North Shore Healthcare, the largest provider of post-acute care in the Upper Midwest, has entered into an agreement with Sound Physicians, a leading physician practice in acute and post-acute care, who will provide after-hours telemedicine support to 52 North Shore skilled nursing facilities in Wisconsin. Sound will work in partnership with GAPS Health, a nationwide physician-led organization focused on enhancing medical directorships and patient outcomes, to ensure that North Shore residents receive quality physician services 24-hours per day. According to David Mills, North Shore's Chief Executive Officer, "Receiving consistent physician support during evenings and weekends has been a challenge for providers for many years. These are the times when we need the most guidance and support from professionals, often at a moment's notice. We are extremely excited to partner with Sound Physicians as they have developed an innovative care model that addresses this issue, resulting in better outcomes and support being delivered to our residents and staff." "Sound Physicians will focus on bringing acute care expertise to North Shore via our integrated telemedicine platform to improve clinical outcomes and reduce unnecessary returns to the hospital," says Brendan McNamara, Chief Executive Officer, Telemedicine, at Sound Physicians. "For 20 years, our high-performing care models have consistently improved acute and post-acute episode outcomes, and we look forward to collaborating with North Shore and GAPS to ensure seamless round-the-clock care." North Shore Healthcare, headquartered in Milwaukee, WI, operates 71 long-term skilled nursing care, short-term rehabilitation, and assisted living facilities in Wisconsin, Minnesota, Michigan, and North Dakota. "We are excited to work with Sound Physicians to manage and care for North Shore residents. Sound's experience delivering expert, on-demand physician services on nights, weekends, and holidays adds additional support and continuity of care to optimize patient outcomes," says Dr. Jerry Wilborn, Chief Executive Officer for GAPS. "This partnership will ultimately help improve nursing satisfaction, dramatically reduce hospital readmissions, and improve the quality of care." Sound Physicians will launch their TeleSNF program at Wisconsin North Shore locations beginning October 2021. For more information, visit: nshorehc.com soundtelemedicine.com gaps-health.com About North Shore Healthcare North Shore Healthcare and its centers proudly serve communities in Wisconsin, Minnesota, Michigan, and North Dakota. With 71 centers that offer long-term skilled nursing care, short-term rehabilitation, and assisted living services, we are the largest post-acute care provider in the Upper Midwest. North Shore is dedicated to being The Right Choice for families and employees by establishing a culture that reinforces the values necessary to be the premier health services provider and employer in each of the communities we serve. About Sound Physicians Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years, our high-performing and affordable care models have combined physician leadership, clinical process, technology, and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in patient care, from hospital to home. Visit us at www.soundphysicians.com. About GAPS Health GAPS Health, headquartered in Dallas, Texas, is a physician-led organization that provides Medical Directorships across the nation. We deliver clinical and value-based programs for post-acute facilities, assisted living communities, accountable care organizations (ACOs), iSNPs, and payers. Now operating in over 20 states with licensure in almost all states, our innovative clinical pods focus on enhancing and improving the effectiveness of physicians and post-acute providers to care for the frail, elderly, and chronically ill, including COVID-19 patients. This press release was issued through 24-7PressRelease.com. For further information, visit http://www.24-7pressrelease.com. SOURCE Sound Physicians Related Links http://www.soundphysicians.com

Dallas, TX, September 23, 2021 – GAPS Health, is pleased to announce the addition of a new member to its Advisory Board. The new member is Miles Snowden, MD, MPH, who brings significant experience and wisdom from an accomplished Healthcare and business career spanning three decades. “We are very excited to have Miles join our Advisory Board here at GAPS! He is a great complement to our team of advisors and adds a unique perspective, given his accomplished Healthcare and business career. Miles is a well-known leader in the key areas where GAPS is focused, making his appointment a strategic and integral part of our company’s growth.” — Jerry Wilborn, Co-founder and CEO, GAPS Health About Miles Snowden, MD About GAPS Health GAPS Health, headquartered in Dallas, Texas, is a physician-led organization that provides Medical Directorships across the nation. We deliver clinical and value-based programs for post-acute facilities, assisted living communities, accountable care organizations (ACOs), iSNPs and payors. Now operating in over 20 states with licensure in almost all states, our innovative clinical pods focus on enhancing and improving effectiveness of physicians and post-acute providers to care for the frail, elderly and chronically ill including COVID 19 patients. For more information, visit GAPS Health at https://www.gapshealth.com

Dallas, TX, July 1, 2021 – GAPS Health announced that they presented to CMS (Centers for Medicare & Medicaid Services) for their June Grand Rounds. The title of the presentation was MEDICAL DIRECTOR ENGAGEMENT: Defining optimal clinical outcomes in post-acute – COVID-19 and beyond. Presenting for GAPS was Dr. Jerry Wilborn, CEO, Dr. Jamison Feramisco, President, Dr. Sonali Wilborn, Chief Clinical Officer, Jeff Winter, SVP and Dennis O’Conner, VP. The learning objective was to understand how the COVID-19 pandemic underscored the need for increased clinical coverage and consideration on clinical workflows as a possible design for future infection control models. The impact of physician leadership and presence on nursing home patient outcomes also was covered during the 90-minute event. “At GAPS we strive to enhance and improve the effectiveness of physicians and post-acute providers to better care for the frail, elderly and the chronically ill,” said Jerry Wilborn, M.D., the company’s Chief Executive Officer. “When COVID hit we leaned into the pandemic and created an innovative care model / triage protocol based on a standardization and specialization of the infected and exposed patients. We created a methodology around Surveillance, Tracking, Assessment, Teaching, and Treatment, which we referred to as S.T.A.T.t. rounds.” Using CDC and local health authority guidelines coupled with teaching nursing home staff about proper PPE and the clinical impact of COVID-19 during and after an acute infection, GAPS was able to assess all individual residents quickly and develop a clinical tracking of residents as positive, negative, or recovered to develop specific standardized care plans. Taking Infection Control policies “from the bookshelf to the bedside” created optimal outcomes. In our retrospective review of three large national chains patients, GAPS presented its findings on 9,579 total patient encounters. Of the 4,364 COVID patients, GAPS had only a total of 13 RTA (Return To Acute) for a 0.14% incidence. Jerry Wilborn, Chief Executive Officer for GAPS said, “Our experience with COVID will help us in the modeling of future infection control responses when they occur.” About GAPS Health GAPS Health, headquartered in Dallas, Texas, is a physician-led organization that provides Medical Directorships across the nation. We deliver clinical and value-based programs for post-acute facilities, assisted living communities, accountable care organizations (ACOs), iSNPs and payors. Now operating in over 20 states with licensure in almost all states, our innovative clinical pods focus on enhancing and improving effectiveness of physicians and post-acute providers to care for the frail, elderly and chronically ill including COVID 19 patients. For more information, visit GAPS Health at https://www.gapshealth.com

