NIC Chats Podcast with Jim Lydiard

Lisa McCracken (00:03): 

Hi, everyone. Welcome to the NIC Chats podcast series. My name is Lisa McCracken. I'm the head of research and analytics with NIC. Super excited today to have Jim Lydiard with us. Jim may not be someone you know, but he's very familiar to us and is well-versed in the topic we're going to cover today. He is the Chief Strategic Advisor for Pine Park Health. Welcome, Jim. Appreciate you joining today. 

Jim Lydiard (00:29): 

Thanks for having me. 

Lisa McCracken (00:30): 

When I talked about your title, I would love to hear a little bit more about your background. I'm always curious to hear where people got to where they are. Before we dive into everything that you know about the healthcare space and value-based care and all that fun stuff, talk a little bit about your background and your journey to where you are today. 

Jim Lydiard (00:53): 

Sure. Thanks again for having me. I would say I unknowingly grew up in the space, primarily as a consumer. Early childhood memories include visiting an uncle who was a quadriplegic in a nursing home, visiting a grandmother who began her experience in senior housing on the IL side of a campus that had ILAL and then eventually began wandering. As so many of our older adults and loved ones do, she had advanced Alzheimer's dementia and had to move to a memory care community. Early fond memories include being a child, going there with my father. I sort of put those thoughts in the back of my head for many years and went about school and college the way that many of us do. 

Jim Lydiard (01:48): 

I also describe myself a little as a failed physician. My degrees are in biology and chemistry. I've taken the MCATs twice but never hit the apply button for medical school. Ultimately, I ended up taking on a sort of sales business development position after school. It all started to come together for me when, personally, things crept back into my world. I began working for a company called Evercare in 2007. My role there was a blend of their hospice division and some of their ISN nursing home division. In particular, I was living a couple of days a week with my grandparents, believe it or not, commuting back and forth through the state between my home base and where my grandparents lived because we had two offices as well. 

Jim Lydiard (02:49): 

What I had learned by living with my grandparents at that time was how broken our healthcare system was for seniors. My grandfather had advanced Parkinson's, and my grandmother on the other side of my family had early-stage Alzheimer's. Living with them for a couple of days a week while working at Evercare was glaring for me, and I really wanted to do something about the broken healthcare system we found ourselves in. While at Evercare, you sometimes stumble into roles earlier in your career and start to think, "I can do more than make a living here." In 2010, I ended up accepting a position with CareMore Health, which today is an acquired subsidiary of Elance or Anthem Health Plan. 

Jim Lydiard (03:40): 

At the time, that's really when I began to do something about the broken healthcare system. I joined CareMore back in 2010, where we were launching various special needs products throughout the Southwest and ultimately across the country. I ended up spending 11 years there, primarily supporting their "Touch" program, which was their benefit plan and care model specifically designed for seniors living in long-term care and senior housing settings. Since that time, I spent 11 years there, and in the last three or four years, I've mostly been at private equity or startup-type companies, similarly supporting homebound, home-limited patients, and those living in senior housing or hard-to-access, hard-to-engage patient populations. 

Lisa McCracken (04:36): 

Fascinating background. I mean, obviously, you were living it personally and professionally too. I think a lot of folks would still agree that we've got a broken system, but I like to think today we're going to talk about some glimmers of potentially shifting that broken system and how we get there as an industry. There's the provider side of things, then there's the customer side, which is a whole other conversation around this. I do want to spend time talking about value-based care, but I also acknowledge that for a lot of people, it's a very intimidating topic. Trying to understand it can get complicated quickly. For somebody like you, maybe not so much, but for a lot of folks, it's a challenge. We know we've got to understand this and take a first step to get our arms around it, but it can be complicated. To the extent that you can, do a little bit of a 101 and level set the conversation. How do you define value-based care as it relates to the senior living sector? What do we need to be thinking about and understanding? 

