“Payoff Will Be Billions if Louisville Can Be Best at Aging Innovation” by Dianne H. Timmering

By Dianne H. Timmering @dhtimmering

Its sector is a leader, but lucrative market to help boomers live better won’t be on without a fight.

Aging is a new dawn of health care. Tens of billions of dollars are at stake as an epochal time for revolutionary wellness and aging care begins. Louisville is contending to lead the revolution but it is not clear yet that anyone has defined exactly how best to compete for and win this new health sector of aging innovation.

The older we get, the more we recognize that age is just a number – and considering the alternative, age, at any age, is a good number.

In his book “The Longevity Economy,” Joseph Coughlin notes that the concept of “old age” is actually a newer invention: “Historically, in many different cultures and time periods, growing old was something experienced on an individual basis – not at a set age … and not always according to the same set of rules.”

Good to know since an avalanche of aging boomers is arriving – a byproduct of a decade-plus period post World War II when the world produced an outpouring of what had been lost in war’s carnage: life. Now, that burst of “baby boomers” is pouring in at a rate of 10,000 a day. They are coming; they are here.

Born 1946-1964, with plenty of company from the years before and after, they want what they want. Considered the “me generation,” it is 40% of total consumer spending and 70% disposable income (Forbes, Sept. 2017). Tech smart, active and focused on healthy lifestyles, they have unprecedented buying power and are generating an innovative health care rush by the thousands who serve them – from the single entrepreneur to the multifaceted provider communities.

But as the new dawn of aging breaks, what does it look like with new rules – or no rules?

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The challenge of influencing, even leading, this new dawn has been set, and Louisville has a real shot at crafting the rules: what it can look like, how it can feel, how health care delivery happens both in hospitals and post-acute facilities and the halls of their homes, how seniors will engage, how they will interact with technological might, how they will access care, pay for it, even prevent sickness.

Yet, this megabuck competition may be Louisville’s to lose. It already has been deemed a national aging innovation centerfold by a 2018 Forbes magazine article based on its health care industry heavyweights like Humana, Kindred Healthcare, Trilogy Health Services, Atria Senior Living, PharMerica (merged now with BrightSpring), Norton Healthcare, Signature Healthcare, Baptist Health, Apellis Pharmaceuticals and others with approximately 375,000 employees across various domains of insurance, home-based health care, hospice, pharmaceuticals, rehabilitation, senior living and skilled nursing.

‘We need to go and get it’

It’s already a powerful economic driver worth $90 billion in revenue, according to Ben Breier, president and CEO of Kindred Healthcare.

“Louisville is considered the aging-care capital of the United States,” said Humana CEO Bruce Broussard, “because of what the companies based here are doing in health care.”

“Health care is our largest sector in the city and Louisville has a legitimate claim, but we need to go out there and get it,” said Kent Oyler, president/CEO of Greater Louisville Inc.

Earlier this decade, realizing the potential in aging care, some of Louisville’s sector leaders began efforts to join forces and grow their economic critical mass. Last year another dynamic was launched to increase the collective strength of once-siloed powerhouses of health care into a juggernaut of unprecedented force.

A dozen stalwart companies in the aging-innovation space formed the Louisville Healthcare CEO Council (LHCC) to aggregate the atomic power of these formidable health care giants and the critical resources big companies can provide for investment, prototype pipelines, mentoring and being a driving force for change – with the intent also of crowning Louisville the monarch of this medical sector.

“The whole concept is to band together with a common voice, a common place for opportunity to happen,” said Randy Buford, president/CEO of Trilogy Health Services.

“My colleagues and I on the LHCC represent the strength of health care organizations we have in this portion of the country,” Broussard said. “With the companies represented on this council, including Humana, you can journey map the entire patient health care experience beginning to end.”

“The creation of the CEO Council was the missing piece. … We are now able to mobilize as an industry cluster and energy source for others to plug into,” said Joe Steier, president/CEO of Signature Healthcare.

“We now have a solid platform for intentional disruption,” Breier agrees. “It’s not always easy to think about innovation, but now we can solve for the big problem – start on one path, change when we need to.”

New tools to speed innovation

Some national innovation leaders agree that Louisville is a viable contender to be the capital of aging care innovation.

“I don’t think it (Louisville) is yet, but it could be,” says Cedric Francois, president/CEO/co-founder of LHCC member Apellis Pharmaceuticals, a biopharma development company working to create sophisticated therapies for autoimmune and inflammatory diseases. “We are about to see dramatic reform, and Louisville is onto something; I like the ambition behind it. The recent CareTech pitch (a LHCC aging innovation pitch competition) is a great example of focusing on an important segment of society that is neglected. Tactically honing into the caregiver is a great approach.”

“Louisville has a shot,” says Unity Stoakes, president and co-founder of San Francisco-based Start-Up Health, founded in 2011 to build a 25-year plan to improve health by investing in a “global army” of entrepreneurs. The LHCC “is a great example of an ecosystem that has emerged around a particular theme,” Stoakes said. “These great companies can not only invest but commercialize (products) and innovate new solutions.”

He went on to say that the emergence of the internet fueled the power of retail and media in the 1990s but outpaced health care innovation; Louisville’s ecosystem is better positioned now to speed things up.

This new speed is optimized by LEAP (Louisville Entrepreneurship Acceleration Partnership), a vehicle for entrepreneurs to jumpstart and accelerate their ambitions of innovation and technology in the aging-care space. It has the early blessing of the Kentucky Cabinet for Economic Development’s organization and funding, the academic and research arm of the University of Louisville, the startup support team at GLI’s Enterprise Corp., XLerate Health’s innovation building, and the LHCC, as well as a new capital model to help finance opportunities and the entrepreneurs needed to make them.

“Health care is a top sector and priority for the Kentucky economy and is so critical in real measurable economic output; it boils down now to focus,” said one of state government’s lead economic development specialists.

A growing collective reasoning emerges: Louisville may finally be able to play host to a full sanctuary of mechanisms and structure for a growing community of wellness and aging-care pioneers.

Cooperation generates excitement

Entrepreneurs like John Williamson, founder/CEO of RCM Brain, a startup looking to use artificial intelligence to improve workflows, are encouraged.

