Q4 2019 Leadership Letter - Paul Kusserow

November 1, 2019

Paul Kusserow

Chairman & CEO of Amedisys

Paul Kusserow is the Chairman and Chief Executive Officer for Amedisys, the largest independent provider of home health, hospice and personal care services, and Chairman of its Board of Directors. Under his leadership, the company has re-established itself both financially and clinically as a leader in the fast-growing home health and hospice industry.

Mr. Kusserow, a healthcare industry veteran with deep expertise in driving growth strategies, previously served as President and Vice Chairman of Alignment Healthcare, Inc., an integrated clinical care company focused on providing care to the Medicare population. Prior to that, he served for five years as Senior Vice President, Chief Strategy, Innovations and Corporate Development Officer of Humana, Inc., a Fortune 75 healthcare services and benefits company.

Mr. Kusserow is on the boards of Picwell, New Century Health and Matrix Medical Network. Mr. Kusserow received his Bachelor of Arts from Wesleyan University, where he was a member of Phi Beta Kappa, a Philip B. Brown Scholar and an Olin Fellow. He received his Master of Arts with honors from Oxford University, where he was a Rhodes Scholar.

Matt:  Is there a book about leadership that's a favorite of yours, or that you typically recommend to others, either on your leadership team or in general?

Paul:  I keep several copies of The Loyalty Effect by Fred Reichheld. I've known Fred for a long time and I've used his work. It's a book I believe very heavily in, as the basic thesis is about the economics of the golden rule. He basically goes out and finds companies and shows how the companies that treat their customers very, very well, and particularly, they treat their customers well by first treating their employees very well. He finds there's a correlation between treating your employees really well and in turn, they’ll treat your customers well. Your shareholders end up being loyal too and so the idea of loyalty creates a lot of stability in a company and creates huge economic value. It's a concept that I believe very strongly in and it uses wonderful case examples. He was also the guy who came up with the Net Promoter System®.

M:  Is there anyone that particularly comes to mind that's had a significant influence on your leadership style or your professional career? A mentor, advisor, or friend?

P:  I'd have to single out two people, my wife and my mother. They're very strong women, and they have a lot of influence over me. I think 85% of my workforce are women and they’re caregivers. So my style pretty much is to try to be more serving. We have kind of a servant leadership style. And I believe my job is to serve my clinicians so they can serve our patients, and that's where our organization and our culture is structured.  One of a servant leadership approach. So that's largely how we do it, and I think other than my wife and mother, who I'd say are definitely the strongest, I also learn more from those who I don't want to be like then from those who I do want to be like. I've had a lot of bad bosses in the past and, and a lot of the way I manage is I don't want to do anything they did. So one of the good things I found having worked in tough situations is that if you can learn from it. Then when you finally get a chance to lead yourself you try to create an environment that's not military style, or lead from the top. The command and control type of leadership just doesn't work in our business.

M:  There’s a saying, “behind every successful man is a strong woman,” and that definitely sounds like the case with these two ladies that are having an impact in your life.

P:  My wife has a towel that says, “behind every great man is a woman rolling her eyes.”

M:  And that's where the motivation comes from. Right? You mentioned learning from previous leaders or bosses that you have had and where you learned how you don’t want to lead. I think it's a good segue to the next question I have about learning from failure. Do you have a favorite failure or an apparent failure, but later led to a success that you were able to learn from?

P:  My role prior to this one, had largely been a strategist and in new business development. Taking old things and find new angles on them and find new lives for them. I’ve had much more failures than I’ve had successes. I think the idea is you shouldn't be afraid of failure. I think the only rule I have is: Don't make the same mistake twice. But everybody has the right to make the mistake once. I believe that if you aren’t really pushing the envelope and failing you aren't really doing enough. So we're all into failure.

One of the most interesting parts of my career was in my first job as a management consultant and after I left, I went to work for the CEO of Reader's Digest, a failed company at this point. We worked on a project together trying to launch a new line of business, and we failed. But what he did, which I thought was really interesting is he brought everybody into a room. We thought that we were going to get brought in to get our butts kicked, and he instead he celebrated it. He said, “You guys did everything right, you worked really hard at this and you failed, but that's not bad. You did all the right things, but it didn't come out the right way. That's fine.” That sent a quite an extraordinary message into the organization.

M:  There are a lot of changes going on with PDGM coming down the pipe and you've been very vocal about opportunities that are coming around the horizon with regards to potential acquisitions. How do you cultivate a culture that is Amedisys across all these people, especially when many of those team members are remote out in the field, and many of them potentially new to the Amedisys organization?

