B (3:39)

As the CEO, when this concept first came up, the idea first arose. Were you reluctant, were you a cheerleader for a brand change, name change?

A (3:52)

You know what, I was a little reluctant initially until I think we went through the process with and I listened to the stakeholders, which were employees, new and old donors, referral sources. So when I listened to everybody, I said, okay, it makes sense. I was a little concerned initially because you worry that people are going to be like, oh, who's that? I don't know who they are or some of the questions we got. When we did rebrand, did you merge? Did someone buy you? Are you going to be changing your mission? You know, all those kinds of things that we've had to speak to who over the last year and remind people, same organization, just a different name. We have not changed anything. So it'll take another year probably before people actually adopt Croix as us remembering who we were.

B (4:50)

Has it created any confusion? Is there anything about it that has been an important lesson learned for you that you would want to say to folks who are contemplating something as big as a name change for their organization?

A (5:05)

Yeah, you know, no confusion with the referral sources because we got so ahead of that, you know, from the beginning, I think one area that has become a big deal is even with patients and people that have seen our ads and listened to us on the radio and everything else. Were you bought by someone? Were your mission change? Are you going to be a different organization now because maybe you're a for profit national company, you know, because there's so many mergers and acquisitions that people get concerned. Were you bought by private equity? So I think that that was the big concern was, wow, is this now going to change the fact that you are so driven by the community, with the community, because our community is so good to us and hence we're good back to our community. That was a big concern for people. We still get those questions, Ray. So it's interesting.

B (6:03)

So you've had to reassure people that you are still the same.

A (6:08)

Yep.

B (6:09)

Been there for a long time. Going to continue to be there for them.

A (6:14)

Yes.

B (6:15)

You know, I'd love to talk with you, Renee, about leadership. That's the know the primary focus here. But before we do that, you are the, the leader of a, of, of a home health and hospice organization. You do a lot of different things, but I'd love to delve a bit just into home care, the home care industry. And there are folks out there who sometimes they'll hear, oh, home care, you know, mom and dad is aging. I want to get, you know, I want to hire an aide for part of the time. I want them to come in. I want to extend their time living independently and at home and, hey, maybe even some skilled care, nursing care if needed, whatever. And that's a thing. But your organization offers skilled care reimbursable by Medicare and others. Can you talk a little bit about your industry, what you do, and some of those distinctions from, for folks who may not be so familiar with it?

A (7:19)

Yeah. So you know, the services that we provide as a certified home health and hospice organization. To your point, Ray? Yes. If you're going to need services that are reimbursed by either Medicare or another commercial payer or a Medicare Advantage plan, there has to be what is considered a skilled, skilled care. And that can mean anywhere from you've had surgery, you need a nurse or physical therapy, occupational therapy at home, you've had a knee replacement, a hip replacement to gee, we need an overall safety assessment in the home and the physician working with your physician, because we do need a physician order. They do have to sign the orders for us to get reimbursed from your insurance. Gee, mom and dad, I'd really like a safety assessment for them at home and to see how they can remain independent, what services they might need and what adjustments they might need to their home. So those are the different. That's just simplifying it, Ray. And then, of course, for hospice, we have palliative care and hospice and palliative care is very confusing for people. So I like to say maybe you have a limited prognosis, maybe you have a chronic disease that you need symptom management for at home, and you don't want to be in and out of the hospital. It doesn't necessarily mean you're, you're hospice eligible. Right. But there's confusion around palliative care versus hospice. So we do work closely with our physicians and our referral sources to really understand how we can work with their palliative care physicians in the hospital to take these patients home and keep them home where they want to be. Because everyone really, truly, to your point, Ray, wants to be home. They want to stay home as long as they can, they might need some wraparound services to help them stay home. And that's what we do. So we assess what are the wraparound services you need. Maybe you need a social worker to come out and help you understand financially, because that's the other piece. So financially, what can you afford in terms of some private help? Because it can become costly. So what makes sense for you? Is it assisted living versus home? And what services do you need to safely stay home? It could be telehealth. So there's many different options. But that's sort of what we do is assess where you're at and what your goals of care are. How do we meet them, where you're at?

