Going forward, hospice and other post-acute providers are preparing to operate within a value-based ecosystem, and Florida-based nonprofit Chapters Health System is no exception.
Chapters provides hospice, palliative care and a range of other services throughout Florida. It has expanded with a number of affiliations during the past three years, including those with Capital Caring Health, Cornerstone Hospice and Hope Healthcare.
The organization has been hard at work in recent years to position itself for risk-based relationships and build out a continuum of care for chronically and terminally ill patients, while maintaining positive employee engagement.
Hospice News sat down with Chapters CEO Andrew Molosky at the Home Care 100 Conference in Scottsdale, Arizona to talk about the organization’s strategies for health care innovation and growth.
Chapters HealthWhat’s next for chapters in 2024? What are your big priorities?
Our big priorities continue to be the focus on advancing the chronic illness and end-of-life platform. That platform consists of multiple things — the traditional hospice services, oftentimes inclusive of palliative care services — the advancement of things that we consider to be prime to our portfolio, PACE, value-based care, accountable care, and things of that nature. So it’s a bit of a balancing act.
I’m sure one of the follow up questions would be how do you prioritize what initiatives to do right now, which opportunities present in 2024. There may be a little more weight into one of those things than another depending on what materializes, but it’ll be that commitment to a diversified portfolio representing end-of-life care.
That was a great follow-up question you proposed there, would you answer it?
So many things are happening in the space, be it affiliations or acquisitions or partnerships, whatever the language is.
There’s also a number of legislative initiatives. If you happen to live in a certificate of need state, sometimes your expansion or your growth opportunities are suspended in different fashions or formats. If a legislative body approves more pay slots, go for it. If the certificate of need opens up and you can get in and go for it, that might jumble the border of your prioritization. So we can have multiple paths concurrently and see which one materializes first.
Can you describe what your home-based care assets look like right now?
Chapters as an organization is maybe a little bit different than a lot of organizations. We have a combination of wholly owned assets, joint venture partnerships, sometimes network management. And depending on what you define as an asset, there’s a number of intellectual capital pieces that are home-based, but don’t necessarily have a tactile touch.
Just as a brief flyby, we have the traditional hospice organizations, which everyone is familiar with. We have palliative care programs. We have a home-based primary care program, pay centers, accountable care organizations and a number of other initiatives.
Then on the intellectual capital side, we have, of course, a couple trademark programs representing veterans and first responders. We have a cybersecurity consulting organization, and a couple other things in development. Those are all ones that have formal filings and leadership, infrastructure, revenue streams and things of that nature.
So if I’m understanding correctly, in the past, it was almost like this kind of à la carte set of services. “We do primary care. We do hospice, home health, etc.,” and now it’s about building an ecosystem.
You can pick your analogy, right, and “ecosystems” is good, or the solar system. If you have the patients as the center, you have to have multiple planets orbiting it. A lot of those have moons around them. Any one of them standing alone is just one celestial body, but when put into the solar system, everything functions, maintains a balance. Some are moving faster than others, but it’s all centered around that patient.
What are the key relationships that an organization like yours has to build as you develop this value-based health care ecosystem?
I think the first relationship that you must establish is a pretty good internal harmony with your employee base, your stakeholders, your governance structure, whatever that might be. Because nothing will waylay an organization faster than when you have people feeling the priorities differently.
Some view this as a margin game, others as a volume game. Some are all about the size of your footprint, others are in this for publicity. But the first and most pivotal relationship is employee engagement.
Outside of that, though, I think the second step is, whatever your agreed upon internal direction is, identifying which stakeholders are key. If you’re going to be playing a population health or a value-based game, your network is first and foremost. You can’t even do it before you secure payer relationships.
So in order of priority to me, if you’re going to play in value-based networks, efficiency is critical as a second step after internal harmony. And then of course, third becomes the payer relationships. You have to fill the revenue side of things to justify all this investment.
What is the importance of scale as you build these value based relationships? I’m thinking in terms of the multiple affiliations that Chapters have had. Is the need to build scale in part driven by those value-based relationships?
I think you’ve asked the chicken-or-the-egg question. Some of it starts with who you want to be as a company, and I think that maybe is more important that even then the mechanism you choose, whether it’s acquisitions, the capital outlay, or the member subs if you’re a nonprofit, or as some sort of clinical integrated network with like-minded folks.
Because just being big doesn’t always solve it. In many cases, it’s just being complicated. But if your desire is to be able to procure large contracts and large payers who want large partners, well, then that makes sense.
If you’re in a low-margin business that is capital intensive. Okay, that makes sense. If it’s a path to aggregate an equity component, ultimately flip the portfolio for more than you paid for it, Certainly scale is going to get you there. So I think it starts with the motivation.
Some people just get big because the people next to them have gotten big, but there’s no real purpose in it. And that tends to lead to trouble; its growth, with no tie to any real strategic plan. So I think there’s a notion of scale as the lag measure to the lead measure, which is your organizational strategy.
Companies featured in this article:
