Cracking The Code Of Home Care
In 2020, I took over the home therapy technology and productivity group — inheriting a problem that had defeated every previous attempt: more than a thousand clinics scheduling remote care with paper, whiteboards, and memory. Here is how the thinking went, and what shipped.
All figures drawn from the public record; where results remain internal, they are described directionally. Visuals recreated as abstractions — no client artifacts or confidential data appear on this page.
A thousand clinics, zero visibility
Home dialysis was the strategic bet: better for patients, better economics, a board level priority. Underneath it, more than a thousand home therapy clinics across the US were scheduling patients with notebooks, whiteboards, and sticky notes. No one outside a clinic’s walls could see its schedule — not the market, not the region, not the enterprise. Planning growth on top of that meant signing a blank check and hoping.
As nothing else was visible, the only productivity number leadership could see was patient trainings completed — and that single proxy carried the weight of judging an entire care model. Several attempts to fix the problem had already come and gone. The group I took over owned the challenge, along with the skepticism every failed attempt had left behind.
Everyone said technology. The ground said trust.
The prevailing diagnosis was a technology gap: buy a scheduling tool. Walking the workflows surfaced two deeper truths. The first is that home therapy does not run on the company’s time — it runs on the patient’s. In-center dialysis offers a fixed schedule that patients are assigned to; home care coordinates itself around patients’ lives, physicians’ monthly rounding, care partners, and homes. Any tool built on in-center logic would fail here. One already had.
The second truth was cultural. Resistance at the clinic level was not stubbornness — it was fear. Visibility meant being judged by leaders who had never managed remote care and did not yet understand its workflow. Whatever we built, adoption would have to be earned, not mandated.
Three ways forward — one already proven wrong
A partner, not a purchase
The selection came down to more than a feature list. The winning platform gave us room to grow: a managed package inside our Salesforce based clinical environment, web and mobile applications, and the flexibility to change operating models without changing systems. I evaluated it against three horizons — our strategy now, in two years, and in ten — and against whether the company behind it would grow alongside us as a true partner. Just as decisive was their willingness to push our thinking and rebuild processes together, because this was never only a technology project. It was a technology, process, and culture transformation in one — and it had to be designed for the people who feared it most.
The platform’s requirements weren’t drawn up in a conference room — they came from a live laboratory. Our operating model pilots (Case 03) ran as a direct feedback loop into the design, so the technology was built to flex across every staffing model the business might choose, rather than hard coding one — while locking in the critical processes the business would never deviate from. One integration discipline governed everything else: clinicians never leave their clinical workflow. Scheduling lived inside the care platform. Telehealth sat at the point of service. Tasks like foot checks and lab draws attached directly to the appointments where they belonged, so nothing had to be remembered separately.
Increments the clinic could feel
- ✓Industry first scheduling & workforce management platformThe first solution of its kind in US home dialysis — intelligent appointment recommendations, route optimization, automated patient reminders, and market level visibility, designed around the home workflow rather than adapted to it.
- ✓Scheduling embedded in the clinical workflowBuilt directly into the Salesforce based care platform, so nurses and care technicians never leave their clinical tasks — with related care actions attached to the appointments themselves.
- ✓Telehealth at the point of serviceRemote care connection woven into the same workflow — keeping patients home, which is the point of home therapy — alongside a reimagined in clinic experience, from arrival to education.
- ✓The first true operational dataset in home dialysisFor the first time anywhere in the US industry, real data on how home care actually runs — the code cracked, at a scale designed to travel globally.
What the discipline returned
Adoption climbed steadily as the rollout matured — reaching 90% across a base of more than 1,230 home clinics nationwide by 2023, and holding there since. Alongside the platform, redesigned point of care tasks improved patient adoption by 20%. The turnaround led to promotion to Senior Director — inheriting systems accountability for a $2.2B business, and the mandate to scale the same playbook.
Technology that gets adopted beats technology that gets admired.
What this page doesn't show
The operating playbook — how the work was sequenced, how champions were won, and how the change was made to stick. That part isn't a storyboard. It's a conversation.