Healthcare at Home: The Rowan Report

By Michael McGowan (founding president  of OperaCare, LLC, former OASIS coordinator for CMS Region IX when OASIS was first introduced).

In July 2017, James Cosgrove, Director of Health Care Reviews for the Government Accountability Office, reported the Medicare Advantage (MA)improper payment rate for 2016 was $16.2 billion.

Pair that with the assertion by CMS official Jonathan Morse that the “largest contributors” to billing mistakes in standard Medicare were claims from Home Health providers and Inpatient Rehabilitation Facilities. He also stated that improper payments in the MA program are “most often payments for which there is no or insufficient supporting documentation to determine whether the service was ‘medically necessary’.”

As such, the home health industry should not be surprised at the intensity of Medicare Advantage audits we are just now starting to see. As the Silver Tsunami ages into Medicare, and as the volume of MA claims exponentially increases, we can expect to see the OIG and Congress require more and more auditing of MA claims.[McGowan prepares us in the healthcare at home industry to understand payment claims as a non-negotiable federal payment mandate.]

Home Health providers need to understand and prepare for the fact that these claims will be targeted in a data driven manner. They must know what the triggers for those audits will be. They will always be located in assessment and visit documentation. In our work with provider agencies, we have found that the best time to avoid setting off these triggers is during the OASIS assessment, and that the best strategy to use at that moment in the episode of care is to use a Software-Assisted Scribing Process.

Standard Medicare has a similar and almost as serious a problem making accurate payments to doctors, hospitals, and other health care providers. According to recently published statistics, Standard Medicare’s payment error rate was $41 billion for 2016. Many hospitals, emergency departments, and even physician practices have begun to depend on medical scribes to reduce billing errors and free up physicians to focus on patients.

As the Medicare payment system transitions from the “honor system” to a hi-tech, high-volume, data driven, claims adjudication environment, successful providers will come to realize compliance with federal payment mandates is a non-negotiable requirement. Initial compliance on the part of the contractor is far cheaper to the system than the retroactive, penalty-dependent compliance methods that government payers have been relying on for the past twenty years.

In our Home Health experience across the country, we have begun to urge providers to know and manage their data prior to submission. In fact, this has become our motto, “Do not submit what you cannot defend!” This is the easiest way to position your agency for success.

Michael McGowan is the founding president of OperaCare, LLC. He was the OASIS coordinator for CMS Region IX when OASIS was first introduced. He can be reached at 916-343-1164 or michael@operacare.com.

©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

By Homecare Homebase staff

CMS is experimenting with new payment systems that create incentives for providers to increase their efficiency, communication, and quality of care. Alternative Payment Models (APM) promote outcomes-based care and use specific metrics to measure quality of care, patient satisfaction, and health outcomes. Care organizations are scored, with top-rated providers rewarded with higher payment rates. This is one of the top goals of CMS’ Home Health Value Based Purchasing initiative.

The rationale is that health care providers know better than anyone else how to improve care, and understand where the bottlenecks occur. The financial incentive inherent in the model encourages them to be proactive, work in partnership with other providers, and address the needs and concerns of patients. Outside the rigid fee-for-service payment models, caregivers are able to treat patients as individuals and design appropriate care plans.[Details are provided about healthcare at home service providers’ need to embrace The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) even though the bill isn’t set to affect all reimbursement rates until 2019.  More extensive details are also  provided about CMS’s instituting 3  mandatory Alternative Payment Models (APM) as part of its concerted efforts to improve quality of care and reduce costs. The successes achieved in quality of care and cost control by Pioneer ACOs are indicated. The very pressing need for healthcare at home service agencies to improve their performance is voiced and means to do so are suggested.]

Health care providers hope that this individualized approach will lead to better patient outcomes because it provides a more holistic view of the patient.

The APM Market Share is Growing Steadily
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed with overwhelming support of both parties and directed a transition away from fee-for-service payments to a pay-for-performance model. Even though the bill isn’t set to affect all reimbursement rates until 2019, many providers have already embraced the new model.

