The Ankota Healthcare Delivery Management Blog

How Can Disruptive Innovation Transform Health Care: 10 Minute Video

One of my favorite authors and professors is Clayton Christensen from the Harvard Business School.  He has written numerous books about disruptive innovation - the kind of innovations that often go on to replace the way something is done.  More recently he wrote The Innovator's Prescription, which was named as Ankota's Book of the Year for 2009.  Here, thanks to BigThink.com is a 10 minutes video of Dr. Christensen explaining these key concepts.  Home Care and Private Duty Care organizations should realize our opportunity to be a major part of the most needed innovation in healthcare today.  Enjoy the video.

 

Some leading candidates for Ankota's book of the year in 2010 are The Checklist Manifesto, by Atul Gawande, and Healthcare Won't Transform Itself, by George Halverson.  Check out our blog posts on these books by clicking their links.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Relationship and Results Oriented Health Care is a Win/Win

One thing that we've really enjoyed as we've launched and grown Ankota is that home care people are willing to share their needs, their best practices, their frustrations and their ideas on how to make care better.  We're also proud of our reputation for listening and innovating in response to what we learn. 

One of the home care and private duty care "luminaries" who I like to talk to every few months is Ginny Kenyon, who runs Kenyon HomeCare Consulting.  Our discussions always start around a certain topic such as breaking down the silos to improve transitional care, or how to better connect agencies and family members, and Ginny always provides crisp input from her experience and the agencies she supports.  But the part of our calls that I like the most is when Ginny tells a story that she's really passionate about.  Today she shared a story from her experience as a respiratory nurse, which I'll paraphrase below"

Back when nursing was more personalized and the goal was to do whatever you could to yield the best possible outcome, I was working as a respiratory nurse with some of the toughest patients you can imagine [many of whom suffered from end stage COPD].  There was a treatment plan and course of care that I had to deliver, but what I would always do is to find out what was important to the patient.  I'd very simply ask them "How can I help you?" and "What would you dream to be able to do that's not possible for you?"  The result was a patient-centered vision and goal, which often proved very powerful.

One of my patients [who we'll call Bob] told me that he dreamed to get back into his wood shop so he could build flower boxes and planters.  Once he shared this, we were on a mission, and we were able to work together over the course of a few months to get back into that wood shop.  Integrating the required treatment elements was easy as part of attaining the goal.  And a few short months later, Bob rewarded me with some planter boxes he had built for me.  The boxes were wonderful, but the improvement of Bob's life plus my own personal satisfaction as a caregiver was priceless.

Ginny shared that one of her friends and colleagues, Ruth Hansten, has built a care delivery methodology around these best practices, which she calls Relationship and Results Oriented Health Care* (RROHC), which is pronounced like "rock".  I have a link below to Ruth's site where you can learn more.  Ginny also shared that there will be some forthcoming webinars about RROHC that you won't want to miss.  We'll follow up with more from Ginny and Ruth in upcoming posts.

*RROHC is a registered trademark

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Healthcare Reform without Permission - A Recipe

Today's post is inspired by a presentation I attended at the Northeast Home Health Leadership Summit last month in Boston.  The speaker was Dr. Randall S. Moore, CEO of American Telecare Inc.  Randall's company makes Telehealth equipment, but he caught my ear when he said, and repeated, that he doesn't believe Telehealth should be reimbursed.  As you'll read in the post below, it's not his vision that his company shouldn't make money.  Instead he challenged the participants to think differently about how to get paid.  If, for example, Telehealth can be proven to reduce the cost of hospitalizations and lower the cost of care for an individual or class of individuals, wouldn't the people paying the big bills be willing to pay a much smaller amount for the Telehealth system and for the home health agency who monitors it in exchange for the savings?  Of course they would, but our healthcare fee-for-service system doesn't reward or encourage such behavior, so in many cases it doesn't get done.  Dr. Moore gives us a recipe for getting it done, which we share a glimpse of here.