“Now a motivated start-up with a relevant solution may have a better chance at a connector and interested BigCo (big company) influence,” Williamson said.

“Innovation can now take hold in a real system, and have an outcome,” says Mary Haynes, CEO Nazareth Home Inc.

“Baptist Health is actively working together with other Louisville-based health care companies and their CEOs, and the academic community,” said Gerard Coleman, CEO of Baptist Health and a recent addition to the LHCC, “to identify both existing companies and innovative start-ups that will not only help support and improve the lives of the senior population, but also the lives of those who care for them.”

The pace of technologies like AI (artificial intelligence) and nontraditional care settings like staying in the home longer is accelerating, with help from the powerful connectivity engine of telemedicine, “smart” home technologies, virtual reality, sensors that can determine just about anything, apps that can detect paid and unpaid caregiver burnout, analytics that can predict a fall before it happens, even the nonimaginary realization of “domotics” (domestic robots).

If it achieves traction, Louisville can not only redefine care delivery with its great depth of expertise but re-create and re-cast the meaning of aging – what it actually means to age – rewrite the rules and become a mecca for entrepreneurs who aspire to advance their fields, products and services because of the support system that awaits them.

The current excitement around the LHCC is demonstrable, but there also is some better-late-than-never sentiment.

“There were stops and starts” in the city’s ascendancy efforts regarding well and aging care, said Randy Buford.

When Signature Healthcare moved to Louisville in 2010 from Palm Beach Gardens, Fla., it had hoped to quickly be part of a broader business community of shared learning and collaboration. Signature viewed with reverence the rich health care legacy of Humana, Vencor, Kindred, ResCare Human Services and others. However, there was not as much collaborative synergy-creating connectivity at first.

“The main difference now,” said Joe Steier, CEO of Signature, “is that the health care vertical is being embraced by both private and public resources with funding shifts and resource support.”

Nine years later there is a broader sense that Louisville should fight even harder to wear the aging-care innovation crown, not only because of its existing juggernaut and health care legacy, but because the longevity economy is real. And it is big.

Success would be felt statewide

According to Coughlin’s “Longevity Economy,” which was released in 2013 by AARP and Oxford Economics, the financials of meeting the care needs of the aging generation clock in at around “$8 trillion, and this is growing,” said John Reinhart, an early innovation leader.

And what is it worth in real dollars to the city and the commonwealth of Kentucky? Hard-dollar figures on aging care’s present role locally do not exist, but should Louisville’s existing force achieve recognition as a leading world center and attract even 1% of the global longevity economy to move or expand here, that $80 billion would represent a 40% expansion of the state’s current $200 billion GDP.

According to recent reports, Louisville is already Kentucky’s primary economic engine and generates 42 cents of every state tax dollar, funding public services in all 120 counties.

“Expanding … in the aging care and wellness space is a top priority,” said Mary Ellen Wiederwohl, chief of Louisville Forward, the city’s economic development agency. “Health care is transformative to a local economy, creating growth in office space utilization and innovation jobs well above the median wage.”

In fact, think of the economic force of the 65 and up U.S. population as its own territory and space quantified by its own country calculated by GDP (Gross Domestic Product) and boomers become the third largest country in the world.


“We now live in a world chock full of older people, with, as of 2015, 617 million people aged 65-plus, a population roughly double that of the United States, the world’s third-largest country,” according to “The Longevity Economy.”

In fact, the Greater Louisville economic health care engine right now “reaches nearly half of the nation’s aging population and over 80 million people annually,” said Tammy York Day, president/CEO of the Louisville Healthcare CEO Council. And that will only grow as the Longevity Economy does.

An entrepreneurial system’s payoff

To be able to harness a part of the multitrillion-dollar aging care innovation world would bring Kentucky and Louisville into a first-tier city, perhaps as much as landing an NBA team would.

“And we would be solving problems,” Steier said. “I know our post-acute (care) space is five times more challenging to survive in than when we relocated here. … To have external peer support, accelerated alignment for the big change stuff and a safe place for objective dialogue is invaluable.”

“Funding for innovation in aging care can come from cost-avoidance for organizations paid under value-based or other recent incentive structures,” said David Jones Jr., managing partner and chairman of Chrysalis Ventures, a Louisville venture capital firm. “For example, Medicare Advantage insurers might be interested in paying for healthy food or telemedicine consultations in the home, if these innovations keep seniors out of the hospital.”

And just how important is the academic and research side of health care innovation? Big enough to be a founding member of the LEAP initiative: the University of Louisville, with a top entrepreneurial school, academic and research arms, and the UofL Trager Family Institute for Optimal Aging, is considered a critical factor to the overall success of this developing ecosystem.

“We are all in,” said Neeli Bendapudi, University of Louisville president. “Especially from a research perspective. We have all the pieces of the (aging) industry (in Louisville). It’s what we want to be known for, and be a part of our city, state and industry focus.” “The Trager Family Foundation and Republic Bank Foundation are heavily invested in the community, particularly in making us (Louisville) a center piece in serving the aging public,” agrees Steve Trager.

Consider the following scenario for local, state, national and international innovation collaboration:

An entrepreneur is here, starts a company, develops a specialized technology, receives early-stage connections through LEAP, accesses capital, builds out a commercialization strategy through XLerate Health mentors, connects to fellow travelers and partners through GLI’s more than 400-member Health Enterprise Network, becomes an academic clinical trial at UofL, pilots with a local national BigCo, is showcased at The Thrive Center and scales its way to product adoption by the Louisville Healthcare CEO Council either for sale (B2B, B2C) or product service enhancement – an epic collaboration of resources in an aging world.

Louisville’s odds improve if…

But most are in agreement that the following must happen:

• The BigCo doors stay open.

• The LHCC giants engage – Kindred’s Breier and Humana’s Broussard are very engaged, according to a council member.

• The entrepreneurial innovators show up – LEAP aims to be a catalyst.

• The research and academic arms find effective ways to integrate their formidable power into the enterprising process, which requires variations of venture capital, investment and “friends and family” money to fund it.

• More access to new capital.

