people healthy at home for a longer period of time.

Help At Home had a very exciting entrance into New York recently. Can you give us a background on that entrance and then also explain how that’s changed the scale of the company? And maybe what you’re looking to do next in terms of growth after that?

That transaction happened in April and we’d been working on it for several months. Coming out of ‘21, with that transaction included, were at about $1.5 billion, so that’s where we stand from a size perspective.

New York is obviously a very large Medicaid market that we wanted to be in and we found two great companies to join with us in this transaction. We’re very excited about it and are looking to grow the New York market at the same pace that we’re growing the rest of the company.

We really want to build out our density and our current footprint, but at the same time, we’re looking to expand into new markets. We just have to make sure we can provide that density. So the acquisition we made in New York gives us that footprint, mostly in the city and the boroughs, and it allows us to grow that business and do tuck-ins moving forward.

Once you had that entrance in the New York market and you got those two providers, was it easier to start thinking about building out density in other areas also in New York?

We’re actively pursuing growth in the New York market, yeah. We’re looking for other acquisitions and other growth opportunities in New York along with the other markets that we have high density in like Pennsylvania, Ohio, Georgia, Michigan and Missouri.

Are there any other states that you all are looking at right now that you might want to enter into, or is that still too far out?

It’s not too far out to say. We don’t publicly identify where we may or may not go.

We’re looking at a lot of different transactions and a lot of different states. I’m not sure we want to jump across the country for a one-off state unless it made a lot of sense or had some size to it. We’re going to be diligent and disciplined around our geographic footprint. But if it makes sense and is a good platform as we enter a new state, we’ll do it.

There’s obviously a lot of exciting things going on around Medicaid right now, especially under this administration with home- and community-based services. There’s also this extension where states can do more with the funding up until 2025. What does that mean for you as a provider?

A lot of that stuff came aboard during the pandemic to shore up a lot of the companies. The question becomes, how long does it stay? It appears to be going through 2025, but it’ll continue to be part of the reimbursement going forward. It’s good for the industry and it allows us to provide the services and recruit the people that we need to recruit.

Are you bullish in general on Medicaid as a payer source?

I feel really good. None of these rates are permanent, right? These are all certified adjustments made by the states. We feel like the reimbursement is very stable and we’re very bullish on where it sits today and what the future brings.

As we build density, we’ll provide more services to our payers, to the states and to our clients that will benefit from all of the above.

These clients want to stay in the home as long as possible. CMS even provides data and studies that show it’s typically the lowest-cost setting. That’s why everybody’s been talking about it over the last several years. We’re starting to see we can drive outcomes. I, and we as a team, we’re very bullish on the future of what we’re doing.

You mentioned earlier that in New York, for instance, it’s such a big Medicaid market that it made sense for you guys to be there. Is there anything a state could do from a policy perspective that would make them more of an enticing state for you to enter into?

That’s probably a separate podcast all by itself.

Obviously I don’t want to say rates don’t matter, because rates do matter. But it’s really about looking at what services and what outcomes you want someone like us to provide to the clients. We try to take a holistic approach about what’s best for the client, where we’re going and how to do that.

We have several factors when we look at a state being attractive. Obviously density is one of the biggest ones. There has to be a marginal spread between what we’re getting paid and where we recruit at. But it also has to be a partnership with the Medicaid program directly or a managed care company, if the state’s gone in that direction.

It’s all the above, it’s not one item, that makes a difference.

In terms of growth strategy and acquiring companies, do you guys consider that as you grow more – the more caregivers you’ll need?

It’s a challenge for every business in 2022. Going forward, it will probably continue to be a challenge in our industry. It’s different than the challenges in home health care, because we’re not recruiting nurses necessarily in all of our markets.

We feel well positioned on what we’re doing and the packages that we offer, the way we recruit and the speed that we recruit. We’re very bullish on our ability to perform better than the rest of the market.

I’m not saying it’s not a challenge, it’s just that it’s one of our strengths compared to our competition. It was one of the biggest headwinds facing us, but we feel like what we’re doing is making headway and we’re making progress against our competitors.

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