A Nine Month Turnaround, Run Through The Pandemic
Metro New York had absorbed years of executive attention without turning. I turned it around in nine months — remotely, through the months when the city was the hardest hit place in America, driving seven parallel projects with a leadership team known as one of the toughest in the company to reach.
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.
The market years of effort couldn’t turn
Metro New York is unique even among the hardest urban healthcare markets: enormous patient volume in extreme concentration, transportation that defeats scheduled care, homes without the space home therapy quietly assumes, and competitive dynamics unlike anywhere else in the country. For years it had received attention and resources at the president and CEO level — and stayed stuck.
When the question of what to do about New York reached the top of the company, I was put forward as the answer. Then the timing turned extraordinary: days after the kickoff meeting in Manhattan, New York City shut down and became the global epicenter of the pandemic. The turnaround would run anyway — entirely remotely, through the hardest months that city has ever known.
Years of effort. No shared diagnosis.
The market didn’t lack attention, resources, or theories — everyone had a theory. What it lacked was a shared, structured answer to what was actually wrong. Effort scattered across competing diagnoses cancels itself out, which is how a market absorbs years of investment and stays exactly where it is.
So the first work product was not a plan, it was a diagnosis the whole leadership table could agree on. I built critical to quality trees that decomposed “fix New York” into its real drivers across admissions, market development, and the physician and payor environment, each with named actions and owners. Those drivers became the seven projects. For the first time, everyone was working the same map.
Then the city shut down
Run it remotely — which made trust the first job
When I asked the market’s leaders whether we should delay, their answer stayed with me: their operations don’t stop, and neither would this — the work itself was a piece of normalcy to hold onto. Their choice set the terms: seven projects, led entirely from a distance, through the hardest months that city has endured.
That made relationship building the load bearing skill. This was a leadership team with well earned skepticism of outsiders — the kind of trust normally granted only in person, over time, and I would have neither, in the middle of a crisis pulling everyone’s attention elsewhere. It was earned instead through the work: absorbing every hard critique on open calls without flinching, following up offline until intent was unmistakable — that I wanted this team better off than I found them, with the heat taken off, not added. Getting a notoriously hard to reach team to focus on seven simultaneous workstreams, remotely, mid pandemic, was the real turnaround engine. By the end, the market’s toughest skeptic had become a colleague I stay in contact with to this day.
Seven projects, one coordinated program
- ✓Home First concierge modelA home first transitional care model launched in an underserved borough — admitting its first patients mid pandemic — bringing the transitional care concept (Case 04) into the country’s hardest market.
- ✓Medical clearance turnaroundPhysician medical clearance of new patients streamlined from an average of five days to under 24 hours — closing one of the single biggest sources of patient loss out of the market’s clinics.
- ✓Home Foundations for SuccessA home therapy strategy rebuilt from the ground up — education, quality, team culture, growth planning — then handed to the market’s home therapy director to carry forward.
- ✓Scheduling optimizationThe in-center scheduling system’s utilization and leverage optimized for materially improved productivity and efficient staffing.
- ✓Market development & physician matrixMarket development efforts overhauled and physician engagement systematized through an action planned matrix — moving the market’s posture from defensive to offensive.
- ✓Kidney Care Advocate optimizationThe modality education function rebuilt, with structured relationship building between advocates and their field leader counterparts — the engine of home program growth, re-geared.
- ✓Hudson Corridor growth initiativeA dedicated growth strategy and physician matrix for a stagnant, fragmented corridor the market had never cracked.
Delivered in nine months, through the epicenter
From the March 2020 benchmark to the January 2021 close, home dialysis cost per patient per month fell from $1,440 to $908 — a $532 reduction across a 600-plus patient population, roughly $3.8M in annualized savings. Growth and efficiency arrived together, the trade off everyone assumed proving to be a design flaw rather than a law. Every result was delivered remotely, while the market’s teams worked through the pandemic’s hardest months — and the working relationships built then have outlasted the program, the market, and the company.
Trust is the first deliverable. Everything else ships after it.
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.