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Episode 17

How Evergreen Health overcame challenges as the first US home care organization to respond to COVID-19

Jeff Howell (00:01):

Welcome to Home Health 360, a podcast presented by AlayaCare. I’m your host, Jeff Howell, and this is the show about learning from the best in home healthcare from around the globe.

Jeff Howell (00:19):

Hi, everyone. Welcome to another electrifying edition of the Home Health 360 Podcast. We have a couple of really interesting guests on today’s show. Do you remember when COVID was just breaking out in the US? It was the height of everyone’s fear as we really didn’t know what we were dealing with at the time.

Jeff Howell (00:37):

I just remember the first outbreak was in Washington and I thought it was near Seattle. Well, my guests today are from Evergreen Health out of Kirkland, Washington, and they had to deal with the very first COVID death in the United States. This is a fight that none of us asked for, but imagine having to be one of the very first ones responding to the pandemic on the front lines.

Jeff Howell (01:00):

Today, I’m joined by Molly McDonald the program manager for quality and regulatory compliance. Molly, welcome to the show.

Molly McDonald (01:08):

Thank you. Thanks for having me.

Jeff Howell (01:10):

I’m also joined by Brent Korte, the chief home care officer. I think that is the first and only time I’ve come across that exact title in the industry. That’s pretty cool. Thanks for stopping by, Brent.

Brent Korte (01:22):

Hope that the title’s coming on strong, but you’re right. I haven’t heard a lot of other folks with the same title yet.

Jeff Howell (01:28):

Well, let’s start with this. I recently learned that your health system has a five star rating and I’ve come to learn that’s pretty rare for CMS as well. Can you guys give me some insights into what some of the keys are to success to getting such a high rating?

Brent Korte (01:44):

Molly, maybe I can start by clarifying. We are super focused on home care on home health and on hospice. A bit about Evergreen Health we’re a larger format home health and hospice providers who are hospice census is right over 500. Home health is right around 1,500 patients and we have an outpatient hospice as well.

Brent Korte (02:05):

We’re associated with a hospital that has very high quality as well, that hospital has a five-star rating. Our home health has a four and a half star rating, which is something in and of itself frankly, we are quite proud of. Although, we certainly are always striving for five stars given our volume and the difficulty, the risk associated with the patients, the level of acuity of the patients in particular that we provide care for.

Brent Korte (02:27):

We have been super happy and very proud of our clinicians in particular who’ve helped us reach that four and a half star rating through the multiple vehicles of the quality deluge of home health value-based purchasing, which is obviously going to become something far bigger in less than a year now in [inaudible 00:02:44].

Brent Korte (02:44):

It’s quite a bit. I don’t know Jeff, would you prefer we focus on how the system has improved their rating to five stars, or how we as a home care provider have built our quality machine, so to say?

Jeff Howell (02:58):

That’s what I’d like to dial in on for the agencies that may be listening out there trying to figure out what does better patient outcomes mean to you and to them?

Molly McDonald (03:09):

I’d love to talk about that. I think too, just even listening to that it really speaks to how complicated all these ratings are. It seems like it would be so straightforward, but there’s multiple different ratings out there for hospital, for SNF, for home health, and soon to be hospice, and things like that.

Molly McDonald (03:25):

I think that just speaks to the complexity of it and what makes it so difficult. In home health, we’ve come a long way. We aren’t exactly at five stars yet, but we’re headed there hopefully. We’ve come a long way to get to four and a half. I think really with a lot of the programs either from CMS or from the state is making sure that this is something that we don’t just let happen to us.

Molly McDonald (03:49):

All of these things, this is something that we’re going to manage that we’re going to get in front of. That’s really what we’ve been doing so far and what we continue to plan, or we plan to do to continue success in this, if that makes sense. We just proactive is what you want to be and not month to month react to things and just say, “They’ll fall as they may.”

Molly McDonald (04:10):

No, I’m not a big fan of surprises. I want to know where we’re headed and what we’re expecting to see. That’s the approach we’ve taken is to manage it. We do that by educating a ton and making it front of everything, every meeting we’re having with clinicians, with other staff. Really key to remember that we are more, there’s so many different departments.

Molly McDonald (04:33):

Each department has their own impact on all of these metrics, whether it’s value-based purchasing or stars. We see that as a bigger picture here. Each department is getting their own little spin on, “This is what’s going to happen. Here’s the new program coming out. Here’s more importantly your impact on this program.”

Molly McDonald (04:53):

Education is not just really the workings of it for us, it’s the ins and outs of how the program might work. Obviously, there needs to be people will that know that at the agency, but when we think education here we think impact. Here it is and here’s the impact your work on a day-today is going to have. That’s really worked for us.

