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The Shift from End-of-Life Care to Building a Continuum-Based Approach
Andrew Molosky, President and CEO of Chapters Health System in Florida, is reinventing the future of community-based care. Under his strategic leadership, the organization has combined innovation and creative disruption to dynamically shift its position as the nation’s largest not-for-profit, end-of-life care organization into that of the leading community-based population health organization.
Positioned as an unparalleled bridge between traditional provider and acute care-led models, Chapters Health System has become the standard-bearer for similar models nationally.
Remington Report: Under your strategic leadership, Chapters Health System has expanded its mission and vision from a not-for-profit, end-of-life organization into a leading community-based health population organization. Why the change? How does this impact Chapters Health System’s growth?
Molosky: The change was really an expansion of the mission we’ve always served. Yes, it’s true, our roots are in end-of-life, but the real mission has always been a holistic, interdisciplinary approach to delivering the highest quality, lowest cost care in the ideal setting for patients and families. Given our exceptional track record of delivery for the past 40 years in this space it was only logical to extend that same innovative approach to care and thereby solve many of the issues facing our fragmented healthcare delivery system today. As a result, Chapters Health has grown both horizontally and vertically as we expand the number of services we offer and attract new member organizations into our family of companies.
Remington Report: One of Chapter Health System’s differentiation strategies is offering chronic illness management alternatives. This model expands end-of-life care to a far greater role in the lives of patients and their families. How is your organization expanding scope of services and innovative care solutions?
Molosky: The concept is rather simple in nature to explain but the feat here is in execution. Our cultural and operational underpinnings being rooted individualized care planning have perfectly set the stage to incorporate community health services, social determinants of health, and primary care in value-based designs. Using a matrixed approach incorporating home health, advanced illness management, telemedicine, social determinants of health, and primary care we have been able to move our chronic illness care further upstream delivering the low-cost, high-quality experience that has for so long been the provenance of hospice to our patients, families, and communities.
Remington Report: Is Chapters Health System’s community-based population health model scalable? In other words, could it expand nationally?
Molosky: The inherent value proposition of Chapters is precisely what makes us capable of delivering our programming at scale whether regional or national. We have built Chapters to embrace the philosophy of all healthcare being local while programming and economies of scale can be more far-reaching. In an era of network adequacy and strong fiscal headwinds the ability for an organization like Chapters to expand either organically or through partnership and incorporation exists so strongly because of our unique approach to care design and financial success.
Remington Report: Your organization is investing in the development of continuum-of-care services to include home health, palliative care, hospice, durable medical equipment (DME), and pharmacy services. The approach is patient-centric and provides integrated care solutions. The benefit to patients and families provides a holistic approach in their care. How do your strategic partnerships with ACOs and payers benefit as well?
Molosky: The unique nature of our continuum-based approach is one of the rare wins in business where you can truly do the right thing for everyone and come out with benefits for all parties. By focusing on the unique care plan needs of each patient or the unique pain points of each payer or partner we can employ the solutions that bring maximal return while reducing waste and redundancies that are created when using the fragmented healthcare system at large. Think of it this way, when you truly are listening to the patient and what they really want, you avoid using or providing things they don’t want. That part is easy right? The value to our payers and partners lies in listening to them the same way. If their primary goal is member engagement, we customize our approach to meet that need. If their need is emergent care reduction, we build our response accordingly. Having the full continuum of services at our disposal is the key. When you don’t have that you’re forced as a payer to rely upon multiple organizations who almost certainly lack alignment of incentives and goals.
Remington Report: How is Chapters Health System aligning traditional and emerging payment models?
Molosky: I’m often heard reciting the old line “if you’ve seen one model, you’ve seen one model” and I think it applies here as well. I think the answer lies in the realization that what makes emerging models successful is an ownership mentality. The very premise of risk-based medicine is that you do what is right for the patient so that the outcome is optimal, and your success is to. That very basic concept provides 80% of how you align concurrent models of thought or business. There will likely be a great deal of individualization or customization as you expand your business but having highly engaged employees, a strong company culture of care and accountability, and innovative spirit will be key as you look to bring your company along on the journey from traditional to emerging. It is also key to remember that it is a journey that is never complete. What was emerging last week is traditional next week. It’s always going to be a balancing act but that’s the fun part.
Remington Report: Share with us three key strategies important to the growth of community-based organizations.
Molosky: The most common question Chapters Health System gets is how to bring this sort of approach to our market. Where do we start? The answer, while very straightforward, does require a great deal of organizational planning. The top 3 strategies I would encourage anyone considering a leap of this magnitude would be:
- Clearly define your organizations goals. You can be anything you want, to anyone you want really. However, the steps to getting there are often complex and sophisticated. Have a very clear set of end goals in mind.
- Define your build, buy, partner strategy. There are an exceptionally small number of organizations that have ownership of all the entities and capabilities needed to execute a plan of this nature. Having a full continuum – whether owned, managed, or relied upon is key.
- Invest in your communication plan. Having an understanding and buy-in from all the key stakeholders in your organization is tantamount. You will be doing something very few others have done. It will lend itself to excitement and anticipation but also confusion and potentially hesitancy or fear. Managing that early on and assertively will be critical to maintaining the momentum needed for long-term change.
Produced by Remington Report Custom Media Solutions
About Chapters Health System
Chapters Health is a progressive leader in delivering innovative risk-bearing programming, hospice, palliative care, home health, durable medical equipment and pharmacy services designed to improve the lives of those affected by advancing age and illness. Chapters Health has redefined its position as the nation’s largest not-for-profit, end-of-life care organization into that of the leading community-based population health organization touching the lives throughout Florida. Having developed a team member-led culture focusing on quality outcomes over volumetric throughput to drive profitability, Chapters Health has reinvented itself as the optimal choice for the provision of low-cost, high performance chronic-illness care.
This combination of innovation and creative disruption has dynamically shifted the healthcare landscape in the Florida markets in which Chapters Health serves and has become the standard-bearer for similar models nationally. Through incorporation of predictive analytics, risk-modeling, geriatric case management and social determinants of health, Chapters Health has become an unparalleled bridge between traditional provider and acute-care led models and that of the community space. Chapters Health is a proud recipient of the Great Places to Work in Aging Services designation for the third year running. To learn more, visit chaptershealth.org.