B (9:57)

Great. Thank you for providing that overview. It really is a portfolio of services that can be offered to folks in the home, which that's where folks want to be. We know that that's certainly where people want to stay as long as possible. So that's helpful. Now, you've been doing this for a little while and number years, as you said, more years than you care to mention. What has changed in that time related to care that's provided in the home?

A (10:28)

A lot has changed, Ray. So when I first was in home health care back in the, I don't know, must have been the 90s, there was a whole different, you know, Medicare changes their reimbursement model, if you will, payment model frequently. Right. So back then, one area that was first of all, people are sicker now than they were back then. Right. Because people would stay in the hospital, they would get the care and then they would come home. So people are much, much sicker now than they were back in the 90s. And we were providing home health aid services sometimes twice a day, and guess what? It kept people out of the hospital and people were able to die at home and we didn't maybe even call it hospice sometimes back then. Right. But they were part of our community and we would care from them till end of life. But we were able to provide way more, what I said to you before, wraparound services than than the payment structure allows today. So fast forward, there was many payment, different payment models instituted which, which change sort of the way that we deliver home care. Right. But what has not changed is the fact that patients still need and much more skilled care in the home and you know, coming home right out of the icu, coming home on IV therapy or different therapies that we never delivered in the home. So people are much sicker. We don't want them to go back to the hospital. So how do we do that? That's the big question today is how do we work with the other providers of care, meaning our skilled nursing facilities, rehabs and hospitals to keep these people home and out of the hospital. So that's really why we're expanding our palliative care program or limited prognosis or chronic disease, however you want to frame it so that these patients don't go in and out of the hospital. But it takes a lot of resources, takes, it takes money and education to do that.

B (12:43)

Sort of touched on this a little bit. But in terms of how it's changed over time, if you look up ahead, what are the biggest trends that are impacting organizations such as yours?

A (12:56)

Good question. Medicare Advantage payment model is so complex for our industry. And the Medicare Advantage increased penetration within, while I'm in the state of Massachusetts. Right. So, you know, I know it's different across the country. It's, you know, 52% below our direct cost. So for people that don't understand, it's really crippling our industry. Medicare Advantage is crippling our industry. And I think the challenge is the gaps. And the challenge is that we are the smallest piece of everybody's overall budget. So when you talk to the health plans they got, they have bigger fish to fry, right? They are looking at drug costs, they're looking at, you know, hospital cost. And the way our health care system is designed and the way the payment models are designed is counterintuitive to what you think the incentives are not, don't make sense in terms of quality of care and health care. Now, I can't solve that problem. But what I can say is we see the big gaps and trying to work with the payers, it's very difficult because we are the smallest piece of their budget. And they don't have the resources to say, hey, we can pay you in a different payment model, value based model, which is the model that Medicare pays in home health. A value based model, which, you know, I think it's a good model because, yeah, we should be quality. We should, we should have good, good metrics, you know, and be, and be rewarded for those. So that's, that's a big challenge for our industry going forward. I think going forward too. I mean, technology, yes, is a great augment 100%, but we still need people to care for our aging population in the home in particular, people that aren't able to use the technology and maybe don't have a caregiver that can support them with the technology that is A challenge. What I'm also seeing is we have more and more aging patients that are Medicare Medicaid, so dually eligible and cannot afford private wraparound services. But there's a shortage of caregivers. So even if you work with the elder service plans, they don't have the caregivers to support these patients. So we are sort of hitting a crisis in terms of how are we going to care for these people at home.

B (15:44)

I guess I'll ask only because it's such a big topic right now. But, but AI, you know, because you're such a high touch in the home service, you know, would you say AI is opportunity, it's a concern, or is it not so relevant to you?