The COVID-19 emergency overturned nursing home operations overnight in almost every respect, notably with regard to the provision of clinical care. And according to a panel of physicians who work in the nursing home setting, some of those changes should stick around, even after the public health emergency finally comes to a close. Namely, they want to see collaboration between physicians and frontline staff continue, as well as for skilled nursing facility physicians to keep serving as a resource to hospital partners. “We never saw the kind of teamwork [before] that we had in nursing homes, finally,” Nazir said in a March 26 webinar hosted by Skilled Nursing News and sponsored by MatrixCare. “We would have drooled over this kind of teamwork for the past 40 years, …and I challenge doctors to really continue the behavior doctors have shown in nursing homes, which has made me so proud, finally.” Keeping up the pace While SNFs are required to have a medical director – a physician responsible for coordinating care at the facility – by law, the pandemic highlighted the shortcomings of that role as it presently exists. But it also shows how it could improve. Even before COVID-19, cracks in the model were showing. Dr. Arif Nazir, chief medical officer of the Louisville, Ky.-based Signature HealthCARE, is one such physician. He’s been pushing for better collaboration between doctors and nursing homes for years, he said during a March 26 webinar hosted by Skilled Nursing News and sponsored by MatrixCare. Dr. Justin DiRezze, CEO at Theoria Medical x 5-Star Telemed, pointed some of those out to Skilled Nursing News back in 2020. “I always had the notion that the second I discharge this patient to post-acute, the physician’s there immediately, and they’re seeing the patient, and they’re doing an evaluation,” DiRezze said, speaking of his time as a hospitalist at a major acute care provider. “I had this false sense of sense of security when I was sending patients to post-acute care facilities. I never fully understood why they would come back, because how does the patient come back if there’s a physician there all the time? Well, we both know that’s not how it is in post-acute.” The ravages of COVID-19 could be the catalyst for significant change in the role of medical director, and one CEO of a company providing medical directorships to SNFs predicted just that at the start of the year. “For decades, physicians and SNFs have not been aligned to provide the best clinical outcomes for residents,” Dr. Jerry Wilborn, CEO of the Dallas-based GAPS Health, told SNN in a 2021 executive outlook. “SNFs have been considered an afterthought by many physicians, as it is often not their primary clinical focus. As a result of a paucity of effective physician presence across the industry, SNFs have developed their own clinical protocols without the input of physician guidance. We need to redefine this relationship.” Some of the aspects of care provision in the pandemic provide a blueprint for how that relationship could be redefined. Dr. David Clayton, national medical director at GAPS Health, pointed out on the March 26 webinar that the partnership between nursing staff and medical directors improved drastically over the course of COVID-19. “When we look at how much education and how much co-management took place this year, I don’t think I’ve ever seen medical directors and nursing staff work more closely and more hand-in-hand as part of an interdisciplinary team,” Clayton said during the webinar. “Quality went up, outcomes improved, and there was a lot more collegiality and teamwork happening that I saw across all of our corporate partners.” The use of telehealth facilitated this optimism for Clayton; he witnessed how technology in the pandemic allowed for a more widespread deployment of physician resources and care, in a more efficient way. GAPS’ STATt [“surveillance, tracking, assessment, teaching and treatment”] rounds for COVID-19 patients make use of telehealth, and allowed for a 99.9% ability to treat in place, Clayton said, which he argued would have been impossible going bedside to bedside in person. However, some wariness is needed when assessing the benefits of telehealth and technology in health care, Nazir cautioned. The collaboration between nurses and physicians that occurred during the pandemic – the cooperation he had strong praise for – could be a “confounder” in assessing how much benefit technology brings. “There is a very good place for telehealth, but being in a room with the patient is so valuable, seeing their environment and seeing exactly what their body language is,” Nazir said. “So to me, telehealth is great; it helped Signature patients immensely. But I heard a lot from many, many physicians about how it had an aspect that was not fulfilling.” He called for “tons of research, very, very quickly” to be able to examine the outcomes and benefits of telehealth. Dr. Rayvelle Stallings, corporate medical officer at the Norcross, Ga.-based operator PruittHealth, also emphasized the importance of having a good grasp of metrics, noting that over the course of the pandemic, “data became huge.” “Whether it was actually monitoring temperatures and O2 stats, we could pull up a dashboard everyday on our COVID patients,” Stallings said. This allowed Pruitt to see opportunities to use new therapies, for example, and to see the statistics and findings across the company, and it’s something that will have benefits well beyond the pandemic, she explained. “We were forced to use it because it really made a huge difference, and I really think continuing that type of utilization of data – and we at Pruitt utilized data from a transparency standpoint,” she noted. “We did not have patients and families coming in, and we have a dashboard so they could look at that data themselves.” Physicians as storytellers The need for clinical transparency also includes communications with staff, a point that Stallings emphasized with regard to vaccination efforts among front-line staff who have been hesitant about taking a COVID-19 vaccine. SNFs have not been immune from the challenges of an era of distrust