A HCP-LAN study estimated that 25% of CMS reimbursements in 2016 would be to providers using some form of APM. Other industry experts predict that the majority of insurers (not just CMS) will move quickly to adopt value-based healthcare payment models. A separate 2016 study found that 58% of payers are “along the continuum towards full value-based reimbursement, a 10% leap since 2014.”

Meanwhile, CMS announced three mandatory APMs in December 2016. The model projects are to run until 2021, but if they’re successful, CMS could accelerate implementation:

• AMI (Acute Myocardial Infarction) model – launches July 2017
• CABG (Coronary Arterial Bypass Graft) model – launches July 2017
• CJR (Comprehensive Care for Joint Replacement) model – launched in April 2016, and coverage updated in the December announcement.

A Successful Vehicle for Cost Control
While quality of care is, of course, a primary concern, the need to control spiraling healthcare costs as the US population ages is also quite important. These alternate models appear to be successful at both. CMS touted the results of one project in 2016:

According to the results, over 400 Medicare ACOs generated more than $466 million in total program savings in 2015, accounting for all ACOs’ experiences.
    […]
The mean quality score among Pioneer ACOs increased to 92.26 percent in PY4 from 87.2 percent in PY3. The mean quality score has increased in every year of the model, with a total increase of over 21 percentage points since the first year.

That same CMS report indicated that many providers qualified for “shared savings,” meaning higher reimbursement rates. However, those shared savings are allocated based on quality measurements, so lower-performing providers may find their reimbursement rates cut. The trend towards risk-sharing is changing both the operational and competitive landscape of the home health care industry.

The Home Health Care Industry Is Changing
In theory, this should be the very best time to operate a HHA. Payers are demanding cost reductions and home-based care costs far less than hospitalization and other institutional options. HHAs however, struggle to find and retain qualified staff, comply with reporting requirements, and improve quality of care. Many have the added challenge of working with non-Medicare providers, who have their own sets of expectations. It is the classic “doing more with less” conundrum that is increasingly being addressed through industry consolidation.

In a 2013 report, Harris Williams, a middle-market investment bank, anticipated the trend’s increasing popularity, noting:

The need for greater scale, operational efficiency, and comprehensive care delivery capabilities is driving market consolidation. Over 50% of HHAs generate less than $3 million in revenue. Reimbursement pressures will reinforce the consolidation trend driven by the need for scale and better operating leverage to maintain and increase profits.

While some of the consolidations are larger HHAs buying smaller agencies, hospitals and rehabilitation centers are buying into Home Health as a way to manage services. Particularly in the APM or ACO payment environment, it makes sense to have relationships with reliable care providers. Those relationships can be good for HHAs as well, since “margins are always thin and, absent a full merger, stronger alliances with hospitals mean more referrals.”

APMs Are Here: Is Your Agency Ready?
During the past decade, change has been the only constant feature of the healthcare market. Workflow management and reporting rely on technology while outcomes-based initiatives make proper reporting even more important. A single paperwork discrepancy can cause care delays and denials, requiring extra staff time to sort out the issue. For instance:

Agencies are reporting increasing denials related to a mismatch in beneficiary’s Medicare number, some of which is out of the agency’s control. For example, the suffix in the Medicare number changes from a “B’ to a “D” because the beneficiary’s status has changed from married to widowed.

Working with other stakeholders is not always easy. As we saw with the Pre-Claim Review rollout, lack of training and guidance so frustrated doctors that some temporarily stopped referring patients to Home Healthcare. HHAs had to step in and help physicians and hospitals understand the new documentation requirements.

Great performance can lead to more referrals, but lower-quality performance can send referrers packing. A hospital executive in Tennessee was blunt about the issue in an interview with Becker Hospital Review:

The behavior of other partner facilities and providers is managed through data review to make sure our expectations are being met. If a facility is not meeting the originally established expectations, the facility is notified and Campbell Clinic patients are shifted to other partner facilities. Campbell Clinic has found this method to be an extremely valuable tool to keep external partners accountable for their decisions and their actions regarding BPCI patients.