A (16:02)

I think it's opportunity and a concern. So I think the opportunities with. I think it's relevant for sure, Ray. I think where there's opportunity is within the, the systems that we're currently using for our electronic medical record and documentation. Like how do we improve the documentation time for the clinicians so they can spend more time seeing patients and not so much time documenting due to the highly regulated, you know, highly regulated home health and hospice. All healthcare is highly regulated. Obviously the concern can be, you know, sensitive information, HIPAA making sure that patient confidentiality and in your protecting patients information is a concern when you're working with different AI companies. So a lot of different opportunities coming out in terms of potentially medical record and billing and different efficiencies you can find.

B (17:09)

Are you actively looking at those? Are you taking more of a approach?

A (17:14)

We are looking. We are actively looking at, in particular for documentation.

B (17:21)

Okay.

A (17:22)

Looking at different opportunities there. We are also looking at workflows and streamlining and you know, so, so we are, we're researching different opportunities. I mean, we're not leaping or jumping in. Was sort of watching some other people. How is it working for you?

B (17:42)

Yeah, yeah, Let. Let there be other canaries in that coal mine maybe.

A (17:46)

Yeah. Right.

B (17:48)

You know, just to go back a little bit to an earlier comment you made about Medicare Advantage and the fact that it pays 52% below direct costs. Listeners of this podcast will know that, that Medicare Advantage has been a topic here in the past and, and you know, know, would understand if they've listened to some of those episodes, one in particular. And I'll, and I'll put a link to that in the show notes. But Medicare Advantage is challenging not just for the industry, but as the conversation went in that episode, for subscribers, for patients. And so.

A (18:21)

Right.

B (18:22)

So, you know, there's the, the concerns have been aired and are noted. But that said, what would you say to someone who's listening to this, who hears the statement that Medicare Advantage is paying that far below direct costs and who themselves are facing very high health care bills, premiums that are going up, employer contributions that are going down, and they would just say, well, Renee, you got to reduce your direct costs. You're so expensive health care, what are you going to do? And maybe the only way to get you to listen is to lower your reimbursement. So you have to respond. What would you say to someone who thinks that?

A (19:04)

Right. Oh boy. Yeah. So the complexity of how we get paid in our industry, right? So if you think of the biggest payer is Medicare people over 65 and then you have your commercial payers, right? So our costs keep going up. All right? Every year our costs go up. Medicare threatens to cut us every year. But it does not keep up with inflation. It does not keep up with salaries and the cost of benefits that we have to provide to our employees. Not only that, we are very highly regulated. And what happens is you have to spend a lot of money to, to be in a value based program, right? Because you have to have all the staff and support to help you with education and training and documentation. And so to stay highly regulated, you not only need the infrastructure of people, but you need technology. And technology is very expensive. Now nobody's reimbursing you for technology, so no one's reimbursing you for technology. And, and they're not keeping up with the cost of your labor. And we don't have any opportunity to negotiate. So we can't negotiate obviously with Medicare or Medicaid, right? So we can advocate. So I do a lot of advocacy with the alliance for Care at Home and the Home Care alliance of Mass. We can advocate, we can support the data to show why they should be paying us a certain amount. But there's only so much money to go around. We, we don't have a big voice, right? So the big voices are pharma and the physicians and the hospitals. So our voices is, like I said, pretty small compared to them in terms of the budget. So what I would say to people is, here's your concern. If you, I understand the cost. It's a lot to sign up for Medicare AB and a supplement. You know, it's all good when you're not sick. Medicare Advantage when you're not sick and you're just going to the doctors and you're getting your appointments. But when you need care and you want to specifically go to a particular physician hospital rehab, you may be denied. So you have to look at the out of network cost. What's going to happen when you get sick and you want to go to the Brigham on Mass General and maybe that's out of network. We see access to care issues for patients. So many of the organizations are not taking in particular insurance. I know one organization we work really closely with in my region is not taking United Healthcare. So you know, for those patients that have a United Healthcare Medicare Advantage plan, they cannot access one of the biggest systems in terms of healthcare. So these are the things you have to think about. And when you're sick and you need certain it looks good because you might be getting like a hearing and vision benefit. But those benefits are really cheap to be honest with you. It's very cheap compared to if you have an out of pocket cost or a big co pay if you go out of network. So I, it, it's not a perfect answer Ray, but.

