Latest / Anatomy Of Leadership / The Debate: Vertical Integration, Payvider, or World-Class Care—Which Path Forward? | Part Four

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The Debate: Vertical Integration, Payvider, or World-Class Care—Which Path Forward? | Part Four · Anatomy Of Leadership

• 0:00
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• 0:47
  Dragonfly Health Ad: Welcome to TCM Talks, an anatomy of leadership.
• 0:51
  Dragonfly Health Ad: We continue the conversation in part four, the debate.
• 1:11
  Chris Comeaux: Como both Paul and Christopher say that remaining focused on hospice and pout care leaves the organization downstream and vulnerable.
• 1:20
  Chris Comeaux: Why do you still defend that strategy?
• 1:23
  SPEAKER_01: Well, because focus is not the same as passivity.
• 1:27
  SPEAKER_01: You're kind of confluencing those two.
• 1:30
  SPEAKER_01: There is an assumption creeping into our conversation here that bigger scopes makes a better strategy.
• 1:35
  SPEAKER_01: It does not.
• 1:37
  SPEAKER_01: Sometimes expansion is vision.
• 1:40
  SPEAKER_01: Sometimes it's fear wearing a badge as strategy.
• 1:43
  SPEAKER_01: You know, hospice is one of the most extraordinary care models ever created.
• 1:48
  SPEAKER_01: When it's practice at its best, it treats the patient and family as the unit of care.
• 1:53
  SPEAKER_01: It brings an disciplinary team into the home.
• 1:56
  SPEAKER_01: It addresses physical, emotional, social, and spiritual suffering.
• 2:00
  SPEAKER_01: It supports caregivers.
• 2:02
  SPEAKER_01: It provides medications and equipment related to the terminal illness.
• 2:06
  SPEAKER_01: It responds around the clock, and it continues through grief and bereavement.
• 2:11
  SPEAKER_01: Hospice is an absolute true medical specialty.
• 2:15
  SPEAKER_01: And that's why having board-certified physicians, CHPN nurses, and LCSWs all make it a true specialty care model that is not easily replaceable or like some interchangeable part.
• 2:30
  SPEAKER_01: Pallad Care also practices a true specialty.
• 2:33
  SPEAKER_01: It brings expert symptom management, communication decision support, and whole person care alongside disease-directed treatment.
• 2:42
  SPEAKER_01: It can serve patients much earlier and then not requiring them to surrender every curative option, which is one of the biggest challenges when hospice was brought into being.
• 2:52
  SPEAKER_01: So those two together make a formidable care continuum.
• 2:56
  SPEAKER_01: So my strategy is to dissect what makes each of those models special, then define the components of world-class performance, measure honestly where we're at today, and then build organizations that become unmistakably, unequivocally excellent.
• 3:14
  SPEAKER_01: World class is not a marketing adjective.
• 3:17
  SPEAKER_01: It means reliable and consistent access.
• 3:19
  SPEAKER_01: It means clinicians with mastery, performing with mastery.
• 3:24
  SPEAKER_01: It means symptom response measured in hours, not days.
• 3:27
  SPEAKER_01: It means care plans that reflect the patient's true goals.
• 3:32
  SPEAKER_01: It means the family knows whom to call at 2 o'clock in the morning and they trust that the right people are going to pick up the phone.
• 3:38
  SPEAKER_01: It means excellent transitions, low unwanted hospitalizations, meaningful spiritual and psychosocial care, disciplined compliance, and superb caregiver experience, and a culture in which people can do the best work of their entire lives.
• 3:55
  SPEAKER_01: It also means being clear about the difference between primary powdered care skills that every clinician should possess and specialty powder care for complex needs.
• 4:07
  SPEAKER_01: If everything is called powdered care going forward, eventually nothing is.
• 4:12
  SPEAKER_01: Let me say that again just to be absolutely make an emphasis on it.
• 4:16
  SPEAKER_01: It means being clear about the difference between primary powder skills that every clinician in the care continuum should possess and specialty powded care for complex needs.
• 4:28
  SPEAKER_01: If everything is called powdered care, then eventually nothing will be.
