Charles: 00:00
I look at the lens a little bit differently – AI shouldn't be looking to solve problems. It should be able to amplify what you do really, really well and then make it more efficient, more proficient.

Tony: 00:13
Welcome to another edition of Transcending Home Care, Transcend's podcast focused on growth and current events in the home-based care space. Recording this on February 6th from the freezing tundra known as the Mid-Atlantic at the moment. And I've got a great guest today ... Charles McDonough, who is the CEO of Delaware Hospice, covering the entire state. Charles and I were both at Home Care 100, which was last week for us, might be a little bit more than that for those folks listening to this by the time we get it published. I hadn't been there in over a decade. I had been there once when I worked at NHPCO to talk through some advocacy strategies on the hospice side at the time. I thought it would be good to get some rapid reactions. Charles is very well networked in the space. He's worked for a number of providers across the home-based care continuum. And of course, in his current role at Delaware, he's keeping his finger on the pulse of a lot of this as well. And not everybody can go. I'm not trying to spoil Lincoln Healthcare leadership's secret sauce, but there were some takeaways. There were some things that caught my attention. And I'm sure the same is true for Charles. So I kind of just wanted a thought partner and someone to spar with about the conference, about who was there, about what was talked about, what wasn't talked about. And you know, kind of just talk shop about it. So, you know, with that, Charles, welcome to the pod, my friend.

Charles: 01:53
Hey Tony, appreciate your having me, brother. Good time.

Tony: 01:56
Yeah, it was. It was a lot of good networking at the event and some interesting presentations besides. So before we get to the presentations, I guess the first question I kind of want to dive in with you on is what were the conversations you had in the hallways that maybe were different from some of those sessions? Like what was the vibe outside of the actual presentations for you?

Charles: 02:21
Yeah, that's a great question. Home Care 100 is one of those really interesting events that everybody gets kind of stepped back from the day-to-day. We all compete within our markets, right? And really get to sit down and talk and have honest conversations about plaguing it, what's plaguing us? And, you know, this year wasn't really any different from the normal, except that I think there was a lot more energy coming out of it. And, you know, we talked about a lot of the things that were on the main stage, and they're always full of big ideas, big tech, information, all these models. But when you step outside, it's kind of like, okay, this is great. How do we go get it all done? Right. We all have all of these initiatives going on in the day-to-day. We're trying to bootstrap it together just to make sure we can get that one next patient through. And actually had a conversation with a colleague of mine at one of the coffee stations and say, we're talking about all of this future. How do we do it? Right. And for me, it just kind of clicks. And somebody else leaned over is like, I know, right? Is that we're talking about the big data imperative, we've got all this information, but how do we turn that cause and that idea into action? Right. And so everybody's talking about staffing strain and burnout and you know, you've got innovation and bandwidth. And so that's really, I think, a lot of the back and forth that happens is why we all get really excited about how we move this forward. The heart of conversation is really like, how do we move forward with the team that we've got? Because, and you know, Tony, I've said this to you before. There's just not enough health care for help care, right? And how do we migrate from what we're doing today as sick care into health care? Yeah, which I shamelessly stole from Dr. Oz that he said several weeks or months back, but it rings true, right? Is that there's just not enough to get it done today. And it's trying to keep our teams focused without having all the shiny objects and shiny swirls, if you will, cloud our day, which is, you know, really important as well.

Tony: 04:19
Yeah. Another way to frame that up, because I agree completely, is the big ideas were all there, and that's a great place for them. It's good to step out of the day-to-day, like you said, but even in an age where tech is accelerating, and we're gonna talk about AI, I have a lot of thoughts later in the podcast to get to about that, but change management is still king, right? We are it, the product is the people in home-based care. Tech is gonna augment that, it's gonna help us make better decisions, it's gonna help us prove our value to the 800-pound gorillas upstream. But AI is never going to be able to. I made this persona in my head, Charles. And maybe you and I talked about this. I'm not sure if we have since the conference, but "Beverly." So I have this persona of Beverly. Beverly is a 62-year-old hospice nurse who has been doing hospice for 40 years, and she's tough as nails. In my head, she smokes a cigarette. Maybe that's pejorative, but she's seen it all, and she's heard a million times about a new EMR that's gonna save her time. She's heard about patient care updates and how we have to change focus. And she's dubious, right? Color her cynical, she wants to take care of her patients. She's been through this a million times where there's some new initiative, and then six months later she never hears about it. One of the takeaways for me is that I don't know that we've ever done a great job communicating to the Beverlys in home-based care. But none of this that the larger healthcare system needs from us is going to work unless we're more intentional about what Beverly needs versus what we saw in Arizona, if that makes sense.

