As Zach Cattell, the newly appointed president and CEO of CarDon & Associates, celebrates wins, he is mindful of several challenges stemming from both federal and state policies, with the biggest one currently being Indiana’s shift to managed Medicaid.

Managed Medicaid is only currently implemented in a few states such as Illinois, Iowa, Ohio and Arizona, and has been in place since July of last year in Indiana, where about 80% of nursing home residents are Medicaid beneficiaries. It has caused major headaches in the states, including for Indiana-based CarDon.

Indiana’s transition to managed Medicaid through a dual integration program has a complicated process with impact on admissions and eligibility, requiring CarDon to overhaul internal workflows, Cattell noted.

“We had to redesign our approach and be more efficient to tackle those challenges. It’s a significant undertaking, but we’re doing it because the care for our residents depends on it,” he said, adding, “That’s really been the biggest wrench thrown in the system in the last nine months or so.”

In the state, Medicaid plans are outsourced to three different managed Medicaid providers – Anthem, United Healthcare and Humana.

Cattell, who was assigned to his present role in early April, said CarDon is forging ahead successfully despite such challenges.

With a strong 2024 marked by high census and progress in hiring, especially in nursing, Cattell has his sights set not only in overcoming challenges of managed Medicaid, but setting the bar high for care quality.

In a wide-ranging interview, Cattell sat down with SNN to share performance targets, readmissions rates, staffing initiatives for frontline staff and leadership, and CarDon’s growth plans.

“It’s hard to focus on just one win from 2024,” he said, adding that he is “most proud of” CarDon’s work in advancing value-based payment (VBP) programs at facilities, particularly those that contributed to cost reductions in Medicare and elevated CarDon’s role in the sector.

Investments in new service lines, staffing and footprint

In 2025, CarDon plans to boost investments in new service lines, pharmacy integration and workforce initiatives, he said.

CarDon is planning to expand existing locations and add new locations in Indiana.

“Smart growth is a key priority for us this year and into the future,” Cattell said.

CarDon is family-owned and operates 20 communities. Its recent investments include additions in assisted and independent living options.

“We want to make sure that when we make an investment, it is one that is done with the long view in mind,” he said.

Despite market challenges, CarDon has no plans to downsize and remains “very bullish” on its current footprint. The company’s model of care integrates a full range of services from short-term rehab to memory care, all supported by a strong interdisciplinary team and long-standing use of telehealth.

On staffing challenges, Cattell reports improvement in certified nursing assistant (CNA) and registered nurse (RN) hiring, having added 125 new team members this year. And, agency staffing is now down to zero in 16 of its communities.

For staffing initiatives, in addition to traditional workforce development tools like loan assistance and career pathways, CarDon is also focused on workforce development of leaders, offering two internal leadership programs such as the Leadership Acceleration Program, or LEAP, for first-time managers, and the CarDon Leadership Academy for senior staff.

“Our leaders are asking for more leadership training, which is remarkable,” he said.

Regarding service lines, CarDon has added an in-house pharmacy, expanded its nurse practitioner workforce, and launched a companion care service. Cattell explains that companion care supports both residents in the community and those recently discharged: “Helping that individual get back into their home… particularly if family is not available.”

Driving down systemic costs

CarDon has been able to drive down systemic health care costs and Cattell shared key strategies behind those improvements.

The organization’s 30-day readmission rate is at 12%, which is significantly below the national average of 25% and Indiana’s 23%, Cattell said. Also, CarDon’s average length of stay has dropped to 18.5 days. Meanwhile, Cattell also showcased his company’s dialysis readmission rate of 14%, which is starkly better than the national average for outpatient dialysis of 34%.

These results reflect CarDon’s strong coordination between internal teams and external partners, especially hospitals, he said.

“We have advanced care planning and palliative care discussions way up front to make sure they align with patient and family goals,” which, Cattell explains, not only increases quality but also reduces cost of care.

CarDon is actively engaged in Affordable Care Organizations (ACOs) and Institutional Needs Plans (I-SNPs), working with two I-SNP partners currently.

“It is true that if you focus on doing the right thing for the resident, everything falls in place,” says Cattell. He also pointed to early and proactive discharge planning, post-discharge follow-up, and strong interdisciplinary team coordination as vital to keeping residents healthy and out of hospitals.

And, CarDon continues to embrace Medicare Advantage (MA), despite administrative burdens.

“We try to approach it from a partnership perspective,” says Cattell. “It’s not always easy… but the plans need to be open to change.”

As for regulatory compliance, that remains a strength for the company, with Cattell noting that CarDon typically receives 50% fewer citations than the state average as the company works hard to remain survey-ready at all times.

The transition into Cattell’s new role has been smooth, allowing him to focus on leading up a comprehensive strategic and financial planning process that will guide CarDon’s next several years, he said.

“We’re sought after by residents and their families, by hospital systems and physician groups, because we have the best people in wonderful communities in which to care for our residents, and we’re going to keep investing in both our people and communities,” he said. “We’re halfway through CMS’ 2030 accountable care goal and those next five years for us are going to be very important with new leadership and new and new focus and new vision.”

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