ALIYA has spent the past several years transforming distressed skilled nursing facilities into higher-performing operations, but CEO Efriam Weinfeld said the company’s focus has recently shifted from rapid expansion to strengthening its existing footprint, including by giving facility leaders a greater ownership stake in their communities.  

“[Earlier] our mentality was to grow in order to build a foundation, which might sound backwards,” he said. “We spent the first couple of years growing, learning, seeing, and being exposed to both the good and the bad from other organizations that we absorbed.”

However, the Illinois-based skilled nursing provider drew some valuable lessons and now finds itself on a different kind of focus.

Over the last six to nine months, ALIYA has prioritized improving leadership, operational consistency, regulatory compliance and clinical quality.

“We’ve focused really on not growing, but on taking a step back, being introspective about what was working, what wasn’t working, and learning from that, and putting those things in place,” Weinfeld said.

ALIYA has invested heavily in both operational improvements and capital expenditures to rehabilitate its facilities, prioritizing many required substantial infrastructure investments – including roofs, HVAC systems and water heaters – before cosmetic renovations could be justified.

One of the company’s biggest achievements has been measurable improvements in quality outcomes. Weinfeld highlighted a companywide 30-day rehospitalization rate that averaged approximately 17% over the past three months, while the provider’s high-volume sites averaged 11.1%. Both figures are significantly below the national average of roughly 25%.

In addition, approximately 90% of ALIYA’s facilities now hold 5-star Quality Measures ratings. Leadership restructuring, including the appointment of a chief clinical officer and the promotion of Crystal Shelby to chief operating officer, has been instrumental in driving these results, Weinfeld added.

ALIYA, which currently runs 18 facilities, is going to be introducing more innovation through robotics, technology, enhanced programming and modern facility renovations, he said.

And certainly, geographic expansion beyond Illinois is still part of the plan, especially into clustered urban markets where facilities can share resources, clinical expertise and referral relationships rather than operating in isolated locations, Weinfeld told Skilled Nursing News.

Building “Sister organizations”

Building an organizational culture where local leaders have greater autonomy and ownership over their facilities even as the company continues to implement its core growth strategy of turning around struggling facilities is a key focus, Weinfeld told SNN.

To that end, ALIYA plans to continue expanding its ownership model by creating what Weinfeld calls “sister organizations,” led by independent operators with equity ownership while remaining under the ALIYA umbrella. This structure is intended to preserve an owner mentality and avoid overextending centralized leadership as the company grows.

Two such regional operators already oversee roughly 800 to 1,000 beds in the Chicago area, Weinfeld said.

On capital investments, Weinfeld said ALIYA continues to reinvest virtually all earnings back into the business rather than distributing profits. While early investments focused on essential infrastructure, the company is now increasing spending on facility aesthetics, modern nurse stations, resident environments and additional capacity where occupancy supports expansion. Some facilities are being evaluated for adding beds to address high occupancy levels.

Although skilled nursing acquisitions remain available, Weinfeld said ALIYA has become more selective.

Early in the company’s history, ALIYA often pursued nearly every opportunity, but today it prioritizes disciplined growth that does not strain operations or compromise resident care. Financially, the company has strengthened considerably, transitioning from primarily leased properties to owning much of its real estate and securing direct acquisition financing as lenders have gained confidence in its performance.

New service lines and reimbursement

On new services, ALIYA continues expanding in-house dialysis, Weinfeld said. The company has now established dialysis programs in 12 of its 18 facilities, allowing residents to receive treatment without leaving the building, reducing hospitalizations and improving continuity of care.

Another major initiative the company has undertaken is the expansion of respiratory and ventilator care through its specialized Thrive division.

Inspired in part by his personal experience with his grandfather’s ventilator care, Weinfeld said ALIYA aims to create high-quality, aesthetically appealing ventilator units rather than treating them as institutional afterthoughts.

As an example, Weinfeld highlighted one recently acquired facility that underwent an immediate renovation of its ventilator unit despite significant operating losses. That facility currently cares for 18 or so ventilator patients while maintaining a rehospitalization rate of approximately 14%, he said, demonstrating that high-acuity care can achieve strong clinical outcomes.

That said, rather than introducing ventilator programs across every facility, ALIYA intends to concentrate this expertise within Thrive to preserve quality and avoid market oversaturation.

Regarding value-based care, Weinfeld said ALIYA’s strategy has always centered on delivering strong clinical outcomes because quality naturally leads to better financial performance.

While the company participates in existing value-based care reimbursement models, Weinfeld is really bullish on Accountable Care Organization (ACO) models, he said. ACOs better align incentives without disrupting care delivery, unlike I-SNPs, which Weinfeld said can limit care.

“The ACO model doesn’t really change the workflow of care like an I-SNP does,” he said. “It just allows you to … really believe in your care. So I love it.”

As ALIYA grows, Weinfeld said he hopes to launch ALIYA’s own ACO, potentially with strategic partners so as to take on more financial risk and share in the rewards of its quality outcomes, rather than relying on third-party organizations with misaligned incentives.

“Why not take a bet on our care and know that what we have is good enough that we should benefit a little bit from that,” he said.

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