Throughout Andrew Carter's career as a healthcare administrator, he has recognized nurses as powerful advocates for their patients. "They're a group of professionals who put greater emphasis on doing their work than telling their own story," said Carter. "I love to tell the story." Carter recently began his tenure as CEO and President of the Visiting Nurse Associations of America (VNAA), where he will have ample opportunity to tell the story of home health nursing to policy makers as they make decisions with critical ramifications for member VNAs.

"The VNAA will continue its strong focus on advocacy and promoting our members," said VNNA Board Chair Nancy Roberts. "In the coming years, we see advocacy and policy as focal areas, as we recognize the huge implications for our members in the current healthcare debate. Andy has a strong policy background, as well as strong and effective communication skills. He is going to be a very effective player in that debate."

As president of the Ohio Children's Hospital Association (OCHA), Carter increased Medicaid reimbursements to his member hospitals by $65 million over 4 years. He says he has succeeded with payers by impressing upon them the distinct and essential role that children's hospitals play in the healthcare system and their strong dependence on Medicaid. (One member drew 53% of its revenue from Medicaid payments.) "Even a tiny adjustment in the payment system could reverberate dramatically," said Carter. "The same is true of VNAs and Medicare."

In addition to winning more equitable payments for members, Carter was recognized as a skilled communicator who garnered awards from such groups as the Public Relations Society of America. Before taking the helm at OCHA, Carter had run his own healthcare consulting firm and held leadership positions with Foundation Health Corporation, the state of Massachusetts, and Catholic Charities. He holds a master's degree from the John F. Kennedy School of Government at Harvard and an undergraduate degree from Georgetown University. Much of his career has been spent in advocacy for people whose access to healthcare was threatened. "My longtime concern for Americans who are at risk of being overlooked by the delivery system drew me to this job, and it will drive my efforts on behalf of this vital part of the healthcare safety net," he said.

Carter succeeds Carolyn Markey, who retires after a decade leading the VNAA. When Markey took the reins, member updates were faxed out because most VNAs didn't have Internet access, remembered Roberts. She praised Markey for many accomplishments, including establishing a Washington, DC office, expanding member services through grantsmanship and corporate partnerships, and building a strong leadership team. Through CHAMP, a distance learning program that helps nurse managers institute evidence-based practice, Markey helped bridge the gap between academia and home health practice, said Roberts. The emphasis CHAMP places on quality strikes a chord with the new CEO. "VNAs provide $240 million in charitable care, regardless of patients' ability to pay and regardless of reimbursement," said Carter. "We need to demonstrate that VNAs are providing the highest quality of care possible under the circumstance. In a very, very crowded field, we need to differentiate the VNAs dramatically."

Carter met with VNAA members for the first time at the organization's annual meeting in April. Characterizing himself as a "listener and a careful student of what healthcare communities face," Carter said the opportunity to meet with so many members as he assumed the new post was priceless.