• 4:32
  Chris Comeaux: So, Como, how does excellence alone answer the eight challenges that I set the table with?
• 4:38
  SPEAKER_01: Well, it's not excellence alone, it's strategic excellence.
• 4:43
  SPEAKER_01: On hypercompetition, your first challenge, you know, mediocre organizations compete on relationships, geography, or price.
• 4:51
  SPEAKER_01: But world-class organizations, they compete on trust and demonstratable outcomes, including decreases in total cost of care.
• 4:59
  SPEAKER_01: Then hospital physicians, payers, and consumers, well, they will know exactly what becomes better when we're involved.
• 5:07
  SPEAKER_01: That's why they're going to demand world class.
• 5:10
  SPEAKER_01: On your reimbursement challenge, focus protects discipline.
• 5:14
  SPEAKER_01: We know our unit economics, or we should be better going forward.
• 5:18
  SPEAKER_01: What's our staffing model?
• 5:19
  SPEAKER_01: Our cost per patient day, our quality drivers, and the services that create genuine value.
• 5:25
  SPEAKER_01: In fact, if you look at how Elon Musk did what he did at SpaceX and Tesla, he applied first principle thinking.
• 5:32
  SPEAKER_01: And then basically, which is exactly that, is basically figuring out what are those services that create genuine genuine value, go deep on that, become world class, throw the other stuff out.
• 5:43
  SPEAKER_01: And then we advocate for payment that recognizes quality rather than launching business aligns that we don't even know how to operate.
• 5:51
  SPEAKER_01: On your workforce challenge, people want to belong to something excellent: a clear calling, superb leadership, manageable systems, professional development, in other words, pouring into your people and the chance to master meaningful work, those are competitive advantages.
• 6:09
  SPEAKER_01: We should repair the work rather than continuously asking our people to absorb new ventures.
• 6:15
  SPEAKER_01: On demographics, the baby boomers, they're not going to accept a generic commodity.
• 6:20
  SPEAKER_01: They're going to research, they're going to compare, they're going to ask questions, they're going to demand responsiveness, and then they're going to expect care that's tailored to their values.
• 6:32
  SPEAKER_01: A world-class provider earns active consumer preference rather than relying upon referral sources or a mousetrap that someone else built that's just expecting them to passively go along with the care flow that's been pre-mapped out for them.
• 6:47
  SPEAKER_01: I think that's a key flaw in their thinking.
• 6:50
  SPEAKER_01: Now, on your regulation challenge, the strongest defense is operational integrity.
• 6:56
  SPEAKER_01: We should be the field standard bearers for eligibility, documentation, quality, stewardship, transparency.
• 7:03
  SPEAKER_01: And we should have, as Dr.
• 7:04
  SPEAKER_01: Bayak has reminded us many times on the TCN Talks podcast, zero tolerance for fraud, waste, and abuse.
• 7:13
  SPEAKER_01: Now, on your technology challenge, we should use that as an accelerator for excellence, not a strategy itself.
• 7:20
  SPEAKER_01: AI can absolutely remove clerical burden and should.
• 7:23
  SPEAKER_01: It should also help us detect symptoms sooner, should help us personalize education, and it should also help us make meaningful data available.
• 7:32
  SPEAKER_01: And or technology must give time back to the bedside.
• 7:38
  SPEAKER_01: That's how we should apply technology as an accelerator, not as some panacea.
• 7:42
  SPEAKER_01: And it's critical to be world class.
• 7:44
  SPEAKER_01: Now, in your speed of change challenge, a strong identity as an organization absolutely creates resilience.
• 7:51
  SPEAKER_01: If an organization does not know what it must preserve, then every new trend becomes some strategic identity crisis.
• 7:59
  SPEAKER_01: And then on your last challenge on mental health, hospice and powdered care already possess the interdisciplinary DNA to address grief, isolation, and distress in caregiver burden.
• 8:11
  SPEAKER_01: So let's become exceptional at deploying that.
• 8:14
  SPEAKER_01: So let's return to your example earlier about Mary.
• 8:18
  SPEAKER_01: She doesn't need us to own every part of her life.
