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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton


How Much Should You Spend on IT?

Seven steps to help you better position your organization to answer the question

By Steven Heck


“How much should we spend on IT?” I have been asked this seemingly simple question for more than 30 years. The answer has always been the same. It depends on what you want to get back.

The answer was less complicated when computers didn’t do very much and the automation of mundane manual tasks was obvious. Providers tackled mainframe-based billing in the 1970s. We developed functional ancillary systems when the mini-computer explosion took place in the ‘80s, and we started using smart desktops for order entry by the ‘90s. In the early years of the new millennium, computers and software finally began to directly impact patient care. Technology has now become ubiquitous, and health care is highly dependent upon both its effectiveness and its availability.

As technology moved from the back rooms to the bedside, we fought a related series of skirmishes as we centralized and standardized IT functions, from departments to hospitals to delivery systems. Each battle revolved around the specific need of a group versus the collective need of the integrating entity. But little was said about how IT was measured and evaluated. Adding complexity was the fact that we are a highly regulated industry. At every turn, our direction has been heavily influenced by the newest regulation; if diagnosis-related groups (DRGs) were a teaser, the American Recovery and Reinvestment Act (ARRA) and the Affordable Care Act (ACA) were tidal waves. And as the waves passed through, we still managed to avoid the question of how to view IT assets. Leadership instinctively bought more stuff, but collective insight and communication about incremental value simply did not take place.

During the past five years, the industry has poured money into IT to comply with the ARRA and ACA, even as the economics of health care have become more challenging. The piggy bank is depleted and depreciation is pounding operating margins. The cost-cutters have been summoned, and that nasty question is now being asked across the nation: How much money should we spend on IT?

As with most important questions, there is no simple, off-the-shelf answer. You must have strong people, a powerful culture, and consistent leadership to even know that it is a hard question to answer in a meaningful way. After spending too much of my career as an expert witness on benchmarking litigations, I can assure you that the answer will not come from a hired gun with a proprietary database. You must dissect your expense structure, align incentives, and stop treating IT as some mystical overhead expense. IT, for the most part, is an investment and should be treated that way. Expect hard return on investment (ROI), but understand that you will achieve that ROI only if you baseline and measure.

Here are seven steps to help you better position your organization to answer the IT spending question:

  • Establish a baseline of all your technology assets. This includes people, equipment, licenses, and contractual obligations.
  • Once you have a baseline, keep it current. Figure out a way to make this a regular discipline.
  • Acknowledge that most of your “lights on” production support costs are fixed. They should be understood and compared to those of similar organizations, but they’re not going away unless you turn off the associated systems. The expense is directly tied to how much and how well you are expected to support operations.
  • Have strong IT governance and establish guiding principles to ensure you do not inflict long-term pain. A few frightfully obvious areas include business continuity, security, and refresh cycles. If you’re still fighting to get off of Windows XP, for example, you have a problem. And remember, just because we call these fixed costs doesn’t mean they won’t increase. It just means that they are not discretionary.
  • Differentiate between fixed and discretionary expense. Some projects are mandated or unavoidable (ICD-10, meaningful use). Most projects, however, are discretionary and should be treated that way. What is the hard dollar return and how does it improve both patient and clinician’s experience? Who owns the investments and how will we know if the effort was successful? Most importantly, who owns the responsibility to collect that return?
  • Most provider organizations continue to have too many small projects that consume too many resources without keeping score. These activities also make macro-level benchmarking an exercise in futility. Keep small projects short (and finish them), and develop strong IT governance to keep the number under control.
  • Steal the best from the commercial IT outsourcing model. Continuously measure the scope, service levels, and cost of production services. Treat new investments (projects) as investments, expect a return and remember they will become part of the future production environment.

Finally, consider putting an end to annual allocations of IT expense. Direct costing to a central source increases system alignment and removes the unfair taxation argument that is part of every budget cycle. When you understand how and where your IT expenses are going, it helps a great deal. It helps much more if you understand the value derived from the technology that you deploy. If you understand both, then you won’t have to ask how much you should spend on IT.


About the Author: MedSys Group President Steven Heck has more than 35 years of experience in health care information technology, including consulting and sourcing skills in the provider, payer, and life sciences segments of the health care industry. Heck is responsible for overseeing MedSys Group’s Advisory Services Division, which focuses on three major service areas: Best Practices, to achieve the efficient use of IT resources; Practice Redesign and Optimization, to dramatically improve returns from huge IT investments of the last five years; and IT Planning. Many of the country’s leading health care organizations have sought his leadership and advice on investment, planning, and deployment strategies. Heck is a frequent speaker at Scottsdale Institute, HIMSS, CHIME and the Outsourcing Congress.






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