B (22:30)

Well, as much as none of us want to get sick, I guess this is, this is a buyer beware situation for subscribers who are contemplating this. And you have to, you have to project out into a future when you may have some health challenges. And unfortunately the, the, the advertising, the marketing around Medicare Advantage is very intense, pretty effective and it's, you know, it's a complicated decision and for those who are becoming Medicare eligible it feels like a no brainer to many people. And it's just, it's the easy, you know, the, there's a low bar to entry into these plans.

A (23:13)

It's an issue. It's true. Right. And I think the scary thing is, you know, for 15 years maybe, correct me if I'm wrong Ray, but the government's really been trying to. Oh yeah, get, get. They don't want the risk of Medicare.

B (23:27)

Yeah.

A (23:27)

So they would like to privatize it to have it, to have it run by the insurance companies. The problem there is that there's no regulation about how the insurance company uses those Medicare dollars for your care. So there's no regulation on the payment model or structure. There's no law or anything. You know, overseeing that. I think the only thing they have to do is show that they have, I don't know, good quality or something. I'm not sure what their metrics are but I do know they do not have any oversight or regulation over how the payer pays the provider, which is where it becomes sticky. So it what, you know, I did see a new, some new chatter about potentially the government Pushing auto enrollment for Medicare advantage when you're 65, which would be disastrous. Yeah, so we're. We're pushing back on that at the alliance. But, yeah, these are the kind of things, and it's basically just getting rid of that risk.

B (24:37)

Yeah.

A (24:37)

Yeah.

B (24:38)

Well, I'm glad that there are industry groups and consumer groups who are paying attention to this. So I'm glad you're pushing back. Please push hard. I know you have had a leadership role in the alliance and in industry advocacy groups. So thank you for that great backdrop as we sort of switch over into the leadership realm a bit here in this conversation. But there have been a lot of changes in the broader healthcare industry. Certainly there have been changes within home care, hospice and so forth. Many larger organizations have formed. Many of them are for profit. How does CROI Health fit in and compete in this new world?

A (25:26)

It's a really good question. Well, I'll tell you, there's a couple of things we do that we've been doing for the past 11 years, too. Is one thing that is really important for us is we do a lot of fundraising. And the reason we started fundraising back in the day was because we had a residential hospice house and we knew that was a charitable endeavor and it was most likely never going to even break even. Right. So we knew we had to start fundraising for that. And it's a great, great. The community just loves that it's there. And. And so we want to make sure that we add to that endowment so that it can be there into perpetuity. But it's very expensive to. To run. And also, the hospice house was not covered by. The room and board is not covered if it's residential. Right. So for people that can't afford room and board, we make sure that we raise money so that they don't have to worry about that. Right. Because we definitely want it just to be a charity within the community. So in doing that, Ray, when you talk about leadership, we are meeting with business leaders and also, you know, philanthropists throughout the region. And there is so much I've learned about. Well, first of all, the generosity of people is just incredible. But as a leader, when you're doing this kind of work, you need. You have to be authentic and you have to be transparent. So it can't be something you. I really don't know how you teach it. It's something that you definitely have to be passionate about. You have to be passionate about and believe in the mission. Right. But it's. It's so important to me. So I feel like I love to spread the message. So two things you're doing, you're raising money for your program. You're also spreading the message. You're educating people on what does palliative care mean, what's hospice mean, how do you access that, when do you call? And people get to know our organization. So when you talk about competing, you really do need to brand your organization as high quality, which we absolutely are and we work hard at. Like I said, it is an expense to have the infrastructure. But high quality, you want to make sure your patient engagement scores are five because you want to know that people will fill out those surveys which are, you know, have nothing to do with us. So they are definitely authentic surveys and that you're doing well. And if you're not, why. Right. So this is how we compete. We're also looking at what's a differentiator for us. So truly, one differentiator for us. In my region, not. I mean, this is stuff people are doing across the nation, of course, but in my region is no one else is doing primary palliative care in the home because it comes at a cost. Right. So our program, we're expanding where most people are not even providing palliative care services in the community, and we're working closely with our hospitals in the state to provide this for patients. And that's a differentiator. So you do have to look at some of your differentiators. You know, what is your brand and how are you going to expand that? And I would say anybody that's in nonprofit health care should be fundraising, you know, but it's, it's a. Definitely a time commitment from the CEO with your philanthropy team. So you have to think about that.

