Talkin’ Shop: Transcend Staff Chats About the State of Home-Based Care

Sometimes it’s good to put two “like minds” in a room and get them talking. You don’t have to ask us twice! Transcend’s Stan Massey and Tony Kudner sit down for a free-flowing conversation about the biggest trends in home-based care over the last 10 to 15 years, and discuss what skills might serve providers well in the years to come.

With much of Transcend’s research, we aim to have a discrete point of view and easily digestible takeaways. We want to ensure our insights and thoughts align with our philosophy and perspectives on home-based care so we can pass useful ideas on to our clients and partners.

While we’re all for brevity and concrete information, sometimes it’s fun to just sit down and chat. There’s so much going on these days that it can be refreshing to just have an open-ended conversation about the state of the community. In this episode of our Transcending Home Care podcast, Transcend’s Senior Partner Stan Massey and Chief Strategy Officer Tony Kudner sit down for a free-flowing conversation about the big trends in home-based care that shaped the last 10 to 15 years and made some guesses about what the future might hold.

Stan has decades of experience in home-based care. He has supported some of the biggest rebrands the community has seen and has written some of the most memorable and moving campaigns to connect family caregivers to the support their loved ones need. Tony recently joined Transcend after spending time in leadership at several national home-based care providers, as well as working in advocacy and policy for one of the major trade associations.

Data is becoming increasingly engrained and revered in the world of healthcare. And, indeed, data is vitally important in improving medical science, measuring outcomes and proving the value of specific processes.

Yet, as data continues to grow in priority, that emphasis can cause patients to feel like a number in an ever-expanding sea of numbers. Going back to Hippocrates, medicine was designed to treat people, not just diseases. In fact, one of the main principles of the Hippocratic Oath centers on respect for the patient’s autonomy.

So how do healthcare providers retain the humanity and dignity of patients and their families while data reigns?

In this episode, Tim Short (M.D., HMDC, FAAFP, FAAHPM, FNAP) joins host Stan Massey of Transcend Strategy Group to discuss this crucial topic. Their conversation covers how to engage the art of empathy, as well as how to maintain a feel of high-touch care while high-tech continues to emerge in all facets of healthcare practices. Tim and Stan even discuss how to leverage technology to improve communications with patients and families, so they feel heard and understood.

As implied by all those letters after his name, Tim has enjoyed an illustrious and impactful career in family practice as well as in practicing hospice and palliative medicine. He most recently served as chief medical officer at Hospice of the Piedmont in Charlottesville, Virginia, where he also was director of their education institute. That program developed education and training modules for healthcare professionals on a variety of subjects.

Among other positions at several institutions, Doctor Short also served as associate professor of palliative medicine at the University of Virginia. While there, he was clinical director of the Schwartz Center rounds and course director for the “Heart of Medicine,” mentoring first-year medical students on how to apply skills such as the art of listening, communicating with patients and having difficult conversations. 

Value is more than a buzzword in home-based care these days. Agencies know that payers, policymakers and consumers are all expecting it in the care they provide. But where should a hospice or home care agency start when thinking about how to demonstrate that value? How do you create a value proposition when there isn’t yet a roadmap for doing so?

It all begins with taking a step back and defining exactly who you’re trying to prove value to: Is it the payer? Is it a health system? Perhaps a patient and their caregiver? Once you’ve truly defined your audience, the rest can start to fall into place. Agencies can then start to examine the MMA – what’s Measurable, what’s Monetizable and what’s Attributable to their efforts.

In this episode, Craig Solid, PhD, owner and principal of Solid Research Group, joins host Stan Massey of Transcend Strategy Group to discuss creating a value proposition for a home-based care organization and get into the details of how to think about proprietary versus public data sources, defining audiences, and finding your key allies and advocates.

Solid Research Group (SRG) is a healthcare consultancy focused on defining and demonstrating value and business cases for scale-stage medical device and med-tech companies. SRG has advised and built business cases for early-stage companies across the United States, Europe and Australia. While SRG’s focus is on scale-stage companies, other clients have also included large companies (Medtronic, Optum, Boston Scientific) and various academic institutions.    

A financially viable home-based palliative care model is driven by appropriate practices, processes and logistics. A big part of establishing successful parameters comes from starting with a sensible staffing model.

What are the right roles in a palliative care start-up? How should a provider schedule patient visits? What’s the proper mix of in-person visits versus support by phone or virtual video visits? How does the right level of patient care translate into manageable caseloads for clinicians and social workers? How can providers make sure services are covered by reimbursement?

In this second episode of a two-part series, Mark Hendrix, president of nTakt, and Amanda Copeland, a palliative care nurse practitioner, join host Stan Massey of Transcend Strategy Group to discuss staffing, billing, telehealth and other smart palliative care practices. 

