Healthcare at Home: The Rowan Report

by Tamar Frumkin, Director of Marketing at Swift Shift, a firm helping early stage startups build meaningful and impactful brands both in the United States and Tel Aviv for recruiting and retaining firms’ new service employees.

Everyone is talking about recruitment/staffing and what to do. As our industry faces what could be considered an impending “crisis,” some pioneers are more accurately approaching these challenges as an opportunity to improve infrastructure and efficiencies. Like many things in life, a blanket “crisis” label is causing a scrambling that may be missing the nuances in our current system which are stifling growth and demand.[Much of this short article is spent introducing the effective recruiting work of Assaf Shalvi, a Manhattan-based entrepreneur who urges healthcare at home industry principals  to focus on creating value-driven engagement for their field staff, and so effectively  aligning them with principles of Demand Induction–i.e., making the whole hiring process more accessible and engaging. Means to find and retain new talent are shared with HCTR readers to good effect by Assaf Shalvi; and further means that Frumkin and Shalvi will share in an upcoming issue if HCTR are noted.]

Value-Driven Engagement For Your Field Staff
One Entrepreneur in Manhattan has a new perspective to fix this issue, using the same principles of Demand Induction (learn more about that here). Assaf Shalvi believes that by making the whole process more accessible, this will quickly not only fix the retention/churn issue facing the industry, but also introduce efficiencies for field staff engagement. In Shalvi’s view, CSMs and Schedulers should be focused more on the client experience and less on phone tag.

“When you’re selling someone a dream vacation, you don’t start the story by asking them to apply for a visa, get an updated passport or pack their bags. You present pictures of sunset beaches, gourmet delicacies and scenic views,” explains Shalvi. “By turning the value proposition on its head, Swift Shift is creating a solution to add meaningful engagements to the recruitment process for nurses and caregivers, offering them value and engaging with them on the channels they prefer – mobile and digital.”

Bridge Salesmen Versus Bridge Builders
Shalvi isn’t the first pioneer to address this issue, but he does have a fresh approach. With the warning flags in healthcare raising high, there has also been an outpouring of “solutions” which are just more of the same over-architected processes creating additional walls to engagement. Can it be valuable to use 3rd party recruiters to help find the right talent for your agency? Yes. Could posting on Indeed and other job boards help fulfill your most imminent recruitment needs? Yes. Can re-addressing internal benefits you offer employees decrease the astronomical churn rates facing home healthcare? Yes. But these solutions  are not scalable, sustainable, or savvy enough to solve the breadth of the shortage we are facing.

“If you think that spending the majority of your recruitment budget on job sites and incorporating a “spray and pray” strategy will fix this, then I’ve got a bridge to sell you,” jokes Shalvi. The principles of Demand Induction and the phenomenon of additional pathways creating further demand, is how he is planning to solve this problem.

Shalvi’s plan hearkens back to the days of Robert Moses, the Master builder of NYC in 1936. Robert Moses built the Triborough Bridge, not realizing that additional pathways created would give birth to increased traffic into Manhattan. Technology has been creating similar infrastructure with digital infrastructure for years. No need to look further than Uber, AirBnB, Postmates, or TaskRabbit to see how efficiencies have created new demand and even new work forces. If technology can convince people to schlep strangers around in their personal cars for extra income, just imagine what it can accomplish for the home healthcare industry.

Finding New Talent Isn’t the Biggest Problem
Yes, home healthcare needs to find a way to appeal to a new demographic, a new generation and a new workforce. But the biggest issue is churn. With $3 billion dollars currently being spent on Home Healthcare Recruitment, it is staggering that $.53 of every dollar spent is on re-engagement of previous employees. Lack of targeting, inefficiencies in workforce engagement, and barriers to case application and completion are the culprits of this troublesome statistic.

Swift Shift and Shalvi plan on making big announcements in the weeks ahead. So stay tuned for his new pioneering take on recruitment.

Tamar Frumkin, Director of Marketing at Swift Shift, has extensive experience and knowledge in helping early stage startups build meaningful and impactful brands both in the United States and Tel Aviv. Tamar currently lives in Manhattan. She can be reached at tamar.frumkin@swiftshift.com or on Twitter @Tamarush. She writes more about recruitment and retention on her blog.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

“Our goal from the beginning was to empower patients across the healthcare delivery system and make sure that Americans who chose to enroll in the Exchanges had a good customer experience while making enrollment more cost efficient, and the results show that we accomplished our goal,” said CMS Administrator Seema Verma. “In a market that is experiencing soaring rates, I am proud of the hard work CMS put into making sure that our customers didn’t experience the website failures that were commonplace with HealthCare.gov in previous open enrollment periods.”[More details are provided in this article about CMS planners’ goals for the fifth open enrollment period for the Health Insurance Exchange and those achieved.]

