Episode 10: Innovators Series: A Conversation with Michael ... · Michael McHale So I went to school and graduated from Georgia State University in Atlanta, Georgia. I had left Michigan

Episode 10: Innovators Series: A Conversation with Michael McHale,

President and CEO of TRU Community Care Appeals| April 24, 2020 | huschblackwel l .com

Speaker Statement

Meg Pekarske Hello, welcome to Hospice Insights: The Law and Beyond, where we

connect you to what matters in the ever-changing world of hospice and

palliative care.

In this episode, I talk with Michael McHale who’s president and CEO of

TRU Community Care in Boulder, Colorado. Michael is a friend, colleague

and hospice innovator. As a former board member of the National Hospice

and Palliative Care Organization, Michael is always thinking of ways to

lead proactive growth and change. He’s driven to solutions by the

fundamental question, how can we better serve the needs of our

community?

In today’s conversation, Michael shares his insights on where hospice is

going, how we transform as an industry and the challenges to change. We

explore a new delivery system TRU is developing which will radically

change how they care for patients across the organization’s continuum of

service which spans PACE, serious illness, home health, palliative care and

hospice. Michael shows how financial investments in new ways of doing

things can pay for themselves through economies of scale and staffing

efficiencies. While the complexities of care delivery and payment can be

dizzying, it is clear from this lively conversation that being grounded in the

seminal question ‘how can we help?’ is the way forward for all of us.

So first, Michael McHale, I’m so glad that you accepted my invitation to

have this conversation, because I really admire the work that you’ve been

doing, and you and I have known each other for a lot of years. I’ve always

Episode 10: Innovators Series:

A Conversation with Michael McHale,

President and CEO of

April 24, 2020



Speaker Statement

stayed in the same place, but you’re moving around and now you’re in the

much coveted area of Boulder, Colorado. And so first thank you and thanks

for making the time. But I wanted to start this conversation with you

sharing a little bit of background about yourself. And I’m going to go way

back here, Michael. So this is pre-hospice, this is when you’re growing up.

So where did you grow up, Michael?

Michael McHale So I grew up in Michigan. Spent my formative years there and left when I

was about eighteen.

Meg Pekarske So what did you love doing when you were growing up?

Michael McHale You know, Michigan is such a beautiful state just to be outdoors. And so I

really enjoyed just a lot of the outdoor activities that the state had to offer,

from its beautiful landscape to the water to just spending time with family

and friends in a small community growing up.

Meg Pekarske And now you found mountains. But I’m not going to skip ahead yet. So

you leave Michigan, so where did you go to school? Where did you go to

college?

Michael McHale So I went to school and graduated from Georgia State University in

Atlanta, Georgia. I had left Michigan to take a job with the airline industry.

So went to work for Delta Airlines and had an opportunity to move a little

bit around the country with them. Have lived in Boston and in Miami and

ultimately ended up out in San Diego, California. But I went to school

because I was working for them – went to school in Atlanta. Graduated

from Georgia State University and then went back to working for Delta for

the next thirteen, fourteen years.

Meg Pekarske Really? So what were you doing with Delta?

Michael McHale Did a lot of different things. I started out in customer service. Was able to

move over to government affairs and marketing. So just had a real

opportunity over the almost twenty years that I was there in total to just try

and do different things. That’s one of the benefits of working for a large

company.

Meg Pekarske Yeah. Wow. So when was your first foray into healthcare then?

Michael McHale Well, Meg, I was approaching 40 and going through my midlife crisis.

Meg Pekarske I can attest that’s real. [inaudible at 4:18:5] But it is. It’s real. Yeah.



Speaker Statement

Michael McHale It is real. And my self-questioning was, is this what I want to do for the rest

of my life? I knew I would probably have to work until I’m 65 or 70 and so

at the time had, you know, 25, 30 years ahead of me. And really began to

question what is my contribution going to be? So I went back to school. I

wasn’t married at the time so I couldn’t go through a midlife divorce.

Meg Pekarske [Laughing].

Michael McHale I couldn’t afford a sports car, so I decided to go back to school to get a

master’s in healthcare administration. And that’s how I came into

healthcare.

Meg Pekarske So what was it about healthcare? You said – and I totally agree with you in

terms of midlife – I mean, we say ‘crisis’, but I think it’s just you begin

asking yourself different questions than maybe you’ve asked yourself

earlier in your life. And so you said about what kind of contribution you

wanted to make? I mean why healthcare was the contribution that, you

know, stuck with you?