Dr. Moore began his presentation by citing a few great books and authors, both of which have been reviewed on this blog.  The first was Clayton Christensen's The Innovator's Prescription, which was Ankota's book of the year in 2009.  The other was George Halvorson's Healthcare Won't Reform Itself.  Note also that a video of Kaiser Chief George Halvorson is available here.   But he moved quickly to his formula for reform without permission, by first listing some ingredients:

• Deliver a compelling return: (Dr. Moore asked for a volunteer to buy a $20 bill for $15 - there was skepticism at first but who wouldn't take that deal?)
• Solve a critical problem / Address a Top Priority (this will grab attention)
• Realize that a new outcome will require a new process (Expecting a different outcome from the same process is insanity)
• Make things better by making them easier - not harder
• Explain your improvements in monetary terms.  (improving quality is nice, but saving money fosters buy-in)

These aren't the easiest ingredients to get ahold of, instead they require teams (which bridge the traditional silos of healthcare) to work together and they require genuine ingenuity in the healthcare delivery process.  To draw an analogy, the success of the iPod isn't because Apple made a better or cheaper MP3 player than everyone else, but rather it's because they reinvented the music delivery process so that you can get a song for $1 and the record companies and artists can get their share of the profit.  If Apple can do it, so can we, and in fact we can deliver much more value and savings than the iPod, so why not.

How can home care save money, let me count the ways:

• A hospital day costs $1,800
• A skilled nursing facility day costs $500

Whereas home care has the "value menu" for under $100:

• A home telehealth day (equipment and nursing) costs $20
• A home health aide for 4 hours costs $76
• Home infusion costs $90
• Home Dialysis costs $90
• The cost of an avoided readmission is $0 (free)
• and the value to the patient of a day outside the hospital is priceless

Given that healthcare reform is not going to happen overnight, let's start reforming it ourselves.

Ankota is very interested in helping agencies to redefine the delivery of care.  If you are having trouble getting your software to support the new models of care you seek to deliver, please contact us and give us a chance to help out.  For Ankota's white paper on transitional care, click here or contact Ankota. 

 

Medication Adherence is a Huge Drug Problem in America

Patients don't take their meds...  and this is not only a huge problem for elderly care but is a broad issue across all ages and demographics.  According to an article attached here from Pharmaceutical Commerce magazine, the statistics are horror stories:

• 1/3rd of Teen Asthma sufferers take their prescription
• 1/2 of High Blood Pressure sufferers take their medicines
• Even doctors don't take their meds 20% of the time

Here are some of the reasons why:

 

In home care it's a much bigger issue.  According to the investor presentation that accompanied the Amedisys annual report for their fiscal year ending March 2009, their average patient is 82 years old and has been prescribed 13 medications.

We've also read many case studies on transitional care (taking care of patients after a hospitalization) and have learned that medication adherence is among the leading root causes for the 20% readmission rate of Medicare patients within 30 days of discharge.

So in order to fulfill Ankota's mission to improve the quality of care outside the hospital and promote aging in place, we're going to need to follow this issue closely.  In order to help, I found an interesting blog written by Amy Yoffie, the founder of iReminder.  You can learn reach her blog by clicking on the banner below.

Ankota provides software to improve the delivery of healthcare outside of the hospital.  In addition to offering a comprehensive software suite for Private Duty Non-Medical Home Care, and software to improve scheduling efficiency for home care, medical equipment delivery, infusion therapy and respiratory therapy operations, Ankota is helping to meet the needs of emerging care models such as transitional care and geriatric care management.  To learn more, please visit www.ankota.com or contact Ankota. 

Reshaping Health Care Delivery per the CEO of Kaiser Permanente

George Halvorson, Chairman and CEO of Kaiser Permanente, has proven the thesis of better care at lower cost time and time again.  He is an excellent speaker who can answer difficult healthcare questions easily, in plain English, always citing outcomes and costs.  He also does a great job focusing on what's important and avoiding the "issue of the day" banter that the media gets caught up in.  So, if you want to get up to speed on the potential of healthcare reform without any politics, I'd receommend that you listen to George.

Thevideo interview below was conducted by Peter Hopkins, President and Co-founder of BigThink.com.  The interview lasts almost an hour, but I highly recommend it for the following reasons:

• It points out the issues in health care that really matter
• It is driven by facts - costs and outcomes
• It shares best practices
• It will make you smarter than everyone else at the water cooler or the Christmas Party

Enjoy the video!

