• Posted on August, at 16,

    Meet Brian Jurutka, president and CEO of the National Investment Center for Seniors Housing & Care (NIC). Jurutka took the position of president in August 2015 following a role as senior vice president with digital analytics company comScore, and assumed the CEO position of NIC as part of a planned succession following the transition of NIC Founder Robert Kramer from CEO to strategic advisor.

    Spotlight on Technology

    Do you see investors starting to push operators to invest more in technology in order to make their operations more efficient?

    Yes. I think there are always opportunities to increase efficiency in the operation or in operations through technology, although technology isn’t the end-all, be-all. Some of the simplest solutions can mean essentially having a sheet of paper with the relevant information. But having the full-fledged electronic medical record (EMR) or electronic health record (EHR) integrated with the upstream system can provide additional visibility and opportunity as well.

    With three years in NIC leadership, Jurutka has vastly expanded his knowledge of the senior housing and care market during a time of flux for many operators. We sat down with Jurutka to hear about what he has learned in his time at the helm, where NIC sees opportunity in a changing senior housing landscape, and where lessons from the Navy (he’s a former nuclear submarine officer with a degree in aerospace engineering) apply to his role today.

    Senior Housing News: Tell me about how you got into senior living.

    Brian Jurutka: I got a call out of the blue from a recruiter. I had no background in senior living, no background in not-for-profits, and so I kind of had the question of, “Why me?” I guess I was fortunate that the board-led search committee hired a great recruiter and also put criteria out there that was innovative.

    What I learned, having that discussion with the recruiter, was really that my role in the organization I was at previously, comScore, plays a very similar role [to the one I now hold for NIC], despite being a different industry. What I mean by that is that when you want to have a conversation about how many people visited a given website and compare apples to apples, you use comScore, because it’s the independent third party provider of data and measurements in the internet space. It’s like currency, and NIC is too.

    It plays a very similar role in the senior housing space by providing standards and definitions in a common language for understanding. It gets you past that initial awkward phase of, “How do you define this? How do you define that?” Now you just have a common language [to talk about] businesses, opportunities, risks, trending information and aggregating it over, obviously, many different components. I understood the business fit.

    As I had the subsequent discussion with the board-led search committee, I had the opportunity of getting exposed to the volunteer leaders themselves. It was fantastic. You’re being interviewed by folks who have taken the time out of their day on two different occasions to fly to some other city and interview folks. That gives you a sense as to the board members’ level of engagement and commitment to the organization.

    Having the opportunity to work with a lot of those industry leaders was certainly attractive, and then I got the opportunity to meet staff and the staff was just terrific. Then of course, I met this guy named Bob Kramer, a force of nature. I got the opportunity to interact with Bob, get a sense of his passion and vision and get a sense as to his understanding of the industry.

    Put all that together and then take a step back and look at NIC’s mission: enabling access and choice for America’s elders by providing data analytics connections that bring together capital seekers and capital providers. It’s also an opportunity to engage with a lot of great folks. At the end of the day though, if we do our job right by providing this platform of transparency and allowing efficient and informed connections, we can benefit millions of America’s elders.

    If you look at all the macro forces and the silver tsunami that’s coming, all those things put together say, “Gosh, what a wonderful opportunity.” Working with those industry leaders and staff, the favorable trade winds and how NIC is positioned as an organization. It has a stellar reputation. Obviously I made that leap.

    When the recruiter called you, did you know what senior living was?

    I didn’t even know the term ‘senior living’ but I was tangentially exposed to skilled nursing through an acute-care episode of my grandfather who lived in California. My parents went through that and I was exposed to it as the grandchild—the conversations around, “What are the options?” “What does it look like?” But I had not previously been exposed to the independent living (IL) space. There was a whole world I didn’t know about.

    Was there any hesitation? You’ve got some pretty big shoes to fill replacing a guy like Bob.

    Yes. It’s definitely not “replacing”—with someone like Bob, it’s succeeding or it’s following. Bob is a visionary leader, incredibly dynamic, and I keep telling him, “Bob you’ve got to write a book.” He could write a fantastic book on all of his life experiences, but when I think back on NIC and the means by which this transition has been accomplished, I think it speaks a lot to how the organization thinks about the long-term as opposed to the short-term.

    For a guy who’s supposed to be taking time off, he seems pretty active.

    He is. He’s in a role which is perfect for him, as a scout and icebreaker, reaching out to what we would call non-traditional NIC constituencies. Those are really non-real estate-based senior care enablers with whom traditional seniors housing and care can partner, ultimately creating value for the residents, for the communities and for those partners.

    Coming from comScore, what are some of the things you learned there that you can apply to bring NIC to the next level?

    The data component is huge. If we take a look at the organization overall, of course the events component is important, but if we look at why folks invest in seniors housing, those institutional investors in particular want to take a look at the data.

    That data background is important for understanding the means by which one onboards data, processes it, gets it into a final product solution, packages it, and thinks about additional data sets that come on board—what’s easy, what’s hard. I think those are a lot of the pieces that I used to have the opportunity to be involved in at comScore and I think that’s an important component.

