CEO Cathy Conway: The Business of Hospice Is Changing

Cathy Conway, chief mission officer for the Hospice of Santa Cruz County will take over as the organization’s CEO effective June 1, following the retirement of current chief executive Michael Milward, who has led the organization since 2012.

The organization’s board unanimously approved Conway’s ascension after a rigorous national search and extensive interviews with potential candidates. Conway joined the organization in 2004, building on a wealth of experience in public service in the nonprofit and for-profit sectors.

Conway comes into this new role during a time of crisis as the COVID-19 pandemic continues to hammer at the nation’s health care system. Hospices nationwide are contending with supply shortages, the need to boost telehealth, and finding ways to maintain continuity and quality of care while also preventing the spread of the virus.


Conway sat down with Hospice News to discuss how she plans to meet these challenges as well as her long time priorities moving into 2021.

Can you tell me about your own professional background and what drew you to the hospice field?

I’ve been at Hospice of Santa Cruz County for 15 years now. I started my career in the for-profit world and worked for a large, high-tech publishing company. During that time I started volunteering at a 15-bed hospice in San Francisco. Pretty quickly, it became clear to me that the work that I was doing as a volunteer, being at the bedside and being with people who were coming close to the end of their life, was way more fulfilling to me than my work in the corporate world.


After a couple of years volunteering, I decided to make a change. I actually took a year-and-a-half to volunteer full time at the hospice. After a while, I realized I was doing work that was more meaningful to me, and I formally shifted into the nonprofit field and started working in hospice 15 years ago. It was really drawn out of wanting to find more fulfillment in my work.

You’re taking the helm of this organization during a time of crisis. What has your organization’s experience been like so far during the pandemic?

It’s certainly a time of unknowns for all of us. Our organization has had to transition quickly from life and work as we knew it to adapting to this new reality. Our leadership team has been quick to respond. Of course, we want to ensure that all our patients and families and bereaved community members can continue to receive the services that they need, and also that our staff can provide those services safely.

Santa Cruz County adhered to the shelter-in-place order early. Our county continues to have a low number of COVID-19 infections. We’ve done a really good job with flattening the curve. I think our leadership in the state of California and in our county health office has been really strong. We’ve been really connected with our county health office and in a group that we have called the Health Improvement Partnership — a gathering of all the health care providers in our county. We’ve been working really well together.

I think what impressed me the most about our organization is how quickly our team has been able to really pivot and adopt new practices to serve our community. We see this with telehealth, and we certainly see it with our clinical teams.

A few weeks ago, we began a virtual volunteer visitor training, so that when we open back up those volunteers be ready to serve our community. We’ve held webinars on advanced care planning during COVID-19 to make sure our community has information they need to make informed decisions about their health care preferences. I really feel like everyone has stepped up in the organization to make sure that our community still has access to the services that we provide.

What are your top priorities as you come into this new leadership role?

I’m excited to step into the new role. My priorities have had to shift because of the crisis situation that we are in. My top priority is the safety and well being of our staff and the patients and families that we serve. It’s really clear to me that our staff need to feel safe and confident in order to provide the care that our patients and families deserve and expect from us.

Along with ensuring that all our teams have the [personal protective equipment (PPE)] that they need to get their job done, we’ve been focusing a lot on making sure that they also have what we’re calling emotional PPE. The three components of that are connection, culture and coping. The connection that they feel as we reach out to staff and to see how they’re doing, knowing that some of our staff who are there to serve our patients are also taking care of their kids at home right now, and homeschooling and just all the challenges that are going on. We’re making sure we’re connecting with them often.

From a culture standpoint, emotional PPE is all about effective leadership and communication. We’re making data-driven decisions regarding the changes in practice, and we’re communicating with our staff a lot. We’re doing regular COVID updates. We started these clinical town hall meetings once a week where all clinicians can get on a call with our leadership and physicians, our chief clinical officer, our chief medical officer, and they can ask any questions they want about COVID and about our practices.

The last piece is coping and making sure that our staff have access to tools and resources that they need to support their emotional well being.

It’s been this really interesting balance. Early on, we made sure we got all the materials they needed to be safe doing their jobs, but this emotional PPE is really a big part of what we’re doing as well.

