The Transcend Growth Manifesto

Tony Kudner (0:00 - 14:26)
It's a truth. This role isn't for everyone. Team members and growth roles don't get to stay just because they care. Leaders need to have compassionate but honest conversations about whether team members are truly built for the work they're doing. I want to say this very clearly. Sales and growth roles are not for everyone.

Welcome to Transcending Home Care, where we explore what it really takes to grow, lead and sustain home-based care organizations in a changing world. I'm your host, Chief Strategy Officer here at Transcend, Tony Kudner. As we look ahead to 2026, I want to challenge everybody listening to this, especially those folks who are leading growth, business development, admissions or intake functions to pause before setting another round of DO MORE goals.

Because here's the truth, folks. Growing in home-based care and hospice today isn't about working harder. It's about working smarter, aligning tighter, and questioning a lot of the assumptions that we've built our strategies on.

So in this episode, we're obviously going to mix it up a little bit. Instead of our usual interview format, I'm going to unpack five simple but powerful questions your hospice growth team should ask before finalizing your 2026 plan. Transcend's suggestions are based on our 2025 work with clients across the home-based care space and our first-at-hand experience about what works, what doesn't, and where we think you can really move the needle next year for sustainable growth. With that, let's dive right in. 

Question 1. Going into 2026, do we know the right growth to pursue?

Look, every organization wants to grow, but not all growth is good growth. This is something we've talked about often on the podcast. Too often, we see programs chasing top-line volume. That means more referrals, more admissions, more territory, without asking whether that growth aligns with our mission, our care model, or our operational capacity. Here's a common example. You might see a spike in hospital referrals, but if those patients are short stay, high acuity and high cost, your census is going to increase, but your sustainability and length of stay won't.

On the other hand, investing in community-based relationships, palliative providers, primary care, assisted living, and long-term care environments, these may grow more slowly but produce healthier, more sustainable census growth, if approached strategically. So before you set your 2026 targets for growth, ask yourself these questions. Where does strategic growth come from for us? Which sources bring in patients we can serve well and serve earlier? And which parts of our market hold untapped potential we've been ignoring because they don't look like the quick wins we're used to? You see, real growth begins when you stop chasing everything and start doubling down on the right things.

Question number 2. Are we measuring what matters? It's time to have a metrics talk.

If your growth team is still managing primarily by referral volume alone, you're missing the story. Yes, volume tells you how much is coming in, but it doesn't tell you how well you're converting it, how quickly you're responding, which sources are yielding the right patients, or where breakdowns are happening after intake. That's where metrics such as conversion rate, length of stay, source mix, and referral to admission timelines come in.

Again, let's take two examples. Program A receives 500 referrals a month but converts only half of them with a 60-day length of stay. Program B receives just 350 referrals but converts nearly three-quarters of them and maintains a 75-day length of stay.

Program B, with 40% fewer referrals, outperforms Program A in census growth. The best hospice growth teams don't just report numbers, they interrogate them. They're constantly asking questions like, why did our conversion rate dip? Why is length of stay lower from Hospital A? Why are 20% of the inquiries coming in never even resulting in an evaluation? When your data starts telling stories instead of just being statistics, you're managing with insight instead of inertia.

Question 3, and this one might be a little uncomfortable. Do our people have the tools to win? Every time we work with a home-based or hospice provider that's struggling to grow, Transcend finds some common themes. Everyone's busy, but no one's aligned. Liaisons are outselling features and benefits, maybe even doing what we call info-dumping to referral sources. Admissions is focused in checking every box on the intake form and the intake people are buried in acuity. Leadership is wondering why growth feels stalled even though everyone's working so hard. The problem in these cases usually is never effort, it's alignment. From Transcend's perspective, growth happens when your entire team, from referral to admission, shares the same definitions of things like urgency, eligibility, process and success. When your liaisons know how to qualify an opportunity. When intake understands how fast a same-day assessment should happen. When admissions knows what messages were shared upstream so the patient experience is seamless.

(5:45 - 10:22)
And it's important to note that this alignment doesn't happen through memos. It happens through shared goals, clear playbooks and ongoing coaching. There is another piece that leaders overlook and this is the uncomfortable part, having the right people in the right roles. It's a truth, this role isn't for everyone. Team members and growth roles don't get to stay just because they care. Leaders need to have compassionate but honest conversations about whether team members are truly built for the work they're doing.

I want to say this very clearly, sales and growth roles are not for everyone. They are high-velocity, emotionally demanding work that requires resilience and accountability. If someone's struggling with follow-through, avoiding conflict, or hesitating to ask for the referral, I want to say this doesn't make them a bad person, but it does probably make them someone who's in the wrong seat on the bus.

Leaders owe it to their teams and the patients and families they're trying to serve, as well as their mission, to address that reality early and directly. Now sometimes the answer is coaching, sometimes it's redefining a role, and sometimes it's making the hard but important decision to transition someone out so the right person can step in and perform. 
As you're looking ahead to next year, ask yourself, does everybody on the team know what success looks like? Do they have the tools, mindset and accountability to execute on the plan we're setting? And do we have the right people in the right roles? Because even the best strategy is going to fail without the right talent behind it.