Mark’s company, nTakt, is focused on building sustainable palliative care programs by utilizing meaningful technologies, uncomplicating processes and providing hands-on training. Mark has over 35 years of experience in process improvement and business turnaround. He is trained as a Lean Six Sigma Blackbelt with over 10 years of experience applying Lean concepts in healthcare settings. Mark also has served as Operations Director for CMMI Palliative Care Grant and has had results published in the Journal of Palliative Medicine.

Amanda Copeland, AGNP, has dedicated over 20 years to caring for seriously ill patients, primarily focusing on hospice and palliative care in home settings. She is passionate about supporting seriously ill patients and families during this difficult part of their life’s journey. Amanda played an integral role in building a successful home-based palliative program that has served more than a thousand families and continues to expand into new regions.

Most healthcare providers – especially providers of care at patients’ homes – started their organizations offering one particular service line. Whether that original service was home health, hospice, private duty nursing or something else, many organizations felt the need to expand their services and engage with patients for more needs over longer periods of time.

When these organizations added even one more service, they often began to talk about their “continuum of care.” But how expansive should a continuum be? How can agencies know what service lines to add and when to make the expansions? How do you make margins on new service lines? And what about staffing when it’s challenging enough to keep current positions filled?

In this podcast episode, Rhonda Sanders, chief mission access officer of Empath Health, joins host Stan Massey to share details of how her organization has built a very robust continuum of care that engages patients and families at different stages of life. Empath Health offers 10 service lines – and growing – including a sexual health program for adults of all ages. Rhonda and Stan discuss Empath’s business strategies for adding services, keeping up with staffing demands, the use of telehealth, appealing to managed care plans, different reimbursement models and more. 

Rhonda Sanders joined Empath Health in November 2021. Rhonda plays an integral part in helping Empath Health continue to evolve as a customer-driven organization and is responsible for driving growth and enabling access among consumers, payers and referral sources for each of the organization’s services lines as well as overseeing the agency’s managed care strategies. A seasoned executive in healthcare operations, business development and sales, Rhonda has succeeded in leading growth strategies for home-based healthcare providers serving large, multi-state regions. Most recently, Rhonda served as vice president of business development for Amedisys Home Health, Central Region, in Lubbock, Texas. She also served as area vice president of sales/operations for Kindred at Home in Texas, New Mexico, Colorado and Oklahoma. 

Due to the historically weak reimbursement stream from CMS for palliative care, providers often have been conflicted with providing this undeniably helpful service and staying out of the red while doing so.

Some hospice providers started their palliative care service line with the mindset that it would be a “loss leader” – they expected to lose money on the service but hoped to build relationships with patients and families sooner, convert them to their hospice care as early as appropriate, and make up for the loss through stronger hospice census and LOS. For most providers, things didn’t really work out that way.

So how can providers deliver the comfort and quality of palliative care without hurting themselves financially … and build a program that can be sustainable?

In this podcast episode, Mark Hendrix, president of nTakt, joins host Stan Massey of Transcend Strategy Group to discuss wise approaches to solving the palliative care dilemma. The conversation covers billing practices, the role of telehealth, a smart foundational model to build a strong palliative care program, the future of reimbursement and much more.

Mark Hendrix has over 35 years of experience in process improvement and business turnaround. He is trained as a Lean Six Sigma Blackbelt with over 10 years of hands-on experience applying Lean concepts in healthcare settings. Mark also has served as Operations Director for CMMI Palliative Care Grant and has had results published in the Journal of Palliative Medicine.

Most providers of home care are struggling with major staffing shortages – especially among nurses, CNAs and social workers. The COVID-19 pandemic ushered in a new era of professionals reevaluating their careers, resulting in massive job changes and even “the Great Resignation.” Turnover among many healthcare providers is at record levels.

Recently, Transcend Strategy Group and MAC Legacy partnered in a national research project to explore what healthcare workers look for in their careers so employers can be more effective with recruitment and retention.

According to the research results, 30 percent of healthcare workers say they are likely to change jobs during the next year. Yet, not many have home care as their destination of choice. For instance, fewer than half of RNs say they would consider opportunities in home care.

In this podcast episode, Marcylle Combs – president and CEO of MAC Legacy – joins host Stan Massey and Transcend CEO Stephanie Johnston to discuss details of the research findings and insights gleaned. The conversation covers what the home care workforce cites as their top reasons for leaving a job, as well as the priorities they’re seeking from a new position.

By unlocking these motivators, home care organizations can promote their current attributes or build new ones to be more attractive to workforce recruits – and help reduce turnover of their staff.

