Home health providers of all shapes and sizes are currently taking a good, hard look at themselves in the mirror.
For the Atlanta-based Visiting Nurse Health System (VNHS), that self-reflection has meant redefining relationships with payers, reprioritizing internal operations and recommitting to talent acquisition, according to Dorothy Davis, the nonprofit’s president and CEO.
“In the business of taking care of people at home, we’re not a large-scale provider like some of the others in our market,” Davis told Home Health Care News. “How does a small, regional provider like VNHS compete? What are the distinct advantages we have to leverage and offer something to the health care landscape, to our patients?”
Established nearly three-quarters of a century ago, VNHS is a mission-driven, diversified home-based care provider with annual revenues typically above $60 million. The organization has a patient census of about 6,500 across its service lines.
“Who we are today — and pretty much since I have been CEO — is a home health, hospice, palliative and private-duty provider,” Davis said. “And we have a Medicaid waiver population that we serve.”
Davis officially rose to the CEO role in 2019, just a few months before the COVID-19 pandemic began to reshape post-acute care in America. Before taking over as CEO, Davis served as vice president of strategy for VNHS.
Before that, she helped Tenet Healthcare (NYSE: THC) build, market and operate a care coordination service line. Davis is now working to bring that population health experience to VNHS as she charts the nonprofit’s future course.
“My background really has been, for most of my professional career, spent working in the aging field, particularly working with what is now kind of the buzzword of ‘population health,’” Davis said. “I do not have an extensive home health or hospice background, but I do have a real passion and love for health systems that support folks in the home.”
Restructuring for the future
As CEO, Davis immediately kicked off a “ground-up” restructuring process to reevaluate everything from debt and finance structuring, to VNHS operations and personnel. As for that latter focus, that has already translated to a drastically different management team, with 50% of the team newly hired in the past six months.
“My focus today is on talent,” Davis said. “Talent directly below me, but also the recruitment of nurses.”
Restructuring has additionally meant closing an in-patient hospice unit to better direct VNHS resources. In some cases, it has likewise meant walking away from existing contracts with payers.
Prior to Davis taking over, VNHS had a fairly large base of commercial patients. Today, it is focused on its fee-for-service Medicare business and delivering care to Atlanta’s especially vulnerable populations.
“Our mission is to take care of indigent and Medicaid patients,” Davis explained. “Our mission is not to underwrite the Humanas, the Uniteds, the Cignas, the Kaisers in our marketplace. We had a very large commercial base of patients in home health and hospice, so I’ve reset and re-engineered, if you will, our payer relationships.”
Instead of scrambling for commercial business, VNHS has been strengthening its relationships with other community-based groups and nonprofit health systems. Atlanta has a deep and rich ecosystem of such organizations, Davis noted.
VNHS formed several new referral relationships during the public health emergency, partly thanks to its dedication to caring for COVID-19 patients when other home health and hospice providers weren’t.
Davis and her team are now turning to those relationships for growth.
“We’re kind of emerging from the last 13 or so months, having served more COVID patients in Atlanta than other providers,” she said. “Now, it is being able to maximize those relationships that we have served well for COVID and having enough staff to grow from those new relationships.”
Emerging from crisis
Since last spring, Georgia has had nearly 1.1 million total COVID-19 cases and over 19,600 deaths, according to data compiled by The New York Times.
Despite the challenges, VNHS made the decision very early on to care for COVID-19 patients. In fact, based on metrics gathered by analytics partner Trella Health, VNHS has been among the most active providers for coronavirus-related care.
“I communicated to our management team and to our partners early on that we’re going to do the hard work, secure the personal protective equipment (PPE), which for a small, regional player is challenging,” Davis said. “But we were able to secure those supplies, survive and make sure our employees remained safe.”
Currently, roughly 90% of VNHS hospice staff are vaccinated against COVID-19, according to the CEO. More than 70% of the organization’s home health workers are vaccinated.
Not too long ago, it looked like Georgia might develop into a U.S. COVID-19 hotspot, but that never really happened, Davis said.
“Especially for us, post spring break, we were expecting a surge,” she said. “But we haven’t seen it. We haven’t seen it in our employees. We haven’t seen it in our patient numbers.”
With the pandemic increasingly under control, VNHS will continue to seek out qualified in-home care professionals to help meet skyrocketing demand. During a recent press conference hosted by LeadingAge, Davis explained how her organization had to turn away more than 500 patients in four months due to labor shortages.
“From a competitive perspective, I consider this to be our biggest day-to-day combat, understanding and measuring the amount of business we turn away simply on that supply-demand dynamic,” she told HHCN.
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