Michael McHale Yeah. I realized at the time, when I evaluated what I was doing in my life,

a lot of my volunteer work at the time was working with seniors. And so I

really wanted to get into working for and serving seniors, which I

originally thought I wanted to get into long-term care. And so when I

graduated with my master’s, I actually became a nursing home

administrator out in San Diego. And it was working in that nursing home –

which was a great facility, a great experience, wonderful people – that I

really kind of learned about end-of-life care and was kind of bitten by the

hospice bug at that time. And had an opportunity to go to work for San

Diego Hospice, which at the time was probably the leading institution in

the country doing a lot of research in cutting edge evaluation and learning

about end-of-life care. So it was a great opportunity to learn from the best.

Meg Pekarske Yeah. So what have been your different roles in hospice? So when you

started with San Diego, what kinds of things were you doing back in the

day?

Michael McHale So I started in business development. And so I came in on the business

developments of the organization and moved into some of the clinical

operations. So I, at San Diego, had the opportunity to oversee admissions

intake triage. And at San Diego, we were – just at that time because of

growth, we had created a call center, and were beginning to look at the

capability – this was almost twenty years ago – of using telemedicine as a

tool to connect with our patients and families, and also to connect our large

organization to keep our employees engaged and in contact with each

other.



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Meg Pekarske Interesting about how like that moves, has moved with you since that’s a

lot about what we’re going talk about today. And before we get into the

exciting things that TRU’s been doing, I wanted to take just a few moments

to talk about what your assessment is about where hospice is going.

Because I think it’s an important lead-up as to as you’re building

transformation in your organization, you’re doing that because you think

you need to meet something in the future. And I wanted to sort of spend a

little bit of time of where do you think hospice, end-of-life care, you know,

chronic care management, all these words – but what do you think that’s

going to look like in 10 years, and how are we going to provide care and

who are we going to serve, is it the same or different? Just share some of

your insights as to, you know, we’re having this conversation in 10 years,

you know, what’s the world like?

Michael McHale Yeah, you know, Meg, I think what was eye-opening for me is when we as

a nation were going through the conversation about the Affordable Care

Act. And the reality at that time was that we’re going to have this rapidly

aging population that’s going to significantly increase in size. We’ve had

the benefit of living life longer because we’ve discovered ways to live

longer with diseases that used to take our lives more quickly in the past.

And through all these conversations, I began to realize that, you know, two

things are happening. One is, where the definition of end-of-life now is

much longer and much more protracted and the debilitating effects that

living long with complicated diseases is going to be a reality for all of us.

But the cost of all of this is going to exceed what we can do as a country.

And though, with that in mind, you know, myself, as well as our team here

at TRU, has really been looking at ways – how do we engage and interact

with somebody sooner in the disease process? Because now, you know,

where hospice when it was started from the point of diagnosis to death, six

months might have been long enough. But now the reality from the point of

diagnosis to the ultimate passing of the individual, we’re talking years and

years and years and our system’s not set up to really help facilitate and help

an individual to live fully and to live well while they’re impacted by all the

effects of living with a complicated disease.

And so that, along with the cost, we know that we’ve got to design a

system that looks at improving the quality of life, but also looks at

managing the cost of living longer with these complicated diseases.

Meg Pekarske Which leads to sort of my first question. What is the biggest hurdle to

getting to 10 years from now, I think is just how do we pay for it, right?

Michael McHale Yeah.



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Meg Pekarske And, you know, I think one reflection I have is that I think something

maybe we don’t do enough, because as you’re talking about, we’re not

talking to people earlier enough in the process, and now there’s more

recognition of advanced care planning, about what are the goals of my

care? And I think that that’s something hospice does so well, is what are

the goals? What’s important to me? How do I meet those goals? Because

sometimes I think healthcare is something that happens to you as opposed

to something that I want – this is what I want – and that as a provider,

you’re trying to help people meet those goals. And so I think it’s a mindset

that we do really well in hospice and how do we get that upstream, because

ultimately I think if you talk to every, anyone, they would want that. Like

yeah, I want someone to ask me what I want. Like, what’s important to me

and that my healthcare goals – those are things that I can establish. And

like creating a vision for what I want my life to look like.

And so – and I almost feel like if we have those conversations, you know,

your healthcare path takes different turns, you know. And so – but, you

know, ultimately, you know, a hurdle I see is just cost. And I think that as

CMS is innovating and we have these demonstration projects, I mean – but

it still hasn’t caught up to I think where we need to be and also where

we’re going.

But I guess besides money, what other hurdles do you think there are to

getting to where we need to go?