Brent Korte (05:13):

Just to add onto that first off, I want to significantly acknowledge that Molly has been the backbone and the behind our design of our quality improvement. We have had a significant design associated with improving our quality really since value-based purchasing started in the nine pilot states, obviously Washington being one of them.

Brent Korte (05:36):

Molly was talking about really what I view as intentionality. When we talk about improving quality, it can very often, and for good reason be relegated within many providers as, “Well, we have someone that does quality, or we have someone that looks at oasis, or we have someone that does so and so.”

Brent Korte (05:53):

We instead have made quality front and center culturally to our organization. That’s easy for me to say in my role, easy for Molly to stay in hers. I would hope as I look out my window to my left, as I see clinicians coming and going that each one of them would say that they each have had their journey of understanding quality and caring for quality.

Brent Korte (06:13):

Likewise, bring quality full circle to help improve our ability to keep our people. They care, they have pride in the fact that we are ideally the top quality provider in our service area. That’s different. There’s a different approach to that and we have very materially worked on culture building, quality building, culture building, quality building, so that within our culture, down to the clinician level, people understand that in order to be the top of our game the best home care provider, we hope, we want to be.

Brent Korte (06:47):

I’m not going to say that we are or we are not. In our current service area, that involves expertise down to the level of the clinician up to the level of clinicians probably in an even more appropriate way to say it. It is endemic to our culture. We do set very high expectations. Materially through dashboards and materially through leadership.

Brent Korte (07:09):

We set high expectations from day one when we hire new people, when we orient them. I would say the keys to success and our living a quality mindset and that’s a catch phrase, but there is a way to do it, and we do, do that. We’re proud of the way we’ve designed our quality machine for lack of a better way to put it.

Jeff Howell (07:28):

I love the way you phrased the culture and the quality. You weren’t going to get away here without talking about attracting and retaining. Give us some idea of what you guys are up to with respect to when you start out at the very beginning, finding the right people and then onboarding them properly.

Jeff Howell (07:50):

Then, on the ongoing training and culture development. How do you guys excel with respect to attracting or retaining caregivers?

Brent Korte (08:00):

Anyone in a leadership position has long heard that we need to work harder to keep our people. That’s true, but it’s become part of the business ethic of we need to do our best to keep our people, but we have so and so priority, so and so priority. What’s really happened there as we have been from market dynamics perspective, micro in our current territory.

Brent Korte (08:26):

Micro to home care, micro to home health, micro to hospice, you name it, or macro within the United States, then Canada. Imagine worldwide where it really does matter now where people are evaluating their lives. They’re evaluating, “Do I want to be a physical therapist? Do I want to be a nurse? Do I want to be a physician? Do I want to be a chief home care officer? Is this the way that I want to spend my time?”

Brent Korte (08:48):

We have taken a laser-focused approach to trying to ensure that we have not only very audacious goals related to how we keep our people, but that we take action. Again, super easy to say, “Well, we want to be a great provider.” Putting the action behind it involves a lot of work as leaders and a lot of building of again, another catchphrase building of culture.

Brent Korte (09:15):

What does that actually mean? At EvergreenHealth and I would say that, and personally with the personalities that Molly, myself, the rest of our excellent leadership team have are that we stop and listen and care deeply about what the clinicians are seeing in the field. If we don’t know what is happening when we walk in a home, if we don’t know more importantly what the person who lives in the home is feeling when we walk in the home, what is our brand?

Brent Korte (09:43):

What is the value that we’re actually providing to them? What’s the value we provide to hospitals, to our primary partners, to health systems? We work really hard to know that. To do that, you have to be vulnerable. The V word, you have to be vulnerable to this idea that you’re going to hear things you don’t want to hear, and you got to make changes.

Brent Korte (10:02):

We have a material mechanism in Evergreen Health to make sure that anyone on the front line or in our excellent support staff as well have the ability to raise their hand and say, “This is not look, taste, smell, feel right, sound right.” We have a way to bring that forward and make sure that we can make adjustments.

Brent Korte (10:23):

Sometimes, it’s very specific to the person, and it’s not organizational-wide issue, but very often it’s something that we are blind to. It’s easy to be blind to things as leaders. We materially expose ourselves else to this idea that we need to constantly improve and constantly work to keep our people.

Brent Korte (10:41):

We track our tenure. Essentially, length of employment, very, very carefully. I’ll share we’re right under eight years.

Jeff Howell (10:51):


Brent Korte (10:52):

We’re really proud of that one. That includes all the new people that we bring on. If we have this week, we’re orienting six new hospice and home health clinicians in theory, they bring that number down as new employees and we’re still able to keep that top end. We also track turnover and we track retention per department, and really on a team by team basis.