CMS cut wasteful spending and adjusted the open enrollment marketing budget this year to a level similar to what has proven to be effective for other major programs, like Medicare. CMS re-prioritized marketing tactics and focused funding and attention on the most strategic and efficient ways to reach consumers, including targeted digital advertising and email. This year, CMS spent only $10 million on marketing and outreach, which is just over $1 per enrollee all while improving the ease and quality of customer service.  In comparison, last year CMS spent a total of $100 million, nearly $11 per enrollee.

The primary goal of this open enrollment period was to provide a seamless experience for consumers. While HealthCare.gov was scheduled for a total of 60 hours of regular maintenance during open enrollment, the site only used 21.5 hours. This meant consumers were able to shop and pick a plan with little interruption throughout the entire enrollment period. Data from the call center shows that the consumer satisfaction rate remained at an all-time high – averaging 90 percent – throughout the entire open enrollment period. This is up from 85 percent last year.

This year CMS also focused on building new partnerships with the private sector—as a way to begin to shift away from the government selling a private product, similar to Medicare and the successful growth of Medicare Advantage. To empower patients to take ownership of their healthcare decisions, CMS leveraged the capabilities of the private sector to help consumers through the selection process, including increasing opportunities for consumers to connect with agents and brokers. Agents and brokers are licensed professionals who help guide consumers through the complex task of choosing and utilizing health coverage. Many brokers are independent business people who live and work in the communities they serve and have years of experience in assisting clients.

This open enrollment period successfully realigned the Exchange with standard employer and Medicare open enrollment periods and with the calendar year, which offers a single effective date for coverage—January 1^st, 2018—for all of the individuals and families who signed up for coverage. Open Enrollment for 2018 coverage ended with approximately 8.8 million people enrolling in coverage using the HealthCare.gov platform.

To read the week 7 enrollment snapshot, visit:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-21.html

By Tim Rowan, Editor & Publisher of Ho,e Care Technology Report
For years, we have been wanting hard data to lay at the feet of MedPAC and CMS, Anthem and UnitedHealth, to show what we have always known. Healthcare at Home saves more than it costs. When in-home care follows — or precedes — a hospital stay, hospital costs decrease at a rate that dwarfs the cost of the in-home care.

Finally, an unimpeachable researcher studied a statistically significant group, controlled it for covariates, and compared it to a control group. The findings: patients who receive home health care after a hospital discharge save the system about $6,500 over the course of a year. Plus, home health care “independently decreased the hazard of follow-up readmission and death.”

The study, titled “Impact of Home Health Care on Healthcare Resource Utilization Following Hospital Discharge: a Cohort Study,” was conducted by the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University from January 1, 2013 until June 30, 2015 and will be published in the American Journal of Medicine in the near future.[Rowan provides details about this researcher’s m methdology and results followed, and also tesults that  ooked at 64,541 patients, with 11,266 control patients matched to 6,363 home health care patients across 11 disease-based institutes. During the 365-day post-discharge period, home health care resulted in unadjusted savings of $15,233, or $6,433 after adjusting for covariates.* Home health care also resulted in noticeable decreases in follow-up readmissions and death. Patients discharged from the Digestive Disease, Heart & Vascular, Medicine, Neurological, and Urology & Kidney Institutes benefited most from home health care.

Methodology and results
The study looked at 64,541 patients, with 11,266 control patients matched to 6,363 home health care patients across 11 disease-based institutes. During the 365-day post-discharge period, home health care resulted in unadjusted savings of $15,233, or $6,433 after adjusting for covariates.* Home health care also resulted in noticeable decreases in follow-up readmissions and death. Patients discharged from the Digestive Disease, Heart & Vascular, Medicine, Neurological, and Urology & Kidney Institutes benefited most from home health care”  The resarxhers continued: “The study concluded that ‘home health care can improve continuity of care while decreasing overall costs” and that “home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge.'”]

“(W)e observed significant financial and clinical benefits associated with hospital discharge to home with home health care relative to discharge home with ‘self-care,'” concluded the authors of the study.¹

The study concluded that “home health care can improve continuity of care while decreasing overall costs” and that “home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge.”

