Caribou Rewards, a rewards and engagement application built to elevate care agencies to world-class employer status, has announced its official partnership with Right at Home, becoming the national in-home care provider’s preferred rewards and recognition partner for their 433 locations throughout the United States.

Right at Home franchises undertook a 6-month competitive pilot program to inform vendor selection, which was initiated at the end of 2023 in an effort to improve overall caregiver experience.

Specifically, they set out to increase staff engagement, bolster recruitment efforts, and improve caregiver retention. To determine the choice partner, Right at Home compared performance data and qualitative feedback from caregivers, office staff, and agency owners.

Caribou’s mission is to fuel excellence across organizations through automated rewards and recognition programs designed to make caregivers feel seen and valued. In September, Right at Home US selected Caribou after achieving exceptional results in the pilot program, illustrating positive business outcomes for all participating franchises.

“Simply put, Caribou won in every category,” says Jessica Schultz, director of people strategy at Right at Home. “Caribou continues to drive new integrations, and new build-outs to fit our needs. Their adaptability, and their willingness to listen and learn, was unmatched. Plus, their customer service level was superior, and their platform readiness was mature.”

Caribou’s automation capabilities played a vital role in the selection process, as Right at Home franchises prioritized ensuring office staff had no extra work on their plate while administering a new program that seamlessly integrated with their existing scheduling system.

“Our aim is to help our agency partners become outstanding employers and great businesses through a technology-enabled culture that puts caregivers first. This partnership signals Right at Home’s commitment to being an industry leader in using technology to improve the caregiver experience, as well as overall business performance,” says Christian Alaimo, Caribou’s co-founder and chief operating officer.

“The results with Right at Home franchises show how powerful rewards and recognition can be for any in-home care agency’s growth goals and operational efficiency,” Alaimo says.

Within six months, Right at Home pilot franchises saw 15% growth in active staff, 15% improvement in Electronic Visit Verification, and a 65% improvement in retention for new hires.

“Since our inception, Caribou has helped agencies improve their operational efficiency while directing money back into the pockets of caregivers,” says Alaimo. “We’ve put over 5 million dollars in the pockets of hard-working caregivers. It’s a virtuous cycle that positively impacts every stakeholder in the ecosystem.”

Rosaleen Doherty, co-owner at Right at Home Boston, has been using Caribou since 2022, and notes the success she has had with the platform.

“Caribou is a way for us to reach people across our entire company, and help them be seen for the great work they do. We know this equates to job satisfaction, and that’s what we’re all aiming for with our teams,” Doherty says. “Thanks to Caribou, we have a tool in our toolbox that helps us reward our team easily and immediately — without any extra administrative work.”

To date, upwards of 3,000 Right at Home caregivers across eleven states are using Caribou with their local Right at Home office to get points, redeemable for cash incentives, for clocking in and out, referring qualified candidates for open roles, completing important onboarding tasks, or picking up extra shifts.

“We’re excited to see how this partnership evolves year after year, and our Right at Home franchises will be thrilled to have access to a tool like Caribou that their caregivers love,” says Schultz.

Caribou fuels excellence across entire organizations; improving retention, recruitment, and staff performance, all while improving overall operational efficiency. Caribou’s referral programs have generated thousands of hires for agencies, moving the needle on the caregiver shortage that impacts the lives of millions. Find out more about Caribou’s mission at www.caribou.care.

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Home Health Care News: Today we have Mark Salley from ElaraCaring, one of the nation’s largest providers of home-based care.

ElaraCaring has a footprint in 18 states, in the Northeast, Midwest, and Southwest, with approximately 26,000 caregivers in more than 200 locations, serving over 60,000 patients and their families every day. Ellen Kuebrich is with CareXM. CareXM helps home health hospice and health system providers lower costs and increase clinician capacity with high-touch, proactive triage technology and services, including 24/7 nurse triage, medical answering service, RPM and telehealth, and patient engagement solutions.

As we know, the health care industry is facing significant staffing shortages and rising patient demands. With that as the backdrop, I’m wondering if you can both discuss how virtual health technology addresses these challenges and why is it so crucial given this landscape?

Mark Salley: CareXM and ElaraCaring have been working together for quite a while now, and it’s going to be nice for us to be able to share the things that we’ve worked on together in the past, what we’re currently working on in pilot setups today, and talk about some strategies for the future.

The problem, as you set it up, is that our challenges are related to staffing. We know that there’s a shortage of clinicians in the community, and along with that, the cost wage increases that go along with that. The second was the complexity of our patient population. As patients are coming to home care, bypassing nursing homes and rehab centers, it becomes a bigger challenge for us. Patients need more care in the home. I would add one-third, which would be financial, and that’s everything that we just heard about in the last session here, regarding our, let’s call them partners, in the insurance world and what challenges that has for us.

How can virtual health care help with these challenges? I know we’re going to talk about a lot of topics. I’ll just bring up one as an example here, to say that in home care, a very unique situation where we’ve got clinicians driving all over. At ElaraCaring, our average amount of time to drive is about 15 to 20 minutes, but that’s just an average. We are in some very rural areas as well. We could be driving twice that far.

To think about how utilizing virtual can help to alleviate the staffing crisis, give us a better opportunity to take more patients. We know right now that 50% of all referrals coming to home care are actually that home care agencies are able to accept. With virtual, hopefully, we can accept more of those referrals. Of course, with virtual, the hope is that we’ll be able to do these services at a reduced cost.

HHCN: Yes, great. Ellen, thoughts from you on this one?

Ellen Kuebrich: Yes, I think that you’ve got really three immovable constraints. We’re not going to see a let-up in the staffing crisis. We don’t have as many people entering the workforce. We’re seeing that birth rates are lowered. We’re also seeing holds on immigration. There’s not going to be a magical fix for the workforce. We would love a magical fix for reimbursement, but if history is a predictor of the future, we may not see that either. Then you’re going to see that we have this immobile wave of people coming in that are going to demand health care in the home. I think the challenge for providers and operators is we feel like we’re in a really tough spot.

I don’t think it’s if we need to innovate, it’s when we need to innovate, and we need to innovate now. Virtual visits provide a lot of capacity for clinicians that they didn’t have before. You’re able to get better access to care for your patients. As Mark said, we are accepting patients in more and more rural areas that don’t have as much access to care. One benefit that we have is it’s not a replacement in any way. For an in-person visit, it’s a supplement. All of a sudden, you’re getting into high-touch, high-tech care, which is improving the patient experience and their outcomes, but you’re able to do it at a reduced cost and a reduced amount of time.

HHCN: Yes, great. That word efficiency has come up in a few panels already today. Glad it’s making an early appearance here. With the increasing need for operational efficiency, how does virtual health technology help reduce clinician burnout specifically and streamline that health care delivery?

Kuebrich: I think Mark has a really good point, and that’s what we see with our other clients that are doing virtual visits with us. The average amount of time for an in-home visit ranges from 50 minutes to an hour, and that includes the drive time of 15, 20 minutes on either side capping that visit. A virtual visit, in contrast, is 15 to 20 minutes, obviously with no drive time. We found with Enhabit, for example, that they had their virtual visit team able to do 50 patient visits per week where their on-the-ground team was doing 20. Two-and-a-half times capacity for those clinicians. They’re able to see more patients.

I also think that there’s a very emotional connection that our clinicians have to our patients that does need to be addressed. This is something Mark and I have talked about, if you feel like that patient needs you in their home, but you’re actually able to connect to your patients more frequently with a virtual visit, and it doesn’t feel like they’re getting less personal time with you. It’s still just a way to increase that touch. I think the capacity relief is one thing for nurse and clinician satisfaction, but I think also the ability to maybe see a patient more often than they would have been able to with just in-person visits alone really fulfills them in their need to give care.

HHCN: Great. Mark, anything you’d add?

Salley: I get the opportunity to meet with a lot of our field staff on a fairly routine basis getting around the country. Before I share with them what I’m there to talk about, I like to give them an opportunity to share with me. I often hear about the stresses that they’re dealing with, and if I could point out the two biggest would be documentation, which we heard earlier today, the vast amount of documentation that they are currently doing, the time that it takes for them to get that into our EMR. We were promised when EMRs came along that documentation was going to be easier. I don’t think that that’s held true.

The other stress that I hear them say often is the complexity of the patient and how they’re alone in the community. They just feel this pressure, this high level of responsibility to improve the lives of the patients that are becoming more and more challenging. Using technology to help our nurses, I can share that this year we implemented a new technology called Swift. I’m sure many of you have heard of it. It’s a digital wound care management tool, and it gives our nurses the ability to take a high-quality digital picture of a wound. That picture does something that the nurses used to have to do themselves, measures the length, the width, and even the depth.

We’ve helped them in that regard, helping them just take that burden off of them. From a virtual perspective, I can see now how our wound care specialist, who’s now able to support all of the nurses throughout the entire service area without actually having to drive to all of those patients, she can now see all of those wounds, see which ones are improving, which ones are not, and then what I’d like to see is a virtual visit along with that.

Maybe it’s the in-home nurse with the patient and our wound care specialist, and having that three-way conversation, maybe our specialist needs to help teach the patient a little bit more about the complexities of wound care. Now, our nurses feel a bit more supported with these very difficult patients in the community.

HHCN: Mark, curious on the rehab programs that ElaraCaring offers. Any examples you can share there on how you’ve integrated virtual visits?

Salley: Yes. I’m blessed at Elara. I have a wonderful partner in my therapy role who helps the company everywhere in the South. I manage just the Midwest and the Northeast. Phyllis and I have wanted to get into virtual visits for some time. As we thought about it, we realized that we needed to build a better electronic platform before we could implement virtual visits for therapy. It’s a little bit different from nursing. About a year and a half ago, we implemented the MedBridge Home Exercise Program system, which I hope many of you have heard.

In the therapy world, MedBridge is the leading HEP company. It’s fantastic. It gives us wonderful home exercises, videos of the exercises that we want our patients to do. It also gives great educational material to go along with teaching the patients about maybe the total knee that they just had, teaching patients how to get off the floor if they fall. I used to have to demonstrate that myself. Now, I’ve got the video to help. This year we just added another technology called Constant Therapy. It’s relatively new in the market in homecare.

Constant Therapy is designed for our speech therapists. Constant Therapy addresses the cognitive and speech language issues that our neurological patients have. This platform is similar to MedBridge in that it helps them to develop a home exercise program. It has some built-in AI in it. It’s fantastic how once the speech therapist sets it up, and our patients can perform these activities on their own, when the patient answers questions accurately and quickly, the system automatically makes the next question more difficult. When we’re not there, the patient is actually progressing on their own. Our clinicians are seeing that progress.

We haven’t implemented virtual visits yet for therapy. We’ve got the platform in place. As of now, we’re in the middle of a pilot project with CareXM. We’re utilizing their platform to do visits, all disciplines, but with our therapy team, thinking about how they can now use the technology that we gave them. Then the next step will be being able to do visits remotely, augmenting what they do. Both systems allow them to change and alter the exercise program according to how the patient’s feeling, making it harder or easier.

Kuebrich: I would say it was a comment made earlier that you should ask your technology vendors to make changes or to help you to innovate. Mark asked for some features that we haven’t had in the clinical nursing virtual visits, but screen sharing and turning a screen around are being added so that he can show exercises. I would say ask your vendors. They’re partners with you. We want to help improve care and make it easier for your clinicians to do their jobs. If there’s innovations like Mark had for therapy, we want to hear about them.

HHCN: Have you found any difference in how patients in rural areas are able or willing to access virtual care?

Kuebrich: I can speak to that. One thing we’ve seen over our history with virtual visits is you can’t make it hard to do for a patient. While I would disagree that our patients are not tech-savvy at all, I think we’ve gotten beyond that. Everybody’s got cell phones these days. It’s not that wild for them to be using a cell phone. If you pulled out your phone right now, I’d be surprised if any of you had less than 100 apps on your phone. What’s not useful is when you give them a specific app, and then they have to remember, what’s the app? What’s it look like? In time for my visit, now I’m late for my visit.

It’s just not a successful way for them to access care. We developed a way where the system just sends a link to their phone via text message or email that they just click on, and they’re in a secure virtual visit. Making it really easy, whether they’re rural, whether they’re urban, we found that it really improves compliance with keeping those visits and makes it nice for the patient.

I don’t know if any of you have had people over your house, and you’re rage cleaning for an hour before, just trying to get everything ready. It’s so stressful having somebody come into your home, and it’s tiring for an elderly patient. I think that we’ve moved beyond the mindset that this is not as good as a physical visit. It in no way replaces it, but in a lot of ways, it’s actually caring for your patients better when you’re not having them prep the home. They’re not having to prepare tea to have with you. They’re just able to hop on, have a quick visit, get that face time with their provider, and then go about their day.

Salley: If I could just add to what Ellen said with regards to the quality of the virtual visit. The NIH did a study last year looking at the effectiveness of virtual visits during COVID. They found that 97% of patients were very satisfied with the virtual care that they received during the pandemic and that there was a higher amount of satisfaction using video with audio versus audio alone. When it comes to the rural areas, I’d say the biggest challenge is the access to that technology if they have high-speed Wi-Fi service. That’s what we see as the issue in some of our rural areas.

HHCN: I just want to make sure, anything else either of you want to say in general how virtual visits stack up against in-person visits in terms of things like reliability and outcomes, things like that?

Kuebrich: Yes, we’ve seen nothing but positive reactions from patients. As Mark said, there’s been studies that show that there’s a really high satisfaction rate. I would also encourage all of you in all sectors of care to really think of how you can use this technology in ways that maybe you haven’t thought of before. Obviously, home health, really easy to do a clinical visit for virtual care, but we actually have a large number of hospice clients that find that this is a really strategic way to use virtual care as well.

When you have a hospice call, and you’re sending a nurse to the home, but it is a transition call or a death call, and you have a family that is in the worst state that they’ve ever been, it’s actually really helpful to say, “I’ve got a nurse on the way, but I’m going to do a virtual call with you right now,” so that they have a nurse face-to-face to give them that compassion and empathy. Even though they’re not providing the care, they are providing that communication. That’s then where we see outcomes in CAHPS surveys with timeliness of care, efficacy of care, even though this wasn’t an official visit, this really improved their care experience along the way.

HHCN: Terrific. Mark, anything you would like to add there on just general acceptance and reliability?

Salley: I’ll say from a technology standpoint, we’re right now analyzing our constant therapy program, and it’s amazing how much activity is happening when we’re not in the home. To say that for every hour that our speech therapist is in the home with the client, the patient is spending another 7.2 hours. That’s pretty impactful. We know that they’re going to be healing much quicker, learning much quicker if they’re doing it on their own.

In therapy, we’ve always had the question of whether or not people were doing their home exercises on their own. Both MedBridge and constant therapy give us this ability with technology to start to measure the acceptance and the engagement of the patients to what we know, and we feel is important for them.

HHCN: As a journalist, I love to hear stories. Are there any success stories you want to share in terms of whether it’s ElaraCaring or other clients, how they’ve started to integrate this technology?

Kuebrich: Yes, Mark and his team have just really started the virtual visits. They’re much more down the road in our remote patient monitoring and patient engagement. We do have another client that really found that the virtual visits allowed them to scale census as well as really pay for themselves with reduction in readmissions and revocations. They have, gosh, seven, eight states doing virtual visits.

I will say that one of the strategies I’d recommend if you’re considering a virtual visit program is it seems to be more useful to have a centralized virtual visit team, even if it’s small, even if it’s one or two people, that’s going and doing virtual visits and then have your in-person in the field team out in the field. This streamlines, they don’t have to change workflows, they’re just able to keep doing what they’re doing all day.

That tends to work a little bit better. What this client found is that they were actually able to improve census in those areas that were doing virtual visits by 15% just because they had the capacity to take on more people without adding any more staff. These are the companies I think that are going to really thrive in the next five years or so are those that are saying, “All right, we know these constraints aren’t changing. What are we changing about our business to make that work going forward?”

HHCN: What about handling rural areas with limited internet? Is that something you’re encountering at all?

Salley: Yes, a few weeks ago, I was in one of our branches in Indiana, and I was sharing with them all the wonderful things that we’re bringing their way. They were excited, but at the same time, they were concerned because about half of their population is in the very rural part of Indiana where their patients don’t have Wi-Fi. They’re wondering if they would even be able to use the technology that we’re giving them if their tablets would be connected and be able to use the various tools that we have.

Is it a challenge? It is. Elon Musk, if you’re listening, Starlink, I know that there’s certain areas where it’s working really well, and in other places, it’s a little slower, and the cost is, of course, right now too high. I know that over time that’s going to get better because I can’t see them running hardwire through the cornfields around the country in order to get us the ability to do home care.

Kuebrich: Some different strategies can come into play, too. Obviously, the cell network is getting better and better, so using a cellular signal can help with the virtual visit. For those that are truly rural, they don’t have great cell signals at all, they don’t have Wi-Fi coverage at all. We’ve also found that just some proactive patient engagement is a really nice way to increase those touch points with those patients. It doesn’t have to come via a text or an email. It can come from a phone call to a landline, and we can start doing automated engagements asking to automate those check-in and tuck-in calls.

We’re talking about clinician capacity. One of our clients said that at the end of the day, their clinicians had an extra hour, at least, to do tuck-in calls to hit their patients that they needed to see before the end of the day, an extra hour of work. They switched to our patient engagement, and now that’s done with the click of a button. They add their five patients that they need to do tuck-in calls with. We have communication preferences already built out.

At the beginning of this program, they asked each patient, do you like phone calls, do you like texts, do you like emails? I don’t pick up my phone when it rings anymore, so I would always prefer a text. We have patients that do. They’re in those rural areas. They just have a landline, and it’s a recorded message in that nurse’s voice asking if they need any medications or supplies before they head into the weekend. They’ve just saved an hour of that nurse’s time, but really proactively engaged with that patient.

HHCN: Mark, what future advancements in virtual health technology are you most excited about, and how do you think they will impact these topics we’ve been talking about, like clinician capacity and patient outcomes?

Salley: It seems like every day in the news, there’s some new technology out there for us to use with our patients. When I think about the additional testing that can be done, I would love to get that physiological data added to our remote patient monitor for the EKG, for the respiratory testing that they can do. That’s on you, Ellen. We’re going to work on that.

Kuebrich: Hey, we’re already integrated.

[laughter]

Kuebrich: You just tell me when you want it. [laughs]

Salley: When we think about all the various things that we’re doing, from communication systems, texting patients in the morning that we’re coming to see them now, to all of the technologies that we’re doing, but they’re all separate. I’d love to see the day where it can all come together. In our last session here, they were talking about putting a bit of pressure on our EMR, on our vendor, to help us incorporate that more.

We are the customers. I would love to see a world where every day our AI texts the patient, asks them questions like, “Did you do your remote patient monitoring? Can you get on there now? Did you do your home exercise program?” We already know they didn’t, but can you do it now? Did they take their medications? We should, with technology, be able to identify what patients actually need to be seen today so that instead of just going out there because it’s a Wednesday, we should be going out there because that’s the priority patient for that day with less staff, with less ability and more patients.

How are we going to manage it? We need to know that the visit that we’re doing today is the most important one for that nurse, and we heard it in the last conversation as well, so that they can operate at the highest level of their license to treat the patients that need them the most. Then the other patients that are on the list, maybe some are appropriate for a video virtual visit that day. Maybe an audio-virtual visit would be enough. Maybe they’re the ones that are seen tomorrow instead of today.

HHCN: Ellen, how about your vision for the future and how this technology is going to keep augmenting?

Kuebrich: I think to Mark’s point, I’ll tell you a story. We’re meeting with an operator that is using us for both triage and for engagement in virtual visits, and he said, I look at the visit notes every morning, the patient was great. They were happy to see me. That’s just a clear indication that we are not looking at visit prioritization. We’re looking at just visits for visits sake. I’m with Mark. We have both sides of our business. We have probably the most data about why patients are calling in in the after-hours and what failures happen during the day that cause them to need to call in.

We’ve got all of this data from our remote patient monitoring and our proactive triage with patient engagement that I would like to see AI be able to mine that data to predict who needs the visit that day, who is declining, but maybe not showing it in our nursing notes for visits, but we can tell from calls in the after-hours. That would be really interesting to me because I think that we’re going to have to continue to pinpoint where we deliver care the most effectively and where we could take a step back and do an engagement, a video visit, and where my nurse needs to be that day to help the most critical patients.

CareXM helps home health, hospice, and health system providers lower costs and increase clinician capacity with high touch, proactive triage technology and services. To learn more, visit: https://www.carexm.com/.