Michael McHale Well, yeah. I think that, you know, one of the largest challenges, as you

just pointed out, it is going be dollars and cents. Right? And we’ve got

such a siloed, bifurcated system of different payment models and different

benefits that potentially people could become – avail themselves, too. That

I think that what we really need to do – and you and I have talked about

this in the past, you know, my desire would be that a patient comes to us

and we say we’ve got you. Just figure out how we’re going to take care of

you and we’ll figure out what the right funding stream is to cover the cost

of that care. But we’ve got you and we’re going to see you through this

process every step of the way.

You know, one of the opportunities here at TRU is that we do have a

PACE Program and it’s such a truly incredible model of care, an incredible

delivery model, where literally we can say to the individual – because

we’re the insurance program and we’re the provider – we can say to you,

look you just be and we’re going to help take care of you. We’re going to

make sure that you get everything that you need and we’re going to make

sure that we honor all the goals that you desire for your life. And that’s

really taught me that, you know, how do we create a system around that

and then how do we begin to build outside of that model and engage more



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and more folks.

You know, one of the challenges that we’ve learned from PACE in our

community, it is, you know, the model is designed to take care of frail,

low-income elderly. But what about the people who don’t quality for

PACE? Who are just outside that line of demarcation that qualifies you to

be in or to be out. And there are so many folks that are sitting just outside

of it because they don’t quality for it, who have all of these incredible

needs. We’re trying to cobble together with the different benefits and the

different demonstrations going on, to really say how do we begin to take

care of those folks who are just sitting outside the peripheral version of our

system and begin to help them in a very different way.

So we’re really excited about SIP because we think that that’s one way that

we can begin to capture those folks who are not well engaged or connected

to the healthcare system to begin to bring them in and begin to manage and

monitor them, to help them to age and progress well in the existing system.

Meg Pekarske And so just to pause there for our listeners, those that might not know what

SIP is, can you explain what that is, Michael?

Michael McHale Sure. Medicare is looking at a new demonstration model to put primary

care first and one aspect of primary care first is what is being called SIP.

It’s for the Seriously Ill Population. So these are folks who have Medicare

benefit but who are not using the system well. They’re not assigned in the

system. They’re not being taken care of proactively through primary care,

but they’re living with complex illness and become high utilizers of the

system based on their disease and the disease trajectory.

So Medicare’s put together a demonstration. We’ve applied to be a part of

that demonstration. We’re waiting to see if we get to be – participate in

that. But, again, it’s when we look at that PACE population, these are folks

who are sitting outside the system living with complex illness, but because

of lack of resources, knowledge or information, were using our ERs kind of

as primary care, because they’re not assigned. And so how can we better

manage these folks in a system that is more proactive instead of reactive?

Meg Pekarske That’s really helpful. So in terms of – I mean, these are real issues and real

challenges, because you’re building something that doesn’t really exist.

And I think you can see the iterations and how PACE and some of those

things inform, but I guess, inform where things are going in the future and

that there are – because, as you said, PACE is a great program, but the

number of people it can really help, given its qualification requirements, is

somewhat limited. But how do we take what we learn from that to say,

wow, there are lots of things that are super valuable here and that can help



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meet some of these challenges and hurdles in the future.

But again, before we get to the cool stuff you’re doing at TRU, because the

folks that I talk to in this innovator series, I admire their leadership skills.

And so, I guess, what do you think are the leadership skills that you need to

have to sort of lead into this new future?

Michael McHale I guess with anything, it’s just a willingness to be present and understand

what the challenges are that we’re facing. And, you know, one of the things

that I’ve learned along the way, particularly in the twenty years that I’ve

been in hospice, is that, you know, folks have real needs and real concerns,

and our system is set up to react instead of proactively help to manage

through it. And the most challenging thing that I’ve found in hospice is that

we’re now at the end of life for a lot of these folks and we hear and see the

journeys that they’ve gone through to get here. And could we have done

better? Could we have done more to help them to be better prepared, to be

better able to kind of journey through this final stage in life? And I think

there’s a lot we can do!

Again, the current system is not set up to manage that way, but I think that

we, as healthcare leaders, have to (audio breaks) benefits that are out there

and figure out how are we going to cobble these together to create the

system that we want to take care of these folks. And I have to be honest,

Megan, in many ways, you know, I realize that I’m designing the system

that’s going to take care of me. And I’m one of those Baby Boomers who

are going to demand a lot!