of leadership and institutions, and this cannot be undone overnight, as Nazir pointed out in the webinar. The collaborative mentality that emerged over the course of the pandemic goes outside the walls of the nursing home. When the COVID-19 emergency finally ends, one of the most critical roles for doctors who work in nursing homes will be to educate the public on the care provided in the setting. Doing so is especially important after the slew of bad press the sector has received, all the speakers on the webinar agreed. But that education can’t stop at the general public; it has to extend to other parts of the health care continuum, Stallings pointed out. “I would say during this pandemic, I’ve spoken to more [emergency room] physicians and hospitalists than I’ve ever spoken to in the past,” she said. “All of a sudden we became a resource, and it was a necessity to speak to us. I would like that to continue.” Stallings also emphasized how, in an era of social media, physicians have not responded as quickly as they need to – not only to address the concerns that spring up like wildfire on those sites about the COVID-19 vaccines, but to meet people where they are for information. For Pruitt, this meant overhauling how it communicates on those platforms and elsewhere, for everyone from certified nursing assistants (CNAs) to registered nurses (RNs) “The health care industry, we have not been that savvy with social media,” Stalling said. “Every one of our employees, every one of our partners has a smart device. So whether it’s Twitter or Facebook or Instagram or any of those types of things that they can immediately get information, we really changed our communications platform to get everyone at every different level.” This meant using social media and putting information on devices, but also designating “champions” for CNA education on topics ranging from vaccines to infection control processes such as donning and doffing personal protective equipment (PPE). But Stallings also emphasized the need for physicians in long-term care to provide education not just to CNAs but to their fellow physicians and the general public about what long-term care does and provides. The need to do this is only going to grow as the population lives longer and becomes more medically complex, she explained. “There were a lot of things that didn’t happen before, when we talk about communication and collaboration,” she said “I think there’s a huge amount of education [needed], not only among my other colleagues … that have such a skewed view of long-term care in nursing homes. I think we have a huge responsibility to be that education, not just to patients’ families, but to other colleagues.”

In the investment and finance side of skilled nursing, “regional” is commonly cited as a strength for an operator; the idea is that a strong presence in a concentrated geography allows for better relationships with hospitals and referral partners, physicians, and the community generally. But thinking regionally goes beyond the financial well-being of a facility, and even larger chains have been able to use the concept to their operating advantage. Dr. Sunil Pandya, the new chief medical director of Atlanta-based SavaSeniorCare Administrative and Consulting LLC, is taking a regional approach to its clinical programming, as the provider works to position itself for success in an operating landscape permanently altered by the effects of a global pandemic. That means talking in-depth with leaders at Sava’s facilities about their clinical needs and listening closely to what they need — all with the goal of improving quality of care on a range of initiatives, from the Quality Assurance Performance Improvement (QAPI) program to bringing strong infection control principles “from the bookshelf to the bedside.” Sava has outsourced to the CMO role to Geriatric Administrative Provider Services (GAPS), a Dallas-based physician-led organization that provides medical directorships to SNFs; Pandya serves as GAPS’s national medical director of telehealth. Skilled Nursing News spoke on March 22 with Pandya and Annaliese Impink, executive vice president of compliance, ethics, and customer experience at Sava, about how the company is planning for the new future of SNF operations — and what’s it’s doing now to get ready. Can you go into what is entailed in the chief medical director role at Sava? What are some of your immediate priorities for the clinical programs? Pandya: I actually appreciate you asking us what the title means, because many larger groups have what’s called a chief medical officer, and I’m not an officer of the company. The role is really a medical director; I’m a servant leader to both the currently existing medical directors both in the facility and regionally, and [in] more of a collegial situation where I’m a resource for them for a variety of things — everything from bedside clinical to quality to any sort of administrative functions that they provide as medical directors. What we’re trying to do is provide some consistency and quality to the side of the stool of health care. I look at health care as a three-legged stool; I don’t think you can stand with two [legs]. In the skilled nursing world, nursing is obviously huge. They’re the caretakers at the bedside. The administrative — you can’t be without them. [There are] so many regulations, so many quality measures, so many things that they do. And then the third that is recognized by Sava is that you need the medical side. That is part of what I wish to humbly present to them: the medical, nursing, and administrative all working together in a consistent and quality manner. You asked about the short-term priorities. Right now, all of us are still feeling the effects of COVID. We know there’s a light at the end of this tunnel, and I would be remiss if I didn’t say the number-one short-term priority of the whole company and myself is COVID. The idea of vaccination, the idea of the post-COVID syndromes and sequelae, that is definitely our primary focus. But as far as what I’m doing day-to-day, starting with this role, is that I’m starting to listen to the facilities. I’ve been talking with two and three facilities in person at the facility level and even regionally. We’re prioritizing the western North Carolina first, and then what we lovingly term the Lone Star area of Texas, so around Dallas. Then we have national tools, different ideas in our toolbelt, if you will, and we listen to the facility: What are the intrinsic needs of the facility? Do they want to create something more with telehealth? Do they need more QAPI standards? Do they need some medical optimization? Is it about COVID rounds? Is there a dearth of medical specialty in the facility? There’s a variety of different things. So my priorities become the priorities of the facility after I do my initial interview. So after those interviews are done, what comes next? Pandya: Then starts the ramping up process. Sava has outsourced their medical directorships, for lack of a better term, to GAPS Health, and I’m a proud member of GAPS — not only serving the role as chief medical director for these few pilot places where we’re starting, but