Part Two | Dr. Joan Teno Exposes the Hidden Problems with Hospice Ratings and Quality Scores

Can healthcare remain compassionate in an age of private equity, artificial intelligence, and growing financial pressures?In this part two episode, Chris Comeaux continues conversation with Lauren Kaufmann, Assistant Professor of Business Administration at the Darden School of Business at the University of Virginia and Stephen Maiden, Managing Director of Case Writing Research Group, to discuss the future of healthcare, hospice, private equity, artificial intelligence, ethical leadership, and organizational mission.Drawing from their groundbreaking hospice case study, they explore why private equity has become one of the most controversial forces in healthcare, how AI is reshaping patient care and the workforce, and why measuring quality in hospice remains one of healthcare’s greatest challenges.This conversation goes far beyond hospice. It tackles questions every healthcare executive, nonprofit leader, entrepreneur, and business professional should be asking:✔ Can mission-driven organizations survive growth?✔ What causes mission drift?✔ Is healthcare becoming too corporate?✔ How should leaders balance profits and purpose?✔ What role should AI play in human-centered industries?✔ What does a “good death” actually mean?Our Guest:Lauren Kaufmann, Assistant Professor of Business Administration at the Darden School of Business at the University of VirginiaStephen Maiden, Managing Director of Case Writing Research GroupHost: Chris Comeaux, President / CEO of TELEIOS / author of The Anatomy of Leadership👍 If you enjoyed this conversation, please like, subscribe, and share this episode with colleagues and friends who care about healthcare, leadership, ethics, and organizational excellence.Teleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Few topics spark more debate in healthcare than the intersection of compassionate care, ethical responsibility, and financial sustainability.Can mission-driven hospice organizations survive—and thrive—in a healthcare landscape increasingly dominated by for-profit providers?In Part One of this compelling conversation, TCNtalks/Anatomy of Leadership host Chris Comeaux welcomes Lauren Kaufmann, Assistant Professor of Business Administration at the University of Virginia Darden School of Business, and Stephen Maiden, Managing Director of the Darden Case Writing Research Group. Together, they discuss the groundbreaking business case developed around Teleios Collaborative Network and the evolving hospice industry. The conversation explores whether nonprofit hospice organizations possess unique structural advantages that can help them compete against larger, investor-backed healthcare models while remaining true to their mission.  Drawing on research, classroom discussions, and real-world leadership experiences, the guests examine topics including community trust, volunteerism, staffing ratios, organizational culture, governance, marketing, and ethical decision-making. They challenge assumptions about nonprofit and for-profit healthcare while offering a thoughtful exploration of what it takes to deliver “care as a relationship, not a transaction” in today’s healthcare environment.  Key TakeawaysNonprofit hospice organizations may possess structural advantages through community trust, volunteer engagement, and mission-driven cultures that are difficult for competitors to replicate.  The future success of nonprofit healthcare organizations depends not only on care quality but also on effectively communicating their value to patients and families.  Teleios’ hybrid model combines local independence with shared infrastructure, creating opportunities for scale while preserving community relationships.  Quality of care is often reflected in staffing levels, volunteer involvement, and personal relationships that may not be captured in traditional healthcare metrics.  Leadership, culture, and governance—not simply tax status—ultimately determine whether organizations fulfill their mission and deliver exceptional care.  Guest:Lauren Kaufmann, Assistant Professor of Business Administration at the Darden School of Business at the University of Virginia Stephen Maiden, Managing Director of Case Writing Research GroupHost:Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

What if the most important care doesn’t happen in a hospital, hospice, or clinic—but in the moments in between?In Part Two of The Missing Middle in Healthcare—And Why It Matters, Chris Comeaux continues his conversation with Bridget Sumser and Sonya Dolan of Mettle Health to explore the often-overlooked gap between medical treatment and the lived human experience of illness. Together, they unpack the role of grief, community, language, and connection in supporting people facing serious illness, caregiving responsibilities, and end-of-life challenges.This episode challenges traditional healthcare thinking by asking a powerful question: Are we treating diseases while missing the deeper needs of the people experiencing them? Bridget and Sonya share their vision for a future where grief literacy, community support, and compassionate accompaniment become essential parts of care—not afterthoughts.Highlights from