Meg Pekarske [laughs]

Michael McHale And I really want to make sure that we have the right system in place. But

you know, what’s interesting to me is, you know, if you take an example of

somebody’s who is living with COPD, they can live for a long time with

that disease now. But nobody is telling them what change it’s going to have

on their personal life. When you can no longer take that afternoon walk

with your spouse and your dog, that’s an important part of your life. And

when that gets taken away from you, if you don’t consciously recognize the

absence of that, it creates problems in that relationship.

And so how do we step in sooner and help people to think about the total

holistic aspect of how this disease is going to affect you and your family

unit around you, how do we design that system to take care of you that is

proactive and that does help you to begin to think about these larger

questions, because it all plays into the cost.

Meg Pekarske It’s just fascinating because healthcare is so complex, yet it’s so simple.

Because that example you just gave about taking – like, that’s what it’s all



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about, right? I mean, it’s just like, you know, the [inaudible 20:33] and the

billions and trillions of dollars that we spend, but, you know, what is the

question that we’re really trying to help people answer? You know? It’s

sort of simple and really has nothing to do maybe with these interventions

like a test, or – and again, not saying that those things aren’t important.

They are, clearly. But it just is – in terms of what can really innovate, it’s

sort of getting back to our humanness.

Michael McHale Right.

Meg Pekarske And especially towards the end of life of, you know, helping people know

what’s coming. You know, I think that we’re all scared of, you know, death

and dying. Yet it’s the reality that exists. Like, it is coming. We are dying

every day.


Meg Pekarske But it’s the hardest thing for us to talk about. But I think that it can feel

really lonely, you know, when you are losing parts of yourself and your

abilities and you have no one to talk to about that, because it’s not

something that healthcare providers necessarily feel comfortable talking

about and then maybe you can talk about that with your spouse or partner

or whatever. I mean, I know as I get older, you, like, feel different and,

like, those things old people used to say, you realize you’re saying. And

like what’s important.

But someone leading that conversation, because it’s sort of once I think

you start asking those questions, the floodgates open and that can be really

transformative. And it’s really, I think, about educating people and finding

out what’s important to them, which is, you know, work that I think is

simple, yet super hard, and I think undervalued in the healthcare system.

But, anyway, that’s my little diatribe on that. But it’s why I love the work

that I do and the people that I serve, which is you all in the hospice

industry.

I want to jump to how are we living into the future? Which is, what

generated is you and I were preparing for this conversation, and I love

talking to you, because I feel like you’re always really upbeat and you’re

thinking about new and different things to do. And that it’s not that every

single idea you have ends up working out, but it’s like you keep trying.

You keep throwing things on the wall. And I think that that’s what true sort

of leadership is, is you’ve got to keep asking the questions, right? And,

like, being totally driven to ask the questions and we can do better.

So this idea that you’ve been working on at TRU I think is really exciting.



Speaker Statement

But, you know, in the intro I gave some – a brief description about TRU.

But why don’t you, for our listeners who aren’t familiar with your

program, talk about your continuum of service?

Michael McHale Sure. TRU has been – TRU started out as Hospice of Boulder County back

about 43 years ago. We were the first hospice in the state of Colorado. And

what’s interesting is that, you know, being the first – we were probably one

of the first ten in the country – there was no leaders to tell you how to do it.

You had to kind of fend for yourself and figure it out, much to what you

just said, that you’ve got to kind of throw it out there. If it doesn’t work,

you move on from there. And I think that that innovative spirit has stayed

with this organization. One of the things that I found most attractive is that,

you know, this organization really started as a social movement. To answer

your question of how can we do this better, and in working with the

organization prior to coming out here to work for the organization, I got to

meet a lot of the original founders, and that spirit exists today. What was

fascinating is about five or six years ago the board asked itself how are we

going to continue to serve this community? How are we going to adapt and

morph and change as the definition of end of life changes, because people

are now living longer with these diseases. And they made the decision to

become a provider because they felt like this is the best way for us to move

upstream from where we are today and to engage our community in a very

different, meaningful way. So they went down that road and began that

path, and in March of 2017, again before I got here, they opened a PACE

program in the community. So along with the PACE program, we have

about 185 participants on our PACE program today. We have the hospice

program, as I mentioned. It’s been around for about 44 years. We’re

serving a little over 210, 220 folks a day on the hospice program. We also

have a very comprehensive palliative care program. We’ve probably got

about 250 folks on the palliative care program. So we’re taking this

continuum of care and figuring out how do we use this as the basis – as the

launching site to take care of even more folks in our community. So that’s

kind of led us down the road to begin to experiment with new technologies

and new opportunities to take care of more folks in our community.

