As president and CEO of Visiting Nurse Health System, Dorothy Davis is responsible for an organization that provides home health care, community care and end-of-life hospice services to more than 7,000 patients and clients each day throughout greater Atlanta. Under Davis’s leadership, Visiting Nurse Health System has revived its mission, diversified its service mix and driven ancillary revenue across multiple key areas.
Through the Fast Forward Series, Davis shares insight into the next three years of home-based care. In addition, she provides a perspective on Visiting Nurse Health System’s shift from transactional to value-based care models and talks about her plans to leverage AI.
HHCN: What was the career path that led you to your current role?
Davis: This will probably be my longest answer because I am such a non-traditional CEO. I don’t have an MBA, nor did I have any aspirations to become a CEO. I did have a formative career moment early in my career, and that’s the signature story of my career.
I was introduced to a health system CEO back in ’99 who spent his career as an executive in acute care systems — HCA, plus a couple other health systems. We crossed paths because he was interested in working more collaboratively with public and affordable housing.
Since my family’s business was in affordable housing and my first job was in a senior living community, he said, “I want to take you to dinner and pick your brain.” That opportunity landed me an invitation to a meeting he was hosting with a federally qualified health center in New York City. After that visit, he said, “I’m want to hire you. Are you interested?” He saw the entrepreneur in me, which is much more in line with my career orientation than the CEO track. I love solving problems.
At what point did you end up in your current role?
I ended up becoming the interim CEO when the previous CEO left rather unexpectedly. I wasn’t a placeholder, though. The board named me permanent CEO about four months later in 2019.
Fast forward: Where do you see yourself and your company three years from now?
Part of our evolution is restructuring and positioning our business, then creating the platform for success and growth. That’s what I’ve been doing for the last two years, even in the midst of COVID. We are preparing to compete in the metro market by reevaluating our entire post-acute health system.
Right now, we look at each service line as independent because the compliance and regulatory needs are different. Each line of business is very different, and yet everything we do is keeping folks safely at home. Our board is focused on how to remain relevant and competitive in a very fast-changing market, particularly dominated by Medicare Advantage plans, as that growth has really been huge in our market.
We’re aggressively bringing offerings to our health system and payers by leveraging our case management, where we have 4,500 dual-eligible members on long term support as well as our private-duty [business].
Looking at the next three years, what do you think will be the most significant challenge for your organization during that time?
It’s going to be how we understand care shifting from a transactional model to a value-based model. Rapid change is difficult when you’re in this hybrid transactional-value model where things are evolving very quickly.
The scopes of our work are quite different, so we put a lot of focus on understanding patients’ clinical needs and in order to bring more value to the table.
What do you think will be the most significant or the greatest health care disrupter in the next few years?
I think it will be the continued innovation of payment models and managing patients at home. It’s an exciting time, but payers and new models will be plentiful. Keeping up with who’s in the market and how we perform as a community-based health system with multiple lines of business is critical. It requires a lot of leadership and consumption of information to understand what’s happening in the industry.
As a not-for-profit that has been supported by foundations for 75 years, a big part of our mission is to support the most vulnerable populations in our community. Continuing to educate our philanthropic and donor partners on what that means in the changing healthcare landscape is going to be critical.
What do you see as the most exciting economic or bottom-line opportunity?
I think it is the changing payment models and the opportunity to leverage our entire and unique distinct health system by orienting it towards the community. I think that’s an exciting opportunity for Visiting Nurse Health System because we have a diversified service offering and can provide different services than some of our major competitors.
What do you foresee as the greatest technological advancement with respect to your business?
For me, it’s understanding how to infuse our delivery model with AI so we can determine services and frequency to drive down cost. That’s not something providers are particularly great at, but payers are very skilled when it comes to understanding risks and being able to quantify and stratify large populations and risk pools. Taking a page out of the payers’ playbook and infusing it with our delivery will have a significant impact. It starts with understanding what platforms we need to to generate better information and develop intelligence around the key drivers of success in the patient journey.
When I previously worked with primary care, I would discuss frequency of visits with one of our house call partners. In the primary care world, providers with a Medicare Advantage model are starting to understand frequency. In the post-acute and home health spaces, we need to be proactive in using intelligence and data to help determine frequency.
What do you think will be the greatest social influence on home-based care over the next three years?
The aging workforce and ability to grow as an industry are my top two. We’re in a people business. Those are the things that pose the greatest challenges over the next three years. How do we orient nurses and other disciplines to come into our business and contribute? How do we train nurses to understand home health and hospice? There’s often very little education in the clinical settings of our businesses. That’s something I think Visiting Nurse will continue to focus on. We need to partner with our nursing schools and our social work schools to provide an entire care-based view of what our work is.
What I find in talking with some of our employees who love our work is that you either love it or you don’t. People aren’t halfway in, halfway out. It just makes sense. They love the work, but we do not have enough nurses. When I look at our aging workforce, especially some of the nursing data in Georgia, it will have the biggest impact on our business.
What consumer product or service do you think will have the greatest impact on home-based care over the next three years?
I think Medicare Advantage is by far the most consumer-driven decision. Do they fully understand their benefits? I equate it to when I go buy a car, or when I bought a home, because I had to understand the pros and cons of that decision. The consumer decision is often very new to folks and they don’t weigh all of the factors. I think consumers and particularly caregivers will get smarter about these decisions.
Across our entire continuum, consumers, much less very well-educated health professionals, typically have a very narrow understanding of what we do. At that moment in time when someone is referred for care, or somebody chooses Visiting Nurse for whatever reason, they don’t necessarily understand the decision they made when they chose a Medicare replacement product. Past the first or second level of a decision, many consumers don’t think about all the downstream impacts. We have to be an educational partner for our patients to help them understand what their decision does or doesn’t provide.
Complete the sentence. Three years from now, I hope care delivery will be …
More person-centered and at the bedside. We’re combining very good health data with personal beliefs and values into care planning.
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