You mentioned the work that you’re doing regarding telehealth and adapting your services. What do you see as the potential long-term impact of in terms of how hospices are using telehealth?

I think it’s here to stay. I think this has pushed hospices further along. Certainly for us we had been doing telehealth on our palliative care side, but this really gave us an opportunity to step into telehealth the way we’ve wanted to do it. But I think for our clinical teams, it’s definitely a time of adjustment. The connection with patients and families is different these days, and it’s something that everyone’s getting used to. A group of our clinical leaders have developed what we’re calling the “art of the telehealth visit,” a standard of practice for our telehealth visits. We think it’ll guide us into the future.

When we look at the future of telehealth, I think there’s an opportunity to help us stay connected with our lower acuity patients, while perhaps deepening our support that we provide for those patients and families with higher needs. We’re asking questions like: would [telehealth] allow us to be able to serve a larger geographical area? Can we serve more people in the community? Can it be a more efficient use of time for our patients and families?

Looking beyond the COVID-19 pandemic, what do you see as your critical long-term goals?

Our long term goal is to remain our community’s preferred provider of hospice care and serious illness care. Hospice of Santa Cruz County has served Santa Cruz and northern Monterey counties for 42 years now, and we’re really proud to be the preferred hospice provider in our community. For the second year in a row now we’ve received the Hospice Honors Award, which is really important to us because it represents the caregivers’ perspective of the care that we provided.

But with the changes that are happening in health care with the [Medicare Advantage] hospice carve-in, we have to make changes in the way we do business. Hospice business is changing. Our long term goals are adapting to those changes.

As you mentioned, coming in 2021 we have the inclusion of hospice in value-based payment models like Medicare Advantage and the Primary Care First Serious Illness Population model. What risks and opportunities do you see when you look ahead to 2021?

There’s a hope that the [carve-in] may be [delayed]. Members of the [U.S. House of Representatives] Ways and Means Committee have called for a one-year delay of the [value-based insurance design model (MA carve-in)] demonstration. We’ll see where that goes.

The whole purpose according to CMS is to increase access to hospice services and for there to be better coordination between the patient’s hospice provider and their other clinicians. I think the biggest opportunity is to be able to serve patients sooner in their disease process and better prepare the patient and the family for their disease progression.

We talk a lot about this concept of well being — and well being at the end of life. I really believe that a patient and a family can experience well being at all stages of their life, even at the end of life, and what that looks like is a patient’s goals of care being met so they can live with dignity. So I see a lot of opportunity with meeting patients further upstream and really providing that consistency of care.

I think the risks come in a couple of places. We’ve never had to negotiate before for our rates, and we’ve had a consistent timely payer in [the U.S. Centers for Medicare & Medicaid Services (CMS)] That will be a change in our practice. It’ll be a change in our business, and that could be challenging.

I think the other things that come up are patients’ choice of hospice, and whether that will be limited in the future depending on the Medicare Advantage plan and who they have a contract with. That’s a concern. I think the other concerns are potential delays of service if either the admission to care or the levels of care are subject to prior authorization.

We feel very strongly that we want to make sure that patients get the care in a timely manner, that they have access to the care that they need.

How do organizations like yours need to prepare for those changes?

Hospice of Santa Cruz County is one of the founding members of the California Hospice Network. That’s a big piece of this. I hope that the way nonprofit hospices will prepare for this is by realizing that we are actually stronger together.

We looked at California Hospice Network as a partnership that allows the hospices in our affiliation to collaborate on best practices to improve efficiencies and see some benefits in cost sharing. It also allows us to have a bigger footprint of nonprofit hospice affiliates across the state of California. That’s really important because we know that with the carve-in it’ll be a different world.

We anticipate that payers will be more inclined to contract with larger hospice organizations. So as a member of a network, we can really meet the needs of the payers by covering their service area while still remaining the exceptional hospices that we are in our local communities. We will be more aligned and ready to negotiate for these Medicare Advantage contracts.

Do you think that hospices have the capacity to gear up for these new payment models while they’re simultaneously grappling with COVID-19?

That’s the definite challenge, especially if some of these predictive models around COVID turn out to be true. The predictive models are showing that the fall and winter could bring a surge in cases. If that happens, we’re going to be in this place again. It would be very difficult to gear up for a new payment model while in a surge.

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