In Conversation with Brad Smith, CEO of Aspire
By Annie Lamont, Managing Partner, Oak HC/FT
What is Aspire?
Aspire is the nation’s largest home-based provider of care to patients facing a serious and life-limiting illness. We employ interdisciplinary teams of palliative care physicians, nurse practitioners, nurses, social workers, and chaplains who use our data-driven and technology-enabled workflows to provide 24/7 care to our patients and their families. Today, we are working with patients in 23 states across the country.
Why palliative care? How did you first recognize a need or opportunity to focus on that area of healthcare?
I was introduced to palliative care by my brother, who was studying to be a physician at Harvard. He had decided to take a year off to work with Atul Guwande and Susan Block, who was the leading palliative care physician at Dana Farber. We were home for Christmas and my brother was sharing articles about his work. I became fascinated by the research, which focused on the health implications of palliative care.
The studies demonstrated consistently high patient and family satisfaction; rates of hospitalization coming down by about 50% in the last year of life; and costs coming down by 20 to 25% for patients. I thought, “Wow, this works so well, why is it not happening everywhere?”
About six months later, my grandmother became sick and ended up going into the hospital unfortunately without the benefits of ever receiving hospice care. It was a very challenging and personal experience, and I decided there had to be a better way.
How are you leveraging data analytics and IT within your business?
Data is an important part of our operations and we use it in two main ways. First, we use it to identify patients. We work with our partner health plans to collect information from claims and clinical records, and then we project how likely patients are to pass away and have high spend in the coming months.
The second way we use data is after patients are enrolled on Aspire’s service, where we use data to help support our clinicians’ decision-making and ensuring patients get the right resources they need at the right times.
In palliative care, no two patients are the same, so there’s never a definitive right answer. For individual patients, it is more about presenting them with a set of options that they might want to consider.
In serving patients across the United States, what are some notable differences you’ve seen in the way you manage the business or work with stakeholders?
When we started the company, we suspected there would be a good chance that outcomes would be different because we serve patients in places that are so diverse.
For example, we serve patients in the Rio Grande Valley, where 90% of our patients prefer to speak Spanish. We are also in the South Side of Chicago, where many of our patients and their families experience adverse socioeconomic conditions.
But what we have been surprised to learn is, across all those different locations, the outcomes are all remarkably similar — both in terms of patient satisfaction and in terms of the reduction in hospitalizations and transition rates to hospice. I think what that speaks to is people, at the end of the day and no matter their background or socioeconomic status, really want the same thing, which is to be with family members they care about as they near those difficult times.
One big difference is how we engage with those different patients, however. Reaching out to patients in the Rio Grande Valley is very different than reaching out to patients in downtown Chicago.
You previously worked in state government. What lessons or experiences have been most valuable as an entrepreneur and CEO?
When I started the company, I had no idea if anything I had done before would be relevant. It turns out it was very helpful. For one thing, when I led nonprofits and worked in government, I had to bring together people with different perspectives to tackle a common problem. It turns out this is actually very similar to the work we are doing at Aspire.
For example, you have patients and families that really care about the kind of care they are getting. You have health plans that care a lot about cost and quality factors they are held accountable for. And you have investors who are interested in both the underlying mission as well as the financial aspects of the company. In many ways, this is like running a campaign. You need to understand divergent stakeholders and where those different groups are coming from. And, then you need to find the common ground and align all those people. This is far more like politics and leading non-profits than I ever anticipated.
Aspire is featured in Dr. Ezekiel Emanuel’s recent book, “Prescription for the Future”. How did that come about? What’s been the response?
Zeke had heard about us from various people and had reached out to us, so we arranged an opportunity for him to shadow one of our clinicians in Philadelphia for a day. Based on that experience, what he saw was a company that was really making a difference in the lives of patients and families. At the end of the day, what we do is all about serving patients and families, and it is important that stakeholders know about what we do so that we can do more of it. His book has been very helpful in raising the profile of a healthcare issue we care so much about, and highlighting the work we do.
If I weren’t a CEO I would be… running a nonprofit.
What’s on your desk right now? Nothing. I keep my desk completely clean; it makes it easier for me to concentrate that way.
What is your favorite source for news? Politico. I am fascinated by everything that is happening in DC right now.
What’s a great piece of professional advice you’ve received? The best advice I received was from Senator Bill Frist, who co-founded Aspire with me. About six years ago, I brought him two ideas to consider: one in education and one in healthcare. He knew a lot about both markets and strongly suggested we pursue the palliative care opportunity given the vast amount of patient need. Without his guidance, I may never have launched Aspire.
What one piece of advice would you offer to an entrepreneur? Focus on the biggest problems. When you’re starting out and leading a company, it’s often tempting to do the things that are easiest first. But all too often, there are only one or two things you must really figure out to make the business successful. Focusing your time on the one or two most important things is critical.