Your agency’s success is increasingly connected to the success of other stakeholders in the care continuum – from primary care physicians to hospitals to the patients and their families. Data must be shared with other caregivers across platforms and must comply with payer requirements. The dilemma is that managing this process requires IT expertise that many agencies lack. Therefore, it is useful to talk to experts, starting with your own software vendor. They should be contractually required to constantly monitor payer requirements and regulatory changes, ensuring that your software tools reflect the most up-to-date requirements.

Editor’s thanks to the staff at Homecare Homebase for submitting this guest article. They asked us to remind you that Homecare Homebase solutions free you and your staff from the constant data worries, so you can focus on what you do best: providing the highest possible level of patient care.
hchb.com

©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

By Tim Rowan, Editor & Publisher of Home Care Technology Report

Attendees at AlayaCare’s “Better Outcomes 2017” user group meeting were a mix of Medicaid, Private Duty, Nursing, Therapy, SMB, Enterprise and international agencies from as far away as Australia. It gave attendees an opportunity to learn more about AlayaCare’s vision, to collaborate with other home care and health professionals and ideate with software engineers, product managers and designers to solve the issues faced by a number of departments and persons delivering healthcare in the home. [Some of the topics explored in the conference included Home Care Technology North and South and Remote Monitoring and Big Data Applications.  A wide range of topics covered in breakout sessions of this user group meeting is also noted, as is the need for more interdependence  in working with UX and design around a more integrated  plan of care.]

Home Care Technology North and South
Tim Rowan, author and industry expert on home care, provided relevant context to delivering care in today’s world. He provided context into the big picture of the challenges and opportunities faced by home care providers. His insights into the role of technology helped kick off the conference and broadened the perspective of the audience, encouraging them to embrace solutions for remote monitoring, predictive analytics, and physician and patient portals. He also advocated for more client-oriented perspectives through the use of online reviews to promote an agency where people actually search today: Google, Yelp, and Facebook.

Home Care Technology North and South
PwC’s Health practice leader, Will Falk, curated relevant statistics, data, and insights that helped attendees realize the crucial role of home and community care for health systems. Will painted a picture of the role of mobile and how the technology will continue to evolve and shape the industry.

Scheduling Optimization
Schedule and route optimization in home and community care. AlayaCare’s VP of Engineering, VHA’s Director of IT and the PHD chair of optimization Louis-Martin Rousseau discussed the business context, challenges and design of the algorithm that reshuffles schedules based on a number user selected criteria such as continuity, skills, travel distance and other hard and soft constraints.

Remote Monitoring and Big Data Applications
Machine Learning and predictive analytics for remote and vital tracking. Dr. Carolyn McGregor shared her experience in streaming vitals and big data analytics in neo-natal infants and her work with AlayaCare’s work on remote monitoring data for reduction in ER and Re-hospitalization of CHF and COPD clients.

UX and Design around a more integrated care plan that sees more interdependence, logic and decision support use cases between all of the sometimes-disparate functions of:

• Assessments
• Plan of Care
• Scheduling
• Task management and clinical pathways
• Mobile point of care
• QA and clinical best practice

There were a number of breakout sessions that brought together attendees of various roles and perspectives to discuss and contribute to some of the following areas of running a home care business:

• Implementation and post go live best practices; AlayaCare’s VP of Client Success Gosia Radaczynska and Director, Client Success Kristen Saldanha shared a new methodology and critical success factors on how to be more effective and efficient with AlayaCare
• Optimization and Machine Learning Workshop – AlayaCare’s senior product team engage audiences and selected candidate projects for AlayaLabs to investigate innovative solutions to problems across a number of operational and clinical areas
• A variety of product workshops where clients, designers, developers and business leads collaborated on new approaches to streamlining the following areas:
o Finance: Statements and Balance Management
o KPI development
o Coordination efficiencies in the intake process
o Advance Form development with logic and data validation

AlayaCare’s leadership recognized that bringing together their clients in a collaborative setting with their software engineers, designers, product managers and client success managers would help to support the company mission to deliver better health outcomes. The energy generated by the collection of clients, industry speakers and AlayaCare staff was incredible, not to mention the scenery of the Canadian side of Niagara Falls from the hotel windows.