Meg Pekarske So now with the big reveal, what’s your new delivery system, write-up and

building to it? I mean, I think that what I find fascinating about it, and not

to date this podcast, but you and I are recording this during the COVID

pandemic, and I think there’s been interesting testing with what you’re

talking about is this sort of call center, telehealth center that you’ve built

and how strange it is. Some of the things we were talking about were what

are the hurdles to people getting accepting of telehealth, and I think that

that has just exploded given the pandemic right now. Tell me, because you

created this long before COVID, tell us about this new delivery system and

how you utilize it, how it’s staffed, how does it support your different –



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different service-wise on your continuum?

Michael McHale Sure. We did. We started this probably a little over a year ago, and we

actually started it as a study with our partners down at the University of

Colorado Anchutz, the M-L impact lab, to look at the receptiveness of

hospice patients to use this technology, but also look at the receptiveness of

providers to use this technology. So those study results are just being

released, and it’s very positive on both aspects of the study, the efficacy of

using telehealth to conduct the face-to-face visits. We’re resoundingly

affirmative that this technology works, but also we were pleased to see that

the acceptance of this technology, with the patient population as well as the

provider population, was readily accepted and greeted.

And so, you’re right, this COVID situation has really expanded and

accelerated this, and so we’re moving as quickly as we can. We would be

fully ready to launch in a year. We’ve moved everything up to move this a

lot faster because in challenging times there’s opportunity, right, to test this

in a very meaningful way. But just the program itself, one of the things that

we felt very strongly about it is that we needed a way to engage with our

patient population, whether it’s in PACE, palliative care or hospice, to

proactively monitor their disease progression. And what we are trying to do

is to avoid unnecessary acute episodes or hospitalizations by watching the

disease progression, and when things started to move kind of out of the

norm, intervene as quickly as we can to course correct if we needed to as

the disease progressed. And so we spent a lot of time finding a partner that

had the software and the hardware that would allow us to put devices into

folks’ homes that would allow us to have a snapshot and a quick read every

single day of where are we in the disease progression.

We also knew, though, that not only watching our patients on a daily basis,

we had to build up the capacity to have a delivery model that’s just in time

care. So you know in the hospice model, it’s very pre-prescribed in the

sense that we tell our patients hey, the nurse is available on Tuesday and

Thursday, so we’re going to come and visit you on Tuesday and Thursday,

and the aide’s available on Monday, Wednesday and Friday. Whether you

want them there or not, those are the days that are available, and we knew

that as the complexity of diseases progress – that patients need us now,

right? And they needed a way to communicate with us now, and we needed

to have the flexibility to be able to provide those supportive services now.

So as part of the buildout of the technology, we had to wrap our arms

around that this telemedicine center that we’re building is not a hospice

telemedicine center. It’s not a PACE telemedicine center. It’s a healthcare

telemedicine center, so that we’re taking care of over 600 folks through this

center, but the nurse receiving that call needs to understand that yes, this



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patient may be in the hospice benefit, or this participant may be on the

PACE benefit, but we’re delivering healthcare and monitoring and

following their disease progression. The other thing that we needed to

realize is that in each of these programs we have kind of defined benefits,

and so we have a home health program, we have a PACE home health

program, and we’ve got plenty of staff out in the community siloed by

these different programs. And one of the things that we realized if we’re

going to deliver just-in-time care, we need to know where everybody is so

that if Mrs. Jones calls in, we could figure out who’s closest to Mrs. Jones

to intervene as quickly as we can. So it’s been a little bit big brother-ish as

we’re testing GO tracking of our staff, but one of the cool monitors that I

like to look at in the call center is just a big map of our service area with

little dots that represent all of our staff and where they are in our service

area so that we know who’s closest if we need to kind of move a resource

quickly to identify an emerging need.

The other thing that we’re now experimenting with – we found another

partner to help us use predictive analytics. This is something that we’re

doing in preparation if we are so honored to be chosen to be a part of the

SIP program, is that we need to know, given the past utilization and the

disease progression of this individual, where do we think they’re going to

go in the future? What do we think they’re going to need in terms of

intervention in the future so that we know how to staff and prepare for

taking care of this individual? So it’s kind of a combination of having the

latest and greatest technology and GO tracking in disease progression

monitoring married with predictive analytics to really give us a better

picture of who we’re taking care of and how we need to intervene.

The interesting thing though with this technology is it does a lot of the

work for you. So even though a nurse in our call center may be handling 75

patients a day, the systems are doing all the background work and pushing

forward to the nurse you need to call this person, or you need to check in

on this person, or this person’s okay and we don’t need to do anything

today. So it’s just really utilizing that technology to help us to design a new

delivery system that’s more efficient that we’re testing right now, and

hopefully will prove that it’s more cost effective but will allow us to take

care of more folks in our community in a much more proactive way.

In the industry, we learned what we believe is one of jewels in our crown is

our bereavement program – now we need to move our bereavement

program way upstream and begin to have these support programs, so that

as they’re living through this disease progression, as the patients living

with all their questions through this disease progression, how do we better

support use of that so nothing comes as a surprise or you’re not prepared

for anything that comes along. And so we’re testing a lot of online support



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groups right now to see if running a group at 10 o’clock at night, because

that’s what focus groups have told us, when do you most need us? Well, I

needed you at 10 o’clock at night. Well, what’s going on at 10 o’clock at

night? Well, that’s the first time I got to put my loved one to bed, and now

all these issues are coming through my head, and I need to talk to

somebody about it. So we’re just trying to test different ways to meet

patients’ and families’ needs as they live longer with these complex

illnesses.

Meg Pekarske Ah, Michael, I just love it. It’s so exciting and inspiring listening to you

talk about that, because I think that technology’s amazing and the fact that

you and I are doing this podcast and I’m sitting at my home in my bedroom

because it’s the place that has two doors that I can close, you know, as

we’re working from home in this pandemic, and you are where you are,

and we’re doing a video chat. Obviously, only the audio is going to be on

the podcast, but it’s just amazing about how technology can be a connector,

because you and I are having this conversation and I feel the same way as

when I’m talking to you in person. So I think technology can still – I guess

it’s not mutually exclusive from the human connection, which is what I

think we do so well in hospices, but it is about the person. So one of the

questions I would always sort of end these conversations with is what is the

role of technology and where we’re going, and will there ever be a time

where the human part isn’t important? What I was so struck by with your

example is I feel like enveloped in care when you’re describing what it is

in terms of just feeling taken care of. And technology’s aiding us in doing

that, but it’s not like some robot calling you saying your medication’s

ready to be picked up. I mean, this is a use of technology to better provide

the human element of care. So I think it’s really fascinating and inspiring,

but I think it is a disrupter in how hospice people, or your home health

people, are used to serving patients, right? Well, we have an IDT team and

it’s only this nurse that goes and sees or talks to this patient, and it’s very

disruptive by saying oh, wait, no, there’s going to be a nurse that’s going to

be in this call center who’s going to touch a lot of our patients, and if our

patient really needs someone, that might not be you going out. So how has

that been received by your staff, because I think there can be a lot of

battling over well, these are my patients and this is who I serve.

Michael McHale I guess two things on your comments. One is having run triage departments

in my career, you know, one of the things that I always thought was

interesting is listening to that compassionate triage nurse on the phone

instructing a family. And you’re only hearing one side of the conversation,

but just with such a level of compassion in the individual’s voice in

delivering that care. And what was always important to me is I kept saying

gosh, I wish the family could see her level of expression and warmth and

kindness on her face, and they couldn’t see that. So one of the things, and



Speaker Statement

right now you and I through this video opportunity, we can look each other

in the eye, and I think that is so important in any delivery of any cares –

that you and I are looking at each other in the eye and you can see how I’m

reacting to you, and I can see how you’re reacting to what I say to you.

And so, to me, that’s the biggest piece is that it’s got to be so that people

can see your humanness and see your compassion and see your concern as

they’re talking to each other.

Then the other thing is that staff are having to step up every day. We’ve got

social workers doing video consults. We’ve got chaplains and nurses and

physicians who may have said in the past I’ll never do this but now can see

the power of that connection – just to hear the stories that we get from our

patients and families of how important this is, because right now they’re

isolated. You know, in many ways we’re using our technology. We’ve put

iPads into a number of hospitals and to partner nursing homes just to say

hey, if we need to bring the family in because they can’t come into the

facility, let’s bring everybody together so at least they can see mom or they

can see dad. They can look each other in the eye. They can say I love you

one more time through this technology. So I think that what’s happening in

the greater environment around us is really teaching us that we can do this

differently and we still do it in a way that has meaning and value to the

individual who receives that level of care. But to me, and we keep talking

about a cure at the organization, is that it’s those warm handoffs. So in the

example that you gave, it’s the nurse in the call center who’s interacting

with the patient who may need, or you may need, to send another nurse out

to that participant’s home or patient’s home. But when that person shows

up at the home, you need to get on the iPad together so that the patient and

family can see that you’re a team working together. So that even though

the patient may have a level of relationship with the nurse in the call center,

the nurse introduces other folks coming into their home so that they have a

level of confidence and there’s a handoff and an understanding of why are

you going to the home and what have Mrs. Jones and I talked about from

the call center that now I’m asking you to go to the home to check on it. So

we’re trying to put in all the safety net function to make sure that people

feel fully embraced with technology.

Meg Pekarske I love it. I think it’s really extraordinary and very exciting and, like you

said, the current state of things has accelerated this, and I think has made

people feel that, yeah, it’s video but there is still, like you said, connection

there. The more I have these conversations, and I think the challenges of

today, that really technology can be our friend, because I’m very partial to

the human touch, the presence – you used the word presence in terms of

leadership. And it’s like being present and bearing witness is so important.

Not that you can’t bear witness on the phone, but it does feel different. I

think that is so important, the work of bearing witness to the lives of the



Speaker Statement

people that we care for. And the fact is that that doesn’t happen on

Tuesdays and Thursdays, right? And I love your example of the support

services at 10 p.m. because that’s when I can finally sit down, and that’s a

lot of emotion and challenge. You can distract yourself all day long with

the tasks, right? I mean, that’s how grief and other difficulties – keep

yourself busy but then those moments where you sit down and then it’s like

a fear or the concern or the questions, because you have those moments. So

I just love it as a way to essentially design the system around what the

person needs as opposed to what’s convenient to us …


Meg Pekarske … as a provider. And I think that because we’ve never had office hours,

right? We’ve always been a 24/7 provider, and a community-based

provider, which is very different than like being in a facility. I think the

challenges of, you know, how to get to where we need to be in 10 years – I

just am so sure that the skills that hospice providers have are such

important lessons, and are skills need to be so valued. But we need to

obviously step into that fold and break out of this box, because I just think

we have always been there when people need us. Yeah, now it’s fancier

because we can have technology on the board to see where all of our staff

are, but we are uniquely positioned to provide so much value. So your story

is inspiring, and I’m sure it hasn’t been a linear, easy road. You know,

technology, as we all know, is imperfect too, but I just think it’s visionary

and very cool, and the fact that you and your board had the vision of

creating a PACE program and having this continuum of service and that

you’re all owned by the same entity, you can then distribute your staff in

different ways, because, obviously, there’s some unique regulatory

requirements about hospice that need to be employed, and all that stuff. So

I think you are able to still have economies of scale and staff efficiencies

because you’re under one umbrella, which is I think really cool.

Michael McHale Meg, I think that one of the challenges, and I was having a conversation

about this this morning, as it relates to COVID-19, to think that we’re ever

going to go back to the way it used to be, I think is misleading. What’s

being tested now really will impact and influence the direction that we go

as a nation. So I think that we all have to be prepared to kind of read the tea

leaves, if you will, to see what’s coming at us and how we’re going to react

and respond to that. You know, we take very seriously our mission to take

care of our community, and the community’s going to ask us to do it in a

very different way. So we just have to be open, I believe, and receptive to

doing that and meeting them where they are and what they need from us as

we move forward.



Speaker Statement

Meg Pekarske Yeah, I think it is absolutely right – there is no going back. But that’s sort

of life, right?


Meg Pekarske Everything is the same till it’s not.


Meg Pekarske It’s usually an instant thing, or even if it’s not an instant, it’s your

emotional understanding happened sort of in an instant, right?


Meg Pekarske And so it just feels that I agree with you. There is no unliving this, and it is

a transformative experience and, you know, incredibly difficult and

painful. But how can we take what we learn and do better and build off the

compassion – just something I’ve struggled with is just how to have good

deaths. You know it’s not very much part of the current dialog, but just

really heartbroken by people dying alone.


Meg Pekarske You talked about having people in the nursing home or whatever and

bringing the iPads so people can see people, but it’s just, you know, we

don’t want that to be the normal. These are not normal times, but it’s just

like the importance of what we do and the importance of good death and to

try to take that fear away and walk the path, because it’s going to be the

reality for all of us, as you said. We’re doing a system that hopefully will

be there for us.

So thank you so much for sharing the exciting work that you’re doing at

TRU, and I wanted to close with some thoughts – sort of get your thoughts

on some things. Why I started this podcast was really to do this innovator

series, because I love having deep and meaningful conversations with

people, and then I was like, oh, my gosh. I know all these people. I don’t

need to go interview other people – like, I know all these cool people. So I

just appreciate your taking the time to have this conversation, because it’s

really important to keeping me inspired. But I want to know what inspires

you as a leader, because I think leadership is hard work. There are the glory

moments, but those are few and far between, so how do you stay inspired

as a leader. What is your input? What do you listen to? What do you read?