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Home Health Care News: Every year we hear that turnover in home care is a major challenge. The latest benchmarking report puts the average turnover in home care at nearly 80%. Even with COVID programs having ended and turnover remains this huge issue, in your experience, what are some of the main reasons that providers continue to struggle?

Victor Hunt: First, we always hear this number, 80% thrown around. The big thing for us is really taking a look at where is that coming from? How do we actually talk about turnover in an intelligent way, segment that out because there’s turnover that we’re just never going to win those folks back, the non-preventables. Those folks who maybe caregiving isn’t the right industry for them, but we really like to focus on preventable turnover, those folks who are leaving and going to another agency. These are the people who we really want to zero in on and understand what is it that’s breaking the relationship and why is it that we’re not catching this soon enough to actually address the root because and bring these people back into the fold.

We see this all the time where a lot of folks start off and have an incredibly high turnover. When you really dig into it, it’s no surprise, it’s no mystery. Scheduling is the big issue. Caregivers are here to work. They love what they do, and they want to work. They want a schedule that works for them. They want a patient. They want a client who’s a good fit. The challenge is how do you establish that relationship where you can understand that the client they have is actually someone who’s a fit that’s not going to because they want to go and look for that next shift at the agency up the street.

Alternatively, you’ve got plenty of folks who are fighting these three front wars. You have new clients and existing clients that you’re working with. You have recruiting and you have your existing caregivers. How do you make the time to actually understand is this caregiver enjoying the world they’re in and do I have a good grasp on those caregivers who don’t have an actual good shift. Someone who has been onboarded but for two weeks hasn’t had an update on when they’re getting scheduled, it’s no surprise why these caregivers will leave. The challenge comes down to how do you give that back office, how do you give that staff the ability, the tools to scale, so that they can find those issues and get to them quickly.

Kunu Kaushal: I’d say we’re a bit more controversial. We actually enjoy turnover. We’re digging for gold. We look at caregivers as an opportunity for figuring out who the good ones are. You have to be open to the applications. You have to let them come in through the door. For us, we are not as scared of turnover as some organizations are. I think we look at it as, we’re going to find a diamond somewhere in the rough. Years ago, I would tell you we were far more obsessed with the idea of that number, let’s call it pre-COVID, but at that time, you were looking for that skilled caregiver, that caregiver that had been in the industry for a long time.

What we’re finding just with population growth, the demand growth, we’re not having to build caregivers. We’re having to find more diversified caregivers that come from backgrounds that are not, you used to be in the nursing facility or you used to be in assisted living. For us, the reward and recognition, the training emphasis is much higher. We look at it as, if you take 100 shots, if we can get five, 10, 20% of those to work out, because our training was really good or our reward and recognition program was really good, we’re still winning.

At some point you also have to realize the capability of we’re hoping we introduce caregiving to a lot of people that have not seen what caregiving can be. The fact that we’re not a sitter service, that we are not this antiquated model of what caregiving was and introduce them potentially to the healthcare world in general. We have turnover, and it’s okay. We wear it with some pride. We look at the successful caregivers that after 30, 60, 90 days, six months, a year, and we look at them and their profiles and say, “What were you doing before this?” They say, “Well, I used to drive for Amazon,” or “I was looking for a career change and I found home care and I love it.” Those are our wins.

Mike Slupecki: I like what both of them had to say. I think we always viewed it too, as a scheduling challenge from a convenience location versus where they live, those types of things. The other thing too, is when you’re going through the number of caregivers that we’re going through due to this turnover. Our teams are really hesitant to give a brand-new caregiver a 40-hour shift. They have no experience working with it that you’re afraid of, are they even going to show up on their first shift? Some of those people you lose in the first 90 days are because you’re still testing them out, trying to dig for that gold, like you said, Kunu.

It’s really, how do you give them what they want? Because if you give them a 10-hour shift, they’re still looking for another 30 hours in many cases. If somebody finds a better opportunity at another competing agency, then you could lose out on a good caregiver. It’s like any problem that we deal with, there’s 100 things that go into solving it, and addressing the rewards and retention was one thing that we did to impact that as well. It’s never one thing, and it’s never a silver bullet.

HHCN: Obviously turnover creates significant cost for the business in terms of recruiting expenses. I wanted to hear about some of the other impacts of high turnover for home care providers.

Hunt: I think one of the things that everyone here recognizes is the value of reputation. This is a very insular space. Everyone in this room has a reputation. The more we go to these conferences, the better we get to know each other. This is also true on the local level with caregivers. An agency that has a high turnover rate, has a hard problem keeping caregivers, that reputation speaks volumes in those communities. We see this time and again. A family caregiver leaves, you lose the patient too. What about that caregiver who left and they made three referrals?

Those people are thinking about their cousin who brought them into the agency and now they’re thinking, “Hey, should I still or should I go join Betty at the agency up the street?” Reputation has a huge impact. The way you treat those folks, even if they are leaving, there’s turnover that’s good turnover, but it’s the way you treat people on the way out that’s going to lead to those net promoters who are going to bring folks back in even when they’re not working with your team.

Kaushal: I would say one of the downsides is clearly the HR department is very frustrated. From our perspective, what we say is you need to go out and hire 15 to 20 people a week per recruiter in our model. For them, they understand the burden of that. They understand how much work goes into that level of work. From our side, we just try to focus on the efficiency of it. The reality is if we can make hiring 20 people the same amount of work that it feels like to hire two, you’re going to do that work. If through reward and recognition and training you can have higher retention and you can get the gold to come up to the surface, they also feel very successful when that type of thing happens. I would say it’s a short-term challenge. I think there is a ripple effect that happens where, yes, there’s a monetary expense.

If you apply the same tactics of sales and marketing to recruitment and hiring, what you’ll find is none of us would ever say, we want less people calling the business. We want less in-home assessments. That’s also work, but you want a shot at trying to see if something actually comes to fruition with that.

Slupecki: Yes, I think we all know the value to our clients of consistency. They want to see the same face. That’s so critical. The other piece is the client satisfaction side by having the continuity of care, the familiarity with the caregiver that they’ve been using. Yes, it’s reputation, but it’s reputation from both the caregiver side as well as the client side.

HHCN: I want to know, overall, is this a lost cause? What I mean by that is turnover just, a fact of business?

Slupecki: Yes, I think it really is. Again, I think I love what Kunu is saying about trying to find that goal because you do have folks that are just trying to try out a new career and it’s a fit or it’s not a fit, and it’s such a balancing game. When you have eight great caregivers, the phone hasn’t rung for new clients. Then by the time the clients come in, those eight have found another job. There’s a lot of that that’s going on as well. You’re always trying to balance the perfect amount of staff to caregivers. I think it’s really about, yes, we do look at retention.

We do look at average tenure of the caregivers to think that we’re, at least the ones we got, they’re growing with us and staying with us. Those are different metrics than just the turnover. I think everybody has that magic 90 days. I don’t think we’ve overemphasized that because there’s so many things that go into that. I think it’s really the ones that you have, keep them engaged, keep them on board, and keep them working. Then again, try to find the new ones. I’m going to probably steal his lingo over here.

Hunt: It really depends if this is a lost cause. If you’re an agency with 20 caregivers and your goal is to stay at the 20 caregiver mark, there’s no issue with retention. All those folks’ names. You can address these issues. Immediately, you’re responding to text messages. If you’re like most folks in this room and like most folks who are providers today, you want to break past that inflection point of being a small business and become, like most of the folks in this room, a growing enterprise that can actually scale to hundreds, if not thousands, of caregivers.

At that scale, where this becomes a loss is if we’re still trying to do things manually, the old way, like we were when we were 20 caregivers. You’ve got to go give your staff those tools that are going to make, hiring 20 people feel like hiring two people, where you’re going to be able to perform that culture at scale, reach out to those caregivers, and show them that their potential and that they can be engaged in showing you everything that they can bring to the table so that they can actually get those 40 hours that they’re seeking. That’s where we see this being the difference in folks who have a growth mindset versus those who are focused on, we want to do things the old way. That’s where it becomes lost.

Kaushal: I would just say our focus is to do the best that we can, be as efficient as you possibly can, but also welcome home care. Caregivers are going to call out of shifts. Caregivers that were great at one period of time in their life, something changes for them, and now all of a sudden they can’t work those shifts. The caregiver that wasn’t doing a great job all of a sudden gets some training and coaching and gets with a client that they really like, and they are some of the most dedicated people that you’ve ever met to that client. I don’t know about lost cause as much as just accepting this is the game, per se.

Being more efficient and effective though, I think rewards and recognition, what we’re finding is that certainly as an organization, we are doing a far better job around retention, reward and recognition today, literally today, than we were six months or a year ago. I think a lot of that has changed partially because of the technology that we’ve brought in. Let’s be honest too, we as an industry have raised our prices, we have gotten more funding through Medicaid programs, if that’s how it came through, and caregivers are also being valued more than they were as well. You had a segment of caregivers who left to go do something else purely because they were getting better pay.

I think that paradigm will continue to be a pressure. As we continue to bring up their value, their joy in doing home care, that you will see more of them come to us and gravitate towards the industry.

HHCN: I want to talk about best practices that work. What are some existing best practices that have had an impact on turnover?

Kaushal: As we’ve introduced Ava, one of the biggest things that we found as a limiter was the human behavior element of our schedulers, our HR department, our people in the office. The fact is, if you ever want to see when the effort goes away from your business, it’s probably the first hour or two in the morning. It’s also around three o’clock in the afternoon, and all of a sudden we’re not as excited about doing all the work that we need to do. Why? Because people are burned out. We’re asking them to do more with less.

For us, I would say the biggest thing has been automation, some level of very quick response from a reward and recognition standpoint. The caregivers, at the end of the day, want the reward and recognition. They don’t necessarily need to know somebody spent five hours pulling six spreadsheets to figure out that they’re the one that should be recognized. I would say the biggest improvement that we’ve seen really happen is the fact that in their app, through automated messaging, other things, when they do good things, we as an organization, our brand, is saying thank you for all of your hard work. We’re also making it dynamic to them. I think we’ve all had caregiver of the month. If somebody introduces caregiver of the month as a good idea, today we’d all go, okay, we’ve been hearing this from the dawn of time.

The other side of this goes, we have caregiver of the day. With technology, you could go, I was the best caregiver based on metrics in maybe my office or my region. This month, I’ve been automatically looked at for many other reasons other than I’m the favorite by the scheduling coordinator.

HHCN: Victor, you work really closely with a lot of these home care organizations. What are some best practices you’ve seen work?

Hunt: Yes, absolutely. I think that my favorite part about what we’re doing is that we got to work with amazing operators like Kunu and Mike here. They really understand what’s working for their business is often very bespoke to their business. When we look at things that Griswold is doing that are working, those practices make a ton of sense in their context versus, say, Kunu’s agency. They’re going to be different things that work for them, but they can adapt and piggyback on some of those ideas. One story that comes to mind is, take Griswold for instance. We had an example where when we started early on working with their team, we understood that they had a set of best practices for how we engage a caregiver to understand what are those breakpoints that often lead to a turnover.

One example is, does this person have enough PPE to go and actually take care of their clients or are they going in unprepared? There was a weekend caregiver who reported through Ava, “Hey, I’m spending out of pocket on PPE because I can’t get into the office during the week, I’ve got to take my kids to school, I’ve got this other job that I’m going into, I can’t make it to actually pick up the PPE you provide.” That message went to the Griswold director who then responded immediately, “Hey, tell us your Availability, we’ll leave the office open later. This way you can come in and get what you need and not have to spend out of pocket.”

That caregiver is still here with Griswold to this day. These are small examples that compound. Without that level of engagement, this team would be in the dark and many teams would be as well, but that’s a specific area that Griswold has learned and now has prioritized automated for their whole team. We see this all the time, but the key is these folks, everyone in the room who’s an operator here knows the strategy, they know the tactics, the challenges, how do we implement that at scale without burning people out? Like Kunu said, those mornings, those afternoons, that’s where the burnout happens. That’s where those big picture ideas at the beginning of the year start to fade away and we’re wondering, where’s the turnover coming from? It’s all attributable to the things we know.

Slupecki: Going back to what Victor said initially, what is that preventable piece? What are the pieces that you’re losing out of the bottom of the funnel because you’re not effective on your rewards and recognition program? I think addressing that piece and we have shown a market improvement in turnover since we implemented Ava. We kicked it off last October and we’ve had lots of different metrics along with about a 20 plus percent reduction in turnover. Just for the audience here, when I look at it in terms of what we’re spending on a per hour basis, it’s less than 10 cents an hour. If you think you can have a material impact on your turnover by spending an extra seven, eight cents an hour, I think it’s been a really good investment.

HHCN: Yes, and Victor, I want to hear a little bit more about Ava, your relative newcomer to the home care space. Can you share a little bit about how you came to be and how you entered this space?

Hunt: Sure, of course. High level, Ava is a caregiver and clinician engagement platform. We focus on solving turnover, growth and performance. We do this through a variety of tools from rewards, automated communication, surveys, referrals. All of these are part of the toolbox and it’s all based on the best practices that we know these agencies are applying today either manually or have aspirations to apply and want to do this at scale, all informed in a data-driven way. We’re integrating with the systems at play here, the EMRs for all the scheduling data lives, the training tools where we’re looking to actually increase the skills of those caregivers. We’re putting this on autopilot so that the teams can actually say, “Hey, I want to lower call-outs and I want to run a campaign this quarter to invest in rewarding caregivers who are in fact showing up on time, who are actually doing the right things to encourage other caregivers to show up and picking up those last minute shifts.” This is how we can transform an agency’s culture.

In terms of how I got into this space, this is actually, for me, a very personal note because my family has been in healthcare ever since I was born. My grandmother was a career nurse at Jamaica Hospital. She worked on the emergency room floor. Talk about burnout, that’s the eye of the storm. She decided, “Hey, I want to go and scale the impact I’m having.” She started her own home care business. This was decades ago, back when none of the problems we see headlines about today were even known by half the market, but yet they still existed. There was still turnover, there were still hiring challenges, but it was a very different scenario then. Nonetheless, for her, operating was still a completely different ballgame than being a nurse. She decided, “Hey, this isn’t the right trade for me. Being a business operator, I love helping people, but I want to get back to doing that in a controlled scenario where I’m not having to chase people down to clock in, I’m not having to file all these reports.” My inspiration has always been, what could I have done at that point to create a business that would have made her life easier?

Because we need more operators with that level of expertise coming into the space. We’ve seen the numbers, this space is not slowing down at all, and so we want to give folks that tool set where they can take best operating practices and scale so that running your back office, managing staff is not the blocker to building an incredible agency and provider.

HHCN: Mike and Kunu, I would love for you to share what impacts you’ve seen from working with Ava. Mike, maybe let’s start with you.

Slupecki: Yes, a couple different things. As I touched on, we’ve had improvement in turnover, improvement in retention. We also are an endorsed provider under what used to be Homecare Pulse with Integrated Insights. We’ve always scored super well on caregiver satisfaction, but we’ve actually moved that slightly up. Again, we were already at a pretty high number.

Yes, I think that again, the feedback from our directors has been really positive. It was a turnkey implementation, so not that resistance. I think a lot of us in the room are always trying new things. Sometimes they clearly don’t work. Many times they’re that gray area where you’re trying to justify, did that make sense? This was one of the initiatives that we did. Very easy to see, both anecdotally as well as empirically that it’s had a really positive impact on our business.

Kaushal: I’d follow up and just say the first couple of months when we were doing implementation I had a moment of guilt. We’re actually saving money. This is an odd thing to think about when you think about rewards and recognition because typically for us, I think as organizations, we all say, “Hey, we will open up our wallets in order to get great results.” We rolled in our employee of the month, our incentives for the weekend, referral bonuses, all those programs and dollars, and we said, “Let’s see what this would look like under Ava.” I have to tell you, our scheduling coordinators really fascinated me in gamification at work. You have to struggle and give a caregiver $25 and $50 to take a shift for a last minute on the weekend.

They will do a lot for 1,000 Ava points. That’s like $5 or something like that, whatever it translates to. We were not able to reward and recognize around just real behavior that we really value. We talk about talking in and out. When you’re in a Medicaid space like we are as well, you have to clock in and out. This isn’t a, so it’s easier for payroll. This is a requirement on our end. We are measured at least 90% or higher for clock in and clock out using EVV. We were doing fairly well, but what caregivers really wanted to see was we would call them, message them, and be upset with them when they didn’t clock in and out.

We found that we were not only doing that, we were also contacting them when they did clock in and out correctly, when they referred someone, when they were consistently doing certain behavior, when they refer a caregiver. Candidly, I felt bad enough about it that we had to up all of our point values just because I felt a little like integrity moment there about it. It’s like, we were giving you a lot more to get some of this work done. At the end of the day, we’re saving, let’s call it 20% and being much more effective. We upped our value amount. The caregivers love gamification.

I’ll give you a good example of that is just ask a caregiver how many of them have ever played Candy Crush and they’re on like level 500. They like the idea of being tracked in some way that gets a scoreboard that is bigger than their schedule and their paycheck. They’ve really enjoyed it.

HHCN: Unpacking ROI on rewards and retention programs has historically been challenging for agencies. How are each of your organizations, how are owners building a business case for a program like Ava?

Kaushal: Once again, we have, we’re coming up on 15 years of operations. We have done probably everything in the book as far as tried it all. One of the most ineffective things we were doing was putting major dollars in the hands of schedulers and saying, “Hey, here’s some incentive money. Here’s some money to give to a caregiver of the month.” The distrust came to be. Let’s say it’s $5,000 a month between all of our offices and you give it to someone and you don’t really hear the caregivers get excited about it. The caregivers don’t necessarily have a general pool, you find out and you go back through the numbers, the favorites were getting a lot of attention. One of the biggest ROIs in this is that we know and it’s tracked and it’s audited that we can see everyone is getting that fair treatment.

The brand new caregiver who picks up a shift is getting some incentive. The caregiver that’s been here for three, five, 10 years is also getting recognized. At the end of the day, you would think, well, have we taken some empowerment away from the schedulers? Let me tell you, they’re the happiest people that could ever be. Their phone calls now that come in are asking them, why did I only get 1,000 Ava points and not 5,000 Ava points? Which is a great conversation to have with them versus the game that we were playing before. “Hey, can you take this shift on Saturday? I don’t know, is there a bonus there?” They knew the system and how to work with us. A lot of good behavior.

Slupecki: Yes, I think as we talked, I think we got a really clear ROI with some of the things I talked about earlier. The way we notice it’s working too is you’ll have a caregiver that walks in your office and says, “Hey, I’m really appreciative that you remembered my birthday.” You’re like going, it automatically got the points for their birthday. It was, again, one of those things you didn’t have to think about, it just went out. The other thing too was when we first launched it and we’re trying to figure it out, are we going to see a return, that sort of thing, it occurred to our directors that what they ended up doing initially was rewarding all those caregivers that did a great job just because they were good caregivers. Those are the ones that you forget about sometimes because you spend 80% of your time on the 20% that are just driving you crazy and you’re chasing around. Then those ones that perform bad, they actually do something good and you give them money. You don’t give money to the ones that are doing good stuff every single day. It actually felt better to our teams to know that they were rewarding the ones that just did their job, where before those were the ones that were being neglected. I think that also goes to that retention piece as well.

HHCN: What are some other trends that home care operators should be paying attention to in the next one or two years?

Hunt: A major thing that we’re hearing all the time is the 80-20 rule. It’s no surprise that teams are needing to get more efficient about how they’re spending money, be it on salary or be it on tools. Our focus has always been on scaling the personnel that exist and scaling those best practices. For us, it’s really understanding how we make those schedulers’ lives feel so much easier by putting these tools in place where they feel like they can have that reach. Folks like Kunu and Mike don’t actually have to hire an army of back office folks to actually call and check in, “Hey, did you clock in?” “Hey, happy birthday.” That stuff is happening now at scale and it’s continuing to improve. The motivation there, of course, is that we’re not getting much higher reimbursement rates. We’re not getting the level of change that we need to compensate for this looming change of 80-20. We have to get a lot more efficient and a lot smarter about retaining and especially about scaling our back office.

Kaushal: I’ll piggyback on that. I didn’t see some of you this morning because I was literally at a Medicaid director’s office speaking about 80-20, because welcome to Tennessee, by the way. In our conversation, one of the things that’s going to happen around 80-20, just to keep piggybacking on that, they are limited on their funding. What they are telling us is essentially don’t bank on the idea that reimbursement is just going to go up. The reason that we’ve got a six year heads up around some of this stuff is for us to be working on these types of programs.