Charles: 06:12
It makes a ton of sense. In the earlier years of my career, everybody gets super excited, really energized, and there are all these new integrations and all these things. And a lot of times, the big focus is, okay, how do we reduce the administrative burden? How do we make sure that we've got our billing compliance and our charting compliance and all these things as it relates to the regulatory initiatives? But to your point, getting so excited and pushing these items out, it just creates more work for Beverly, right? And so for so many years, that's been the focus is that how do we make it work for the regulation? How do we make it work for the machine? But oftentimes the frontline individuals, whether it be the med tech rooming a patient or you've got the aide in the home trying to identify all the things and then trying to coordinate all this care. And then you get documentation regulation come around with all these standardized sets, which I believe can further healthcare, but doesn't make it any easier for Beverly, right? She goes, what about me? Like, how does this help me, right? How is technology not going to make my life harder? Because I think to your point today, it's not been seen.

Tony: 07:24
Yeah. 100%. Charles, you've been to Home Care 100 very frequently. Was there anything that felt different this year above and beyond the implementation that you just mentioned?

Charles: 07:41
Yeah, I think the big thing that came out of it this year is, year over year we talk about the big imperative, and there's usually big buzzwords throughout the year. But as I was sitting there, we were watching one of the sessions, and it was about intelligent home-based care. What really resonated to me about those speakers is that it kind of energizes, is it was really pointed out that we're not gonna do this if we don't do it together. Because everybody's fighting, not each other, but trying to get the next initiative, the next thing. We're all trying to beg, borrow and steal. And so, how do we create that more longitudinal piece upstream and work together so we complement the healthcare process versus just trying to go complete the healthcare process. And I think that was a big takeaway for me this year on what I got from the group was that really nobody's got this entire thing figured out, even though years past we've kind of talked about it, we've kind of thought about it, but really breaking it down and how do we solve the problems intelligently together that have been plaguing us for years and breaking down those silos that we can actually go get those touch points in, even just a week after the conversations have continued in that exact framework. Hey, I know you do this, we do this, can we help each other? And it's the first time in a while that I've seen that type of shift come out, outside of being one of the national big box players or a national payer or one of the national investment groups out there trying to make it work because if you're not, you know, half a billion in revenue, right? It's harder to get at the table and work those things out. So it's been interesting to watch that work at a smaller organization and have those people still continue to reach out and navigate how do we make this whole thing happen?

Tony: 09:34
Yeah. The underscored point for that, there was a a series of presentations by the payers and the health systems, I want to say on the second day. And maybe one of the reasons that the conversations have continued about we have to figure this out is because there was definitely a moment of some humility. Home Care 100 is where the biggest players are, by revenue, as you said. But the biggest player, I don't know, you're Gentiva, for example. One of the biggest home-based care platforms out there, is 2.2 billion in revenue per year. That is less than Christiana Health System in Wilmington, Delaware. That one hospital system, I want to say, when I was at Accent Care and I was reviewing some of their numbers is maybe like 3.5. And so one of the presenters actually just was like, this is all very important and it's gonna lead to better outcomes and it's gonna save the system money. You also have to understand it's also just not big enough for the larger healthcare system to quite care about day-to-day. We're all about proving our value. We in the home-based care community are like, we can save tons of money, better outcomes, lower costs, higher quality. It's maybe 2% of what a health system or a payer is thinking about in terms of their global day-to-day operations. And I think there's a little humble pie and a little bit of .. okay, the only way we can do this is if we all band together. Maybe that was part of the reason why coming out. Charles, let's talk AI. I have some thoughts, but I want to hear yours first because it's been a buzzword, it's everywhere these days, it certainly was at Home Care 100. Talk to me about that.

