CMS just proposed a 2.4% payment increase for home health in 2027. If that's the only number you take away, you're missing a lot.

Tom Maxwell sits down with Jay Duty, COO at Maxwell TEC, to unpack what's actually happening underneath the headline: a temporary rate cut, a nearly $5 billion recoupment, a full case-mix recalibration, and provider enrollment changes that could put your Medicare billing privileges at risk.

Jay spent his first ten years in the hospital business at HCA before moving into post-acute care strategy, eventually landing at Maxwell TEC. In this conversation, he and Tom walk through what CFOs need to know before they finalize next year's budget, why the "behavioral adjustment" methodology has the industry pushing back, and what a home health specific wage index could mean for high-cost and rural markets.

Topics Include:

• The real math behind the 2.4% headline number and where it actually comes from
• Why the temporary 3% clawback matters more than the payment increase
• How to model your 2027 budget before the final rule drops in November
• The CMS wage index proposal and its impact on rural and high-cost markets
• What CMS's expanded provider enrollment authority means for your Medicare billing risk

The comment period for this rule runs through August 31, 2026. If you're a home health agency owner, operator, or CFO, this episode gives you the framework to build your comment letter and your budget at the same time.

Connect with Jay Duty:

• [email protected] or https://www.maxwelltec.com

Chapters:

• 0:00 Intro: the 2.4% headline everyone's getting wrong
• 1:26 Jay Duty's path from HCA to home health strategy
• 1:53 The first thing Jay checks in a new CMS rule
• 2:21 What's actually driving the 2.4% number
• 3:55 The one sentence every CFO needs to remember
• 4:49 The behavioral adjustment, explained
• 6:26 Real example: therapy-only cases and the 30-day billing trap
• 7:44 The $4.9 billion recoupment breakdown
• 9:54 Is CMS's data methodology actually flawed?
• 12:15 What a strong industry comment letter argues
• 13:33 Why this rule always lands mid-budget cycle
• 14:46 How to model your 2027 budget starting now
• 17:01 Why visits per period keep falling
• 19:45 What investors and lenders should hear from you now
• 21:28 The case for a home health specific wage index
• 24:00 CMS's expanded power to deny or revoke enrollment
• 25:34 Can industry comments actually move the needle?
• 28:16 What makes a comment letter valuable to CMS
• 29:48 Will this adjustment mechanism still exist in five years?
• 31:51 What to do this week if you run an agency
• 33:08 How to reach Jay Duty

Sponsors:

• Maxwell TEC: https://www.maxwelltec.com

What does it actually take to sell a home health or hospice agency, and how do you make sure you walk away with what your business is worth?

Alex Veach, Partner at Agenda Health, joins Last Visit First for a conversation that covers the full arc of the healthcare M&A process, from the moment you start thinking about an exit to the day you close a deal. Agenda Health advised on roughly 25% of all home-based care transactions in 2025 alone, and Alex brings a decade of deal reps and hard-won market knowledge to every answer.

This is not a theoretical conversation. It is a practical, direct look at how buyers evaluate agencies, what kills deals, how to time an exit around regulatory cycles, and why the emotional side of selling a business you built from nothing is just as important as the financial side.

Topics include:

• What the current healthcare M&A market actually looks like for home health and hospice owners and where the opportunity is headed
• The three things buyers prioritize above everything else in smaller agency deals and why compliance now leads the list
• How Agenda's buyer profiling process matches sellers with the right capital partners, not just the highest bid
• What the full deal process looks like step by step, from valuation call to signed LOI, for an owner who has never done this before
• The emotional reality of selling a business you built from nothing and how good advisors help owners through it

Chapters:

