Show Notes / Summary

• Why launch hospice now: continuity, fewer hospitalizations, value-based alignment
• Clarifying myths: CNA hours on hospice, attending provider still leads care
• RAF & staffing logic: ~$6k/mo hospice per diem ↔ RAF ~5; translating RAF → weekly CNA/CHW hours
• Nurse incentives: $150 per admission; double telehealth-assist credit on hospice patients
• Software + workflow: Athena ↔ WellSky (care plans, documentation, pull-through)
• Facility model: converting buildings; estimating FTEs from hospice census + RAF
• Chaplain/social work: leverage in-region LSWs; connect to patient’s faith community
• Respite options: Medicare respite/GIP + GUIDE program for dementia (up to $2,500yr)
• Therapy as palliative strength: weekly PTA/COTA; telehealth support
• After-hours model: optional call, $300 RN death/critical visit; $150 for non-nurse critical checks
• Guardrails: clinical judgment first; financials inform—not dictate—care

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Key Takeaways (for on-air recap & social)

• Presence prevents: Being in the building daily beats any remote administrative stack.
• Rituals > heroics: Small, repeatable actions (exercise + vitals + lunch checks) compound.
• Caregivers stabilize: A modest weekly schedule creates 40 hours of reliable on-site support.
• Therapy cadence matters: Spread the care; keep people moving longer to reduce falls.
• Document to decide: Specific behavioral notes → faster NP decisions → fewer crises.
• Mission creates growth: Aligning to “no hospitalizations” reduces noise and increases referrals.

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Why transitional care is at the heart of Your Health’s model

How incentives for early post-hospital visits worked (and why they didn’t)

Why in-person care matters more than telehealth alone

The growing role of respiratory therapists, physical and occupational therapists, and community health workers

The challenge of patient perception: “too many visits” vs. “too many calls”

Why insurance companies trying to become providers is dangerous for patients

Scott’s philosophy: nothing should be written in stone — adapt and evolve

The simple but powerful call to action for providers: “Go see your damn patients.”

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Key Topics:

• How sudden insurance and policy changes disrupt patients and providers
• The importance of prevention and primary care in lowering long-term costs
• What fully staffed care teams look like and why they matter
• Balancing productivity and patient-centered care
• Why disruption is necessary for a healthier future
• Takeaway: Healthcare continues to be shaped more by profit and red tape than by prevention and patient outcomes. But with innovative care models and a relentless focus on what patients truly need, leaders can shift the system toward better health and lower costs.

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• What Health Connectors are and why they matter.
• The danger of a provider-centered workflow—and how to avoid it.
• Real examples of how proactive home visits catch problems early.
• Why vital signs can be the key to preventing 50% of heart attacks.
• The culture shift needed: salaried roles with responsibility, not clock-in/clock-out mindsets.
• Scott’s challenge to all healthcare workers: “Go see your damn patients.”

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• Scott shares a story about meeting a compliance pharmacist who unexpectedly became the solution to a major organizational challenge.
• The importance of pharmacy compliance and direct-to-manufacturer drug purchasing.
• Why God’s timing plays a role in healthcare growth and leadership decisions.
• The danger of miscommunication across facilities and how to “season” a team for long-term effectiveness.
• How leaders can emerge from any position — from providers to CNAs to medical assistants.
• Why job descriptions must be clear, but leadership requires flexibility.

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• Why disruption in healthcare often means simplifying, not complicating.
• The critical role of Senior Solutions Advisors as navigators, educators, and advocates.
• Real-world stories: from a weight loss patient’s experience to common Medicare misunderstandings.
• How word-of-mouth becomes the best marketing strategy when patients feel truly cared for.
• Scott’s challenge to SSAs: prioritize patient contact, ask deeper questions, and don’t be afraid to admit when you don’t know—just commit to finding the answer.
• Why employers and patients alike need value-based care models that prioritize health outcomes over hospital incentives.

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• Why each patient-facing role at Your Health was created and the specific problems they solve
• How Medicare’s new Community Health Worker reimbursement is shaping care delivery
• The bonus structures that align staff incentives with patient outcomes
• Real-world examples of how metrics reveal opportunity — and lost income — for staff
• The difference between “helping” and staying focused on core role responsibilities
• How community health workers improve care by tackling social determinants of health
• The daily expectations and earning potential for nurses, pharmacists, social workers, and providers
• Why facilitated visits dramatically increase provider efficiency and patient touchpoints
• How sharing the wealth in healthcare creates stronger teams and better care
• The direct connection between role clarity, accountability, and reduced costs for Medicare

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