• The specialization of varied workforce, detailed labor and talent to get it all done is achieved.

And they do it all together.

Louisville then has a good chance.

But there may be a few challenges to overcome.

LEAP recently issued a comprehensive TechStar report assessing the local community and found that even with all the city’s goodwill toward innovation, it was still emerging in three of four categories. “We are emerging, but we want to be leading. We’re emerging because we are moving toward a higher number of start-ups being formed, but we do need more collaboration and impact. This is a team sport. Industry, academia, angel investors, venture capitalist, and mentors – we all need to work together,” says Patrick Henshaw, CEO, LEAP. “We need to go from activity to impact. We need to connect and collaborate.”

Sean O’Leary, EdjAnalytics founder and co-founder/former CEO of Genscape, an entrepreneur his whole career, says that he and others are very “excited about the TechStar report and LEAP” and want to model “it after what Cintrifuse has done in Cincinnati.” Cintrifuse is a consortium similar to Louisville’s LEAP whose plan helped launch the Cincy entrepreneurial landscape into new stratospheres of impact.

“There is an opportunity,” O’Leary said, “for a young company from the B2B side who just needs a chance to prove a product, so that getting the opportunity to work with larger companies” is critical.

But how can Louisville compete with the Bostons and the San Francisco Bays, especially from a capital, workforce and tech development perspective?

Anything that drives the entrepreneurial spirit – and has an epicenter of challenge and economic gain – attracts competitors. And there are other cities vying to be the aging-care innovation capital. In addition to Louisville, experts point to the MIT AgeLab in Boston, for one; another Midwest city that is promoting its “SilverTech revolution;” and also, of course, the Northern California Silicon wave that is also swept up in this innovative aging race.

Capital? It ‘follows the opportunity’

Investment capital for innovation could also present a key hurdle since, as one Louisville entrepreneur said, “We have to work twice as hard to get local dollars.”

“We are addressing this by bringing capital into the region,” York Day said, as well as better leveraging current investment streams and streamlining capital access intricacies.

But there’s good news.

“Capital follows the opportunity more than it creates the opportunity,” said Jones. “We exist to serve the entrepreneur. We are a matchmaker. And most importantly in the context of the LHCC and CareTech [pitch] and what’s going on in the aging economy, the purchasing power of these big companies,” can be huge.

Another constant challenge is the workforce talent and expertise needed; it exists already in Boston and larger first-tier cities.

“It’s a growth area for our economy,” according to O’Leary, who has expertise in the high-level technical and analytical job market.

There are solutions, like the launch of The Hive – a joint creation by Kindred Healthcare and UofL to collaborate, for example, with West Coast tech resources, and to identify workforce early within the J.B. Speed Engineering School and spark thinking about the business of home health and senior care and innovative tech ways to address needs and solutions for this growing aging population.

Another big step toward fixing the workforce deficit is the launching of the IBM Skills Partnership that UofL’s Bendapudi announced in April. In this first-of-its-kind initiative, IBM is teaming with five universities to improve next-generation workforce skills by providing resources – including special training for faculty – to improve tech education “literacy tools” in cloud computing, artificial intelligence, data analytics, blockchain, supercomputing and other areas that are crucial especially in a modern health care world.

And there are the tech innovation hubs popping up across the Greater Louisville area from the new NuLu Hub, Startup Louisville, iHub and the 1804 Entrepreneur Center, where technological creations, solutions and gap-filling ideas grow out of either work experience or personal encounters. The emerging Louisville landscape is populated with the pieces to become a capital of “aging well” innovation, especially focusing on the city’s health care roots, and every leveraged strength of its health care past merging and integrating with the new seeds of startups.

There is a school of pragmatic thought to focus on where one leads or specializes. In Louisville’s case it is aging innovation care.

“The DNA of our health care existence in Louisville is really strong,” said Russell Cox, CEO, Norton Healthcare Inc.

Effective ecosystem attracts talent

If Louisville can’t compete with Boston and San Francisco, for example, for other technologically tuned innovative advancement, it can perhaps win the health care sector battle with its core strengths and increasing competitive advantages in aging care innovation.

Unique to Louisville is the advanced leadership development in the aging-care space underway. Keith Knapp, associate professor and chair of the Health Services and Senior Living Leadership Department in Bellarmine University’s College of Health Professions, a health care quarterback for decades, has developed a senior-care management program for health services and senior living leadership at Bellarmine. There are less than 15 such programs in the country.

“We are developing leaders for tomorrow’s spectrum across the aging services continuum, anything in the post-acute care space including home health, hospice, senior living, etc.,” Knapp said. “Equipping students who are not necessarily drawn to a clinical role but want to be leaders in health care are drawn to this unique career path. The common denominator is the deep-seated empowerment to make a difference.”

The program has attracted more than 30 students into the new major and had its first two graduates this year. New students are coming to Bellarmine because of the program.

“Our program is growing faster than expected; we are recruiting new faculty,” Knapp said. “And we (Louisville) have such a hallmark of leadership in the city, we can bring in the presence of locally based national practitioners to teach courses.”

And while Louisville isn’t Boston, Trilogy’s Buford makes the point that what separates Louisville from these other cities is that if the community gets the right ecosystem going, the talent will be drawn to a city where affordability and quality of life may outpace the competing markets.

“Some entrepreneurs simply can’t afford to live in San Francisco,” Buford said. “With growing access to capital and events like the CareTech Pitch, people are starting to notice our city. It doesn’t happen overnight. It’s a layering of piece by piece.”

“We need to fully adapt the opportunity of Louisville, which is a cool city for young people,” Apellis’ Francois said.

“It’s not just a place to live. It’s also a medical address that can take you fully through your life and enable you to age well, no matter your age,” said Norton CEO Cox. “Companies who provide health care services or products to any demographic can thrive here and achieve stickiness for a long period of time.”

PR efforts crucial to a win

Passport Health Plan CEO Mark Carter, one of the LHCC founders and its current chairman, describes it as “grabbing the space, distinguishing ourselves (from a Nashville market) and winning the PR battle” for the aging-care capital.

Breier agrees.

“It’s ours; especially if we say it enough,” he said.