• 00:00 Introduction to Alex Veach and Agenda Health
• 01:29 Alex's Background and Path to Agenda
• 02:45 What Agenda Health Does and Who They Serve
• 05:14 The Current M&A Market for Home Health and Hospice
• 07:43 What Most Owners Get Wrong About Valuation
• 09:18 Valuation Ranges Across Home Health, Hospice, and Personal Care
• 12:15 What a Platform Deal Actually Means
• 14:22 Buyer's Market or Seller's Market Right Now
• 17:34 How Large Platform Deals Create Add-On Opportunity for Smaller Agencies
• 19:05 Acquisition vs. Recapitalization: What's the Difference
• 21:37 The Top Three Things Buyers Look for in Smaller Agencies
• 25:12 The Role of Team and Key Man Risk in a Deal
• 26:39 How Regulatory Timing and Rate Changes Affect Deal Process
• 29:22 Ads
• 31:59 Building Relationships and Teaching the Business
• 36:47 How Long the Seller Relationship Takes to Develop
• 39:33 Begin With the End in Mind: Prepping 24 Months Out
• 42:01 EMR Data, Financial Readiness, and What Buyers Are Testing
• 45:42 Walking Through a Real Deal: 250-Patient Hospice in Houston
• 46:27 Valuation Presentation and Process Strategy
• 49:46 Ads
• 50:51 The Data Room: How It Works and Why It Matters
• 53:03 Keeping Census Up While Your Deal Is in Process
• 56:46 Managing Team Distraction and Confidentiality During a Sale
• 58:01 Legacy, Impact, and What Alex and Agenda Want to Be Known For
• 1:03:39 The Emotional Reality of Selling Your Business
• 1:04:37 How to Reach Alex Veach and Agenda Health
• 1:05:46 Closing Thoughts

Connect with Alex Veach and Agenda Health:

• Agenda Health's Website: https://www.agendahealth.com
• Agenda Health's LinkedIn: https://www.linkedin.com/company/agenda-business-services/
• Alex's LinkedIn: https://www.linkedin.com/in/alex-veach

Last Visit First:

• Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

Sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Dementia is one of the most feared diagnoses in aging. But most of what families, caregivers, and even healthcare professionals think they know about it is incomplete.

Dr. Shadi Gholizadeh, Chief Quality and Innovation Officer at TheKey, joins Tom Maxwell for a conversation that covers dementia from every angle. Prevention, care, behavior change, the one symptom our aging population is not paying attention to, and what it actually looks like to build a meaningful life after a diagnosis.

Dr. Gholizadeh is a clinical psychologist with training from Stanford, the London School of Economics, and UC San Diego. She has spent over a decade building science-backed, scalable care models at TheKey, the largest privately owned premium home care provider in North America, and she brings that experience into a conversation that is practical, personal, and long overdue.

Topics include:

• The study that found 45% of dementias can be prevented or delayed through lifestyle changes
• The Balanced Care Method and TheKey's six pillars of health in action
• Anosognosia: the misunderstood symptom that changes how families should respond
• Why labeling dementia patients as "resistant to care" is the wrong frame entirely and what to use instead
• Engagement erosion: how decline happens quietly before anyone notices
• The caregiver-as-change-agent model and why it works in the home
• Where AI and wearables are headed in home care
• A story about a son who almost stopped visiting his mom with dementia and what changed

Chapters

• 00:00 Introduction to Dr. Shadi Golizada and The Key
• 02:54 Dr. Golizada's Journey in Clinical Psychology
• 05:35 Understanding The Key's Home Care Services
• 08:48 The Six Pillars of Health and Wellness
• 11:33 Personalized Care and Hydration Strategies
• 14:38 The Importance of Caregiver Stories
• 17:28 Navigating Dementia and Family Dynamics
• 20:21 Education and Awareness in Dementia Care
• 23:23 Hope and Lifestyle Changes for Dementia Patients
• 26:05 Ads
• 29:06 Resources for Aging and Care Coordination
• 31:45 Technology in Home Care Services
• 35:59 AI in Caregiving: Enhancing Relationships and Documentation
• 40:49 The Importance of User-Centric Technology
• 44:28 Engagement and Joy in Care: The Role of AI
• 49:19 Health Behavior Change: A Balanced Approach
• 51:20 Ads
• 57:28 Long-Term Care: Building Meaningful Relationships
• 01:03:50 Transformative Stories: Changing Perspectives on Caregiving

