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Nov 13, 2016 · 22m · top-founders

EP 477: 3,000 Employees, 30+ Years in Business for Medical Care And Peace of Mind with CEO Debbie Johnston

Nathan Latka · 10m spoken Debbie Johnston · 9m spoken
0:00 / 0:00

gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions

In this episode of The Top, host Nathan Latka interviews Care Advantage CEO Debbie Johnston to explore how she scaled an in-home healthcare business to 3,000 employees across 14 locations while maintaining a deep commitment to philanthropy and patient peace of mind.

How this conversation actually went

Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. Nathan holds 52.3% of the talking time here. How this is scored →

Nathan as informed peer 1.8 Guest teaching 2.2 Guest disagreement 0.5 Nathan pushing back 1.2
05100:0010:0020:001:27–6:19 · Nathan as informed peer 2/10 Preview of Upcoming Episode with Ben Dobbins Nathan introduces the guest and inquires about revenue models and the impact of Obamacare, explicitly admitting his lack of knowledge in the space. Debbie educates him on how home care functions as the most cost-effective alternative regardless of regulatory shifts.6:19–8:23 · Nathan as informed peer 1/10 Personal Inspiration and the Founding Story Nathan steps back to let Debbie share her personal motivation and founding background. Debbie explains noticing early hospital discharges and sharing personal stories about providing care for her terminally ill brother-in-law and elderly parents.8:24–12:00 · Nathan as informed peer 3/10 Pricing Economics and Peace of Mind in Care Nathan drills down on the unit economics of charging 20 dollars per hour, questioning how it covers nurse wages. Debbie corrects his assumption by explaining that the 20 dollar rate applies to companion CNAs rather than registered nurses.12:00–16:10 · Nathan as informed peer 2/10 Tailored Patient Care from Hospital Discharges to Hospice Nathan inquires about patient retention, hospital specials, and Debbie's participation in ABC's Secret Millionaire. Debbie describes the emotional tax of reality filming and promotes her work with the REACH charity.16:11–18:34 · Nathan as informed peer 1/10 Finding Fulfillment and Connecting with Debbie Online Nathan asks Debbie how she maintains personal happiness despite dealing with hospice environments. Debbie shares her philosophy on giving, followed by social links and a mid-roll software sponsorship read.18:34–21:16 · Nathan as informed peer 2/10 The Famous Five Rapid-Fire and Episode Summary Nathan conducts the Famous Five rapid-fire segment with lighthearted banter regarding dating advice. He closes out the episode by summarizing Debbie's company milestones and operational metrics.1:27–6:19 · Guest teaching 3/10 Preview of Upcoming Episode with Ben Dobbins Nathan introduces the guest and inquires about revenue models and the impact of Obamacare, explicitly admitting his lack of knowledge in the space. Debbie educates him on how home care functions as the most cost-effective alternative regardless of regulatory shifts.6:19–8:23 · Guest teaching 2/10 Personal Inspiration and the Founding Story Nathan steps back to let Debbie share her personal motivation and founding background. Debbie explains noticing early hospital discharges and sharing personal stories about providing care for her terminally ill brother-in-law and elderly parents.8:24–12:00 · Guest teaching 4/10 Pricing Economics and Peace of Mind in Care Nathan drills down on the unit economics of charging 20 dollars per hour, questioning how it covers nurse wages. Debbie corrects his assumption by explaining that the 20 dollar rate applies to companion CNAs rather than registered nurses.12:00–16:10 · Guest teaching 2/10 Tailored Patient Care from Hospital Discharges to Hospice Nathan inquires about patient retention, hospital specials, and Debbie's participation in ABC's Secret Millionaire. Debbie describes the emotional tax of reality filming and promotes her work with the REACH charity.16:11–18:34 · Guest teaching 1/10 Finding Fulfillment and Connecting with Debbie Online Nathan asks Debbie how she maintains personal happiness despite dealing with hospice environments. Debbie shares her philosophy on giving, followed by social links and a mid-roll software sponsorship read.18:34–21:16 · Guest teaching 1/10 The Famous Five Rapid-Fire and Episode Summary Nathan conducts the Famous Five rapid-fire segment with lighthearted banter regarding dating advice. He closes out the episode by summarizing Debbie's company milestones and operational metrics.1:27–6:19 · Guest disagreement 1/10 Preview of Upcoming Episode with Ben Dobbins Nathan introduces the guest and inquires about revenue models and the impact of Obamacare, explicitly admitting his lack of knowledge in the space. Debbie educates him on how home care functions as the most cost-effective alternative regardless of regulatory shifts.6:19–8:23 · Guest disagreement 0/10 Personal Inspiration and the Founding Story Nathan steps back to let Debbie share her personal motivation and founding background. Debbie explains noticing early hospital discharges and sharing personal stories about providing care for her terminally ill brother-in-law and elderly parents.8:24–12:00 · Guest disagreement 1/10 Pricing Economics and Peace of Mind in Care Nathan drills down on the unit economics of charging 20 dollars per hour, questioning how it covers nurse wages. Debbie corrects his assumption by explaining that the 20 dollar rate applies to companion CNAs rather than registered nurses.12:00–16:10 · Guest disagreement 0/10 Tailored Patient Care from Hospital Discharges to Hospice Nathan inquires about patient retention, hospital specials, and Debbie's participation in ABC's Secret Millionaire. Debbie describes the emotional tax of reality filming and promotes her work with the REACH charity.16:11–18:34 · Guest disagreement 0/10 Finding Fulfillment and Connecting with Debbie Online Nathan asks Debbie how she maintains personal happiness despite dealing with hospice environments. Debbie shares her philosophy on giving, followed by social links and a mid-roll software sponsorship read.18:34–21:16 · Guest disagreement 1/10 The Famous Five Rapid-Fire and Episode Summary Nathan conducts the Famous Five rapid-fire segment with lighthearted banter regarding dating advice. He closes out the episode by summarizing Debbie's company milestones and operational metrics.1:27–6:19 · Nathan pushing back 2/10 Preview of Upcoming Episode with Ben Dobbins Nathan introduces the guest and inquires about revenue models and the impact of Obamacare, explicitly admitting his lack of knowledge in the space. Debbie educates him on how home care functions as the most cost-effective alternative regardless of regulatory shifts.6:19–8:23 · Nathan pushing back 0/10 Personal Inspiration and the Founding Story Nathan steps back to let Debbie share her personal motivation and founding background. Debbie explains noticing early hospital discharges and sharing personal stories about providing care for her terminally ill brother-in-law and elderly parents.8:24–12:00 · Nathan pushing back 3/10 Pricing Economics and Peace of Mind in Care Nathan drills down on the unit economics of charging 20 dollars per hour, questioning how it covers nurse wages. Debbie corrects his assumption by explaining that the 20 dollar rate applies to companion CNAs rather than registered nurses.12:00–16:10 · Nathan pushing back 1/10 Tailored Patient Care from Hospital Discharges to Hospice Nathan inquires about patient retention, hospital specials, and Debbie's participation in ABC's Secret Millionaire. Debbie describes the emotional tax of reality filming and promotes her work with the REACH charity.16:11–18:34 · Nathan pushing back 0/10 Finding Fulfillment and Connecting with Debbie Online Nathan asks Debbie how she maintains personal happiness despite dealing with hospice environments. Debbie shares her philosophy on giving, followed by social links and a mid-roll software sponsorship read.18:34–21:16 · Nathan pushing back 1/10 The Famous Five Rapid-Fire and Episode Summary Nathan conducts the Famous Five rapid-fire segment with lighthearted banter regarding dating advice. He closes out the episode by summarizing Debbie's company milestones and operational metrics.

