Last Visit First

Tom Maxwell
  • 5.0 (2)
  • BUSINESS
  • UPDATED BIWEEKLY

Last Visit First explores the choices, challenges, and stories that define care at home, from the first touch to the last visit. Hosted by Tom Maxwell, Co-Founder & Chairman of Maxwell TEC, the podcast brings candid conversations with leaders, clinicians, and change makers shaping the future of home health, hospice, post-acute, and palliative care. From bedside insights to boardroom decisions, Last Visit First unpacks what truly impacts outcomes, trust, and how care is remembered. Subscribe for new episodes every month. If you lead, build, or believe in better care, this podcast is for you.

  1. 50% Documentation Time Savings? The AI Revolution Hitting Post-Acute Care

    15H AGO

    50% Documentation Time Savings? The AI Revolution Hitting Post-Acute Care

    This episode is a deep dive into the biggest technical shift in the history of home-based care. Tom Maxwell sits down with Dr. Alex Milani, the MD/MBA power-player behind Steno Health, to break down their massive new integration with HomeCare HomeBase. Documentation is the #1 reason for clinician burnout. Between the rigidity of OASIS and the hours spent "pajama documenting" at night, the industry is losing its best people. Dr. Milani explains how ambient "clinical intelligence" is changing the game—acting as a co-pilot that listens in the background, pre-populates complex forms, and gives nurses up to 50% of their time back. Key discussion points: The HCHB Integration: How Steno Health is being deployed at scale to 195,000 clinicians.Ending "Pajama Documentation": Moving from 2005-era "click-click-click" charting to real-time clinical capture.The "Angel on the Shoulder": How AI serves as a safety net for high-risk cases like CHF and fall prevention.Patient Literacy: Breaking communication barriers with support for 80+ languages.The Future of the Role: Why AI won't replace clinicians, but will replace those who refuse to use it.Chapters: 00:00 Introduction to Steno Health and AI in Home Care01:57 Reducing Documentation Burden with AI04:32 Enhancing Clinical Documentation Efficiency07:45 The Future of Clinical Intelligence13:26 Alex Milani's Journey: From Medicine to Entrepreneurship15:35 Steno Health's Unique Position in the Market19:03 Addressing Language Barriers in Home Health20:59 Popular Features and Overcoming Skepticism24:45 Combating Burnout in Healthcare Professionals26:08 Future Roadmap and Innovations26:53 The Role of AI in Healthcare Documentation28:19 AI's Impact on Radiology and Job Dynamics31:28 Building a High-Performance Team33:47 Navigating the Rapid Evolution of AI Tools38:12 The Importance of Effective Onboarding in Home Health41:57 Service Codes and Flexibility in Home Health Documentation45:15 Enhancing Patient Care Through Better Communication49:25 Future Prospects and Industry ChangesSpecial thank you to our sponsors: Premier Sponsor: Trella Health: https://trellahealth.com/ Premier Sponsor: Homecare Homebase: https://hchb.com/Maxwell TEC: https://maxwelltec.com/ StenoHealth: https://www.stenohealth.com/IntellaTriage: https://intellatriage.com/Check out Last Visit First on other platforms: Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182 Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxsYouTube: https://www.youtube.com/@lastvisitfirstpodcastWebsite: https://www.lastvisitfirst.com LinkedIn: https://linkedin.com/company/last-visit-first DISCLAIMER The investment or stock-related information discussed or referenced in this podcast is provided for informational and educational purposes only and should not be considered financial, investment, or trading advice. The views and opinions expressed by participants are their own and may not reflect the views of any affiliated organizations. Content discussed may not be suitable for all investors. Each participant may or may not hold positions in securities referenced during the discussion. Individuals and organizations associated with the participants may serve different clients with varying objectives, risk tolerances, investment horizons, and strategies. As a result, such entities may maintain positions or viewpoints regarding specific securities, markets, or sectors that differ from those expressed in the discussion. Viewers and listeners should conduct their own research and consult appropriate financial professionals before making any investment decisions. #lastvisitfirst #StenoHealth #HomeCareHomeBase #healthcareai #clinicaldocumentation #hospicecare #homehealthcare #nursing #healthtechnologyinnovator #healthtech #innovation #podcast #healthcarepodcast

    52 min
  2. The Logistics of a Calling and Rich Johnson’s Journey to Healthcare CEO