It is an unusually rare opportunity, York Day notes.

“Aging innovation is a national issue, and we are at its center for solutions meeting a critical national need. So why not here?” the LHCC president/CEO said.

“The council’s work is not limited to Louisville,” Humana CEO Broussard said. “Rather, Louisville is the nucleus, and the rest of the country benefits from what’s developed here. The LHCC was created to ensure that we are on the forefront of driving and discovery of innovation, supporting entrepreneurs and businesses, access to infrastructures and capital necessary to bring their ideas to market and scale their business.”

Within this decade, seeds tilled by many local entrepreneurial pioneers have grown together into an opportunity to stake a real claim as the aging-care innovation capital for the nation, maybe the globe. However, Louisville today doesn’t have the luxury of time that allowed a Kentucky Derby first run in 1885 to rise to worldwide prominence and a bourbon industry to mature over recent decades into its present global footing.

A technological environment in which forces can measure change in minutes and seconds must be respected, and action must be taken when the business forge reaches the right heat. If Louisville does not disrupt the current future of aging care, another city will. Louisville could truly be positioned to be a capital for aging innovation, or it could turn out to be a hub that feeds another.

An ecosystem is a dynamic force that if built, nurtured and developed can be an organism of change and make being the capital of aging care innovation a reality. And it looks like everything is pointing forward, with the LHCC dynamically unified, good and deliberate sowing of past efforts and the embarkment of real collaboration, even with some stubbed toes and previous starts and stops.

Louisville is taking the partnership steps to meet the critical needs of research, workforce and capital for the emerging space of entrepreneurialism for an aging globe.

The forces that are for Louisville are greater than the forces that are against her.

Dianne H. Timmering is a correspondent for The Lane Report. She can be reached at editorial@lanereport.com.

This article originally appeared o the Lane Report website  June 18, 2019. You can access it HERE.

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“Louisville, KY . . . A Great City Of Cause And Effect” by Dianne H. Timmering

Louisville, KY is a great city of cause and effect—filled with the power of innovation, a real testing ground for live feedback on products, services, technologies—a testing ground for the fluent edgy ideas and new venture offspring, concept-building from one vision to creation, with entrepreneurs in the making, a knowing, a passionate drive of unstoppable thought leaders with toes in the revolutionary waters of experiment willing to challenge the healthcare experience for generations to come. We need to capitalize on this ointment in our cultural fabric, and not give it to another.

Dianne H. Timmering

“We are US…A Healthcare Marathon Finish” by Dianne H. Timmering

It’s a year later and I still reflect on my time in the race. The race for what—healthcare’s idiosyncrasies of uncertainty, day to day where one word from Washington, whether it becomes regulatory discretionary review or legislative speculation still rings with resonance of possible impact shuttering those it impacts the most— the impoverished, the elderly, the disabled, the rich, the poor, the hopeless—you see everyone has their own healthcare story because I suppose any one rich, or even moderately so, could suddenly be poor if they encountered the worse that could happen in the navel of unscripted sickness.

But that is not what this blog is about. It’s about finishing the race—the New York marathon of 26.2 miles I mean, just, and I mean just under 6 hours—a miracle of sorts for someone who trained with a little bit of a little. —I hate to run, I mean I really do, but the little bit of practice that my mind would allow me to have, combined with the larger aggravated power of hot yoga gave me the breath and endurance of muscle and brain-conditioning to make it through.

Well that isn’t exactly the truth–because we had a plan, a cause, and a mental superpower called PUSH. It was my colleague who said we run 11 minutes and walk 3, run 11, walk 3, pace ourselves—never to deter, never NEVER to veer from this strategic plan—and he was right. And it was the people of New York city—the #Brooklyners, and the #Manhattanites, and the #Queenstown folks, and the precious child who handed us that slice of banana in the #Bronx for so much needed potassium, and the women along the 23rd mile who said did we need a chip with salt as music selection slid into our ears goading us on, fighting for us, pointing us toward the finish, as it seemed like every new Yorker was—those beautiful incredible amazing “citizens” and immigrants who they are—loving, pushing for a good finish. Americans all of them, no matter their legendary heritage, in melting pot fashion of hope—for we are a hopeful nation, rugged individualists. We can’t help ourselves—it is who we are. US.

  1. US. Us — the U.S.—the United States of America.

We are… US.

I finished—with 6 of my professional colleagues who inspired me every day in their deeper commitment to training than what I was willing to do—, knowing in the end, hoping, that I would fight no matter what even if I had to crawl across the finish line. Which is what my colleague and I almost did—he had a busted tendon and I just tired out—my muscles and his clenching up, believe it or not, 800 meters from the finish line. 800 meters was like running the whole 26.2 miles all over again. But we fought through it and we pushed and we pounded to get there—and we crossed that evasive — where are you!? –— line.

I suppose it’s like anything, or any “deal” worth finishing—business, civic, political or otherwise—as my colleague always says—it’s the last 5 yards. And it was the last five yards—and it seems there are no exceptions to this rule.

In healthcare, with its upside down uncertainty, the race is longer, I am finding out, even beyond the 5 yards. But many of the current healthcare business “deals” to try to even conceive of a future are at the 5 yard line— and even then that is only a new start.

But the good kind of one.

NOW, today, we have a chance to finish more than a marathon but re-create a brave new world of healthcare, and in our case long-term-care for the in-coming magnificent barrage of the aged and elderly, those who were conceived after the worst of times of WWII, who became the best of times, the best creations of life, to refill the “slots” of so many lost. But again life comes and it goes, and there is death, but there is also rebirth and they deserve what “US” can give them. They deserve our marathon finish, so that we can give them theirs.

So, if we can get the muscles moving right, the knees to cooperate, the insoles inside the shoes to stay put, the jellies, powders, and goopy proteins, combined with the rigor of a strategic plan, tenacity, ferocity, a little bit of blood, and a molecule of faith, we can finish any race, any deal, anything; and I mean anything. Let us finish the race…., so a new one can begin.

Dianne H. Timmering, MBA, MFA, CNA

“Revolutionaries Fight Back – Defending Those Who Can’t Take Care of Themselves” b y Dianne H. Timmering

When a risky strategy is your only ally …. Business, Politics and the spiritual salve that holds it together.