Jim Lydiard (05:53): 

I think at its core, value-based care is merely a clinical and financial shift in focus—a focus from volume to value. A focus on best care, which organizations define differently, but I think means timely, appropriate care as opposed to simply more care. Also, when a clinical model gets further upstream and builds trust with healthcare recipients, patients, and families—especially the patients we serve in senior housing—and you root your care model in informed consent and educating patients and families along the way, then care plans can enact preventive care, usually at a more affordable site of service, such as the apartment, community, or home of these patients. Care plans are also able to limit and avoid unnecessary treatment, futile care, and wasteful care. This all leads to savings—savings from what that disease state historically would have expected a health plan or Medicare to spend on these sorts of members or beneficiaries. Ultimately, those savings can be shared amongst those involved in creating that change. That’s a clinical and financial overview of how the shift in the care model yields new ways to fund this type of service and how those newfound funds get distributed. 

Lisa McCracken (07:33): 

Right. There is the financial component of it, which I know often gets talked about on the operator side of things, but then there are better ways to do it and best practices. I know a number of operators that have gotten into this space who have also said the reality is this type of care and integrated models are just a better way to do business. We see occupancy improvement, like the stay, which I don't want to say has nothing to do with the value-based care side of it—it’s a positive byproduct of that model that can have financial returns across the board. 

Jim Lydiard (08:09): 

I would argue to a degree, I think it has everything. 

Lisa McCracken (08:13): 

Okay. 

Jim Lydiard (08:13): 

I think it has everything to do with it. That's just the nice part of how value-based care and senior housing work in a very altruistic way. It's the value that we collectively unlock together, and ultimately the member and family benefit the most. 

Lisa McCracken (08:27): 

Right. I want to break down the value-based care piece with a little more specificity. I want to talk about ACOs and MA versions of value-based care. You've seen both and experienced both. Do you think one is particularly more challenging than the other in generating overall impact? On top of that, if you're just entering into this, is there one that's maybe a more natural way to align? Again, because we recognize value differently, there are different resource allocations and levels of sophistication in these models. So compare and contrast the ACO and MA versions of value-based care. 

Jim Lydiard (09:08): 

Great question. And, like you, I get asked this a lot. I would oversimplify it and say that, in my experience, it's generally harder to build scale and membership or grow the MA Medicare Advantage form of value-based care. However, once you grow that population, that cohort of patients and members, there are more levers to impact success. In contrast, it may be simpler to build scale and density on the ACO side, where the patient doesn't have to make a plan change to amass the type of membership needed to impact a value-based care model. However, there are greater challenges to bend the cost curve in ACO care. In 15 years of supporting and leading organizations focused on this space and these payer risk models, I've watched select markets and MA regions begin to actually generate savings in less than a year. 

Jim Lydiard (10:13): 

Oh, wow. I'd say that's fast, but I've seen it. What I mean by generating savings in an MA world is that care expenditures tend to be 85% of the revenue you're bringing in. Most of our listeners thinking about Medicare Advantage have probably heard of the 85% rule. Usually, anything better than 85% MLR means that the product itself has turned profitable. Contrasting that with ACO experiences, I've seen it take a bit longer in ACOs to hit your stride. Usually, one to two performance years is when you see reliable savings. But again, it's quicker to grow and amass the membership on the ACO side, where a plan change doesn't have to take effect. My favorite partnership path option, if you're a listener wondering whether to do one versus the other... 

Jim Lydiard (11:10): 

The beauty of many of your markets is that you might not have to pick one or the other. You can often look to a physician group that partakes in both sides—both MA risk agreements as well as ACO-type arrangements. If you form your opinion at the PCP group level, or the MSO level as it's called, you can usually flex to both tracks in a much easier way. The adoption is easier. Sometimes members are already affiliated with these physician practices, so there's a simpler glide path to growing the attribution on the ACO side and the membership on the MA side. Ultimately, that becomes the linchpin for successive outcomes. 

Lisa McCracken (11:55): 

I would observe that there's been a great increase in some of these partnerships with physician practices, even coming out of the pandemic. I don't have any stats around that, but is that a correct read or not? I just seem to be hearing more about some of those partnerships and alignments. 