also for Sava in general. The concept, starting in North Carolina and then getting over to Lone Star, is: “Let’s go ahead and find out what the needs are and start implementing.” To give you a quick example: Marketing is an issue, where one of our facilities did a yeoman’s job during the middle of the COVID pandemic to become a COVID-receiving facility and now they’re looked upon only as a COVID-receiving facility. So they told me, “Dr. Sunil, is there any way that you could help us with some of the marketing to the hospitals, for them to know that we’re a three- to four-star facility for any patient as we’re now coming out of the pandemic? Because we’d like to see our census at a certain quality so we could help more people in the community.” Certainly that became a strategic objective of mine after I heard that. You start making the calls out to the hospitals, and you start looking at who you know. It’s a very small family network in the skilled nursing and hospitalist world. What are some of the common factors you’re seeing facilities raise clinically? You’ve mentioned the post-COVID syndromes, so how are you thinking about adjusting and responding those at the facility level? Pandya: Definitely when we talk about the clinical conditions, the aftermath of COVID, we actually think that they’re getting more complex. You have a lot of COVID sequelae that you have to deal with; you have a lot of pandemic sequelae. The difference being the COVID-related ones are actual physiological things. We’re seeing COVID dementia from not-good flow to the brain, related to some of the clotting that we’re noticing. We’re noticing clotting issues all over the body that can cause deep-vein thrombosis, can cause pulmonary embolisms, can cause something called microscopic ischemic colitis, which is bleeding in the intestinal tract. Very important for our nursing home, bed-bound patients is [that] it affects their skin. So the skin is not as resilient as it was previously, because you don’t have good blood flow. Then on top of that, you have pandemic-related issues. What do I mean by that? Isolation, loneliness, depression. Some of us on this call have felt it a little bit. Well, certainly our elderly population, the most vulnerable, have felt it even more. They’re being turned, they’re being cared for, but [they were] someone who was used to walking around; now the skin is in a higher-risk state. [There’s] just much to do to help with the assistance of this transition, when you’re coming out of the pandemic. In our lifetime, none of us have done this, so this is not something that we know about. We’re just trying to react as best as possible, and proactively think about the things that are coming in the aftermath. We’re still in it, but we’re thinking about when we get out. Impink: I think the other thing just to add to that is weight loss. That’s another area that we’ve seen as a result of COVID, because people aren’t up and around, and they’re not going to communal dining, so they don’t want to eat, and sometimes they lose their sense of taste and their sense of smell, and that impacts their ability to eat. That’s another area that we really focus on. What are some of the priorities for Sava in terms of QAPI, and what are some of the areas of focus for more development? Pandya: No. 1 is skin, skin, skin, skin, skin. We’ve had this situation before COVID, and now it’s made worse because of COVID, and Impink just mentioned about weight loss; well, some of nutrition even affects skin. So that’s a super important quality improvement that we’re focusing on. We’re also looking at nursing documentation, and we have a big project centered on rehospitalizations. What does that project include? Impink: Certainly a root cause analysis for why that’s occurring, and we have a lot of different focuses on that, because there are a lot of things that go into rehospitalizations. It’s physician education; it’s nurse education; it’s patient education. It’s enhancing and improving skill sets for our nurses, clinical judgment, communication with physicians. There’s a whole bunch of factors that contribute, and one of the reasons that we as a company engaged Dr. Sunil and GAPS was to help us really do that root-cause analysis and focus on developing an action plan based on what the data and the information tells us. So [rehospitalizations] and skin are probably the priority projects for us now in QAPI, and nursing documentation is also a project. But we need to impact skin and rehospitalizations, and then we’ll probably move to medication management. In terms of continued COVID-19 challenges, can you go into the vaccination efforts — what is Sava seeing in terms of uptake among staff and residents? What has been your experience on that side of getting out of the pandemic? Pandya: I believe it’s gone really well. I’ve been part of the effort from the beginning, the first national COVID call we did internally and then all the various different modalities we’ve tried. It’s been a very sustained effort, and we know we need to continue it. There’s no one in our call saying this is even half-done. We have office hours — even at 4 a.m., to provide office hours for the night shift on the other coast. We have Sava senior executives, one of which is myself on these calls just listening, waiting for questions. We’ve done a panel of our regional experts and our other medical experts called myth-busting, if you will, and really we were on the science. Now we’re kind of at the level of data, right? We’ve [gone] from science and explaining the vaccine and this is what it is, and a million people taking it, to now tens and tens and tens of millions of vaccines being delivered — and now we have data to share with people. I think a lot of people have science responses, and then there’s another group of people that have data responses, and they’re still very much logical people. There are some that are science-versus-data, and some that need the data before they can make a decision. What we’re seeing is not so much “vaccine no” as much as we’re seeing “vaccine hesitancy,” where they’re waiting for this data to decrease their resistance. So with Sava, they want to use the chief medical director role as being a source of truth and a source of calm and a source of not going to into the world of Facebook and Instagram knowledge and running amuck with it — but really staying focused on the science and the data. As we move forward, we’re moving toward the potential of mandating vaccination, but we’re rapidly getting our numbers up as far as close to herd immunity. I will share with you that our patients are upwards of 70%, and in North Carolina, where I’m starting, there wasn’t a facility that I’ve spoken to that was less than 85% in the first seven or eight that I’ve done. We’re pretty excited about that, and we’re seeing that number wanting to go up as patients are asking for more clinics, and certainly with [a one-shot vaccine], that’s going to help. As far as the staff, we’re above 50% and I think that’s huge. When you get above 50%, you start getting “herd mentality,” I call it, where people start listening to each other and listening to their staff. They don’t have to listen to administrative people like myself or scientific [arguments]; they can just listen to each other and say, “You know, this wasn’t so bad.” We’re still going to be sustained — we’re considering strongly a mandate. We’re looking at that. But if we can get to two-thirds plus 90% of patients, we’re getting very close to herd immunity, and then the question becomes moot, and we’re hoping that’s going to be the course for us here over the summer. Are you thinking about vaccinations for new patients and new admissions at all, and do you have any plans for that issue? Impink: We do have a plan, probably beginning April 1. We’ve partnered through our COVID vaccine clinics with CVS Health, because they were one of the two major players. What we expect to occur beginning in April is that we will order vaccinations — 10 doses or more, it wouldn’t be less than that — from Omnicare, which is a branch of CVS. We then would get vaccinations from CVS to Omnicare; Omnicare would then provide vaccinations on the day of a clinic to us. We would administer the vaccine to our residents and staff: new admissions, newly hired staff, corporate field support staff, and then CVS/Omnicare would do the reporting back to the federal and state agencies about vaccination rates and that kind of stuff. The plan is to at least, on a monthly basis, have vaccine available to be administered by our centers to our staff and residents, and when we need to keep up with this vaccination rate — which is what we had hoped would happen. In addition, the CVS retail store will be available for staff and ambulatory residents, and they’ll get vaccinated through a separate hotline for long-term care employees, where they will call and have a separate set of appointments and get vaccinated that way. So there’s basically two options for us. We are probably focused more on the in-center option. There’s a little more detail to come about that, but that’s generally what the plan is going forward. It’ll be new employees, new admissions, and current employees that have waited to take the vaccine. We also know the vaccine that we’re going to get through the plan is going to be the Johnson & Johnson versus Pfizer-BioNTech or Moderna. We do think our rates will go up, because people really have been waiting for Johnson & Johnson and just want to do the one shot. Got it. And going back to the clinical side of Sava’s plans, Sava has talked about focusing on dialysis as a way to focus on patients’ increasing acuity. What are some of the other clinical programs the company is looking at and thinking about as priority areas for clinical programming? Pandya: It’s something I’m definitely going to be dealing with, have a role in setting the agenda for, and certainly can be a resource to what we call field support. So memory-care units — our loving term for them is life engagement units — there has to be a focus on right-fitting those in certain environments, where there’s a huge need for that. And it’s even greater with some of the dementias that we’re talking about coming out of COVID. Wound certifications — we want to go through that as a as a clinical practice. There’s some infection control practices, IP [infection preventionist] certifications. Bringing infection control from the bookshelf to the bedside is something that I did when I first started with GAPS — and that’s how I got linked up with Sava, was performing some of those things. You mentioned dialysis, so dialysis dens — we have them in Maryland abd Georgia, and we are seeing what that looks like as far as a service that we can provide in other locations. When you talk about bringing infection control from the bookshelf to the bedside — which is a great phrase — what does that look like? What is the process of going from the principle of it to the practice of it, and how would you like to see that implemented? Pandya: So, you coined a great phrase too – that’s exactly what it is, taking the principle of it, which we all know with our hearts and minds, and putting it to our hands and feet. You’re taking from principle to practice or bookshelf to bedside. So many of us know to wash our hands frequently, so many of us know to keep six feet distance and use hand sanitizer, but this pandemic proves that a lot of us were not doing it. So the idea of what an infection is, and how much it can staggeringly affect all other aspects of our existence — I think we all got a dose of humble pie. So how does that work as you bring it down? We have something called STATt rounds, which stands for: Surveillance, Tracking, Assessment, Training and then a lower-case t for treatment. What we were doing was telehealth rounds for COVID, for each of these Sava-sponsored facilities across the country. We did multiple states, and we were classifying those COVID patients, and that was bringing our knowledge base of these specialists, these “COVID-ists” if you want to call them that, down to the bedside. We were literally looking at their feet; we were some of the first people who said: “Wow, that toe looks blue.” And that was the beginning of “COVID toes.” We saw that in Connecticut, and that was so long ago last summer, when I saw my first. Those are the types of things that we’re able to do to bring it to the bedside, but we’re not stopping there. Now it has to be a relentless pursuit of infection control, right? So we’re thinking about the next pandemic — that will never come because we are going to be ready for it. Now everyone knows that we have to put the time and energy into it, and I’m pleased and amazed that Sava is doing that before I even mentioned. I think that’s one of the reasons they wanted me in this role, because they saw some of the success stories coming out of that telehealth initiative, which was an infection control initiative. Impink: The other thing is the certification. We have infection preventionists in all of our buildings, not just because we’re required to but because it’s the right thing. Now we’ve got to make sure they have the tools they need — through a certification process the company’s committed to — to make sure they have everything they need to be successful. We’re hiring 60 new infection preventionists across the country to supplement or take to the next level the skill set of infection prevention. So there’s a lot of effort on that right now. When you talk about the role and the tools needed for success, does that include the amount of time spent on the role? There’s been a lot of calls for full-time IPs, and I’m curious if that’s something you’re looking to do? Impink: Some of our bigger centers, our 200-bed, 150-bed, multi-story centers, we’re bringing on a full-time infection preventionist, because the way that job was designed originally, they were part-time educators and part-time infection preventionists. That works in a small building; that’s a good model. But it doesn’t work in our 300-bed Philadelphia building, or in our 198-bed center in Maryland, where we’re going to bring on full-time IPs, because we need full-time IPs. We did a center-by-center assessment to determine whether we could do with a 20-hour week, or whether we needed full-time, or whether we needed two IPs.