    MAR 13

    The Logistics of a Calling and Rich Johnson’s Journey to Healthcare CEO

    Rich Johnson’s path to becoming a healthcare CEO began in a juvenile courtroom where a judge gave him two choices: jail or the service. Choosing the Air Force didn't just change his life; it gave him the logistical blueprint to manage a $90 million appropriation by age 18 and eventually build ViaQuest, Inc. into an integrated healthcare powerhouse. Today, Rich oversees 4,500 employees providing a "Circle of Care" that spans hospice, behavioral health, and services for the IDD community. This discussion pulls back the curtain on how military discipline translates to healthcare culture and why the integration of mental health is the missing piece in the modern hospice puzzle. We also dive into the technical "headwinds" facing the industry, ranging from the regulatory shift of Section 504 to the potential for AI agents to solve the hiring crisis for home health and hospice agencies. In this episode, we cover: The Military Mindset — Why accountability and shared values are the only way to lead 4,500 "heroes" in the home.The Integrated Model — How ViaQuest leverages behavioral health to support grieving families and terminal IDD patients.The AI Revolution — Real-world applications for Perplexity Computer and autonomous agents in nurse recruiting and clinical workflows.The Pediatric Paradox — Examining the data that proves concurrent curative treatment actually improves quality of life while lowering costs.Chapters: 00:00 Introduction of Rich Johnson and the ViaQuest story02:02 From the courtroom to the cockpit — How the Air Force saved Rich’s life 04:53 Transitioning from military finance to healthcare consulting06:09 The origin of ViaQuest and stepping into the CEO role at age 3008:36 Creating a Circle of Care — Integrating IDD and Behavioral Health11:21 The decision to pivot away from Home Health to focus on Hospice13:27 Navigating the regulatory landscape and provider "flooding" in Ohio15:32 The calling of healthcare — Recognizing the heroes in the IDD and Hospice space18:48 Leadership lessons — Using military discipline to manage 4,500 employees21:50 Boot camp stories — Learning knots and discovering "I’m short"24:51 The unique challenges of recruiting for the IDD population27:04 Serving the same patients for 25 years — "Three self-made men"28:33 Rebranding the hospice conversation from "dying" to "living"30:19 Why ViaQuest is adopting Bereavement for Life32:05 AI in healthcare — Ambient listening and ending "pajama documentation"34:56 Using Perplexity Computer to build autonomous recruiting agents39:49 Creating automated daily intelligence reports with AI41:55 The Section 504 deadline — Preparing for new ADA website compliance46:50 Industry Headwinds — Facing the "Senior Tsunami" and staffing shortages50:16 The role of remote monitoring and home-based surgery recovery53:08 Legislative gaps in ESRD and Pediatric Concurrent Care56:45 Identifying "Bad Actors" and the future of government audits1:00:00 Inducting a CEO into the Ohio Veterans Hall of Fame1:03:25 Changing lives — Rich’s proudest career accomplishmentsGet ahold of Rich and ViaQuest: ViaQuest, Inc. website: https://viaquestinc.com/ViaQuest, Inc. LinkedIn: https://www.linkedin.com/company/viaquest/Rich's email: Rich.Johnson@ViaQuestInc.comRich's LinkedIn: https://www.linkedin.com/in/richdjohnsonSpecial thank you to our sponsors: Premier Sponsor: Trella Health: https://trellahealth.com/ Premier Sponsor: Homecare Homebase: https://hchb.com/Maxwell TEC: https://maxwelltec.com/ StenoHealth: https://www.stenohealth.com/IntellaTriage: https://intellatriage.com/Check out Last Visit First on other platforms: Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182 Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxsYouTube: https://www.youtube.com/@lastvisitfirstpodcastWebsite: https://www.lastvisitfirst.com LinkedIn: https://linkedin.com/company/last-visit-first

    1h 7m
  3. How to Build a Serious Illness Ecosystem: Lessons from AuthoraCare CEO Kristen Yntema

    MAR 3

    How to Build a Serious Illness Ecosystem: Lessons from AuthoraCare CEO Kristen Yntema