Jim Lydiard (12:16): 

I'd say you hear more about it today. Many of your listeners would probably say that mobile house call physician practices have been serving this space forever. But much like the senior housing industry itself, these practices have become more sophisticated as well. Medicare has had a big role in advancing more PCP-specific ACO models and what CMMI has been able to do. MA plans have also gotten more sophisticated in how they want to partner with physician networks and physician groups. I think it's the perfect storm for innovation, where most people are seeing physician practices potentially becoming the captain of the team as it pertains to healthcare. They are looking for ways to either give risk to those PCP groups, as Medicare Advantage would say, or give more accountability towards those PCP groups, as ACOs would suggest. If those PCP groups are doing their job, they are often the ones that should be on the hook for rendering savings or losses. 

Lisa McCracken (13:26): 

Right, it sounds like a natural partnership. Do you have any insights in terms of if I'm a senior living operator and I've been approached by some different physician groups on that, what questions should I be asking? Are there two or three things I can do to assess alignment and determine who might be a good partner? Recognizing this is probably a complicated and in-depth conversation, I'm sure you have some insights into that. 

Jim Lydiard (13:53): 

Yeah. I think maybe a good stat to follow here is there's just a lot of noise in the space. Yeah. I think I saw a recent article that showed that IN plans, which are again Medicare Advantage products specifically designed for folks that live in senior housing settings, have risen from 40 products or so in 2010 to like over 175 come 2025. So you're talking about basically almost four times the number of products that are out there. And that's just on the Medicare Advantage-specific side. The ACOs have also grown immensely. If I was a community operator, there's probably a few ways I'd start that. That's, I think, what you're getting at. Yeah. First and foremost, these groups aren't hard to find. They're all pushing for growth. What I believe in wholeheartedly is for these operators to just pause for a moment and make an intentional decision to get in discovery mode. 

Jim Lydiard (14:52): 

Take meetings with several large groups locally, regionally, and potentially even nationally, because these groups have timetables with CMS for when they can launch into these markets. Or, if they're just an ACO, they have performance years with timetables on when to announce they're entering a new market. Also, these buildings can easily cross-reference their operational footprint with the footprints of these plans or ACOs. That is not a hard task and can be done with a quick online search. A discovery phase also includes asking not just what this ISNIP or ACO can do for you, but asking your residents what they want and what they want done differently. Ask your staff what impact they’re looking for, and really immerse yourself in kind of a true discovery phase. 

Jim Lydiard (15:48): 

What you're ultimately trying to land on is how your community or operation can differentiate by laser focusing on a healthcare experience unlike any other. Once you know your vision, you'll know what complements you need. Phase two of this is all about finding that complement. Differentiating these partnership options is key. Ultimately, if buildings are going into this for the first time—meaning this isn't a case of "we tried this, it didn’t work, we learned, and now we're applying it with partner two"—but rather you're going from zero to one, you need to find a partner willing to create a glide path that really includes and involves you in the foreseeable future. Operators need to remember that healthcare is a serious business. 

Jim Lydiard (16:36): 

And we've all talked to these residents. Some of these residents have had the same health plan for 30 years. Some of them have had the same PCP for 30 years. We shouldn't take this lightly if we're going to ask these residents to commit and align with a novel care partnership you're adopting. There's a massive responsibility we all have on our hands. As such, those partnerships with IIP plans, ACOs, or general MA plans need to be well thought out. They need to be prepared to endure and not feel flippant to the end consumer, which means the residents in your community. In summary, a thorough discovery phase, analyzing your gaps, and interviewing partners to see who will be the most malleable to where you are in your journey and where you see this going is essential. Usually, this means a roadmap of year over year—here's how the partnership could transform if things are really winning and working between us. 

Lisa McCracken (17:35): 

Right. I think all of those points underscore the fact that this is a commitment you need to make, and you need to have more than just a champion—champions internally. This isn't just a quick initiative. This is really about changing the culture of the organization, and you've got a lot invested in this. It's about putting in the time to do it right. I wanted to talk a little bit about how you've been in the industry for a period of time. You've talked about your background. So, maybe where we are today versus 10 or 15 years ago—let's say 2010, when you began selling value-based care in senior housing. What do you see as some of the differences in community operators today versus then? 