• 8:21
  SPEAKER_01: She needs us to be extraordinary when she needs pouch care.
• 8:25
  SPEAKER_01: She needs us to be there and be extraordinary when she chooses hospice.
• 8:30
  SPEAKER_01: She needs a specialist she can absolutely trust, not a corporation trying to turn every stage of her aging into a service line.
• 8:38
  SPEAKER_01: You know, there's humility in saying this is what we do, and we do it as well as anyone else in the world.
• 8:46
  SPEAKER_01: We can build strong partnerships upstream to ensure against the upstream risk without owning everything upstream.
• 8:54
  SPEAKER_01: We can create preferred relationships with primary care, ACO, hospitals, plans, and community organizations.
• 9:01
  SPEAKER_01: We've done that most of our careers, many of us that have been around a long time.
• 9:06
  SPEAKER_01: We can make our value so measurable and our reputation so powerful that excluding us would be absolutely irrational.
• 9:14
  SPEAKER_01: The future does not belong to the organization with the most boxes on the organization shore.
• 9:20
  SPEAKER_01: It's gonna belong to the organization that patients insist upon.
• 9:25
  SPEAKER_01: Well, it's not excellence alone, it's strategic excellence.
• 9:30
  SPEAKER_01: On hypercompetition, your first challenge, you know, mediocre organizations compete on relationships, geography, or price.
• 9:37
  SPEAKER_01: But world-class organizations, they compete on trust and demonstratable outcomes, including decreases in total cost of care.
• 9:46
  SPEAKER_01: Then hospital physicians, payers, and consumers, well, they will know exactly what becomes better when we're involved.
• 9:53
  SPEAKER_01: That's why they're going to demand world class.
• 9:56
  SPEAKER_01: On your reimbursement challenge, focus protects discipline.
• 10:01
  SPEAKER_01: We know our unit economics, or we should, we better going forward.
• 10:04
  SPEAKER_01: What's our staffing model?
• 10:06
  SPEAKER_01: Our cost per patient day, our quality drivers, and the services that create genuine value.
• 10:12
  SPEAKER_01: In fact, if you look at how Elon Musk did what he did at SpaceX and Tesla, he applied first principle thinking.
• 10:19
  SPEAKER_01: And then basically, which is exactly that, is basically figuring out what are those services that create genuine genuine value, go deep on that, become world class, throw the other stuff out.
• 10:30
  SPEAKER_01: And then we advocate for payment that recognizes quality rather than launching business lines that we don't even know how to operate.
• 10:38
  SPEAKER_01: On your workforce challenge, people want to belong to something excellent: a clear calling, superb leadership, manageable systems, professional development, in other words, pouring into your people, and the chance to master meaningful work, those are competitive advantages.
• 10:56
  SPEAKER_01: We should repair the work rather than continuously asking our people to absorb new ventures.
• 11:02
  SPEAKER_01: On demographics, the baby boomers, they're not going to accept a generic commodity.
• 11:07
  SPEAKER_01: They're going to research, they're going to compare, they're going to ask questions, they're going to demand responsiveness, and then they're going to expect care that's tailored to their values.
• 11:19
  SPEAKER_01: A world-class provider earns active consumer preference rather than relying upon referral sources or a mousetrap that someone else built that's just expecting them to passively go along with the care flow that's been pre-mapped out for them.
• 11:34
  SPEAKER_01: I think that's a key flaw in their thinking.
• 11:37
  SPEAKER_01: Now, on your regulation challenge, the strongest defense is operational integrity.
• 11:43
  SPEAKER_01: We should be the field standard bearers for eligibility documentation, quality, stewardship, transparency.
• 11:50
  SPEAKER_01: And we should have, as Dr.
• 11:51
  SPEAKER_01: Bayak has reminded us many times on the TCN Talks podcast, zero tolerance for fraud, waste, and abuse.
• 11:59
  SPEAKER_01: Now, on your technology challenge, we should use that as an accelerator for excellence, not a strategy itself.
• 12:07
  SPEAKER_01: AI can absolutely remove clerical burden and should.
