This article is sponsored by Netsmart. This article is based on a Home Health Care News discussion with Ashley Puchalski, senior director of Care Coordination at Ohio’s Hospice, Hannah Patterson, vice president and general manager of Workforce Management at Netsmart, and Divesh Aidasani, vice president of Strategy at BAYADA. This discussion took place on August 30, 2023 during the HHCN FUTURE Conference. The article below has been edited for length and clarity.

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/.

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