Jim Lydiard (18:20): 

Yeah, good question. I'd say there are differences on both sides of the coin. There are pros and cons. 

Jim Lydiard (18:29): 

Pros and maybe opportunities for improvement—there we go. On the pros side, when I would cold call assisted livings back in 2010, I would say, believe it or not, only about 50% at best would acknowledge that they were witnessing improvement opportunities in delivering better onsite care. The other 50% just believed the status of healthcare in their building was great. 

Lisa McCracken (18:54): 

Yeah. 

Jim Lydiard (18:55): 

When you break that down one layer deeper, from the 50% that were seeking improvement and acknowledged there were areas to improve, only a small fraction understood that value-based care was a means to do so. 

Jim Lydiard (19:10): 

In 2010, a smaller percentage acknowledged the need for healthcare improvement. By 2024 or 2025, a much greater percentage seems to recognize this need and appears ready to take action. The big pro is the known participation in healthcare, which is vital given that these residents are more frail, and wellness staffing remains pretty lean, even compared to 2010. In terms of areas for improvement, while it’s entirely possible that buildings were as overwhelmed with day-to-day operations in 2010 as they are now, it seems more evident today. When you walk into these buildings, executive directors and health and wellness directors are often using a dozen to two dozen point solutions to run their day-to-day business. 

Jim Lydiard (20:07): 

Turnover in these communities is usually around 100% annually, from caregivers to med techs to dining staff, and all these buildings are still rebounding from occupancy. The big difference I see is that operators at the regional and national levels have to be really critical about what they want to implement and how they intend to implement change. From a behavioral change management perspective, you’re deciding how much you think your team at the local level is prepared for. Otherwise, it’s just going to result in a series of sloppy launches. This doesn’t just apply to value-based care or healthcare—it could be any number of solutions an operator is thinking of implementing. For example, switching up their EMR, changing their long-term care pharmacy, and so on. But you’ve been in the industry for a long time. What is your perspective? You’ve seen a lot from 2010 to 2025. What are your thoughts on that? 

Lisa McCracken (21:13): 

I’m actually surprised when you said that back in 2010, about 50% acknowledged that maybe there’s a better way—that’s actually higher than I would have thought. I think back to 2010 and value-based care and smarter delivery of services. Gosh, I’m not saying there wasn’t quality care and services, but I think we’ve come a long way in terms of understanding value-based care. If you’re in the industry now and you’ve never heard of value-based care, I’d be shocked. Most people at least have some semblance of what it is. I think there’s also an acknowledgment that there’s a better way. Another observation I’d make is that there’s been an evolution where much of the care coordination was historically focused on the skilled nursing side. Now, I see a clear acknowledgment of the gains and opportunities in upstream initiatives, like wellness and prevention, which span the continuum, starting with independent living residents. 

Lisa McCracken (22:14): 

We even see it coming into active adult settings a little bit with some partnerships there. There’s really opportunity across the board. I see greater receptivity to it and interest in learning, which is a good thing. However, to your point, I still think the system is broken. Tech adoption has been a good thing and has progressed since 2010, but it’s mostly not integrated. That lack of integration holds us back. It’s so frustrating for the staff and everyone you hear about—how many plug-and-play systems exist, and yet they don’t talk to each other. I think that’s a significant barrier to fully progressing on this value-based care journey. 

Jim Lydiard (23:02): 

Right. Well said. Thank you. 

Lisa McCracken (23:05): 

Do you have an observation in terms of what’s the one ingredient that most often equates to success in launching some of these healthcare partnerships? Any secret sauce? 