Molly McDonald (11:14):

I think too when you are talking about really asking folks, asking our employees what quality means to them, when we talk about quality culture and quality culture, it’s our role to make sure those are connecting. Making sure that the rules and regulations and the programs that we have to do, we’re entwining those with what our clinicians and what our staff feel is quality and better quality care.

Molly McDonald (11:40):

We’re constantly saying, “What does this mean to you and how we can figure out to get those together and move forward from the get-go? Like Brent was saying, this is from day one, we’re talking about this. This is in the interview process. This is even pre day one we’re talking about this with folks that may or may not come work for us.

Molly McDonald (11:58):

It’s that much part of everybody’s workings that starts immediately. I think the other piece too, that we really pride ourselves on is really impactful is our transparency around everything. We try to make sure that’s happening at every single level. If it’s not, like Brett said, we want to hear it. If you feel like we’re not being transparent and we can really think about how that can go better in the future.

Molly McDonald (12:25):

That’s just a constant thought process with our leadership team about everything. Whether it’s star value-based purchasing, retention, COVID, you name it. That’s really at the top of our minds.

Jeff Howell (12:36):

Well, I think an average tenure of eight years is probably the biggest number I have heard. That’s an amazing number to track. I know we have some anonymized data that actually shows that the older the caregiver, the longer they’ll stay at the agency. People in their 20s, 30s, 40s, 50s, 60s, it’s a straight line up.

Jeff Howell (12:58):

I thought that was interesting, because I thought it might have an arc to it and come down. According to the data that we have, if you hire a caregiver in their 60s, they probably will stay at your agency longer than someone in their 50s and down the road at every 10-year age cohort. I love this idea that your caregivers are your foundation.

Jeff Howell (13:25):

If they’re turning over, then it won’t lead to a 4.5 star rating because you’re not filling shifts. You’re not able to deliver the care. Brent, you said figuring out what is happening in the home, I’m curious to talk about what is going to happen and I’d love to get your take on next generation technology to predict what’s going to happen.

Jeff Howell (13:52):

From the folks that I’ve spoken with in health systems, the industry still needs to get to a point where we’re reporting on many more things. We’re using machine learning and we’re actually trying to figure things out before they actually happen. I’m curious, what kind of things you guys are either utilizing today or you’re looking at?

Jeff Howell (14:12):

Both of your general thoughts on the industry in general in this regard.

Brent Korte (14:16):

This will be a two-sided coin answer, Jeff. The first side is really that I think that much of the technology that home care providers, larger formats, smaller format folks, system based folks, for-profits, nonprofits, you name it, have been seeking has been finding the shiniest object. That shiny object is often telehealth.

Brent Korte (14:41):

Which in and of itself is a very wide-ranging title or term. We’re now learning that telehealth means a lot more than something akin to The Jetsons or something, akin to biometry only, or you name it. We aren’t totally there yet frankly, on the telehealth craze. I don’t know if the object was shiny enough for us.

Brent Korte (15:04):

I don’t know that the object is as shiny as it seems when the closer you get to it doesn’t seem as shiny. Meaning this, that it seems like on the telehealth front, at least that perhaps the industry is still deeply defining itself as it pertains to home health, and then very separately as it pertains to hospice. There are excellent use cases there.

Brent Korte (15:28):

There are excellent applications in particular for reaching folks on the hospice front. It solves materially the economic issue that comes inherent to home health. What are economic limiters within home health? Well, windshield time and drive time. How much time, how many visits are you able to do a day?

Brent Korte (15:50):

If we were able to be beaming clinicians into people’s homes we can do a heck of a lot more visits versus sitting idle in a car or not technically sitting idle, if you’re in downtown Seattle, you’re probably sitting idle, frankly. As you’re driving around, generally not necessarily being productive, so what can you do at that time?

Brent Korte (16:08):

Well, you either have to do something in that time or you have to eliminate that time. Telehealth solves at least one half of that problem. Yet, it is still undefined from a PA, from a particular analysis perspective, super excited about the technology that’s coming. Can’t speak as much to machine learning.

Brent Korte (16:27):

I do know that when we look towards our future, Evergreen Health’s future, we want to be able to provide better care to folks that are needing it and use predictive analysis to help us ensure that the care we’re providing that we’re most prepared for. This involves not just the day of the visit, the day of a patient’s potential imminent death if you’re on the hospice front, it involves how we staff.