    How do you turn two legacy hospice providers into a singular, "serious illness powerhouse"?Kristen Yntema didn’t start her career in a boardroom; she started as a 15-year-old unit secretary, cross-training as a nursing assistant and falling in love with the patient connection. Today, as the President and CEO of AuthoraCare Collective, she is redefining the architecture of end-of-life care.This conversation pulls back the curtain on the 2019 merger that created AuthoraCare and the radical "Culture First" strategy that made it successful. Kristen and Tom Maxwell dive into why traditional hospice is no longer enough and how building a "Serious Illness Ecosystem" allows patients to be the true authors of their own stories long before their final six months. Inside the Episode: The "Pajama Charting" Crisis: How AI and ambient listening are being vetted to save clinicians from documentation burnout.Redefining Success: Why Kristen’s team ignores traditional metrics in favor of "Days in the Community."The Kids Path Mission: A rare look at the specialized world of pediatric hospice and the "Aarvy Aardvark" connection.The "Coffee with Kristen" Rule: Why the best strategic insights come from a $15 Panera treat and a small group of front-line staff.The Future of Palliative Care: Navigating the shift from "Routine Home Care" to high-needs ACO models. Chapters: 00:00 — The "Last Visit First" Origin Story02:35 — Starting at 15: From Unit Secretary to CEO06:10 — The AuthoraCare Merger: Moving Beyond Hospice09:30 — Why Culture Trumps Strategy in Healthcare13:00 — Defining Excellence: The "2:00 AM Confidence Test"22:30 — Building an "Ecosystem" Around the Patient24:38 — HCHB Premier Sponsor Ad30:15 — The "Pajama Charting" Crisis & AI Solutions32:20 — Kids Path: The Mission of Pediatric Hospice38:10 — Rethinking Metrics: "Days in the Community"40:02 – Maxwell TEC Sponsored Ad50:10 — Policy, Fraud, and the Future of the Industry55:00 — Redefining Serious Illness CareConnect with Kristen and AuthoraCare: Kristen's LinkedIn: https://www.linkedin.com/in/kristen-wither-yntema-bb7ab3b7AuthoraCare LinkedIn: https://www.linkedin.com/company/authoracare/AuthoraCare website: https://www.authoracare.org/ Special thank you to our sponsors: Premier Sponsor: Trella HealthPremier Sponsor: Homecare HomebaseMaxwell TECStenoHealthIntellaTriage Check out Last Visit First on other platforms: Apple PodcastsSpotifyYouTubeWebsiteLinkedIn

    57 min
  4. Plugging the Leak: Mastering After-Hours Care in a Value-Based World

    FEB 21

    Plugging the Leak: Mastering After-Hours Care in a Value-Based World

    When the high-stakes discipline of a Navy submarine officer meets the fragmentation of hospice and home health, the result is a radical "Nurse-First" philosophy that challenges every industry norm. Daniel Reese, CEO of IntellaTriage, joins Tom Maxwell to expose why the current healthcare system is failing clinicians and how to survive the coming workforce redesign. Inside the Episode: The "Submarine Effect" on Leadership: Why servant leadership isn't just a buzzword—it’s a tactical requirement for mission-driven organizations. Solving the After-Hours Black Hole: How immediate access to a US-based nurse (not an answering service) transforms patient outcomes and stabilizes the home environment. AI & Clinical Intelligence: A skeptical look at the "AI hype train" and why technology must be used to automate the "maintenance" of documentation so clinicians can focus on "hugging the patient." Personal stakes in ESRD: A raw discussion on why the current Medicare hospice benefit is fundamentally broken for end-stage renal disease patients and how we can advocate for change.Chapters: 0:09 - Introduction of Daniel Reese, CEO of IntellaTriage0:32 - Discussion about Daniel's background as a Navy submarine officer0:40 - Daniel's journey through the Naval Academy and active duty3:31 - Leadership lessons learned from military service5:14 - Daniel's transition from the Navy to business school and family business7:09 - The path to becoming CEO of IntellaTriage9:23 - Explanation of IntellaTriage's mission and services10:53 - Discussion on the importance of telephone nursing and after-hours care13:14 - Issues with interoperability and after-hours care16:56 - Staffing shortages and recruitment strategies20:00 - Homecare Homebase premier sponsored ad20:48 - Predictions for the next five years in the industry23:34 - The impact of Medicare Advantage and value-based care28:59 - Discussion on the role of AI in healthcare32:35 - Potential benefits and risks of AI implementation40:27 - Maxwell TEC sponsored ad45:29 - Daniel's personal interests and family life55:48 - His vision for the future of IntellaTriage and personal legacyConnect with Daniel and IntellaTriage: Daniel's LinkedIn: https://www.linkedin.com/in/dreesembaDaniel's email: dreese@intellatriage.comIntellaTriage LinkedIn: https://www.linkedin.com/company/intellatriage/IntellaTriage website: https://intellatriage.com/Special thank you to our sponsors: Premier Sponsor: Trella HealthPremier Sponsor: Homecare HomebaseMaxwell TECStenoHealthIntellaTriageCheck out Last Visit First on other platforms: Apple Podcasts⁠⁠Spotify⁠⁠YouTube⁠⁠Website⁠⁠LinkedInAbout Last Visit First: In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start. Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care.Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