Jim Lydiard (23:21): 

Yeah. I love this question. I’m sure some listeners would expect me to have a real gem here, like the right payer mix among the resident population, a well fine-tuned, pre-established network of preferred healthcare vendors already in the building, or data and analytical expertise, or a star ED or health and wellness director. Don’t get me wrong—all those things help. They do. However, I would actually say success, in my experience, has been rooted much deeper. I’ve typically seen honesty and humbleness among the buildings as the prevailing factor. Will this building agree, implement with intent, and see this thing through? I like buildings that are willing to call out their blind spots, ones that desire change, maybe even ones that are a little disruptive or rebellious. 

Jim Lydiard (24:24): 

What we are doing is making a monumental change in how healthcare is delivered. This brand of healthcare is hard. These residents, if you just look at HCC scores, risk adjustment factors, and how Medicare begins to add frailty coefficients to this population, are two to three times as frail as the traditional Medicare beneficiary. When you start to deliver care to them, they often have an inherent distrust in the American healthcare system. They already feel it’s complicated, and sometimes they feel as though it has wronged them. I love buildings that are humble and honest, willing to say, "Here’s what we need. Here’s what we’re doing well, but here’s where our blind spots are." Those are often really good leading indicators for success in my eyes. 

Lisa McCracken (25:17): 

Yeah. I would think that’s necessary because the reality is you don’t get it exactly right from day one either. You need to pivot, take a look at what’s working and what’s not, and figure out where you need to evolve and adjust along the way. Do you have any stories from the trenches, if you will—any of those humbling stories you’ve seen over the years? 

Jim Lydiard (25:41): 

So yes, this is... 

Lisa McCracken (25:42): 

Without names, no names. Right. 

Jim Lydiard (25:44): 

Right. This is the part of the podcast where I tell you how many times I’ve failed over the last 15 years at this. In all honesty, this whole type of work is a series of failures in a way. We just hope that we learn from those and can apply them to the next win. I’ve got a couple of good stories that come to mind when you ask for examples. The first one was a lesson in realizing that not all buildings really want what’s best for residents. 

Lisa McCracken (26:18): 

Okay. You’ve got to elaborate on what you mean by that, which I’m sure you will. 

Jim Lydiard (26:23): 

I was probably part of the fastest program to ever be terminated in a new market. Rewind back to 2015 or so. My program was asked, as part of a state-based RFP, to launch in a new market. This was after Anthem had acquired CareMore, and one of the Anthem subsidiary products in a new state had just won a Medicaid bid. As part of that, we were required by the state to launch a care model like ours in nursing homes. We set out on an adventure, interviewing about a dozen nursing homes that housed custodial long-term care patients who were now members of this Medicaid health plan. We ended up selecting three or four buildings with a total of about 180 residents who were members of this health plan. 

Jim Lydiard (27:34): 

We met with the ownership groups of the four buildings—there were one or two owners. We met with the medical directors of the buildings and rolled out how we planned to jump in: bringing in advanced practice clinicians or nurse practitioners, how our back office team would assist in care coordination, and how we’d work with the communities already contracted for direct admit to SNFs when they needed rehabilitation, and Part B services when they needed a lighter version of that, and so on. The launch followed about 90 days of preparation after receiving the state’s approval. We began care, but about 45 days into it, we got a phone call informing us that all four buildings had been sold to one new owner-operator. 

Jim Lydiard (28:25): 

The new owner-operator took a look at our early data. Of the 180 patients we’d served, they were used to copious amounts of ED visits and hospitalizations. We had nipped that in the bud by bringing in more onsite primary care and working much more tightly with both onsite and near-site services. However, what we found with the new operator group was that their vested interest was in ensuring they could send patients readily to the ED, enabling them to turn on skilled days and get a higher reimbursement rate from the state. As a result, we were asked to leave just 60 days after our arrival, despite providing 60 days of great care to 180 patients within a new clinical model. 

Jim Lydiard (29:18): 

It was a very humbling experience. I remember one of my physician mentors at the time, George Fields, who’s now over at Molina, asking me, "Jim, would you have done anything differently? Would you have not taken on this challenge and worked to make improvements for these 180 members?" The answer, of course, was no. But that was an extremely humbling experience because we saw the impact that was possible. We saw what we were building, and yet this new ownership group was more focused on shifting financial priorities than on providing best-in-class care for its custodial patients. 