B (29:20)

So you. So, so the way David gets to operate in a, in an arena with a Goliath or Goliaths would be community financial support, high quality, high satisfaction, and some specialized programs, maybe some niche programming.

A (29:38)

Yeah.

B (29:39)

Is it working?

A (29:41)

It is working. It is working. It is. You know, you never know what's coming down the pike, but we are always looking ahead to what else do we need to do to support that. And is it, you know, do we move into maybe primary elevated geriatric care program or something with our physicians? Do we, you know, what else can we be doing? And you don't necessarily have to own something to be part of the community. Like, if you think about sort of the ACO mindset, you. You can be a preferred affiliated partner, work together, and it's a win, win for both. Right. Whereas you don't have to merge, you don't have to buy, you know, with nonprofit especially. Right. But because that's a big deal. Right? It's a big deal. And we do what we do. Well, I don't not. I don't want to be do what, you know, Social Health does well. The, Their emergency room, their icu, they're all the things we need to work with them on their internal palliative program. There's no. Why are we. There's no competing there, you know, so that's really what we're doing. Ray is expanding our affiliated partnerships, preferred provider agreements, which, with no financial risk,

B (31:08)

as the, as the CEO of a successful organization that has demonstrated some resiliency and has built up some durability. Is there anything that keeps you awake at night that worries you as you think about. As you. As you. So listeners aren't going to get the video, but you're smiling and nodding, so I'm going to infer that that that means that maybe you've had some sleepless nights.

A (31:38)

Many sleepless nights. I hate to say it, but if you're the CEO of an organization and you don't have sleepless nights, God bless, because there are many sleepless nights. And I think other leaders of healthcare organizations that I talk to all the time, they have sleepless nights. So you do have sleepless nights. You worry about. I mean, you want your employee retention, right? Like you want retention, retention, you want to recruit really good talent. But the patient, patient engagement, patient satisfaction is huge. And how are you going to break even? That's all you're looking to do, right, is we just want to break even. We're a nonprofit. Okay. It's really hard. It's really, really hard. With the structure of the healthcare industry today, it's just tough. Yeah. So I do lay awake. I do worry about, you know, future state and, you know, someday when I retire, you want to leave an organization far better than when you came. At least when I say far better, I mean, you know, expanding and growing and thriving and remaining viable in the community and particular Ray, one thing, when you're working closely with donors and you're so passionate about the mission, you need, you know, you, you have a sense of responsibility there because you're like, I'm promising that I'm going to be here and I'm going to provide this care in the community, and I'm going to make sure that this hospice house remains, and we're going to provide free care for people that, that make. I take that Very seriously. Yeah.

B (33:21)

Well, for someone who is listening to this podcast, who may be thinking, gee, I'd like to elevate within my organization and maybe someday lead an organization such as CROI Health, as they're mulling this, what advice would you have for them?