Dr. Gholizadeh is the author of three books, all available on Amazon:

• TheKey Essentials: Navigating Cognitive Change: A New Kind of Dementia Guide for Families by the Leaders in Home-Based Cognitive Support: https://a.co/d/0aLuKhf3
• TheKey Essentials: The Balanced Path: Six Lifestyle Pillars That Shape How We Age: https://a.co/d/0iHbxSKr
• TheKey Essentials: Aging with Confidence: Your Guide to Care, Safety, and Living Fully Wherever You Call Home: https://a.co/d/0dovA0iy

Connect with Dr. Shadi Gholizadeh and TheKey:

• Website: https://www.thekey.com
• Email: [email protected]
• LinkedIn: https://www.linkedin.com/in/shadig

Last Visit First:

• Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

Sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Brian Lobley spent more than 20 years inside one of the country's largest health insurers before crossing the aisle to fix the problem he "helped create." Now as CEO of tango, he is building the infrastructure that gets patients home faster, keeps them out of the hospital, and actually rewards the agencies doing the work.

Tom Maxwell sits down with Brian to break down why the post-acute system is broken, what value-based care looks like when it actually works at the episode level, and how tango is using AI to transform clinical workflows without replacing the clinician.

He explains:

• Why Medicare Advantage networks are broken and what payers keep getting wrong
• How Tango eliminates the referral-to-authorization gap that delays care in the critical first 48 hours after discharge
• What value-based care actually looks like at the episode level and how providers get rewarded for it
• Why 10 to 12 percent of SNF admissions do not need to happen and what fixing that requires
• How AI is cutting 22-minute case reviews to five to eight minutes without replacing the clinician

CHAPTERS

• 0:00 Introduction and Brian Lobley's background
• 1:53 Brian's career path from IT consulting to Independence Blue Cross
• 4:48 Building the tango leadership team
• 8:02 What tango does and how the model works
• 12:09 How home health providers can join the tango network
• 17:33 The interoperability challenge and where the industry stands
• 21:14 Why delays in home health hurt patients, payers, and hospitals
• 27:57 [Ads]
• 30:21 Value-based care: what's actually working vs. theoretical
• 34:49 Expanding beyond home health: hospice and personal care
• 37:24 What Medicare Advantage plans are getting right and wrong
• 43:26 Why payer networks keep failing home health agencies
• 45:06 [Ads]
• 46:10 How tango is using AI in clinical and operational workflows
• 54:43 Hiring at tango and how to join the network
• 56:31 The story behind the name change from PHCN to tango
• 57:39 Closing thoughts

Learn more about tango: https://tangocare.com/

Connect with Brian Lobley: https://linkedin.com/in/brian-lobley-339b2a4

Sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

Last Visit First sponsor Maxwell TEC just hit a massive milestone: their nanaCONNECT platform reached 1 million messages sent across home health and hospice. With a 31% engagement rate and a 1.3% opt-out rate, this is patient communication that actually works.

In this special bonus episode, Andy O'Connell (Director of Product) and Desiree Ardoin (Senior Consultant, Product Adoption) of Maxwell TEC join the podcast to unpack what 1 million connections really means for patients, families, caregivers, and the agencies that serve them.

This is what proactive, compassionate, scalable patient communication looks like.

What we get into:

• The numbers behind the milestone, including a 31% engagement rate (6% is considered excellent) and roughly $436,000 a month in savings versus traditional mail
• The bereavement stories families are sending back, and why Maxwell TEC is rethinking the traditional 13-month cutoff
• How real-time caregiver feedback through text is helping agencies catch problems long before an HCAHPS survey ever shows up
• A quick look at how it all works across NOTIFY, ENGAGE, REACH, and BEREAVE: no app, no logins, just a text from a number families already recognize

Chapters:

• 00:00 Celebrating Milestones in Healthcare Communication
• 02:48 The Impact of NanoConnect on Patient Care
• 06:01 Engagement Metrics and Cost Efficiency
• 08:35 Cultural Sensitivity and Regional Adaptation
• 11:17 Real-Time Feedback and Continuous Improvement
• 14:22 Future of Communication in Home Health and Hospice
• 16:39 Extending Bereavement Support Beyond Traditional Limits
• 19:38 The Human Element in Healthcare Communication

Sponsors:

• Maxwell TEC: Learn more or schedule a demo at https://www.maxwelltec.com

Subscribe to Last Visit First for new episodes every 10 days with the leaders shaping home health, hospice, palliative care and the future of healthcare.