Charles: 11:44
It's interesting because every year it seems like there's some new widget and we slap AI on the label, and there's no doubt that there's a ton of innovation out there, there's a number of pilots that are happening, but that's not really, I think, where AI is going to be applicable. There's always ... how are you going to solve all these problems? I look at the lens a little bit differently: AI shouldn't be looking to solve problems, it should be able to amplify what you do really, really well and then make it more efficient, more proficient. We've seen everything from ... we're tired of the old school-based EMRs, so let's use AI to create a new one. There were three or four of those at the conference. I'm all about let's try to be innovative and break the mold. Or there's the documentation assist support, and then you've got Ambient, and you've got all the different things. And while there are so many different flavors to it, I think the mission and the vision of what we're talking through here is I'm gonna take it back to "Beverly" for a moment. How do we use this to empower Beverly to amplify what Beverly has done well for 40 years, and then teach that to the next generation so we can continue to make it happen. And so I think that there's a lot of AI out there that is trying to solve problems, and there are a lot of barriers that we deal with on a day-to-day basis, whether it be staffing availability, getting the coding right, making sure that all of the physiological data makes sense, and we're making clinical decision support. But how do we get that back in front of Beverly? I think that there's sometimes this misnomer of, hey, we're gonna go do this and solve all these problems and it's gonna cut a lot of expense out of your organization. That's not the way I choose to view it. It's how do we get it back to Beverly and how do we can reduce steps for Beverly so Beverly can spend more time at the bed side and really just try to navigate through all of the muck that comes along with it. Because at the end of the day, innovation and pilots and all this other stuff, that's not the hard part. Anybody can do a pilot. It's infusing that with a steely-eyed conviction in your workplace so that you can scale it and have it become a daily part of operations. Because if you don't, it's never gonna stick. And so that's where I think with all the AI buzzwords ... it's on my phone, it's talking about investments, it's in my kids' lives, it's all over whatever social media platform you choose to use these days. But how do we amplify what we know works well in healthcare and then reduce all of the other noise around it that we've created in this process?

Tony: 14:30
Interesting. I don't disagree. I do think the AI buzzwords are strong. I think the hard part will remain the change management and getting it back to Beverly. I think where I see it a little bit differently, the amount of cash that is being invested in AI that we hear about, like at the stock market level. Just like what OpenAI is doing, what Google is doing, all the other frontier models is making it so cheap and fast to innovate and that came to home care and hospice this year. These guys can stand up a company on the backs of the larger investments and use that infrastructure to bring a product to market so quickly. And I'll get to what you were talking about Beverly in a second. But there was this moment, and this is a marketing and growth podcast so I'd be remiss if I didn't mention it. There was some guerrilla marketing at Home Care 100 that was next level. So for those who weren't there, an AI company literally rented a biplane that you can hang banners in back of and flew it around the resort for about an hour and a half during the Sunday football playoff games that just said you don't need an EMR. It was worth it, and they had the cash to burn to advertise in that way. And the takeaway for me there was ... and Transcend is EMR agnostic. We work with providers who are on a lot of these platforms, and there's a lot of really hardworking people at the EMR platforms and forward thinking, and they've carried the industry for a very long time. I was sitting next to somebody who worked for one of these AI companies at dinner and he was just talking about how fast his dev cycle was. He's like, I use quad code, I used to be an old school programmer, I came up before AI was just literally everywhere. I can now do and push and QA something to production in two days that would have taken me a month. And so that's like part one of the speed. But I think a year before I went to Home Care 100, I would have thought the major EMR platforms are going to push us to adopt AI through them. I no longer think that's the way change is going to happen. I think the AI companies want to throw the football all the way down the field, to be quite honest with you. I think they don't want to lend their expertise to an existing platform, they want to be the platform. And if you're a legacy EMR company, change management for you internally, I would be worried about that if I was sitting in the C-suite of one of these major platforms because you're built around 18-month regulatory dev cycle windows. The next big thing for us is hope that the flag that the government shutdown just ended. They just extended the telehealth flexibilities, but there's going to be a code modifier for it. That's like the news as of when we're reporting this podcast. And so they're thinking in those terms ... we've done it, let's assign story points to this and the project management system, and we can QA it in two months. The AI guys are literally having a conversation with Claude and saying, Hey, read this legislation and start building a new code module that can automatically adapt the workflow based on the inputs you see. And it's done like that. I wouldn't be surprised, Charles, if 18 months from now there were one or two EMR legacy platforms that are struggling to adapt to that new reality. I don't know. What do you think about that?