©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

This urgent plea comes from Calvin McDaniel, Deputy Director, Government Affairs, National Association for Home Care & Hospice

If you have not yet done so, please use the link below to contact your Members of Congress. Then, please encourage your employees to do so as well.

In late July, the Centers for Medicare and Medicaid Services (CMS) issued their proposed rule for payment updates for calendar year 2018. Included in this rule is a 2019 policy proposal, the “Home Health Groupings Model,” which will be the most significant change to the prospective payment system since it was put in place 17 years ago. Some of the most concerning provisions:<>

• It is not budget neutral. This proposal cuts nearly $1 billion from the Medicare home health benefit annually.
• Episodes of care would drop from 60 to 30 days,
• Therapy utilization will be removed from payment calculations, raising access to care concerns

[This short article provides specific directions for members of the healthcare at home service community to promote their displeasure with the proposed payment updates and contact all of their senators and representatives.  Contact points are provided.] Stakeholder involvement in developing this policy was minimal, at best. These proposals have not been tested and there is no evidence to demonstrate the deep impacts they will have on patients and providers alike. This rule is not finalized yet, and there is still time to take action so that the policy may be withdrawn. NAHC is are working with the Administration and Congressional Leaders to remove this damaging model, but the association needs your help to get there.

Please head to the NAHC Legislative Action Center to add your voice to the campaign against this proposal. It is a simple process and will help get the industry’s message out:

1. Click the above link
2. Fill in your information
3. Click “Send Email”

This will send a pre-drafted email to your Senators and Representative that lays out NAHC’s concerns with the proposal and asks that they urge CMS to withdraw it and work with stakeholders on developing changes to the PPS model. You also have the option of deleting the pre-drafted message and writing your own.

Calvin McDaniel can be reached at 202-547-7424.

©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

Home Health providers worried about reimbursement and margins under CMS’s proposed Home Health Grouping Model [HHGM] can take a breath. In other healthcare sectors, providers have been forced to develop efficiencies to live within the strictures of tightening payment rules but Home Health is yet to scratch the surface of such development efforts.

One major component of home health efficiency is nursing workflow patterns. Improving this area has the potential to more than make up for annual reimbursement rate reductions. In general, however, quality in this area has remained at best unchanged over the past two decades. [The author provides examples of systematized efficiencies in clinical practice that have affected change(such as when lengths of stay changed from 10-12 days to 2-3 days).  McGowan suggests that it may just be a matter of time until healthcare at home service provision will model changes in the hospital realm.]

Systematized efficiency gains in clinical practice that parallel the usual and customary best practices of the rest of the Medicare-Certified continuum can result in margins equal to the early days of PPS. A high clinical standard of practice can also become a nurse recruitment and retention tool.

Historically, clinical practice patterns are shaped by systems, which drive the need to attain process efficiencies in order to survive. When Diagnosis Related Groupings were implemented in hospitals, for example, that sector’s care delivery model changed from Procedure-Recovery-Discharge to Procedure-Discharge-Recovery. At the same time, lengths of stay went from 10-12 days to 2-3 days on average, seemingly overnight.

Hospitals changing their care delivery model from P-R-D to P-D-R is a success in the eyes of CMS. Duplicating this success is exactly what Value Based Purchasing and HHGM are designed to do in Home Health. In CMS’s opinion these reforms have worked and continue to work in hospitals. This is exactly why CMS continues to press forward with similar reimbursement plans in other sectors.

Hospitals became efficient in ways initially thought unimaginable; they “leaned out” in order to survive. The hospital industry as we know it today is a testament to resilience and creativity. Home health will follow.

Reduction in the number of home health episodes, visits, and costs will be achieved in one way or another. Abt Associates, one of the HHGM consultants to CMS, documents that 68.8 % of PPS episodes performed now are third or higher consecutive episodes. This is the first obvious target as medical review teams show almost 80% denial rate for medical necessity in these cases. We see MedPAc embracing this reduction in episodes, visits, and costs as well.

