A Q&A With Ohio's Hospice COO, Amy Wagner

In this Q&A, read how the innovative hospice alliance–Ohio’s Hospice–is helping not-for-profit hospices connect with each other to gain huge efficiencies through shared costs, negotiating power, advocacy and education.

Chief Operating Officer, Amy Wagner, shares how the organization saved its affiliates over $500,000 in health insurance costs last year ($1M in 2017) by allowing them to become self-insured vs fully-insured. 

Since being named chief operating officer of Ohio’s Hospice in 2016, Amy Wagner leads the integration and onboarding of new hospice affiliates. 

Today, Ohio’s Hospice includes eight affiliated and two associate, non-profit hospice providers who operate in their respective communities, but can tap into a host of shared mission-support services such as group purchasing, contract negotiation, HR, payroll, quality, training, and technology. Because they can access so many shared services, the hospice affiliates are able to put more resources at the bedside of the patient. 

Why is a hospice alliance model like yours important?

The number of hospice providers in Ohio has grown significantly over the last 15 years, in some counties, going from about one or two providers to 25-30 providers. In light of heightened competition, hospice leaders know it will be more difficult to maintain superior care on their own. 

By joining with local hospice providers, Ohio’s Hospice becomes a sole member of the non-profit affiliated hospices. This allows us to build systems and extend contracts to all of our affiliated hospice partners. 

Take health insurance for example. Because it is a controlled group, we’re able to cover all of the affiliated hospices under our self-insured health plan. We can take on more risk and recognize savings compared to the average fully-insured premiums. 

Last year, we saved nearly $500,000 by being self-insured. In 2017, we saw over $1 million in savings for all of the affiliates combined compared to being fully-insured. It’s allowed us to continue to offer a competitive benefit plan to our valuable staff while reaping major financial savings along the way. 

We’ve been working diligently on centralizing what we call mission support services, which support those delivering care in the field. These services include billing, payroll, human resources, quality and informatics. 

Centralizing these services prevents duplication and creates efficiencies. In addition, it allows more resources to be allocated toward our staff and patients.  

We’ve seen great results, especially with the organizations who have been affiliated the longest. There’s more resources to be allocated toward direct care at the bedside that otherwise would have been spent toward indirect costs. 

With 16 years of experience, where have you seen the biggest change and challenge? 

Healthcare is evolving quickly, forcing us to think and operate differently. When recruiting, we’re now not only competing with other hospice organizations but with other industries, too. 

A big challenge is workforce demand. It can be difficult to attain and retain qualified staff to do this type of work. Although a challenge, it’s prompting us to become more efficient by centralizing back office functions, so our clinical staff can utilize more resources at the bedside – which eases the high demands of their roles. 

Another change is the length of stay. We have much shorter time periods to see patients – the length of stay has shortened for a variety of reasons. This can take a physical and emotional toll on our care teams Therefore, it’s our responsibility to provide the proper resources necessary for them to continue giving quality care in a shortened time period. 

Ohio’s Hospice has gained many efficiencies due to integrated technology. What advice would you offer to organizations like yours when it comes to selecting a technology vendor?

Find a trusting, valuable partner who stands behind their values.  

It’s important to prioritize the partnership aspect. We didn’t want to be a customer, we wanted to be a partner. We have lofty goals, not only with our hospice service, but also with two growing areas – chronic care management and population health management. So, we needed a strong partner to get us to where we need to be as an enterprise. 

Equally important is to consider the continuum of care when selecting a vendor. You’re probably not going to find yourself solely in the hospice world anymore, so you’ve got to think more upstream in order to serve dynamic and different populations in your community. For Ohio’s Hospice, having one electronic health record (EHR) system and one partnership is key to getting us where we need to be. 

Additionally, your technology should help remove the wall between the patient and the caregiver. Make the caregiver’s world as simple as possible with technology and tools that ensure their first priority is the patient – not the technology. 

Another key factor when selecting a technology partner is to make sure they have a road map for mobile capabilities. You don’t want your clinicians carrying around an office when serving clients offsite. Your organization needs the best, most simple tools possible that allow clinicians to focus on their patients.  

Finally, make sure your technology partner allows for seamless exchange of information. It’s vital to be able to share medical records and patient information with other organizations who aren’t using the same EHR system as you.  

Fast forward five years. What will Ohio’s Hospice look like? 

Ohio’s Hospice affiliates and associates will all be on the same EHR, using the same system. I believe our affiliations will continue to grow throughout Ohio as well as our population health and chronic care management care organizations. 

I envision hospices all around the country modeling a program like ours so they can gain efficiencies to continue to provide superior care. My desire for Ohio’s Hospice is to be instrumental in helping other alliances around the country grow.   

About Ohio's Hospice

Ohio’s Hospice is a network of mission-driven, not-for-profit hospice and palliative care providers leading a collaborative transformation to assure superior end-of-life care. 

The organization is dedicated to preserving and sustaining the legacy of community-based, person-centered care at the end of life for all who could benefit from quality, compassionate care regardless of the ability to pay.