In this Priorities, Plans & Perspectives interview, Skilled Nursing News sits down with Brian Cloch, Principal at Innovative Health, to learn about how he manages the rotating roster of day-to-day challenges by staying nimble and maintaining an industry mastermind group that looks out for one another.
Read on to discover how Cloch’s perspective has changed as value-based care takes center stage,, and how he is navigating the pandemic in real-time..
Skilled Nursing News: What was your first job title in health care or health care technology?
Brian Cloch: My first exposure to health care was at the Trade Association of Nursing Homes in Illinois. From there, I transitioned into nursing home administration back in ’83.
SNN: How has your perspective changed since your first day in the industry?
Cloch: When I first got into health care, I thought I was doing some really heavy care. But since then, the care model and health care delivery system has drastically changed. Back then, the average stay in the hospital was 30 days. Now the average in the hospital is probably one tenth of that.
In the early ’90s, there was also a shift toward what consumers wanted, which was an apartment-style approach versus institutional-style approach. We thought there was no way to get away with that because of the regulations and compliance, but the government stayed out of regulating assisted living for a long time.
SNN: Who has made the greatest influence on your perspective?
Cloch: I think the greatest influence I had, personally, were people that understood government and how to work with government.
There’s a guy named Pete Peters, who was a former state legislator and a mentor of mine. He understood how to work with government and get them to work with us as an industry. But otherwise I’ve been more influenced by the movement away from managing sites and episodes of care to managing total cost of care.
SNN: How do you define and execute your professional priorities?
Cloch: I have always chased the opportunity to move closer to value-based care. When somebody moves into one of our communities, we want to control as much as we can to achieve the best outcome. Unfortunately, many factors influence our ability to deliver on that promise. That it’s really hard.
Look at COVID. You have state regulators, federal regulators and hospitals. Everybody wants to tell you what to do and how to do it. Then you have unions, labor and all these other things that control your outcomes.
Every morning I wake up and figure out what my priorities are right now. My day is influenced by so many other people and factors that it’s hard to forecast, it’s hard to predict, it’s hard to think ahead. It’s day-to-day survival, and the priorities are always changing. That’s what’s so challenging about this business.
SNN: What are three of those priorities?
Cloch: Labor, labor and labor. Recruiting and retaining labor is everything right now. The thing that keeps me up at night is labor right now. We can’t change rates to hire. We can’t compete with Amazon who just decided yesterday to raise wages to $18 an hour and throw in free college tuition. How do I compete with that when 98% of my reimbursement comes from the government, who’s still paying based on a small dollar-an-hour wage?
I don’t have the ability to call the government and say, “Hey, I don’t have any CNAs in my building, and by the way, the only way I’m going to get them is to pay $18 to $20 an hour and offer free college tuition.”
SNN: How do you look at planning when a large degree of uncertainty is involved?
Cloch: I think you’ve got to keep your North Star and maintain your direction through value-based care. On the skilled side, we could do 20% to 30% of the exact same care that happens in an acute care hospital for 80% less cost. We can provide 60% of the care provided in an LTAC and an acute rehab at 60-70% less cost. We have to continue to push forward. As the health care systems, look at value-based or managing total cost of care, we will have a place in that conversation as long as we continue to provide high quality, lower cost care than those alternatives.
SNN: How do you keep track of your professional plans and progress throughout all of this?
Cloch: The only way I would put it is, if you’re not moving forward, you’re moving backward. How do I keep track? I mean, it’s daily. I look at how we are doing today, how we are staying relevant to the health care systems that we work with and how we are creating value for the people that need us.It’s a day-to-day, and when you hit a brick wall a few times a day, you have to find a way to break through it or get around it. Every day in health care we’re playing ‘whack a mole.’ The biggest challenge we have most days is figuring out what problem we’re trying to solve. There are so many problems to solve that are all interrelated. They all influence each other so we aim to have some level of success fixing one problem at a time.
SNN: What you do when something doesn’t go according to plan?
Cloch: Call an “audible.” You’ve got to be nimble and quick and ready to call an audible. Again, every day somebody else influences your plan, especially in the midst of a pandemic. When the government comes out with a new policy on COVID, we have to go back to the drawing board because we’re building this plan as we’re flying.
SNN: What do you listen to, read or watch to gain that perspective right now?
Cloch: I give credit to Skilled Nursing News. I wake up every morning and get a look at Aging Media’s emails. I’m probably one of those guys that shows up at 5:36 am to read each morning. I glance through the articles for something that interests me and use that to get some perspective. I also rely on friends in the industry. Calling up Lynn Katzman or Tori Rizzo gives me perspective on things. You rely on friends in the industry and help them wherever you can.
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