ATLANTA – February 23, 2021 -- Bringing more than 16 years of leadership experience in the healthcare technology industry, Sunil Pandya, M.D. (“Dr. Sunil”) joins SavaSeniorCare as the company’s new Chief Medical Director. Dr. Sunil of GAPS Health has worked closely with Sava Senior Care physicians and facilities during the COVID-19 pandemic as a driving force behind the effort to get ahead of cases, serving as the National Medical Director of Telehealth for Geriatric Administrative Provider Services (GAPS Health). Using GAPS Health methodology of surveillance, tracking, assessment, teaching, and treatment, Dr. Sunil has led a team of GAPS physicians serving as virtual COVID-19 specialists in several Sava Senior Care client centers, providing residents and their families an added level of support. “I am honored to join an organization that has such an excellent reputation in skilled nursing and assisted living communities,” said Dr. Sunil. “Through my work with GAPS, I know firsthand about the Company’s commitment to excellence and comprehensive care. I look forward to leading this team and building on that commitment towards the future.” In this new role, Dr. Sunil will be responsible for medical director oversight across the country and will assist the Company with developing and implementing clinical programs for the client centers. Dr. Sunil will serve as a member of the Company’s Quality Assurance Performance Improvement Committee as well as other important committees focus on improving quality care. This role has been added to help fulfill and advance Sava Senior Care’s commitments to comprehensive care and technology, and Dr. Sunil’s leadership in bringing telehealth treatments to the forefront of healthcare exemplifies those duties. “Dr. Sunil’s experience and commitment to healthcare through various channels of treatment aligns perfectly with our model and vision for the future,” said Jerry Roles, Chief Executive Officer of SavaSeniorCare Administrative Services. “His expertise will play an instrumental role in advancing our efforts to provide comprehensive care throughout our network of client centers.” About Sava Senior Care Consulting, LLC Sava Senior Care, through its client centers, is one of the largest providers of skilled nursing, memory care and rehabilitative services in the nation. The staff at each of our client centers strives to provide care that encourages the health and happiness of their residents and patients. Long-term residents are welcomed into a center that embraces their needs and individuality. Short-term patients receive therapy focused on providing quality and nurturing care so they can return home. To learn more about Sava Senior Care, visit www.savaseniorcare.com. About GAPS Health GAPS Health, headquartered in Dallas, Texas, is a physician-led organization that provides Medical Directorships across the nation. We deliver clinical and value-based programs for post-acute facilities, assisted living communities, accountable care organizations (ACOs), iSNPs and payors. Now operating in over 20 states with licensure in almost all states, our innovative clinical pods focus on enhancing and improving effectiveness of physicians and post-acute providers to care for the frail, elderly and chronically ill including COVID 19 patients. For more information, visit GAPS Health at https://www.gapshealth.com

Nursing homes have long existed in a liminal space between acute care and senior living. The short-term rehab side of nursing care has increasingly turned into something like a mini-hospital, as both Medicare and Medicare Advantage have looked to reduce overall spending by cutting down on hospital admissions and lengths of stay — and operators responded by developing high-end “medical resorts” geared toward younger, healthier residents. The long-term, Medicaid-funded units often do not feature the same bells and whistles — both in terms of clinical acuity and creature comforts — but they still house extremely vulnerable people with multiple co-morbidities. The COVID-19 pandemic exposed the danger in approaching nursing home care as simply long-term housing for the elderly. Research has shown that strong staffing coverage is a key indicator of a facility’s ability to keep COVID-19 outbreaks in check, and geriatricians have called for a larger role in shaping nursing home policy and operations. For the second part of SNN’s annual executive outlook, we wanted to see how physicians and specialists can play a role in the continued evolution of nursing care, and how they believe the relationship between doctors and operators must change in the wake of COVID-19. Dr. Jerry Wilborn, CEO, GAPS Health Calendar year 2021 is here and skilled nursing facilities will continue to face many new challenges. This is a resilient industry, and I have no doubts that solving these challenges will create entirely new opportunities. Improving clinical care and enhancing census management will be at the forefront of SNF success and survival as we endure this pandemic and beyond. We have seen the skilled census drop across the nation. This trend was accelerated by the pandemic. Numbers mid-year saw at least a 10% decline as a result of deaths, admission bans, and reduced elective surgical procedures related to COVID-19 outbreaks. It will recover, but I suspect not to pre-pandemic levels. Increased regulatory scrutiny, infection control logistics and cost, increased patient acuity/behavioral problems, and reimbursement cuts will only compound future operational challenges. Public perception post-pandemic may provide headwinds as well. I doubt public perception will enhance census, but it may provide an opportunity or a narrative for payers to further define who is a skilled candidate versus who is not. We have already seen patient-initiated, payer-activated changes like this — particularly for our post-op ortho patients and their discharge destinations. Managing and optimizing social media platforms and focusing on star ratings will continue to be important. A new normal may be on the horizon. For decades, physicians and SNFs have not been aligned to provide the best clinical outcomes for residents. SNFs have been considered an afterthought by many physicians, as it is often not their primary clinical focus. As a result of