speaking balance: gold is Nathan, purple is the guest (3 minute bins)

0:00 · Nathan 97.8% · guest 2.2%0:00 · Nathan 97.8% · guest 2.2%3:00 · Nathan 41.9% · guest 58.1%3:00 · Nathan 41.9% · guest 58.1%6:00 · Nathan 25.3% · guest 74.7%6:00 · Nathan 25.3% · guest 74.7%9:00 · Nathan 45.7% · guest 54.3%9:00 · Nathan 45.7% · guest 54.3%12:00 · Nathan 19.3% · guest 80.7%12:00 · Nathan 19.3% · guest 80.7%15:00 · Nathan 40.2% · guest 59.8%15:00 · Nathan 40.2% · guest 59.8%18:00 · Nathan 74% · guest 26%18:00 · Nathan 74% · guest 26%21:00 · Nathan 95.2% · guest 4.8%21:00 · Nathan 95.2% · guest 4.8%
Sharpest disagreement ▶ 20:24 Playful resistance on relationship question

Debbie humorously pushes back when Nathan presses her to reveal what she has learned about men, jokingly calling him mean.

 Hardest push from Nathan ▶ 9:21 Nathan presses on pricing sustainability

Nathan refuses to accept that full nursing care can be provided at 20 dollars per hour and repeatedly presses Debbie to explain the underlying margin genius.