Who do you talk to? How do you stay inspired?

Michael McHale You know, I think I may have answered that question differently a month

or two ago, but as you mention, we’re right in the middle of the pandemic.



Speaker Statement

What I find inspiring now truly – and I’ve always been inspired – but more

so than ever before is the people who do this work. I sit in an office. I can

come up with 10 good ideas, maybe on a good year, but to watch our

nurses, to watch our providers, to watch our CNAs, our social workers, our

chaplains, the people answering the phone – how they are stepping up and

stepping into this pandemic to take care of this community is truly

humbling and awe inspiring. I mean, I know there’s fear. I can see the fear.

I know that there’s uncertainty, but they are stepping up every single day. I

shared with you this morning we had a big snowstorm, and I came into the

office because we’re essential workers, and the team was all here, and I’m

like, did you not have a problem coming in? But they’re feeling such sense

of commitment to caring for the folks that we have under our programs and

services. So right now, more than ever before, what inspires me is our staff.

I have fear, and I have fear of the unknown with this pandemic, but I find

strength in them and I find strength in their stories, and I find strength in

the resilience of the people that we’re serving. That helps me to get up

every day and to come into the office. I know I’m smart enough to figure

everything out, but I know collectively we as a team – there’s enough

smarts here that we’re going to figure this out. I’m motivated by that.

Meg Pekarske No, that is incredibly inspiring, and you use some words that I feel I use in

terms of describing hospice people and why they’re my people. I think they

step in, they lean in to where no one else wants to, right, because no one

wants to talk about death and dying. It is like, well, we can’t solve this

anymore, so I’m going to go walk away now. It’s like leaning into what

other people don’t want to do and I think a unique skill, and not everyone

can do it. I mean, I think a lot of people can’t do it. And bearing witness to

the stories and the endings is a gift, so, yes, I think hospice folks have just

incredible work to do. It inspires me and motivates me, so that was

touching. I appreciate you sharing that.

Final question, here, Michael. So to build up, and I don’t know who you’ll

answer this – so if you weren’t doing hospice, what would you be doing?

And don’t tell me, be on a beach with a piña colada!

Michael McHale That’s a great question, and to be honest with you, I’m not sure what I

would be doing. I have to say that, you know, the last 20 years of my career

being in hospice care and healthcare have been the most rewarding, and I

am so glad that I had that midlife crisis, wasn’t married, so couldn’t get

divorced, and didn’t have a sports car, because just being a part of or a

player in or witness to the incredible work that happens in healthcare every

single day. I’m not sure what else I would do. I’m sure it would be

something healthcare related. At one point, I had a fantasy of opening my

own little assisted living facility and just having six really great residents

there and just enjoying their wisdom and their contribution every single



Speaker Statement

day. That was something I thought would make my life have meaning. So

if I couldn’t do this, I might probably have just done that, because it would

be so cool to be around people who have such great wisdom and have

experienced life and have so much to contribute even towards the end of

their life that I’m a better person just being around them. So that’s probably

what I would – run my own little …

Meg Pekarske Yeah, I love it. I love it, and it’s so true. I mean, that what people at the end

of their life have to share, because it’s just – and again, maybe it’s just as

you get older you appreciate that. Just like when you were talking about the

midlife crisis, you remember people used to say that, and you’re like I

don’t get that. But then there’s a threshold where it’s like, oh, no, I’m

starting to live those questions myself. I think that people who have lived

through those questions or lived into them to a greater extent than you

have, and learning from them, I think is really inspiring.

Well, this has been an amazing conversation, and I really so much

appreciate your time. Things are very busy now, but I think that your story

is helpful for people to hear right now too, because we are going to live

through this and then how do we meet the needs of the future? There’s tons

of opportunity there about how we take what we learned here and apply it,

and, you know, where we started this conversation was how do we better

meet the needs of the people that we serve. So I think that being connected

and grounded in that question is really helpful.

Thank you, Michael, this has been incredible.

Michael McHale You bet.

Meg Pekarske Well, that is it for today’s episode of Hospice Insights: The Law and

Beyond. Thank you for joining the conversation. To subscribe to our

podcasts, visit our website at huschblackwell.com or sign up wherever you

take your podcasts. Until next time, may the wind be at your back.

END OF RECORDING.

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Episode 10: Innovators Series: A Conversation with Michael ... · Michael McHale So I went to school and graduated from Georgia State University in Atlanta, Georgia. I had left Michigan