Mary Haynor, CEO

A year and a half after recruiting advertising agency Meyer and Wallace to handle the PR for her organization, Mary Haynor heard something she was not expecting. “They told me they were going to go out there and tell the community we had a compassionate and caring staff; that our organization provides the best in home and hospice care. As I looked at the faces of my staff and announced the new advertising campaign at a company-wide party, I realized Meyer and Wallace were right.”

For the past nine years, Haynor has been on a crusade to place Wisconsin-based Horizon Home Care and Hospice as a leader in its field—financially, clinically, and culturally. A year after approving the advertising campaign, Haynor received another surprise: her organization had been named one of the Home Care Elite by Outcome Concept Systems, a leading healthcare information company in Washington state.

“I actually called the company to make sure this was real,” she recalled. “I was so busy trying to make it happen that I didn’t realize we’d arrived. Have we arrived completely? No, but we’re headed there, and we’re closer than we were eight years ago.”

Organizational transparency
Horizon Home Care and Hospice, like many in its industry, strived to make the change from a fee-for-service Medicare environment to an interim payment system and then to a prospective payment system. In its early years, the company struggled with those changes, and through her appointment as CEO, Haynor was expected to bring that into continual balance.

She started by communicating the vision of where the organization was headed and what it would take to get there to the management team. She then told the rest of the staff. “The reality of where we were wasn’t widely known to the staff,” she said. “But you don’t get change without giving people a reason to change.”

And those changes were not superficial. Haynor and the management team went through each department, weighing their strengths and weaknesses and determining what was and wasn’t working. “We looked at how we provided care, what it cost, if we were doing it well, if we could do it better, and if we could do it better for less. From medical records to billing to IT to clinical staff, every facet of how we provided services was evaluated.”

Prior to her arrival, Horizon Home Care and Hospice had lumped its finances into one pot, meaning each department couldn’t be held responsible for its successes or failures. Income statements and business activities that typically help an administrator to evaluate each department were inseparable. Today, nothing could be further from the truth.

“Our CFO, Laura Krause, has taken it from the department level to the individual level, with each employee held accountable for outcomes in their own jobs,” Haynor said. “She started giving the management team information and then moved it to individuals. It’s been a process over nine years, but it was worth it.”

Technology and innovation
Fortunately one area in which Horizon Home Care and Hospice had always excelled is in its IT department. With a paperless base from which to build, Krause’s next step was to build on the organization’s current computer system, adding capabilities to accommodate Horizon’s size and provide the kinds of reports she desired.

In 2001, the organization switched to a new computer system, enabling the administration to analyze outcomes by clinician. The process improvement director then worked with Press Ganey to drill patient satisfaction surveys down by clinician. Although the move required additional training to incorporate both Horizon’s and Press Ganey’s systems, the administration reached its goal of providing significantly better outcomes while pinpointing financial strengths and weakness.

“We’ve significantly improved our patient outcomes, especially in the areas of surgical wounds and dyspnea, which is why we were named one of the Home Care Elite last year,” said Haynor. “We were probably 20 percentage points behind the national average before we made these changes, and now we’re that much ahead. It’s been a dramatic shift.”

From there, Horizon invested in telemonitoring for patient homes, which the organization has incorporated into its patient EMR. The program’s capabilities include monitoring heart failure and diabetes patients, and Haynor expects it to expand over time. “Telemonitor-ing had been available for years, but until we could incorporate it into our patient records, we didn’t see the point. Now that we can integrate all of our patients’ information, it has been and will continue to be a tremendous asset.”

According to Haynor, these kinds of changes are the future of her organization as she moves beyond primarily worrying about financial strength and good outcomes to focus more on innovation. “Innovation is the true leadership philosophy of Horizon Home Care and Hospice,” she said. “We opened a grief resource center last year that is unique to Wisconsin, and already phase two is being built.”

With several other strategies for innovation under her belt and the possibilities of regional expansion in the back of her mind, Haynor has confidence that her organization will continue to be a leader in its field.