this Episode:✔ Why the word “hospice” can create unintended barriers to care ✔ The difference between treating illness and caring for the whole person ✔ How grief begins long before death and affects all of us ✔ Why community—not healthcare alone—is the missing middle ✔ The future of serious illness support and human-centered care ✔ How anyone can learn the skills of accompaniment and compassionate presence ✔ Mettle Health’s vision for transforming the way we navigate illness, loss, and mortalityWhether you’re leading a healthcare organization, caring for a loved one, or simply interested in improving the human experience of healthcare, this conversation will challenge and inspire you.Subscribe for more conversations on leadership, purpose, healthcare innovation, and human flourishing.Guest:Sonya Dolan Co-Founder, Mettle Health Bridget Sumser, LCSW; Director of Counseling and Programs, Mettle HealthHost:Chris Comeaux, President | CEO of TELEIOS and author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

What happens after a serious diagnosis—but before hospice care begins?In this compelling conversation, host Chris Comeaux sits down with Sonya Dolan, Co-Founder of Mettle Health, and Bridget Sumser, Director of Counseling & Programs, to explore one of healthcare’s most overlooked challenges: the “missing middle.”Drawing from decades of experience in hospice, palliative care, caregiving, and serious illness support, Sonya and Bridget discuss the critical gaps patients and families face as they navigate life-altering diagnoses, caregiving responsibilities, grief, and uncertainty. Together, they unpack why traditional healthcare systems often struggle to address the emotional, relational, practical, and existential realities of serious illness—and how Mettle Health is working to fill that gap through compassionate accompaniment and human-centered care.This episode offers valuable insights for healthcare leaders, hospice professionals, nonprofit executives, caregivers, and anyone seeking a deeper understanding of what it means to truly support people through life’s most difficult transitions.🔹 In this episode:• What inspired the creation of Mettle Health• Understanding the “missing middle” in healthcare• Why caregivers need support in their own right• The limitations of traditional healthcare and reimbursement models• The role of accompaniment versus treatment• Building resilience and coping skills during serious illness• The evolution of interdisciplinary and transdisciplinary careWhether you’re leading a healthcare organization, caring for a loved one, or simply interested in improving the human experience of healthcare, this conversation will challenge and inspire you.🎧 Don’t miss Part Two, where the discussion continues with deeper insights into caregiving, grief, communication, and the future of compassionate care.Subscribe for more conversations on leadership, purpose, healthcare innovation, and human flourishing.Guest:Sonya Dolan Co-Founder, Mettle Health Bridget Sumser, LCSW; Director of Counseling and Programs, Mettle HealthHost:Chris Comeaux, President | CEO of TELEIOS and author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Can consumers really trust hospice quality ratings?In Part Two of this powerful TCNtalks / Anatomy of Leadership conversation, Chris Comeaux and Cordt Kassner continue their discussion with nationally recognized hospice researcher and policy expert Dr. Joan Teno.Building on Part One, Dr. Teno explores how patients and families can make better-informed hospice decisions, why current quality reporting systems often fall short, and how artificial intelligence could transform the future of hospice quality measurement. She also addresses one of the most pressing challenges facing the industry today: preserving public trust while combating fraud, profiteering, and unethical practices.Drawing from decades of research and policy leadership, Dr. Teno offers a thoughtful perspective on the future of hospice care, the importance of transparency, and the critical role healthcare leaders must play in protecting the integrity of the hospice mission.Whether you’re a hospice professional, healthcare executive, policymaker, clinician, or family caregiver, this episode offers valuable insights into the future of end-of-life care.Key Takeaways:✔ Why consumers need better tools to evaluate hospice quality✔ How AI could improve hospice transparency and decision-making✔ The risks of oversupply, profiteering, and declining public trust✔ Why quality data should empower both providers and families✔ The extraordinary impact hospice clinicians continue to make every day✔ The future of hospice care, accountability, and patient choiceChapters:0:00    Welcome And Part Two Setup0:21    A Better Way To Find Hospice3:06    Weighting Scores Without Punishing Small Programs6:01    The Denominator Problem Behind Star Ratings10:58  Rural Hospice Reality And The Willie Sutton Rule12:08  AI Can Hallucinate Hospice Quality16:47  Public Trust And A Saturated Hospice Market23:36  Ghost Hospices And Which Data To Trust26:04  Do CAHPS Questions Still Fit Hospice Today27:44  Concurrent Care And Why Hospice Stays A Hard Choice33:40  Giving Back Through Mentoring And Substack35:57  Subscribe