Senior Whole Health is well positioned for government's health care push

Julie M. Donnelly, Boston Business Journal, 4/17/09

Senior Whole Health LLC started with a simple idea: administer health care for the poorest elders, and do it in a more cost-effective, patient-centered way than the government can do it.

The success of the company can be measured in its revenue growth — $215 million in 2008, up from $147.4 million in 2007. It can also be measured in lower nursing-home admissions, according to a study by MassHealth.

The fastest growing private company in Massachusetts is a Health Maintenance Organization for so-called dual-eligibles — patients who receive both Medicare and Medicaid. Executive Director Pamela Gossman said, "These are not old people who became poor, they are poor people who became old."

The company started in 2004 in Massachusetts. In January 2007, the company began operations in Connecticut and New York. Senior Whole Health quickly pulled out of Connecticut after it could not secure a contract with the state's Medicaid administrator, and now has 700 members in New York.

John Baackes, recruited by the company's founders to take over as CEO in 2004, said the company is well positioned to leverage its existing infrastructure and take on new business. He said culturally, the company has become much more "directive," rather than reactive, as it matures.

"I dropped in with a sort of management team in place. My role — and the style that evolved — was really to encourage a team-oriented approach," Baackes said. "It's still the case today."

The company has 192 employees, 160 of whom are in Massachusetts. Company officials say they expect to add approximately 20 jobs over the next year.

The company has offices in Cambridge and Raynham and currently serves about 5,400 patients in the state. Senior Whole Health receives, on average, a total of $3,500 per month, per patient, from federal Medicare and state-run MassHealth, which administers Medicaid. Many of the patients have multiple chronic illnesses, with diabetes and congestive heart failure being two of the most common.

Senior Whole Health's goal is to keep people at home for as long as possible — an outcome, officials say, that results in lower health care costs and improved quality of life for seniors.

Gossman said that once a senior enters a nursing home, typically his or her health deteriorates significantly in the first 90 days. In one fairly typical case, a man with early-stage Alzheimer's disease whose elderly wife couldn't take care of him, and whose daughter worked full-time, received home health care visits and was able to go to adult day care. He also was able to return to his family.

Senior Whole Health has the flexibility, Gossman said, to contract with anyone in the health care system who can help the patient. Patients typically keep their same primary care physicians and are each assigned a nurse case manager. Senior Whole Health contracts not only with home health companies and with doctors, but also with elder agencies that are located in just about every community in the state, to the tune of $11 million.