P:  This is a kind of a roundabout way of answering your question, but I'd say one of the interesting things, at least in my role has been that's been very intriguing to me and kept me very engaged in my work here is that my role as a CEO has changed extraordinarily in the evolution of Amedisys. You know, firstly, when I first came in, we were in real trouble as a company. We were in trouble with the government, we had a lot of leverage because there were huge fines. We had extraordinary turnover with our employees, our quality was poor, and so it was a real turnaround. We had to really change elements of the company, including getting out of lines of business. And then we moved to focusing on the patient and doing a couple things really well. So we focused very much on the basics. That was very operational, getting rid of all the junk operationally, so we could be good at our core businesses. We became really good at our core businesses and then we started to grow like mad. And now we're kind of valued and looked at as a growth company. Now we're taking it to our next phase, which is we're trying to become an innovative company that innovates in this area, to create more depth, more distinction to what we do, more products that are different, so that we can become highly differentiated in this space. So we've really gone through four iterations as a company. It's been a very fast migration.

I'd say what what I've learned is that different people bring different things to the process. And I'd say it took an iteration, we basically went through two teams of people in the turnaround and in the stabilization process. We have a really good management team now. So my role and what I do every day is very different than what I ever expected to do. But my basic job is to do blocking and tackling for the really good people on my team. There's nothing really I can tell my Chief Operating Officer, Chris Gerard, about any of the nuances of home health, hospice and personal care. He's been doing this since he's in his early 20s. He knows more about it than I'll ever know. So my job is to make sure he gets what he needs to make sure he understands the big picture of things but to stay out of his way. Our Chief Financial Officer, Scott Ginn, knows more about the mechanics of the business and the analytics of the business than anybody. I can't tell him anything he doesn't know. So my job is to, again, make sure that he gets heard and that we're all working together as a team. Same with human resources, same with legal, same with government, same with IT. So my job is to get the best people and to provide blocking and tackling for them. Make sure we all are singing off the same hymnal and right now we're running our core businesses really well, we're spending a good portion of our time figuring out how can we differentiate ourselves and how can we create real value in the marketplace, and take better care of our patients. As long as it results in better patient care, we believe that ultimately we can't go wrong.

M:  On the note of innovation, I saw that Amedisys has a really innovative approach with ClearCare for serving the personal care space, but in general: Have you thought about how Amedisys is progressing and wanting to address the growing staffing needs for senior care over the next 5 to 10 years?

P:  We think about it a lot. I still get and review turnover results every week. I pour through them so I know exactly who's left. I know how long they've been with us. I know what their productivity is. I know the reason for their leaving. And I if there's something that looks amiss to me, I call up the manager and say what's going on here. If I see too many people leaving under a certain care center name, I have our HR folks go and take a look at it. I have very little tolerance for turnover. My belief is if we create a great environment, people should want to stay with us. And our job, again, is to serve our people. So if we do that properly, people won't leave us at all. But again, we're in 40 states and we have 22,000 people. So shifting that culture in some places has gone very well, other places it's slower than we thought. But ultimately, that's how we're going to take care of it. The issue, frankly, that we're moving towards in the home health industry, isn’t really an issue of a shortage of people. I think it's more of the issue of how to employ people properly, with the right services at the right time for the right reasons. If we could totally optimize the best care at the bedside, I believe we would use a lot of different types of people in different ways that would optimize care and probably provide care much cheaper. And then give the patient exactly what they need when they need it. So I think we're viewing things more as: How do we create individualized care plans? How do we drive those individualized care plans to the patient level? Then, how do we work with the logistics of individualized care plans, which are very, very difficult. But we're getting to that, that's the big challenge for the industry. I think we need to assemble a group of people with very diverse skills, keep them and then employ them exactly at the right time in the right place. And so the idea of scheduling is extremely important in our business. Those are the people that I believe are the most important people in our care centers.

We've looked at a lot of the workflow that we do by diagnosis, so CHF for COPD or whatever it might be. We've seen there's real opportunities to use different types of clinical expertise as well as non-clinical expertise. The other thing that I'm very obsessed with is how do we incorporate family members, neighbors, friends into the care plan. These people have the most motivation of anybody, it's people they love and care for. Therefore, I think there should be some ability to include them to drive better outcomes. When I go out and see caregivers, a lot of the time they won't engage with the family member that’s concerned about how they can participate in the care of the patient. I think there's a lot of opportunity with people who can add a lot of glue, or love, into the system, which I think would drive better outcomes. When I see how much we underutilized family members who live with that person and if we could really get them educated on the disease, get them educated on the care protocols, we could do a lot there. I think there's some real opportunities with unskilled caregivers in the home, particularly over the long term. There's certain states where you can do this with Medicaid, where you can fundamentally employ family members. I think under capitation and Medicare Advantage will move towards that at some point. So I think that's an area we're excited about. One final thought, medication adherence is one of the key drivers of readmissions. If you sit down with that caregiver who's in the home, there’s often somebody alongside the patient, particularly when it's men, there's generally a spouse or a daughter. There are real opportunities to educate them about what needs to get done. And they can really provide a lot of the glue in the times when we aren't in the home.