Brent Korte (16:54):

It involves what do population dynamics look like in our area, in our service area, and other service areas as we start providing greater value to our patients and our families. We’re super excited about predictive analysis. Am I lukewarm on telehealth? No, super excited about it. I’m looking for a little more definition, a little more shine before we make that significant investment.

Brent Korte (17:20):

I don’t know that it’s “sexy enough” for us to sign into. Yet another telehealth platform and then ask ourselves, “What was our intention behind doing this?” First, what problem are we to trying to solve and how does technology solve it? That’s more of our approach.

Molly McDonald (17:37):

I think so too, from the telehealth when I talked to some clinicians about it, some of the hesitancy is home health is obviously the environment is the home. When it comes from telehealth so many things, the next step to the question, whether you’re assessing something is, “Well, let’s go take a look at that. Let’s go see how you’re doing in your environment.”

Molly McDonald (18:00):

That feels the telehealth piece feels very limiting in that. It’s probably not the safest to say, “Can you pick up your computer or your tablet and go walk around with it to your house?” That feels very, very odd. I think finding where the balance of using telehealth meet the needs of patients and caregivers it’s been a little bit of a slower go as opposed to like a static provider appointment or something like that.

Molly McDonald (18:27):

I note rehab staff too it’s just not as used to using telehealth. It’s not something historically we’ve done a ton of, especially in home health. That’s who I would talk to a lot about it, where one thing with telemonitoring and that’s been around forever and things like that, but the actual hands on work I think is a little bit tougher to wrap our heads around when it comes to telehealth and home health.

Molly McDonald (18:51):

I think too with predictive analytics, when we talk about data and outcomes that’s one thing. Then the other part is as we grow as a provider, as we grow and where we live in Seattle using it to tailor care specific to that region or that patient even, I think that’s what’s super exciting that we can really utilize moving forward a lot more than we do.

Jeff Howell (19:16):

I don’t know if it’s just me, but I also feel like telehealth needs to mature as an industry. There seems to be no clear winner and it’s a whole bunch of small companies that are standalone pieces. I just feel like in any industry, you need to have someone who emerges with the right funding, the right product, and the market can get behind that. I just don’t feel like there’s a clear winner right now.

Brent Korte (19:46):

Jeff, I agree fully. Again, economically, we have a ton of money going into this. We know that there’s a lot of investment whether it’s private equity investment or just a number of companies that have gone, that have IPO in last 24 months. It isn’t lack of attention or money perhaps, it may just be asking ourselves what is the problem we’re trying to solve?

Brent Korte (20:12):

Very interestingly, switched another example that I think Molly had mentioned, during the pandemic we were forced very early to figure out how to ensure that our folks were communicating when they are no longer able to see each other. The grand irony there this was a national problem for folks that generally weren’t working from home that show up in the office environment.

Brent Korte (20:33):

There’s the water cooler in the fridge and the lunchroom, and all that. We already didn’t have those things. We have the highway. I-5 for us is our hallway. We were used to a remote workforce. Some of these tools that have come up, some of them were already there. Some of them have propped up that allow us to look into a camera to talk, to be as close to real collaboration as we were when we were in the room.

Brent Korte (21:00):

What does that do for home care? It saves a heck of a lot of time for folks having to drive into our headquarters. That’s one out of 12,000-ish agencies nationally that is probably experiencing a significant increase in productivity and likely back to that employee satisfaction piece that people are able to collaborate.

Brent Korte (21:22):

From a tech perspective and NextGen technology, I’ll be super excited to see how people can collaborate to where it feels even more like we’re in a room, that we’re actually in the same area. Maybe that’ll be the future from a home care perspective that it can feel more tangible. In particular, our average age, Molly, what? 82-ish.

Molly McDonald (21:49):

Yeah. Usually, mid to low 80.

Brent Korte (21:51):

The concept of adopting technology too. We’re actually getting in this point where the entire boomer generation will have been using their thumbs on their mobile devices for a long period of time. We’re getting into that. That’s going to change the vernacular as well.

Jeff Howell (22:06):

Well, and the silver lining of the pandemic as everyone’s grandma knows how to use Zoom as well. When we speak about telehealth, technology adoption is one of the big challenges. Certainly, we’ve all been forced to adapt.

Molly McDonald (22:21):

I think too, just another thing that just made me think of this as really listening to all of these conversations and everything comes around back to improving patient outcomes and the whole patient experience, I think we’re seeing that, and we’re having the investment of our clinicians in this technology.

Molly McDonald (22:39):

Our clinicians are feeling more supported. Their leader can hop in on a patient conversation and be in these IDTs or whatever your agency calls it. The leader can pop in on these all over the place immediate. They’re feeling more supported. Really, it goes everywhere when we can do that from the get-go.