A (33:40)

Okay, I guess my advice would be this. When you're leading an organization like this or any organization, you really need to be a content expert. You need to be the expert, and you need to be able to identify and understand red flags. Even if you, you know, you might be getting the data you might be looking at, you have to have that intuitive sense to understand, because as you grow and expand and your organization becomes bigger, how are you trusting and validating? How are you validating what you're trusting? And I think that's where sometimes people, you know, you. You literally can't take your eye off the ball because it can become a slip, slippery slope. And leadership. You need to be a transparent, authentic leader. I would say that's the most important thing. And understanding that you don't think you're intimidating, but people, because of your position and your title, people are intimidated by you. So when you're asking questions, they're like, why is the CEO asking me a question? You know, that was a learning for me because I was a nurse. I did work in the organization and management roles, but never reported to the board and never was the CEO. So I was like, why are people nervous when I'm asking them questions? And you just realize with the title becomes people are nervous. And so you have to sort of say, okay, I'm just here for fact finding. I'm just here to, you know, understand what's happening. So, yeah, so, you know, you have to look at. This is where a coach comes in, Ray. This is where our coach comes in. I think if you're thinking about a role like that, as you're moving up the ladder, why? Ask yourself why? What is the why behind it? Because if it's for the title, if it's for the money, don't do it. It's got to be that you really have a passion for the mission and you want to grow it and expand it. And you're like, I'm so excited about the viability of this organization, Future State. I would love to do that. And that's kind of how I landed in this role was, you know, the previous CEO was very passionate about quality and education and care for patients in the community. Really cared about the community, and so don't I. So I feel like that was Sort of the driving force behind me. I did not. You don't always know what you're getting yourself into in terms of the other pieces, but it's a learning curve. But I would say for anybody that's embarking on that, you need a. You need a coach.

B (36:41)

Well, thank you, Renee. There's some very practical suggestions in there. Content expertise, being aware of the landmines, developing a discerning eye. But at the tail end of your comments, you mentioned authenticity, which has become sort of a hot topic theme on this podcast. It has been coming up a lot in the conversations I'm having with the people that I'm working with is folks are wanting to be true to themselves and to their vision and to their values. And this notion of passion for the mission, boy, I couldn't agree with you more. That will sustain you. There are peaks and valleys in a job such as the one you have, and there are some sleepless nights. But if you truly care about the mission and you can storytell that and engage your community and your board and your employees in the work of the mission, you can, you can, you can get through those valleys much better and, and, and more strong. So, so that, that really resonates for me.

A (37:59)

Yeah, no, it's so true. You can, you can and you get. Just as soon, you know, you feel defeated sometimes due to the structure of healthcare. I mean, it's not just my industry, but. And then you have some moments where you're like, wow, we are really making a huge difference. You know, the emails, the cards we get. When I see people and they say, oh, my God, you have no idea how. Thank you so much for the phone call, help guiding me through how I reach out for my loved one. I didn't even know that palliative care existed or I don't understand how to access hospice. That's when I'm like, okay, we really add so much value to people in their lives because let's face it, Ray, no one wants to talk about end of life care or look at, like, what do we do if we need hospice? No one really talks about it until it's really kind of a crisis. Right? Yeah. So for sure.

B (38:58)

I want to thank you for being on my podcast, Renee. Really appreciate it.

A (39:03)

Thank you for having me.

B (39:04)

CROI Health is a successful organization. It's an important part of its community, does good work. I think anyone who does some research into your organization will learn that pretty quickly. If anyone is interested in learning more about your organization or learning more about you, where would you direct them.

A (39:25)

Yeah. So our website is www.croi health c r o I.org and my email is R McGinnis M C I N N E S@croy health.org so email me. Put something in the subject line so I pay attention. I get a lot of emails and let me know if you have any questions. Happy to answer them.

B (39:51)

Well, I appreciate it. Appreciate you're willing to be accessible. You know, to the point about aspiring leaders. One of the things I've learned is that that makes up a pretty significant proportion of my audience, you know, based on what I've been able to gather from the metrics and the questions that come up in the comments and so forth, is folks who are wanting to have roles such as yours. And so I think hopefully they learned a lot from from you today. And again, I appreciate you being on my podcast.

A (40:21)

Yeah, thank you so much, Ray, and so great to see you again.

B (40:25)

Thanks for listening. Leaving a positive review and letting others know about this podcast will help a great deal. My mission is to help empower organizations that matter by supporting those who lead them. I offer coaching, mentoring and consulting services. You can learn more about me and my work@race bodoni.com.