Keswick Multi-Care CEO Carmel Roques and the changing health care scene

By Adam Stone, contributor

Over the past decade Keswick Multi-Care Center has served seniors with a nursing home, an assisted living facility and an adult day program. Under the guidance of CEO Carmel Roques, who came on board two years ago, the nonprofit has moved increasingly toward helping seniors return home after hospitalization. Roques spoke with us about the changing mission of Keswick and the evolving health care landscape.

How have you been reshaping Keswick? Historically we were mostly serving people who were going to stay with us for the rest of their lives. In the last two years we have focused on expanding our mission impact by providing services to people who come from the hospital and whose goal is to go home and be as well as possible. At the same time, part of the trend we are seeing and responding to is that, overall, the people who leave the hospital are sicker than they used to be and are less far along in their recovery.

These seem like contradictory pressures? Welcome to health care post-Affordable Care Act. Now everyone in health care is being tasked with looking at the individual patient and doing three things: improving actual health outcomes, improving the actual experience the person has with the health care they receive, and at the same time controlling costs.

How do you do all three? We do that by greatly expanding the services we provide for people who need a recovery and rehab period before they can go home. We provide more transition coordination services. Do they have the medications they need, and do they understand how to take them? Do they have a followup appointment? Do they need adaptive equipment at home?

What challenge do you face with this expanded mission? It’s about making sure we have gotten the right complement of staff with the right experience on board and then getting everyone moving in the same direction. I do love growing people internally and bringing them up, but sometimes there is an area of expertise where we don’t have anybody internally. Then we will go to a search firm; we will post in places where the people we want to hire go to school. There are a variety of strategies for doing that, it’s not one single thing.

Tell us about a mistake, a lesson learned? In the second year of our program I was overly optimistic about how many people we would actually be able to serve. Now, this business has very tight margins, so you only have to be off by one or two patient days to blow your budget. It was not a catastrophe, it was a small mistake. But I learned that, given the nature of our business, it is better to be quite conservative on our projections of utilization rates.

We are in such a dynamic environment in health care right now, it is very difficult to have the kind of certainty about the numbers that we used to be able to have. The broader strategic learning there is that our destiny is very tied to what is happening to hospital systems and what is happening with the home care providers. We all have to tightly align what we are doing and work together. There is no standing alone anymore.

How does your expanded mission impact budgeting? It is extremely important strategically that we think of ways to become less dependent on Medicare and Medicaid, because those are so hard to predict. So we are looking at raising funds, we are looking at private pay by creating added value to our services.

Best thing about the job? This is one of the most exciting times in my career. I love being a part of creating new models and changing the way things are done, in terms of both public policy and service delivery. We have a chance to be architects of the next system, and there is nothing more exciting than that.

Keswick Multi-Care Center

CEO: Carmel Roques

Employees: 300 full-time, 132 part-time

Annual budget: $33 million

Clients annually: 1,500

2014 readmission rate: 8.25 percent

State average readmission rate: 22 percent

Source: Baltimore Business Journal

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