Molly McDonald (22:58):

Some of these technologies have really let us do that. Even though we’ve been a bit remote this whole time using this is just really upped everything in that aspect. That was an unintended obviously of the pandemic, it forces into that I don’t know when we would’ve gotten to that point without it.

Jeff Howell (23:17):

For the layman out there, you hear this narrative that the knee-jerk reaction is, “We have a pandemic. We need to get our seniors out of buildings and back into homes.” I’m curious, I draw the analogy to September 11th. At the time, I was in commercial real estate. There were people that thought, “No one’s ever going to rent space in office towers again.”

Jeff Howell (23:41):

We saw it even happen. It was so graphic. Then, a short time later, just prior to the pandemic, the vacancy rates in Manhattan they’ve never were at a more favorable vacancy rate. I’m curious, your thoughts what you’re seeing in growth of service lines and assisted living hospice. Most people carry this narrative that the future of care is health in the home.

Jeff Howell (24:10):

Of course, we see the value in that. I’m curious from a facility standpoint, if you guys also see. As actually just getting back to normal and people will forget about the pandemic, at some stage, life just goes back to how it was because there are different aspects of the healthcare continuum that were necessary.

Jeff Howell (24:31):

Once we get back to normal in the hopefully not so distant future, things will go back to normal. What are your thoughts on that?

Molly McDonald (24:38):

I just to speak to the whole, “Are we going to go back to normal?” I think we saw a little bit of that just as we’ve gone through the pandemic and the two years that we’ve been in this. Things aggressive at first and then they pull back and then as things surge, we’ve seen it go back and forth. I do think there’s going to be a component to that at one point.

Molly McDonald (25:01):

The narrative of the future is in the home; I think it’s more than a narrative obviously in this work for that reason. It’s a little bit more than hope. That’s not the best strategy. I do think we’re moving that direction. I think home health and hospice has done a great deal of work to prove that narrative is true, and that our folks are getting better.

Molly McDonald (25:24):

We are at the table to support the facilities and to keep people out of that from a health perspective, a satisfaction perspective, a financial perspective that we have our place. I think we’re just getting better and better at showing that.

Brent Korte (25:38):

I just wrote a few notes down. I love this question. We all want to say that home care is the future because we work in home care. It’s great. Behind that, I go back to looking at the economics of what’s happening. We know it’s very convenient to say that we have the silver tsunami and we have the baby boomers that are going to need care, which is certainly significantly in excess of present supply.

Brent Korte (26:10):

That seems very clear. I think there’s something else at play though. One of them is this and we’re seeing it today. The timing of this question’s excellent. We’re seeing it today as the Omicron variant of COVID is overwhelming our nation’s healthcare infrastructure. At our own hospital, within our system doing it I would say very good job of managing an onslaught of patients and the EDs.

Brent Korte (26:42):

As busy as we’ve ever heard that it’s been, opening new floors where our hospice care centers is very busy with trying to take overflow patients, you name it. What that means is this is that during this likely busiest phase of the pandemic, now not the grimmest face, perhaps you think about New York in April 2020, you think about so many cities in New Orleans, you name it.

Brent Korte (27:10):

Frankly, Seattle on the 29th of February 2020, and leap date. Today, something different happening where we have a numbers game where we have folks that more people getting sick, but the level of their sickness is significantly worse, which means hospitals are getting overwhelmed, which speaks to this one fact, are there enough hospitals in the United States?

Brent Korte (27:37):

Now, it’s easy to say today in Washington state there are not, we need more help. In general, looking at the numbers minus the pandemic, there are. There’s enough ability to take care of trauma and acute care, et cetera. Will that change in the future? Well, it could, but the bigger place, this is that consumer intentions within the economy have changed.

Brent Korte (28:00):

People have realized that they don’t have to, number one, be at a high hospital. Number two, they don’t want to be at a hospital. It could be that the food, “I don’t like Jell-O.” It could be that the TV’s too small and too far away. I don’t understand that remote that’s on the court. It could be the fact that they don’t want someone coughing next to them.

Brent Korte (28:17):

It could be also more importantly that they realized that technology and healthcare, and this industry that was formerly in the shadows called home health and hospice, the home care in general is now front and center because they’re seeing people come into their homes. They’re seeing folks go into their neighbor’s homes.

Brent Korte (28:35):

They’re thinking, “Well, that’s pretty smart. I now don’t have to expose myself to illness or to frankly, what’s generally not the most enjoyable time to be being in a hospital.” Now, I can stay at home. There’s just so much exciting work relative to that. I think the tides are changing, Jeff. I think it’s permanent.