    Even as we take a look at NIC, it’s in a different phase and a different industry, but the concepts are actually very, very similar in terms of how you think about what it is that you put out on a regular basis.

    Brian Jurutka, President of NIC

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    NIC really started off as a depository that was funded by the capital base for investors, but now the data that NIC collects can be used from an operations perspective. Do you see that as a conscious shift?

    I would still stay we’re an investor-focused organization. However, as we start onboarding different data sets, I think there’s that recognition particularly in seniors housing that the operations are an important thing for investors to understand as well. We’re now introducing quality metrics that are provided to us via PointRight, which essentially does analytics on Centers for Medicare and Medicaid Services (CMS) data. They’ll feed us the classic CMS Five Star data, along with some of the derivatives and their own proprietary short-term and long-term [hospital] readmission rates.

    In a world that is moving toward value-based care, where referral relationships and readmissions become important, it’s important for investors to understand the system. If you look at a community that may be having some challenges in that space, there may be low-hanging fruit to turn that around.

    More from the Leadership Series

    In a world that is moving toward value-based care, where referral relationships and readmissions become important, it’s important for investors to understand the system. If you look at a community that may be having some challenges in that space, there may be low-hanging fruit to turn that around.

    And if you look at a community that is doing well in that space, you may price it very differently from an investor perspective. Those operational metrics, particularly in seniors housing and care, are where a lot of the discussion is. If you look at the IL space, we’re very similar to multifamily, but if you go all the way down and continue into skilled nursing, it starts interacting quite a bit with hospital systems.

    Has NIC specifically worked toward more of a focus on skilled nursing and health care?

    I think there will always be opportunities for folks to just focus on the hospitality piece and not worry about the health care piece, but one thing that we saw at our recent Spring Investment Forum is that there are opportunities for health care to come to seniors rather than seniors going to health care. The U.S. population spends $600 billion a year or so on Medicare and $180 billion on Medicaid for that overlapping population, and there is a move toward managed Medicare, Medicare Advantage plans and managed Medicaid that involves value-based care.

    This truly is an opportunity for seniors housing to play in that space because it houses so many high health care costs for seniors. Seniors housing providers have folks on-site 24 hours a day. They have the opportunity to influence medication management. They have the opportunity to influence so many things in a wonderful setting that there’s just this opportunity to partner with many of the managed care companies.

    Not everyone is going to pursue that and not everyone is going to decide to build their own capabilities but I do think in partnering with [managed care organizations], there’s the opportunity to create additional products.

    Do you think there’s hesitation among providers to target those value-based care relationships?

    Yes and no. I think folks on the leading edge are clearly seeing those opportunities, which isn’t to say that folks who decide not to pursue that won’t be successful. I think there are opportunities for both. One of the speakers at NIC’s Spring Investment Forum said we should plan for a world where there’s a hundred percent managed care.

    There are probably still opportunities to focus on hospitality but there are also clearly going to be people who come up with new business models and partnership models that take advantage of these new opportunities. [There was a lot of talk about] Medicare Advantage, [what it looks like] to take the biggest portion of the bundle and partner. We’ll have our own home health. We’ll take the discharge from the hospital and go ahead and put it in our system for managing rehab at home.

    The broader component is risk and understanding where you want to play in that space. Care coordination is a wonderful opportunity.

    With NIC’s recent focus on skilled nursing, do you see the organization branching out even more into skilled nursing, home health and across the care continuum?

    Yes, we are providing additional information in the skilled nursing space. We have another initiative, the skilled nursing data initiative, which is one of the few areas where we can gain insight into Medicare Advantage rates relative to the skilled nursing population.

    I think in the next five years or so, this is the area that we’ll continue to build out, particularly in everything from IL through skilled nursing, and look for those metrics that make sense from an investor’s perspective.

    However, skilled nursing is a different beast. There is a lot of data out there already from CMS and operators have access to it. [In order to gain efficiencies across the continuum, you] need these partnerships with payers upstream and you have to have [a consistent] language in communicating with them.

    I think there are opportunities for assisted living operators to have that strategy and participate in that value chain to develop that same language and those same standards in communication with health care assistants and payers. That shared language will continue to expand the space.

    We keep hearing about how payers and insurers are starting to finally pay attention to senior living. Do you think that’s happening more in general?

    I think so. … A small minority of Medicare patients make up the majority of the spend. Those patients tend to be the ones who have multiple chronic conditions as well as ADL needs, and who live within assisted living and skilled nursing. That’s the target population. If you are the Medicare Advantage plan or managed Medicaid plan and you’re looking to change the cost dynamic, that’s the population to look at.

    TECHNOLOGY

    Does technology—including tech already in place—seem like a key piece for some of the providers going in the direction of the managed care opportunity?