Who will take care of those who can’t take care of themselves?

By Dianne H. Timmering

July 2017

Legislative victory!: Senate Bill 4 – Medical Review Panels! Kentucky gets tort reform! A form of civil practical justice to resolve frivolous unmerited litigation that elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent.

 Excerpt: The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give. We fought for both policy and legislative victories; not because we want “protection” from the accountability of care, but so that we can give it.

These two victories are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider, with the right to a free trial! Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us. Dianne H. Timmering

July 2017 – Starting July 1, 2017, after years of a battle, a plan, a struggle and finally a revolutionary win, both Medical Review Panels and Urban-Rural reclassification took effect in the commonwealth of Kentucky.

The financial impact from unfiltered litigious cruelty is not yet known although as the first line of defense against unscrupulous carpetbaggers, its financial relevancy will reveal itself over time. Regardless of this critical point, perhaps it is the emotional breath that will follow our July first momentum, during our own national freedom of independence, which will be a beacon of hopeful relief for our Signature leaders and other “valiants” who take care of the elders of our times.

Policy victory!: Kentucky gets urban/rural re-classification after 14 years of inactivity –a significant change to meet the critical care needs of so many vulnerable aged Kentuckians and compete for wage competitiveness for the care-giver gifts of care.

The Rural to Urban re-classification, unchanged for more than a decade—a “material injustice” by a former governing body, is simply an issue of updating the system to allow providers to be reimbursed under the appropriate demographic area. For years, un-reimbursable care-ratio dollars have been unclaimed even though we have given the care anyway. Now dedicated long-term care providers can not only better care for our precious “consumer,” but find the beloved care-giver at a competitive wage rate that has turned out, the national shortage of care-givers, to be one our greatest nemeses of care delivery. We were an industry on the “brink of failure” not because of lack of supply and demand, or even operationally but because of litigious extortion and payment unfairness!

But neither of these revolutionary wins came without a cost: they took a fight, a strategy, a boldness and intentional risk, even without the assurance of any kind of win. The SignatureNation, and others, have been involved in both this legislative (MRPs) and policy effort (Urban/Rural) for more than a decade – in incipient development, maturation, and advocacy. As healthcare leaders of today must often do, we CHOSE the path of involvement for it was the only way to enact the change we needed for an industry almost on the “brink of failure” (the American Healthcare Association phraseology).

Both were decidedly long-term strategies because nothing short-term was working in the current legislative and executive branch governmental make-up. To get what we needed to battle industry pressures and unnecessary headwinds, we pivoted in 2014 from a strategy of defense to offense, deciding to get to the root of why nothing was happening, why such antiquated regulatory restrictions (urban/rural re-classification) and tort reform efforts were consistently meeting unmerited opposition.

We made the bold move to be out-in-front, to begin the effort to change the make-up of the governmental landscape. Not because of Democrat or Republican leanings, but because as “Health-o-crats”, we needed to change the foothold of inertia and old political ways which were driving our business to the edge of calamity.

We are fighting now for the same thing on the federal level even with an influx of baby boomers and a “sicker” patient population coming in. Where will our people go?

Fighting seemed right not only because of an expanding marketplace in Kentucky, but because of Signature’s more than decade old mission of hope and vision of “compassion-care” rescuing communities and elders who needed us. My precious mother passed away of acute Parkinson’s disease in a Signature center and I am forever grateful that they took loving care of her, because at home, we simply couldn’t anymore; and moreover, didn’t know how.

A revolutionary strategy must be bold and resolute.

With intention, we supported a dark-horse gubernatorial candidate as well as legislative candidates who supported our issues; we built relationships, educated politicians about our vulnerable patient population, invited them to our facilities, discerned ebbs and flows of underlying opposition, and pivoted at key junctures which significantly increased the odds for a win regardless how risky the strategy had become.

When, for example SB4 (Medical Review Panels) finally hatched out of the House in late February 2017, we, among others, were a part of it until last minutes of the final vote. We co-led the umbrella consortium with the KY Business Chamber, the Kentucky Hospital Assoc., Leading Age and the KAHCF (SNF Assoc.), co-drafting legislation, fighting back against dilution, drawing a line in the sand when we thought the strength of the review panel was dead. Signature leaders and CEOs from across the state battled for a strong bill with courage, fortitude and collaboration, pivoting when needed, holding resolve when demanded.

The Kentucky team was not afraid to get involved in the future of its own destiny!

It was time. We fought for a structure for fair and equitable judgement as the ubiquitous nature of healthcare engagement is based on human ethics, social determinants, expanding sickness of co-morbidities and good human intent. The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give.

The MRP vote, tenuous when it finally happened – 51 – 46 passing via a simple majority—was a zenith moment, a penetration of time, when business, God and politics all worked together for a common good.

What stood out to me of course was the first amendment right of spiritual freedom, when Jason Nemes, one of the bill’s architects and an ally, who in the end wanted a good bill and one that would withstand a constitutional challenge, but give fairness to both sides with expedited “pay-outs” for someone found to be indeed injured or neglected, it was his invocation of something sacred to me, something I co-founded and built with my co-partner, Joe Steier. Jason said that long term care companies are good, do care for a vulnerable population, and are targets. He then singled out Signature Healthcare for our spiritualty pillar – the caregiver beauty of soul, united with the SHC chaplain corps, unique to our industry, focused on whole patient well-being—in volume and reach, in width and depth for a deeper sense of human wellness. That we were a company, “trying to do right.”

Maybe through our model and vision to change the landscape of long-term care forever, our trials of purpose forge a trail for those who follow behind. We are perfecting the model of equal parts – business, God and politics to make it a whole, for healthcare is not driven by these buckets in single domains. Good policy drives productive business strategy with the ethereal iron impact of spirituality, tying the salve of patient possibility and the infrastructure of sustainable business with real hope in healing.