Brent Korte (28:58):

Are we going to see hospitals continue to be built? So long as you have folks that are trying to compete for a better hospital, for a more beautiful hospital, for a taller building, yes, you’re going to see that. I think in general over time, we’re probably going to see so much of the care go back into the community, which is logical.

Molly McDonald (29:16):

Well, I think we’re seeing that too, not just in home health, but we’re hearing about new programs happening all the time. Whether it’s outpatient therapy, that’s now going to the home. In some of the tech companies, they’re having their almost internal health system. It’s very one, technology base, of course. Bringing it to the consumer and we’re, “We’ve been doing this. That’s that’s our gig.”

Jeff Howell (29:45):

That leads into my next question. I was going to ask about predictions for hospital at home. There’s so much confusion around this topic. It’s like, what you say, Molly, you guys been doing this. My question really is and I say this as a layman is, my latest understanding is that hospitals are trying to wrestle control to administer the care at home instead of contracting out to home health agencies.

Jeff Howell (30:14):

I’m curious on your take on that. I’m also just wondering at what level my view is hospital at home actually involves more medical equipment that you don’t traditionally find at home health? Somewhat chronically ill patients will have some kind of devices that they require, that will be residing in their home to make this almost like a makeshift hospital for them. Am I somewhat accurate on that? What am I missing on it?

Molly McDonald (30:46):

Admittedly, I’m not by any means an expert in hospital at home, but when I hear people talk about it a lot there’s components of that already in home health when we talk about devices. In particular what Brent’s been talking about with the Omicron, we’re seeing a lot sicker people at home and it’s just been humping and ramping up as the pandemic has gone.

Molly McDonald (31:07):

Even previous the pandemic honestly, we saw that. It’s just more acute since the pandemic’s been starting. We have been seeing some of that already and there’s room for that. I think what’s really cool when I read about hospital at home, just the opportunity and the potential we have to take the best of both worlds, and make something really great.

Molly McDonald (31:28):

Say, “We have these experts in home health and we have the experts in the hospital, let’s put this together and make it efficient.” It’s a really, really great opportunity. We have some folks that are, and I think when we were chatting about this before we said something about there’s lots of days that we feel like in the current home health environment, we’re just a heartbeat away from being a hospital at home.

Molly McDonald (31:52):

Minus a lot of the facility obviously and the equipment, and things that we talk about, but the patients are there. The need is there for sure. We’re organically rising up to meet it when we can and where we can. It’s already built in a little bit into the system.

Brent Korte (32:12):

The design is quite simple, remove capital costs, find the right patient type, provide care. Capital costs, well, actually of some people may or may not understand that building a hospital is excessively expensive because of code, because of frankly markup from contractors. It’s really something else. Removing that cost is excellent.

Brent Korte (32:41):

This is an emerging market. I think the design behind it is super intuitive, but I think we’re going to run into some operational cliffs. Evergreen is actually, I’m not trying to play it safe here at all, Evergreen Health has done a wonderful job of embracing this idea that 15% of our system is home care at this point.

Brent Korte (33:06):

The system in and of itself have done a beautiful job saying, “We get that what you’re doing is not the same as running a med search floor, doing surgery or delivering babies, or doing scans, you name it.” I worry that notion that respectful to everyone who’s administrators in the hospitals right now that the notion of, “Well, we can do it better because we know to run healthcare, because we know to run a hospital.”

Brent Korte (33:35):

That will not work in hospital at home. There’s going to have to be a strong home care element, but more importantly, someone who understands how to run a business, which is remote and how to run a business, which involves significant logistics that don’t just come to one place. We’re in and out of 2,000 homes today.

Jeff Howell (33:52):

By logistics, you mean chaos, right?

Brent Korte (33:56):


Molly McDonald (33:57):

I think too it’s really not making it a competition and not pitting it, but really let’s keeping your eye on the end game. Like we talked about, taking the best of both, but working at the same time and together. Not to sound cliche, but we have to do that for it to succeed.

Molly McDonald (34:15):

We can’t make it better for one of the systems and worse for the other. That’s not going to be sustainable.

Jeff Howell (34:23):

That makes sense. Brent, circling back on when the pandemic hit, my understanding is that you gave a presentation at the Home Care 100 Conference. This was, I presume the response plan that you folks put together as a result of being the first to have to deal with the breakout outbreak?

Brent Korte (34:45):

Yeah, that was something else. Going back to what would be late January, early February, I think it was specifically early February 2020, we had the normal Home Care 100 Conference. That’s coming up in Phoenix in a couple weeks. This is now two years ago. We had the normal conference and then we got back and it was amazing.