And The Brain BookmarkGuest: Dr. Joan TenoMD, MS; Adjunct Professor of Health Services, Policy, and Practice (Brown School of Public Health); Adjunct Staff, RAND CorporationCo-Host: Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice AnalyticsHost: Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Are hospice quality ratings really measuring what matters most?In this powerful episode of TCNtalks / Anatomy of Leadership, Chris Comeaux and Cordt Kassner sit down with nationally recognized hospice researcher Dr. Joan Teno to uncover the hidden problems behind hospice ratings, quality scores, and public reporting systems.Drawing on more than 30 years of experience shaping hospice and palliative care policy, Dr. Teno explains why many publicly reported quality measures may fail to capture the true experiences of patients and families. She discusses the challenges of transparency, the unintended consequences of current reporting systems, concerns about fraud and oversight, and how artificial intelligence could help transform the future of hospice quality measurement.Whether you’re a healthcare executive, hospice leader, clinician, policymaker, or nonprofit professional, this conversation offers valuable insights into the complex realities behind quality scores and what must change to better serve patients and families at the end of life.In this episode, you’ll learn:✔ Why hospice ratings may not tell the full story✔ The biggest blind spots in today’s quality measurement systems✔ How some providers avoid meaningful public reporting✔ The role of AI and data analytics in improving oversight✔ What meaningful transparency should look like for consumersChapters:0:00     Leadership Sets The Tone0:22.    Monthly Hospice News And Framework3:38.    Why Oversight Beats Payment Redesign8:28.    Transparency Limits And Small Hospice Loopholes13:10.  Blind Spots In Quality Reporting18:56   Using AI To Pick A Hospice23:45.  Moratorium And Rebuilding Trust27:30   Clinicians Needed To Catch What Models Miss29:18   Part Two TeaserGuest: Dr. Joan TenoAdjunct Professor, Brown School of Public Health | Hospice & Palliative Care Researcher | 2023 AAHPM Lifetime Achievement Award RecipientHost: Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of LeadershipC0-Host: Cordt Kassner, 👉 Subscribe for more conversations on leadership, healthcare innovation, hospice care, and mission-driven organizations.Teleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Most leadership advice sounds inspiring until you have to practice it with real pressure, real people, and real consequences. Our host, Chris Comeaux sits down with Mark Miller,  former Vice President of High Performance Leadership at Chick-fil-A and bestselling co-author of The Secret and Lead Every Day, to get brutally practical about servant leadership, ego, and why the best leaders stop asking “How do I get more from my team?” and start asking “How do I help my team win?”They talk about why the servant-leader mindset is hard to adopt in the first place: it often isn’t modeled, it isn’t taught, and our default human setting leans toward “me and mine.” Mark shares research that puts a spotlight on the real obstacle many leaders face, ego, and we explore how it shows up in everyday decisions, team dynamics, and organizational culture.Mark addresses the tension that trips up even well-meaning managers: how do you serve people while still holding them accountable? Mark makes the case that accountability is not a harsh tool, it’s a gift that helps people reach their potential, and he explains why great leaders keep results and relationships high at the same time. Mark also dig into Lead Every Day, a leadership operating system built around three disciplines: becoming a better leader, improving team performance, and strengthening the organization, plus the simplest daily push that changes everything: start where you are, use what you’ve got, and do what you can.If you care about leadership development, team performance, and building a healthy culture that still delivers results, this conversation will give you language, stories, and next steps you can use immediately. Subscribe, share this with a leader who needs it, and leave a review with your biggest takeaway.Guest:Mark Miller, Business Leader, Wall Street Journal and International Best-Selling Author, Communicator, and Co-Founder of Lead Every DayHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

What does it take to build a leadership culture that scales across generations, industries, and millions of customer interactions? In this powerful conversation, Chris Comeaux sits down with Mark Miller — former Vice President of High Performance Leadership at Chick-fil-A and bestselling author of The Secret — to explore the principles behind extraordinary leadership. From his humble beginnings as an hourly team member to helping shape Chick-fil-A’s leadership development strategy, Mark shares hard-earned wisdom about influence, intentionality, and what truly drives organizational growth.  Throughout the episode, Mark unpacks the foundational leadership framework behind the acronym SERVE: See the Future, Engage and Develop Others, Reinvent Continuously, Value Results and Relationships, and Embody the Values.  