For Amir Hamad, the newly appointed CEO of Tennessee-based nonprofit Alive Hospice, the future of the field is full of promise — if providers manage change effectively.

Alive Hospice, founded in 1975, serves 12 Tennessee counties with an average daily census that hovers around 420, with plans to grow. The organization also operates two inpatient units and provides inpatient palliative care at six hospitals. Under Hamad’s leadership, Alive also recently joined an Accountable Care Organization (ACO).

Hamad came to Alive from the hospital world, with executive tenures at Ascension Health and HCA Healthcare (NYSE: HCA), among others. Before becoming CEO, he also served on the board of Alive Hospice.

Hospice News spoke with Hamad about his plans for Alive Hospice, as well as the major headwinds and tailwinds facing the provider community in 2025 and looking ahead to 2026.

What are your priorities as you come into this new role at Alive?

It boils down to people, quality and growth. Those are my three things. I say people first. I am not a quote guy, but the one I hang my hat on is from Richard Branson: “Clients do not come first. Employees come first. If you take care of your employees, they will take care of the clients.”

You could say that hospice patients and palliative patients are your customers. It still translates. So for me, the people are the key component, making sure our staff are in a good position and moving that forward.

Then quality, nothing happens without quality. If you have an organization that is a robust organization, well funded, well supported, if you don’t have quality, then it’s all for naught.

So quality and then growth, hospices are going to have to grow. If you look at hospice, it’s had a very short life thus far. It’s moved pretty steadily. It’s been pretty status quo. Now there are opportunities to grow, but I don’t know how many organizations, at least the not-for-profit organizations, have really been on the forefront. At Alive, we’ve set the vision, and we’re going to move forward with that.

Really, it’s innovation. We’ve got to have frontline innovation. Look at all these new payer things that are happening — ACOs, [Programs for All-Inclusive Care for the Elderly (PACE)] programs. You look at organizational efficiencies. So innovation is really key.

When we’re looking at growth, we look at how we expand your services. That’s key for us. We offer hospice. We offer palliative care. We do pediatrics. We do Geri-Pal in long-term care facilities, and we do grief support. We have everything we need to grow. It’s just really identifying what component we put where and how to move that forward.

How do you intend to achieve that growth?

It’s balancing growth with the mission. We’re a highly mission-oriented organization, which I’m sure a lot of hospices are. Literally everything we do is based on that mission. And we continuously say that to make sure that we all don’t forget.

So for me, again, it’s the innovation; it’s the partnerships. Alive is the third oldest hospice agency in the country. We should be expanding services. I think a lot of people get really comfortable in what they think is appropriate size, but that’s taking away from the community in general. If you’re offering a good product, which we are, you should be able to touch as many people as possible. Now, does that impact your finances? 100%, right? But as I said before, we’re mission-aligned.

We’ll always make sure that our finances are where they need to be, but we do go above and beyond a little bit making sure that the mission is fulfilled.

What are the major headwinds you’re facing as you work towards those goals?

You have your general headwinds, right, financial, regulatory and ethical. Financial is going to hit all hospices. Hospice is still pretty new when you’re looking at health care in general. I think maybe the government’s trying to figure some things out.

Watching the news, you see some of these hospice agencies engaging in fraud. So that gives people pause. Do I feel comfortable giving you more money if there’s agencies out there managing through fraud? So for us, it’s making sure we’re setting a good example, making sure that people feel confident in the services we give, and making sure that they feel confident and that we’re doing it ethically and being trustworthy.

The government gave a 2.6% [reimbursement] increase this year. We’re seeing a little less than that in the Nashville area on the reimbursement side. So that’s challenging when you’re giving people raises at 3% or whatever agencies are giving. So we’ve got to figure out a way to be able to grow, to be able to fill that void. Volume always helps, but growth for us is going to be the key component, while keeping the mission front and center.

The other thing is the workforce. In health care in general, it’s the workforce. We’re recommitting and looking at schools differently. I think coming from the hospital side, this helps the organization here at Alive. Because I’ve been through this for years and have tried different things.

Some worked, some didn’t. The last hospital I was at was a large quaternary care center, and we had an over 50% vacancy when I got there. We were able to whittle that down to 20% in two years. You do that by thinking outside the box and trying different things, really mentorship programs and getting people in early so they feel confident and supported.

We are getting into schools. Thankfully, I have a lot of contacts at schools because of my last job, so I can get our chief nursing officer involved with them and catch people earlier. But from a staffing perspective, that’s always going to be a challenge. We need to retain our people, which we do really well here.

What are the biggest opportunities and tailwinds that you see in 2025?

It’s expanding the community-based services. We need to get into these long-term nursing facilities. We need to recommit to our home services. We are really good at what we do. So we should be showing people what we can do.

Artificial Intelligence is huge. It helps with efficiency significantly. So getting into that even more than we currently are.

Then there’s just strategic partnerships. Nashville has a large health care presence. Mainly, ascension has a significant amount of facilities. HCA has a significant amount of facilities, and Vanderbilt. With those three looking at the hospital side, partnerships are incredibly important.

I think in the past, we’ve thought of them as referral sources, but that’s just a component of what they do. How do we work better together to provide the community with a service?

Let’s try some things that maybe have not been tried before or have been looked down upon, and let’s make sure that it’s hitting on delivering for the community. Let’s make sure it’s delivering for the organization.

What do you foresee for a live hospice or for the hospice market in general, looking ahead to 2026?

Alive is just coming off of our 50th anniversary. So really, 2026 for us as an organization is recommitting, making sure efficiencies are in order, finances are in order, growth and strategies are in order, and quality. With that, we’ll be able to handle whatever comes.

We have the [Hospice Outcomes and Patient Evaluation (HOPE) tool] coming. HOPE is a change. It’s challenging, but we’ll get there. We always do. We’ve got to succeed. We will succeed. But people have to believe it and convey that down to their staff.

When you’re focusing on expanding services, embracing technology is important. That is key for us, and we’ve got to continue to double down on it. But I’m actually invigorated. There’s a lot more benefit than risk if you’re doing it appropriately. We’re going to make sure we’re identifying the opportunity and evaluating it as a team. This is not a top down approach.

That’s what I feel like 2026 looks like, just doubling down and taking the punches as they come, but knowing that we’re going to get through it and be even better for it.