Mistakes do happen. We know this and own it. Our community is frail. Our framework of care for the elderly resident is through the core of Sacred Six engagement, state of the art clinical training combined with spiritual hope in medicine against growing chronic sickness and the highest levels of frailty. We love our residents, and our intent is to take the best care of them. The MRP does two things – it elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent. It allows the facts to come out, for the unemotional truth to be told and considered. We just want the fairness of what a Medical Review Panel could and will bring to the discussion beyond the automatic lever of accusation, but the relevancy of the good intent of care and the full details around the situation. And it doesn’t preclude the plaintiff to due process and the right to a trial.

As the fourth of July coincides with the enactment of this legislation, these two moments are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and ultimate judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider. Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us.

These are RevolutionaryTimes.

UPDATE!: But the fight goes on. The MRP bill is a good one—with measured and fair authority for both sides (the plaintiff and the defendant) with no 7th amendment violation; the right to a free trial is NOT in jeopardy – the designated time periods allow for the facts to be heard—a visceral wall against frivolous litigation. Medical Review Panels not only expedite the evaluation of a patient’s claim and help detect whether it has merit, but can expedite a “pay-out” for someone found to be indeed injured or neglected and does not stop access to a fair trial or the courts. But still the fight goes on…..

Dianne H. Timmering, MBA, MFA, CNA

“Too Fast, Too Soon, But Exactly the Right Plan – A Commentary” by Dianne H. Timmering


The recent strategy from the Governor’s administration, while ideal and brilliant as they reached into the inner-workings of the legislative process to determine procedurally what they could do with a supermajority in both chambers in the first five days, it was simply – too much, too fast, too soon.

But it wasn’t wrong.

And reasons for tort reform, namely Medical Review Panels, not passing this week, because it will during the regular session in February, we strongly believe, had to do with other “powers,” I see that now, rather than totally having to do with complications of understanding its “language” as currently written. First of all, in an unprecedented Saturday move, seven bills passed the House, and as we understand it, the Governor will sign them all or already has, in the 10 day period to follow. It was just a lot.To be clear and fair, the MRP bill submitted in the Senate by Dr. Alvarado, a good friend of ours, was legislation de-shelved from a few years back and enhanced, written in fact so it would easily defy a constitutional challenge. It did not have all the “teeth” we wanted, but that was and will be tweakable in future amendments or regulatory enhancements in the following session.

Regardless of your politics, it was incredulously and profoundly fantastic to find a current Governor unconcerned about a future election and only focused on the fact that for decades key business pro-legislation had been held up by a previous legislature mired in broken-down years of cronyism. The new legislative supermajority is now steeped with the vicissitudes of opportunity going for “broke” in the first five days of the legislative session. Who could blame them!?

Their intent was to pass: Prevailing wage repeal, Right to Work, a form of Tort Reform and a few other “tee-ed” up policies which have been both “alive” and “dead” on the docket for years.

Simply, Kentucky business is mad and the government is responding, finally. Even as you listen to the declining statistics around businesses and doctors leaving the commonwealth or never coming in the first place, because of government restrictions and regulatory laws where businesses would find themselves challenged even before opening their doors; there is hope.

The irony is that Kentucky is a poor state and needs business with jobs, good paying jobs but instead it seems we have relied on the perpetuation of the “welfare” state where coveted tax dollars go to those who presumptively needed the most help (good in social theory, but is it true?).

Many make fun of “trickle-down” economics from the supply-side brigade, but the truth is that the right kind of economic policy does trickle-down into job opportunity, food on the table, purposeful paths and new taxes for local and state governments to truly help those in need, sustain a real Medicaid dollar for our elders, those with mental health needs, helpless children, etc., not just for those who have learned to maneuver around in the current system and take advantage of its antediluvian ways.

(That’s why in the dismantling of Medicaid expansion in its current form, the new waiver will require able bodied folks to work and pay a co-pay, while taking care of the “least among us.”)

The Governor’s, and House and Senate leaderships’ strategy was surreal – pushing through prevailing wage repeal (ensuring wages are more representative of actual wages paid in respective regions) and Right to Work which could unleash international companies across the borders of our “map” with immediacy, especially with the new coggled mindset from the incoming Trump administration for jobs to stay in the confines of the U.S. manufacturing legacy. So timing could prove as fruitful as God’s timing even when it seems that opportunity is lost.

Medical Review panels, for example, did not pass this week, not because of opposition but for the following reasons – one being that the bill had facets to it about which the new members needed to be educated including defining some of its “language.”

But I personally think, in reflection after the last 72 hours, it had much more to do with something else and that is what DID pass on Saturday, was very emotional to many and the House leadership “chose” to slow down MRPs because of the outcry from the labor unions against the Right to Work law, as well as the emotionality around Senate Bill #5 and HB 2 (the Ultrasound Informed Consent Act).

I watched the governor very compassionately meet and converse with a big protest of labor union workers on Saturday morning who had gathered in the Rotunda. Truly, the labor union folks touched my heart. The governor in his wisdom, listened to the leaders, even if he disagreed, but honored their voices. Labor unions will still exist, they just can’t require a worker to join and pay dues to keep their job. We are surrounded by states with Right to work laws – it was time. And now new business will come to our borders.

But an even bigger reason may have had to do with the more controversial SB 5 and HB 2. When I was in Frankfort on Friday, that was the buzz because of its nature – after the 20th week, no abortion can take place and HB2 mandates an ultrasound. Regardless of where one stands on these issue, both sides respected, there was opposition to this bill, but it seems that the five-day strategy benefited this passage.

Objectively speaking, high emotion with a cross-section of bills from both the social and business sectors sidelined MRPs, now a priority left on the agenda for the following month. The governor knows its importance to us!, Leader Hoover, others, the head of the Health and Welfare committee ….

A group of healthcare leaders, the KHA, the KAHCF, met with Chairwoman Addia Wuchner of H&W, a former nurse, in a private meeting on Friday after the chamber adjourned. She was quiet, but asked us to trust her, saying very little beyond that, but giving every indication that MRPs will pass just that there was different work ahead for the immediate moment.

Now, seeing what did pass, and intuiting on the momentum of the week, the reasons for her statement have come now to more of a divine light to me.

