By the Bay Health CEO Skelly Wingard: The Case for Nonprofit Hospice Consolidation

Nonprofit hospices should consider the benefits of collaborating or combining with like-minded organizations in order to ensure sustainable growth and reach more patients, Skelly Wingard, CEO of By the Bay Health, told Hospice News.

Wingard became CEO in June following the departure of her predecessor, Kitty Whitaker. Established more than 45 years ago, By the Bay Health is among the oldest nonprofit hospices in California. The organization serves eight counties around the San Francisco area.

Previously known as Hospice by the Bay, the organization rebranded in 2021 to reflect a broadening scope of services. The nonprofit organization affiliated with the University of California at San Francisco (UCSF) health system in 2015.


Now, the organization is pursuing a merger with nearby Mission Hospice & Home Care, which was founded in 1979 and also services the San Francisco Bay area.

Hospice News spoke with Wingard about the forthcoming merger, growing consolidation in the nonprofit sector and her priorities for 2024.

By the Bay Health
Skelly Wingard, CEO, By the Bay Health

What’s top of mind for you, as you look ahead to 2024? Where do you see the biggest challenges and opportunities?


Probably a little bit contrary to what most folks would say right now, I think we’re in an incredibly exciting and probably really pivotal time in health care overall.

Yes, there’s headwinds; we all know what those are with reimbursement shrinking and cost of care increasing, and recruitment and retention of our most important resource being really challenging.

I also would say that there are positive or favorable tailwinds that are here with us as well. The industry at large and the communities that we’re serving really are interested in looking at providers that can service them in unique and different specialized ways.

I see the opportunities for not-for-profit organizations like By the Health being a niche that populations are looking for. A lot of aging population folks are not interested in the package deal of health care. They’re into looking at what unique qualities does anyone who’s going to provide my care have, so that I’m getting care where I am.

For By the Bay, it is one of our top priorities to ensure that folks have really high-grade access to health care and equitable access to health care, and that there’s also equity in the quality of health care that folks are receiving.

When I look at a for-profit model that is beating down every single corner to gain margin, and then I look at the not-for-profit model that is truly trying to design an equitable, high-access health care model, along with equity in the quality of care, and making sure that we listen and learn from patients rather than just beating for the margin — I think we’re in a good place.

We’ve got a really intelligent aging population that knows what they want, and they want the best. They don’t want to just pick up the phone and go through an automated answering service that’s going to get them the same exact routine care every single time.

How is By the Bay Health designing its care delivery around those specialized, customized needs of patients?

A lot of what we do is really bi-directional communication and interactive approach with our patient populations, whether that be from the front end of just starting the hospice experience or into the back end and the grieving process.

We really have our ear tapped into the patient’s experience, the family’s experience and the provider’s experience, so that we’re listening and learning. The key to our success really has been around our continuous process improvement, where we don’t shake the model and stick with the model. That’s probably not solving for the greatest needs of a population that changes its dynamic. Our continuous process improvement is probably our biggest strength.

Regarding the merger with Mission, how did your two organizations first come together to discuss a possible transaction?

We have a tiny bit of overlapping geography, so the two organizations knew each other really well. And there was some overlap of physician providers. If they would be getting a patient that maybe we had before or vice versa, organizations chat.

My predecessor [as CEO], Kitty Whitaker, said to me when I came on board that [Mission] seems to have a really aligned mission to to By the Bay Health. It really seems like we both understand the mission of hospice care and are deeply integrated into the communities. And so she said that might be someone that we should chat with.

So I started conversations very quickly, actually week one of being in this role with Dolores Miller, their CEO, and we started to chat about what this might look like for us to be able to come together as a combined organization that could service a greater geography.

What will the merger allow By the Bay Health to do that it perhaps wouldn’t have done otherwise?

First and foremost, when you think of when you start an organization, you’re really trying to serve a purpose. When By the Bay Health was created, it was to make sure that the dying population’s wishes were served at the end of life, the ability to die with dignity in accordance with your wishes and to be at home with your family.

There’s a million components to it. Way back in 1975, we were the first hospice agency in California. Even back then, the real drive was to grow the mission, to drive it as far reaching as possible.

To be able to combine our organizations, hospice and home care, it really does expand that mission even further. So number one is being able to just reach more patients.

In business, scalability is so critical. If we’re going to have operating costs that allow us to provide this level of incredible care, it is the side of business that we have to pay attention to. We’re not-for-profit, so we’re not fighting for the deepest margin that we can get. However, we’re still a business, and so the ability to scale is really important as well.

I would also say that there’s growth with the number of employees that we’re going to have in this combined organization.

And how many employees will that be?

It will be approximately 600 or a little over 600 combined.

It seems like this year nonprofits have been more active in terms of affiliations and acquisitions and mergers than the for-profits. It’s kind of been an interesting turn-around to see further consolidation among nonprofit hospices. Do you foresee further consolidation in the nonprofit sector?

Given that the business model is really tough when you have a census of 100 or 50 or 60. You still need a chief financial officer and a chief operating officer. You still need all those executive level leaders, and you still need management. You still need the team to be able to do the work, and you just don’t have the census to support the operating costs.

You’ve got to have the revenues. If you don’t have the census, then you don’t have the revenue to be able to pay for those teams and services and all of the various costs that exist in that business.

I perceive consolidation happening for sure, and my hope is that the consolidation occurs at the right time. With our merger with Mission, this has been an incredible experience for both of us to come together and talk about what this combined organization is going to do together.

I would just encourage other organizations to think about what’s possible in combining and merging with other organizations and thinking about the communities that we can support in a different way.

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