Charles: 18:53
I think you're pretty spot on. I can tell you that in having conversations with all the EMR companies, kind of like how they are thinking and feeling about it. Because hey, it comes back to Beverly and how do we connect them to the patients and all the things. I can tell you that I know that there are some that are thinking about it. They're really excited about it because it can improve their time to market, their consumer satisfaction and their class scores, etc. I think that like any industry, there are also those that don't understand it. They're trying to figure out how do we continue to be us without losing us because we've been this staple in this area for what have you. So I think that you're gonna see some risers and fallers like you do anytime there's some big pivotal industrial change. I think we'll see. You know organizations that are growing continue to thrive, and ones that don't don't. And I do believe that the best way to adapt these companies is to leverage what you can. But I think again, it goes back to amplify what you do really, really well. Use the new tools to fill the gaps. And if you can do that, you end up being a lean, mean fighting machine. And regardless of anything you do, you can be an EMR company, a healthcare company, you could be Fintech. It's if you leverage it and you leverage in a way to amplify what you do well so you don't lose your consumer base. I think those organizations will survive to your point. I think the, or at least to the conversation, those that don't, I think they're really going to struggle because when you look at the operating cost of what it takes to maintain a legacy EMR and they're not using that to improve my opex. I have to look at that lens as well because to your point earlier, they're riding on the backs of these big investors and they can do it quicker, faster and cheaper. And then they can pass those savings along. And you and I have seen this over the years. Look at the OASIS coding over the last 10 years about how much that has changed and the price points and what that's come into, whether it be onshore versus offshore. Now it's AI coding. And there are big hospital-backed EMRs that are using charge capture systems that just look at the physician documentation. So I think those that rally around it will make it work, and the ones that don't are gonna have a really hard time.

Tony: 21:16
Yeah, it's gonna be really interesting, I want to say five years, but 18 months. At Home Care 100 2027, we'll look back, I think, on what happened this year and think it was quaint at this point. Charles, if someone couldn't attend this year, maybe just to wrap up, what's the one insight or takeaway that you think they can't miss? What would you say to somebody who's like, what was the main theme? What are you thinking about coming out of it?

Charles: 21:48
So the whole piece was the data imperative. Again to your point, a lot of talk about AI, a lot of talk about all of the information that comes out of it. I think the big message that I heard and what I personally took away and really brought back to our organization in Delaware was the future of healthcare is not going to be any one provider alone. It's not just going to be hospice alone. It's not just going to be home care. It's not just going to be skilled home health, but it's going to be everybody building and collaborating to build a better care at home strategy. Whether that be primary care in the home, whether it be palliative in the home. There's a lot of buzz around PACE programs or PACE-adjacent type things. We're a CMS guide provider because we're trying to get more upstream in our Part B book of business. I think the big piece I took away is how can we work smarter and more collaboratively to really create this environment and ecosystem? And I personally believe the companies that go back and try and do that well, I think are going to thrive and they're going to continue to create a better ecosystem. I think the ones that don't are absolutely going to struggle. Just this past week, to your point of the podcast, look at the investment between Elara, Ares and DaVita. If that doesn't signal what creating a better care at home strategy means, I don't know what else does. So that's the way we look at it in Delaware. I think that's the way other  organizations like mine are starting to look at it. And I think what's unique around our ecosystem, I was able to take that same message back to my large health system partners in the state. And it's that conversation we're having across the board is how do we fill the gaps? How do we work upstream together so that I can be more than a blip right on their competitive landscape or partnership landscape? But I think to me that's the overall theme. If you couldn't attend or you're reading all these different pieces that are coming out on social media, or you're listening to you and me talk about this. It's building a broader care at home strategy that's gonna be the future.

Tony: 23:52
Yep. Got it. We can't keep our heads down and like, oh, we're just a hospice provider. That's what we're good at. That's what the community knows. It's not gonna fly.

Charles: 24:03
That's right. Agreed.

Tony: 24:05
Well, Charles, thanks for coming on today. This has been great. I feel like we could easily talk for another hour, but you've got a program to run and we're both trying to stay warm and think about Beverly. Thank you, Beverly, for all the Beverlys out there.

Charles: 24:18
Great job, Beverly. Yeah, that's right.

Tony: 24:20
Providing the care. I usually end the podcasts at Stephanie Johnston, our CEO's, insistence ... a complaint. And since I just was on the planes from Home Care 100, I'll do a pretty generic airline one. People who play dumb about how many carry-ons they're allowed to take on a plane. It's 2026. If you are flying, you should know what is allowed and what is not allowed to carry on to an airplane this day and age. Don't have two purses, a rollerboard and a puppy carrier, and blink with doe eyes when the gate agent asks you which one you're gonna check. It's ridiculous. Be better. So that's my complaint. Charles, stay warm up in Delaware. Thank you very much for the time and appreciate you being on the pod, my friend.

Charles: 25:11
Appreciate it. Same to you, friend, and stay warm.

Tony: 25:14
Yeah, take care.