Adam Francis of Host Healthcare: 5 Things We Must Do To Improve the US Healthcare System

No matter what your opinion is on the US healthcare system, we can all agree that now more than ever our healthcare workers are our heroes in scrubs. It’s been really inspiring — whether you are in the healthcare industry or not — to see how businesses and everyday people have recognized our healthcare professionals on the front lines making the ultimate sacrifice of their own health to help our community stay healthy.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Adam Francis.

Adam Francis is the President and CEO of Host Healthcare. While pursuing a bachelor’s degree in philosophy at the University of Notre Dame, Adam discovered his true passion: business and finance. Adam went on to get his Master of Arts in philosophy at Boston College with plans to go into academia, but realized that he wanted to have a bigger impact on the world. His entrepreneurial spirit led him to developing an interest in the healthcare staffing industry and ultimately start his own agency, Host Healthcare, in 2012. Host Healthcare is now ranked as the #1 travel healthcare company in the U.S.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Prior to starting Host Healthcare, I was pursuing a graduate degree in philosophy. As an undergraduate, I focused most of my coursework on the history of philosophy and never considered going into business. I was passionate about my studies and at one point was considering going into academia.

However, I realized that I was not as passionate about my studies as my peers. I did not see myself writing essays and books that are read only by a handful of individuals in academia. I wanted to do something outside of my comfort zone, and something that would enable me to make a bigger impact on the world.

I realized that something was missing from my otherwise well-rounded education. When I was in college from 2007–2011, our country faced the most serious recession since the Great Depression, and I wanted to figure out why that happened.

I was lacking in real world knowledge and experience, so I started to study economics and finance in my spare time. I became intensely interested in these subjects, and the idea crossed my mind that maybe I could start my own business. Based on my family’s background in the 80s and 90s in healthcare staffing, I started studying the industry and saw the huge potential in the years ahead. Considering that most startups fail, and failure was not an option for me, I decided to start a travel healthcare staffing business in 2012 because I thought that it had the best chance of success based on my knowledge and experience.

At first, it was not so much about the specific industry I was in but building a company and a team focused on strong values and a meaningful mission. Whether I was in healthcare staffing or any other industry, the journey and motivations behind it seemed more important to me than the industry itself. As the initial startup years passed, I became passionate not only about growing a business, but about the healthcare industry as well. I still have a long career ahead of me, but I love what I am doing and see myself staying in this industry for the foreseeable future.

Can you share the most interesting story that happened to you since you began leading your company?

In 2015, we were growing rapidly, and our entire Accounting function was under one individual. He ended up leaving the company unexpectedly and left us with a plethora of issues that he left unresolved: there were many issues that took months to clean up such state taxes that hadn’t been paid on time (I found out that I had a tax lien in the state of Wyoming against me that dropped my credit score by 150 points), expired business licenses, and payroll and billing issues, to name a few. After discovering these issues, it seemed that he left because he was unable to get to all his work and the situation kept getting worse, and perhaps due to a communication breakdown between us, he did not feel comfortable being honest with me about the situation and his need for extra support. He knew the walls were caving in and I would soon discover the magnitude of the mishaps. He chose to quit with little notice.

I was upset about this situation, and as CEO, the burden fell on me to clean things up. Although this was one of the most concerning and stressful situations that happened in our very early years, I learned some important lessons.

First, that somewhere along the line, there was a breakdown of trust between me and him, and that as CEO I am always responsible for what is happening at the company.

Second, that trust ought to be the cornerstone of any strong company culture, and this incident was the initial catalyst that led me to reimagine our company culture going forward. After the dust settled and the new Accounting Team was in place, I turned my focus to cultivating a company culture based on trust, authenticity, vulnerability, and a shared purpose and values.

Third, I was very frustrated for months about what happened and felt betrayed, playing the victim. Over time, I learned that I was not the victim; if anything, our former Accounting Manager was suffering in his role because of my inexperienced leadership and the weaknesses in our company culture. This was a defining moment not only for my own development as a leader, but for the company culture that would eventually lead us to new levels of growth and success in the years to come.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

When I first started, I had no significant prior leadership experience, and had what some may call “imposter syndrome.” I had a certain concept in my mind that good leaders demonstrated strength, formality, and lack of vulnerability. At the time, it was more important to me that I conveyed a certain image of myself to the outside world rather than being authentic.