National Association for Home Care and Hospice interim president Bill Dombi welcomed the results. In a report on the study published on the NAHC web site, he said, “This important study clearly demonstrates that home health care has significant dynamic value in controlling care costs and achieving better patient outcomes. The study proves that a strong investment in the expanded use of home health care by Medicare, Medicaid and proves that a strong investment in the expanded use of home health care by Medicare, Medicaid and other payment programs would save billions in unnecessary health care spending.”

FacebookTwitterGoogle+Email

Dr. Grey, who is the Chief Science Officer at SENS Research Foundation and VP of New Technology Discovery at AgeX Therapeutics, coined the phrase, “From Aging in Place to Thriving in Motion” during his presentation, titled “Rejuvenation Biotechnology: Why Age May Soon Cease to Imply Aging.” Dr. Kvedar took a different road to the same conclusion. In “The New Mobile Age,” based on his co-authored book of the same title, he discussed the mobile health devices that can be used to help elders to not merely attain longevity but also to remain healthy throughout a longer lifespan.

In another keynote, AMA president David Barbem M.D. focused on the need for physicians to have a place at the table among new healthcare technology development companies. Titled, “The New Era of Digital Medicine: Physician Insights and Leadership Critical to Success,” Barbem also stressed patient input as key to gauging effectiveness of new technologies. Absent input from those two groups, he reported, you wind up with the problem prevalent today of physician burnout, with many doctors saying that technology is “not working for them.” Many mention “an overwhelming amount of clerical work.” “Obviously,” Dr. Barbem suggested, “there is a great need to make life easier for physicians as a way to help them help us get healthy.

Lastly, we heard the push for acceptance of artificial intelligence technologies from IBM vice president Kyu Rhee MD, who is CIO of its Watson Health division. He changed this reporter’s way of thinking about AI’s use in healthcare when he noted that familiar EMR systems may be key to building a static system of record but they are not necessarily systems from which we can learn. AI systems, on the other hand, continue to “learn” from medical records and improve them. Rhee concluded with an invitation. “Let’s work together to transform health with AI.”

The Partners Connected Health Symposium will return to Boston next October.

Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at audreyk3@charter.net.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

Tilong, however, disabled his ankle monitor and disappeared early in the morning of October 13, the day he was to be sentenced. Judge Harmon issued a warrant, designated him a fugitive, and sentenced him in absentia. Prosecutors had asked for 35 years for Ms. Neba, who pleaded not guilty and forced a trial. They expressed surprise that the judge would double their request, and that Tilong, who pleaded guilty, would receive an even longer sentence.

The case involved the co-owners of Fiango Home Healthcare Inc. near Houston. According to court documents, the couple paid bribes to Medicare beneficiaries and then created claims using their information though no services had been rendered. Tilong’s record-setting sentence may have been high because he fled but Judge Harmon is not making comments to the press about her rationale for either sentence.

“I am not a heartless person. I think I am not. I hope I am not,” Harmon told Neba before announcing the sentence. She imposed the maximum allowable sentence for each count and then ordered that they should be served consecutively. “That is just the way the law works,” she added, even though a pair of U.S. Supreme Court decisions in December 2007 reaffirmed that federal sentencing guidelines are merely advisory.

Obliterating Previous Records
For comparison, Lawrence Duran, the owner of a Miami-area mental health care company, was sentenced to 50 years for orchestrating a $205 million Medicare scheme that defrauded vulnerable patients with dementia and substance abuse. A Detroit physician who administered chemotherapy to healthy patients, a man federal prosecutors then called the “most egregious fraudster in the history of this country,” received 45 years.

According to court records, after Tilong failed to show up for his sentencing hearing in October, a pretrial services officer notified District Judge Melinda Harmon that the officer received a tamper alert on Tilong’s ankle monitor around 7:30 that morning. The officer had several calls made to Tilong’s cell phone but none were answered.

Tilong’s nine guilty pleas were to one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, three counts of payment and receipt of health care kickbacks and one count of conspiracy to launder monetary instruments. In a separate but related case, he pleaded guilty to two counts of making and subscribing false statements.

Neba’s case, though related, was distinct in that she was perceived as the organizer of the scheme that extendd to at least five other people. Court documents cite:

• Neba’s use of “sophisticated means” — going to great lengths to conceal her fraudulent activity, money laundering and kickback schemes.
• Neba was found to have falsified medical records, sometimes while Medicare auditors were in the office, to make patients appear sicker on paper than they actually were.
• Neba’s role as organizer of a criminal activity that involved five or more participants. “Ms. Neba intentionally engaged in or caused the conduct that constitutes sophisticated means,” the judge said.
• Neba’s attempt to obstruct justice by telling a co-defendant, before arraignment in the federal courthouse, “to keep to her story,” specifically “not to tell anybody that she, [the co-defendant], was paying the patients.”

