Trefzger, CEO of ALG: Providers of senior housing must adapt to the ‘new world’ of work, take care to survive


Faced with the Covid-19 pandemic last year, ALG Senior has made big changes, moving to a more decentralized operating model while changing the name of the company.

But amid these and other changes brought on by the pandemic, the Hickory, North Carolina-based provider has remained committed to clinical innovation, according to CEO and Chairman Charlie Trefzger.

“We have worked a lot on our clinical innovation projects through Covid,” he told Senior Housing News.

These efforts have produced data and best practices that have been “incredibly powerful” in helping ALG manage care during the pandemic, he added. The clinical efforts also support ALG’s work to launch a Medicare Advantage special needs plan, with plans to launch in January 2023.

The company is now investing in investment projects and is also expanding its portfolio through acquisitions and new developments. ALG currently operates in seven states, with a concentration in the southeast, and Trefzger plans to exceed 150 communities by the end of 2021.

And ALG is working to address the current challenges related to Covid-19 and the labor shortage.

“I’m telling my operators, stop looking in the rearview mirror to drive your car, look out the windshield, because we’re going in a new direction,” Trefzger said. “The wage rates that existed before are gone. We are in a new world and you had better adapt to it or you will not survive.

Clinical innovation for a value-driven world

Prior to the Covid-19 pandemic, ALG Senior pursued clinical innovations under the leadership of Chief Medical Officer Dr Kevin O’Neil, an industry veteran who was previously CMO at Brookdale Senior Living (NYSE: BKD) and Ascension .

O’Neil had drawn up a plan to create “innovation centers” in certain ALG communities, to pilot or test new approaches to care. When Covid-19 hit in 2020, ALG – like all senior housing providers – went into pandemic response mode; however, O’Neil and Trefzger also remained committed to innovation goals.

“During this time, we have made it clear that we cannot lose sight of the direction we need to take, especially when it comes to clinical issues that we know are important,” O’Neil told SHN.

Thus, ALG has established six innovation hubs, located in various markets of North Carolina, including rural and more urban areas. And the company has set itself the goal of achieving objectives linked to five priorities:

  1. Infection control and vaccinations
  2. Reduce avoidable transfers to emergency services
  3. Reduction of fall events
  4. Advanced care planning
  5. Behavioral Interventions to Reduce Drug Use in Memory Care

To meet these priorities, ALG worked with innovation hub communities on a variety of initiatives throughout the pandemic.

For example, the company worked with the Geriatric Practice Leadership Institute, an initiative funded by a grant from the University of North Texas Health, on an advanced care planning project.

O’Neil was “shocked” by the number of memory care residents who did not have medical orders regarding the scope of their treatment for end-of-life care – for example, a POLST form. doctor for life-sustaining treatment). The number of advanced care plans increased by 30% in the ALG communities that participated in the corresponding innovation project.

Regarding falls, the company has set up a program called ARISE, for “ALG’s reduction in serious fall events”. This approach involves involving home health, therapy and other health care partners to assess residents and ask them key questions to determine risk for falls, with interventions focusing on different levels of risk. . A low-risk resident could enroll in a fitness program with targeted strength and balance exercises, with more robust interventions related to those at higher risk.

Drug reduction in memory care was addressed through work with Dr. Sheryl Zimmerman of the University of North Carolina, Chapel Hill. A prolific researcher in the residential and senior care industry, Zimmerman has worked on non-pharmacological interventions to combat dementia-related behaviors. ALG Senior uses them successfully, such as light therapy, aromatherapy, music therapy, and robotic pets, O’Neil said.

Also with Zimmerman, ALG is working on how to provide dental care to memory residents more efficiently and has tested the effectiveness of peripheral lighting around the bathroom door, which reduces nighttime falls.

At Brookdale, O’Neil worked with Dr. Joseph Ouslander to adapt the INTERACT program to assisted living, and he continues these efforts at ALG Senior. INTERACT stands for Interventions to Reduce Acute Care Transfers and involves various practices, many of which use checklists. Reviewing checklists creates more discipline in assessing whether a resident should be transferred to an emergency room and helps ensure smoother transitions when they do occur.