Brent Korte (35:08):

We literally had just gotten back. I’d been away from my family at the conference. I was putting my daughter to bed and I got a call from my boss. She sits in our senior leadership team at the system and said, “Are you sitting down?” I was, like I said, putting my eight-year-old daughter, two years ago, to bed.

Brent Korte (35:35):

She said, “We’ve had a death at the hospital.” I’m like, “Shocker.” It’s what we do. We have a lot of deaths at our hospital and our home health and our hospice rather. It was a COVID positive patient and I’ll never forget it. I’ll just never forget that moment. When we go into work the next day, this is now a Saturday.

Brent Korte (35:53):

We get through the next two days, Molly and I were in there. A number of other leaders from EvergreenHealth Home Care, we’re at our hospital, just trying to work through incident command. It’s amazing to see a well-run incident command and EvergreenHealth just did a beautiful job. It could have been an earthquake, it could have been a terrorist event, you name it, but they just were the utmost professionals.

Brent Korte (36:17):

CDC was there and news vans were there. We were literally advising the CDC. We, for a moment thought the CDC would be telling us what to do instead, it was the opposite. This is through the week and Monday rolls around. I think it was very early in the week. We did a call for the Home Care 100 Intelligence Group.

Brent Korte (36:40):

Interesting enough, I’d be curious to go back and listen to it because we were absolutely raw, sleepless. 16 to 20 hour days for weeks on end. This was the beginning of that. Surfing off of adrenaline and just trying to solve problems. Trying to figure out how we’re going to keep our people safe. We realized early we had three goals, Jeff.

Brent Korte (37:02):

The goals were to keep our people safe, to keep providing care in the community. Now, remember at the time, the idea of are you actually going to send your staff out into people’s homes where you could spread the disease or where our staff could get the disease. This was a very scary concept in the moment. Those were two of the three.

Brent Korte (37:21):

The last one was that we wanted to stay in business. We recognized very early that we are going to have to do things provide care very surgically, for lack of better way to put it. To make sure that we are going to protect every part of our operation, our employees first, our community and our patients second.

Brent Korte (37:42):

To make sure that they’re employed. That was the finest of tight ropes or the thinnest line I suppose we’ve ever had to walk and we did it. Was it perfect? No, but it was really maybe the most unforgettable part of my career personally, that I may not remember. I remember the feeling of it, but it’s hard to remember day after day after day.

Brent Korte (38:09):

Molly, really led our home care incident command. We would go to the hospital and have their incident command. Then we’d come here and Molly was one of our top leaders of our incident command, which I’ll hand it off to Molly in just a second, which says, I think it also speaks to our culture, “It didn’t have to be me.”

Brent Korte (38:26):

Frankly, it was Molly because she was right for the position to make sure that everyone in their seat was doing their job and advancing the cause that we were remaining objective. It allowed me to lead our organization the way I need to lead. Lead our organization and her to do the same thing.

Molly McDonald (38:45):

Thanks so much. That was very nice things to say. I think the biggest part in the beginning was so unknown. We had our three goals and asking people doing things that may spread it or not spread it, or keep you protected. We didn’t know. We were asking for so much trust and faith into each other, in our system, at EvergreenHealth that’s system, in our clinicians.

Molly McDonald (39:16):

Again, speaking to what Brent was talking about in our culture, it was just ingrained from the beginning. It felt very like, “This is what we’re doing.” There was no real pushback. There was no real questions about what we were doing. We just went for it and it worked out. Again, Brent said we did some things right, we did some things wrong, but we kept moving forward.

Molly McDonald (39:39):

I think really that’s what continues to make us what we’re doing today work. Even though we’re in a very different place than we were two years ago, but sometimes it feels like a

Jeff Howell (39:51):

Well, it’s incredible leadership and courage that this is the healthcare equivalent of being a surprise attack by the enemy.

Brent Korte (40:02):

Jeff, to make it perhaps be a bit more melodramatic about it, we have to keep bear in mind that February 29th was something 60 days, 59 days from the start of PDGM. We were about to start getting our data. We were actually really excited going into the next before the pandemic came, we built up PDGM.

Brent Korte (40:23):

We built up the new payment model for home health and how we’re going to change our operation to make this work. Then, COVID happened and what was two years of work really was like, “Well, I guess we’re not going to know where we stand.” That made it all the more interesting. We try to survive under of those conditions.

Jeff Howell (40:40):

Molly, what’s a trend in home health that you think is pretty powerful, but nobody’s talking about?