As we move to the 30 day HHGM care episode, and it will come in one fashion or another, our current practice of Assessment, Creation, and Implementation of a care plan in 3-5 days will eat up 20-25% of the initial payment episode without coordination of care with treatment.  Our patient recertification practices will rapidly change in a similar manner, just as BID diabetic care changed under payment pressure a few years ago.

Combine all of this with the fact that patients come to us much sicker than ever before, and with the mandate that we keep them out of the hospital for at least 30 days, and it is easy to see that we cannot continue the practices of the past twenty years.

History also shows us that CMS watches our data, reads our documentation, and benchmarks our efficiencies against Hospitals, SNF’s, LTACH’s and IRF’s, each of which has gone before us on the reform road. As such, CMS is demanding a different path, just as they did with the aforementioned providers.

It may sound bold to say this, but if we the home health community are not actively engaged in change to meet VBP, HHGM, reductions in reimbursement etc., we may need to check our pulse. If it is not at zero yet, is may be soon.

Of course, the argument I hear is “It’s not in my state yet.” And, of course, the logical reply to that is: “When CMS sees how quickly they can cut costs, gain control over the contractor community, and flush out 30-50% of the agencies, how long will it take them to roll it out nationwide?”

Speaking from experience, I know these necessary process improvement changes are possible. My team and I have designed a process and paired it with a software product and today the system is well past the concept stage. Efficiencies resulting from the clinical practices we teach are keeping our clients ahead of the shrinking reimbursement rate curve. Are the changes we require easy? Of course not. But that is not the question. The only question that matters is, “Is change in clinical practice patterns required to survive?”

Michael McGowan is the founder and President of OperaCare. He is a former OASIS coordinator and trainer for CMS Region IX. He can be reached at “Michael@OperaCare.com.

PlayMaker, the leading sales platform for post-acute care, announced today the addition of Holly Miller as Vice President of Sales [as of Sept. 2017].

“The addition of Holly to our company represents an exciting new phase of expansion as we aggressively grow our market share across the post-acute care industry. Our innovation, products, and industry-leading solutions continue to lead the marketplace and hiring Holly further validates PlayMaker’s ability to attract the best and brightest,” said John Griscavage, CEO of PlayMaker.

In her role as Vice President of Sales, Miller will help to continue the trajectory of growth PlayMaker has experienced over the past five years. “Holly’s experience and proven track record as a sales leader make her the perfect fit for PlayMaker,” said Griscavage. “Her approach to solution-based selling will ensure that our clients are receiving the exact products and services they need to remain competitive in the marketplace.” [More details about Miller’s extensive experience in healthcare technology and sales are noted in this short article,  A brief history of  PlayMaker is also provided.]

Miller has over 15 years of healthcare and technology sales experience. Most recently, she served as Associate Vice President of Sales, Non-Acute & Medical Technologies at HealthStream, a company that provides workforce development, patient experience, and provider solutions for the healthcare industry.

In this role Holly was responsible for developing and executing a sales and market strategy to both launch and expand HealthStream’s solutions across the Non-Acute and Medical Technology markets. While there, she demonstrated a consistent track record of exceeding sales expectations and achieving record-breaking growth.

Holly earned her bachelor’s degree in Business, Management, Marketing, and Related Support Services from Middle Tennessee State University.

About PlayMaker
PlayMaker is the leading sales platform for post-acute care. The company’s solution combines industry-specific referral management tools with EHR referral history and actionable market data to empower sales teams and executives to achieve their growth goals.
playmakercrm.com

©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

We took that question to Netsmart’s EVP of Corporate Development, Kevin Scalia. His game plan is clear, to connect as many healthcare services entities as possible into one coordinated communication system with patients at the center. He calls it the Netsmart “Health Home.” “We have the largest market share by miles in the Behavioral Health market,” he began. “We built a platform that works like an air traffic controller. It is connected to Emergency Department information systems, for example. Patients register with a local ED and our BH software customers get an alert when they show up. Now we are taking that model into Home Health and Long Term Care.”