a paucity of effective physician presence across the industry, SNFs have developed their own clinical protocols without the input of physician guidance. We need to redefine this relationship. As a clinician who has dedicated his career to caring for patients in the post-acute ecosystem, I was troubled that there were nursing homes during the heights of this pandemic that closed their doors to in-person physician rounding. Granted, there were successful telemedicine pivots and workarounds; this was a missed opportunity, truly underscoring the misalignment between physicians and SNFs. Physicians are essential and crucial members of the care team, especially given the increased clinical complexity the SNFs are now handling. And therein lies the opportunity. Integrating active and dedicated physicians into the clinical and FINANCIAL operations of the SNF will lead to better clinical outcomes, census stability, and success in value-based initiatives. Value-based initiatives will continue to play an ever-increasing role in defining which patient goes where, how long they stay, and what specifically needs to be done during that stay. Many value-based initiatives are based on clinical outcomes. The best way to achieve optimal clinical outcomes is to engage the physician with the signatory authority to impact patient care on all post-acute fronts. Every SNF by mandate has a medical director. In my experience, this is where we begin. For example, there are facility-based savings that can closely tie into measurable outcomes by simply managing medications. This should be a medical director-driven initiative. The medical director has purview over all residents. No resident in their seventh, eighth or ninth decade of life benefits from medication regimens including 10 to 20 or more medications. Unfortunately, this is often overlooked by all stakeholders. Physicians, pharmacists, and interdisciplinary teams managing medications as a part of what we do daily, with unrelenting diligence, will positively influence outcomes: Return to acute rates drop, skilled med costs decrease, rehabilitation participation and outcomes are improved, falls decrease, wounds heal better, appetites improve, families are appreciative, and most importantly our residents feel better. This is one of many examples whereby effectively integrated medical directors can help achieve success within the SNF for all residents. Our go forward opportunity is an empiric one. Better outcomes, financial stability and census management is at stake for us as an industry. I mentioned “US” as an industry — that includes physicians as a means to better end, and to no longer view them as vendors, but true partners. We have to create the new normal by melding the regulatory knowledge of the administrator and director of nursing with the clinical experience and insight of committed medical directors/attendings. Nurse practitioners and physician assistants need supervisory and collaborative support in this space to really succeed. As physicians, op-cos, and owners, we all have to recalibrate our expectations and redefine our relationships. I think this opportunity, however it looks, will drive the new normal, and create new clinical and administrative pathways for better resident care. Dr. Ari Kalechstein, President, Executive Mental Health In retrospect, 2020 has been a brutal year, particularly for the skilled nursing community. Prior to the onset of the pandemic, reviews from various executives at investment groups offered mixed reviews regarding the viability of SNFs in the future; raised concerns regarding future reimbursement at the federal and state level; and offered caveats as to the effects of various investment funds on the manner in which SNF operators attempt to generate revenue. Then, with the onslaught of the pandemic, SNFs struggled to adapt with the day-to-day costs associated with ensuring that facilities remained open — e.g., ensuring that facilities maintained adequate safety on behalf of residents and staff, sustaining the appropriate staffing levels, and reducing staff turnover/absenteeism. Aside from the financial and/or operational concerns, SNFs faced additional issues, including how to maintain the continuum of care for residents when a subset of the care providers were not allowed to enter the facility. For example, during the first several months following the onset of the pandemic, a number of SNFs struggled to implement mental health services as a consequence of learning to manage and cope with COVID-19, both in terms of prevention and treatment of the disease. While this was understandable, it did not lessen the need for residents to receive that mental health care, particularly given the prevalence of depressive, anxious, and trauma-based symptoms within that cohort. Eventually, and as a result of the good relationships that were fostered with our partner facilities, many facilities worked with EMH to integrate telemedicine media so that mental health services could be resumed/implemented on behalf of residents. Given this context, the key challenges that emerged in 2020 also represent opportunities for the SNF community to recast itself in 2021 and beyond. Communication is key: At the outset of the pandemic, one of the most vital communication tools was rendered moot — the face-to-face meeting. Hence, it was necessary to re-conceptualize the method and frequency of communication. In March, we quickly transitioned to internal Zoom calls and scheduled them in the morning and the afternoon, seven days per week, and make a concerted effort to establish new ways of connecting with our partners via media outreach, blogs, social media, surveys, and personal outreach. We see open communication as a vital component of success for SNFs in 2021. Adapting to 21st century technology: At the time of the onset of the pandemic, it was our experience that most SNFs were averse to utilizing telemedicine technology. Even after the onset of the disease and the ensuing lockdowns, our experience at EMH was that a number of SNFs were slow to embrace the implementation of telemedicine. Our experience was that, for those SNFs that worked with us to create solutions that circumvented the issues posed by the pandemic, their residents ultimately received the mental health care