    58 min
  5. Unleashing Creative Genius in Home Health & Hospice with Dr. Heather Hodges

    FEB 11

    Unleashing Creative Genius in Home Health & Hospice with Dr. Heather Hodges

    Is leadership in home health a calling or just a job? In this episode of Last Visit First, Tom Maxwell sits down with Dr. Heather Hodges, organizational psychologist and CEO of Hodges Group International, to discuss the "Heart Work" required to lead frontline teams in the care at home industry. Dr. Heather Hodges shares her journey from a creative professional to a leadership strategist within the home care industry. She introduces her groundbreaking framework, The 12 Types of Creative Genius, and explains why innovation isn't just for scientists—it’s the engine that allows clinicians to solve complex problems at the bedside. Key Takeaways: The 11-Second Rule: Why listening just a few seconds longer leads to better patient outcomes.The Hero’s Journey of Leadership: Moving from a "weak" hero to a "strong" guide (the Yoda vs. Luke Skywalker analogy).Culture as Retention: Why people don't leave organizations; they leave supervisors—and how to build a culture people won't want to leave.Creative Genius: Identifying whether your leadership style is driven by the Head (Cognitive), Heart (Relational), or Hands (Functional).Chapters: 00:00 – Meet Dr. Heather Hodges: Leadership Strategist02:03 – The Career Shift: From Creative to Home Health Executive05:47 – Personality Science: Using the Enneagram to Lead Diverse Teams08:38 – The 12 Types of Creative Genius (Head, Heart, and Hands)14:52 – Cultivating Culture: Tapping into Frontline Innovation20:08 – Heart Work: Bridging the Gap Between Nursing and Management28:05 – Communication Secrets: The 11-Second Rule for Clinicians32:36 – The Future of Care: Balancing AI Tech with Human Empathy45:57 – Self-Reflection & The Hero’s Journey of Leadership50:31 – How to Connect with Dr. Hodges & Final ThoughtsConnect with Dr. Heather Hodges: WebsiteBook: Heart WorkBook: The Creative Clinical LeaderAudio Book: Heart WorkPodcast: I’m In!Special thank you to our sponsors: Premier Sponsor: Trella HealthPremier Sponsor: Homecare HomebaseMaxwell TECStenoHealthIntellaTriageCheck out Last Visit First on other platforms: Apple PodcastsSpotifyYouTubeWebsiteLinkedInAbout Last Visit First: In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory. 'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start. Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care. Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

    53 min
  6. Charles McDonough (Delaware Hospice) | Ripping Down Barriers in Post-Acute Care

    FEB 2 ·  BONUS

    Charles McDonough (Delaware Hospice) | Ripping Down Barriers in Post-Acute Care

    Live from Day 2 of the Last Visit First podcast at the 2026 Home Care 100 Leadership Conference in Scottsdale, Charles McDonough, President and CEO of Delaware Hospice, joins the podcast to discuss the evolving definition of "community care." As the leader of the nation's first hospice in the first state, Charles isn't just leaning on legacy—he’s leaning into disruption. In this briefing, he explores how Delaware Hospice is leveraging the GUIDE model to redefine dementia care and why "upskilling" internally is the only sustainable answer to the national nursing crisis. Charles and Tom also dive into a provocative discussion on state licensure laws: are they protecting quality, or are they artificially suppressing the workforce? Chapters: 02:15 – The Dementia Mandate: Why specialized cognitive care is the next industry frontier.04:45 – Scaling Through Partnership: Expanding into Pennsylvania and Maryland via non-profit collaboration.06:30 – The Licensure Bottleneck: Is it time for a universal clinical license?08:50 – Virtual-First Care: Connecting rural patients to elite clinical resources.Connect with Charles and Delaware Hospice: Website: https://www.DelawareHospice.orgLinkedIn: https://www.linkedin.com/company/delaware-hospice-inc../Charles's LinkedIn: https://www.linkedin.com/in/charlesmcdonough Special thanks to our sponsors: Premier Sponsor:⁠⁠⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠Lincoln Healthcare Leadership⁠ #Hospice #DelawareHospice #HC100 #NonProfitHospice #DementiaCare #GUIDEModel #NursingShortage #HealthcareInnovation #LastVisitFirst #Podcast #HealthcarePodcast

    10 min
  7. Jason Gerard (Agape Care Group) | The M&A Playbook for Regional Scale