    Yes. We have seen that over and over again. It’s about having that common language and definition of success and being able to communicate the process. Conceptually it sounds easy but if you imagine you’re in the hospital system and there are 30 different skilled nursing communities and 20 different assisted living communities, each one with their own protocols, then all of a sudden [care coordination] becomes really hard.

    However, if there is some standard of communicating that information out, [the coordination] gets a lot easier. You need someone on each side of that willing to agree on what the standards are, and that requires an investment obviously to build those standards.

    That means not just technology, but the processes and systems as well. Technology is an important piece, but it wouldn’t be the only component.

    What do you think operators are doing with metrics to help their business? Do you think operators are using NIC metrics to help improve their businesses?

    Yes, I think from a benchmarking perspective, one of the classic examples is the same example I would use at comScore. Let’s look at one of the highest level metrics, which is often unseen. You say, “Gosh, occupancy went down by 50 basis points quarter over quarter but the industry went down by 100 basis points.” That gives you some benchmark and some understanding as to, okay great, while our occupancy went down, we did better than industry average.

    If you look at our actual rates initiative, you can take a look at the example that regularly comes to mind, which is the hotel industry, where occupancy and rate is provided on a daily basis. We’re at a place right now where we’re beginning to get that information on a quarterly basis, which gives us a sense of the average discount for folks who move in.

    Again, the operators will use that information to inform their decisions on whether or not they’re going for pricing or occupancy or some combination.

    Do you see potential in taking some of your data and having more of a consumer-facing product where people could see what actual rents are being charged?

    I think there’s an opportunity for doing that if the right forum exists. There’s a concerted effort to go out and do that, though traditionally we’ve been more B-to-B focused.

    We’ve started to see some real occupancy pressure based on NIC data. How do you stay unbiased for your members?

    That’s one of the things that we have many discussions about. We put the data out and try to be as neutral as possible. We want to make sure that investors see the data as neither talking up an opportunity or minimizing it.

    The industry seems to be a little numb to the occupancy numbers right now. Do you think the next 12 to 18 months are going to be really rough with people just putting their heads down to try to fix the problems that they know are there already?

    It’s always dangerous to prognosticate. I think there’s recognition that there’s a lot of supply in the market, and I don’t know if there’s more supply to come. You have to figure out your place in the market and figure out your value proposition.

    Do you think the real innovation in senior living is going to come from the bigger providers or the smaller ones?

    I wish I knew the answer to that, but I think you can take a look at some of the announcements made by larger providers like what Welltower is doing with ProMedica.

    You can also take a look at some of the smaller operators. Many times, that innovation comes from out of nowhere. Look at the Ubers of the worlds. They came out with something that was completely sideways.

    LEADERSHIP

    What’s your definition of leadership?

    Leadership is pointing folks in a direction and motivating them to head in that direction. Taking that analogy a little bit further, sometimes you run, sometimes you walk. You try to keep going in the same direction. Sometimes you have to zig and zag, but it is motivating folks to head in a particular direction.

    Leadership is pointing folks in a direction and motivating them to head in that direction. Taking that analogy a little bit further, sometimes you run, sometimes you walk. You try to keep going in the same direction. Sometimes you have to zig and zag, but it is motivating folks to head in a particular direction.

    What’s the biggest challenge you’ve faced in your career?

    When I made the switch from Capital One to comScore. I was working for a large company, and part of that was in the Navy. At the time, comScore was 150 people, pre-IPO. It was definitely a challenge getting up to speed, but it was exciting at the same time.

    What’s the biggest risk you’ve taken in your career?

    From a risk perspective, that really was the transition, from Capital One to comScore. At the same time it was exciting — the opportunities to really learn something new.

    What’s the best piece of advice you’ve received in your career?

    It was from my boss, the squadron commodore, back in the Navy. He would always say, “Quit polishing the cannonball.” Really what he means by that is at some point you have enough information, you’ve got to make a decision, and you’re going to get the job done. “Quit polishing the cannonball. Let’s go.” You never have perfect information. At some point you’ve got to make a decision and go.

    Whom do you consider to be your mentor?

    In the seniors housing space it is clearly Bob. He’s fantastic and he continues to be good counsel.

    What has he taught you?

    One of the biggest things is really around helping ensure you get all the relevant perspectives in decisions and communications. He is masterful from that perspective. He’s the master of relations. He’s built a lot of relations that can help get folks to take actions that are good for the industry. A lot of that is really around understanding what common interest folks have and how you get them in line with the mission. It’s a great feeling to go to them and say, “This is what we are working on. Help me think through this.” He’s inevitably able to provide some good counsel from my perspective.

    What’s the biggest challenge senior housing faces?

    Labor. Even from the NIC perspective, from a data perspective, we started reporting out Bureau of Labor and Statistics data—which are essentially average wages by different categories—because there’s this importance of understanding wage pressures on the industry.

    I think the biggest opportunity for assisted living is deciding whether or not providers want to participate in the health care opportunity. I think skilled nursing—almost by necessity—will allow them to get there. I think assisted living will need to figure it out.