Other clinical innovation initiatives have proven to be effective in achieving multiple priorities. For example, ALG Senior has created a “Certified Supplier Program”. As part of this program, third-party caregivers who work on-site in ALG communities are encouraged to become ‘certified’, which means they go through a process of understanding their roles and responsibilities and those of ALG.

While residents can always choose their healthcare providers, the approach has helped improve the quality of care by identifying the best partners, O’Neil said.

All of these and other efforts are not only aimed at improving the health and well-being of residents, but are part of ALG’s broader value-based care strategy. Trefzger and O’Neil believe the writing is on the wall, in terms of assisted living facilities becoming an increasingly important framework of care for population health efforts – that is, systems healthcare providers, payers and other entities recognize that providers of retirement homes can drive better outcomes and lower costs for key patient and beneficiary groups.

To be successful in a value-based world of care, elderly care providers must have strong clinical programs in place – especially to provide more proactive care – and collect the data proving their value to the whole population. health system. This creates a baseline for partnering across the continuum and obtaining a financial benefit from payers.

Elderly care providers can also become payers themselves by initiating Medicare Advantage plans, as ALG intends to do.

Having good coordination of care between different providers is another essential ability for success in value-based models, and this is an area Trefzger is particularly sensitive to after personal experience. Earlier this year, her own mother suffered from a lack of coordination of care between various specialists who were working against the grain.

“It’s going to become more and more important for providers like us to be actively involved, if not in charge, of coordinating care,” he said. “… You have to have this ability at your fingertips – and because it doesn’t really exist right now, innovators and disruptors have to come out and do it, literally, for themselves.” “

A new world

As the Clinical Innovation Centers determine which approaches work – and which don’t – pilots grow across the portfolio, O’Neil said. And before the pandemic, ALG was a leader in requiring staff to be vaccinated against influenza, and a Covid-19 vaccine mandate went into effect on November 1.

But in other aspects of operations, ALG has moved away from company-wide mandates to empower local leaders.

This is a strategy that other providers have pursued as well, as it is widely recognized that retirement homes remain in many ways a local business, driven by market dynamics and benchmark relationships at the level. of the micro-market.

Covid’s financial and operational pressures accelerated this change at ALG, and it was the right decision to go down that path, Trefzger said.

“Covid really required, in many ways, a decentralized approach,” he said. “We couldn’t get into the buildings, we weren’t able to necessarily provide the on-site supervision that many companies do, because of that. In many ways, EDs have been left on their own to figure out a lot. “

They have done “extraordinarily well” in this regard, and he remains committed to the current approach, in which CEOs and other leaders at the community level make key decisions but receive support from the company level.

Today, leaders at all levels of the company are focused on incredibly tight labor markets. ALG has increased its pay rates and also offers health insurance which is “to a very large extent paid for by the employer,” Trefzger said.

It is crucial to retain the team through salaries, benefits and other efforts, he stressed. High turnover not only comes at a significant financial cost, but can also erode an organization’s culture and quality of service.

“Why not just hire people who are ready to work… at a high rate of pay from the start, and who have great service, a great product,” he said. “That’s the philosophy I’m using right now.”

However, it also recognizes that ALG and other providers cannot pass all of the increased labor costs on to residents, especially the fixed-income middle-market cohort that ALG specializes in serving.

So ALG and other vendors must learn to operate more efficiently in order to preserve their margin, Trefzger said. He believes the decentralized model helps achieve this efficiency by leveraging scale to manage tasks related to areas such as billing and human resources, while allowing staff at the community level to focus more on delivery. the best services and care.

As 2022 approaches, Trefzger and O’Neil recognize the challenges that will continue into the new year, with communities being squeezed not only by labor and other operational pressures, but also by continuing threat of Covid-19.

“We’re not out of the woods yet,” O’Neil said, noting that European countries were seeing rising infection rates, which could portend another spike in the United States.

Thus, he stressed that the ALG teams “cannot be complacent” and must continue to forge ahead with clinical innovation efforts and disseminate the results.

“I’m a big supporter of giving it away,” he said. “I don’t think it’s good for us or the industry to accumulate information. So if we find something that works, we’ll be happy to share it.


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