The Pennant Group (NASDAQ: PNTG) has appointed Dr. Derrel Walker as its chief medical officer, a new position for the company.

Walker came to Pennant in 2011 as a medical director in one of the company’s Idaho branches. Pennant is the holding company for a cluster of independent hospice, home health and senior living providers located across 13 states.

Early in his tenure at Pennant, Walker began making house calls and was struck by the value of engaging patients in their home environment, as well as with clinicians’ extensive capabilities for providing care in the home, he told Hospice News.

Hospice News sat down with Walker at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver to discuss Pennant’s priorities for his new role, as well as the company’s visiting physician services.

What are your top priorities as you build this new role as CMO?

It’s a developing role. Pennant is an enigma in the health care system, because it’s not a top-down-driven company. 

We’re a leadership company, and we’re trying to build physician and nurse practitioner leadership in the hospice space. Part of our first steps in this was to develop the physician council to build partnership and leadership among the providers that work in the space. The other piece is the quality and compliance as it relates to physicians and nurse practitioners. 

We’ve spent a lot of time in the first few years of the physician council developing hospice medical director and nurse practitioner onboarding training that go from A to Z, including the basics of the regulations and [which patients] qualify, and how do you determine prognosis, and what is deprescribing and how do you navigate that. That’s been a big focus. Quality, compliance and leadership are a big portion of what we’re after.

What has your journey been like with Pennant?

So my journey has been a pretty long one. I started out with one of the first agencies at Pennant, the one in Boise, Idaho, where we’re based, just right at the beginning.

Then I kind of wandered. We started doing the house calls, mobile palliative care, geriatric primary care work. We started to develop that process in 2014 through 2016 with pilot programs. I started to visits at home and take my doctor bag and go sit on someone’s couch and talk through them how their health is doing, and that’s been a big portion of what I’ve done with Pennant over the past few years,

To me, the main thing is the perspective of what you see and experience in the patient’s home. It’s really difficult and different to sit in a clinic and see a patient and try to understand how to help them. You can prescribe and you can do the tests and labs. But being in their home and seeing how they how their life is, and seeing who they are, it changes your paradigm significantly.

Can you say more about the mobile physician program and where hospice and palliative care fits into it?

We have various forms of it. Our vision is to focus on completing the health care continuum and in the home space. My belief, strongly, is that palliative care is needed very early in a patient’s lifetime. The way we view it at Pennant is that the post-acute care continuum is still too siloed, and it still has too many gaps. So as we’ve designed our home visit programs, it’s been focused on what are those gaps and how we fill them.

Does a patient need palliative care, or do they need geriatrics, or do they need primary care? What is it that they need the most? The patients that we take care of are the elderly; they have multiple chronic conditions. And what we are really looking for is to fill that patient’s need, whatever it is.

If you go see the patient, and right now they need a little bit of management of their diabetes and their blood pressure, then we work on that. And if they say, “I’m really worried about this cancer,” that’s eventually going to take their life, then we need to have a goals-of-care conversation. You need to have a little bit of prognostication, and you need to have symptom management.

What happens is the patients are stuck between these silos, and there’s gaps. Our focus is trying to fill those gaps. 

Are the mobile medicine program’s personnel all physicians or other other disciplines involved?

Its a combination of physicians and nurse practitioners. Right now, we have a little over 60 of those. They work really closely with and are embedded in our hospice and home health operations, but we carve out this space where they see the patients before they enroll in hospice or home health. 

Can you say more about how that team interacts or coordinates with hospice and home health?

The way our company is set up, it’s really locally driven. If you’re familiar with the way we operate as a holding company, we’re really locally owned, locally driven. So we have a little bit of variation in these mobile provider programs, but generally they are embedded in home health and hospice.

A lot of times, for example, the nurse practitioner will do some of the face-to-faces for the hospice so that they know what’s going on with their patient and be able to intervene quickly to avoid hospitalization. This helps with those metrics that we’re all trying to meet by lowering the cost of health care and reducing hospital stays.

Usually the leadership and support for those providers and those practices are the same as those for home health and the hospice. They just become part of the team, and we feel like that goes a long way to help complete the care continuum.

How is it scaled currently? You have a big home health business, a big hospice business, where does this program fit in?

Over the last few years, we’ve done some acquisitions, just because some of the hospices that we have purchased have programs like this that do the same thing.

This last year, we acquired a group in Arizona that did a similar thing. There was a home health and a hospice with the mobile provider service program so we acquired that group. Then with our recent acquisitions in the northwest and with [Signature Healthcare at Home], a lot of the Signature groups have mobile provider groups that were along with them in a similar format.

That’s been part of it. Most of it has been driven locally by the leadership of the home health and hospice agencies. They’ve come to us as a resource group and said, “Hey, we want to do this. Can you help us?” We have an internal group in our service center that leads out in helping people build these programs and set them up and grow them. That’s been the majority of it, but we’ve had some of these acquisitions that have kind of accelerated the process.