Frontpoint CEO Korte ‘Taking the High Road’ on Hospice Growth

Most people who work in hospice have a story. For Frontpoint Health CEO Brent Korte, that story began at 20-years-old when he volunteered to help dying patients in Calcutta, India.

This was a formative experience for the future home-based care leader, which was later reinforced as he saw some of his own family members receive home health care.

“It was called the Kalighat House for the Dying and Destitute. I was with my buddy, hair in a ponytail, and we walked in and volunteered,” Korte told Hospice News. “My experience there changed everything.”


Texas-based Frontpoint is an emerging provider of home health, hospice, palliative and personal care with a focus on Medicare Advantage enrollees in Texas markets. Before taking the helm of this new company, Korte spent eight years at EvergreenHealth, where he served as chief home care officer.

Hospice News spoke with Forte about the growing influence of Medicare Advantage, and Frontpoint’s plans for national expansion after a recent infusion of investment dollars from the private equity firms Cimarron Healthcare Capital and Tacoma Holdings.

You are building a very Medicare Advantage-focused business. When I talk to hospice providers, many seem very apprehensive about Medicare Advantage and these value-based models. What is the opportunity that you see within Medicare Advantage?


As it pertains specifically to hospice, It’s not lost on me that by virtue of us having a large Medicare Advantage base or a large home health base — whether it be Medicare Advantage or not — that if we’re taking the right care of our patients, then we’re going to make sure that they’re receiving the right level of care based on their conditions.

In our example, we have over 2,000 patients on a given day in Texas and hospices that are able to support them as these patients may move from home health to palliation towards the end of life. We can help capture that continuum in a better way.

The beauty of that is that we can take care of them at our Medicare rates, which are generally very positive. That allows us to provide great care to them. So It’s largely focusing on keeping patients in the right care setting.

If we don’t have a hospice providing excellent care, then we’re probably not providing the care patients need, right? We don’t want patients on home health who are hospice appropriate.

Is Frontpoint currently participating in hospice VBID?

There are actually no VBID payers in our territory right now, which is surprising because we work with every single insurance company that’s in the [Dallas-Forth Worth (DFW)] Metroplex and many in Houston.

What influence do you think Medicare Advantage could ultimately have on the hospice space in the long term? Where could you see this going?

I’m as worried as anyone else who’s taking a rational look at this. Why would [the U.S. Centers for Medicare & Medicaid Services (CMS)] be moving towards VBID? It could very likely diminish benefits and decrease costs. I don’t personally think that there are any superfluous costs that are unnecessary to the care that’s being provided in hospice.

In fact, I think many companies, frankly, could be providing more care. As Medicare Advantage and those payers take part in the VBID pilot look at hospice, and possibly something that becomes more universal, the real worry is that there’s the benefit diminishes. That would mean that the dying in our country are not taken care of at the level they should be. I’m really worried about that.

As an industry, hospice, home health, and home care all need to lock arms and make sure that we are protecting our patients and not diminishing the benefits that they deserve.

Following the recent recapitalization, Frontpoint will be pursuing acquisitions and seeking to foster greater synergy between their home health and hospice business. Is there anything you can share about your acquisition pipeline or whether hospice deals might be forthcoming?

There are many interested parties that seem to be quite interested in selling. We’re vigilant about partnering with organizations that may need the right type of additional oversight to improve their services, but we’re not looking to partner with anyone — whether it’s in Texas or nationally — who has anything less than a stellar reputation. We want unique providers that are putting the patient first.

There are such things as better hospices and worse hospices. There are better home health [companies] and worse home health. There’s a way to stratify that. We are very purposefully keeping our caseloads low. We are very purposefully competing for the best hospice clinicians in any area where we provide care.

We want to win on care. That’s a different thing from a business perspective. You could win on cost containment. We are going to be very vigilant about our costs, but we’re also not going to do it in a way that is going to hurt patients or put us in a tough spot from a patient care perspective.

So the pipeline, honestly, there’s quite a bit coming at us presently, and I think we’re very early on in our journey and are being very selective about the right partners. That goes across the board, everything from the quality of care to reputation in the community, to the valuation and in the sale price.

There are some hospices that are out there that are looking at their value at a rate that we think the market probably doesn’t support. There are others that are more reasonable and are looking for this type of partnership where we can come in and help them get more organized, and back them with best practices and a retention model that is going to help us grow and thrive in the next decade.

Can you say more about that last bit that you mentioned about retention?

We could change the word “retention” to “people.” We are in an era of human capital, becoming a people-focused employer. That’s an easy tagline, “Become a people-focused employer.” But if we aren’t taking care of our folks, then they can’t take care of our dying patients.

We’re talking about patients who are looking down their final six months of life, possibly the final hours of life. I subscribe to the concept that patients come second. We have to put our employees first so that they can put patients first. So by virtue of putting the patients second, we actually do put them first.

So what does that mean? It means that we’re absolutely focused in every conversation and every decision on keeping and motivating and supporting our people. That’s everything: Are we a good place to work? Are we flexible?

Do we have actual benefits that help support families? Do we have a way to help our employees who are experiencing compassion fatigue? Do our employees feel like they’re citizens of their organization, or do they feel like a number?

If they feel like a number then I’m failing in my job. I want to build an organization where we have a group of employees who are (and feel like) citizens of an organization — that have a voice and feel that their work matters so that they have a redeeming experience working for our organization — so much so that they don’t want to leave.

We pay competitively. We don’t want to pay the most. When you pay the most you’re usually trying to cover up another ill within your organization. It’s very common.

Can you add some color on the kinds of synergies that you hope to develop or enhance between your hospice and home health businesses?

Seamless referral flow is really important and a lot easier said than done. This is what many of the acute-care [electronic medical records] are attempting to do, interoperability, etc. But when you’re within your own organization, it makes that a lot easier.

There are some economies of scale, obviously, as we centralize, currently in Texas, as we professionalize and build up our HR processes. And we have what I would consider is going to be one of the most intuitive approaches to payroll and HR in the industry. We’re working on that presently.

We’re going to be able to support all of our people. The larger we get, the more we can pour resources into that central mechanism. It’s from that central mechanism that we can support our agencies with more efficiency, but there’s a big, big caveat here. Our goal from day one was to maintain and defend the regionality and the community aspect of every organization that we partner with. And that is hard.

That means that when we grow from presently a Texas organization, and we go to another state, we’re not going to bring Texas-based hospice and home health practices. Because people have different expectations.

Local culture plays into health care and the health of the community more than anything. Health care is local, and we’re really, really focused on that. That means we’re not going to corporatize anything. We’re going to centralize the right things. If something doesn’t feel right to the local group, and it doesn’t seem like the right way to go — all the way up to the point of maintaining separate EMRs if that is the right thing for the area — then we’ll do it.

There’s no point in centralizing simply to make processes fit the company. We want the company to fit the community.

That’s a really interesting approach. You also have some de novos in the works in some Texas markets. Will any of that expansion include hospice?

Growth within the DFW Metroplex is already planned, and we have early growth planned for within the Houston area. We have our eyes on San Antonio, Austin, and Waco [Texas], and in the periphery of all those areas.

We’re just now in our sixth week as a company [as of Oct. 13], so we’ve got some pretty fun plans ahead. We already have a great structure and two hospices that are led by excellent leaders. We have excellent clinicians.

De novos allow us to make sure that our culture in the state of Texas is intact and community-based. One of our hospices in Houston, Highland, has as sort of a local slogan they’ve been using, which is, “Highland takes the high road.”

I love that because Texas has a lot of hospices, there’s a lot of variability within the end-of-life care that is provided. There are choices you can make. You can say that a nurse is going to have 10-to-12 patients, or you can say a nurse is going to have 20-to-30 patients, and we know that one of them is probably more favorable to better care. I really appreciate that they’re out there telling the community that they’re taking the high road, and I can tell you that from what I’ve seen they certainly are.

You mentioned the plans to take the company national. Is there anything you can share at this point about what it will take to achieve that? Do you have a timeframe in mind?

In the last six weeks, I have spoken with folks that have providers in six different states, but we are not going to acquire for its own sake. We’re going to let the logic of a deal work itself out. When we see the right deal, we will pursue it.

We will likely be in another state in the not-so-distant future. After that happens, we will be building a central office that will likely be in Colorado. At that point, we will really be set up for growth. So I think it’s going to be ramping up over the next year or two years.

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