The numbers are in — and home health care is at a turning point.

In this data-packed episode of Last Visit First, host Tom Maxwell sits down with Scott Tapp (CEO, Trella Health) and Carter Bakkum (Senior Data Scientist, Trella Health) for a quarterly deep dive into what the Medicare claims data is actually telling us about the state of home health and hospice in America.

Key Stats from This Episode:

• Home health market: $162B in 2024 → projected $380B
• 94% of U.S. counties saw a reduction in home health agencies (2019–2023)
• 2,201 new hospice NPIs enumerated in LA County since Jan 2020
• Average patient risk score increased from 2.3 → 2.5 (2021–2024)
• Readmission rates dropped from 11.9% → 11.8%
• Time to start of care: 4.8 days → 3.12 days
• 724 hospitals participating in the TEAM model
• $11.8B in annual Medicare reimbursements tied to 3 TEAM categories

Chapters:

• 00:00 - Introduction & Guest Welcome
• 00:59 - Who Is Carter Bakkum? Scott Explains
• 01:45 - Why We're Doing Quarterly Data Deep Dives
• 02:04 - Big News: Trella's Monthly CMS Data Access
• 03:19 - How Trella Combines Billions of Claims
• 04:43 - The Lag Problem with Finalized CMS Claims
• 05:39 - CMS Moratorium on New Home Health & Hospice Licenses
• 05:59 - The $162B Home Health Market & Home Infusion Surge
• 07:10 - Shocking Stat: 94% of Counties Lost Home Health Agencies
• 07:53 - Carter Explains the County Reduction Data
• 09:10 - Trella's New Interactive NPI County Map Tool
• 11:20 - 2,200+ New Hospice NPIs in LA County Alone
• 12:30 - The Fraud Hotspots: Clark County, Franklin County & Miami-Dade
• 12:54 - Does the Map Include Change of Ownership (CHOW)?
• 13:35 - What the Moratorium Means for De Novo vs. Acquisition Strategy
• 14:33 - The 36-Month Rule & Who's Actually Acquirable Right Now
• 15:10 - Is This Essentially a National Certificate of Need?
• 15:32 - What Comes After the Moratorium? New CMS Rules Explained
• 16:22 - Real Impact: Access to Care Is Already Being Restricted
• 17:09 - Tom's Story: No Home Health Available in Upstate New York
• 18:30 - The PR Problem: Seniors Seeing Home Health as "All Fraud"
• 19:49 - Adherence to Home Health Discharge Instructions Is Rising
• 21:02 - Should We Look at Adherence by Rural vs. Urban Classification?
• 21:26 - Home Health Is Treating Sicker Patients — And Doing It Better
• 22:22 - Patient Risk Scores: Up from 2.3 to 2.5 (What That Really Means)
• 25:00 - Readmission Rates Down Despite Higher Complexity
• 25:38 - Why Patients Are Being Discharged So Much Faster Now
• 27:03 - Time to Start of Care Dropped from 4.8 to 3.1 Days
• 27:47 - Introducing the TEAM Model: What It Is & Who's Affected
• 29:43 - Carter's TEAM Data: 724 Hospitals, Upside/Downside Risk Explained
• 32:15 - $11.8 Billion in Medicare Reimbursements at Stake
• 33:20 - Why CMS Chose These 5 Episode Categories
• 34:10 - The $36,000 Variance in CABG Costs Across the Country
• 34:39 - 39% of TEAM DRGs Are Discharged to Post-Acute — The Opportunity
• 35:41 - What This Means for Home Health Agencies RIGHT NOW
• 37:10 - Call to Action: Submit Your Data Questions for Next Quarter
• 37:40 - Closing Thoughts from Scott & Carter
• 38:51 - Goodbye & Happy Memorial Day

Have a topic for next quarter's data deep dive? Drop it in the comments below.