Lisa McCracken (29:58): 

Well, it obviously reinforces the importance of goal alignment. Is everybody rowing in the same direction and focused on the right goals at the right time? 

Jim Lydiard (30:08): 

I've got one more that's, that's a real good 

Lisa McCracken (30:10): 

Okay. Sure. Let’s hope that’s a more constructive lesson learned because, quite frankly, that’s disheartening to hear. But it reinforces, as I said, the importance of alignment. 

Jim Lydiard (30:23): 

Well, you’re asking for humbling stories. 

Lisa McCracken (30:26): 

Yeah. 

Jim Lydiard (30:26): 

On many podcasts, we just listen to the wins, but the hard reality is there are a lot of misses along the way too. This next miss, which will probably end a little more lighthearted, is a lesson in how healthcare doesn’t have to be so complex. Sometimes the simplest solutions are the right solutions. I remember years ago enrolling a member at a memory care facility. This was a low-income memory care community, one of those cottage-like setups with 10 residents in six or seven cottages on one campus of care. I remember this one patient vividly—he was a younger patient of ours, and the building took a chance on our referral to them. 

Jim Lydiard (31:25): 

We referred this member to the building. The member moved in, and shortly thereafter, the member experienced an unavoidable hospitalization due to some complex interactions with pharmacy needs. The member spent four or five days in the inpatient hospital setting and then returned to the building. Not even 30 minutes after the member arrived, I got a phone call from the executive director of the community. They said, "Jim, you’ve got to help us. Mike just got dropped back off, and we’re going to have to send him back out." I asked, "Oh no, how can I help? What’s going on? Do we need to send a clinician out?" The executive director, in the most matter-of-fact way possible, said, "Unless you can get Mike underwear, we’re sending him back out." 

Jim Lydiard (32:23): 

I had to pause for a moment, and my first thought was, "Where’s the nearest Walmart?" My second thought was, "If I’m ever in a pinch and not feeling great, should I call my insurance agent for something like this?" Nonetheless, I found myself in line at Walmart buying underwear because, unfortunately, the hospital had discharged this patient in a hospital gown and nothing more. The patient returned to this poor memory care community, surrounded by peers and residents, without any clothes. All the data science, technology, and clinical treatment plans in the world couldn’t have prepared me for this return-to-acute-avoidance issue. It was a humbling experience—a reminder that sometimes it’s not about cool population health data science or technology. It’s about humanism. This guy just needed some clothing, and the community wouldn’t send him out. Here we are, years later, and let’s hope Mike is still doing well there. 

Lisa McCracken (33:27): 

Yeah. Well, it shows the importance of some of the basics and transitions of care, right? 

Jim Lydiard (33:33): 

Right. And you can edit as much of this out as you prefer. 

Lisa McCracken (33:36): 

Oh, I think we’ll leave that one in. It keeps people engaged. I’m sure the listeners are hooked now. All right, let’s wrap up because we’re coming up to our time here. I’d love to hear your thoughts on what other healthcare trends you have your eye on at the moment. Are there any that relate to our listeners in healthcare and housing or the intersection between the two? 

Jim Lydiard (33:56): 

Yes. I’d like to attempt to coin a phrase today. I think we’re entering into a world where, previously, there was healthcare and then there were these communities more commonly known as hospitality. I think we’re entering a world where "health hospitality" is going to be a thing. And what I see in the... 

Lisa McCracken (34:17): 

Not heard that one before. I'm gonna remember that. Health hospitality, you have to tell me how to spell it then. But go ahead... 