This movement toward a universal healthcare network is Netsmart’s long-term goal.[Rowan explains how Netsmart plans to bring together  multiple types of companies and help them work well together.  Scalia also unveils the fact that  Netsmart’s Health Home will become its own nationwide Health Information Exchange and that the company welcomes providers of all types to share patient data through it. “We are a founding member of ‘Care Equality,’ which recently merged with the ‘Commonwell Health Alliance,'” he added. “That nationwide interoperability system has tremendous potential.”]

“As ACOs become insurance companies, they need connectivity help across business sectors,” continued. “We are already bringing all types of clients together to discuss how to work together toward this end. We do not have time to wait. In fact, we already have 15-20 Home Health clients connected into the network and four or five of those are already using our population health system to manage bundles and ACO relationships.”

He also confirmed universal suspicions that there might be a good fit between the HealthMEDX system, which was built for LTC providers and later expanded into Home Health and Hospice, and the DeVero point-of-care application. He said that integration is already in process and has its first joint client. Talks have begun with other DeVero clients — including the San Jose company’s marquee customer, Kindred — about wiring into Netsmart’s national HIE network.

Scalia does use this language, that Netsmart’s Health Home will become its own nationwide Health Information Exchange and that the company welcomes providers of all types to share patient data through it. “We are a founding member of ‘Care Equality,’ which recently merged with the ‘Commonwell Health Alliance,'” he added. “That nationwide interoperability system has tremendous potential.”

Though Commonwell has been as notorious for its one missing member as for the good it has brought to healthcare’s interoperability needs, Scalia emphasized to us that Netsmart has a strong working relationship with Epic as well. The hospital, physician practice, and Home Health software company actively exchanges patient data with all Netsmart products, he told us.

Mutually Beneficial Acquisitions
With regard to Netsmart’s wave of acquisitions, he explained that they target companies with good products and loyal customers that may not have the wherewithal to invest heavily in R&D. “We spend as much on R&D as the total budget of many other post-acute software companies,” he asserted. “DeVero, for example, has a phenomenally successful User Interface for nurses and they can roll it out rapidly to large-scale clients, as they did for Gentiva and then Kindred. But no software company has ever been successful selling the same product to both small and large clients. We have always had a couple of EHRs in each market. As we talk to a client, we can detect which one they need. If a multi-business line company wants to have all its divisions on the same platform, Vision or Allscripts can serve and they can integrate DeVero on the front end if it suits their needs.”

To facilitate matching software products to client needs, the company has built out over the past 7 or 8 years Netsmart’s CareGuidance™ solution suite, under the direction of Senior VP Scott Green. Green the teams charged with driving the company’s interoperability, population health, consumer engagement and analytics operations.

“We realized that one EHR is not enough to serve clients in a value-based purchasing world,” Scalia concluded. “You need family engagement, 3rd-party cooperation, payer relationships. So we have different products for small and large organizations, and to accommodate companies rapidly growing from small to large, but they all wire in to one large EHR. This is what we did in Behavioral Health. The complexity of the HIE market is a problem for some. If each entity has to figure out how to configure a CCD, they may not have the bench depth in IT to do it. So, we built our own HIE, connected it with Epic, and can electronically push a referral in either direction.

Payer Engagement
He added that Netsmart is now working with Managed Care Organizations to coordinate care and payment. “We work together to identify what they do well and what we do well,” Scalia said. “An MCO might remind someone when to get a colonoscopy but how do you deal with a frail elderly person with depression? They need help from both Home Health and Behavioral Health. If you do this effectively, payers would love to engage in a full-risk model but they can’t because they don’t have the IT infrastructure and the analytics. We do. Because we do, we can help our clients participate with payers in a way that is financially viable. They are clients become recognized leaders and more and more business gets funneled to them.”

The EVV Situation
We asked Scalia about Netsmart’s response to the 21st Century CURES Act and its mandate that every state establish an electronic visit verification mandate of its own. “If they need our assistance when they go into a state, we wire EVV providers into our network,” he replied. “So far, we have developed interoperable communications with Dial N Document, Sandata, and CellTrak.”

©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