Leader Hoover has performed perfectly this week, allowing his “youngest” members to flex a little bit of questioning muscle. They deserve their “day in court” (pardon the pun), but with it so close to the endzone, especially with the outcry of the business community, and what is truly best for the state of healthcare, as well as a long be-speckled past of attempts at passage even with due process and a right to a jury trial in-tact, and the Governor’s mandate for tort reform beginning with the passage of Medical Review panels, it is time for it to pass. It seems to me that politics and business definitely overlap – it involves, strategy, timing, patience and well, politics.

Next steps – Members will privately caucus now, the veterans educating the new, as will we educate, before the House chamber meets again on Feb. 7, and MRPs will find its light of day. It doesn’t mean we won’t have to watch for any opposition by the trial attorneys but we will fight with fortitude and win.

The truth is – tort reform is a not even a healthcare issue (although you could make the case that it is life or death depending on access to the right care and insurance rate affordability); it is so much grander, it is a pro-business indication of a thriving community allowed to innovate, set prices (another reason we need it – bc SNF can’t even set our own prices to overcome litigation unfairness), contain costs and operate within the parameters of set strategic mission and passionate cause.

Let a measure of supply and demand do its job as an organic indicator of good and bad business. Let our quality of care speak for itself, or not. At the end of the day, tort reform is a pro-business magna carta – a form of freedom and definitely an open portal for “life-rafts” to not only survive but cross streams through the opening doors of Kentucky—no longer needing to be pried open, but with a swan-like grace, opening, welcoming, and ready.

By Dianne H. Timmering, MBA, MFA, CNA



“An Inaugural Two Week Reflection” by Dianne H. Timmering

As I reflect back on this past inauguration weekend, I specifically remember four White House transitions. The first when President Herbert Walker Bush won the White House in 1988, the next, a Republican to Democratic transition with President William Jefferson Clinton in 1993, and then in 2001 when President George W. Bush, Jr. won the White House (with the “hanging chad” debate), and again in 2008 when President Barak Obama captured it back.

And now this one, another, although one that I viewed on and off as millions did, from the television set, like it was the sixties again, and the first man was landing on the moon.

At first crack of trying to express my emotional response, it felt very much the same, even though the news media may give the impression that there are first times for certain momentous inaugural moments. The protests were always brisk from the opposing team who had lost, the loss still so raw in the sinews of the mind that the heart had to protest like a purging of pent-up fury. Like before, like now.The 2001 inaugural was especially heated because of, well, “chad”, which ultimately decided who won Florida and therefore the Electoral College, and with it the election—the centuries-old democratic process, the deciding determinant as to who would rule the nation. The protests were especially broad in 2001. I remember swimming upstream inside of such angst—beyond angst’s reach to fix what it thought should have been different—and understanding the unresolved disdain for the bifurcated system, its own checks and balance of power between the urban populace and the rural rest.

This past weekend, I watched as the Trumps and Obamas walked out of the capitol building, the new president now the world leader, the former one, with his lovely wife, walking to Executive One, no longer Marine One. Oddly, I had the same ping that I had had when president and Mrs. Bush got on the helicopter in 1993, when the Clintons were taking power. I was enlightened by this tug, that Republican or Democrat it was still poignant as the change of power is historic in its peaceful swap. Even though I disagreed with many of his policies and overly burdensome regulatory mandates, President Obama was still my president too. For example, I thought one of the best was to give millions of undocumented long-standing immigrants citizenship, a celebration of America’s hard-working melting pot, who would now work freely, when they already have been, meet American workforce growing demands, and pay taxes. It was overturned but I am still hopeful for redemption for them, even for those this weekend who were denied entry due from some of the most war-torn worlds.

40 Syrian refugees alone are slated this year to relocate in Bowling Green, Kentucky. I am hopeful commonsense compassion resumes it course as the new administration’s footing settles, and certain elements of the recent travel ban are quickly vetted for those immigrants very deserving of refuge – but in the short-term, thank God for Canada’s open arms.

I actually worked on the inaugural committee in 1989, co-editor of the inaugural guidebook – the depiction of all the official inaugural events in a concentrated linear order – location, date, time. We worked night and day and my boss actually would have preferred if we had stayed the night in nearby cots so that we didn’t lose any travel time. Any inaugural only has about a two month planning window. I have a memory of Chuck Norris coming by and encouraging us – it was the 80s, and that was big-time!

In 1989, cell phones were brand new – and I had one as big as a shoe box but so proud to have been “important enough” (a woman of the 80s!) to have been able to use the technological advancement of portal communication. I would have never expected how small phones would become, but then who knows really from day to day with the speed of new sound and spirited inventions.

We staffers were behind the scenes then, as they are now, as you saw them running around last past weekend in the background of the television viewing. Not much really has changed even though everything does. The parade—the same, the presidential viewing box, the lunch, the ceremony, the elegant Balls–

In 1989, in my division, we were also responsible for not only who got invited to the parade viewing box, but its infrastructure as well. It was a very cold day that day in January, and there was no heat in the box (a big mistake!), so the kids, and grandkids and eventually the new president and newly appointed not-yet-confirmed cabinet, as well as press secretary Marlin Fitzwater, and Chief of Staff, Andy Card, eventually left the stands for warmer places. I must admit that I secreted away and watched the parade from the 4th floor of the Old Executive Office Building next to the White House and fell asleep, warm and tired curled up in a large window sill, while the parade was trumping down 16th Pennsylvania Avenue.

That night I attended the ball at the Omni Shoreham with a friend, who was also helping with “advance” work for the newly minted George H.W. Bush. I remember the dark velvety 80s poofy, shoulder-pad extravaganza I wore and my friend running to get me from admiring the ballroom pageantry so we could lead the president to the stage, the dance, and again, out the door. The president had I think 11 or 12 other balls to attend so timing was key.

A funny moment I do remember is when we were leaving seeing the famous Ricky Shroeder, who was the little kid in The Champ and the 80s show, Silver Spoons, very famous at the time, who had found champagne to his liking, getting in a limousine and people running up to him because there was an actor in Hollywood who was actually a Republican. I say that tongue and cheek of course, and yet with full accuracy of my memory of such a time.