Jim Lydiard (34:24): 

I think the big overarching trends right now include rural care, which seems to be a significant focus. Many companies are starting in this space, investing in it, and selling within it. It’s a big challenge for most health plans and the government, not just regarding healthcare expenditures but also access to care for aging populations. Medicaid is another big theme right now and is, in a way, having its heyday. Since 2007, we’ve seen a lot of investment and health plan innovation in Medicare Advantage to support the space. I feel that same level of investment and innovation is either already here or on its way for Medicaid. We’re going to see a significant expansion of that as eligibility increases state by state. I also like solutions around care navigation, particularly navigation performed by lay, nonclinical people. Candidly speaking, I think I’d be a great care navigator myself. I know enough about different topics—not deeply like a clinician—but enough to help guide a senior or someone with lower health literacy to better understand and access healthcare opportunities. Lastly, I think behavioral health is another key area of focus. 

Lisa McCracken (36:00): 

Definitely, that was gonna be one on my list. 

Jim Lydiard (36:01): 

Yeah, it’s definitely on the rise because it has gone from being something relatively taboo just a few years ago to now being something everybody talks about and feels comfortable discussing. Generally speaking, I’m fascinated by the harder problems in healthcare, the tougher solutions, and the winding roads. I think all of those have a place in senior housing or hospitality. 

Lisa McCracken (36:28): 

Hospitality. Yeah, that’s a very good one, and we’ll remember that. Like I said, I’ve got to figure out how to spell it, but I get what you’re saying, and I think... 

Jim Lydiard (36:37): 

Yeah. But again, you’re in tune with all this—housing, finance, markets. What are you seeing upside in? 

Lisa McCracken (36:43): 

Yeah, well, definitely. Behavioral health and mental health are areas I was going to mention. Outside of cognitive impairment and dementia in Alzheimer’s, I think these are issues that operators are dealing with every day. The question is, what are the opportunities to bring forth more solutions and strategic partnerships on that front? Quite frankly, it’s already a bit of a crisis. It’s talked about more now than in the past, but there’s still much to address. You mentioned care navigation, and I think there’s huge opportunity there. Even within the senior living setting, there’s significant potential for population health management in general and for helping residents and their family members better navigate the system. 

Lisa McCracken (37:38): 

With care navigation, thinking through the business model is essential. You’ve seen different organizations bring forth various services and platforms on that front—sometimes they work, and sometimes not so much. What I mentioned earlier about upstream initiatives is exciting. It’s great to see organizations and the sector pivot from the "sick care" model to a "WellCare" model and recognize the opportunity to make a meaningful impact on residents across the spectrum. Those are the things I think about, and I see great opportunity there. One final quick question: By 2030, all Medicare beneficiaries are supposed to be in a value-based care arrangement. Is that going to happen? Yes? No? Is that aspirational, or do you think it’s realistic? 

Jim Lydiard (38:34): 

I don’t think it’s going to happen—not because of the Medicare Advantage side of that number. I think we’ve seen what Medicare expected, with more than 50% of the population now choosing a Medicare Advantage plan, which they deem credible for that stat. I think the issue lies more on the ACO side. Despite CMMI’s attempts with not just launching PCP-related ACOs but also specialty-related ACOs—for oncology, renal care, cardiovascular, and even pulmonology—we’re not seeing as much adoption on the Medicare side. I think over the next few years, we can significantly close that gap, but my guess is that by 2030, we’ll still be at best around 75% to 80% of the way there. That will still be meaningful. As long as everyone starts to become more accountable—through ACOs and risk populations—the whole goal of value-based care, which is to bend the cost curve, should still start to materialize in the way we intended, particularly over metrics like GDP. 

Lisa McCracken (39:57): 

Right, I agree. 75% to 80% is nothing to be ashamed of—that’s significant progress, for sure. Well, Jim Lydiard, we appreciate your time with us today. Jim Lydiard serves as the Chief Strategic Advisor at Pine Park Health. He is also a very loyal NIC volunteer and heads up our Partnering for Health focus area committee. We acknowledge your constant support of the NIC stakeholders and your service to the industry. Thank you for being with us here today. Thank you, everyone, for listening to another NIC Chats podcast. You can access this podcast and others on our website at www.nic.org. Thank you so much. 

Jim Lydiard (40:38): 

Thank you.