    FEB 2 ·  BONUS

    Jason Gerard (Agape Care Group) | The M&A Playbook for Regional Scale

    Live from the Woodpecker Room at HC100, Tom Maxwell welcomes Jason Gerard, CFO of Agape Care Group. Jason shares the remarkable growth story of Agape Care, which expanded from a single-state provider in South Carolina to serving over 6,500 patients across 10 states in just a few years. He breaks down the strategic decision to remain "hospice-only," the importance of their pediatric program ("Hands of Hope"), and the unique integration playbook that ensures one plus one actually equals two in an acquisition. Plus, a shoutout to integration star Carrie Vanden Magdenberg and her journey from Maxwell TEC consultant to Agape Care leader. Chapters: 01:10 – The Growth Engine: Scaling from 700 to 6,500+ patients since 2018.01:55 – Partnership with Linden: Why Agape Care Group recapped with Linden Capital Partners.02:25 – Tight Geography: Why staying close to the "flagpole" in the Southeast is a strategic win.03:00 – Hands of Hope: Serving the unique needs of nearly 200 pediatric hospice patients.04:35 – The Niche Advantage: Why Agape chose to double down on hospice rather than diversify into home health.05:40 – The Integration Secret: How a customized integration plan keeps employees engaged and assets protected.Connect with Agape Care Group and Jason: Website: https://agapecaregroup.com/LinkedIn: https://www.linkedin.com/company/agapecaregroup/Jason's LinkedIn: linkedin.com/in/jason-gerard-tx Special thanks to our sponsors: Premier Sponsor:⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠Lincoln Healthcare Leadership⁠ #Hospice #AgapeCare #HC100 #HomeCare100 #HealthcareM&A #HealthcareCFO #LastVisitFirst #PediatricHospice #HandsOfHope #HospiceGrowth

    7 min
  8. Joe Randesi (Element5) | Building the Next Workforce for Post-Acute

    FEB 2 ·  BONUS

    Joe Randesi (Element5) | Building the Next Workforce for Post-Acute

    Live from the Woodpecker Room for Day 2 of the Last Visit First podcast at Home Care 100, Tom Maxwell welcomes a true post-acute tech pioneer: Joe Randesi, CEO and Co-Founder of Element5. Joe explains why the world is moving beyond simple SaaS toward Agentic AI—digital workers that autonomously navigate EHRs, verify eligibility, and manage authorizations. He breaks down the "swivel chair" problem and how Element5’s vertical-specific agents are designed to eliminate the "paper cuts" of back-office operations. Joe also shares his perspective on why the industry is finally "leveling up" through collective innovation. Chapters: 01:10 – The DeVero Journey: How co-founding an EHR led to the automation revolution.01:45 – What is an "Agent"? Defining the digital worker that automates the financial journey.02:45 – No Smoke Breaks, No COVID: Why agents are an OpEx solution for back-office bottlenecks.03:30 – Building Blocks: How Element5’s vertical platform allows for rapid, at-scale innovation.05:10 – "Fail Fast": Joe’s advice for agencies looking to adopt disruptive technology.05:50 – The Value of Face-to-Face: Why Home Care 100 remains the preeminent "deal-making" venue.Connect with Element5 and Joe: Website: https://www.E5.aiLinkedIn: https://www.https://www.linkedin.com/company/e5ai/Joe's LinkedIn: https://www.linkedin.com/in/joerandesi Special thanks to our sponsors: Premier Sponsor:⁠⁠⁠⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠⁠⁠Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Lincoln Healthcare Leadership⁠ #HomeHealth #Hospice #Element5 #HC100 #AgenticAI #WorkflowAutomation #PostAcuteCare #RCM #LastVisitFirst #JoeRandesi

    6 min
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out of 5
2 Ratings

About

Last Visit First explores the choices, challenges, and stories that define care at home, from the first touch to the last visit. Hosted by Tom Maxwell, Co-Founder & Chairman of Maxwell TEC, the podcast brings candid conversations with leaders, clinicians, and change makers shaping the future of home health, hospice, post-acute, and palliative care. From bedside insights to boardroom decisions, Last Visit First unpacks what truly impacts outcomes, trust, and how care is remembered. Subscribe for new episodes every month. If you lead, build, or believe in better care, this podcast is for you.

Information

  • Creator
    Tom Maxwell
  • Years Active
    2025 - 2026
  • Episodes
    33
  • Rating
    Explicit
  • Copyright
    © Tom Maxwell
  • Show Website
    Last Visit First

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