At a time when the hospice industry is grappling with intensifying competition and only modest increases in benefit utilization, renowned hospice executive and industry advocate Carla Davis brought clarity and strategy to the forefront in an education session at the 2025 Axxess Growth, Innovation and Leadership Experience (AGILE).
Drawing from years of operational leadership and market expertise, Davis guided attendees through key data trends shaping the current hospice landscape and offered actionable insights on how organizations can not only survive but thrive, achieving sustained double-digit growth even in a crowded market. Below are her takeaways.
Understanding the Landscape
Davis began by framing the current state of hospice care. While overall utilization has grown over the past 15 years, that growth has slowed significantly in the last five.
Meanwhile, the number of hospice providers has increased by 50% over the past decade, causing the average census per provider to drop to around 50 patients.
“The average census per hospice is at the lowest point in ten years right now,” Davis said.
This means more hospices are competing for the same patient population, making growth harder to achieve.
She also noted a subtle but important trend: although the average length of stay has increased, the median length has remained flat, suggesting that while some patients receive extended care, most still enter hospice late in the disease process.
Combined with rising spending, these dynamics are drawing increased scrutiny to the industry.
Strategic Levers for Growth
Faced with these challenges, hospice providers must adapt. Davis offered a set of strategic levers designed to help organizations grow sustainably in a competitive market:
- Service Line Diversification: Expanding offerings beyond traditional hospice care to meet broader patient needs and create new referral pathways.
- Partnership Development: Building strong, mutually beneficial relationships with healthcare partners.
- Key Account Management: Nurturing high-value accounts, treating your most prolific referral partners with extra love and care.
- Payer Engagement and Education: Understanding payer structures and proactively educating case managers, nurse navigators and medical directors about hospice eligibility. Soft education to beneficiaries, such as hospice benefit notices, can also drive awareness and long-term impact.
- Direct-to-Consumer Marketing: Reaching patients and families where they are, including on social media.
- Community Integration: Including local organizations like senior centers and Alzheimer’s Association chapters in your sales strategy. These relationships often lead to longer stays and deeper community trust. “Every salesforce I’ve ever led, I have required community accounts to be a part of their sales plan,” Davis said.
Immediate Actions to Drive Growth
To complement long-term strategies, Davis outlined practical steps organizations can implement right now to accelerate growth:
- Lead at the Local Level
Growth isn’t just a leadership directive, Davis explained; it’s a cultural mindset that must permeate every level of the organization.
“Everyone has to be connected to the fact that we want to help more people,” she said, emphasizing that local leaders are the catalyst for this shift and should set the tone that growth equals impact.
“You may be a part of a larger organization, and certainly the top leader does matter, but in a market, it’s really who on the ground is leading and do they set the tone that growth is the fulfillment of the mission?” she asked.
- Reframe Complaints as Opportunities
“You can tell a lot about an organization by how they handle a complaint,” Davis said. Instead of viewing them as setbacks, treat them as opportunities to identify gaps, improve processes and build trust.
- Engage Medical Directors in Growth Conversations
Medical directors play a critical role in ensuring eligibility and care plan appropriateness, but they can also be powerful growth partners.
“If you have the right medical director who’s not afraid to speak in the community or introduce you to their partners or peers, that is game-changing,” Davis said.
- Simplify Front-Door Management
Admissions are the gateway to impact. With urgency as a guiding principle, Davis shared how her team launched an inpatient unit in just eight days to meet critical needs during the COVID-19 pandemic.
“Improbable doesn’t mean impossible,” she said, reminding the audience that eligibility and patient choice are the only two requirements for admission. Overcomplicating access, she warned, can mean missed opportunities, leaving patients and families unsupported in critical moments.
- Assess and Optimize Your Sales Strategy
Growth requires clarity about who you serve, how you reach them and what impact you want to make, Davis said, urging organizations to take a hard look at their market position and sales structure.
“What are we striving to be?” she asked. “How does that compare to actual utilization?”
She recommended evaluating salesforce territory and account load.
“Most good sales leaders would say that 50 to 75 [accounts] is the max you should ever have,” she said. “You should be breaking them down into As, Bs and Cs. Have your top ten as your As, your medium targets as Bs and Cs, and your call plan should correlate.”
- Strengthen Afterhours Care
Organizations that deliver responsive, clinically sound support on evenings and weekends stand out in the market and earn lasting loyalty from referral partners.
“Referral partners will love you,” Davis said.
She encouraged leaders to regularly audit their afterhours protocols to ensure triage teams are empowered, documentation is streamlined and escalation pathways are clear.
Davis’ strategies emphasize not just operational excellence, but a deeper commitment to mission: helping more people, more effectively, in life’s most vulnerable moments.
To continue learning from leaders like Carla Davis and connect with peers driving meaningful change, join us next year for AGILE 2026, May 4-6 in Dallas. Click here to register.