I would just say for those that do private pay and you think 80-20 doesn’t quite apply to you or something to that extent, just realize that means Medicaid, which has already seen some reimbursement hikes over the last COVID era, post COVID era. Those rates are there. Some of those organizations are also going to start paying more to the caregiver. In some states where Medicaid rates are getting pretty close to private pay, the wage of caregivers is going to start going up. Just in Medicaid, it’s not an affordability issue. We work off of authorizations. If we’ve got the work, the clients are typically with us. Our average length of stay on Medicaid is four and five years. Just a length to say on a client that’s getting 30, 40 hours a week, it’s good work, and now reimbursement comes up. We are going to see a competitive nature. We’ve already seen that with VA. I think there’s probably people in the room that have seen reimbursements go up, so you’ve been targeting VA. Billing with VA has become easier, so now you’re moving towards that. I think in some way, however 80-20 works out, that will become a strategy and a trend that you will find the Medicaid programs are actually a really good business for the caregiver from a wage side.

Slupecki: I think just like the speaker this morning said, use AI wherever you can use it and use things to drive efficiency. This is just one of many ways we have to keep that personal touch. I think it’s cliche. Our business is a personal touch business, but anything we can automate, anything we can throw AI at, that doesn’t impact the relationship we have with our clients and caregivers, do it.

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The post HHCN FUTURE- Hacking Turnover: New Strategies to Address Caregiver Engagement and Retention appeared first on Home Health Care News.

Sarah Khalid: I’m the product manager on the Labs team, so we focus more on the research and development, and the next suite of innovative features that are going to hit the platform, so typically AI, machine learning, these innovative next-generation technologies. We test a lot with those and get them into production for our clients.

Guillaume Vergnolle: I’m a senior data scientist in AlayaCare, so basically, I’m working on the implementation and how to create those AI models that can eventually help in some of the healthcare problems such as caregiver retention, or patient re-hospitalizations, or trying to extract important information from the clinical documentation among others.

Home Health Care News: Artificial intelligence has obviously been around for a while, but there’s been an explosion in terms of the popularity of it over the last few years. People are talking about it more, especially with ChatGPT and other language models. People are really wondering how it’s going to affect them, how it’s going to affect their business, how it’s going to affect their industry. I’m curious how you think it’s going to affect the whole health industry specifically.

Khalid: Yes, absolutely. Just to take it back and make this industry-specific, so we know that, of course, caregiver retention is such an issue within our industry. Just referencing Home Care Pulse’s recent reports: 64% turnover rates for our caregivers and our nurses in the field, 40% averages for back-office staff, including coordinators’ intake. This is a real problem that plagues our industry, of course.

Additionally, one in four caregivers are likely to leave within the first 30 days of being hired. What we’ve uncovered with some of the data that we’ve been looking into is that this is often due to scheduling-related issues, not being scheduled for preferred hours or preferred care within the first few months of working. There’s a lot of data and a lot of interesting insights that we can extract and pull out of our industry today.

When we think about how to combine some of that with AI and a lot of the generative models that are now being used and thought of, we can get really creative with some of the ways that we can combine those powerful technologies with our data. There’s a lot of creative different use cases. I think more and more, we’re going to start to see this being seamlessly integrated in the entire retention problem. I’m excited to talk more about how we also envision that.

Vergnolle: Yes. I guess we’ll be seeing AI being used more and more in many different industries, healthcare among others. It will also take a bit of time, because we know that AI models can be super good at very complex tasks, but sometimes can perform poorly on very simple tasks. We’ve seen the emergence of models like ChatGPT and others that are being better at tasks that they have never been trained on.

At the end of the day, the models will be as good as the data they’re being fed, so the data is really central in how you design your models. We’ve seen some very simple limitations. For instance, like models that can predict if nurses are about to quit their job. Then when applied to PSW, it will perform really poorly, just because it wouldn’t be looking at the right data points. We’re ramping up. We’re trying to find how to properly apply AI in this sector and all the steps that will lead us there.

HHCN: It sounds like a good place to start. It’s starting to collect data for businesses so they have that applicable data that can be fed to the AI model eventually.

Vergnolle: Definitely. Sometimes I often describe data as clay. It’s like your base material in order to build a solution that could be like a vase, for instance, if I keep on the metaphor of the clay. I guess one thing that you need is to get the right expertise in order to come up with those solutions. When it comes to retention problems, make sure that you’re actually collecting the right data to measure when your employee leaves, and for what reasons. To try to capture this data should really be the base when it comes to building solutions to try to figure out that.

Khalid: Just to add on to that, so now we’re starting to see that a lot of the ways that companies are storing their data, these databases are now being seen as knowledge bases that are eventually going to feed into the model. We can do a lot of interesting tasks on top of that knowledge base. Now, there’s the recent release of a lot of these Retrieval Augmented Generation models.

What we can do is we can ask a series of questions on top of that data and pull out some of these interesting ways that we can use this in combination with the current retention practices that we have. Absolutely the distress, the data is the most. It’s still the most important thing when we’re using AI as a tool to solve these problems.

HHCN: What are some of those retention use cases that you’ve seen so far?

Vergnolle: What comes to mind is identification first. That’s like how we can identify among the employees at your company who are dissatisfied, or who is about to leave. There are very simple ways to go through that. Surveying should be the first solution that comes to mind. Then we can try to think of how we can continuously measure this dissatisfaction across time, because surveys are just punctual, we can do them every couple of months eventually.

If we’re collecting the right data points, it can be like the number of hours that your employees have received. We can compare it against the number of hours in their contract or compare it to their availability. There’s a lot of data points that you can try to measure to make sure that your employees are having the service, like the volume of service they’re asking for.

HHCN: Yes, schedule volatility has been one of the biggest reasons. Owners and C-suite executives have told me that caregivers and home health aides are quitting. Particularly of late, even the best of the best workers have been burnt out because their schedule is so unpredictable from one week to the other, so it gives them no real assurance that their personal life isn’t going to be thrown a wrench week by week. I’m curious, what challenges do owners and C-suite executives face when they’re trying to implement AI that you guys have seen?

Khalid: The thing that comes across time and time again, as we touched on, is how the data is being collected, just to keep stressing on that point. Particularly when we’re tackling some of these retention problems, a lot of the time, just in the nature of this conference, Continuum, the data is being stored in so many different places. We actually see a lot of different owners that are storing their data, maybe in Google Docs, maybe just still in Excel, in a bunch of different sources. Still the challenge, not just in making sure that the data that’s being collected, is of quality.

Actually a lot of these large language models, they’re quite forgiving for some data quality issues if they have enough context. They’re forgiving for some spelling errors and some mistakes that traditionally have been really difficult to manage with more classical machine learning problems. Still, making sure that all of that data is harmonized, and as well making sure that when we’re speaking to the different stakeholders that are collecting and putting in the data, that everyone agrees that this is the central source of truth. When we’re talking about, for example, speeding into and predicting whether someone is satisfied, whether someone is at risk of churn.

If we’re collecting reasons such as termination reasons, a lot of the time these will be unstructured. They live in, again, a bunch of different places. We all need to come together and come up with more formal data contracts when we really start to work on these problems.

Vergnolle: Yes. I guess the two main challenges I’ve been facing on my journey as a senior data scientist is, one, the data pre-processing. It’s good to have the right data captured, but then to make the data speak, basically too. You need to curate your data to have it taking the right shape, and that takes most of your time. I was surprised because at the university, when you’re doing your master’s degree in artificial intelligence, you mostly work around models and AI, how to properly train them, how to run the evaluation. Then coming to the professional world, I was surprised how much time it takes pre-processing just to get the data in great shape. That’s one of them.

I guess the second other big challenge I’ve been facing is definitely getting a model into production because you need to validate, to ensure to have a pipeline in place, but also you need monitoring just to make sure your model keeps on spitting good results, that your results make sense. So many things can evolve. For instance, COVID-19 had a huge impact on all the models that were in place just because all of a sudden, all the data distribution has been changing. All of a sudden, new data points were coming in. We need to adapt. We need to measure how our models are performing before being deployed but also after. That’s also super important.

HHCN: Yes. If you have a thesis of where AI could help in your business and you go to implement it, what’s that process like over time? How do you make sure that once you implement it, it’s actually going to be able to be drawn out widely across the organization, and ultimately work and save you on your bottom line or whatever?

Vergnolle: One thing that really worked for us is being really close to the users. The end users, they will actually use the system that you’re trying to design, because in the end, they will be the one using it in their day-to-day to add it in their workflows. Adoption is very important. To have a good adoption rate, for that you need a good explainability and also trust. You need to build trust with your model.

If you can derive metrics, have a good evaluation metrics to be able to say, “My model works X percent of the time.” If you have access to historical data, you can run your model on historical data and see how if it was applied at that time, how it would have performed. That can help build trust. Then also with time, of course. You can give some trial periods where you can get used to the prediction and how to interact with your solutions. That can really help.

For the explainability parts, I’d say that most of the time AI is seen as a black box. Sometimes it is, to be honest. If we go back on the retention problem, it is not enough to say that an employee is at risk of leaving a job. You need also to be able to give the reasons why. That helps build that trust that eventually helps with the adoption. That’s, I would say, the highway to make sure that your product down the line actually helps the user in their workflows.

Khalid: Yes, just to stress that, of course, at the individual user level, it’s very important to build that trust. When we bubble it up to the agency level and the teams that we’re working with, it’s even more important to build that collective trust. Making sure that the workflows that we’re designing are not very foreign to their current practices, this is something that’s really key. It’s going to help a lot with adoption. That’s typically the method that we co-innovate with our users. I think that that’s probably the best method to make sure that these systems are being adopted well, and there is that trust being built in.

Then I think just having these conversations, again, at more of a collective level, because this is a tool, this is a technology that isn’t going anywhere. It’s going to continue to adapt and change rapidly. I think just having these open forum conversations about what other people are doing with AI and how they’re building these systems, these are all ways that we can start to build collective trust with the tool being used and being adopted.

HHCN: Yes. In regards to trust, I’ve heard, for instance, that sometimes like ChatGPT gives information to someone that shouldn’t have it or to make up answers. How do you grapple with those sorts of things that are still embedded in AI as we know it, if you’re implementing this into your business?

Khalid: Yes, it’s a real challenge. For us, I think, and for a lot of companies that are creating these AI systems, it’s still of utmost importance to stress that this is not meant to be a replacement tool, but it’s meant to be decision support. Throughout the entire process, when we’re training, when we’re building, when we’re thinking up how AI can be used, we are considering the process of the human being in the loop. Ensuring that we’re collecting the correct reasoning for how we’re able to deduct certain predictions, how we’re able to come up with certain responses, that’s of utmost importance.

I think that there’s a lot of fear generally when we talk about AI as it’s going to be replacing a lot of us humans and the tasks that we do day-to-day. The truth is, again, it’s meant to be more of a decision support tool. In addition to that, the industry that we’re in, the data is extremely sensitive. When we begin to experiment with a lot of these models, these large language models, even as simple as running an API call with, say, an openAI and playing with a ChatGPT. This is something that actually can result in data leaks, and breaches, and actually giving over your data to an external company.

I think we all need to also just be very informed when we’re experimenting with these models, some of the risks there when it comes to personal health information also being leaked. There’s a number of different things.

Vergnolle: I guess to add to that, it’s even more important that we’re in the healthcare sector. Down the line, all the predictions that you’re doing using those models could affect a patient’s health, so eventually life. Having the proper security layers are even more important in that sector. You need to adapt your strategies. For instance, all the proprietary models that are out there available, like the ChatGPTs and so on, most of them have been trained on web data. They’ve been scraping Wikipedia pages and many other pages.

You need to make sure that you can actually apply those models to the application domain that you’re working on. That may also require you to build your own guardrails. A guardrail is something that has been used by OpenAI and all those model providers to prevent the models to behave in a certain way. For instance, you can give it a try yourself. If you ask ChatGPT how to wire a car, it should say, “Hey, sorry, but I’m not allowed to answer that question.” In our fields, we also need to build our own guardrails. How do we prevent those large, like those models, those chatbots to not go in certain areas?

HHCN: If I am a Home Health Care executive and I’m considering AI and implementing it, how do you get started? Are certain organizations too small? What do you need in order to get started?

Vergnolle: I would say first, being data-driven is very centric. If you want to include any AI project, what is good is there’s a good amount of AI models out there if you need to use them directly. Though I would not start from which model to use. I would first encourage you to start to identify your problems and ask yourself which problem can be solved using AI.

I feel like often, AI is seen as a solution, whereas it should be seen as a tool. You can look for yourself. There are some articles talking about coffee machines augmented with AI like the first. That’s questionable, is AI properly used in that context. Whenever you’re starting a project, ask yourself the question, what would be the right tool to solve this problem? AI could be a part of the answer, but also make sure to consider which tool would be optimal.

HHCN: Oh, for instance, it can tell when a worker might be about to leave. The onus is still on the owner to make sure that they don’t leave. It’s part of the process, it’s not the entire thing.

Vergnolle: That’s it. For instance, if you don’t even have your hands on the data on what the turnover metrics are, maybe this is where I would start before actually envisioning adding AI on top of that.

HHCN: In terms of when you guys are working with home-based care providers, what are the biggest pain points that you’ve seen so far? What are some of the questions they have most of the time? Are there many themes that have come up?

Vergnolle: It’s one of the areas of challenges that we had, is generalization among others, just because each care, each agency or each provider, may have different ways, different workflows, and how to make solutions applicable to different markets. That’s one of the challenges that we’ve been facing. You need to make sure that you’re, in a way, flexible to allow for different markets to use your solutions, but also accurate in each of those. That’s one of the challenges that we’ve been facing.

Khalid: I’d also say, just to stress on Guillaume’s point of generalization, when we’re thinking about the different stakeholders that are going to be interacting with the systems, we really need to ensure that they are considered and thought of day zero. When we’re thinking about those processes, oftentimes, maybe when an owner is excited to just dive right into AI as a solution, as Guillaume stressed, it’s a tool. It is not necessarily going to be the answer for some of these problems. Being able to have that thorough setting up of what is the objective involving the stakeholders, because ultimately, what we’re trying to predict in the end is some of their reasoning processes for how they come to the conclusion that, actually, this person is at risk of churn.

A lot of these models now too, in the frameworks that have been released, which are really interesting, is you can begin to see how the model is reasoning in each and every step, and how it’s using the data, how it’s interacting with a set of different APIs, and how it’s coming up with the conclusion that this is why I believe that this nurse is at risk of churn.

We still need the stakeholders throughout that entire validation process to make sure that we have that trust. I would say that, yes, for owners, not getting too excited about how we can start to use LLMs right now, and maybe thinking about it in a more holistic perspective of that.

HHCN: I also imagine the owner bringing in a caregiver or a home health aid may be beneficial because you have their perspective as you’re building the model, and you’re understanding why they might churn.

Khalid: Completely, yes. Another use case that actually feeds into some of those problems with churn is when caregivers and nurses are out on the fields, often with some of their day-to-day tasks, they’re doing a lot of this documentation. They’re doing a lot of note-leaving and note-taking. We can actually use another set of LLMs and machine learning to pick up on different patterns when they are leaving some of those notes, pick up on different sets of behaviors.

Maybe we can pick up on sentiment when they are leaving those notes as well. That gives us a clue, too into how they’re feeling and how that feeds into retention as well. That’s an indirect way to understand their overall sentiment. Doing direct interviews, that is always something that’s completely valuable, and something that we need to consider when we’re building these systems.

HHCN: Is there anything that you’re excited about that could be applied in the future that maybe not be possible now, whether it’s in the home health industry or just in business at large?

Vergnolle: I’m personally very excited. We’ve seen those models coming up that are mostly around chats. We’re seeing more and more models coming out that use multi-modalities, so not only text, but also pictures, videos, sound even. Can you imagine having almost an assistant that could pull you for the whole day where you can monitor your patient’s health like vitals, for instance.

Even with pictures, you could look at a wound. Say, if it has evolved, if it’s actually getting better. As a caregiver, for instance, just having that device and just saying out loud all the care documentation that you want to take. At the end of the day, it just makes you a nice paragraph that is just a summary of what you’ve been sharing doing that day. I’m seeing a lot of applications that mix all those different applications and modalities. In the future, they could build great products.

Khalid: I‘m actually quite excited about a lot of the creativity that we can evoke with these models. You’re starting to see a lot of different creative use cases that, yes, we can implement into our businesses. Just from, again, more of an outside perspective, so I personally love to write. I actually like to evoke large language models in more of a Socratic dialogue to get deeper into understanding some different holes of creativity. I think that that’s something that’s really interesting that we could also in the future implement with some dialogue with some of these agents.

Right now, it’s an interesting time because there’s a lot of focus on the knowledge that is available on artificial intelligence. I do think in the future, businesses, society at large is going to start to adapt to more artificial wisdom, in a way. How can we ensure that the systems that we’re building out are in sound principles? We’re not just focused on this age of information and getting overwhelmed there.

I think that just due to the nature of where we are right now in the industry, the ML industry, the home care industry, we’re going to start to think about these more perennial, I think, larger existential questions, and build our systems in a way that it’s touching on these principles very, very comprehensively.

To learn more about how AlayaCare can help your organization ensure operations are consistent across multiple locations with real-time information updates for key stakeholders, visit https://www.alayacare.com/.

The post HHCN Continuum: Embracing Technology to Recruit and Retain Caregivers appeared first on Home Health Care News.

Home Health Care News: What do you see as the main challenges right now in the home healthcare space?

Ellen Kuebrich: We’re in a pretty unique time, where we have more people than ever that are aging into care. We have fewer people able to take care of those, both currently with the staffing crisis. I think, demographically, we’re going to continue to have this problem because children of baby boomers have fewer kids than baby boomers did. Even if you look at the last 20 years, there’s going to be less people entering the workforce.

Even if the same amount want to get into healthcare, we’re going to have fewer people able to take care of our patients. While our payment system and our government are saying that they really value, and they see care moving to the home, we’re not getting paid as if we’re valued that way. I think the biggest problem, if I had to summarize it, would be the age-old adage that you hear all the time is we have to figure out how to do more with less.

Mike Kearns: Yes, I’d agree. Certainly, we’ve heard a lot today about the workforce shortage and the challenges of retention. That is certainly something that is weighing on everyone. We heard today that the delta right now between the pre-pandemic levels and today is around 900,000, I believe. That continues to be a significant pressure for home health organizations. Many of the customers that we talk to, that’s what they’re dealing with. The biggest challenge is how do we do more with less?

HHCN: As we’re dealing with these pulling forces of patient outcomes, staff retention, and squeeze margins, how do providers not only survive but thrive in this environment?

Kuebrich: That’s a challenge. I think if you are expected to do more with less, the only possible way that you can achieve that is through becoming more efficient. We have to find ways to create efficiencies that weren’t there before. Joyce, you said a little blurb about us in how we help providers transform how they treat the function of triage, it’s really when in what happens when your patients are calling in. We do that through a pretty unique combination of a technology layer that’s coupled with our services.

We’ve got over 100 RNs, over 450 non-clinical patient care advocates to help providers reimagine how they’re handling when a patient calls in. When we talk about how we create efficiencies that weren’t there before, I think the easy answer that comes to everybody’s mind is technology. That’s got to be our savior. AI’s coming, and it’s not going to really just figure everything out for us on its own.

I think technology is going to be a critical piece in how we address this crisis, but I don’t think it can be technology alone. There’s never going to be care that’s delivered without a human element. What I think we need to do is really find a marriage between technology innovation and that human touch to help create those efficiencies.

My suggestion, if you want an actionable place to start, is to go back, talk with your operational teams, and start looking at all of the functions of your business, all of the operational functions, and how are you treating each of those functions. Then start to organize those actions into different buckets. Where do I say I absolutely want one of my clinicians on this? There’s not a day where I don’t want my clinician touching this part of the patient journey.

Where could I use technology to handle this function? Where could I look at outsourcing somebody else to handle this function? What that exercise is going to do is allow your clinicians to breathe. We’ve got to take care of our clinicians if we want to take care of our patients. It’s going to give them the room to practice to the top of their license. It’s really going to start to create efficiencies again that weren’t there before so that we’re able to scale without having the linear function of labor backing us up. We don’t have that luxury.

HHCN: We’re focused on home health today, but this, obviously, applies to hospice as well. I’m sure some of the people in the audience as well as a lot of the attendees do both home health and hospice. Do you want to talk a little bit about that?

Kearns: Yes. Obviously, many of the customers that we talk to and that we work with are doing both hospice and home health. There’s certainly a lot of similarities and differences between them, from a patient volume and the acuity of the patients. That certainly varies across the different organizations. In order to thrive, whether it’s hospice or home health, utilizing resources, like Ellen is talking about, is important as well as focusing on quality outcomes. I think that’s really the differentiator for a hospice or a home health organization.