Question 4. Are our admissions and intake process accelerating or blocking growth? Your referral to admission pathway is not a back-office workflow, though it often gets treated like one. It's one of the most strategic levers you have. My colleague Courtney Penn often looks at programs and asks questions like, are your evaluations happening quickly enough? Is there seamless communication between liaisons, intake and admission nurses? Are eligibility determinations variable by clinician or by day of the week? If the answer to any of those questions is yes, then your growth strategy has a structural limitation, no matter how strong your sales effort is. Put another way, it's one thing to make the front door ring, it's another thing to open it and let people in.

High-performing programs treat admissions and intake as extensions of their growth engine. They measure things like speed to evaluation, same-day capacity, documentation quality, after-hours response, and handoff precision. They know that a smooth, confident, fast admissions process is often the difference between a family choosing you and a family defaulting to a competitor who simply moved faster. If you haven't mapped your entire intake-to-admission process and interrogated and examined every friction point, early 2026 is the year to do it.

Think about that for a second. You could, without having to generate any more referrals, increase the number of patients you're serving simply by looking at how efficiently your admissions process works. Sometimes, that's a much lighter lift than finding more referrals to generate, especially because the referrals that you do get sent, if admitted, lead to higher trust with those referral sources, building a virtuous cycle.

So now it's time for question 5. Is our growth strategy still a fit for today's market? Take a step back. Hospice and home-based care are not the same markets they were even two years ago, let alone before COVID. Referral sources are consolidating. For-profits are outpacing nonprofits in speed and sales discipline. Discharge planners and health systems are under extreme new pressures to discharge folks to the community and keep them in the community to avoid re-hospitalizations. And in some cases, the decision of where the referral goes is moving farther and farther from the bedside upstream as value-based care takes root. And families still have low trust for services like hospice and home-based care.

(10:22 – 13:03)
Against this backdrop, is your strategy keeping pace? Maybe your liaison territories were drawn for a market that no longer exists. Maybe your messaging hasn't evolved to emphasize choice, advocacy and speed. Maybe your eligibility comfort level is still anchored in the definitions of 2018 instead of today's realities. 2026 is not the year to rinse and repeat your growth strategy. It's the time to revalidate, rebuild and reconsider. The hospices, home health agencies and home care agencies that grow next year will not be the ones clinging to old playbooks. They'll be the ones with the courage to rethink growth from the ground up. 

So, let's recap.

Number one, know the right growth to pursue. 

Number two, measure what really matters and interrogate your data. 

Number three, equip and evaluate your talent.

Number four, analyze and optimize your admissions and intake processes. 

And number five, challenge the playbook. 

If your team can answer these five questions honestly and act on what you uncover, you're going to walk into next year with clarity, alignment and a growth strategy that is sustainable and leads to tangible results. Because growth isn't just a number on a dashboard. It's a reflection of discipline, intentionality and belief in your mission. 

And of course, Transcend is here to help. I think you know this about us. In 2026, we're already booking clients who need help with a lot of these steps. Maybe in your case, you just need an outside set of recommendations and perspectives in the form of our GRO Assessment to inform what you'll do internally. Maybe you need some sales training tools or help analyzing or defining your key progress indicators. Maybe you need someone to do research on the market and help you analyze claims data and have a better understanding of consumer needs. Maybe you need a full-scale partner to overhaul your entire growth operations.

Whatever your situation, know that we're always here. Our team focuses only on home-based care growth. We have worked for community-leading organizations in critical operations roles, and we know what it takes, and we've been where you've been. But we also know that mission and culture are critically important to the work that we do in home-based care. And without mission alignment, sustained growth simply isn't possible. 

So that's it, folks. That's the 2026 manifesto from Transcend.

(13:03 - 14:26)
Finally, as a little bit of a footnote, my colleague and our CEO, Stephanie Johnston, encouraged me to put a small rant at the end of these. For better or worse, I'm a little nervous about it, but here it goes. So, I'm going to put in something personal at the end of it that bugs me and I'm trying to deal with day to day.

So, many of you folks know it's conference season. It's sort of wrapping up here in the home-based care space. The Alliance Conference in New Orleans was a couple of weeks ago. Stephanie and Courtney from our team attended the NorthStar Conference in Colorado a week before that. And there's some state conferences in the mix. So here's my complaint and cry me a river, I know. But coffee stations at conferences are set up horribly inefficiently.

As somebody who spends a lot of their time helping optimize admissions and intake functions, this irks me. The general setup is the cups and then the sugar and the creamer and then the lid and then the coffee. My suggestion is that the order should be cup, sugar, cream, coffee, lid.

Thank you for coming to my TED Talk. Thanks for listening to Transcending Home Care. I'm Tony Kudner, and we'll see you next time when we'll be back to our normal interview format.

Have a great 26 ahead.