He explains why leadership is ultimately about service — not position — and why organizations that fail to intentionally develop leaders will eventually plateau.  Chris and Mark also discuss the tension between results and relationships, the importance of creating a common definition of leadership, and how healthcare, hospice, and nonprofit leaders can prepare for the future by multiplying leadership capacity throughout their organizations.  For leaders navigating complexity, growth, or organizational transformation, this episode offers practical insight and timeless leadership principles from one of the most respected leadership voices connected to the Chick-fil-A legacy. Key TakeawaysGreat leadership requires balancing both results and relationships— not choosing one over the other.Organizations plateau when leadership development does not scale with growth.Leadership is fundamentally about serving strategically, not simply being helpful or nice.Strong cultures are built when organizations create a shared definition of leadership.Continuous learning and reinvention are essential for long-term leadership effectiveness.If this conversation challenged and encouraged you, share this episode with another leader in your organization.  Subscribe to the podcast for more conversations designed to help healthcare leaders, nonprofit executives, hospice professionals, and business leaders live and lead with greater purpose, clarity, and impact.  And don’t miss Part Two of this powerful discussion with Mark Miller.Guest:Mark Miller, Business Leader, Wall Street Journal and International Best-Selling Author, Communicator, and Co-Founder of Lead Every DayHost:Chris Comeaux, President / CEO of TELEIOS | Author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Hospice has always been about people, but the future of hospice will increasingly be shaped by data—and that shift is both exciting and unsettling.In Part Two of The Future of Hospice: How HOPE Will Transform Reimbursement & Care, Raianne Melton and Andrea Hale unpack how the HOPE tool could redefine hospice reimbursement, value-based care, and quality measurement across CMS, Medicare Advantage, and health systems. The conversation explores where hospice measurement may be heading—from symptom impact scoring and burdensome discharges to acuity tracking, HUV utilization, and the growing importance of consistent documentation and actionable clinical data.The episode also focuses on what hospice leaders can do now to prepare: improving point-of-care documentation, simplifying EMR workflows, leveraging real-time analytics, and exploring AI-powered ambient listening to reduce clinician burden while preserving compassionate care. Ultimately, this conversation is about helping hospice organizations prove their value with measurable outcomes while staying true to the mission that defines hospice care.This episode offers practical insights for hospice executives, nonprofit healthcare leaders, clinicians, and anyone navigating the evolving landscape of end-of-life care.Guest:Andrea Hale, CEO of Valley Hospice Raianne Melton, Director of Clinical Services of Professional Services for AxxessHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

The future of hospice care is changing—and the HOPE assessment tool may redefine how providers deliver care, document outcomes, and receive reimbursement.Healthcare is entering a new era where quality outcomes, patient data, and accountability are driving the future of care delivery.  In this episode, we’re joined by Andrea Hale, CEO of Valley Hospice, and Raianne Melton, Director of Clinical Services of Professional Services for Axxess, whose expertise and frontline perspective help unpack one of the most significant shifts happening in hospice today—the implementation of the HOPE assessment tool. Their insight provides valuable guidance for hospice leaders, clinicians, and organizations preparing for the future of reimbursement and patient-centered care.In Part One of this important conversation, we explore how the Hospice Outcomes & Patient Evaluation (HOPE) tool is poised to transform the hospice landscape.  From evolving CMS expectations to the growing emphasis on quality metrics and patient-centered outcomes, this episode breaks down what hospice leaders, clinicians, and healthcare organizations need to understand now.Join us as we discuss: • What the HOPE tool is and why it matters • How reimbursement models are shifting in hospice care • The operational and compliance challenges providers may face • Why documentation and quality reporting are becoming more critical than ever • How organizations can proactively prepare for the future of end-of-life careWhether you’re a hospice professional, nonprofit executive, healthcare leader, or business decision-maker, this episode provides timely insight into the changing future of compassionate care delivery.Our Guest:Andrea Hale, CEO of Valley HospiceRaianne Melton, Director of Clinical Services of Professional Services for AxxessHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of Leadership🎧 Subscribe for more conversations on healthcare leadership, hospice innovation, and mission-driven care.Teleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast