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Wouldn’t it be great if all long-term and post-acute care providers had an electronic health record (EHR) adoption blueprint that guides them through the process, step by step, to implementation? That’s exactly what LeadingAge’s Center for Aging Services Technology (CAST) has done.

CAST announced very recently that it has updated resources on EHRs to include something called a 7-Stage Adoption Model. Developed by CAST for the following LTPAC entities:

• Adult day care
• Attending physicians
• Assisted living
• Acute rehab facilities
• Home health/home care
• Hospice
• Life plan communities
• Long-term acute care hospitals
• Long-term care rehab facilities
• Skilled nursing facilities
• Intermediate care facilitites
• Intellectual disabilities/developmental disability facilities
• Programs for All-inclusive Care for the Elderly (PACE)

The resources also include an updated EHR Selection Portfolio, an interactive online guide, and a new case study that outlines one provider’s journey through EHR adoption. According to a statement from CAST, previous EHR adoption models focused primarily on inpatient settings like hospitals and nursing homes.

This model, however, is aimed at helping all aging services organization in “choosing an EHR system that fits the needs of the organization, its providers, and its consumers, patients, and clients.”

In my opinion, it’s refreshing to see a tool more reflective of where the industry is headed—a more integrated care model that is more about the patient and the care, not driven by the setting.

According to Majd Alwan, CAST executive director, “the CAST EHR Selection Portfolio’s new 7-Stage Adoption Model was tailored to help long-term care providers not only improve efficiency, but also quality of care for their residents.” He also said that he hopes the model will make it easier for more and more providers to integrate advanced EHR functionalities into their operations, and use them to continuously improve care quality.

The 7-Stage model provides a framework to assess the level of adoption and sophistication of use, as opposed to just the overall rate of adoption, of EHRs in long-term and post-acute care. The model also draws from the HIMSS 7-Stage EMR Adoption Model, PointClickCare’s 7-Stage LTC EHR Adoption Model, and Gutkind-Savage’s 10-Stage International EHR Adoption Model.  

No, this isn’t a post about recent high school graduates—it’s actually about their parents, or more specifically, Americans 40 years and older. I am among that group, and we are, for the most part, unprepared to pay for long-term care (something many of us will need in the second half of our lives), uninformed about how it will or can be paid for, and reluctant to go anywhere else but to our own bedrooms to be cared for if or when we need that care.

How do I know this? Here are some stats: A recent survey of Americans 40 and older further illuminates the problem that most of us are woefully ill equipped for the likely inevitability of needing long-term services and supports (LTSS). The survey found that 77 percent of this cohort would prefer to receive long-term care in their own homes, with far fewer choosing to receive care in a senior living community (11 percent) or a nursing home (4 percent)—no surprise here. Released by the Associated Press-NORC Center for Public Affairs, the survey also asked this same group about their preparations for long-term care, and one-third say they’ve done no planning at all for their own care needs.

Moreover, a majority (64 percent) have little confidence that they will be able to pay for it, and just 13 percent are “very sure” they have long-term care insurance, while 4 out of 10 mistakenly believe that Medicare will pay for their care.

Making matters worse, the cost of long-term care is getting more and more expensive and more and more out of reach for a majority of Americans. The Genworth 2016 Cost of Care Survey found that the price tag for long-term care has risen steadily over the past five years. The average hourly rate for a home health aide is $20, a rate that has risen by only about 1.28 percent in the last five years. Assisted living care, at $3,628 per month on average for 2016, has grown by 2.16 percent in the last five years.

Nursing home care—at $225 per day—has made the largest jump in cost, of 3.12 percent in the last five years. No matter how you look at, the cost of long-term care is high—staggering in some cases--and there is no indication that any of these costs will decline in the coming years.

There is a very cool calculator on the Genworth website that helps you figure out what your future costs of long-term care will be, right down to the closest major city. I decided to find out what the price tag will be for me 15 years from now in my fair city of Cleveland, and the numbers are sobering: In 2031, the average annual cost for a home health aide will be about $72,184; an assisted living community will set me back $74,315; and a private room in a nursing home will be $142,165 per year.

If you’re skeptical about whether or not you will need this type of care one day, here’s another stat: Seventy percent of people who turn age 65 can expect to use some form of long-term care during their lives.

What can be done about it? Back in February, a group known as the Convergence Center for Policy Resolutions released a set of recommendations for long-term care financing reform. The framework was developed over the last three years by a group of policy experts and senior-level decision makers representing a “wide range of interests and ideological views,” known as the Long-Term Care Financing Collaborative. Members of the group include Howard Gleckman of the Urban Institute, Jennie Chin Hansen, immediate-past CEO of the American Geriatrics Society, and Gail Wilensky of Project HOPE. Here are some of their recommendations:

• A universal catastrophic insurance program aimed at providing financial support to those with high levels of care needs over a long period of time.
• Private sector initiatives and public policies that will revitalize the long-term care insurance market to help address non-catastrophic LTSS risk.
• Efforts to encourage retirement savings and develop more efficient and innovative use of home equity to assist middle- and upper-income families finance LTSS needs for those risks that are not covered by catastrophic insurance benefits.
• A modernized Medicaid LTSS safety net for those with limited lifetime incomes who are not able to save for these care needs, as well as for those who deplete their assets paying for medical and long-term care costs, including more flexible public programs that can deliver care in the setting most appropriate to the needs of individuals.
• Stronger support for families and communities that are the bedrock for people receiving care at home.
• Better integration of medical treatment and personal assistance.

Although the group acknowledged that many details are yet to be worked out and many questions remain unanswered regarding LTSS financing, they call for more research and “better support stakeholder agreement and informed policy making.”

Not surprisingly, support for policies to help caregivers face the costs of providing long-term care is widespread. Seventy-two percent of those surveyed for the NORC study said they support state programs to provide paid family leave, 83 percent support tax breaks for caregivers, and 73 percent support a Social Security earnings credit for caregivers taking time out from the workforce to provide care.

Just as the cost of college tuition looms for many of us 40-plus Americans, so too does the specter of shelling out thousounds for long-term care. This cohort needs to be educated about what kind of care they will need as they grow older and the reality of how much it will cost.

As these issues are worked through over the coming months (and years), it is wise to look for opportunities for your organization to inform the conversation. Explore solutions you might offer to meet the needs of a cohort with widely varying levels of need, extremely high expectations … and limited resources.

Seventy-two billion dollars is a substantial sum of money for any industry. But did you know that this figure represents the projected revenue from markets created by senior caregiver spending in 2020? That’s what a recent report from AARP and Park Associates reveals: “Caregiving Innovation Frontiers: A universal need, a growing opportunity—leveraging technology to transform the future.”

Here’s another staggering stat: $42.9 billion. That’s the expected profits from six market segments affiliated with caregiver spending this year alone. If you’re paying close attention, you’ll note that the difference between these two numbers represents the expected growth in these combined markets in the next four years: $29.3 billion.

Yes, that’s a sizable and respectful figure, and it represents an opportunity that providers of aging services may want to consider seizing—as the day is close at hand.

The figures are derived from survey data detailing consumer needs, interests, and behaviors, as well as an examination of services already in the marketplace, says AARP. The report also provides detailed descriptions of the six market segments that will produce the aforementioned revenue and are ripe for opportunity now:

1. Daily Essential Activities: Meals, home and personal care, home repair, delivery, transportation services.
2. Health and Safety Awareness: Health vital alerts, diet and nutrition, medication management, personal safety monitoring, telehealth.
3. Care Coordination: Care planning, care professional engagement, records and benefits management, recovery support.
4. Caregiver Quality of Life: Respite and backup care, social support, health and wellness, financial/job security.
5. Social Well-Being: Digital inclusion, life enrichment and empowerment, community networking, life companions.
6. Transition Support: Home retrofit services, long-term care insurance planning, long-term care provider referral, legal assistance, hospice/funeral planning.

In addition to breaking down revenue forecasts for each of the segments, the report is packed with details about companies already offering similar services in each submarket segment and littered with relevant factoids that bring the opportunities into context for providers. For example, did you know that 67 percent of caregivers want to monitor their care recipients’ health and safety but only one-tenth of them are currently doing so?   

If you’re looking for opportunities to expand or diversify your services into the community—or if you simply need to market a technology or service you already offer—I would suggest reading this report ASAP, as it offers an insightful and very helpful examination of the near future for aging services providers. How will you seize the moment?

Long-term care (LTC) delivery is no longer relegated exclusively to the nursing home. Today, these long-term services and supports (LTSS) are delivered with increasing frequency in settings ranging from assisted living and senior living communities to individuals’ personal residences.

The LTC trade association LeadingAge, for example, reports that 61% of its Top 100 constituents have already diversified their service lines to include home and community based services.[i] Recent developments with accountable and managed care organizations indicate that the trend of providing care and services in less institutional settings will continue for the foreseeable future. These models’ value-based payment strategies have made effective care coordination and care transitions top priorities.

Hmmm...are we really a "long-term" industry?

Each setting within the LT-PAC network has its own distinct characteristics.  Traditional nursing homes, while in the process of evolving into other service lines, are still prominent players in the care continuum. Finding specialty areas and expanding into including short-stay rehab, is becoming increasingly important to this sector. An area of significant growth in LT-PAC is short-stay rehab. For those operators, outcomes are the primary emphasis.

Assisted living (AL) is another sector undergoing significant change. Its traditional consumer base is increasingly receiving AL services in their homes, causing providers to offer new services lines, often memory care. For AL, sales and marketing technology is critical. Memory care is a hot area—the prevalence of Alzheimer’s Disease and other forms of dementia assure demand for these services well into the future. Demonstrating outcomes and interfacing with applied technologies are of interest to this sector. Finally, home and community based services (HCBS) including home health, hospice and adult day are increasingly a part of the LT-PAC system.

Nursing Homes

Skilled nursing and intermediate care properties specialize in providing intensive personal and/or healthcare services. According to the Centers for Medicare and Medicaid (CMS), there are 15,681 certified nursing facilities in the US. Of these properties:

• 55% are controlled by multi-facility organizations; 45% are independent

• 69% are for-profit; 25% are nonprofit; and 6% are government facilities

• 6% are dedicated special care units (Alzheimer’s, Rehab, Ventilator, Hospice, Aids, Other)[ii]

Traditionally the “bread and butter” segment of the continuing care spectrum, skilled nursing has been undergoing a process of “right sizing” over the course of the last decade. The number of skilled nursing facilities has been on a steady, but gradual decline. However the number of skilled nursing units overall—as well as the number of residents—has remained constant. Smaller facilities are being replaced with larger, more cost-effective plants.

This segment of the market is now on the brink of a more significant transformation. Due to such factors as demographic shifts, consumer demand and expectations, new Federal health policies and a changing state payor landscape, the standard “nursing home” is changing its focus to chronic, medically complex care and/or short stay rehabilitation services. Both consumers and payors (Medicare/Medicaid and private insurers alike) are pushing care delivery back into Home and Community Based Services (HCBS) for clients whose needs can suitably be delivered outside of a facility setting. Far from its “old folks’ home” roots, the skilled nursing facility is being challenged to care for those patients who are not ready to return home (or to lower levels of care acuity). With progressive frequency, medically complex cases requiring more intensive care and patients recovering from acute events (rehabbing from strokes, cardiac procedures, hip replacement, etc.) are the new nursing home patient.

[i] LeadingAge. Ziegler. “LeadingAge Ziegler 100.” (2013): 4

[ii] American Health Care Association. “LTC Stats: Nursing Facility Operational Characteristic Report.” (2013): March

Short-Stay Rehabilitation

Approximately one-third of hospital patients are discharged into post-acute care. The most common setting for the delivery of this care is the skilled nursing facility specializing in short-stay rehabilitation, making it one of the fastest growing service lines in the LT-PAC spectrum. Facilities providing short-stay rehabilitation offer services to patients who need additional support while recuperating after a hospital discharge.[i]

Services provided might include:

• Physical therapy

• Occupational therapy

• Respiratory therapy

• Speech therapy

• Wound management

• Cardiac rehabilitation

• Pain management

• Ventilation care

There is a determined course of treatment, often involving a therapy regimen. Typically, these services are in place to improve a patient’s transition from hospital to the community. Rehabilitation measures are taken to promote optimum attainable levels of physical, cognitive, psychological, social, emotional and economic usefulness so that an individual can maintain maximum functionality.

The emphasis of short-stay rehabilitation is on results. Payment sources for this service line (primarily Medicare, managed care and/or private insurance) demand both optimal clinical outcomes and cost-effectiveness. Having the data to demonstrate efficacy in both areas is imperative.

Assisted Living

Since each state has its own terminology and standards for this service line, there is no uniform definition for assisted living (AL) across the US. Generally speaking, however, AL supports people who have restricted functionality, due to advanced age and/or disability. Residents are in need of help with activities of daily living (ADLs) like eating, bathing, toileting or ambulating, but are encouraged to live with the highest degree of independence possible.[ii] The current service model is directed at an average resident who is 85, has one or more chronic health conditions, and requires assistance with three or more ADLs (activities of daily living). 42 per cent of AL residents have been diagnosed with some form of dementia. [iii] Services typically include prepared meals, security, organized social activities, laundry and transportation. Assisted living communities are increasingly providing clinical services such as medication management, ointment and light dressing application, and therapies to keep strength and daily function as high as possible.

AL is an extremely diverse market segment. Far from homogenous, this sector ranges from the very small to extra-large. For example, of the 31,100 AL communities accounted for by the Centers for Disease Control and Prevention (CDC):

• 50% are considered small (4-10 beds)

• 28% are categorized as large (26-100 beds)

• 7% are classified as extra-large (more than 100 beds)

Large AL communities (26 or more beds) make up 35 per cent of all AL communities, yet house a full 81 per cent of all AL residents.  Conversely, small to medium sized communities significantly outnumber larger communities, but account for only 19 per cent of all residents. [iv]

The sector is more homogenous in other demographic characteristics:[v]

• 82% of AL communities are privately owned for profits

• The remaining 18 percent (about one in six) are nonprofit or owned by state, city, or local government

• 62% are owned by independent operators (particularly smaller communities)

• Approximately 38 percent of facilities are chain-affiliated

The same trends causing skilled nursing to change its service and operational model will have a significant impact on assisted living as well. The services provided by assisted living are more readily transferred to less congregate settings. The sector is beginning to respond by converting traditional assisted living units into memory care units. In fact, complete memory care wings—and entire communities—are beginning to emerge as a major trend within the long-term care continuum.

Memory Care

An emerging sector in long-term care and senior living is memory care.  Typically housed within a skilled nursing or assisted living community, memory care units cater to consumers with Alzheimer’s disease (AD) and other forms of dementia.  The statistics are staggering.  One in nine people age 65 and older are afflicted with AD and about one-third of people age 85 and older have the disease. As life expectancy increases and the population ages (more rapidly, now that Baby Boomers have begun turning 65), the sheer number of Alzheimer’s cases alone is expected to mushroom.  By 2025, the number of people 65 and older with Alzheimer’s disease is expected to increase by 30 per cent.  Some project the number of AD cases to triple within one generation.[vi]

Upward trends in life expectancy and the aging of the US population are what make the memory care offering so popular.  Assistance with ADLs and care management of chronic conditions are services more easily transferred to HCBS.  Cognitive impairment, however, poses unique challenges and risks—and is often more easily addressed in a congregate setting.  While this sector is small, compared to the other service sectors, the growth change for memory care surpasses all other sectors.

Home and Community Based Services

Home and Community Based Services (HCBS) is a term used to describe an array of non-institutional care alternatives. When describing HCBS, the word “community” is used in a broader sense which can include a person’s home as well as other locations within the general community. Development of HCBS remains a priority for many public healthcare programs. In addition to the cost savings these programs are expected to generate, it is also the desire of most consumers to receive care and services in the least institutional setting possible. For the purposes of LT-PAC delivery, those service lines include home health, hospice/palliative and adult day care.

Home Health Care

As the name implies, home health care services are provided in a person’s place of residence. The home may be a single family home, apartment, or senior living community. Home health services are frequently provided after a hospitalization or short-term rehab stay to assist in a patient’s transition back home. Home health care encompasses such services as assessments, provision of care, treatment, counseling and/or monitoring of clinical status. These services are delivered by a host of professionals including nurses, physical therapists, occupational therapists, speech therapists, audiologists, dentists, social workers, dieticians, and more. Home health care is usually provided when a person requires intermittent care (a few hours per day/a few days per week), rather than full-time.[vii] If more regular, round-the-clock care is required, a facility-based model of care is usually recommended for cost-effectiveness.

Hospice Care

Often referred to as “end-of-life care,” hospice services are provided to individuals diagnosed with terminal illnesses who have a limited life expectancy (usually defined as six months or less). Care provision departs from the traditional model of clinical treatment and instead focuses on the palliative management of pain and other symptoms. Meeting a person’s emotional, psychosocial and spiritual needs is a primary focus, as is assisting the family to cope with the loss of a loved one.  

Adult Day Care

A form of long-term care, adult day care provides interim (less than 24-hour) assistance for individuals who require supervision or assistance, but not round-the-clock nursing care. These community-based programs are designed to provide a safe setting for the provision of social and health services. They also provide a respite for caregivers in need of a break from the demands of their caregiving role. There are several popular models of adult day care services.  The social model provides meals and supervised activities. A more medical approach focuses primarily on the delivery of health care. Specialty models have developed as well, offering services for those with dementia, brain injuries, and other chronic conditions.[viii]

Summary

What was once a safety net for our nation’s elderly has evolved into an ever-more-complex and interwoven system of long-term services and supports for a broad population of Americans. The medical model of old has evolved into a person-centered paradigm, wherein the money follows the patient. Today’s long-term/post-acute care now encompasses skilled nursing, short-stay rehab, assisted living, memory care, and an array of home and community-based services. Consumer demand and the advent of ACOs and MCOs are driving significant change. Fee-for-service is being replaced by value-based payment. LT-PAC providers must demonstrate their outcomes and cost-effectiveness just to survive.

[i] Pratt, John R. Long-Term Care: Managing Across the Continuum. 3^rd Edition. Sudbury, Mass.: Jones and Bartlett Publishers, 2010.

[ii]   McSweeney-Feld, Mary Helen. Oetjen, Reid. (Eds.) Dimensions of Long-Term Care Management, An Introduction. Chicago: HealthAdministration Press, 2012.

[iii] Mollica, Robert. Houser, Ari. Ujvari, Kathleen. “Assisted Living and Residential Care in the States in 2010.” AARP Public Policy Institute, 2010.

[iv] Ibid

[v] Ibid

[vi] Alzheimer’s Association. 2012 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia. Volume 8, Issue 2

[vii] Pratt, John R. Long-Term Care: Managing Across the Continuum. 3^rd Edition. Sudbury, Mass.: Jones and Bartlett Publishers, 2010R.

[viii] McSweeney-Feld, Mary Helen. Oetjen, Reid. (Eds.) Dimensions of Long-Term Care Management, An Introduction. Chicago: Health Administration Press, 2012.

It's happened to the best of us - that frustrating first call after a major solution launch.  The phone rings, and a sales rep start asking...

• "Where's the price sheet?" 
• "Competitor abc is setting this trap for us. How do you recommend we respond?"
• "Do we have a case study on that?" 

If your response is… “Launch?  What launch?”  Ooops.  Like the best laid plans, the best laid launches require military-like planning.  Major launches should involve nearly everyone in the company.  Yet rarely do companies have a quarterback whose sole purpose in life is to lay awake at night and worry about huddling the team around launches. With no one in charge, launches escape, followed by a circus.  Here's a (true) story to illustrate. 

Chapter 1, The Escape.  

Years ago I was working for an organization where engineering was able to include code in a release for an often-requested feature a month ahead of schedule, but forgot to let others in the company know.  The only mention of it was deep in a help file in the release notes, and one very-happy customer happened to find it, and called the support desk with a question.  Our support team, along with the rest of the company, was not aware that the feature was on the street just a wee bit early. 

Chapter 2, The Circus.  

Teams company-wide had to drop what they were doing and backfill. Sales needed prospecting profiles, pricing, FAQs, brochures, PowerPoints, updated proposal language, contracts, warranties, demo tools, and more.  Executives needed talking points.  Finance needed sales forecasts and costing.  Support need FAQs, hands-on demos, and detailed product notes.  HR needed revised quarterly goals by department, and outlines of special training needs.  Partners needed camera-ready materials to repackage. Marketing needed have media plans, news releases, and campaigns ready to drive demand.  Everyone felt disrupted and understandably annoyed.  

A booster shot for brand

A bad launch, like the one shared in this story, hurts brand.  So why is it a coordinated launch is something everyone wants and no one is willing to champion? There's a real opportunity for marketing to champion the coordinated launch cause, like a booster shot for brand.  A little pain ahead of time goes a long way upon go live.  With a tried and true approach, great communication, and a little project management - it's not hard to pull off.  And wow does it save headaches--most importantly, for customers. The payoff in service upfront will yield dividends for years to come.

A killer checklist

The secret to a great coordinated launch is having executive support, working a killer checklist, anticipating challenges, and leveraging the strengths of your team.  At Quantum Age Collaborative, we use a 60+ item checklist with our clients that has been refined over the past two decades and will be in perpetual refinement for decades to come. Each launch is unique and offers little best practices that collectively make for big impact.  

ROI that keeps on delivering

When staff are fully empowered to stand behind the launch, executives can expect to see faster ROI for the company-wide investments that went in to it. Sales is ready to spin, marketing is ready to drive demand, finance can forecast, and support is ready to take calls.  The ROI comes a whole lot earlier, and with far fewer headaches.  A little military-like planning really pays off. 

Oh one more thing… when you're calculating ROI for a coordinated launch effort, don't forget to include savings on aspirin! 

More than a decade ago I attended a panel discussion at a national healthcare conference. After a lively
exchange between the C-level panelists, the floor was opened up for Q&A with the audience.  The first question posed was “What keeps you up at night?”  One CEO’s response was “finding good people” – and his colleagues on the panel concurred. 

It’s a thread we hear over and over again.  And it seems universal, even in the best run organizations, regardless of stage in company life cycle, size, or industry.  Large companies seem to struggle with best applying the talent they have, and smaller ones often struggle with asking talent to stretch across unfamiliar business functions.  While every executive strives to hire A players, the reality is they still crave expert input to move their organization forward in meaningful ways.  And they long for experts who collaborate with the organization’s existing teams (not in a vacuum)—not those who rattle off the standard bulleted list of recommendations, then move on to the next gig.  But these experts can be incredibly hard to find—and they are expensive (if not impossible) to hire.

During my many years in healthcare publishing, I took countless calls from executives on the hunt for experts to help tackle challenges, small and large.  The need was universal:  whether it be leaders in academia, state associations, product/service solution providers, healthcare operators, entrepreneurs…even fellow publishers.  During these conversations I’d hear about the need for  a fresh perspective.  Acceleration. Deep expertise.  Senior wisdom.  Innovation.  Creativity. Things every organization needs to different degrees in slightly different ways and at different times in their progression.

That was the genesis a year ago of a vision for a new type of community, a gathering of experts in healthcare with global perspective, grounded in the reality of decades of experience.  So I started a list of experts who’ve impressed me in this business…and the gifts they bring to the people they serve.  Before long, I had a list of dozens – all with dream-like CVs, and power-packed results only experts who really know their stuff can deliver. There was one little problem.  How in the world could I hire them all and create the dream company?  Ironically to hire them would take away their elfin magic, which is what all those CEOs want in the first place: an outsider to come in and shake things up.

So enter Quantum Age Collaborative.  What you are about to experience is an agency unlike any the world has ever seen, where the most amazing, brilliant, and passionate people we’ve ever met are joined together under a common purpose:  to move healthcare forward.  They do so tirelessly because it is so much more than just a job, it’s a calling.  Over the course of their careers they have touched tens of thousands of lives, and they exist for the pure joy of bringing out the very best in people to achieve their vision, aspirations, hopes…and dreams.   But these aren’t ordinary dreamers.  These uber gurus get energy from results that matter.   They are die-hard realists pushing results.  Results like:

• Finding a single coding change that generated millions of dollars in justified additional revenue, which opened up an opportunity for one organization to launch a new, state-of-the art community and rehab center.
• Creating a business plan to launch an entirely new category of operator, which will thrive in a new era of healthcare and payment reform.
• Helping an entrepreneur get an innovative new solution off the ground, generating awareness leading to tens of millions in organic revenues.
• Guiding a senior living organization to effectively tell its story of quality outcomes to win ACO and MCO partners.

For the first time in healthcare, leaders looking for just the right mix of experts can turn to Quantum Age Collaborative.  Whether they need a booster shot that lasts a week, or embedded experts to move major initiatives to meet longer-range strategic goals, the Collaborative offers a huge diversity of talent. You won’t find lightweights on this website; this is no temp agency.  Quantum Age offers only the best experts at the top of their game. The collaborative is a transparent, accessible, and supportive network of the best of the best people we’ve found, whose reputations are built on trust.

So…what is keeping you awake at night?  Ready to achieve the impossible?  Let’s collaborate.