There are stories I promise you from this past inaugural, similar to the ones I am sharing with you – richer, funnier, more or less poignant, sorrowful, angst-filled, hopeful, angry, glad or resigned to the fact of the new President. Wherever you stand, in this menagerie of emotion, rest assured that while it all seems new or unexpected, fiery or surreal, a blessing or the apocalypse, the truth is that inaugurals and their “moments” ring with more similarities than differences, even when debating crowd size.

The question now is only—will the new president actually lead and hear and perform around his “messaging” in concert with the “forgotten man and woman.” An editorial comment – I do like his unabashed approach of transparency which in my 30 year political tenure has not existed with such potency, good or bad. People do want the truth and he brought an element of this new thematic approach, the irony of it, in boldness to Washington. So now let’s see if “the truth” of something can make better public policy.

A new president comes out firing. And mistakes will be made. Let words and actions evolve with the forces of spiritual, judicial and legislative oversight… Take a deep breath. Wait with every controversy of a promised election. Like his approach or not, let’s see if some of his raw blanket statements blend well for many in a nation of need. Only time will have those secrets, daily revealed now that we are beyond Day one and 100 days ensues.

By Dianne H. Timmering

Stay tuned for more – next blog “Trumped! – these are revolutionary times, where will HC stand or fall?”

Dianne H. Timmering, MBA, MFA, CNA

“The Truth About Tort Reform” – #WeAreKY by Dianne H. Timmering

The truth is – tort reform is a not even a healthcare issue (although you could make the case that it is life or death depending on access to the right care and insurance rate affordability); it is so much grander, it is a pro-business indication of a thriving community allowed to innovate, set prices (another reason we need it – bc SNF can’t even set our own prices to overcome litigation unfairness), contain costs and operate within the parameters of set strategic mission and passionate cause.

Let a measure of supply and demand do its job as an organic indicator of good and bad business. Let our quality of care speak for itself, or not. At the end of the day, tort reform is a pro-business magna carta – a form of freedom and definitely an open portal for “life-rafts” to not only survive but cross streams through the opening doors of Kentucky—no longer needing to be pried open, but with a swan-like grace, opening, welcoming, and ready.


Dianne H. Timmering, MBA, MFA, CNA

“Poetry Memoir of a Warm Day on December 26, 2016 in Louisville KY” By Dianne H. Timmering

2:20 p.m. I walk in shorts.

The sky is busy. The clouds race across using the stable blue for a sweeping canvas. So much to write. It roars and the wind carries it sounds. I am listening but I can’t make it out. The pines blow and wave and add to the shouts of the hemisphere. Listen out loud. A warning? Or a beckoning that life is ready to be lived in. 

A day stuck in time. The trees claw at the sky. Give me the fruit of my arms so I can live again. 

No portals today but smashed heavens one a top of the other knowing it is close and a good place to be. For those who have gone before us. To emulate its same rules and passions on this planet.  Thy will be done. On this earth as in the heavens. 

The leaves dance on her asphalt path-guided floor. Skip. Every sound is a note, every note a word. Decoding the earth. I value her.

The sounds are coming from inside the portal – waste no time, He says. El Shaddai – He is the boss

This particular cloud portal moves. Like a giant hand – the earth like its own pod or time-castle. A lunar capsule to a new land. Where they come from it or we pass through. I am not sure.

 With a rise (qum!) of suddenness, the pressure was gone and I could breathe. Gone, no more compression at all, and with immediacy. Only healed. Maybe it was physically and emotionally calming or both, but regardless the pain was no more and I could leap again.

To sustain my “miracle”, I discerned to continue to breathe deeply, meditate (working on this as a practice), be present to the condition, and take the supplement of turmeric – a miracle spice on so many different levels including brain health, mind clarity and a functioning heart…qum!

If more people understood they could pray for themselves, would we see more healings, more understanding of where to seek help, especially with the “right” words spoken over the need?

Aramaic words give me the control of peace. qum! Rise!

Salu witiheb ikon b’au wtiSkxun Mt7:7-11 Luke 11:9

Ask and it will be given to you, seek and you will find Mt:7-11 Luke 11:9


Dianne H. Timmering, MBA, MFA, CNA

“Heart Palpitations: Praying for Myself In Original Words of God – Aramaic” by Dianne H. Timmering

I was having heart palpitations…

Does true healing or emotional freedom require the right words with intentional presence? On this occasion I said them in Aramaic – an original language of God and the angels…

Itlabbabi brati amar-na qum!

Take heart, my daughter, I am saying to you, rise!

The power of the Ask and the right words of prayer.

Let me explain – Most recently, after finishing the New York marathon last month, I have had some of my more irregular heartbeats, an occurrence that I have had for years even with an assuredly healthy heart. I tend to hold my breath when I am thinking about something, like I am on a plateau of a mesa in an Arizona spring, in a different realm of air, where I don’t think I need any, like I am okay in any depth of the ocean. But then suddenly I find myself without, and I realize I’m not breathing, but gasping, and an angry heart erupts.

Sometimes it’s intercession for someone, or flat out stress – The day of the marathon, for example, just before the race, I had a bad one. Now the stress of running a marathon, training, preparation, worry that you are ready, enough “goos” in my running belt?, have I had enough protein to endure, fear you won’t make it …, is an easy indicator that that was the cause. But the last one I had had while previously training was so beat against my chest that I had to stop running and almost crawl back to my house.

I know how to calm a heart. Breathing through it. Big gulps of what is given freely. Coaching myself.

A couple of weeks after the race, I was in hot yoga and had to leave the studio because of such an event. I suppose stress is a direct impact of influence on just how fast it flutters and how long it is, but then one day this past week, it felt as though someone was stomping across the sternum climbing up a hill, spikes in the snow.

In a study of miracles we are researching, I decided to employ one of the miracle patterns we have de-coded – the power of the Ask, the right words of prayer, how said, what prayer language, when, even the essence of the healing touch, trying to hear God on what to do about a hammering heart …

Zeli baSlama wahwaiti xalima

Go in peace, and be healed… He said.

I said those words over myself – a tap to my sternum, an Ask for healing, an affirmation in Aramaic that I was…. Itlabbabi brati amar-na qum!

by Dianne H. Timmering, MBA, MFA, CNA