That’s what can help them thrive because, as you focus on those quality outcomes, the patient experience improves, obviously, their health improves, their satisfaction improves. That leads to more referrals, and it really helps you to grow in a market where maybe organizations are focusing on something else. I think quality outcomes are very important for hospice organizations to focus on.

HHCN: How can the strategic utilization of outsourcing, insourcing, and technology revolutionize the delivery of care in both home health and hospice?

Kearns: Each of them have benefits and certainly, risks and challenges. If you start with outsourcing, certainly, there’s real benefits to that. It can be a cost savings model. If you’re able to outsource some of your non-core competencies to another vendor and alleviate that pressure from your staff, that can be a huge win. Really, that is what we are positioned to do. Outsourcing also provides flexibility and scalability so that you can fluctuate up or down, depending on the needs and the demands of your patients. We do see that there are benefits to the outsourcing model.

Insourcing is a little bit different. Obviously, you have more control. As you build your team internally to solve whatever problem it may be, you maintain that quality control. That’s a real benefit to the insourcing model. One pattern that we’ve seen at CareXM is that many look at insourcing and outsourcing as a trade-off. They’re really, they’re not if you’re working with the right organization.

As Ellen mentioned, at CareXM, we’ve brought them all under one roof. We have some customers like LHC that are using a hybrid model, where they’re insourcing their core competencies, and they’re outsourcing those that aren’t. We work with them to be able to do that. We have technologies like remote patient monitoring and patient engagement to where they can utilize our technologies as well to improve communication and improve coordination across the different specialties.

That’s definitely a big challenge for a lot of these organizations because home health, for example, is multidisciplinary. It requires a multidisciplinary team that is working, in some ways, feels like silos. Having that coordination and communication, having those tools in place to be able to do that, whichever model you’re going with is critical to the success of it.

Kuebrich: I think Mike hit the nail on the head, there’s no one-size-fits-all all solution, but we have seen time and time again that pairing these together as a function, saying we’re going to insource some functions, outsource some functions, and use technology to handle some functions is consistently the most effective way. It’s going to be a combination, and it takes a little bit of work to see where it is. There’s trade-offs with all of them.

For example, if you need just some pressure to be relieved off of your staff, you may want to just straight outsource functions of your business, and that’s okay. That may be where you start. It’s always good to have an eye on a path to the future of, I just need to relieve the pressure on my staff today. I know that overall and over time, that I’m going to lose some control, I may lose some quality there, so here’s our plan to potentially insert some of that function later or to handle it with technology, so it’s more consistent.

HHCN: How long does it take investments in this area to kick in for providers? Are we talking instantaneously, two years, three years?

Kearns: It really depends on the complexity of the model that you choose. Most solutions, you should start seeing a positive impact in year one. I would say, if you’re not, then it could be a bad fit, could be the wrong solution, could be the wrong vendor, could be a number of factors. You should start to see some positive impact within year one with growth in year two and going forward. In some cases, it could be instantaneous.

As Ellen mentioned, we have customers in some cases that just want to outsource everything to us, and that has a very quick effect. There are factors that go into determining that the vendors know– you want to make sure that whichever model you’re choosing to go with that the vendors that you’re working with have a good implementation plan.

We’ve had a really strong team that can implement all of their locations, all of their patients, get them up and running. It’s critical that you have that in place. Then having the proper training for your staff. We know in healthcare that people don’t change, right? Most industries don’t love change. Having good training in place will help mitigate some of those challenges and help you get to that ROI even quicker if you can get them up and running.

Kuebrich: I would say that for all of your partners out there, your vendor partners, ROI, and demonstration of that is table stakes these days. I think we’re partnered with a lot of the vendors out there and integrated, and they fully believe that as well. Everybody knows how hard providers have it right now, and everybody is striving to help you to relieve burden on clinicians and improve the patient experience. They should all be doing that through some type of an ROI for you.

I think most of the really good ones, and there’s tons of good ones here are. Don’t be afraid to ask and push them for that.

HHCN: Ellen, we’ve talked a lot about patient engagement in past years. Why is this such an important topic at this point in time?

Kuebrich: We actually refer to patient engagement as proactive triage. We are drowning in data. I know you all are because you all have great EMRs, and you’ve got so much information about what your patients want, what they need, and when they want it. It’s really important that we do something with that data. Patient engagement is a wonderful way to try to pre-empt any event from happening. You can imagine the effect that satisfaction has on readmissions. If we’re reaching out proactively, they’re not heading back or going to the ER.

I think the problem that we see with patient engagement is it’s a really tough job to do manually. I know that any hospice provider in here wants to do a tuck-in call on every patient every night, but we can’t do that. I would love to check the schedule, make sure that everybody knows that I’m coming tomorrow every evening before I leave for work, but that’s an extra hour for my nurse every day to try to follow up and engage my patients that way.

This would be a function where I’d say, I don’t necessarily need a nurse doing that. That’s not practicing to the top of her license necessarily. That’s something I could solve through technology. We’ve got an automated patient engagement platform where you can proactively send out any type of engagement that you want to your patients. Again, we’re giving our nurses back a little bit of time in their day, and we’re just re-bucketing.

HHCN: Potential obstacle with outsourcing, insourcing, and technology implementation?

Kearns: Again, depends on which model you’re going with, but we’ve talked about the benefits of outsourcing and how it can save you money. One of the downsides is you give up some of that control. From a quality perspective, you’re now reliant upon another vendor to maintain that same level of quality. We’ve always said that we believe the best people to provide patient care to your patients are your nurses, it’s your staff, it’s your team, so we really try to live that.

All the solutions that we’ve built are built around that thesis that we want to encourage your patients to communicate with your team as much as possible so that you don’t lose that level of quality. When they’re unable to, when they’re in a death visit, when they’re on a call with another patient, our team can back them up, and that maintains that high level of quality within your group.

Certainly, one of the risks that you see from an outsourcing model when you’re dependent on external vendors, there’s always a risk from time to time of there being a disruption in service, which can have an effect on your patient’s care. No one is without that. There’s a hurricane hitting Florida right now, and there’s going to be disruption in service. That’s definitely one of the downsides of an outsourcing model.

In a lot of cases, you have to overstaff to meet the demands of your patients, and that gets very expensive. Many of the customers that we start talking to, that’s the first thing we look at, is we provide a free consultation for all of our customers before we ever sign on the dotted line as it were. We walk them through what that cost is on a per patient per day basis, so they can compare it to solutions that they’re considering.

Certainly, when you have that level of staffing, you have to make sure that you do have a plan in place to retain that staff, and that is one of the risks and challenges to the insource model. Like we’ve talked about, it doesn’t have to be mutually exclusive. You have the ability to leverage both through the models that we present.

Kuebrich: If you know that the risk of fully outsourcing is that your quality could suffer, I would make sure that you’re getting a lot of data and reporting on that outsourced function so that you can consistently monitor the quality, make sure that you’re using it for quality assurance, performance improvement, put a PIP together if you need to. I also think technology is a way to mitigate some of that risk, where it makes it hard for your clinician or an outsourced clinician to do the wrong thing.

If we can keep them on a straight and narrow path that we want them going down in terms of care, you’ll be able to mitigate some of those risks. I think those are the right risks to consider in any of those models.

HHCN: Can each of you just get into some of the detail around that? Maybe, Ellen, we’ll start with you.

Kuebrich: Elara Caring is one of our customers, and they use us for remote patient monitoring and patient engagement. One of the things that we’ve really found with them is that they’ve benefited through the fact that we believe that there’s not one size fits all, especially when it comes to remote patient monitoring. A lot of that has to do with access to care because you may have a patient that doesn’t have WiFi or one that doesn’t have a good cell signal, one that doesn’t know how to use a tablet and do not make them try to use a tablet.

We have to find different solutions that work within the same platform that meet the patients where they are and what they are comfortable with. That’s how it’s successful when your patient uses patient engagement. They use the model where they use our technology platform, and then they insource the monitoring. Even though they could use their people if they wanted, they really have a tight hold on that. They’ve been able to reduce readmissions by 30%, and that’s been in the last eight months.

Again, when we talk about the ROI and being able to have that come to fruition, it’s really a good marriage when you have an amazing partner like Elara. I will tell you, though, one thing that they’re really good at, and I would encourage all providers to do, is talk to your vendors like they’re your partners and ask them for what you need. Let us know where their struggles are because we’re always wanting to try to cement the relationship and help this be a successful room.

HHCN: I think that’s a good point in just viewing it as more of a partnership. Mike, did you want to weigh in on this as well?

Kearns: For those who were at Home Care 100 earlier this year, hopefully, you had a chance to see when we had Carla Davis from LHC provide feedback on our pilot with them. Since then, we’ve been able to expand our solution across the entire LHC organization hospice, and now, we’re looking at home health as well. This is regarding the triage service that we were able to provide.

When LHC came to us about a year ago, we started working with them in August of last year. We created a pilot that focused on providing services to 17 locations, about 1,600 patients, and it was really that heart of the hospice group that they had acquired. We’re working very much with Carla Davis, and she’s been just a phenomenal partner for us. They were dealing with the same challenges that we’re all seeing, the labor costs, how do we drive down our labor, the constraints of the market. Certainly, the quality was a big concern for them.

They felt like, in an after-hours triage setting, they weren’t able to answer all of their calls, they weren’t able to answer them timely, and the patient experience was really struggling. We implemented the hybrid model using CareXM smart staffing. Many of the groups that we talk to come to us saying, “I can’t hire enough people to cover my calls.” That’s because what they’re trying to do is staff for their peaks. They’re trying to staff for the worst times, Saturday, Sundays, when patients are calling in. You have to overstaff for that. We know this from a decade-plus of experience.

As Ellen mentioned, we have a team of over 100 nurses ourselves. All of the pains that you’re experiencing are pains that we’re also experiencing. We’ve just gotten really good at managing it. They were dealing with that, and they were trying to figure out how many people we needed to hire. We showed them, through a flexible hybrid model, where we can send the call to them using our technologies when a patient needs help, they’re able to get ahold of their nurse. When the nurse is unavailable, we back them up, which happens about 15% of the time.

With our technology, they receive the calls, they take the calls when they’re available, they’re documented in our platform, which has an integration with Homecare Homebase. Then, like I said, about 15% of the time, the call flows over to our team. Because we were able to do that with them and show them how to become really efficient, they were able to see substantial savings.

About a 40% reduction in capacity allocation of nurses, meaning they didn’t need as many nurses to take the calls as they were planning on, so they didn’t have to hire as many people through our time. They saw reduction in actual patients contacting LHC of about 30%. You’re driving down the number of times that patients feel like they need to call in. You’re doing it at a cost savings of close to 40%. That, obviously, led to a significant increase in nurse satisfaction.

They ran internal surveys and saw that their nurses were happier. Then certainly, the patients were happier. A model like that with LHC has been very well received, certainly, but had significant ROI that they were able to see within the first six months. Now we’ve rolled it out across the entire hospice organization, and we’re rolling into home health next. A real win for them, and it really validated a lot of what we had shown them beforehand.

HHCN: Thank you both for going into detail about that. Mike’s really speaks to what you were saying before about when you start seeing ROI within that year. I want to read something that I read from CareXM. “Clinicians need innovative approaches to reduce or eliminate off-hours documentation and restore work-life balance while increasing the quality of documentation, which, in turn, leads to better patient care and reimbursement.” We’ve talked a lot about these things, innovative approaches already. Is there anything else? I want to turn this one to you, Ellen.

Kuebrich: Yes, I would say, integration, integration, integration, get your technology partners to integrate. They all do wonderful things. It reduces nurse documentation when they’re talking to each other. We have integrations with almost over 25 EMRs. We have information flowing one way to them, our nursing notes are going back in, we’re getting patient demographics and medications, and again, anything that you can do to reduce the chance that a nurse or a non-clinician will make a mistake, the better.

I think that technology is a really good way to solve that and keep them on a path, so these clinical pathways that we have developed. I also think that we will always say, there’s a human element to care, and technology will just augment your team in the best way possible. I think it’s also really important for us to not just put a focus on how we’re getting paid through value-based purchasing with readmissions and patient satisfaction, but also, just consider how clinician satisfaction and care of our clinicians impacts that patient care and our patient outcomes.

If we can give them the bandwidth to not feel like they’re pulling their hair out, or they’re elbow deep in wound care and their phone’s buzzing in their pocket, and they don’t know which choice to make and which patient to prioritize, a happy clinician is going to give worlds better care that you will want that for your teams as well. I’d say, anything that we can do through technology to eliminate parts of their job that you don’t need them to do is great.

HHCN: What current crisis have we talked about today that you see as the industry’s biggest opportunity?

Kearns: I’d be curious if everyone agrees, but I think it is the workforce shortage and retention that’s putting just increased pressure on every organization, and there’s no end in sight, as certainly as the population is aging, as disease prevalence continues and a chronic setting, it becomes very difficult to manage for this increased population that we’re seeing. It’s important that whichever model you choose, or a combination of models, that the organizations are well positioned to do that.

As we’ve mentioned, we have a team of 100 nurses. We have a tech-enabled service that we can provide. As you’re talking about just the benefits of the different organizations, certainly, one advantage to CareXM is we brought it all under one roof, and there’s a lot of those challenges we solve for. That is going to have a positive effect on your workforce. Again, we have our own team of nurses and we’re listening to them, and we’re innovating based on what they’re telling us.

We’re building platforms by nurses, for nurses, by providers, for providers so that we can help solve those problems that you’re experiencing. I think that that does help with retention. That does help as you’re hiring. We’ve heard from some organizations that one very large organization, actually, said that they feel like that because they’re using our platform, they’re shaving off up to two hours of unnecessary repetitive admin work, logging into this system adding notes, logging into the system adding notes.

There are real efficiencies gained from having the right technology partner that can benefit your organization. I think that that helps mitigate some of those challenges that we’re seeing from a workforce shortage.

HHCN: We’re at the point where I want to start wrapping the conversation up, but before we do that, Mike, can you tease some of your company’s main priorities for the year ahead?

Kearns: Yes. Similar to what I just said there, we are constantly innovating. Patient engagement was a big rollout for us this year. We worked on certainly improving our technology to meet the demands of Elara and Inhabit and other organizations that have started using our platform. We have technologies that are built by nurses, for nurses. We want to make sure that our solution fits within hospice and home health. Next year, we are rolling out even more technologies that will, hopefully, improve that and make the experience better for your patients.

Then we also work with many of the vendors that you see here today and really improve our integrations, so we’ll continue to do that as new technologies are developed outside so that our customers, that work with CareXM, have access to others as well.

HHCN: Ellen, what’s the overarching message that you have for our attendees today regarding where their priorities should be headed as we look on to 2024?

Kuebrich: I agree with Mike that the elephant in the room, the biggest crisis is the staffing crisis. Taking a good hard look at ways that we can address that, I’d say, treat everybody that’s here at this conference or any of the conferences that we all go to as your ecosystems. While I realize, there’s competitors on the vendor side and competitors on the provider side, we really are all trying to innovate into the same direction.

I’ve seen so much good come from leaders in the industry that are collaborating together and really putting their heads together on how we solve this problem from marching on the hill, which we heard a great talk earlier about that on how we can all be better advocates to supporting these associations that are advocating for us, but I would say, take a look at technology, where can that augment my nurses time, where can it take something off their plate?

Take a look at insourcing, where do I definitely not want to take this function away, and then take a look at outsourcing is, where would I feel comfortable? If I had control, and I was monitoring them with data and solidly integrated programs, I could trust a partner to take on this function for me.

CareXM is a patient engagement platform that acts as an intelligent, virtual nurse call button whose mission is to care – about the patients, staff, and business of healthcare partners. To learn more visit: https://www.carexm.com/.

The post HHCN FUTURE: From Crisis to Success – Unlocking the Power of Outsourcing, Insourcing, and Technology in Home Health and Hospice appeared first on Home Health Care News.

Home Health Care News: I know this is a topic that a lot of you have been talking about for the last couple of days, and a lot of you want to learn a lot more about, and we have two great panelists on stage to help out with that. Sheri, first of all, can you explain the Thrive Center, what you do, what your mission and vision is?

Sheri Rose: We are a nonprofit innovation center out of Louisville, Kentucky. All types of technologies that are the future of us aging wherever we may want to be. Our vision is to transform quality of life and care for an aging population. As we do that, we explore a lot of technologies that are startups just being introduced into the ecosystem. As a nonprofit, we don’t sell out of there. We’re more educational. We like to focus on the possibilities for aging in place. We see technologies from all over the globe that we take into the Innovation Center.

In addition to being in that physical space, we also have what we call the Thrive Alliance. The Thrive Alliance is a group of providers from across the US, from California, to New Hampshire, that want to be the early adopters of technologies. Many of them are faith-based non-profits. We do have some for-profits, but they’re really looking at bringing about quality of life for their residents.

HHCN: Then how do the Thrive Center and CDW work together?

Liz Cramer: CDW and the Thrive Center is a partnership. As CDW has grown, Healthcare has become its own vertical with account managers focused on post-acute and senior living industry, acute/hopsital and ambulatory space. Sheri and I worked very closely together because, again, within CDW, as we’re working with the providers out there, we want to make sure we’re looking at the new technology that’s coming out into the industry for home health, skilled nursing and on senior living campuses, but also aging in place, and what that looks like.

Sheri and I collaborate on all kinds of discussions, and with new startups and technologies coming into the space, and it’s great to be able to bounce ideas off and talk with customers about it as well.

Rose: If I might add to that, from the very beginning, we were founded in 2017, and I am a co-founder. As we were designing the center of what we wanted to be, we wanted it to be immersive. We wanted to show innovation in action, and CDW was there from the very beginning on helping us with that design, and providing an infrastructure, because when we look at the future of technology, it’s going to require an infrastructure in place, and that’s key to what CDW does. Buildings where many of them are very old, a lot of these future technologies are not going to work.

CDW is huge in the acute care space, but they wanted to look at post-acute. I applaud them for leading out into senior care, because as many of you all know, there’s been a lack of technology. I was actually with AT&T in Bell South. Before I retired, I was doing some consulting and then co-founded the Thrive Center. I looked at the post-acute players where they didn’t have the opportunity to adopt EMR. Many of y’all know that it all went to the hospitals, and with the hospitals, they got meaningful use incentives to adopt EMR technology. Post-acute was left behind. We’re really working very closely with them and CDW to bring technology into the post-acute market, whether it be in a facility or at home.

HHCN: Obviously, home-based care providers, for the most part, care for seniors in their homes. I want to go through some of the biggest challenges that seniors do face when they’re aging in place.

Cramer: As we’re looking at technologies that are coming into this space, whether it be from the home healthcare provider or from the family, the infrastructure is always a challenge, but then the challenges of digital literacy are also there. I think COVID really moved seniors to use technology, and they’re not going backwards.

Even though there’s lots of discussion that our older adults don’t necessarily want to use technology, it’s not that they don’t want to use it, they just need some education and some confidence in being able to use it. Some of that challenge is, it’s not necessarily that they don’t want to use it, they just don’t know how, and they’re not really sure where to go to ask for help. Sometimes the family members are not the best ones to provide that education because it can be a little frustrating. Those are some of the challenges we’re seeing, because, again, we think they don’t want it, but once they get it and they start using it and they get used to it, there’s no going back.

Rose: I get asked all the time, will older adults adopt technology? Absolutely. If you came into the Thrive Center, you would see VR technology, you’ll see programs. What we like to do is take technology. When I say innovation in action, we invite them in, and we engage them in those technologies. They may be in a program for gait and balance. They may be in stroke recovery with a, it’s a product out of Switzerland that we have. I always tell the post-acute players that you have to prepare for the baby boomers.

I’m a baby boomer. I have to tell you, technology’s not new to me. I had the first bag phone, and so I’ve gone along with technology over the years. I always tell the care providers that you have to prepare for these baby boomers because we’re going to come in with all the devices that we’re now using in our home. I have two daughters, and they’ll demand it because that’s how they communicate.

Now when we look at moving care to home, I do believe that’s where it’s going. You’ve heard a lot of discussion on aging in place, and where is that? Is it an independent living where there’s congregate living? Is it in the home? We are seeing so many technologies that can monitor that person in the home. I think you will see technology be adopted, so prepare for the baby boomers.

HHCN: For the future of tech in home healthcare, how do startups get into discussions with Thrive and CDW? How does that relationship start?

Rose: We have a lot of partnerships. We’re also a technical and business advisor to the National Institute on Aging. I mentor a lot of startups. I’m now doing a boot camp challenge with NIA mentoring a startup. We see them at the very early stages with a system that they plan to sell into. They have to understand the reimbursement structure, who’s going to pay for that technology.

We also see companies that come in globally. The companies that come in from other countries with maybe a single-payer system, they enter the US, they talk to us, and we have to really train them on that product. May have worked in Israel. It’s not going to work in the US unless you change your business model. Very different from a single-payer system, as you all know, when you’re talking about reimbursement models. We also have a partnership with the Center for Aging, Brain Health Innovation in Canada.

I have a company coming in here in a few weeks. They have a product for stroke recovery. I invite providers and people to come into the Thrive Center to see the products. We really drive adoption in a lot of different ways, and we’re very collaborative. We work with a lot of students and I engage those students into research with the products. I just finished mentoring three occupational therapy students working on their doctoral capstone. They get to learn the future of what these technologies can do, and the community gets to engage in them as well.

HHCN: Liz, anything to add?

Cramer: From a CDW standpoint, and with Thrive, for those that don’t know, CDW is a services and solutions technology provider/company. We don’t make anything. We partner with technology providers. A lot of times, a lot of my role is looking at the new technologies that are coming into the space, meeting with them, and working with them to scale the product. I come from the provider side. I’m a physical therapist assistant by background, and worked in the industry prior to coming to CDW. It’s really nice to be able to see the solutions and technology coming into the industry, and, like Sheri said, we talk with them about the fact that, ‘Hey, this is how the industry works, this is how the payment system works. This is not going to work.’ If we adjust your model a little bit, and then potentially look at, is this something that we’re really missing at CDW that we could take to the market as part of a solution that we’re taking out to our customers.

HHCN: Especially at a time when rate cuts are prevalent in home healthcare, there’s going to be providers looking at different technologies. The care-at-home trend is becoming so popular that more and more technologies are coming into the space, which can be overwhelming for providers. How do you help providers sift through all that and make sure they’re really landing on solutions that will help them and their patients?

Cramer: We really look at, one, what’s the problem you’re trying to solve? I think it can be overwhelming. There’s so many solutions coming into the industry. We saw a huge influx with COVID, and they just keep coming. Trying to sift through that is difficult. Sheri and I do spend a lot of time with the solutions, but really looking at those that are continuing to grow. Just my two years with CDW, there’s a few different solutions that I saw initially when I came in that I was like, “I don’t know if these are going to work.” We’ve stayed connected, and they’ve continued to grow and add on, and even connecting solutions that are, I see one that does one thing and another compliments it well so if they come together that is really solving a problem.

HHCN: Sheri, I know you mentioned a few already, but what are some of the more interesting innovations that you think are happening in the space?

Rose: We have a smart home. That’s the focal point of the center. In the smart home, we’ve seen a lot of technologies that are now getting out into the provider market and being adopted. One, it’s called Toi Labs. It’s TrueLoo. It’s a smart toilet seat.

The founder was a Harvard engineer. It analyzes the output of that individual. You can tell a lot about that individual from their output. You can pick up on change in condition. They can denote dehydration, colorectal cancer. They’ve actually picked up on pancreatic cancer. Also on UTIs. Let’s think about it. When do you usually know? A lot of older adults will not realize they have a UTI. They present with confusion or a fall. Now you’ve got further complications. They first put it in their memory care unit because someone with dementia is not going to tell you what’s going on, but they were able to cut falls. They’re now expanding it throughout their personal care. To think of something like that, being in the home to catch someone early and to pick up on change in condition. That’s one product.

We’re looking at smart chairs and smart beds. The first thing I would tell you is, it depends on the stage, because not every technology is going to work for every person at that particular stage of aging. Where a watch for wandering might work today, tomorrow, that person with dementia is not going to wear that watch. I’ve had some entrepreneurs say, “We’ll lock it down on them. They won’t take it off.” It’s like, “No, you won’t.”

I cared for my mother who passed in 2019 with Alzheimer’s. I learned a lot about the agitation and frustration. What I’m looking at now, because there are a lot of technologies, is the non-intrusive motion detection within the home.

There’s been a lot of discussion on AI. I almost look at artificial intelligence as a buzzword that can solve some of these problems. Do I know if they got out of bed? Are they on the floor? Did they go to the refrigerator? Those are the things that we’re looking at.

Then we have a product from Israel Intuition Robotics that’s a social companion robot called ElliQ and it’s proactive. Does it work for everybody? No. They actually launched out of Louisville at Thrive in Naples, Florida. They sent me 20 of them. I had a few of them come back.

As Liz talked about loneliness and isolation, everybody, during COVID, came out of the woodwork with a product to solve loneliness and isolation. It’s not new. It’s been around forever, but what happened is we experienced it during COVID ourselves when we didn’t have an opportunity to reach out and touch and communicate with a lot of our family members. The state of New York, bought 900 ElliQ’s and distributed them throughout the state of New York into the rural areas. We are now seeing a lot of the states look at what products can help for aging in place and at home.

HHCN: We were talking earlier about sometimes it’s actually the patient that you have to convince on the technology. “Hey, we’re going to put this in your home.” Well, a lot of them say, “No, you’re not.” How do you get through that barrier where you’re having the patient trust the process?

Cramer: With regards to that technology coming into the home for the patient/resident and them not wanting it, a lot of times, that discussion also has to be with the family, because that technology is not only there to support the patient/resident, and hopefully help to keep them aging in place where they want to be from a safety standpoint, but also for the family members that aren’t living there, that maybe live out of state that need to know that mom or dad or grandma or grandpa or whoever is okay.

A lot of these technologies have that ability for not only the care provider, whether it be home health or senior living community, to learn daily activity patterns and when the patient/resident is up and moving around or their day-to-day movement. Many times, it’s the family that also wants the communication as well, the AI on the back end to know and alert them if something changes. This automation gives care staff time back in their day versus calling family members to report if the family has already been notified. I agree with Sheri as AI being that buzzword, but really the exciting benefit is how are we using it to be proactive in providing that care, or be preventative in providing care as well?

HHCN: I just want to give a minute for final thoughts, advice, call to action, just anything that you would like to end with, Sheri or Liz.

Cramer: I would just say final thoughts would be, I think we’ve provided care, the same way for many, many years, and it’s a bit of a culture shift, so my call to action is, let’s continue to think outside the box, and how can we make this work as we continue to see the number of older adults continuing to rise, wanting to live at home, and what does that look like? Again, thinking outside that box to what’s available for us to provide that care.

Rose: I would quickly add to that two things. One, entrepreneurs struggle going into the home because it’s a B2C market. That’s very difficult. Partner, as a home health organization, partner with those entrepreneurs, because if they’re collecting that data, they have to be able to hand it off to someone who is clinical that can take action. Look at partnerships.

Then the second thing I would say is, become part of a value-based organization, because that’s what they need. If you’re going to do value-based care, I think the payers are going to have to pick an organization, partner with a technology provider, and if you can deliver, and you can, we know you can through technology, that you can drive healthcare outcomes. That’s what you’re going to have to prove for these value-based organizations to partner with you.

CDW is a leading multi-brand technology solutions provider to business, government, education and healthcare customers in the United States, the United Kingdom and Canada. Our broad array of offerings range from hardware and software to integrated IT solutions such as security, cloud, data center and networking. Learn more at www.cdwg.com/seniorcare.

The post HHCN FUTURE: Exploring the Future of Technology in Home Healthcare appeared first on Home Health Care News.

Home Health Care News: Why don’t we all just talk about what your organization does and what you do for them?

Ashley Puchalski: I’m with Ohio’s Hospice. We service about 60 of the 88 counties in Ohio, providing hospice care throughout the state. My role as the senior director at the care coordination center is to help coordinate care across the state. We take incoming calls from patients and families as well as the providers and employees throughout the entire state for all of our affiliates. We coordinate the care with the providers that are available to meet patient care needs.

Hannah Patterson: I’m the vice president of our workforce management solutions at Netsmart, a Healthcare IT vendor that provides services and solutions technologies for home care, post-acute providers and our human services clients. My responsibility there from a workforce strategy is finding solutions and technologies to assist in the workforce shortages to support and streamline back office, front office, clinical staff.

Divesh Aidasani: BAYADA is a home health company founded in 1975 that provide a diverse range of services from home health, hospice, personal care services, both in the Medicaid space and the private pay space, private duty nursing for pediatrics and adults, habilitation for populations that have intellectual and developmental disabilities and then also ABA therapy for autism. I lead strategy for the company and I also oversee referral intake, which is what we’ll talk about here shortly.

HHCN: Ashley, let’s start with some of the challenges, and what would you say the biggest challenges are that you’ve encountered with managing a mobile workforce for field clinicians?

Puchalski: I think we’ve had the opportunity to optimize different technologies. We’ve been very fortunate to try to platform and leverage our staff that we have and the resources that we have on the backend operations within Ohio’s Hospice. Coordinating care for 60 counties of the 88, identifying where these providers are in the field, what are their credentials, what is their availability. Are they available? Are they with a patient currently? Are they able to coordinate that care for speed to care? Being able to see that was always the biggest challenge. Utilizing CareRouter has given us a huge leverage to be able to increase our speed to care.

We want our patients to be comfortable, we want them seen, we also want to help our providers in the field not feel the burden of trying to manage and coordinate all that. We want them to be present with their patients and have the tools that they need at their fingertips with an ease of an application. Technology can be extremely scary for many people. We want to make sure that’s the ease of use so that they can efficiently utilize it to meet that patient care need.

HHCN: What is a key initiative BAYADA is looking to address with their advancing technologies to support a more streamlined workforce?

Aidasani: BAYADA has spent a tremendous amount of energy, time, money and technology. We actually hired a head of digital products last year, and we have oriented the company now into several products, digital products that are aligned with very specific experiences around workforce enablement. There are a few key initiatives under that that we have funded now. The first one is around caregiver enablement. It’s how do we help recruit faster and recruit the right people all the way to training, onboarding, giving caregivers a form of community within BAYADA because it’s such a big firm, and also helping them find different jobs and also applying across different business units. That’s a key place that we’re spending a lot of time on.

The second one where I spend a lot of my time is around referral intake and management. I think that’s where we have a huge opportunity to be able to serve more clients and drive our conversion rate higher. The way we’re trying to do that is by reducing our average handle time or time it takes to process a referral with a lot more automation and things like that and then also reduce our average speed to answer. In doing so, really enhancing the experience of everybody involved in the entire workflow from intake to admission. The third area is revenue cycle management, which is around optimizing experiences.

Again, this is for our administrative staff around accounts receivable, around prior authorizations and then just reporting, which you need the most accurate information at all times for that. In the fourth area of investment, we at BAYADA are relatively large with eight or nine different business units, and we have multiple practice management systems and EMRs. It’s really about how we take each one of them and modernize the platforms to make sure there’s a lot of configurability in each one of them. How do we re-look at the workflow, reduce any friction points and eliminate unnecessary documentation, stuff like that, and underpinning all those four initiatives is a heavy investment in our data and analytics infrastructure.

Think of data lakes and things like that just to have the most accurate information at all times. Then also, eventually, it opens the door to more advanced AI use cases, which we can actually go after once we have all of that built out. That’s all underway at BAYADA at the moment.

HHCN: What advancements in technology or just evolution has BAYADA put in place, if any, when it comes to onboarding?

Aidasani: I think it all starts with looking at the overall process first. That’s where there’s been a tremendous amount of work in looking at the overall process in our recruiting practices across eight or nine different business units and actually synchronizing that quite a bit to do it right and then using technology to enable it. Right now, the stage we’re at is actually synchronizing everything across different business units. Then we’re also investing in the right tools to enable the recruiters to do what they’re supposed to. Then training and onboarding will be part of that application that we’re actually building to do that quickly and to do that efficiently and well, and then keep providing more ongoing training as clinicians stay with us for a while.

HHCN: Hannah, you obviously work across a large client base and hear concerns on a daily basis. What are some of the trends you were hearing on how agencies are going about this enablement and automation in the workforce?

Patterson: Even the panel before, listening to that most of them are private-pay clients, they have different needs and different processes than those that are on a commercial plan or Medicaid. You’re looking at your margin profiles. Everyone’s looking to see how they grow. If you look at the specifics of each program and the tactical pieces of what’s repetitive that you can automate with the technology, those are areas of focus that you can increase your margin, that you’re reducing staff and refocusing them somewhere else because it’s a repetitive tool, whether it’s collection, whether it’s clinical documentation and efficiencies.

You hear AI, RPA, those types of things that are really helping organizations in healthcare streamline and grow so they can repurpose their clinical staff or their credentialed staff in a more streamlined, effective way. When you start with the referral intake, it’s one of the biggest areas of a challenge because you’re repeating the same information in multiple systems because it’s not streamlined across one efficient workflow. You’ve got three to five folks that are credentialed, or that require a specific skill set to do that role. How do you reduce the amount of times that you’re entering the same information into multiple systems to streamline the efficiencies down to impacting the care that you’re delivering for that patient?

If you think through the automation, each program, each agency is going to have probably a different area of focus, but what areas are you seeing the highest turnover for your staff? Are there things that you can focus on there to reduce burden and streamline their workflows? Like Ashley’s organization, she found the challenge of sending their clinicians halfway across the state instead of repurposing someone that’s 15 minutes away with technology of seeing exactly where that clinician is to be able to increase the speed to care and provide and deliver better services.

HHCN: Touching on and going into speed to care, Ashley, how have you and the team at Ohio’s Hospice been able to address those challenges with speed to care and what results have you seen?

Puchalski: Dating us back, we had paper and a pen that we used to write down everybody that was working that night. We even on a smaller scale where the RNs or LPNs or social workers or chaplains that we had on services and available that night to meet the patient need and their hours they were on, and writing down and Google maps a little bit where their location was to who could meet that need. It was extremely challenging. There was probably a lot of wasted drive time that delayed the patient care. Our goal initially was 120 minutes from the time of receiving a call to the time that we got to the bedside of a patient, for urgent and non-urgent needs.

Meaning the patient has some respiratory distress, or their pain medications aren’t lasting them as long and are a little bit more ineffective and trying to get someone there in speed to care. We’ve now been able to leverage our goal to 60 minutes with this technology, which is huge, so we’ve cut it in half.

We’ve decreased travel time significantly. As Hannah stated, we’re able to look across the state, those 60 counties and say where are these individuals located? What is their status? Are they charting? Are they driving? Who is closest? And cross-utilize those teammates across all of our affiliates. My team at the Care Coordination Center manages 135 employees approximately after hours, and those are just nurses. We also have chaplains, social workers, other individuals that we help coordinate care with, but our primary coordination is the nurses.

As patient families call in, we, in a month, average around 1900 calls that we take, and our triage nurses triage those to the best of their abilities, but then when there is a patient care need that’s needed then that’s when they coordinate that care utilizing CareRouter, seeing where that patient need is and who that closest provider is to meet that care.

Patterson: I’ll piggyback on where Ashley was, too, because I think part of being able to collect data in a system then allows the recruiters for her organization to say, “Okay 80% of our calls are coming from this county or this specific area, so you can start heavily targeting recruiting in those specific areas.” If you know where you’re delivering the services in the care coordination, you can streamline and automate technology and then flip it into your recruitment strategy as well. Recruitment and retention, I should say.

Puchalski: The goal, really, of CareRouter, too, is to utilize all that information. It has great reporting so we can see how many urgent and non-urgent care requests have come in. Obviously, with the patient population that we’re servicing with hospice, things can certainly change drastically, and we know that. We can also evaluate, are there a lot of pain calls coming in from patients not being appropriately managed? Again, our goal is to keep them out of the hospitals and aging in their home and comfort with their loved ones. We do service patients that are in facilities as well as home patients and we even have an inpatient unit.

We’re really trying to keep them in their home, keep them comfortable, and again look at trends. Are we seeing a lot? There might be education that we need to do either with the family or with our clinicians. This tool that we have really allows us to dig deeper in that and get those reporting factors.

HHCN: We’ve obviously touched on the workforce in your caregivers, but how has the program affected family and patient care?

Puchalski: Obviously the faster that we can get there, the more confidence they have in the care and services that we provide. We also platform our care coordination center answering a call within 60 seconds of each call coming in once they press the number. Again, they get in touch with a real live nurse right there. We start triaging the calls, giving them the reassurance that they need and the care and services that we provide and then letting them know that we will have a caregiver en route. Once the caregiver does go en route, Care Router has an available opportunity to allow them to have a text update to say that Nurse Ashley’s on her way and she’ll be there in approximately eight minutes.

Just that reassurance that we have not forgotten them, that we will be there as soon as possible is really done leaps and bounds in our customer service for the patient and family experience.

Patterson: It’s like an Uber for healthcare. How many of that a clinician’s on the way and someone in your organization, family’s calling asking where’s your staff or where are they? They’re getting the real-time update of how far away they possibly are.

Puchalski: We figured if Pizza Hut could do it, we could do it.

HHCN: What’s the response been from your field staff about these new technologies? How is the implementation going, just what feedback have you gotten from them?

Puchalski: I think there’s always the challenge, and when you’re constantly trying to deliver more technology this field staff can be overwhelmed with it. One more piece of application that I need to remember how to use or when to use. The way that it’s been developed and the ease of use has really allowed them to really, as soon as they open up the application, they can see what visits that they have. They can go en route, it has the address, it takes them into Google’s map so they can get there the safest route. It has the family telephone number that they can call and also just let them know that they are en route as well.

Are there any additional needs that you have? It gives them a snippet of what the call was as well as letting them know what time the call came in, and what the care needs were. I think having that technology and the ease of use of it, it was very easy for them to take ownership in it and want to engage in that application as well.

HHCN: Divesh, you mentioned earlier about the referral and intake process, how have you addressed that and what results have you seen at BAYADA?

Aidasani: Our primary goal with referral intake was, as I said before, is to drive to be able to serve more clients, drive conversion rate higher. In doing so, our first challenge was, how do we enable a proper workflow for everybody involved? We’ve got sales team members involved, our central intake coordinators involved and then we also have the local branches involved. How do you make everybody work in a seamless way and eliminate a lot of the phone calls and emails which is where the work’s going? That’s the first opportunity for us, and so we’ve been building our own intake and referral management system around that.

Again, remember we’re eight to nine different business units, so it’s a little bit more nuanced for each business, so we need a lot more configurability in that sense. The second step is there’s a lot of opportunity around just reducing manual work. If we’re having an intake system, we want to avoid dual entry. In doing so, we’re actually leveraging RPA already which has actually led to a decrease in the average handle time and speed to answer because now I don’t have to actually copy stuff into my EMR. The third one is really around if you put yourself in the life of an intake coordinator, they might have multiple applications open.

One is around, do I serve the zip code? Another one might be around, do I have a contract with this payer? Third one might be around, how do I confirm the insurance benefits this individual has? How do you take all of that and put it within their workflow in the same application? That’s the third area. The fourth one is for us to have real-time intelligence and make decisions. A lot of our analytics today are retrospective in nature. We’ll go back in time and look, “Okay, well this is what we did.” How do you make that real-time right there to be able to make better decisions?

Whether it’s decisions around prioritizing referrals or whether it’s decisions around, I can have a view of an account across the different business units, whether it’s a hospital or a physician account, or I can have a view of a patient being served by multiple business units for us which we call practices internally and providing a very harmonized experience to that patient. That’s the type of stuff we’re working on, so a lot of the work we have done so far has been around RPA. A lot of the stuff now we’re working on is that intake system. I would say one of the challenges we definitely face in the industry, and I’m assuming some of you also face the same, is interoperability.

A lot of the systems that send us referrals may not have APIs to send us all the data appropriately or a lot of the EMRs or practice management systems we have downstream to push the data into, do not have APIs to accept all that information seamlessly, and that’s where RPA becomes a little bit of a stopgap. The second area of a challenge that we face a lot is what I’d say, semantic interoperability. You might name Aetna Medicare Advantage as exactly that way, I might name it as AETNA and she might name it as just Aetna, and so you need manual intervention in the middle to actually standardize the data which we just have to live with at this point. If anybody has creative solutions around that we’re pretty open.

HHCN: You talked about obviously what you’re doing now at BAYADA. What’s on the horizon to address technology strategy? What’s in the future thinking?

Aidasani: David made a huge bet. He’s invested a lot in technology. We have a head of product now, and product managers align with those specific products, so a lot of the work is ongoing. I think a couple of really cool opportunities that also stem from this investment is, one, it allows us to reevaluate all of our processes. Things are done a certain way but when you have product managers focused on specific areas, they can ask, “Well, why do you do it this way? Why not look at it a different way? What’s the job that needs to be done? How do I help you address that rather than assume that the workflow today is the most optimal workflow?”

That’s a really positive move from that investment. I think the second thing also, as I said, we’ll just have a lot more intelligence now in making a lot of the decisions. We’ll move from retrospective analysis to real-time predictive analytics which really helps us do a lot of this stuff. I think we’re already leveraging some models and algorithms to predict care management for certain clients, but now it helps us go much beyond that with appropriate machine learning and AI models that we could do once we have all these investments pan out. That’s what we look forward to.

HHCN: What are some things agencies aren’t thinking about that can make a difference for their organization?

Patterson: I don’t know if it’s necessarily not thinking about but it’s always a good reminder that our healthcare industry and the industry in general is you’re staffing five different generations of employees. You have a wide range of how you’re going to deploy and implement one solution or an efficient technology in five different generations. The youngest generation never grew up in this industry without a phone. More than likely, when they’re graduating and they have a nursing degree, they were already in a clinic, they were already on a laptop, or EMRs was part of their graduation process.

Then you have the inverse of probably your most strategic or important staff that you want to keep and retain because they deliver good care or even your collectors in your billers that have been in the workforce for 30 years, getting them to remove their spreadsheets. Even though you have technology, they still want their spreadsheets just as a peace of mind. I think it’s just a good reminder, regardless of what technology and the solutions that you’re implementing, just reinforce, it’s your strategic, executive management level that you have that it’s a barrier, but you can use that barrier to assist in ensuring the success and then reducing those repetitive processes.

I think it’s just always a good reminder to challenge the status quo just because one of the most critical folks in an organization leaves, doesn’t mean that that’s the critical role you need to replace in your organization. Look at what that role is doing and then see if there are efficient ways to divide out and then recruit where you have a huge gap. I say that just from the technology and the staffing perspective, it’s important. Where I sit in my company, I have responsibility for networking and clients whether they’re a state agency, an MCO, so payers are a client of mine, and then also provider agencies, so as providers are becoming payers, payers are becoming providers, you need good data to make data-driven decisions.

Make sure you’re looking at the right specifics of your organization to make those specific decisions and where you’re going to invest time, energy and spend.

Puchalski: I’d piggyback off of that, your providers in the field, your clinicians, your nurses, they want to continue to provide that amazing care to their patients. They don’t want to be disrupted when they’re providing that intimate care on the bedside of a dying patient or whether they’re doing skilled care education in a home care patient setting and having the trust in that technology, as Hannah stated against those multiple generations and the technology that we’re giving them. Once they have that tool that we have, and they see the efficiency and the effectiveness so that they can really provide that care without interruption, gives them the buy-in to continue to use it and again, enhances their presence at the bedside to do what they’re really there to do without a barrier.

Aidasani: I would just add one thing that we have learned through some hard work here is, appreciate the nuances of whatever business line you’re trying to solve the problem for. Initially, when I joined BAYADA, I would say it felt like there were so many commonalities between a lot of our different businesses where we could see a lot of similarities between home health, hospice, personal care, and private duty nursing. When you go deep into it and you spend a lot of time in the day-to-day and the payers are so different as well and the care that they have to deliver is also different that you can’t think that one approach is going to work for everybody.

There might still be 80% commonalities, but the 20% is where everything breaks and I think you have to really pay attention to that 20% and make sure you appreciate the nuance and develop the system that’s right for that particular care type.

HHCN: Hannah, what results are you seeing with agencies leveraging those kinds of things, especially in back office settings?

Patterson: One of the clients that is taking on our collections automation, you’re not going to do that in a private pay setting. However, for your commercial insurances or where you have a huge AR, you’re reducing or seeing an increase of 69% of efficiencies with automation of the standard processes that you would go into a technology and collect. Just looking at various ways of just rethinking those tactical repetitive processes is key to growth. Then being able to repurpose your staff that you do have in other ways. I understand, when I talk to clients and the agencies and prospects and even payers, technology is always one of those, we don’t need that, we have these people say, “Okay, how much do you pay 60 of those people today? Let’s roll that out in an Excel spreadsheet and let’s do the math.”

Now, if we’re going to invest $15,000 in something that could offset a $300,000 investment that you have, it seems like a pretty good approach. I think just the reminder of these tactical, repetitive processes, I think the back office is one of the biggest areas. I think a lot of times this industry usually focuses on the clinicians because usually 80% of your workforce is the clinicians, 20% is probably back office, but you’re spending a lot of your expense, too, in that back office and that’s where you’re getting your cash collections, too, to obviously generate more opportunity to grow the business.

HHCN: What opportunities would you all say you’re most excited to see in the industry, whether it comes to technology, workforce enablement?

Puchalski: I definitely think continuing to grow the technologies that we have and invest in the ones that we are already using to capitalize on those is huge. Again, I think the goal for all of us is having proactive care versus reactive care. That’s what’s going to keep those patients even whether they’re hospice or home care out of that hospital. You can start to track trends with the information that’s presented to you. Do they happen to call in a lot for uncontrolled pain or do you see that they have some anxiety just around their diagnoses and things that are going on and maybe scheduling proactive visits, maybe scheduling proactive calls to assess their needs versus, again, being reactive when they call in and then you’re trying to play catch up. I think just really using those technologies to leverage the information that we’re given.

Patterson: I would say pay attention to the trends that are coming out in the payer markets of what types of services that are going to be reimbursed. Most agencies, if you’re private pay only, entering in the LTSS or the commercial space, I think, is important to continue growing. Post-pandemic, there have been a lot more services being opened and lines of diversification in Medicaid. I know Medicaid, some reimbursement rates depending on where you are, are significantly thin, and then others they’re very prevalent.

I think paying attention to where the federal funds are being provided. That’s also where a lot of organizations are seeking grants because along with those funds, they need providers like you all. I mentioned I work with MCOs and states, they need providers to take on these services for the populations that we service in this industry, so they’re asking. You guys have the data of knowing what you’re doing in your traditional lines of business and your programs. They just need to know how you’re going to operationalize it to support the new growth if it’s an area of opportunity that you guys are looking to expand.

My biggest focus is probably paying attention to what types of services that are being provided that are coming out and the rules and what’s actually being expanded upon, but Medicaid is going to be a continuous growth opportunity, I would say, for this market if you’re not already in it paying attention to those specifics.

Aidasani: From my vantage point, what I’m really excited about next is the evolution of healthcare where at least at BAYADA, we’re making this a point where the product manager and the engineering team is part of the team now. It’s not just the clinical team and the ops team, but there’s a digital team on the table helping make appropriate decisions that’s thinking about things very differently. I think that just having an engineer on the table who can think about problem-solving in a very technical and different way just opens a lot of doors to how you could provide care. I’m pretty excited about that, I know there’s a lot of digital health companies and things like that, but I think that mindset is pretty important in care delivery.

Patterson: Them understanding how the operators are operating makes it more efficient for them to deliver.

Puchalski: I think that’s huge, too. The platform that we’re really working on is we’ve continued to partner with other non-for-profits throughout Ohio right now, home health agencies, care management agencies, United Church Homes that has different home-based care and really creating that ecosystem of care continuum of providers within our organization and our Ohio platform to be able to keep those patients aging in place because it is challenging to find those. We heard earlier you’re selling your home to move in with your family. That may look different, but just servicing them where they are and trying to keep them comfortable in their environment as long as we can.

Netsmart enables home-based care organizations to improve quality, outcomes and efficiencies – and thereby revenue – through technology solutions and business services. More than 35,000 post-acute and human services providers choose Netsmart and our CareFabric® platform to accelerate digital transformation and advance person-centered care. To learn more, visit: https://www.ntst.com/.

The post HHCN FUTURE: Workforce Enablement – Emerging Technologies to Improve Staff Experience and Efficiency appeared first on Home Health Care News.

Home Health Care News: Can you provide a brief background for the audience on yourselves and your company? Jason, we’ll start with you.

Jason Banks: I’m the Vice President of Business Development for nVoq. nVoq is a speech recognition provider in the home health and hospice space. My background is in technology in the post-acute care space. I’ve been in the space for a little over 20 years. Having run a provider for about two and a half years I know how difficult it is for the folks here at the conference in the room. I’m excited to talk more about how organizations survive and thrive under some of the headwinds that they’re facing and look forward to the conversation.

Jennifer Maxwell: I am co-founder, CEO and a counselor in the mental health acute hospital space. From there I moved into home and community-based services, all the 1115 waivers in the state of Colorado, and oversaw the Adult Protection Area Agency on Aging and other adult services programs. From there, I moved into the trade association space and was the CEO and executive director for the Minnesota Home Care Association.

For about three and a half years after that, my husband and I became business partners. I did a small stint in sales in corporate, and we decided to start Maxwell Healthcare Associates. We are a post-acute care, home health, hospice, and palliative care consulting firm. We cover all 50 states and all payer sources as well as private equity and technology.

HHCN: Given the tightening of the belts, everyone’s trying to become more efficient, but also trying to cut back on cost. What is the value proposition? How do you convince someone that it is the time to invest in a tool like nVoq?

Banks: We’re in a cycle. The cycle never really stops, right? You’re going to have up periods, down periods, you’re always going to face reimbursement challenges and regulatory challenges.

The interesting thing that I see is that there’s always an uproar when it comes to payment cuts. No matter what, if there’s a payment cut or even an increase, that’s not to the level that the organizations in our industry find acceptable, which I don’t think there’s ever been one that’s been acceptable, then there’s a huge uproar about it, right?

There’s not the same uproar as it relates to regulatory compliance and regulatory burdens that CMS continues to come out with, and I find that interesting. I know we have comment periods on some of the proposed changes to regulatory. I don’t see the same level of outrage on the regulatory changes that are occurring.

I think there’s so much there in terms of burden that’s put on the individual clinicians from a regulatory perspective. Let me just give you one example. When we had to comply with the addendum on uncovered services, it placed undue burden on the provider, on the clinicians, on the entire system. We were covering much of the non-primary hospice diagnosis stuff anyway.

I feel like there’s just not enough visibility put on the regulatory compliance, and I know there’s a whole cottage industry there focused on OASIS answers and how we answer those questions and staying aligned with care plans, and if you watch a clinician, whenever you say the word care plan, their eyes start to roll in the back of their head.

I think that nVoq has a value proposition in multiple areas, making clinician workflow more efficient and improving the quality. Most of the technology that is out there, and the EHRs do a great job, we’re partnered with most of them, they do a wonderful job at keeping the organization in regulatory compliance as it relates to the documentation. There’s a gap there in efficiency, right? A lot of times with technology, there’s a trade-off.

The more efficient you make the clinician, quality suffers or the higher the quality they suffer from an efficiency perspective. nVoq is unique in that we’re making it faster for clinicians to document, which ultimately will result in less burnout. There are studies out there that state after-hour documentation is the number one cause of clinician burnout. We feel like we make a significant difference there, but also in the quality of the data as well. Those are the main value propositions that we’re looking to drive.

HHCN: From the consultant perspective, how do you explain why investment matters even in times like this where cuts are occurring?

Maxwell: That’s a great question. A lot of the work that we do, we’re going into organizations and we’re figuring out how to strategically align the innards of the organization, all the operations, the people, the workflows, also quality and bottom line is your DSO and cash flow, right? When we think about all of those things, timely, effective, efficient documentation that meets, as Jason said, the regulatory requirements, that gets into the EMR in a timely fashion and is up to date, provides a much better reimbursement potential and a quicker reimbursement potential.

If you know that your clinicians are working off of narratives that are highly detailed and using an assistive technology that helps to maybe remind that clinician, “Hey, did you ask that question? I don’t think that one was finished in the OASIS set.” Those are some of the things, and especially on the home health side, that really help.

I would also say to the point of documentation outside of the home, if you’re documenting after-hours and you’ve had six or eight visits throughout the day, and you’re coming back and trying to remember what you did with your first patient of the day at eight o’clock at night, after homework, after swimming lessons, and whatever else it is, that quality of documentation, and what you remember is not going to be as accurate as it should be.

Which increases your issues with, is the plan of care being followed correctly. Are you seeing things that potentially this patient might need sooner than later? Then the care teams are not aligned either. When you think about being able to bring in that technology to document quickly, being able to be less distracted when you’re at the patient’s bedside as well. Then my last piece to that is quality of care goes up, and patient satisfaction.

We all know that patient satisfaction is going to be a big deal because that’s your star rating. That’s what CMS is looking at the end of the day. If you don’t have good satisfaction scores, you’re also going to have the issues with payment as well down the road.

HHCN: Jason, you said earlier that you admitted that you were biased. Can you provide evidence of how this can make home health agencies more efficient during a cut period?

Banks: We’ve actually done a number of formal and informal studies over the last two to three years in working with organizations around improvement in DSO. How quickly are we moving from care to the bedside to reimbursement for that care? We’ve been able to improve DSO in a lot of cases by speeding up the documentation, but also moving it closer to the actual patient visit itself. You see things like NOAs getting sent out earlier, QA processes getting sent out earlier, and the QA process not being as back and forth so it can lower QA costs.

Then, ultimately, we’re seeing a tremendous impact on clinicians’ satisfaction, which ultimately we’re tying to retention. We just recently worked with an organization that saw the clinicians that were using our speech recognition engine tool about a 20% reduction in turnover. As I look across the industry, there are a number of things that organizations can do to help with clinician shortage and clinician burnouts. Not a lot of them, though, have a direct impact to the clinician the way that speech recognition does.

We have organizations today that are producing video testimonials from their clinicians saying, “Hey, with this tool, I’ve been able to save 20%, 30% of my charting time.” If you look at an industry average of home, health and hospice, the average amount of documentation as compared to care, is about 20% to 30% for a routine visit and upwards to 50% to 60% for an admission visit.

It’s a significant amount of time, which also means they’re saving a significant amount of time. Those organizations are using those clinician testimonials as recruiting tools. I don’t think saying, “Hey, we’re investing in our clinicians.” Again, I don’t think speech recognition is the panacea for everything, but it is an important thing to directly impact one of the biggest burdens that clinicians face, which is the documentation time.

HHCN: Sometimes it’s a better place to start with retention than recruitment, trying to keep the clinicians that you do have. Do you see this as something that can really be leveraged to help home health providers hold on to their clinicians longer-term?

Maxwell: Absolutely. What we’re seeing when we work across organizations, some of you have obviously state regulations and overtime and a half after hours for documentation. Some of our larger clients out in the California area, anything after 5 PM is paid at time and a half. Also, they are struggling to be able to get their family life and work-life balance into play. What we’re seeing is if they’re doing it during the workday or even as much as you push the button and you’re talking into the microphone in your car, into the mobile device.

Being able to get that taken care of before you get to the next home is a greater level of satisfaction to clinicians, is what we’re finding. Those that leverage speech-to-text technology such as nVoq really do save that time throughout the day. We’re able to bring in more admissions, be able to move clinicians quicker through different processes without them feeling the stress of, “Oh my gosh, I have all of this paperwork to do, and all of this documentation.

They are really feeling satisfied with the work they are doing, and they are feeling like they are providing the care that they set out to be a clinician for and being able to work at the top of their license rather than sitting behind a computer and typing.

HHCN: For both of you, how much time do you think this can save on a daily basis for clinicians?

Banks: It depends. For instance, we’re seeing upwards of 45 minutes to an hour savings on every admission visit from a documentation perspective. Then, on more routine visits, subsequent visits, we’re seeing in the area of 7 to 10 minutes saving per visit on the documentation side. It does result in significant cash flow improvements, ROI improvements, significant savings on turnover, etc.

There’s a very strong ROI component. Usually when we start working with home health or hospice organizations, they intuitively get a lot of head nods from the clinicians and also the IT department, they intuitively know that this is the right thing to do. It’s normally getting over that ROI hump with the financial buyer, whether it be the CFO or somebody else within the organization, if she is focused on how is the ROI going to pay for itself, that’s typically where we are spending the most time, I would say, again, that a lot of the clinical leadership, they just intuitively get this right off the bat.

HHCN: Even if the ROI is there at a time like this when providers are busy, how do you help them get through the burden that is applying any new technology to their business. I imagine that’s not an easy process, especially for some of the agencies that are short-staffed, and don’t have a person on board who specifically has that job. What do you do to help them ultimately get that to be a part of their business without it really hurting them in the short term?

Maxwell: I think that’s where the partnerships come into play. MHA is a partner with nVoq. We actually, in the client life-cycle of working with organizations, to your point, boots on the ground within any one organization to implement a series of technologies. We strategically align the technology at the right time. When we’re hitting an efficiency level within the organization in a specific type of workflow, then we feed in the voice to text.

We get the organization bot on board and trained on what the new process is going to be prior to just slapping the technology on them, because at that point, they haven’t really had a chance to absorb it, be able to talk about it, and have true buy-in, because there is a team focus when we look at organizations as a whole. Then as we work individually with clinicians and chaplains and therapists, there’s a different angle that they’re all coming at, “What is it in it for me? What is in it for my patients?”

They have a smaller ecosystem than the larger ecosystem. We really sit down and walk them through the why, not only the how, and then show them what those results will be, not only for themselves, but for their clinical teams, for the outcomes of their patients, and for just overall work-life balance.

Banks: It’s about getting the most value out of the tool. It’s exactly where they have executive-level buy-in, exactly where they have Maxwell’s help in terms of change management or getting clinicians the information on what’s in it for them. Why is this important? In addition to the how. The how is fairly easy to figure out. I always talk about this.

Clinicians do an amazing job in our industry, but there’s a certain percentage of them that don’t have five minutes to go to the bathroom in a day. Introducing a new technology is like it’s so difficult unless you convince them that this is in their own best interest. Maxwell does a great job of that, but also preparing the organization to say, “Here’s what we need from you in order to be successful as well.” I think Jen put it great.

HHCN: Jason, how do you differentiate yourself from other companies in the industry?

Banks: I think we’re really focused on moving the needle for the individual user, for the provider organization. We really want this to check all the boxes when it comes to technology and how it’s going to produce an ROI for an organization, but also how it’s going to influence that individual clinician. I can tell you that every day when we have these listening sessions that we do with clinicians, they tell us, “It’s changed the way that I feel about my work. I feel like I get to spend more time with my patients, which is why I got into this industry,” and Jen talked about it earlier. These are special men and women that get into home health and hospice.

The whole reason why they get into this industry is because they’re relationship driven. They’re not transactional individuals. When you take that relationship aspect away because they’re so worried about, I’ve got this much charting to do at the end of the day, and I got to get to my next visit, and my next visit, and they’re not really present at that time, it’s taking a lot of that satisfaction away from them. Even if we’re making a dent in that, and I think we’re doing much more than that, it’s really beneficial.

Partnering with leaders who understand the industry like Maxwell is also a differentiator for us. We know that Maxwell understands exactly the needs of these organizations and how to impact change within them. I think that makes us different as well.

HHCN: What does the integration look like in current mainstream EMRs?

Banks: We are integrated with a number of EMRs. We also are available as a standalone offering. We actually integrate with the operating system, so Windows and Android devices. If your clinicians are using iOS, we would integrate with the EHR side. All of that behind the scenes is very, very simple. The technology is simple to deploy and, operate. We work in SSO environments, clinicians have a real seamless experience. IT can push it out via mobile device management or whatever tools they have to deploy it.

We try to make that as frictionless of a process as possible so that we can focus on leveraging Maxwell to get these in the hands of the clinicians. We don’t have any technical barriers that we have to jump through to get there.

HHCN: Jennifer, what other areas should home health agencies focus on improving or automating through technology?

Maxwell: I would tell you the world of technology and tech-enabled solutions is definitely top of mind, top of priority in our space. If you think about all of the technology that’s out there in different verticals, whether it’s when it comes to technology and automating things, that we’re starting to see more of a flood. I think when you think about technology, you need to think about what it is that you want to solve. What’s the problem you want to solve? What is the ROI that you need out of it?

We’re of the mindset that good technology will pay for itself, right? If you think about ROIs on technology that’s out there, a technology that should cost you a lot of money, but it’s not going to pay for itself and you’re still going to have to have money out of your pocket probably isn’t the technology that you want to use, go forward. We’re always thinking about those types of things that ROIs, the different use cases.

Even when we think of nVoq as a use case, some of the use cases that we’ve come up with is, “Hey, why aren’t you using nVoq for your QAPI program? You can do batch audits; you can automate things even further. I’m a strategic advisor and owner of another technology and data science AI company. When you think about the data that can go in and what the possibilities are coming out of in an automated fashion that really delivers better quality outcomes for patients is really where we’re headed, right?