Marcylle Combs, BS, MS, RN, CHCE, has shaped MAC Legacy to turn complex problems into simple solutions for home health and hospice providers. With more than 30 years’ experience in these home care categories, Marcylle has held many roles, including field nurse director, administrator and owner/president of a successful home health and hospice company.

She also serves on the board of directors for the Home Care and Hospice Financial Managers Association (HHFMA) and chairs the Women in Leadership Committee for HHFMA. 

It’s no secret that most seniors in America want to maintain their independence for as long as possible. In fact, according to the Disabled Living Foundation, the majority of seniors say they fear losing their independence more than they fear death.

For many, a main hallmark of independence is being able to age in place. A survey by AARP revealed that 90% of Americans age 65 and over want to stay in their home and 80% believe their current residence is where they will live until they die.

Other statistics show 27% of seniors currently live alone – and that number is projected to keep growing as Baby Boomers age. So, a crucial key to empowering seniors to maintain their independence, especially if they live alone, is the use of technology to monitor their health and well-being.

Ryan Herd – founder of Caregiver Smart Solutions and CEO of 1 Sound Choice (a company specializing in smart home automation) – joins host Stan Massey of Transcend Strategy Group in this engaging discussion on remote monitoring technology and its increasingly important role in caregiving.

Whether you’re a professional provider of home-based care or a concerned family member wanting to keep tabs on a senior loved one, existing and emerging technologies are making remote monitoring easier and more effective. Ryan and Stan cover a variety of significant factors for remote monitoring, including fall detection, looking for changes in living habits, tracking clinical vital signs and much more.

With 30 years of experience in smart home technology, Ryan consults with the home building and healthcare industries and is a sought-after speaker. Because of his expertise, he was selected by the National Kitchen & Bath Association to be a 2019 NKBA Insider to assist in educating its members about the importance of collaboration between technology integrators and the design community.

Ryan offers unique insight into smart home technology, the Internet of Things (IoT), and the significance of technology in the home today. He also is the author of “Join the Smart Home Revolution,” Amazon’s #1 best-selling smart home book.

COVID-19 magnified the need and desire for patients to stay out of hospitals if possible. A national survey conducted by Transcend Strategy Group revealed that more than 60% of family caregivers had greater confidence in the quality of care provided at home during the pandemic versus care in a facility. Plus, the repeating surges in COVID cases across the country pushed many hospitals to the brink – and sometimes beyond – when it came to inpatient beds available.

Cooper Linton – associate VP of Duke HomeCare & Hospice – is at the forefront of helping a major healthcare system rethink how certain patients can receive care at home instead of in a hospital. In this discussion with host Stan Massey of Transcend Strategy Group, Cooper discusses the pioneering efforts of Duke University Healthcare System in starting a COVID Care-at-Home program and examining the option of starting a Hospital-at-Home program.

The conversation covers a variety of issues related to these programs, including patient criteria to identify candidates for home care, the different demands on providers for managing higher acuity patients at home, and the growing imperative for remote patient monitoring and other technologies to enable the efficiencies necessary for a larger home patient census.

Cooper has deep expertise in managing home-based and community-based care. Before taking his current role at Duke HomeCare & Hospice in 2018, he was VP of marketing and business development at Transitions LifeCare (founded as Hospice of Wake County) for 13 years. His career also includes experience with home health providers.

In addition, Cooper is co-host of his own podcast “Edge of Aging” – a series that asks, “What if we reimagined how we provide care for older adults and their caregivers?” and explores the possibilities. 

COVID-19 ushered in an overwhelmingly stronger preference for patients to receive care at home rather than in a facility. A national survey by Transcend Strategy Group revealed that 60 percent of family healthcare decision makers are now more confident that quality care can be provided at home versus 33 percent feeling more confident in the quality of care at a facility. 

This preference, along with the growing demand for care as the huge demographic of Baby Boomers continues to age, is opening new opportunities and challenges for providers of home-based care.

In response, Bill Dombi – Doctor of Law and President of the National Association for Home Care & Hospice (NAHC) – has said that providers of home-based care must demonstrate “a willingness to not only embrace change, but to lead it.”  

Through this important discussion with host Stan Massey of Transcend, Bill offers his insights to three key areas of necessary change: 1) Widening the understanding of what home-based care can provide; 2) The role of technology and other innovations in meeting the demands of home-based care; and 3) Developing a bigger and better workforce to handle the growing volume of home-based patients.

Bill has served at NAHC for more than 30 years, including his role as president since 2017. He also serves as executive director for the Home Care & Hospice Financial Managers Association. Bill specializes in legal, legislative and regulatory advocacy on behalf of patients and providers of home health, private duty home care and hospice care.

With nearly 40 years of experience in healthcare law and policy, Bill has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975.