• 12:10
  SPEAKER_01: It should also help us detect symptoms sooner, should help us personalize education, and it should also help us make meaningful data available.
• 12:19
  SPEAKER_01: And or technology must give time back to the bedside.
• 12:25
  SPEAKER_01: That's how we should apply technology as an accelerator, not as some panacea.
• 12:29
  SPEAKER_01: And it's critical to be world class.
• 12:31
  SPEAKER_01: Now, in your speed of change challenge, a strong identity as an organization absolutely creates resilience.
• 12:38
  SPEAKER_01: If an organization does not know what it must preserve, then every new trend becomes some strategic identity crisis.
• 12:46
  SPEAKER_01: And then on your last challenge on mental health, hospice empowered care already possess the interdisciplinary DNA to address grief, isolation, and distress and caregiver burden.
• 12:58
  SPEAKER_01: So let's become exceptional at deploying that.
• 13:01
  SPEAKER_01: So let's return to your example earlier about Mary.
• 13:05
  SPEAKER_01: She doesn't need us to own every part of her life.
• 13:08
  SPEAKER_01: She needs us to be extraordinary when she needs pouch care.
• 13:12
  SPEAKER_01: She needs us to be there and be extraordinary when she chooses hospice.
• 13:17
  SPEAKER_01: She needs a specialist she can absolutely trust, not a corporation trying to turn every stage of her aging into a service line.
• 13:25
  SPEAKER_01: You know, there's humility in saying this is what we do, and we do it as well as anyone else in the world.
• 13:33
  SPEAKER_01: We can build strong partnerships upstream to ensure against the upstream risk without owning everything upstream.
• 13:41
  SPEAKER_01: We can create preferred relationships with primary care, ACO, hospitals, plans, and community organizations.
• 13:48
  SPEAKER_01: We've done that most of our careers, many of us that have been around a long time.
• 13:52
  SPEAKER_01: We can make our value so measurable and our reputation so powerful that excluding us would be absolutely irrational.
• 14:01
  SPEAKER_01: The future does not belong to the organization with the most boxes on the organization shore.
• 14:06
  SPEAKER_01: It's going to belong to the organization that patients insist upon.
• 14:11
  Chris Comeaux: Okay, Como here's what I could affirm in your worldview.
• 14:15
  Chris Comeaux: You're protecting something the other strategies could accidentally dilute or maybe even destroy.
• 14:20
  Chris Comeaux: Hospice and special deep care, they require deep competence.
• 14:25
  Chris Comeaux: Expansion creates managerial complexity, and complexity can turn excellence into inconsistency.
• 14:32
  Chris Comeaux: There is wisdom in mastery, a clear identity, and a refusal to chase every adjacent opportunity.
• 14:39
  Chris Comeaux: As I shared earlier, there are cautionary tales hospice leaders can learn from other industries who've tried to become all things to all people, and they did none of them well.
• 14:49
  Chris Comeaux: That General Motors' example is the one that I alluded to earlier.
• 14:52
  Chris Comeaux: Again, how did Toyota compete and ultimately win?
• 14:56
  Chris Comeaux: They did it on world-class quality.
• 14:58
  Chris Comeaux: Exactly, I think, the point that you're making.
• 15:01
  Chris Comeaux: You're also placing a bet on brand and consumer preference.
• 15:04
  Chris Comeaux: If the baby boomers become more active choosers of serious illness care, a trusted world-class organization really could have power that traditional referral models really underestimate.
• 15:16
  Chris Comeaux: And you also remind us integration is not synonymous with ownership.
• 15:21
  Chris Comeaux: Partnerships, open networks, shared protocols, data exchange, and warm handoffs can create continuity without requiring one enterprise to employ every clinician and bear every risk.
• 15:34
  Chris Comeaux: So I love those key points that you make.
• 15:36
  Chris Comeaux: Now, let me poke holes.
• 15:38
  Chris Comeaux: First, the patient cannot choose a hospice she never ever hears about.
• 15:43
  Chris Comeaux: Excellence at the end of the funnel does not guarantee access to the funnel.
• 15:47
  Chris Comeaux: If payers, ACOs, health systems, and primary care platforms control the relationship upstream, well, your world-class program may receive Mary with only three days left, or not at all.
• 16:00
  Chris Comeaux: Second, pality care economics really remain difficult.
• 16:03
  Chris Comeaux: Calling the service world class does not fund the interdisciplinary team.
• 16:08
  Chris Comeaux: Without risk contracts, philanthropy, health system support, new codes with payment attached, or downstream value, a superb community powder care program may be financially still fragile.
• 16:21
  Chris Comeaux: Third, referral partners do not always act on value.
• 16:25
  Chris Comeaux: Unfortunately, they act on convenience, contracts, network design, habit, ownership, and incentives.
• 16:32
  Chris Comeaux: You may be objectively better, but then still be outside the preferred pathway.
• 16:37
  Chris Comeaux: Fourth, hyper competition includes substitutes, hospital at home, advanced illness management, home-based primary care, Medicare Advantage Care Management, and technology-enabled platforms may perform pieces of what hospice and both care do.
• 16:52
  Chris Comeaux: If consumers can't distinguish the difference or the expertise, well, that excellence is invisible.
• 16:59
  Chris Comeaux: It's invisible to the one who maybe matters the most.
• 17:03
  Chris Comeaux: Fifth, focus can become dignified word for strategic inertia.
• 17:07
  Chris Comeaux: We're protecting the mission can really conceal fear of investment, unwillingness to build new capabilities, or nostalgia for a referral environment that is disappearing.
• 17:19
  Chris Comeaux: Sixth, the demographic change cuts both ways.
• 17:23
  Chris Comeaux: Baby boomers may seek a world-class specialist.
• 17:25
  Chris Comeaux: I agree with you on that.
• 17:27
  Chris Comeaux: But they may also prefer one seamless platform that already knows them.
• 17:31
  Chris Comeaux: You're betting they will interrupt an established relationship to choose you at the hardest moment of their lives.
• 17:38
  Chris Comeaux: And seventh, you depend on others to create continuity.
• 17:42
  Chris Comeaux: Partnerships are often celebrated at the signing ceremony, and they fail in the daily work, the different records, different incentives, no shared accountability, and nobody answering after hours.
• 17:53
  Chris Comeaux: So, Como, how do you keep focus from becoming, well, irrelevance?
• 17:59
  SPEAKER_01: Well, by refusing to define focus as sitting around and waiting, a world-class strategy must include absolutely these things: market intelligence, consumer education, data interoperability, measurable outcomes, surely preferred partnerships, rapid access, speed to care, deliberate upstream presence.
• 18:21
  SPEAKER_01: We should teach primary care teams, embed public care expertise, and support ACO partners and create open doors for patients and families long before hospice eligibility.
• 18:33
  SPEAKER_01: But we don't have to own the patient's primary care or the insurance product to matter.
• 18:37
  SPEAKER_01: We need enough strategic reach to ensure access and enough discipline to preserve and advance mastery.
• 18:45
  SPEAKER_01: And let me challenge both of my colleagues Chris Christopher and Paul.
• 18:49
  SPEAKER_01: Ownership is not going to automatically equal loyalty.
• 18:52
  SPEAKER_01: Patients do not owe our enterprise their next episode of care.
• 18:56
  SPEAKER_01: The only way our continuum or our risk model succeed is by keeping the patient from choosing someone else.
• 19:03
  SPEAKER_01: That's not truly succeeding.
• 19:05
  Chris Comeaux: Well, that might be Como's strongest case.
• 19:09
  Chris Comeaux: Mastery without passivity, partnerships without captivity, and a brand the patient actively chooses.
• 19:16
  Chris Comeaux: Let me say that again.
• 19:18
  Chris Comeaux: Mastery without passivity, partnership without captivity, and a brand the patient actively chooses.
• 19:26
  Chris Comeaux: Well done, Como.
• 19:27
  Chris Comeaux: So let me do some cross-examination where each strategy potentially can fail.
• 19:33
  Chris Comeaux: So I'm going to do one short cross-examination.
• 19:36
  Chris Comeaux: Each of you gets one question for another of the other characters.
• 19:40
  Chris Comeaux: Paul, you go first.
• 19:42
  SPEAKER_02: Well, Christopher, if your financial model shows that a shorter hospice length of stay reduces total cost in a particular year, who protects the patient from your spreadsheet?
• 19:53
  Chris Comeaux: Well, independent clinical governance, for one, transparent outcomes, and a payment model that measures quality over a meaningful time horizon.
• 20:02
  Chris Comeaux: But I will turn it back.
• 20:04
  Chris Comeaux: If your frail elderly practice keeps managing crisis and delays hospice because the team believes it can do everything, who protects the patient from your clinical pride?
• 20:14
  SPEAKER_02: Objective transition triggers, external review, and patient goal measures.
• 20:19
  SPEAKER_02: The danger is real.
• 20:20
  SPEAKER_02: That's why timely hospice transition must be a key performance indicator.
• 20:25
  SPEAKER_02: I would absolutely agree and indicate that.
• 20:28
  SPEAKER_02: All right.
• 20:29
  SPEAKER_02: Christopher, your question.
• 20:31
  Chris Comeaux: Well, okay.
• 20:32
  Chris Comeaux: Como if a payer controls 10,000 high-need lives in your market and selects a lower quality owned provider, what exactly does your world-class strategy do next?
• 20:44
  SPEAKER_01: Well, because it produces evidence, it activates consumer demand, and that's a key one.
• 20:49
  SPEAKER_01: It makes exclusion reputationally and clinically costly, and it creates alternative partnerships and it advocates for choice.
• 20:58
  SPEAKER_01: But I do concede my central weakness in my thesis.
• 21:01
  SPEAKER_01: Quality without access is not enough.
• 21:04
  SPEAKER_01: But that's why world class must also include our market access strategy, not merely clinical operations.
• 21:12
  SPEAKER_01: All right.
• 21:12
  SPEAKER_01: Como your question.
• 21:14
  SPEAKER_01: Well, Paul, when your organization is operating hospice, special deep house care, home-based primary care, after hours response, care management, technology, contracting, and multiple billing models, what are you willing to stop doing so that it all remains excellent?
• 21:30
  SPEAKER_01: Because that's a huge challenge.
• 21:33
  SPEAKER_02: That may be the most important implementation question.
• 21:36
  SPEAKER_02: The continuum cannot become a collection of under-resourced mediocre programs.
• 21:41
  SPEAKER_02: Totally agree.
• 21:42
  SPEAKER_02: We would stage the build, establish readiness gates, and centralize only what truly creates leverage, and absolutely refuse to launch the next layer till the previous one meets defined clinical, cultural, and financial standards.
• 21:57
  SPEAKER_02: That's how.
• 22:00
  Chris Comeaux: Good job, gentlemen.
• 22:01
  Chris Comeaux: Each strategy is now admitted it's Achilles' heel.
• 22:04
  Chris Comeaux: For Paul, it's complexity and the possibility that continuity becomes internal substitution.
• 22:12
  Chris Comeaux: For Christopher, it's conflict of interest and the possibility that alignment becomes financial domination.
• 22:19
  Chris Comeaux: And for Como, it's access and the possibility that mastery becomes irrelevance.
• 22:26
  Chris Comeaux: So, gentlemen, thank you.
• 22:28
  Chris Comeaux: There is so much wisdom in what you shared.
• 22:30
  Chris Comeaux: Here's where I land after hearing all three of your strategies or your worldviews.
• 22:35
  Chris Comeaux: These strategies are distinct, but they're not always mutually exclusive.
• 22:40
  Chris Comeaux: In fact, the wisest path may be a sequence rather than a single leap.
• 22:45
  Chris Comeaux: An organization might first establish world-class hospice empowered care.
• 22:49
  Chris Comeaux: That's foundational.
• 22:51
  Chris Comeaux: Without excellence at the core, expansion magnifies weakness.
• 22:55
  Chris Comeaux: Let me say that again.
• 22:56
  Chris Comeaux: Without excellence at the core, expansion magnifies weakness.
• 23:02
  Chris Comeaux: It might then build our partner into a frail elder continuum where market conditions, capital talent, and mission support it.
• 23:10
  Chris Comeaux: That creates an earlier relationship and a better journey.
• 23:13
  Chris Comeaux: And it might then choose an appropriate level of financial participation, contracted value-based payment, limited professional risk, ACO participation, a joint venture, or for a small number of organizations with the scale, capabilities, and capital, ownership of a plan or other risk-bearing structure?
• 23:33
  Chris Comeaux: The strategic question is not simply, hey, which box do we s select?
• 23:39
  Chris Comeaux: It's these key questions.
• 23:41
  Chris Comeaux: What problem are we solving for the patient?
• 23:44
  Chris Comeaux: What capabilities do we genuinely possess?
• 23:48
  Chris Comeaux: What capabilities can we build without weakening our core?
• 23:52
  Chris Comeaux: Where do incentives help or harm the patient?
• 23:56
  Chris Comeaux: And how will the patient exercise meaningful choice?
• 24:00
  Chris Comeaux: And what evidence will tell us that the model is making life better, not merely making the organization larger?
• 24:08
  Chris Comeaux: So let me land the plane with these three points.
• 24:13
  Chris Comeaux: The patient and family absolutely have to remain at the center.
• 24:17
  Chris Comeaux: Every strategy says that, but the test is going to be whether the operating model really proves it out.
• 24:23
  Chris Comeaux: Does the patient experience fewer handoffs or merely more services carrying the same logo?
• 24:29
  Chris Comeaux: Let me say that again.
• 24:30
  Chris Comeaux: Does the patient experience fewer handoffs or merely more services that just happen to carry the same logo?
• 24:37
  Chris Comeaux: Does the caregiver receive real support or appear as a data field in an assessment?
• 24:44
  Chris Comeaux: Do we measure quality of life, goal concordance, trust, and the ability to remain safely at home, or only utilization and margin?
• 24:53
  Chris Comeaux: Do we introduce hospice when it becomes the right choice, even when another part of our organization could keep billing?
• 25:01
  Chris Comeaux: And do we help a patient choose another provider when that provider is the better fit?
• 25:07
  Chris Comeaux: Patient-centeredness is not a sentence in the strategic plan.
• 25:11
  Chris Comeaux: It's the willingness to design incentives, measures, governance, and daily behavior around the interests of the patient and family, even when those interests do not maximize our own enterprise.
• 25:24
  Chris Comeaux: Second key point: the customer is changing.
• 25:27
  Chris Comeaux: I alluded to this in the opening of the show.
• 25:30
  Chris Comeaux: We're entering the age of the baby boom serious illness customer, and too many strategies or strategists treat that as a volume forecast rather than a transformation and expectations.
• 25:42
  Chris Comeaux: Baby boomers have advocated for themselves and created disruption as they've moved through education, work, finance, travel, media, retail, and retirement.
• 25:53
  Chris Comeaux: Why would healthcare be the one industry they quietly accept it as it is?
• 25:58
  Chris Comeaux: They will ask why is care fragmented?
• 26:01
  Chris Comeaux: They're going to research quality.
• 26:03
  Chris Comeaux: They will expect technology that makes access easier.
• 26:08
  Chris Comeaux: They're going to challenge paternalism.
• 26:10
  Chris Comeaux: They will want honest conversations earlier and they will expect services to adapt to their lives rather than forcing their lives into our programs.
• 26:20
  Chris Comeaux: The winners will not merely manage a large elderly population.
• 26:24
  Chris Comeaux: They're going to understand that they're a different customer.
• 26:28
  Chris Comeaux: Number three, the patient wants choice, not a mousetrap.
• 26:32
  Chris Comeaux: This may be the point our field is most at risk of missing.
• 26:35
  Chris Comeaux: In fact, many in healthcare, I think, are missing this.
• 26:39
  Chris Comeaux: Many strategies are built around the assumption that once a patient enters our clinic, our continuum, our ACO, our network, or our health plan, that the patient will remain inside the system that we designed.
• 26:52
  Chris Comeaux: But the patient is not a captured life.
• 26:55
  Chris Comeaux: The patient is a person with agency.
• 26:58
  Chris Comeaux: Continuity, no doubt, is valuable.
• 27:00
  Chris Comeaux: Simplicity, that's valuable as well.
• 27:03
  Chris Comeaux: Trusted relationships are valuable, but none of those should become an excuse to limit meaningful choice or quietly steer someone towards the option that's most profitable to us.
• 27:15
  Chris Comeaux: The best model will not be the slickest or stickiest mousetrap.
• 27:19
  Chris Comeaux: It will be the model patients and families choose to remain in because it has earned their trust, and the model confident enough to help them leave when another choice serves them better.
• 27:31
  Chris Comeaux: So, should the future belong to world-class hospice and palliative care?
• 27:35
  Chris Comeaux: Yeah, because no strategy can compensate for mediocre care.
• 27:39
  Chris Comeaux: Should hospice organizations vertically integrate into palliative care and then frail elderly primary care?
• 27:45
  Chris Comeaux: For many, the answer is yes, because patients need continuity before the final chapter, and hospice cannot assume that access will take care of itself.
• 27:55
  Chris Comeaux: Should some organizations also become payviders or participate meaningfully in risk?
• 28:01
  Chris Comeaux: Yeah, because incentives shape care, and the field cannot afford to be financially illiterate or permanently downstream.
• 28:09
  Chris Comeaux: But each yes comes with a warning.
• 28:12
  Chris Comeaux: Do not let excellence become isolation.
• 28:15
  Chris Comeaux: Do not let integration become captivity.
• 28:18
  Chris Comeaux: Do not let financial alignment become financial domination.
• 28:22
  Chris Comeaux: Keep the patient and the family at the center.
• 28:26
  Chris Comeaux: Build for the baby boomer customer who is arriving.
• 28:29
  Chris Comeaux: Preserve real choice.
• 28:31
  Chris Comeaux: If we do those three things, this debate will really have served this purpose.
• 28:36
  Chris Comeaux: Because the ultimate goal is not for Chris, Paul, Christopher, or Como to win, which if you've not figured out by now, my name is Christopher Paul Como, and I go by Chris.
• 28:47
  Chris Comeaux: The goal is for Mary and her family to win.
• 28:51
  Chris Comeaux: Thank you for joining me for this special edition of TCN Talks Anatomy of Leadership.
• 28:55
  Chris Comeaux: And thank you to our listeners.
• 28:57
  Chris Comeaux: In many respects, you can embirth today's episode as I listened to many of you and the things that you're wrestling with.
• 29:04
  Chris Comeaux: It really gave me a vision for this, which is probably the most complicated podcast that we ever pulled off.
• 29:11
  Chris Comeaux: Note in our show notes, we'll have the entire script because I have a feeling this is a document that you're going to want access to.
• 29:17
  Chris Comeaux: And as always, at the end of each episode, we always share a quote, a visual.
• 29:21
  Chris Comeaux: The idea is to create a brain bookmark, a thought prodder about our podcast subject to further your learning and growth and thereby your leadership.
• 29:29
  Chris Comeaux: We're hoping it sticks, like a brain tattoo.
• 29:31
  Chris Comeaux: Again, be sure to subscribe to our channel.
• 29:33
  Chris Comeaux: We don't want you to miss an episode.
• 29:35
  Chris Comeaux: Please, if you're interested, check out the book, The Anatomy of Leadership, on Amazon.
• 29:39
  Chris Comeaux: Tell your friends and your co-workers about this podcast.
• 29:42
  Chris Comeaux: You know it's easy for us to reel against the world and be frustrated by things.
• 29:46
  Chris Comeaux: Let's be the change that we wish to see in this world.
• 29:49
  Chris Comeaux: So thanks for listening to TCN Talks Anatomy of Leadership.
• 29:52
  Chris Comeaux: And here's our brain bookmark to close today's show.
• 29:56
  Dragonfly Health Ad: The future does not only belong to the organization with the most boxes on its organizational chart.
• 30:05
  Dragonfly Health Ad: It may belong to the organization patience and test.