Alex Markowits is founder, president and CEO of Spring Hills, one of the nation’s most innovative centers of residential and home care. He is advancing senior care, population health, acute and post-acute care management, memory care, support care, home care, and more. He’s bringing technology into centers that have not seen these advancements before and is a pioneer in charting the future of senior care. The timing for Alex’s leadership couldn’t be more critical as 25% of the U.S. population will be 65 years or older by the year 2034. In this Medika Life exclusive, we speak with one of the nation’s change agents in reducing hospital readmissions and advocates for healthy aging in place.
Gil Bashe: What has happened to transform the original senior care concept into a community of support that also deals with health needs? Where have you seen the shift?
Alex Markowits: The shift has happened as a result of people wanting to stay home. People want to stay in an environment that they’re used to and enjoy. Holistically, it makes a lot more sense, both from a rehabilitation and convalescing perspective. As technologies and care delivery systems evolve, we’re able to offer a higher level of home care that meets people’s needs.
Bashe: In addition to all of these investments — you have 35 care facilities in the U.S. today and growing — you have looked at how the very best hotels manage the guest experience. How have those best practice observations, combined with your philosophy around technology and empathy, informed Spring Hills becoming a center of excellence?
Markowits: To your point about hotel management: when we go on vacation, we look forward to it. We’re excited and count down the moments to that trip. Our idea was to provide an environment that seniors look forward to, not a place where they “have to go.” This led to a cascade of decisions: from hiring and training the right people, to harnessing their empathy, to help them understand why the senior is there and what our tasks and goals are in terms of delivering on their expectations. Technology geared to support the human experience frees up our staff to focus more on our residents.
Bashe: You work both with hospital systems and in post-acute care management. Do you have a different philosophy for where each person is in their care journey when they come into a Spring Hills community?
Markowits: The philosophy of care, frankly, transcends the level of care. At the end of the day, that person is somebody’s mother, father, husband or wife. They’re not just patients, they’re somebody’s loved one. We’re always people first. This is why we chose to call them residents. Yes, they are our patients, they’re clients, and ultimately, they are somebody’s loved one and that’s what we train our associates to see. Regardless of their memory care or rehab program needs, or long-term care expectations, we must align our minds and actions to see our residents as community members.
Technology is Never a Replacement for Human Connection
Bashe: We’re so connected today; we have iPhones, remote watches, all this technology. What other technologies does Spring Hills use to make sure that people are in touch with a care system? What technologies do you think are important?
Markowits: What technology provides is the plan and the path for recovery. It points out immediate problems. It allows us to communicate and coordinate to meet all the various resident needs so that there are no surprises. Digital technologies guide our health staff and free them to use their training to help residents avoid rehospitalization. By combining care with technology, we can give people back time, the most precious thing, which we cannot barter or buy. At the end of the day, if we can give a resident back a day of their life at home, together with their families, then we have accomplished what we set out to accomplish.
Bashe: You’re using state-of-the-art technology, looking at heart function, at hemodynamics, tracking arrhythmia risks, even advancing recovery through rehab in aquatic therapy pools. All of this is a tremendous investment. Is Spring Hill going to continue to invest in cutting-edge technologies in order to match what the community needs? What technologies are you looking toward in the future?
Markowits: Absolutely. Yesterday’s technology is old technology, so we’re always seeking to upgrade. A decade ago, we used sensors to evaluate residents’ personal care patterns. The data would offer a baseline on their behavioral health, and that helped us engage quickly if something changed, whether it was toileting or sleeping patterns, depression, anxiety or pain. It all comes back to translating the investment in technology into something people value — quality time and a better lifestyle.
Now, we’re expanding into population health, the force multiplier for making sure we support people who need us, to anticipate risk. Whether it’s artificial intelligence or wearables, treatment for those needing post-acute care and for long-term residents needs to be state-of-the-art. At the same time, we need to be state-of-the-heart. Technology must support care. It’s never a replacement.
Can Senior Care Reach and Serve People at Home?
Bashe: Spring Hills has some 7,000 individuals under your supervision at this time. It’s a phenomenal system: you’re using technology, empathy and the best practices of the hotel industry to create a high-quality customer experience. I’d imagine most people in the brick-and-mortar care business would resist looking at home care as a natural ally, yet Spring Hills has fully embraced home care. Could you share a bit about your home care philosophy?
Markowits: The home is our biggest competitor. When a prospective resident looks for services, the biggest competitor is where they currently are — their home. Even if they’re in the hospital, home is their comfort zone. But if we can deliver care services at home, perhaps we can keep them safer there for a longer period, possibly forever, so they don’t need to explore institutional or assisted living settings. Using remote monitoring technologies, telehealth and even wearables to monitor people’s stability, we can create and provide services beyond our buildings. We can care for people where they want to be, rather than where the system dictates. Supportive care must become the standard.
Bashe: You’re a pioneer in the field of care, starting with one facility in Morristown, New Jersey, and now 35 locations throughout the nation. You have brought in physicians, health staff, economists and health-system experts to champion partnering with hospitals. How do you think the care industry is going change in the next year? What are three things on your radar screen?
Follow the Trends in Senior and Post-Acute Care
Markowits: Here are three trends to watch:
1. In the next year, we are going to see more agreements where payers work with larger providers on value-based care. For example, payers will tell a provider — a hospital center — that they will pay a set reimbursement amount for serving a heart failure patient. If the system is able to discharge that patient to recover safely outside the hospital, the center will do well. But if the patient is readmitted, then it’s going to be a loss to the facility. Right now, some 23 to 27% of patients who leave a hospital end up returning within 30 days. That readmission rate impacts outcomes and costs, and it’s disruptive to the patient’s recovery. With post-acute care and population health management, it can be lowered to 10%. That’s our goal.
2. Patients and families are going to become smart consumers and find options for skilled services at home. That will be a big kick in the gut for those who are just providing nursing home services, refusing to understand that people don’t want to stay in a facility for 20 days because that’s what Medicare will pay before their copay begins. They want to be able to go home sooner, to enjoy life with their loved ones in an environment where they’re comfortable. Also, people will travel further for skilled services than the five to 10-mile radius around their hospitals and home. Just like people travel to exceptional hospitals for care, they will now seek out the best post-acute care settings.
3. I believe the next year will bring a big push for CMS to penalize hospitals for rehospitalization, and hospitals will really scrutinize their partners when it comes to skilled services and post-acute services. Providers will look at the quality of the discharge centers, not just convenience or their prior relationship. They will put people first and consider the best option for that patient. Care and cost do have a meeting point. Hospitals and their physicians are increasingly sophisticated about the importance of CMS rankings and the influence every rehospitalization has on reputation. These trends suggest that the voice of the patient and their family is having a powerful impact, and the system will have to work better for them. The result is not measured by whether the procedure was successful; rather, whether the patient is on the road to recovery. Health innovation is all about serving the needs of the patient and their family.
Bashe: Alex Markowits, thank you. You’ve talked about critical aspects of care we don’t focus on enough, innovative concepts of care where empathy and technology support the human touch. You’ve talked about long-term care not just as a place to be but as a place to heal, live, enjoy and accomplish your life’s aspirations with all the support you need. We appreciate you offering this inside perspective.