Sponsored by Trella Health:

• Learn more Trella Health: https://www.trellahealth.com
• Connect with Scott Tapp: https://linkedin.com/in/scotttapp
• Connect with Carter Bakkum: https://linkedin.com/in/carterbakkum

Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

Former DOJ prosecutor Jonathan Porter joins Tom Maxwell for the Season 2 premiere of Last Visit First, and the timing could not be more critical. With CMS announcing a nationwide enrollment moratorium on hospice and home health agencies and over 440 providers already suspended, every operator in the industry needs to understand what is actually happening and what to do about it.

Jonathan spent years at the Department of Justice taking down healthcare fraud schemes involving billions in billings. Now, as a partner at Husch Blackwell, he defends the hospices, home health agencies, and healthcare executives caught in the crossfire. He knows exactly how this machine works from both sides of the table, and he is not holding back.

He explains:

• Why legitimate agencies are getting swept up in enforcement actions designed to catch bad actors
• How the whistleblower incentive system is structurally built to go after the good guys with deep pockets rather than the fraudsters who already moved their money offshore
• What actually triggers a federal investigation for a compliant hospice or home health agency
• The real difference between a compliance program that protects you and binders collecting dust on a shelf
• How AI is creating brand new enforcement risks that most operators have not thought about yet
• When self-disclosure to CMS or DOJ makes sense and when it does not
• What to do the moment an agent shows up at your door

CHAPTERS

• 0:00 Introduction — Meet Jonathan Porter, Former DOJ Prosecutor and Partner at Husch Blackwell
• 1:07 Jonathan's Path: From Capitol Hill to the DOJ to Healthcare Law
• 4:09 Prosecuting Doctors, Executives and a Pastor: What It Taught Him About Human Behavior
• 7:39 Why He Left DOJ to Defend the People He Used to Investigate
• 8:59 The CMS Crackdown: 447 Hospices and 23 Home Health Agencies Suspended in LA Alone
• 12:35 Why the Government Keeps Lumping the Good Guys In With the Bad
• 13:30 The Whistleblower Incentive Problem: Why Relator Lawyers Target Deep Pockets
• 15:51 Payment Suspensions: What Happens to Legitimate Agencies Caught in the Crossfire
• 19:42 What Actually Triggers a Federal Investigation for a Compliant Agency
• 24:33 Ads
• 25:52 Husch Blackwell, the Anti-Kickback Statute and How It Applies to Hospice and Home Health
• 33:15 Real Examples: When Giving Something of Value Crosses the Line
• 34:59 Home Health Enforcement: What DOJ Is Actually Watching in the Data
• 38:41 Whistleblowers: Disgruntled Employees, Wired Informants and Data Mining Companies
• 41:43 Ads
• 44:08 AI Enforcement Risks, Self-Disclosure and Where the Line Is in Clinical Documentation
• 51:44 The Three Things Every Compliance Officer Needs to Address Immediately
• 54:43 Binders on a Shelf vs. a Compliance Program That Actually Protects You
• 58:21 If Jonathan Could Change One Thing About Government Enforcement
• 59:58 Don't Panic: What Every Operator Needs to Hear Before It Gets to That Point
• 1:01:44 How to Reach Jonathan Porter and the Husch Blackwell Team

Learn more about Husch Blackwell:

• https://www.huschblackwell.com

Connect with Jonathan Porter:

• [email protected]

Sponsors:

• Premier Sponsor: Trella Health: ⁠https://trellahealth.com/⁠
• Premier Sponsor: Homecare Homebase: ⁠https://hchb.com/⁠
• Maxwell TEC: ⁠https://maxwelltec.com/⁠
• StenoHealth: ⁠https://www.stenohealth.com/⁠
• IntellaTriage: ⁠https://intellatriage.com/⁠

Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

Compassus CEO Mike Asselta on clinical insights, care leadership and the future of healthcare. He leads one of the nation's largest home-based care companies, 10,000 caregivers and $1.5B in integrated services. He finally sat down with Tom and did not hold back.