It’s not about, okay, we’re going to cut a bunch of jobs. It’s about how we don’t have the clinicians coming out of school anymore.

The volume that is required to take care of the people that are going to be needed to be cared for is the numbers that don’t match up. We got to think about technology from a holistic pattern, whether it’s workflows, whether it’s speech to text, whether it’s data science and AI that can do predictive analytics for patient outcomes and visit scheduling.

There’s a plethora of those things that are out there. I always tell everybody, think about it and think about what you want to be strategically in the next one to three years as we see these cuts coming.

HHCN: Jason, does nVoq have any translation services from Spanish to English?

Banks: We don’t at this point in time, we do handle accents and dialects very well though. What I find is, I slur my words together, [laughs] I find that even clinicians with ESL (English as a second language) actually do really well with the tool because they have good word boundaries. Really, it does an excellent job. We work with clinicians all across the country that have various beautiful dialects and accents and the tool does really well with them, but we don’t translate just yet.

We’re also experiencing new models where we go out and we’re doing this with a couple of providers today where we’re implementing speech recognition as a part of their EHR rollout.

The clinicians just intuitively take to speech recognition thinking, “Well. I guess this is how we do our dictation. How we do our documentation, we just do it via dictation.” We’re seeing tremendous value and uptick there. As they’re learning the new EMR, they just roll in speech recognition like it’s a natural part of the process. We’re seeing that that makes a tremendous difference. Versus, again, you’re disrupting them multiple times if you’re rolling out a new EMR and then you’re trying to add things on top of it.

HHCN: Once a home health agency does sign on, what does the clinician adoption rate look like?

Banks: Typically, you’re going to get 60% to 70% adoption right off the bat. Then it’s really about creating that model that is sustainable to get to 80%, 90%, 95% adoption. We have clients today that are well above 95% adoption rate, but that’s where Maxwell comes in. They understand how to organize and get the organization ready and make sure that they have the executive level buy-in, and they have a plan to roll this out. Again, a lot of it is about the why, as you pointed out earlier.

nVoq Incorporated provides a HIPAA compliant, cloud-based speech recognition platform supporting a wide variety of healthcare delivery scenarios including post-acute care with an emphasis on home healthcare and hospice. To learn more, visit: https://sayit.nvoq.com/.

The post HHCN FUTURE: Addressing Home Health Agency Readiness for Potential Payment Cuts in 2024 appeared first on Home Health Care News.

Home Health Care News: In this panel, we’re going to be talking about alternative home care employment models. Please tell me what your organization does, and what you do for your company.

Christina Andrews: I’m an internal and external consultant. At Axxess, we provide solutions for the care-at-home industry. Whether it’s home health, hospice, palliative home care, we have a solution that meets that specificity so we can keep care in the home, where we know all of our patients and clients and family truly want to be.

Lucas O’Connell: AssuranceSD provides financial management services and self-direction across 13 states. We essentially provide the back office, employer-related, and payroll functions to individuals who self-direct folks who are aging, have an intellectual developmental disability, or part of the VA system.

Francesca Rinaldo: I lead growth and strategy for our homecare line of business called CareLinx by Sharecare. CareLinx is a national network of about 450,000 primarily non-medical care providers, so we provide personal care, ADLs, companionship, but we also have a growing number of clinicians on our platform as well. We work with payers, providers, employers, as well as directly with consumers to provide those homecare services.

HHCN: Christina, why has employee engagement been such a point of focus for you? Also, what are some unique ways providers can engage with their employees?

Andrews: Employee engagement has been something I’ve been connected to for many years because at the end of the day, for us to do what we need to do for the care-at-home industry, we need the employees. The pandemic really gave us an opportunity to look at employee engagement differently through a lens. Typically, we hear more about the experience component, right?

That’s when you hire someone, what is their connection to their overall job, then specificity, their communication with their manager? What was their onboarding experience? What did that look like? Now, we’re hearing a lot of buzz about well-being. Meaning the well-being of the organization or the whole person, so leaning in and taking a look at, what do the social determinants look like for each employee? Financial, health, the mind, body, and spirit.

When you put those two equations together, the experience as well as the whole being, that promotes greater success within retention, as well as recruitment of top talent. When we think about today, only one in four employees feel that their organizations truly are tuning in to their well-being. One in four. However, when an organization adapts that employee engagement program, the experience, plus the well-being, 69% of the employees state, “I’m not going to look for another job. I’m connected.”

79% of the employees state, “I’m not feeling the burnout like I used to.” That is important because your employees can be the word of mouth for the next top talent. They are five times more likely to say, “This is the employer of choice. Come work alongside me and work with this organization.” The other thing that the pandemic has done for us is it’s allowed us to look at our culture, so what is culture? Is it a mission or a vision statement or is it truly the fabric of your organization?

What I mean by the fabric of your organization, its key characteristics that are palpable that you can feel. As a leadership team, have you defined what those characteristics look and sound like? Hustle, hunger, love of learning, self-starter, humility. What does that look like? The reason why that’s important is because those characteristics, if you recruit with those characteristics, you are going to attract ambassadors versus employees.

Ambassadors are individuals who are going to help your organization scale. It’s going to help bridge the gap with workforce scarcity because they’re going to own the success. They’re not just an employee who is showing up, checking off functions, and ultimately saying, “Thank you for my paycheck.” When you put those components together, the well-being, the experience, and culture, it allows you to tune in to a different set of personas.

I think this is very unique for the homecare industry. You have an opportunity to attract the career caregiver, someone who’s been caring for individuals in their community their whole lives, but, “Hey, now, there’s a profession? I can actually do this with flexibility?” You can also attract young adults that need that sense of purpose.

For women with multiple children or a spouse who travels quite a bit, it rounds out that care profession within them. In addition to empty nesters, they need that connection again, as well as retirees. What’s my purpose after I retire? All of that and the combination of the employee engagement truly will help us bridge this gap that we’re experiencing today.

HHCN: At AssuranceSD, Lucas, how has technology played a role in employee engagement? Then also, how does it meet different generations of employees where they’re at?

O’Connell: In a self-directed service model, typically, a friend or family member is going to be your caregiver. Finding those caregivers, identifying who those best matches are, having an element of choice as opposed to maybe a more kind of traditional assignment allows for technology to bring folks both within your community, people who live around you but you might not otherwise come in contact with, to have that opportunity.

It’s also important to self-direction to note that many of those caregivers did not see themselves as caregivers. They see friends or community members who they’d like to help out with. Sometimes they just begin as a backup caregiver. Over the course of time, I think you made a great point, Christina, in terms of the professional caregiver concept, they take to it. They get the bug. You find that the caregiver workforce grows and expands organically as a result.

Rinaldo: At CareLinx, the company was really founded on the premise of bringing not just high-quality care to care recipients and their family members but also really creating an ecosystem within which we support what I personally think is the most undervalued resource in the American healthcare system, which is the non-medical caregiver or, potentially, the unpaid family caregiver. We really leverage the technology to get them better pay because they can negotiate their rates with faster pay.

We often do same-day pay with our caregivers. Then we also provide them with resources for professional development. For example, we partner with CareAcademy to train them in specific programs. When we work for a payer, for example, if there’s specific training we need to implement, we often leverage CareAcademy. They often use our platform almost like a LinkedIn for their caregiving career.

In that way, we’re actually able to draw in a lot of the personas that Christina was talking about, the unpaid family caregivers who now suddenly have this realization, “Wow, I am a caregiver. I can bring my skills to other families.” I was actually just talking to a young man over the weekend. I was at a restaurant with my husband, who was trying to break into the wine industry. At the same time, he actually became an unpaid caregiver for one of his neighbors, who’s an older adult man who lives by himself.

They have this wonderful relationship where, basically, he goes in and he provides those personal care services. I said, “You could do this as part of your career.” He was like, “Really? There’s a resource for that?” I said, “Yes, absolutely.” We can use the technology to really engage with people who maybe don’t even realize that they have the skills to do this and really build the capacity of the network.

Andrews: I love that you bring up the fact of professional development. In 2025, 75% of the workforce will be made up of millennials. When we think about today, we are living in an employee-driven market. What that means is we’re much savvier about the employer that we’re going to choose, right? The millennials say, “The number one thing that I’m looking for in my employer of choice is professional development.”

I was on LinkedIn the other day looking, perusing. In North Carolina, I saw an ad for a local care-at-home industry provider that literally said, “Hey, you come work for us as a home health aide. I’m going to invest in you today, send you to go get your certification.” At hello, even before applying, they’re like, “Wow, you’re already looking at how you’re going to professionally develop me within the care-at-home industry.”

Well, technology has a way of really engaging individuals at onboarding. It could be non-medical skilled, non-skilled, but what is your role? What’s the specificity of your role? How do you even use the technology to do the care that you need to do or to perform the role? It also can take them through ongoing training as well as development.

Then we also have providers here that have looked at different ways of engaging employees. I’m not really much of a gamification person, but some of these engagement platforms encourage your staff to refer to your organization. We think about right now having to pay for bonuses or retention. The gamification allows them to spread out what that looks like based upon performance and annual reviews. Really looking at technology and how it’s going to embrace driving that overall engagement, especially as we have those generations to come like the Gen Z-ers and the millennials.

HHCN: Lucas, for those in the audience that might not be familiar with the two distinctions, what is the difference between self-directed programs versus self-determination?

O’Connell: That’s a great question. Self-determination is really a philosophy, a concept. I think it’s perhaps best embodied in the phrase that many of you may have heard, “Nothing about me without me.” It’s the idea that the person is at the center of care and that they have choice and control over services that are delivered. Many of you are practicing self-determination in agencies that you manage today.

Self-direction or self-directed services are more specific. In self-direction, the individual is actually established as a household employer. We obtain an employer identification number for them and they recruit, train, and essentially manage the caregivers or employees that provide services to them. Self-directed services include personal care. In many cases, respite, transportation. In some programs, folks can even purchase goods or services through what is always an individualized budget.

CMS also identifies the need in self-direction for an information and assistance resource or a support broker. That individual’s critical in educating that individual in that family, in many cases, how to self-direct services. The prospect of waking up one day and being able to supervise or manage an employee is intimidating at best. The support broker really provides a foundation for that individual to be successful.

In most programs, we have employer authority as part of self-direction. That simply means that that individual is able to make decisions, again, hire, fire, manage employees. Something exciting in many self-directed programs is called budget authority. Folks essentially are able to take what otherwise would’ve been an allocated amount of money, funding that they would use in a more traditional agency environment, and spend it within certain parameters and rules as they see fit.

That also allows for caregivers to receive a more competitive rate of pay. Maybe they use unpaid or generic resources to offset maybe less hours being provided by that more highly-reimbursed caregiver. It’s an exciting movement. It started in the ’90s as a result of a Robert Wood Johnson Foundation grant. Today, there are self-directed programs in every state.

HHCN: There’s obviously, clearly, and maybe always going to be a gap between workforce scarcity and ultimately just a provider or an agency feeling good about where they’re at from a staffing standpoint. How can technology bridge that gap?

Rinaldo: One of the things that we leverage our technology for at CareLinx is really understanding the density of available workforce in a particular market ahead of a program launching. What we do is we can actually look at the ZIP code level, how many non-clinical, as well as clinical providers we have registered on the network, whether or not they’re recently active within the last 30, 60, 90 days.

Then we can create education and incentives around reactivating those providers if they haven’t been recently active ahead of a program launch. We typically would do that with four to eight weeks of runway because we want to engage them at the right time so that we pique their interest and then they’re engaged in taking the shifts that are available through that program. We don’t want to do it so far ahead of time that they actually lose interest.

Andrews: Business intelligence comes to mind. In the last session, she spoke a little bit about the dashboard opportunities within technology to predict burnout. That capability exists today. Whether you’re looking at full-time PRN, you’re looking at the shifts, visits, weekends, weekdays, the communication with their direct manager, point-of-care documentation. Is it during the shift or is it after the shift?

There are so many metrics that really apply itself to overall burnout. As an owner, as a manager, you can address it more proactively. The other thing too would be route optimization. I think that’s what you were referring to too. That’s huge because the travel time for caregivers, depending on if you’re urban or rural, could also equate to burnout because what they want to do is be in the home caring, not driving around everywhere.

In addition to schedule optimization, especially if you’re serving multiple pockets, how are you managing that overall scheduling component of employees with caregiver matching? The caregiver matching, I think it’s an attraction for an employee who is looking at an employer of choice because you get to know who I am, my skill set, my certification, my license, what I may or may not like as it relates to, “They have dogs in the home.” He or she may be a smoker. Maybe they live in an area that I’m not that comfortable with. That caregiving matching also can be attractive when choosing an employer of choice because you’re looking out for my well-being.

HHCN: Lucas, AssuranceSD had success with these alternative models, particularly when it comes to retention rates. What is it about self-directed care and that model lends to some of these higher retention rates?

O’Connell: The turnover, the attrition within the self-direction workforce, is notoriously low for a few core reasons. First of all, the interview itself and the recruiting is conducted by the individual receiving services, often in tandem with family or what we call a circle of support. Individuals who are interviewing often are doing so in the participant’s home. They know exactly what they’re getting into. It often comes with a little bit of introduction and an actual hands-on education regarding what that work is going to entail.

In self-direction, you typically won’t have a caregiver providing services to more than one individual. Maybe two at most. Again, to this earlier concept, we often see members of the immediate community, maybe teachers, members of the clergy, even folks that individuals run into at the grocery store, being petitioned to interview. That relationship of almost one-on-one really does make for a meaningful experience. We continue to be amazed at how long caregivers remain with the individuals served. It’s probably one of the most impressive aspects of self-directed programming.

HHCN: Francesca, Sharecare recently announced it will bring its care management and transitional care programs for high-risk populations to more than just Medicare Advantage beneficiaries. Two-parter, how do you try to implement those programs and what are those conversations like when talking to health plans?

Rinaldo: Yes, so just to give you a little bit of context, we worked with one of our health plan partners last year to do an actuarial analysis to look at the impact of a very focused transitional care benefit, personal care, non-medical support in the home for 15 hours after a hospital or skilled nursing facility discharge. We basically compared eligible engaged members to eligible non-engaged members. These were matched cohorts, so we matched them on age, gender, level of risk.

What we found is that even sending a non-medical caregiver into the home for a very focused period of time in that first 60 days after discharge was resulting in a 21% reduction in 30-day readmissions for those high-risk older adult populations. We obviously are very excited about these results. We’ve been working with our health plan partners to now take these learnings and expand them to other high-risk populations.

For example, we’re working with one of our partners to implement these transitional care programs in high-risk maternity and postpartum populations, complex chronic pediatric populations in their families, and complex behavioral health populations. The idea is, when we’re talking to the health plans, we really want to make sure we’re closely integrating with our clinical and care management teams, and we’re really tailoring these programs to the specific needs of the populations.

We know, for example, for an older adult population, some of the root causes of readmissions are going to be not fully understanding the discharge instructions or not having a medication reconciliation or follow-up in a timely manner in the first 30 days post-discharge. Potentially, fall risk. For the maternity population, those risk factors are going to be really different, right? We’re really tailoring these programs and providing the same in-home support, but making sure that we’re engaging the members with the caregivers to do different types of screenings and assessments that can really help us to fully understand their current risks and also uncover new ones.

HHCN: From a quality perspective, obviously, with the rise of value-based care, how can technology provide clinical intelligence and guidance as a way to keep outcomes and some of these high-quality scores at the forefront? Christina, you want to start with that one?

Andrews: I would say, again, business intelligence, starting your day, ending your day, focusing on the quality metrics that you are leveraging to get a seat at the table for the future. How does that align with the quadruple aim? Making sure the specification of those metrics truly align with all four of those elements because, ultimately, quality plays into all of those other areas. We were talking about that earlier. The other thing too is the models in which your technology provider offers. Is it just a one-type model or does your technology partner offer controlled flexibility to fit your unique models? Because that will also provide guided validations to ensure that you’re focused on the quality that matters.

HHCN: Lucas, anything else to follow up on that one?

O’Connell: I would just offer that when you have that continuity of caregivers, especially when folks know the individual personally or have a relationship that spans more than several months into years, the opportunity to gather data points shift-by-shift, day-by-day, and the implications is drastically greater. It’s taking something that’s entirely quantitative and making it more qualitative as a result of, in this case, opportunity self-direction gives.

HHCN: Francesca, anything to add?

Rinaldo: This dovetails with the themes from the panel just prior to ours, but I think there’s a huge opportunity to use different data sources to risk stratify populations. We’re using claims, ADT data, pharmacy data, but one of the things we found, which actually adds a whole another unique dimension to data, is the data that is actually being gathered by caregivers in the home. We leverage our mobile app to actually have caregivers conduct different types of screenings and assessments or even just record their observations.

It adds this depth that you don’t get, for example, via a telephonic care management assessment for social determinants of health because you actually have someone there in the home who has eyes on the patient and can really understand like, what does their food insecurity look like or what does their transportation insecurity look like? One of the things that I really encourage people to do is think outside the box about the different data sources that you can incorporate to help you really focus your resources in these complex populations.

HHCN: Clinical outcomes is obviously a huge part of this, but then also just financially, I feel like cost-effectiveness is often brought up when considering the pros and cons of this type of care. When promoting these models, how can they help the bottom line for providers and for families, patients, members?

O’Connell: I think the theme throughout these couple of days is the workforce shortage. In self-direction, you essentially have family members and individuals being served acting as very passionate and empowered recruiters on behalf of the caregiver workforce. That’s not just limited to those folks who are being served in self-directed programs. You find that communities and states where self-direction is robust and well-invested in, the actual caregiver population across the board surges.

This is an incredible population of people. These are folks who don’t necessarily appreciate how rewarding caregiving can be until they have that opportunity. In so many instances, we meet folks who have had business education backgrounds who have found their way to caregiving and will do all they can to remain in the industry. The cost of recruiting that I know many of you are stifled by is really, really well-served by self-directed services.

HHCN: Francesca, what about from your perspective?

Rinaldo: When I think about managing cost of care at scale, I think about efficiency, removing those redundancies, those repetitive steps. I think one of the risks when you implement new models of care is that you’re basically introducing new variability into an already established system. With that variability comes additional cost. I think that’s a risk we run with implementing some of these new models. The flip side of that is if you’re really thoughtful about how you implement them and you really think about coordination of care and data sharing across providers and settings of care, you can mitigate some of that risk.

HHCN: Christina, when Francesca mentions efficiencies, when you hear that, what do you think about that? What is Axxess doing to help bridge that gap?

Andrews: It’s basically reducing the redundancies. How many times does an individual have to input the data versus how it flows from one component of their care delivery into another component? Reducing redundancy, but what you were making me think of is I was on a call with a client the other day who actually pulled the data together, positioned himself at a table with two payers based upon the care models that he implemented to show how he was saving on cost, improving quality.

Again, that’s very attractive if you use the data to position yourself at the seat at the table. Optimization of workflow, utilizing the data, leaning into the quadruple aim really helps to round out what it needs to look like. The other thing that Francesca made me think of, I had an opportunity to have a conversation with a CEO/president of UnitedHealthcare over a couple of regions. He flat out said, “If I have a provider coming to the table wanting to get into the payer world, if they don’t align with the quadruple aim, if their model doesn’t align with the quadruple aim, we’re just not going to look at it.”

HHCN: How can these alternative models address those aims in a way that traditional care models might not be able to?

Rinaldo: Again, when I think about our model really founded on the idea of self-determination, self-direction, and the example that always comes to mind when I think about these models is work that we’ve done for respite relief in collaboration with the Elizabeth Dole Foundation and the VA. What we found is when we were doing the need-finding and working with Elizabeth Dole Foundation to implement these programs and really talking to the veterans and trying to understand their needs, we found that a lot of them were very hesitant to allow newcomers into their homes.

We created a pathway where when a veteran enrolled in the program, they could actually designate additional family members or neighbors or friends who could become that caregiver. Then we created onboarding processes where we would basically vet and train those designated caregivers by the veteran at the same level that we would any other professional caregiver on our network. That really ended up in everybody winning because the veterans were getting great quality care.

We were building the capacity of the network in those markets because those caregivers, once they were onboarded to the network, could also then provide care to other veteran families in their local geographic area. You’re also containing the cost of care by building up the supply and then you’re driving great outcomes because you’re building that trust and that relationship. When the caregiver really knows the patient, they’re able to identify those early signs of clinical deterioration or those social factors that can lead to poor outcomes.

O’Connell: My favorite example is the impact self-direction has on underserved communities. We’re all familiar with the challenges of finding and deploying caregivers in rural settings. The challenges that come with tight-knit communities that are maybe not open to bringing folks into their home that they don’t know. When you have a strong self-directed program, people are able to, again, engage within their communities, recruit within their communities.

