About This Episode
Leadership & Operations Consultant Retirement Home Insider
Episode : 2025-12-01T07:22:42.009Z
Leadership & Operations Consultant Retirement Home Insider
In this episode of Full Circle, we sit down with Mark, a philanthropy and fundraising leader whose career began in the 1980s as a theology teacher — until a school $300,000 in deficit handed him fundraising as a baptism by fire. Mark shares how fundraising has drifted toward a transactional, sales-driven model, and the cost of that shift: donor retention rates of just 42%, with 8 out of 10 new donors never giving again. He explains why the problem starts at the top — boards measuring only dollars raised while ignoring donor retention and lifetime value — and why understanding a donor's "moral biography" matters more than moving to the next gift. The conversation also covers fundraising across sectors, the danger of small organizations copying broken big-organization models, and how senior living communities like Mosaic structure philanthropy below the operating line to ensure residents never lose care, even when they can no longer pay.
In this episode of Full Circle, we speak with Kishan, a skilled nursing facility executive director with a decade of experience in Indiana's long-term care industry. Kishan walks us through how Indiana is ahead of the curve in bringing value-based care to skilled nursing — from state-incentivized Medicaid quality programs to enhanced provider coverage models and treat-in-place protocols that have measurably reduced hospital readmissions. He explains the I-SNP (Institutional Special Needs Plan) model in depth, including how Indiana's largest SNF operators — despite being competitors — came together to build one of the country's largest I-SNPs, sharing risk and care teams across facilities for better resident outcomes. The conversation closes with his take on AI in skilled nursing, from admissions paperwork to EMR-integrated tools, and advice for operators looking to build collaborative I-SNP models in other states.
In part two of our conversation with John on Full Circle, we dive into AI and innovation in healthcare — where AI is creating real value today (administrative work, revenue cycle, staffing) and why he remains cautious about clinical applications, emphasizing governance, compliance, human-in-the-loop oversight, and the emerging liability questions the courts haven't yet settled. John also breaks down the evolving landscape of CMS models, the push to bring specialty care into value-based arrangements, and value-based enterprises as a path to collaborative innovation. He closes with his blueprint for redesigning US healthcare — simplified incentives, overinvestment in primary care and behavioral health, accountability across care transitions, and social infrastructure — plus sharp advice for healthcare builders: focus on execution and coordination along the care continuum, because the most expensive patients aren't the most medically mysterious — they're the ones falling through the cracks.
In this episode of Full Circle, we sit down with John, a healthcare strategy leader whose unconventional journey began as an artillery officer in the US Army, where recruiting physicians first pulled him into healthcare. From his time at Merritt Hawkins to consulting across solo practices and large health systems, John shares a bird's-eye view of the business side of American healthcare. He unpacks what value-based care really means — an operating model for accountability — why the same problems show up at every level of the system, why healthcare costs remain uncontrolled despite a decade of innovation, and how administrative bloat, short-term incentives, and the fee-for-service chassis hold transformation back. A candid conversation on where healthcare strategy gets won and lost.
In this episode of Full Circle, Dr. Franco, a board-certified internal medicine physician with 20 years of experience and a private practice of nearly 4,000 patients, shares his journey from employed medicine to independent practice. He discusses why physician costs make up less than 10% of healthcare spending, how primary care has shifted from prevention to "sick care," where value-based care falls short, and his move to a prevention and wellness-focused practice model. He closes with advice for young physicians looking to build an independent practice.
Join us on Full Circle for an insightful conversation with Dianna Shaw, an award-winning healthcare leader and trusted senior care consultant. Drawing on over 25 years of diverse experience in nursing home operations, Medicare/Medicaid health insurance, and geriatric care management, Dianna provides a holistic view of the complex elder care ecosystem. In this episode, she offers practical advice for families navigating the senior care system, highlighting how to overcome confusing medical and insurance language to close the healthcare literacy gap. Dianna also tackles pressing industry issues like the impact of direct caregiver staffing shortages, the logistical realities of aging at home, and the vital importance of proactive planning to ensure you can find the right, high-quality care solutions for the aging loved ones in your life.