Adversity prepared health exec for new role at helm of SynCare

January 9, 2010

Stephanie DeKemper believes everything in her adult life has prepared her to run SynCare LLC.

She’s so sure that she’s buying the company.

DeKemper is set to close on her purchase Jan. 13, acquiring the 4-year-old company from its founder and chairman, Dr. Steve Simpson, a pediatrician in Gary. She declined to disclose the purchase price.

SynCare helps evaluate and coach Medicaid patients at high risk for hospitalization—due to multiple chronic diseases or high-risk pregnancies or just the day-to-day challenges that come with being poor.

DeKemper, 52, has seen all those challenges before. She was on food stamps herself once, after her first marriage ended and she was a single mother with two kids. She was a police officer for 10 years, which brought her regularly into the lives of people struggling with what she calls “the culture of poverty.”

“You see a lot of stuff” as a cop, DeKemper said. “You get a pretty good understanding of why people do things.”

DeKemper transitioned from being a detective to designing programs to fight substance abuse for the U.S. Department of Health and Human Services. That got her interested in health disparities among minorities, leading her to help found the Indiana Minority Health Coalition and serve as its first executive director.

She later became chief operating officer of Managed Health Services, a subsidiary of St. Louis-based Centene Corp. It serves about 200,000 Medicaid patients on contract with the state of Indiana.

It was then that she saw the power of getting high-risk patients the knowledge and medical care they needed.

“If you provided an individual with supportive education and the right care, the outcome of that was savings,” she said.

Since DeKemper took the reins at SynCare, her contacts at Managed Health Services helped SynCare win a contract to provide disease management to Managed Health’s riskiest patients.

SynCare uses nurses and social workers to call and visit Medicaid patients to evaluate their needs, teach them about their health issues, and establish specific goals to improve their health.

Patients on Medicaid tend to have far bigger problems than those with employer-sponsored, or commercial, insurance, said Dr. Jeff Wells, former director of the Indiana Medicaid program.

Medicaid patients are more likely to have not just one chronic disease but two or three. So instead of disease-management firms facing just one daunting task of educating and helping a patient to manage diet, exercise and blood sugar levels, they may also be dealing simultaneously with heart failure or asthma.

Patients in the Medicaid managed care program, which in Indiana is called Hoosier Healthwise, pop in and out of the program. The average child enrolls in Hoosier Healthwise for less than one year, Wells said.

Also, Medicaid patients’ poverty or language barriers often make it harder for them to navigate the complexities of the health care system, or force them to make trade-offs between getting to the doctor and getting food or shelter or clothing.

“There are challenges that exist or potential barriers that exist that are going to exist to a much lesser extent in a commercial population,” said Wells, who is now finishing his medical residency and starting a company, OurHealth, that aims to open primary-care clinics at employers’ offices.

Wells is skeptical that disease-management services actually save money overall, saying he knows of no rigorous study that has proven those savings. Nevertheless, he added, any efforts to help patients manage their chronic diseases is important.

DeKemper is staking her company’s profitability on the belief that she can save her clients money. The contracts SynCare has signed with Managed Health Services and Missouri-based HealthCare USA pay SynCare for its cost of services with no profit. SynCare earns a profit only when it reduces medical bills, by taking a cut of the savings.

“I can save my clients lots of money,” DeKemper said, “by preventing their patients from hitting the hospital emergency room.” She said SynCare’s work has resulted in savings ranging from three to seven times as much as its clients paid for the service.

DeKemper joined SynCare 18 months ago as a consultant. She decided to stay, eventually becoming CEO, because of three “jewels” she found there.

• SynCare uses software developed in-house that helps identify the patients most at risk for serious health complications or most likely to become high-risk.

The software helps SynCare know which of the 385,000 patients it has responsibility for need personal attention right away. It also generates assessments of problems and steps to remedy them without injecting bias that nurses can let slip in. And it makes it easy for SynCare to report all kinds of outcome data to its clients.

DeKemper, who said she’d never seen software so good, is probing whether to package the software and sell it separately to insurers or other disease-management firms.

• SynCare had figured out how to make money on the most expensive part of its work—in-home visits—which are even more important because of the extra complications of Medicaid patients. SynCare does this by using a matrix that tells it how many patients each of its employees can handle, planning field routes efficiently, and doing lots of pre-visit preparations.

• Last, DeKemper was impressed by the passion the SynCare staff had for serving the Medicaid population.

Those three things—a clear competitive advantage, supportive economics and passion for the business—are the overlapping circles that can form a “hedgehog concept,” which Stanford University business professor Jim Collins identified as a key ingredient to building an enduring, successful company in his book, “Good to Great.”

So DeKemper has steered SynCare to focus exclusively on Medicaid programs. She’s hoping to sign up clients in eight more states in the next three years.

“I’m really passionate about this,” she said. “I like what I do.” •


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