Hospice Savannah CEO: Nonprofit Providers Collaborate to Survive

To weather continuous changes in the health care space, nonprofit hospices see an increasing need to work together.

A trend is growing in which nonprofits form collaboratives in pursuit of greater efficiency and bargaining power with payers. Most recently, a group of five providers in Georgia and South Carolina formed the Southern Care Collaborative.

Collaboration creates a pathway to growth and long-term viability, as well as helping to ensure that patients have access to hospice, according to Kathleen Benton, CEO of Georgia-based Hospice Savannah Inc., a founding member of the Southern Care Collaborative.

Benton recently spoke with Hospice News about the market forces driving these collaboratives and the challenges and opportunities that come with them.

What are some of the primary drivers that pushed the collaboration forward into existence?

When I started as a leader in the industry about four years ago, I was floored at how many hats a hospice leader in the nonprofit side often has to wear. It’s very hard to proactively lead when you are in the weeds just keeping up with patient care, ongoing staff education and shortages, and keeping up with regulation and reimbursement changes.

I saw a need to get us out of the weeds and in a different direction. The future is collaboration if we’re all to survive. That survival is made up of multifaceted paths.

We need to survive fierce competition from private equity and capital venture firms diving into the hospice merger and acquisition market in new heights. We’re up against billion-dollar companies that can throw millions into their budget for compliance, staff recruitment and operational efficiencies. We’re in a different world than they are in affordability and sustainability.

The terrain in hospice is distinctly different as far as regulatory scrutiny is concerned as well. We need to stay well-informed about the layers of regulation. For larger hospices, they may have a compliance team or officer in charge, whereas smaller hospices might have their leadership share this role. But the kind of regulatory scrutiny hospices face is too big for dual-tasking.

No matter what ebbing and flowing hospices have seen or what changes have come down the pipeline in the last decades, what is happening now in the next five years in health care is very, very different. It’s a new world that will be perpetuated by an aging population. We didn’t have a dominant aging and ill population in the United States but we do now.

This is a resource issue of finding a different way to afford providing care. We’ve grown to see that collaboration is needed, and we’ve had our eyes wide to it.

What were some of the largest snags along the way to forming this collaborative? What caused these challenges?

What I found challenging in the beginning to starting this collaborative was just finding others with the same mindset. Not everyone feels comfortable being transparent all the time as you need to be in a collaboration.

There needs to be an openness and letting our defenses down to keep our eye on the ball of the future of good quality hospice care. That’s what matters most in the end, is the integrity of care for the patient. It’s not about our individual legacies or identities; it’s coming around the table, putting down your guard and pushing yourself into something new.

It’s difficult to step outside the norm and embrace change and transparency. It’s even more difficult to do that during COVID when you have so many fires to put out daily. But we built this together despite the pandemic, we couldn’t just put it all on hold and press the timeout button.

The challenge is figuring out where to go from here. As we grow, more cooks in the kitchen can be a challenge. When you’ve got a lot of leaders in a room, it can be both positive and negative. There’s different structures, different workplace culture and different things that help each succeed. But forming what these collaborative relationships look is driven by the same goal that keeps us on track, the same mission to give quality care. We’ve really worked together on that goal.

What are factors that could make or break collaborations? How are you addressing these?

What makes or breaks it is having that common goal and humbling yourself at the table. It’s the ability to come in and candidly talk about, for example, our quality scores and what was down versus what needs to improve. Seek out recommendations versus shying away from talking about this.

The other thing is believing that there’s going to be real, future change. It’s being motivated to make hard decisions, make major changes and make a point to show up and prioritize discussion. That’s really important and crucial.

You also need to have your board with the same mentality and not keep them at arm’s length, but bring them along into the collaboration. They need to understand the need for looking different and investing in a collaborative effort rather than acting in a silo. It might be rebranding as you come together and represent yourselves differently. You’re also investing in a future structure that maybe will house the back-office differently than before. It’s recognizing how that saves money and builds up employee support.

Leaders and stakeholders have to understand that value-based care will impact hospices in some way. Today it’s collaborating, tomorrow it will be approaching payers and learning the payer world, which hospices never really had to do with reimbursement so Medicare-driven. We didn’t have to work much with commercial payers, but change is coming.

In tomorrow’s challenges, there’s strength in numbers.

What are some of the biggest opportunities on the horizon for hospice collaboratives?

When you’re learning from other organizations that are as patient-driven and family-focused as you are, the collaboration on innovation is awesome. It’s the opportunity of what we can give one another, and that’s ideas. With shared innovation, the sky’s the limit for what we can really do for patients and families at the end-of-life.

Hospices together are so powerful for the future needs of health care.

When hospices come together and collaborate, that’s where potential for betterment of quality-driven health care to serve a deficit comes in. Communication is that deficit. The missing link in health care is communication, and we can be that for anyone going through an illness. We can be the captain of the ship to walk families and patients through their experience and help ill people. We keep it all wrapped up in a bow so they know what’s going on, and the need is tremendous for hospice to grow in the health care system.

What are some areas in which the collaborative is currently banding together to invest?

We’re investing in heightened technology that will include business analytics, quality assurance, patient and staff education and drive better efficiencies. Technology is a wave in health care, but if you’re smaller it’s not what you can put your money into.

One of our collaboration’s overarching goals is working towards clinical integration. We’re looking for key areas of quality that we can standardize. We pulled together and bought an education tool that has some protocols and policies built in that will help us all across the board in terms of functionality and staff training. Other staffing areas we’re looking at are investments in onboarding, education and data platforms linking our palliative and hospice staff together.

We also went in and are working with the same compliance expert to create a compliance plan for us all. We’ll all be following the same template of compliance and utilizing the same tools for self-auditing to gather best practices. We’re setting the bar high for ourselves from a compliance standpoint.