Hospice CEOs Share Top Lessons Learned During a Challenging 2021

Hospice providers saw a great deal of change during 2021. The industry continued to reel from a global pandemic while enduring worsening labor pressure. The market saw shake-ups through massive mergers and acquisitions that reshaped the competitive landscape, as well as regulatory enforcement reform and the onset of the Medicare Advantage hospice carve-in — to name a few. 

Hospice News asked provider executives about the most important lessons learned during a tumultuous year that will inform their strategies and direction during 2022. 

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Many health care institutions were forced to rapidly adapt to the demands of COVID-19. Some fared better than others, and in the process, our teams learned a great deal about what it takes to lead and innovate during crisis and change. Even though the last two years have been unlike others we have faced, we know that things are going to continue to change in health care. The leadership skills required of us during the last two years are the ones that will be required of us in the future.

We learned the importance of remaining nimble, allowing agility across roles and functions to work in the best interest of the collective. We learned that we must let our teams reexamine the linear processes we have in place, as the processes themselves may require rebuilding. We learned that we must commit to transparency and vulnerability through ongoing communication, as in the absence of truth, people will create their own.

And finally, we learned to implement structure and routine where possible, building predictability amidst chaos. What these lessons all share is their connection to the common mission and vision, ensuring our employees are and feel cared for above all else.

— Joshua Proffitt, President and Chief Operating Officer, LHC Group (NASDAQ: LHCG)

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Continuing to develop flexibility in how and where we deliver care is essential. The pandemic forced us to use tools and approaches that we had never used before in order to meet the needs of patients, families and referral sources and to get better efficiency with the workforce we had. Some of these changes resulted in consumers being less satisfied with the services, so finding ways to increase the value and satisfaction of flexible services, such as virtual visits, will be an area of focus from now on.

As the number and types of at-risk and value-based providers and models of care increase, we continue to focus on developing disease-specific programs that can address the unique needs of patient populations, such as those with heart failure, dementia, [chronic obstructive pulmonary disease], and advanced cancer. Being able to deliver reliable outcomes for specific patient populations, rather than relying on a generalized approach, will also be key for us as we focus on expanding our work with managed care and direct contracting entities.

Retaining our workforce will be a focus for the coming year. COVID resulted in retirements and decisions to not return to work. Focusing on job satisfaction, employee engagement, and flexible work arrangements will all be part of our planning to assure that we can retain our staff since workforce shortages are persisting into 2020.

We learned that both referral sources and patients/families increasingly want an “easy button” in order to choose to work with you. We are focusing on care navigation, where we provide solutions and help find the right services and fit for the patient needs on our end, versus making our referral partners or families do the work of figuring that out on their end.

— Susan Ponder Stansel, CEO, Alivia Care

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The No. 1 priority for us organizationally is the staffing component and continuing to ensure we’re being nimble and doing everything we need to deal with the environment we’re in. The two most important lessons learned for me during 2021 and 2020, the full pandemic, is first the importance of communication. It’s never been more important for leaders inside of an organization to have frequent communication across the company so that everyone understands what’s going on, but also for a company of our size and scale to have the flexibility to communicate to specific targeted audiences in a variety of ways. You can dynamically react to situations that are changing on an hourly basis throughout the country.

We’re not perfect in any regard related to that, but we had made great strides pre-pandemic that were all aimed at solving that need because of natural disasters that occurred within our portfolio, hurricane season running through Florida, wildfires occurring in California. We had made a lot of investment to say we want to be able to dynamically send messaging, guidance, safety protocols back and forth to all of our employees. We used all those tools throughout the pandemic. This includes communication and collaboration with our health care partners that are going through the exact same dynamic, and we need to understand what’s going on inside of their institutions so we can be stewards and good partners.

I think the second piece is the importance of purpose. It’s never been more important to not assume that all of your team members are always aware and reminded of why they’re at your organization and why we’re working together collaboratively. We need to be humble, be transparent, be real with everyone and openly communicate to provide a clear path forward. I think the organizations that do that come out of the pandemic with a workforce that is even more dedicated to them, because they see what the company did to help support them.

— Nick Westfall, CEO, VITAS Healthcare, a subsidiary of Chemed (NYSE: CHEM)

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The word “nimble” comes to mind. You’ve better be nimble in your approach. In terms of M&A, we previously talked about being opportunistic, to look for opportunities to create opportunities to invest in businesses that make our company better, that are aligned to our company and really be thoughtful of who we’re targeting and where we’re targeting. It has to ultimately kind of fit the bigger picture growth approach, or it just doesn’t make a lot of sense to burn a lot of calories on it.

As we move towards the evolving payer landscape, there’s going to be a value-based component. I would just kind of point back to that strategy from a density perspective. As we have begun to work further upstream, engage with the payers across South Carolina in Georgia, the ability matters to lay a map on the table and say we serve every county in this state. That resonates as you begin to think about how you create value in those relationships and those potential partnerships. We’re seeing that on the payer side, as well as with the hospital systems. They are beginning to be much more aware of footprint capabilities and components of what you offer.

— Troy Yarborough, CEO, Agape Care (speaking at the Hospice News GROWTH Summit)

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We certainly have seen a robust change from senior housing. Census is going to be more home-based. In that approach, we’ve started utilizing more nurse practitioners to provide additional services and a different additional care for our patients that quite honestly, we historically had not had not even thought about.

To be able to have a nurse practitioner that can have that dialogue with the patient, the family, the primary caregiver, in a more consistent manner — once a week or every two weeks as opposed to once every 60 or 90 days — has established a different level of expectation, but also a different level of opportunity for us to really focus in on the progression of a patient through the hospice benefit.

— Heath Bartness, CEO, St. Croix Hospice (speaking at the Hospice News GROWTH Summit)

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I think we have muscles that we can leverage relative to the pandemic, policies, protocols, delivery of care, alternative methodologies, that we have now at the ready. Even right now, in this unique phase of Omicron, we are taking full advantage of those playbooks. There was a ton of work, to adapt and to modify care delivery in the safest, yet highest quality way possible and managing those two goals. The good news is, there’s the infrastructure, and the policies, protocols and sort of muscle memory in order to do that.

We have continued to advocate for vaccination. So if boosters become the new definition of vaccination, we will continue to drive our internal efforts and playbook for that as well.

As far as staffing, we have been on an ongoing campaign to improve the work/life and workload balance of our staff, trying to do as much as we can to create efficiency, increase job satisfaction and streamlining. That is part of the global goal of us coming together is to be able to leverage scale as well as best practices. That’s something that we’ve been very much focused on. By doing that, you eliminate noise that gets in the way of those closest to patients and families and referral partners, as well as reduce emotional stress that we believe is a huge factor of a staff burnout and staff dissatisfaction.

 — Todd Stern, Executive Vice Chair and CEO of Hospice, AccentCare

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Partnerships matter. What we continue to have reinforced out there in the marketplace is developing strong partnerships with your referral sources. The joint ventures we have are the biggest source of growth and stability for the business.

Mission matters. Having a mission-driven organization that gets you through the most difficult times is critically important across the board. There’s the ups and downs that happen, but if you can keep people focused on the mission, that’s incredibly important. 

Being a flexible organization matters. We’ve learned to pivot on a dime on through the pandemic, and that comes through a different set of muscles, how we spend time together, how we prioritize or how we look at data. We’re constantly looking at how we both react to and get ahead of things we’re seeing kind of come in, and I think those are three things that will stick with us.

— Steve Rodgers, CEO, Accent Care