In early 2013, I decided to start wearing a tie every day to work. Part of me thought, and still thinks, that ties are a cool fashion accessory. However, my reasoning at the time was that I looked very young and needed to sport more formal attire to be taken seriously.

There is a photo that we took as a team after we celebrated the company’s first birthday — we had around 12 employees at the time. I never imposed my dress code on others, so everyone was dressed fairly casually except for me, standing out amongst our team in the middle of the photo as “the dude wearing the tie,” which on this particular day was way too long and looked a bit ridiculous.

After seeing this photo, I decided to stop wearing ties, and fairly quickly transitioned into a more casual attire. Within a month or so, I no longer had a distinction between my “work wardrobe” and my “non-work casual wardrobe.”

While seemingly insignificant, this change marked a shift in my leadership style. I went from being non-approachable to more approachable. I went from not discussing anything personal with our team to becoming more vulnerable and authentic. Although I still had a lot of personal development to do, my conception of what it meant to be a good leader changed for the better. Perhaps coincidentally, after the change in my wardrobe and more importantly the evolution of my leadership style that it represented, we grew by 200% over the next nine months.

What do you think makes your company stand out? Can you share a story?

Our brand promise is to always put the needs of our Healthcare Travelers first. The relationship we have with our Travelers is built on real trust and mutual respect. Because our brand and company values are inextricably linked, those two things make us stand out. Our company values aren’t just words scrolled on a wall in our office, we live and breathe by the following six core values at every level of the business:

1) Lead with integrity

2) Team strength

3) Driven by excellence

4) Embrace positivity

5) Mastering our craft

6) Personal accountability

What advice would you give to other healthcare leaders to help their team to thrive?

My advice to other healthcare leaders is to utilize your team and gather input from them as often as possible. I genuinely care about getting insight and feedback from all levels of the organization and will be sure to do so before making decisions for the company. Incorporating openness, transparency and honesty into my relationships with my team has created a strong culture and made Host Healthcare a great place to work. We’re not perfect, but we’re willing to take honest feedback even if it can be hard to hear. This has led us to have strong results that follow us to the end goal.

As a leadership team, we focus on holding one another accountable. I’ve found that painting a clear picture of Host Healthcare’s mission and vision has allowed all team members to clearly see the way in which their role plays into the overall success of the company. In the end, this results in more long-term commitment to the team.

Some of the greatest advice I have come across in my career comes from the book 5 Dysfunctions of a Team, written by Patrick Lencioni, which discusses how the absence of trust is the cornerstone of a dysfunctional team. Lencioni explains that if your team is afraid of being vulnerable, they won’t be honest when there are problems. Without these two aspects, healthy conflict and conversations will be impossible and both of those are vital in having a functional team.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

The US healthcare system typically ranks lower relative to other developed countries due to our challenges with higher per capita cost, less access to care, and poorer patient outcomes. Interestingly, the three are interdependent because if costs are high, then fewer people will have access to care, which will result in negative outcomes. Our healthcare system is unique in that we are 34% funded by private health insurance (usually employer-sponsored) and 10% funded through out-of-pocket spending. When someone loses their full-time job, they can quickly find themselves and their family without healthcare coverage. In 2018, there were 31 million uninsured citizens despite the country’s efforts to address this issue through the 2010 Affordable Care Act (ACA). With so many different funding sources (i.e., insurance, Medicare, Medicaid, other government and community payers, out-of-pocket, etc.) there is a lack of patient care coordination due to the fragmented ways in which healthcare is reimbursed across all of the various payer sources. Even though the ACA was intended to drive volume-based reimbursements to more value-based care, that shift has been slower than anticipated and so the cost savings have not necessarily materialized. In 2018, healthcare expenditures made up 17.7% of the US GDP, which is higher than other developed countries.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

There are many changes that could be made — here are five that could drive significant improvement in our overall healthcare system and population:

1. It would be great to see our nation shift our resources from the treatment of acute disease to one where our population has greater access to primary care focused on the prevention of disease through health and wellness programs. Prevention of serious health conditions such as diabetes can make a huge difference in medical costs and quality of life. According to the American Diabetes Association, patients with diagnosed diabetes incurred medical expenditures that were 2.3x higher on average than what the expenditures would be in the absence of diabetes. The total estimated cost of diagnosed diabetes in 2017 was $327 billion, of which $237 billion was direct medical costs and $90 billion was lost productivity.
2. Our nation is in need of increased funding for mental health resources. A 2018 study by the National Council of Behavioral Health showed that 50%+ of US adults have sought or considered mental health treatment for themselves or others. Despite the high demand, there is a lack of access and funding for mental health resources. 38% of Generation Z have sought mental health treatment for being suicidal, and 45% of Generation Z feel their mental health was harming their physical health. 76% of adults agree that mental health is just as important as physical health and so we need to find a way to make mental health resources much easier to access.
3. During the Covid-19 shutdown, the usage of telemedicine accelerated into the mainstream. In an April 2020 Morning Consult poll, 23% of US adults reported using telehealth services for an appointment with a doctor, hospital, or specialist. To expand access to telemedicine, the federal government relaxed telemedicine restrictions, increased reimbursement coverage for telemedicine services, temporarily allowed licensed providers to practice across state lines and expanded the types of providers allowed to provide telehealth services. These were positive steps to increase access to healthcare services and continued support of these changes would be beneficial for the industry.
4. The nation needs to continue working on prescription drug reform. Studies show that 30% of Americans are not taking their prescription medications as directed because they are cost prohibitive. On the one hand, we don’t want to stifle innovation or the development of life-saving treatments that improve the length and quality of life. However, the cost of prescription drugs has continued to escalate over time with drug companies receiving 20% of healthcare revenues overall but capturing over 60% of profits. Hopefully this is an issue that can garner bi-partisan support in Congress.
5. Our government should continue working towards ensuring that all Americans have access to healthcare services. Despite the passage of the ACA in 2010, there are still 31 million uninsured who do not qualify for Medicare, Medical or other payer programs and cannot afford to purchase individual plans on their own. When they do need healthcare, they are forced to pay out-of-pocket. To make matters worse, the uninsured are then billed at retail prices which are substantially higher than the negotiated prices paid by Medicare and the health insurers. We are charging the highest prices to the population who have the least ability to pay those prices, which results in many personal financial crises, bankruptcies and unwanted harassment.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

As individuals, we can make our own health and wellness a priority to avoid preventable conditions. For example, obesity is associated with serious health risks and complications. In 2018, 42% of US adults were considered obese, including 9% who were considered severely obese. We can also actively seek out mental health support for ourselves and family members when needed for our overall emotional health and well-being.

As corporations, we should also continue to provide employer-sponsored health insurance coverage for our workforce and their families, as well as other employee assistance programs to ensure there is access to mental health support. As healthcare services organizations, we can continue to stay involved in the healthcare industry and advocacy groups to drive policies that promote greater access to health services, reimbursement for care coordination and telehealth, and portability for licensed providers and clinicians to more easily work across state lines. There are geographic shortages of healthcare workers across the country and it’s important for healthcare systems to be able to put clinicians with the right skill sets in the right places at the right time.

From a community perspective, we cannot expect patients to always come to acute care hospitals and emergency rooms to receive treatment. This is not cost-effective for them and they avoid care because they are intimidated by these settings. We need to meet people in their own communities and provide them with the care that they need locally to address their chronic health conditions. This takes collaboration with local communities and their leaders to establish effective healthcare networks to service the entire population.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

When it comes to the interplay between the general and mental health systems, I believe the two areas should be integrated as closely as possible — not looked at separately. Looking at these two as separate entities creates a gap in healthcare as mental health often manifests in the physical being. For example, the way that a patient thinks about his or her pain plays a major role in the recovery process. The more we can continue to learn about the interplays of physical and mental health, the closer we’ll be to creating a system that fully caters to both.

How would you define an “excellent healthcare provider”?

What makes an excellent healthcare provider is the same thing that makes a great teammate at Host Healthcare. Someone who puts the people they serve first, demonstrates integrity, personal accountability and positivity. Now more than ever, healthcare providers are pushing our world forward because it’s their passion — it’s what they love. They aren’t just clocking in and out of work or going through the motions, they’re putting their heart and soul into their work. Our goal is to align the skills of our healthcare Travelers with the best opportunities so that they can use those skills to be the healthcare heroes that we need right now.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

One of my favorite quotes is by the 17-century philosopher Blaise Pascal: “The heart has its reasons, which reason does not know.” In this quote, Pascal was referring to limits of reason in relation to spirituality. However, it always meant more to me, and has been relevant to me over the years both personally and professionally.

When I first started Host Healthcare, my ideas concerning leadership were nascent and somewhat naïve. I thought that a great CEO is hyper-rational and focused almost exclusively on developing and operationalizing a winning strategy. Basically, the CEO gives directives based on reason, and others follow those directives, resulting in the implementation of a strategy that is superior to the competition.

What I have learned over the past eight years is that a great CEO is someone with a heart who can connect with others in a meaningful way to gain their trust, respect, and inspire them to strive for excellence. Sincere human connections with individuals or a culture cannot be explained strictly in rational terms. It must come from and be guided by the heart. While this statement may seem trite, in my experience some leaders either do not really believe this or struggle with it (I struggled with this concept early on).

Within this context, strategy is irrelevant if leaders do not have a healthy company culture in place — guided by authentic leadership — that will support and buy into that strategy. Although explaining the “why” behind decisions from a rational perspective is important in cultivating transparency, teams buy into decisions not so much because they believe in the reasoning behind a decision, but because they believe in and trust the individuals delivering the message. In this sense, company cultures also have their own hearts that cannot be explained, cultivated, and guided in strictly rational terms.

Are you working on any exciting new projects now? How do you think that will help people?

Something we recently launched is our COVID-19 Resource Center on our website, which includes emergency license wait times, crisis response jobs (places where there is immediate need for healthcare professionals), and highlighting businesses that are offering discounts or free services for healthcare professionals. We are continuing to build out our COVID-19 resource center to make the lives of our Travelers better by providing critical information when they need it.

We hope that this will also help our partners with needs for healthcare staff disseminate information and job postings quickly and easily so positions can be filled efficiently and serve the communities where there are urgent needs.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

For me, being a great healthcare leader means being a great business leader. Broadly speaking, I believe the principles of leadership transcend specific industries. A few of my favorite books include:

• The Five Dysfunctions of a Team by Patrick Lencioni

This engaging book was transformative in my understanding of why so many teams are dysfunctional and how eliminating those dysfunctions — at the root caused by absence of trust — is the essence of my role as CEO on the Leadership Team at Host Healthcare.

• Under the Hood by Stan Slap

When I read this book, my views on leadership with respect to company culture were challenged directly. I realized how little I knew about company culture, because as CEO I am not part of it and do not experience it in the same way as our employees. One of the author’s main points is that company culture is a separate organism living within a company, with its own objectives and values, existing to protect itself. Leadership must understand this before considering its role in shaping and energizing the culture.

• Great CEOs are Lazy by Jim Schleckser

This book is not about how to work less, but how to work more effectively. As CEO, there is always more that I can be doing, and it is easy to feel overwhelmed. It is tempting to fall into the trap of feeling guilty for not doing enough. This book helped me realize that my job is not to do and be everything to everyone, spending little time on many things, but rather focusing my time on eliminating the most significant problems and constraints that are preventing the business from continued growth and success. It is a fantastic book for leaders who struggle with how to manage their time and delegate effectively to have the greatest impact.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Something we have started to initiate this year that I want to do more of is recognizing our healthcare professionals — for their sacrifice, their commitment, and their selflessness. Our healthcare professionals have families, significant others, children, yet they are showing their unwavering commitment to the overall health of our communities. No matter what your opinion is on the US healthcare system, we can all agree that now more than ever our healthcare workers are our heroes in scrubs. It’s been really inspiring — whether you are in the healthcare industry or not — to see how businesses and everyday people have recognized our healthcare professionals on the front lines making the ultimate sacrifice of their own health to help our community stay healthy. We did a campaign earlier this year when COVID-19 was at an all-time high, called Hosting Our Heroes. We asked staff and social media followers to share stories of their own healthcare heroes to shed light on their impact and make that person’s day a little brighter. We ended up receiving all kinds of images and stories of nurses with bruises on their faces from their masks, with face shields and beds set up within hospitals working around the clock. Those stories are both moving and motivating. If everyone can continue this level of appreciation for healthcare professionals, even after this pandemic, that would be a well-deserved outcome. I know everyone at Host will not forget everything our healthcare professionals have sacrificed (and have always sacrificed) to save lives.

How can our readers follow you online?

Please follow along on our social channels for the latest updates and announcements!

• Instagram: @hosthealthcare
• Facebook: https://www.facebook.com/HostHealthcare/
• LinkedIn: https://www.linkedin.com/company/host-healthcare-inc-/

Thank you so much for these insights! This was so inspiring!