With 31 years of healthcare leadership behind him and a platform covering home health, hospice, palliative care, infusion and private duty services, Mike is driving healthcare innovation and the future of patient-centered care from the inside out.

He explains:

• How you scale a $1.5B home-based care company without losing the culture that made it great
• The AI investments that are giving nurses their evenings back and cutting intake from 4 hours to 15 minutes
• Why joint venture partnerships with health systems are the future and what the Providence deal taught them
• The palliative care strategy, the SNF-at-home model and where the patient journey is actually heading
• The nurse practitioner workforce crisis and the clinical data signals every provider should be watching
• What great care leadership looks like at scale and the legacy he is building at Compassus

CHAPTERS

• 0:00 Introduction — Meet Mike Asselta, CEO of Compassus
• 0:27 Mike's Career Journey: Lab One, Quest, Fresenius and Three Failed Retirements
• 3:28 Entering Home-Based Care: The Fragmentation Shock
• 5:20 Leading a Mobile Workforce: Care Leadership at Scale
• 6:18 Compassus by the Numbers: $1.5B, 11,500 Caregivers and a Mission-First Culture
• 8:24 The Leadership Summit in San Antonio: Leading With Heart
• 12:11 Operational Excellence vs. Clinical Excellence
• 14:15 The Single Biggest Strategic Decision of Mike's First Two Years
• 15:19 Why Hospital-Health System JV Partnerships Are the Future of Post-Acute Care
• 21:07 Inside the Providence Partnership: Values, Scale and Continuity of Care
• 23:21 How Health Systems Should Be Thinking About Hospice and Palliative Care
• 26:45 The Hospice Conversation Nobody Wants to Have (But Everyone Needs To)
• 28:09 Industry Fragmentation, Fraud, Waste and Abuse — and Why the Real Story Isn't Being Told
• 30:06 Ads
• 31:45 Independent, Hospital-Owned or JV? What the Industry Looks Like in 10 Years
• 32:30 Interoperability, Faxing and the $781M Problem CMS Is Finally Addressing
• 33:58 Balancing Home Health, Hospice, Palliative Care and Infusion Across the Patient Journey
• 35:58 SNF at Home, Nurse Practitioners and the Next Frontier of Home-Based Care
• 37:52 The Nurse Practitioner Workforce Crisis and the Student Loan Reclassification Problem
• 40:28 Palliative Care Volumes Up 50%: The Compassus Strategy
• 44:41 Clinical Data Signals Every Home-Based Provider Should Be Tracking
• 48:31 AI Is Transforming Intake: From 4 Hours to 15 Minutes
• 49:37 AI at the Bedside: Reducing Start-of-Care Time by 50% and Ending Pajama Charting
• 52:23 Ads
• 54:37 Revenue Cycle, AI Workflows and the Art of the Possible in 2026 and 2027
• 57:17 Claude Cowork, Agentic AI and the Back Office Revolution at Compassus
• 1:00:14 Real-World AI Win: A 45-Minute Fix for What Should Have Been a 3-Week Project
• 1:02:03 Reducing Nurse Fear and Burnout Around AI Adoption
• 1:04:47 Developing the Next Generation of Home Health and Hospice Leaders
• 1:08:00 Mike's Legacy: What He Wants Compassus to Be Known For

Learn more about Compassus:

• https://www.compassus.com

Careers at Compassus:

• https://www.compassus.com/careers

Sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

How do you manage a $17 billion investment firm while staying focused on meaningful clinical impact?

In this episode of Last Visit First, Tom Maxwell sits down with David Schuppan, Co-President of Flagship Funds and Co-Head of Healthcare at The Vistria Group. With a career spanning over $10 billion in healthcare investments across 28 companies, David is one of the primary architects of the modern post-acute landscape.