Then those caregivers are highly knowledgeable because they’re from the community about other resources that exist outside of personal care, respite, and the like. You’re also empowering that individual in the decision-making and choice to own health outcomes in a really unique way. We find that attendance at regular doctor visits, medication administration routines, this idea that I am owning my health and my experience because of the additional choice and control I have lends itself to better outcomes, higher quality of care, and definitely a happier patient and team member at the end of the day.

Axxess is the leading technology innovator for health care at home, providing solutions that help improve care for more than 3 million patients worldwide. To learn more, visit: https://www.axxess.com/.

The post Alternative Home Care Employment Models: From Workforce Sharing to Self-Directing Strategies appeared first on Home Health Care News.

Home Health Care News: I think there’s a lot of exciting technology and we’re going to talk through a little bit of what’s real, what’s not real, what’s out there right now, and what’s coming in the future.

A lot of what we’ll discuss relates to workforce shortages and payment challenges, which are driving technology innovation. Naomi, I want to ask you at a very high level what do you see as the two or three game-changing types of technology in home-based care right now?

Naomi Goldapple: We can’t ignore LLMs, which are Large Language Models which is what’s running ChatGPT, but I don’t mean ChatGPT — like the one that everybody uses to cheat in school or write recommendation letters or translate — but the actual underlying models that you can use for all kinds of different applications. It’s really quite exciting and revolutionary right now. I can tell you that with my team, there are things that we’ve been building for the last year and a half using natural language processing [NLP] that we literally had to trash because these new models are just so much better. There’s so much that you can do with it.

It’s very exciting. I also think the world of wearables is becoming more and more of a reality, so it’s less gimmicky than it was before. Like these little sensors in the home for fall detection or strap something onto your grandmother and then you can detect things in that. Those were a little bit invasive and I’d say gimmicky and now they’re becoming a lot less invasive.

It’s going to be a game changer when we don’t have enough caregivers to be physically in the home. Then my last one that I’ve always been a big proponent of is voice. I think being able to use the Alexas, the Google Minis, and all that, but with the large language models. Instead of writing your prompts, these can be questions and it works just as well. There’s a lot that you can do for remote patient monitoring and for drug adherence, and there’s all kinds of stuff that you can do with this technology.

These are areas that have practical uses right now. What about long term? What’s coming next?

What I think is coming next is actually these things becoming mainstream and becoming part of processes and becoming regular technology that’s actually embedded into processes. Right now, it’s a little bit gimmicky. You could be using ChatGPT maybe to help a little bit here and there but how do you actually leverage this so we’re squeezing out costs from the processes, and we are really making things more efficient. I think we’re going to see in the next two to three years real differences in efficiencies because honestly, there’s no choice. Everyone’s got to cut costs out.

The long term might not be as sexy but is really taking these sexy things and making them reality.

We’re going to talk a little bit more extensively about AI right now. How could predictive AI in particular revolutionize data utilization for home-based care agencies allowing them to make better decisions than they currently do?

That’s an easy one because predictive AI is able to use predictive algorithms, and there’s so many different things you can predict. There are companies who are making real gains with, for example, claims or things like, do I want to predict whether I should take on this referral? Is it going to be profitable? Do I have the staff to staff this? Those types of things are really very important in terms of keeping the profitability up.

There’s also predicting risk, risk of so many things. We’re in a caregiver shortage, so risk of who’s at risk of leaving. That’s pretty important, and you need to know early who’s going to be leaving so that you can actually mitigate these. Getting those early warning signs. Something that I know I’ve been working on a lot is the risk of hospitalization. Risk of any of these adverse events.

Being able to automatically consume all of the data points that are collected every single visit, and being able to automatically put people into different categories, high risk, low risk, medium risk, and then what do I do about that, so that I can meaningfully move the needle with the measurements.

Sometimes from my perspective, I’m not an expert when it comes to AI, but it seems like within the past six months there’s been so much hype about ChatGPT. How much of the power of AI is overblown? What could it really do? Is it really game-changing like we said earlier?

Yes, I think it is, but not in the way that I think everybody got super excited about three, four months ago because all of a sudden everybody was able to just go on to the internet and ask their own questions and see the marvel of this agent being able to spew back amazing stuff. It really quickly democratized AI. It wasn’t just a bunch of researchers who were able to see the power of these models, it was everybody. That got everybody really excited, but it has died down now because aside from writing a letter for you, doing some translations, maybe writing a blog post, how can I actually weave this into my processes?

That’s where it’s going to change. There’s some things that people are using right now, for example, Copilot. GitHub Copilot is what ChatGPT is for text, it is for programmers. It’s pretty amazing. You can say, this is what I want to do, I want to build an application that does X, you can start it off and it can literally write all your code for you. Right now people who are building applications, we’re seeing like 30%, 50%, 60% productivity gains in terms of being able to be more efficient. Those things are pretty amazing. Where we can use the large language models is things like summarization. Going through the nurse’s notes, going through all this and picking out what’s important, and just summarizing that back.

Being able to do the question and answer, tell me about this patient, tell me about this client. Really being able to query any of your datasets with natural language is a game changer. Think of even accounting. I want to know if this particular visit is going to be profitable. It can go into your dataset and give you back a point of view — but again, we always have to be careful that there’s a human involved because it sounds smart but it’s not really smart. We know it’s intelligent, but it’s really still mathematical. Everything is just a prediction and it’s predicting the next word, or it’s predicting the next thing based on what it’s been taught.

It’s not really using outside intelligence to make that. You need to have a human that’s working alongside.

You mentioned using AI as a means to predict caregiver turnover. Can you talk a little bit more about that? How’s that being done exactly?

Sure. We collect information about our caregivers all the time. We know what their schedules are, we know what their skills are, we know what their availability is, we know what their behaviors are. Do they usually clock in and clock out with accuracy? How long do they have to travel during the day? We have all kinds of information and we can start to see patterns in that information.

Through the research that we’ve done on my team, we can see a few things. One is the higher their utilization is, so whatever the delta is between what are the hours they want to work and what are the hours that we’re giving them, that is almost the number one driver of happiness or satisfaction for caregivers. If they can have a schedule that is allowing them to earn a fair wage and get the hours that they need, they’re going to be pretty happy.

That’s very important as a metric to keep an eye on, to make sure that that delta doesn’t get too big. We’ve also seen things like: what is the delay between hire and actual first visit. If that is too long, they get disenchanted and they leave right away. You have to make sure they have the white glove treatment and what’s happening in the first 30 days, 60 days, 90 days, make sure they’re part of the family, and that works well.

You can have that on a dashboard, you can have metrics and you can be able to pinpoint when something is going off, and you can literally pick up the phone and be, “Hey, what’s going on? Do you need some more hours?” You can really mitigate this. We’ve been looking at trying to understand the groups, the clusters of caregivers by their behaviors. We can see there’s certain types that clock in and clock out with a lot of accuracy.

Some of them work, they do their documentation right away. When we do this, we have clusters of, we call them the hard workers and we can see hard workers have these types of characteristics. Then we had some that came out as sloppy workers and they had different characteristics. The highest numbers of clients who block them, they usually try to clock in when they’re not physically there yet, or a bunch of other things. You can start to identify behaviors and say, “This one smells like that type, I want them to be more this type, how can I judge their behaviors?” Be really data-driven about it.

You’ve already mentioned some really amazing real-world use cases of AI, and there’s probably several more that you could pull from, but do you have two or three real-world examples of providers doing something cool with AI that you haven’t talked about yet?

Well, we definitely see a lot in terms of claims processing, so reducing the error rates in claims. That’s where we can use something called anomaly detection, where we can see what a clean claim looks like, and then if there’s anomalous behavior that can be picked out before things are submitted so that they’re not rejected.

There’s definitely been a lot of impressive reduction in numbers of rejected claims by using anomaly detection algorithms. Then I think I’ve seen more and more what I was talking about in terms of caregiver churn. Then because the industry is forced to be more metrics-driven in terms of outcomes and reimbursement based on outcomes, we’ve seen a lot using these algorithms to get better total performance scores and try and reduce those hospitalizations, those falls so that they can get better overall metrics and really protect their reimbursements.

What about future uses? Are there any use cases for AI moving forward that you find really exciting but we’re just not quite there yet?

I alluded to things in the home, and I think this is really where we’re going. There’s not enough people to be in the home all the time. People want to be in the home, and there’s technology that’s becoming more and more accessible to be able to help monitor in the home, and even be interactive with the loved one at home to be able to make sure, are they taking their medications?

Is there anomalous behavior today? Usually, they wake up around this time and then they make it to the kitchen around this time, and then they do it this time. These sensors can try to see, they don’t seem to be getting up within the same timeframe today. These alerts can go to a caregiver or to other people to say, “You know what, they might be at risk of a fall. Something might have happened,” and you can go in and mitigate.

I think this ability to do remote patient monitoring is getting a lot more sophisticated and can be even interactive. Even things like loneliness, where they can start to talk to these agents who can talk back about, I’d like to hear this song, what’s the weather today? There’s a storm coming, and they’re afraid of storms so there can be more interactivity that can really be leveraged so that the caregiver doesn’t have to be there 24/7, and that can really help. I’m pretty excited about that.

In one of your previous responses you mentioned how important it is for there to be a person behind the AI tool, what are some of the other dangers of maybe leaning too strongly into AI?

I don’t know if you’ve heard the term hallucinations when all this came out three, four months ago and everybody’s playing with ChatGPT, but then there was also Microsoft Bing that came out at the same time, and then people were having conversations with Bing and all of a sudden Bing went off into a strange tangent and was telling this guy that he should leave his wife.

I was like, what is going on around here because these models, they tend to, if you don’t put guardrails, they can hallucinate. They start to grab information and contextualize in ways that are going off of what you want it to be doing. You have to make sure that they’re designed properly, but we always have to make sure that what we’re building is just decision support.

It’s not prescriptive, it’s not replacing because it really is the professional that will make that call. There’s some funny examples. If you are a caregiver, let’s say, instead of going to a visit as a caregiver, you want to just say, “Hey, can you tell me what has changed since the last time I visited this client?” Maybe it was the week before.

How nice it would be if it could just summarize for you, “Well, from the last time you were there, they changed this medication, they fell once, this and that.” That would be so great instead of hunting and pecking in your application or even in paper to try and read what the last person wrote, that would be great. When we were playing with this, the first thing that comes back is just the basic demographics about, well, this person is a 90-year old woman with these comorbidities, etc. so you just get a little summarization.

Then there’s what’s changed since the last one. One of them we saw was this person, let’s say Mr. X is a newborn. We were like a newborn, why would it be a newborn? We realized that the date just took today’s date, that date was blank. It was today’s date and therefore the large language model just assumed, well, they’re born today, therefore it’s a newborn. We were like, how do you have a newborn with all those comorbidities? You really need a human to take a look at that and make sure that you correct those types of things and that you train it properly.

One of the dangers is definitely the data. You have to make sure that the data is correct and accurate. You also have to put on those guardrails because you also want to make sure you’re not sending a bunch of personal health information to OpenAI, which you could very easily because when you’re playing with ChatGPT, they’re using your questions and your data to make it better.

You don’t want to be doing that with information in your database. You need to put guardrails. The other thing is about privacy as well. You have to make sure that the data that you want to protect is being protected and you can just share cleansed data, anonymized data, and you’ll still get the information out.

We spent a good chunk of this conversation so far looking at AI specifically. I want to shift gears and talk about data and data strategies and mistakes that providers typically make when it comes to their data strategies. What are some of the common challenges that home-based care agencies face when it comes to effectively using data?

I’m sure nobody would disagree with me, data capture, data input, and consistency. Getting everybody in your organization to input data in a timely and accurate fashion of course, it helps when you have fields that will validate, but everything starts with how you’re capturing the data. Garbage in, garbage out if it’s a sophisticated algorithm or if it’s just for regular information, that’s pretty important.

I’m finding that over the past three years, I feel like I would be talking to maybe one data person at providers, and now I feel like I’m talking to data teams. The providers are getting more sophisticated and really starting to leverage the data more, and really understanding where your data is coming from. One thing that we do notice is things like schema changes.

If you are relying on certain data to then amalgamate for other downstream processes, so let’s say you’re taking data from one vendor system, and then you have data from another vendor system, and then you’re making a report, and then that gets sent on to X and maybe that’s your utilization report that people are depending on, you have to make sure that if those vendors or if somebody changes anything in the database, that you’re aware of that so that you change all your downstream processes so that everything doesn’t get broken.

Everything is becoming very amalgamated because you want to get all the aggregated data together so you can get the fullest picture. You have to make sure that those data contracts with wherever the data is coming from, that those are set in place.

You just mentioned a few really good ones, but are there any other best practices providers should keep in mind as part of their data strategies to make sure that they’re collecting data that they could then actually act on?

One thing that I always talk about is being very hypothesis-driven. Why are you collecting this data? Why are you putting together this report?

These things are really important, and what are you going to do with it, because I’m sure you’ve created, or you’ve looked at dashboards that they were interesting at the beginning and then you stop looking at them, or you look and you’re like, oh yes, but what do you actually do with those results? Especially in AI, you have to think about how people are going to consume these predictions, because in AI everything comes down to a number.

It’s a prediction. It’s like 0.67 and you have to convert that into something that is really actionable. Maybe 0.67 means a medium level of risk, but it’s rising. If I’m telling that to a caregiver or a clinical supervisor that this particular patient was stable and now something is changing, what do I do about that? We don’t want to be too prescriptive again because we don’t want to say, “You should do this, because we don’t want to be responsible for that.

You still need the professional to make that call, but they can come up with all their mitigation strategies. When it’s somebody who’s medium risk with these types of things that are at a risk of fall and are not taking their medications, go to our guides, and this is what you have to do. You have to make sure that everything is actionable. If you see that there’s a caregiver that is at risk of churning, what do you do about it?

Do you just say, “Huh, it’s too bad, they’re probably going to quit next week. What do I do about it?” You need to make sure you finish the workflow and you think these all out and that you actually pull out the proper data that’s going to answer those questions.

During a lot of these conversations, I love going back to real-world examples to paint a picture of the things we’re talking about. When it comes to successful and effective data strategies, could you maybe share a real-world example or two of providers doing data-driven decision-making effectively that has had an actual positive change on their business?

One of the things that my team was working on for the past few years is all about schedule optimization. Using optimization algorithms to make sure that we’re not leaving big holes in schedules, that the right person is at the right place at the right time with the right skills, and continuity of care. You make that all configurable. What has been designed and what we’ve seen now is that a scheduler comes in the morning and says, “What are all the vacant visits that I have to fill?” They basically press a button, say optimize, and boom, it gives you all the proper matches because you’ve configured it properly.

We’ve seen some providers, they said this is something that used to take us the entire morning or even into the afternoon trying to find who’s the right person. With the press of a button, you have everything done in about 10 minutes. Sometimes you send them, you put it onto the schedule. Sometimes you have to do a shift offer, depending how you’ve organized things with the care workers.

This has eliminated tons and tons of repetitive tasks. Now, this only works if the availability is up to date, if we actually know when people are available. It only works if the skills are up to date. It works if we have the care worker and the client’s home addresses up to date. If any of those are wrong, it’s going to give erroneous answers. Then the scheduler is not going to trust it. Because you get very, very little margin for the user to actually trust these algorithms.

Because they’re already mistrustful, they think they’re black boxes. You want to try to make these as explainable as possible, given these are the reasons why it came up with this, and these are the actions. You have to design all that workflow. This is something we’ve seen has really started to change dramatically in terms of taking something that would take a morning, an entire day into a few minutes, which is pretty exciting.

There are other parts of healthcare that seem further along in their data journeys, so to speak. When we think about home care, how sophisticated is the industry at this point in your view?

If we compare it to the hospital system or other healthcare. Back in 2016, Geoffrey Hinton, one of the godfathers of deep learning. In 2016, he said, nobody should study. We are not going to need any radiologists in five years, that entire profession is going to be wiped out because AI can read the X-rays much better and much more accurately than any human.

We’re now in 2023, 5 years have gone by and radiologists are still needed. Today, we’re starting to see hospitals really starting to use this technology to actually not necessarily reduce the number of radiologists, but to reduce their workload. They only get now, here are the 10 that are potential tumors, let’s say, versus going through 500 and going through.

Now these are starting to be not just point solutions, but these are starting to be systematic in the healthcare system. I don’t think we’re there yet in home care. In home care, it’s still a lot of playing around and point solutions. I think over the next few years it’s going to become systemic that these applications are going to be part of the regular workflow because we need to get more efficient.

I want to get to some of the other emerging technologies that you’re really excited about, but tie a bow in the data point specifically, and AI. What have been some of the macro trends that are advancing the use of AI and advancing data strategies in home care? For me, for example, value-based care seems like something that you can’t do well if you don’t have a strong data strategy.

That’s one of the first things, because if you’re all of a sudden being measured on very specific criteria, you’re like, “How do I even know what to change to change the levers? How do I know what’s going to move the needle on which metrics?” This is definitely moving the needle. The CMS with the TPS, the Total Performance Scores, very specific scores for very specific things. What do I have to do to actually get a better score here and a better score there so that I can rank better so I can hopefully get better reimbursements. This has been a real forcing function to get more data-driven. I would say there’s always been a problem with churn, but the labor shortage, necessity is the mother of invention.

Because we have this labor shortage, that has been a real forcing function also to try and be more efficient, be more optimized, use these precious resources in a more optimal fashion, and make sure that they’re happy. I think that has really pushed the needle on needing to improve the technology.

I know we’ve talked in the past too, just about the shrinking margins that a lot of agencies are facing. You need the data component, the AI component, potentially the automation component, just to do more with less.

You have to eliminate as many repetitive tasks. I joined this industry about four and a half years ago, where I was meeting a lot of people who were still delighted because they came from a paper-based to a digital environment, and now we’re really going from digital to really data-driven. It’s a short history of really diving into this. Starting to use AI models, that’s really quite an accelerated path.

Now I feel like I’m talking to data teams and providers are hiring data scientists and they’re hiring data engineers, and they’re building these sophisticated data stacks because they’re like, “We’ve got to try and be more efficient and we’ve got to try and find the efficiency.” I’m really seeing a big change in the industry to try and be more data-driven and then leverage technology at every step of the way.

At the start of this conversation, you mentioned how you’re excited about sensors and wearables too, because they’re less gimmicky. What’d you mean by that?

I remember pre-COVID when people used to come to your office and knock on the door and show you stuff. People would come with all kinds of crazy stuff. Like, here, here’s a laser. You could point at your grandmother’s forehead, you get all of the vitals. Here’s another thing that you can stick under their shoe and you get all kinds of stuff. Some of them work some of the time, but if you have a sensor that has to be in their shoe to be able to tell if they’re at a risk of falling, somebody’s got to be there when that shoe doesn’t fit on properly or the sensor slips out, like it’s not as practical.

I find that the technology has gotten more sophisticated and it’s gotten less invasive. More like sensors in the home as opposed to cameras in every room, which you can’t do from a privacy perspective. You don’t want to have full cameras all the time. I think all of that. The other thing is that we’re all getting used to it.

You start to integrate that with how can that also care for the people that are in the home? Here’s a reminder, did you take this medicine, and with vision, you can see did they take the right medicine? I don’t think that’s the right one to take at this time. You can imagine all these scenarios and all that technology is quite mature. It’s ready to be used. It just has to be designed in a way that is seamless to how somebody lives.

I think that’s pretty exciting with the voice, the computer vision, the sensors, and then the newer older generation they’re more used to using technology. They know how to use Facebook and all that stuff. It’s not going to be as crazy a leap as maybe the generation right now to be able to start trusting and living with that technology.

Looking ahead, what tips and strategies could you provide to help home-based care agencies prepare for the future using a crawl, walk, run approach based on their current level of data utilization?

It’s at the beginning, where are you today? You need inventory of your data stack, your collection processes that you have right now. Really identify what are the main questions? What do I want the data to tell me? Come up with those hypotheses. What are the problem areas? We have really seen a reduction in profitability in this particular area. We have too many people, we have too many schedulers. What do we do about that? How do we reduce that?

You have to really pinpoint everything. Where is it very inefficient? Let’s see if we can pinpoint how to solve that. Find out what are the problems first, what’s the data that’s going to answer that? Then you can start getting sophisticated with putting processes into place, leveraging this sophisticated technology.

To learn more about how AlayaCare can help your organization ensure operations are consistent across multiple locations with real-time information updates for key stakeholders, visit https://www.alayacare.com/.

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