that they desperately needed. Creating new employment opportunities: As we worked with partner facilities to implement telemedicine, it became clear that one obstacle was that those SNFs oftentimes struggled to find the staff member to move the telemedicine hardware from room to room. To solve this problem, EMH created a new position, the device technician (DT), which was fully subsidized by EMH. Our experience has been that, once our partner facilities embraced this option to facilitate the needed mental health care on behalf of residents, our partner facilities appreciated that EMH “thought outside the box,” created a simple, straightforward solution, and absorbed the cost of the DT. Attending to the needs of care providers at SNFs: It is well-documented in the peer review literature that, during the pandemic, health care providers are at an increased risk to experience depressive, anxious, and trauma-based symptoms. Anecdotally, this has been our experience, as well. Yet, and to the best of our knowledge, many health care providers do not seem to be accessing the mental health care that they need. The ramifications of this are manifold. For example, untreated mental health conditions are more likely to lead to absenteeism at work and job turnover. In addition, and for those individuals with mental health conditions that go to work, they are likely to demonstrate performance deficits. From our perspective, to the extent that SNF administrators can attend to the mental health needs of their staff, we perceive that there will be a number of benefits. A healthier staff will likely demonstrate better job performance, reduced absenteeism, and a lower likelihood of leaving their job. Additionally, to the extent that employees perceive that their employer is invested in their well-being, those employees are more likely to view their job in a favorable manner and feel committed to it. Taken together, 2020 has been a year of extraordinary challenges, both personally and at work, that probably exceed those which most anyone has previously faced. I believe that 2021 will be similarly difficult. My perspective as a CEO was to communicate effectively and frequently with the EMH team, be honest about what I knew and didn’t know, lean into the myriad challenges that we faced, maintain cautious optimism, and believe that my team and I would devise solutions that would carry EMH through the pandemic. Of course, there are no guarantees about the outcome for 2021; nonetheless, I believe that our approach to managing in the time of the pandemic was effective and may be useful for others.

SavaSeniorCare was able to successfully recover more than 1,000 residents with COVID-19 after teaming up with a physician group to launch a pilot program at about a dozen facilities when the pandemic first hit. Now, the company is expanding the program to help other facilities manage the disease and prevent future outbreaks. “I don’t know how you go through a pandemic like this without medical services, oversight and guidance, because they have a very different level of training, a significantly different level of training than our nursing staff does,” said Annaliese Impink, executive vice president and CXO of SavaSeniorCare. “I think we would have struggled without them,” she told McKnight’s Long-Term Care News. COVID-19 specialists The Atlanta-based company, which currently operates 169 facilities across the United States, began working with the Geriatric Administrative Provider Services (GAPs) physician group in May to help treat COVID-19 residents. Sava quickly identified about a dozen designated centers that were taking COVID admissions for the pilot program. The GAPs physicians acted as “COVIDists,” or COVID-19 specialists, working alongside medical directors at each facility over a period of eight weeks. The physicians would conduct virtual rounds multiple times a week. They monitored negative residents to ensure they didn’t contract the disease, managed the treatment of positive residents and conducted widespread surveillance of all residents to prevent facilitywide outbreaks. The physicians also conducted training with staff about properly wearing and disposing personal protective equipment and reviewed its company guidance and policies on COVID-19. “I would say because of their tracking and surveillance and really bringing a much more focused eye, we had a lot of success in recovering our patients,” Impink said. Learning experience Physicians had more than 3,400 encounters with residents, helping recover more than 1,000 COVID-positive patients, according to Sava. Impink specifically noted that one of its centers in Connecticut had more than 90 positive residents and was able to recover about 94% of them through the program. Overall, nine facilities out of the original group had graduated from the program and were COVID-free by the end of the eight weeks. Impink added that since then, just two facilities overall have experienced recurrences in cases. “They learned a lot from these GAPs physicians. One of the things that we struggled with early on was just learning how to wear your PPE and just really understanding that. One of the benefits is they had that expertise,” she said. She noted that even though each facility has its own medical director, this partnership allowed them to have a consistent treatment approach for COVID-19 across the board. “It gave us the opportunity to have somebody look at our protocols and practices and the guidance we were giving our centers and say ‘yay’ or ‘nay’ to that. Without that, we wouldn’t have had that one-stop resource. It was very valuable,” Impink explained. Thinking out-of-the-box Sava is now expanding the program to about six more facilities in California, Colorado, Texas and South Carolina to help manage its pandemic response. She added that she “absolutely would” recommend that other nursing home operators implement similar partnerships for their facilities. “You had to think differently in this pandemic and you had to think outside the box,” Impink said. “This GAPs model that we put in place during this pandemic was a thinking out-of-the-box approach that worked for us.” “Thinking out of the box during this pandemic has been helpful to us and that approach with GAPs was one example of that,” she added.