A Sense of Purpose: Q&A with Interim Health CEO Jennifer Sheets

Sheets emphasizes the value of home health in the healthcare continuum and patient-centered care.

Before stepping into the CEO role at Interim Health in 2019, Jennifer Sheets’ career had progressed from working as a transplant ICU nurse to CEO of different hospital systems. It wasn't until two members of her family needed home health services that she realized the importance of home and community-based services.

Believing that the future of healthcare was in the home, she transitioned from acute care to post-acute care in the mid-2000s, working for several home health and hospice organizations. HealthLeaders spoke to Sheets about her experience as a clinician helping her as a leader, hiring and keeping employees engaged, and issues facing the sector.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: How has your experience as a clinician helped you in your role of CEO?

Jennifer Sheets: My clinical background has greatly influenced my leadership style. That ability to think critically with a care-planning methodology has always given me an advantage and a different viewpoint on business operations. I think it's really helped me in how I lead people, how we think about the business, and most importantly, never forgetting the people that are at the bedside and the patients that need us the most.

In my time as a hospital CEO, what was obvious to me was how many people got lost in the system—patients we saw coming back to the hospital that we thought we had discharged safely but they weren't able to continue with their care plan, or they weren't able to get placed in a nursing home or rehab, or they discharged very quickly so we would see that revolving door back into the hospital. It became obvious to me that we were missing something somewhere, and that's when I went down my journey of driving integrated care. I think that's the biggest opportunity for our country when you think about the healthcare spend and delivery, most importantly from the home health point of view.

HL: How has that experience enabled you to support Interim Health's clinicians?

Sheets: We talk a lot about why we do what we do. A lot of what you find, especially once you get in the C-suite is oftentimes a lot of finance, investment, or business-brained people from a lot of different industries. While all those things are super-important, we can't lose track of the fact that everything we do touches everyone's son, daughter, mother, and father, and you have to remember that at the core of healthcare, it's not just about business, revenue, and cost. It is about increasing access to care, making sure we're taking care of those people, and providing critical services. We talk a lot about results, just like anybody else, but we also spend a lot of time talking about how we engage our workforce, how we find, train, and keep the best people, how we add real consumer-directed care.

Everybody out there talks about patient-centered care, but the reality is that nobody provides it. Interim Health wanted to be that company to put that stake in the ground, and we did in 2019. What we really focus on, which I think is wildly different, is how do we think about the whole person? Not just the diagnosis that everyone is looking at but whether they have access to the resources they need.

HL: With the growing demand for aging services, how can providers leverage their experiences on the job to get policymakers to address issues like low reimbursement rates?

Sheets: There's a rebasing of home health rates which is not right and we also don't think it's something that CMS has the authority to do, but it’s another cut to our industry. The cumulative impact of these Medicare cuts is billions of dollars carved out of the Medicare program at a time when more and more people need our services. As providers, we're already facing significant challenges coming out of the pandemic—workforce, increasing costs, etc.—but these cuts now threaten patients’ care and access. Small, rural, medically underserved communities unfortunately are going to be uniquely harmed because of the increased cost of serving these populations.

These regulatory changes are hard to deal with and they're very damaging. When you think about vocal everyone in the industry is, they're especially burdensome for small- and medium-sized businesses that are trying to figure out how to grow and mitigate these challenges. We work with lots of the top home health companies to really push back on these home health rate cuts. We certainly don’t agree with the base rate cuts that have already happened, but what we're really pushing for now is a stop to any new cuts. There should be no new cuts in our space because the reality is even if home health and hospice services were growing, it should be exactly what we want to see in our country. It's the lowest-cost care setting, it's where the outcomes are better, it's where people want to be, and it's the biggest bang for the healthcare dollar at 1/40th if we can keep that person at home.

The one thing I would also call out is that coming out of the pandemic, home health saw an increase in the knowledge of the services that home health and home care can provide. Going into the pandemic, different healthcare professionals and patients didn't know what could be done in the home. The pandemic made people realize that there were other options. What we've seen as an industry is about a 40-45% increase in the number of referrals into home health. Unfortunately, what we've also seen is that there's a 30-48% non-admit rate, due to the labor shortage.

HL: How has Interim Health navigated the workforce shortage?

Sheets: We focus on the experience not just the job. We launched different programs to help show clinicians they were made for home care; they just didn't know it yet. Looking back at my time in the transplant ICU, I loved what I did, but I had no idea what happened to my patients when they left the ICU unless they ended up back in my ICU. One of the unique opportunities that home health offers is for a nurse to have continued engagement with a client. If you drive integrated care like we do, even if the patient is not in home health but is being supported by the home care side of the business, you can still have a  touchpoint and can see the progression of that patient. That really connects with clinicians who are in this to impact lives. We focus on the fact that you can have not just a job, but a relationship with your patients.

We focus on flexibility in work schedules. We have other programs in place like career pathing, to help people learn more about disease processes and how to provide the best care. We do a lot of recognition.

The challenge in our industry in general is that we’re never going be able to pay what the hospitals pay because of reimbursement rates, so we have to attract our workforce in a different and unique way, and it's more about commitment to purpose and commitment to outcomes.

HL: By 2030, about 20% of the nation's population will be of the age where they would possibly need some type of aging service. Looking at the current efforts to advocate for and strengthen aging services, do you think the sector will be ready by then?

Sheets: There's still a lot of work to be done, and if we are going to be prepared for this influx of folks, we must be coordinated better. We must be coordinated better from acute to post-acute. We also must be coordinated better with the decision-makers in Washington, D.C. who are working on increases or cuts to reimbursements. If we're going to be ready, we must push as much care as we can down that healthcare continuum.

The reality is the home is where people overwhelmingly want to receive care, but on top of that, it's where the outcomes are better. In a pandemic, it's where transmission is most minimized. It's also where the cost is less. We need to be pushing care in the home for people who can receive care in the home. Then, if they can't receive care in the home and they need to be in a skilled nursing facility for some reason, or they need a rehab center, we still need to be keeping them in the lowest level, high-quality setting available.

In my opinion, the biggest thing that needs to change is that instead of a care delivery system that has the hospital at the center and the hospital will send patients out to the rehabs, home health, etc., depending on the patients, the home needs to be in the center and we need to focus on how to keep people happy and healthy and independent at home for as long as possible. That's what it's going to take for us to handle the numbers coming at us.