We go behind the scenes of the "Power of Three" investment model and discuss:

• The History of PE: David’s early days working with industry legends Bryan Cressey and Carl Thoma.
• Portfolio Strategy: Why Vistria invested in industry leaders like Homecare Homebase, Mosai (Medalogix), tango, and Anew Health.
• The "Duals" Frontier: Why the intersection of Medicare and Medicaid is the next great value-based care opportunity.
• AI in Healthcare: Shifting the industry from the "IQ business" (data analysis) to the "EQ business" (human-to-human care).
• Scaling for Success: David’s advice for CEOs looking to scale from $50M to $500M and beyond.

David also shares a personal look at his legacy and why he believes private capital is the "action engine" for improving the lives of patients and families.

• 0:00 - Introduction to David Schuppan
• 1:27 - From Missouri to Wall Street: David’s Origin Story
• 4:30 - Meeting the Founders of Private Equity (Cressey & Thoma)
• 8:07 - The Sourcing Strategy: Active Listening & B2B Healthcare
• 10:43 - The Vistria Group’s "Power of Three" Model
• 15:22 - The Mosai & Medalogix Story: Data-Driven Outcomes
• 16:25 - Tango: Aligning Payers and Providers
• 22:39 - Relationship-Driven Private Equity vs. Transactional PE
• 25:42 - The Home-Based Care Ecosystem (Anew, Help at Home, PACE)
• 29:27 - AI in Healthcare: Use Cases in Recruitment and Operations
• 37:34 - David’s New Role as Co-President of Flagship Funds
• 42:40 - The Future of Consolidation in Home Health & Hospice
• 46:03 - The Toughest Investment Decisions & Lessons Learned
• 49:20 - Advice for CEOs: Scaling to $500M
• 54:58 - The Legacy of Patient Impact

Enjoyed the episode? Let us know in the comments! Make sure to leave a like and subscribe!

Last Visit First:

• Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

Check out our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Connect with David and The Vistria Group:

• https://vistria.com/contact/

Most families are flying blind when it comes to aging. They think the system has their back, but Dr. Katy Lanz is here to tell us that the healthcare machine is actually built for billing, not for people. As a triple board-certified doctor who has advised CMS and helped lead one of the biggest palliative care providers in the country, Aspire Health, she knows where the cracks are because she’s spent her career trying to fill them.

Millions of us are currently caught in the "Sandwich Generation," struggling to raise kids while simultaneously managing care for our parents. Katy reveals why these caregivers are actually the most influential force in the entire industry and how a "Family Operating System" like LifePlans can handle the logistical chaos before a crisis forces your hand.

Key Takeaways:

• The 80/20 Rule: 80% of stability is social, not medical, and ignoring this leads to unnecessary hospitalizations in the "ER trap".
• Integrity vs. Despair: Navigating the final psychological battle that determines if aging is defined by fulfillment or regret.
• Rural Healthcare Deserts: Why geography is a primary risk factor as local hospitals continue to vanish across America.
• Proactive Life Planning: How moving from reactive crisis management to a centralized hub protects family relationships and prevents clinical burnout.

Chapters:

• 00:00 Intro
• 00:09 Intro to Dr. Katy Lanz
• 00:47 Katy's Journey into Serious Illness Care
• 03:41 The Role of Aspire Health
• 07:34 Innovations in Palliative Care
• 11:51 The Intersection of Aging and Mental Health
• 14:40 Navigating Healthcare Systems
• 19:40 Future Policy Dynamics in Healthcare
• 24:45 The "Sandwich Generation" and Caregiving
• 30:25 The Evolution of Palliative Care in America
• 33:10 Challenges in End-Stage Renal Disease (ESRD) Care
• 35:23 Innovative Solutions for Life Planning
• 40:20 The Concept of Whole Person Care
• 48:13 Last Visit First: A Personal Reflection
• 50:07 Legacy and Impact in Healthcare

Enjoyed the episode? Let us know in the comments! Make sure to leave a like and subscribe!

Last Visit First:

• Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

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Connect with Dr. Lanz:

• LinkedIn: https://www.linkedin.com/in/katylanz/
• LifePlans: https://www.ourlifeplans.com/