Quoted in The National Law Journal, Patrick Souter, of counsel at Gray Reed & McGraw in Dallas and a professor who teaches health care fraud and abuse at Baylor Law School, said the prison term is unusually high “even for Texas” with its reputation for handing out tough sentences. But such an anomaly may not be one for long, at least in his state, he added.

“We’re seeing more health care fraud enforcement out there now than we’ve seen in the past. With these types of prosecutions and verdicts, we may start seeing more and more sentences closer to the [statutory] maximum, or at least significant sentences, because of the serious nature of the crime.”

Neba’s attorney Michael Khouri has filed an appeal challenging how the sentencing guideline range was calculated and arguing, among other matters, that the sentence is excessive.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Rwport.

Two weeks ago, we printed the testimony of Ohio Council for Home Care and Hospice Executive Director Joe Russell regarding his state’s chosen model to implement Electronic Visit Verification as mandated by the 21st Century CURES Act (see sidebar below). Ohio’s model is controversial because, Russel testified, it places a burden on providers that have already implemented EVV in advance of the mandate, especially those using a vendor other than the one with which Ohio contracted to coordinate the mandated system.[Rowan notes that a rebuttal article to  that piece was soon after printed in HCTR, authored by Sandata CEO Tom Underwood. For the current issue of HCTR, Rowan notes,  yet another take on the value of EVV  [is presented in this article as opinions solicited from  long-time EVV vendor and principals of  software solutions such as CEO Don  O’Rourke (CEO of Prime Care Technologies a Duluth Georgia-based provider.  In fact O’Rourke’s company’s many features include: providers’ avoidjng retraining costs efforts and associated disruption of changing vendors].

[In our continuing effort to explore a topic that impacts so many of our readers, this week, we sought out the opinion of  [a range of company’s principals such as Don O’Rourke (CEO of Prime Care Technologies–a Duluth Georgia-based  provider) of flexible hosting,and managed services and cloud-based software solutions since 2003). Also featured are: CEO Jim Hoey; and COO Carl Mickiewicz. Overall O’Rourke and Prime Care Technologies were given extensive detail about this company’s capabilities to help users to avoid retraining costs and  efforts associated with disruption of changing vendors; and to allow providers of multiple-state agencies to use Prime Care Technologies’ single master EVV repository].

[Prime Care Technologies’ use and advantages accruing to users–continued…]

• Providers avoid retraining costs, efforts and associated disruption of changing vendors
• Multiple EVV vendors use a single repository
• Providers reap the benefits of competition among EVV and EMR vendors, who will continue enhancements
• Competitive pricing is established by each vendor rather than state mandate
• Multiple state agencies may use the single, master EVV repository
• Data silos are eliminated
• Provider data can be analyzed and benchmarked by the state
• Claims data can be integrated
• During the four-phase implementation, eligibility data can also be included

Interestingly, this is variance to the 4th model described to us in detail by Tom Underwood last spring. (See HCTR, Aug. 16, 2017, “Four EVV Models States Might Choose; Three Lead to Disaster“)

Prime Care Technologies’ model has an important distinction from Underwood’s 4th model. It is better described as a separate, 5th model, where the state does not select an EVV system but rather requires providers to select an EVV system already in the marketplace that conform to state requirements. It requires EVV vendors to conform to, and pay for, interface specifications jointly developed by the states and Prime Care Technologies.

The state pays for the ongoing maintenance, support, and enhancements to the Repository and Aggregation services. No state-sponsored EVV system; minimal changes to EVV software solutions already in the state; no replacement or training costs to providers or MCOs that are already using an EVV system.

Prime Care Technologies’ state-centric, Neutral Cloud Repository and Aggregation Model accepts EVV data from any vendor and delivers it to any state Medicaid system in that state’s specified format. According to Hertzberg, this means skilled and non-skilled healthcare at home providers mandated to deploy EVV may continue to use their current EVV systems as long as their vendor implements the simple, flexible, open systems interface sponsored by PCT. He listed additional advantages of the aggregator model for us:

• Providers avoid retraining costs, efforts and associated disruption of changing vendors
• Multiple EVV vendors use a single repository
• Providers reap the benefits of competition among EVV and EMR vendors, who will continue enhancements
• Competitive pricing is established by each vendor rather than state mandate
• Multiple state agencies may use the single, master EVV repository
• Data silos are eliminated
• Provider data can be analyzed and benchmarked by the state
• Claims data can be integrated
• During the four-phase implementation, eligibility data can also be included

About Prime Care Technologies
PCT has worked with a number of EVV vendors to promote the Aggregator model, including Dial-N-Document and CareWatch and the EVV Standards Workgroup for Home Care. Since 2003, the company has equipped healthcare providers, payers, and state agencies with flexible hosting, managed services and cloud-based software solutions that continue to evolve based on the ongoing needs of healthcare related service delivery. Based in suburban Atlanta and with a staff of 150, the company has deep experience in multi-vendor interoperability. Services include data integration from over 70 healthcare applications into the leading data warehouse in Long Term Post-Acute Care; 3,500+ EDI payer integrations, and technology-driven solutions installed in more than 6,500 customer locations in 47 states.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

Rhonda is the company’s Regulatory Analyst and a certified hospice and palliative nurse. She told us, “I determined there are a lot of interdisciplinary, holistic process via twice-monthly es within home health that are similar to hospice.” Ms. Whitehurst decided to make her expertise available to customers as early as April.

Customer coaching
“Some said they would wait for publication of the final rule, some were already asking questions, others were everywhere in between,” Whitehurst said. “We started monthly meetings when it was still a proposed rule, simplifying the regulatory language to best of our ability. We also looked found areas where it would impact our software, but that turned out to be only about 30% of the puzzle.”

Today, the company offers a twice monthly “Regulatory Summit” via Webex. “This was created in response to customer request,” Ms. Oakes said. “We cover how the regulations interact with customer processes as well as their software. Internally, we looked for enhancements to make it easier and more obvious to surveyors. It helped us to re-script our own policies and procedures, so we were better able to verbalize how our software supports the new regulations.”

Fixing CMS errors
With a touch of justifiable pride, Whitehurst pointed out “one of the reasons the COPs were delayed was because we alerted CMS the regulators were mistaken in the way they handled sub-units. They thought each sub-unit needed a separate administrator, which is not true. As a result, Peggy Wilkerson from CMS gave a beautiful presentation at one of our summits on how to deal with that error in the regulation. It turned out the delay was a good thing; it gave us time to engage customers, try things, revise our message.”

The summits dealt with one regulation at a time, including three sessions on the complex issue of patient rights. Whitehurst and her staff found that the Interpretive Guidelines were ambiguous, creating as many questions as answers. The goal, she said, was to build, together with customers, what surveyors will be asking for, such as verbal orders matching the plan of care.

“It is exciting to see competitors working together,” Oakes said. “Even if they already meet the new COPs, we came up with ideas to exceed them. Together, we have been using the COPs as an opportunity to enhance the user experience.”

Cadence
One of the concepts prominent in the new COPs is Cadence. Oakes explained it to us this way. “CMS is saying, whatever the agency decides for a process — how often to update a plan of care, the timing of certain types of orders, etc. — surveyors will look for adherence to your own policies. By giving no direction about what these policies ‘should’ be, CMS is telling us they will use this as a lab, learning from providers about what are the best policies.”

Cadence refers to timing and triggers an agency establishes to determine, among other things, when a plan of care update is required. For example, one agency might say a POC update is warranted if a patient declines in two or more ADLs. Another might say a POC must be updated every 30 days, regardless. Still others might define what constitutes a reason for an update in their own specific terms. Whatever an agency’s cadence, they must adhere to it. “We assured them their software would cover them whatever their processes and policies would be,” Whitehurst concluded.

Change changes McKesson
Outside the COP preparation services that have been launched, General Manager Whitehurst wanted us to know she is emphasizing a consultative relationship with customers. “All product improvements follow discussions with a set of customers on a panel,” she said. “That helps us to know what they need and what are their desired outcomes” Rhonda Oakes now has weekly calls with implementation teams, services, and support teams to keep her in the loop, necessary now that support receives more regulatory questions than software questions.

A year ago, Change Health initiated a support model called “Effortless Experience.” Team members are being certified in an approach that standardized the custom, “Let’s take the opportunity when customer is on the phone to see what else they need.” This policy has resulted in an increase in support calls but a corresponding increase in satisfaction as well.

The company also published a white paper on the concept of software vendor involvement in customer COP preparation.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com