Molly McDonald (40:48):

Nobody’s talking about it, I don’t know about that one, but I think there’s a trend the interdisciplinary that’s been a word that’s been around forever. Really sitting and thinking about it. Brent mentioned our PDGM model it’s leaning more towards that is the true interdisciplinary.

Molly McDonald (41:07):

Meaning we’re not getting together, and the PT is saying, “Here’s what I’m doing.” The nurse is saying, “Here’s what I’m doing.” The OT is saying, “Here’s what I’m going to do.” It’s really turning it around and saying, “What are we doing for this patient together?”

Molly McDonald (41:20):

Not saying, “This is what the patient needs this week. Where can we make that happen?” As opposed to I think we’re getting there, but it’s still pretty siloed within ourselves. We just don’t talk about what true interdisciplinary means and how to meet the patient’s needs. The other piece that I’m thinking about that is really true, that is home health’s ability to support their community.

Molly McDonald (41:49):

That’s something too, I think with the pandemic has brought that out and when we make decisions and we make our strategy is really how we’re going to do that, and our community is getting bigger and bigger as we grow. How we have to change with that and keeping that at the forefront of everything, and making that in the front.

Molly McDonald (42:07):

Instead of just seeing how things happen and seeing how things happen when we make these changes, and saying, “Well, we’ll see, we’ll see how it plays out in the community and things like that.” That needs to be in the front of our decision making before. I know Brent talks about retention. He’ll probably jump in on that, which is excellent as well.

Molly McDonald (42:29):

Speaking from a clinical perspective I think that’s something that we’re almost getting there, we’re getting there, and getting there, but we just truly don’t, we define interdisciplinary in different ways.

Brent Korte (42:40):

Well said. I’ll make this one short. In order to succeed as a home health and hospice business, we need to go back to the people. Going to the people, going to our communities, going back to our of staff internally is going to mean better care and success in business. I don’t think that’s been talked about enough. This speaks to the for-profit or the not-for-profit.

Jeff Howell (43:06):

Well, folks, we’re almost bumping up against our time here, so I’ll get you out on this last question. Molly, I’ll start with you. Then Brent, you can bring us home. Give us a reason to be optimistic about future in the care of the home.

Molly McDonald (43:17):

I think in general, I’m super optimistic because the industry of home health and hospice and home care, and our clinicians, they’re just the most versatile industry, the most versatile clinicians historically. I know in the future, we just continue to rise up to meet the needs. I’m super optimistic about that.

Brent Korte (43:40):

We know that the world became homebound in early 2020, or I will say, should have certainly become homebound in early 2020. When that happened, what we were already doing was thrust forward and highlighted and home care is absolutely on the map. Why be optimistic about the future of home care and just care in the home in general?

Brent Korte (44:08):

Everything we’ve talked about, people realize that they can achieve health, not receive healthcare, but they can achieve health by staying home. Home care is the bridge between public health or health, and applied healthcare. We are the ones that are out in the community. We’re the ones helping patients die with less pain.

Brent Korte (44:33):

Helping families get through the death of family members. Helping people live as independently as possible. The boomers, the baby boomer generation that are coming are fiercely independent and they want to skydive. This is not a stereotype. It’s very true, they’re very independent. They want to live, live, live.

Brent Korte (44:53):

Home care allows that, and it does so in a place where they’re certainly comfortable. I’m super, super optimistic about our future.

Jeff Howell (45:04):

That generation is used to ordering everything they want on their phone and why should home health be any different than that? Well, Molly, you said rise up and I certainly am inspired by the work that you folks are doing. Certainly, you folks have risen up throughout the pandemic.

Jeff Howell (45:23):

I wish you continued success. I’m going to be following you guys pretty closely. I’m pretty inspired by the work that you’ve done. Thanks again for coming by today.

Brent Korte (45:33):

Thanks for the opportunity.

Molly McDonald (45:34):

Thank you.

Jeff Howell (45:37):

Home Health 360 is presented by AlayaCare. First off, I want to thank our amazing guests and the listeners. To get more episodes. You can go to That’s spelled Home Health three-six-zero, or search Home Health 360 on any of your favorite podcasting platforms.

Jeff Howell (45:58):

The easiest way to stay up to date on our new shows is to subscribe on Apple podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on to get alerts for new shows and more valuable content from all care right into your inbox. Thanks for listening and we’ll see you next time.

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Episode Description

Navigating the Pandemic wasn’t easy for anyone, let alone being a care agency that had to manage the first COVID death in the United States, and everything that came after. Learn from Molly McDonald, Program Manager for Quality & Regulatory Compliance, and Brent Korte, the Chief Home Care Officer, how they overcame these new challenges and how they are adapting these learnings into their post-pandemic processes.

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