 Biggest teaching moment ▶ 9:48 Clarifying CNA vs RN care tiers

Debbie corrects Nathan's conflation of general caregivers and registered nurses, defining the different skill levels and associated billing tiers.

 Nathan holds their own ▶ 8:24 Nathan dissects the unit economics

Nathan challenges the financial viability of home care rates by analyzing labor costs against potential state and federal healthcare subsidies.
the scores for every segment, with the reasoning behind each
ChapterTopicNathan as informed peerGuest teachingGuest disagreementNathan pushing backWhy
Preview of Upcoming Episode with Ben Dobbins 2312 Nathan introduces the guest and inquires about revenue models and the impact of Obamacare, explicitly admitting his lack of knowledge in the space. Debbie educates him on how home care functions as the most cost-effective alternative regardless of regulatory shifts.
Personal Inspiration and the Founding Story 1200 Nathan steps back to let Debbie share her personal motivation and founding background. Debbie explains noticing early hospital discharges and sharing personal stories about providing care for her terminally ill brother-in-law and elderly parents.
Pricing Economics and Peace of Mind in Care 3413 Nathan drills down on the unit economics of charging 20 dollars per hour, questioning how it covers nurse wages. Debbie corrects his assumption by explaining that the 20 dollar rate applies to companion CNAs rather than registered nurses.
Tailored Patient Care from Hospital Discharges to Hospice 2201 Nathan inquires about patient retention, hospital specials, and Debbie's participation in ABC's Secret Millionaire. Debbie describes the emotional tax of reality filming and promotes her work with the REACH charity.
Finding Fulfillment and Connecting with Debbie Online 1100 Nathan asks Debbie how she maintains personal happiness despite dealing with hospice environments. Debbie shares her philosophy on giving, followed by social links and a mid-roll software sponsorship read.
The Famous Five Rapid-Fire and Episode Summary 2111 Nathan conducts the Famous Five rapid-fire segment with lighthearted banter regarding dating advice. He closes out the episode by summarizing Debbie's company milestones and operational metrics.

Statements from this episode (9)

Disclosure
Care Advantage charges approximately $20 per hour for companion CNAs
“It runs about for a companion CNA about 20 dollars an hour.”
Debbie Johnston Nov 13, 2016 ▶ 4:56
Insight
Johnston: Home care is always the least expensive healthcare option
“No matter what kind of care comes down the pike, we know that home care is always going to be the least expensive, and it's the push for facilities to keep people in their home.”
Debbie Johnston Nov 13, 2016 ▶ 5:44
Assertion Not checkable as stated
Johnston saw hospitals discharge up to 70 unready sick patients daily
“Running outpatient services for a hospital, and I saw it go from where we went and had zero outpatients to like, 70 a day, and we were pushing people out, and they were sick, and I'm like, oh my gosh, these people aren't ready to go home”
Debbie Johnston Nov 13, 2016 ▶ 6:43
Assertion Not checkable as stated
Johnston observed hospice patients becoming younger and more numerous
“We had a fair number of hospice patients, and unfortunately, they seem to get younger and younger and more and more.”
Debbie Johnston Nov 13, 2016 ▶ 7:38
Disclosure
Most private duty in-home care is paid out-of-pocket, not by insurance
“Well, a lot of it is private pay. It is unfortunate that our third party payers don't always pay for the care advantage side, the private duty side. That tends to come from the patient.”
Debbie Johnston Nov 13, 2016 ▶ 8:44
Assertion Not checkable as stated
Johnston: Care Advantage has roughly 3,000 field employees
“We have 3000, probably, field employees, and then each office has anywhere from three to five people in it that manage those people.”
Debbie Johnston Nov 13, 2016 ▶ 10:29
Assertion Not checkable as stated
Johnston: Care Advantage serves roughly 500 active patients
“We probably have 500 patients, and I think I'm being conservative.”
Debbie Johnston Nov 13, 2016 ▶ 11:53
Disclosure
Debbie Johnston: Care Advantage offers a $69 hospital discharge package
“We have a 69 dollar special where we come to the hospital, pick you up, take you by the pharmacy, set you up in your home, and make sure everything's good, and you're good, and then we leave.”
Debbie Johnston Nov 13, 2016 ▶ 12:34
Assertion Not checkable as stated
ABC's Secret Millionaire films participants 14 to 16 hours daily
“In terms of what people don't know about those kind of shows is they film you for 14 to 16 hours a day and ask you the same questions over and over again, and it's just physically, it was physically and emotionally very taxing.”
Debbie Johnston Nov 13, 2016 ▶ 14:15
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