M:  How are you exploring ways to innovate patient care with your staff through non-traditional caregivers such as a patient’s family? Where are you in the process of experimenting and implementing new changes?

P:  I think the key for us is where you mentioned ClearCare. What we've done there is basically instead of buying up an industry, which I don't believe you can ever build a major presence in the personal care of business due to the nature of fragmentation of that industry, so we’ve just taken a very different approach by focusing on building a network. We're in the very early stages of that and there'll be some bumps along the road. It's a very different way of approaching the world. Eventually in areas where we can’t own things, we’re going to become network builders. One of the key things that we're going to do, is find ways to deliver care in non-traditional ways. The key thing to that is going to be the technology. So the question is how do we take the ClearCare data and combine it with the data that we generate in Homecare Homebase? And then how do we build care planning tools that funnel out through the workflow systems above ClearCare and Homecare Homebase? We will start getting more into technology, data, analytics, because we will be generating much more data. Then we have to put that into our care planning algorithms to drive the best care planning for the best outcomes. So I think there'll be a lot of data work. We spend a lot of time on research, so that we understand what we've got and what the outcomes are when we innovate. We spend a lot of time on care planning, a lot of time on care coordination, a lot of time on scheduling tools. So there's a technology piece or a workflow piece, or a logistics piece that’s incredibly important that we can’t get with the current systems that are out there.

M:  Some of the things you’ve mentioned previously might answer how Amedisys is working towards being the employer of choice in the marketplace, but is there anything you want to add?

P:  I just believe people vote with their feet. Therefore, I look at turnover. I think our turnover rates are extraordinary now. I think our overall turnover rate is below 15%. For the industry, that's extraordinarily good, I think the best in the industry. I want to get it low so that no one wants to leave because we find the more we keep people, the more productive they get, the more they learn how to use our technology and systems, the better care they can provide to our patients. So we are focusing now a lot on training and a lot on orientation, particularly with clinicians. And we believe that the more we focus on bringing those people into our way of doing things and making them feel very quickly as part of a family of caregivers, that's the key driver to maintaining and keeping a good stable workforce. It's very different when you go into a great care center and they describe themselves as a family. When you go into a not-so-great care center, they talk about themselves as individuals. And so they think about their needs, not the needs of the care center. When you are in a great care center with great results, they talk about their family and how they're there pitching in to take great care of the patient. So ultimately, what we want for all the care centers is that kind of family orientation, so that people believe they are part of a greater good and that their people have their backs and that they're dependent on it and that they're there to drive really good outcomes.

M:  What are some of those key items that differentiates a great care center with a family environment versus one that’s not operating on that same level?

P:  I think it's the Director of Operations, that leader. Sometimes we promote great clinical managers or great nurses and assume they can lead without training. Then we realized, you do need to be trained about how to take care of clinicians and how to get the most out of clinicians. We need to continually be able to assess and train our Director of Operations, and make sure they’re very good and have strong people around them, particularly clinical managers and schedulers. And again, it’s the environment, how much do they really care about the people they're managing? It's important that they understand there's nothing other than those people that make that business. They're in rented space. There's nothing other than the people who get up every day and come to work that makes this business tick. 

M:  You mentioned your leadership team and how your job is to block and tackle for them to remove roadblocks so they can perform at a high level. How do you evaluate and select those team members and what is the decision-making dynamics of your team once they’re part of it?

P:  First and foremost, it’s important that they understand that we’re a caregiving organization and that the job of providing great patient care comes first. So whenever we bring somebody on at a senior level, we interview them as a group. I have a big round table where I work and it'll be me and three or four other people who will sit down and discuss our thoughts, feedback, and have just a general conversation. That's how we work with the management team. We make decisions together because everybody is somehow involved and therefore that's the orientation we have to have. For me, it's all about ownership. My team participates in these decisions without getting overbearing and crazy about over participation. But if they participate in these decisions, they own them. From my perspective, certain decisions, we all have to own moving forward. Therefore we spend a lot of time making sure we're all on board because key decisions on the company involve all of us. So we all have to be aware of it, or agree with it, understand what the what each person has to do, and therefore we can move forward together. I think we have a pretty good approach to that. Another dynamic we have is when our people take advantage of the expertise of other leaders on our team. So when something is clearly in someone’s purview, and it's their world, we leave them alone, and we don't get their knickers. As an example, I don't get involved in the small details and operations because somebody better than me is doing that. Nor do I get fault for small details regarding finance because I have better people who can make that decision on their own. Also by allowing them to do that and make those decisions, they love their work better. So again, it's creating participation at the top and allowing autonomy in the middle and at the bottom.

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