 

From and Ankota perspective, this interview is another great example that validates the promise and importance of healthcare delivery management.  Regarding electronic medical records, Mr. Halvorson gives clear examples of how their value will be realized when they are used for coordination of care.  He also talks about numerous conditions, such as Congestive Heart Failure (CHF) where hospitalizations can be cut in half by applying the home care and telehealth based best practices that exist today.

If you're looking to better coordinate care between doctors, hospitals, home care and patients, we'd like to help.  Please download our whitepaper on transitional care here, or contact Ankota to let us know how we can help you provide better outcomes at lower cost.

iPhone App for Diabetes Gets $100,000 Grant... Of Course it Does!

I just read an interesting article by Mitch Wagner @ Information Week HealthCare (link below), talking about a $100,000 grant made to a Princeton student to continue developing an iPhone app that serves diabetics.

Don't be surprised by the rapid acceptance of smart phones in healthcare. They are portable, powerful, and ubiquitous mobile platforms. Adoption in healthcare is just getting started: consider that more homes in the US have cell phones and internet access than they do land lines. This seemed obvious to the Princeton undergraduate, Matthew Connor, and to the residents in the article that welcome their use.  This generation not only grew up with technology and is comfortable with it, they may not even remember a day when they did not have a cell phone.

iPhones, Blackberries, and the like are great for capturing complex data for diabetics and many other patients. The wireless services that enable them and connect them with compute resources are massively scalable and reliable. Applications will abound that will assist patients and the medical community to better manage healthcare and organize the model by which it is delivered.  It is just getting started.

This model is particularly well suited to assist the transition of care from hospital to home, an area where my company, Ankota, is focused. Once the patient leaves the hospital, multiple parties must be scheduled and coordinated, equipment delivered, and so on. The closed loop system you would expect is virtually non-existent. Treating physicians often have no idea how their patients fare after discharge or if they even follow the doctor's orders and take their medications. People and resources are not well coordinated and operating costs are higher than necessary because of it. The national average rate of readmission is needlessly high at 18%. And expensive.

Smartphones--with the applications and real-time communications to drive them--provide an ideal infrastructure for facilitating care and monitoring healthcare delivery outside of the hospital. This will better enable proactive care that benefits people with chronic conditions, a huge and rapidly growing segment of our population. Patients lives will be improved, hospital readmission rates will go down, and the cost of delivering care will be better managed.

To read the Information Week article in its entirety, go to http://www.informationweek.com/story/showArticle.jhtml?articleID=219500004

Crisis in Healthcare Reform & NAHC Conference Converge This Week in LA

The crisis facing the home healthcare care industry has never been more severe than it is today. Just as the NAHC National Conference is taking place this week, Congress prepares to vote on health care reform bills that will decide the fate of many of these businesses. Association President Val Halamandaris explains this threat and NAHC's position in a video statement on the NAHC web site. He explains it in a very frank, clear manner and I encourage you to take a few minutes to view it here http://www.nahc.org/

President Obama has proposed $34 billion dollars in cuts to Medicare home care benefits-or roughly 11% of expenditures-while the Senate bill proposes a whopping $56 billion dollars in cuts. What is clear is that cuts are going to be made, and the compromise will likely fall somewhere between these two numbers.

This is incredibly shortsighted. Instead, we should be driving more care into the home and providing incentives for the health care system to better manage the transition of care from hospital to home. There are tremendous cost savings available here that will be productive, rather than the destructive cuts that are likely to happen.

Consider the following:

1) Lower Costs. Home health care costs a fraction of hospital and clinic-based alternatives, including skilled nursing facilities.

2) Better outcomes. Home-based care supports Aging in Place and Hospital at Home, initiatives that support patients so that they can live productive lives at home. Studies show that patients prefer to be at home and actually fare better when they are able to receive care there.

3) Reduced readmissions. Hospital readmissions run about 18% nationally and, under reform proposals, Medicare will not reimburse hospitals for them. Home health care is the optimal delivery model for the type of follow up care that has been shown to reduce readmissions by as much as 50%. As people are discharged from hospitals earlier, the focus has to shift to provide better transitional care.

4) Chronic Disease. The hospital-based model was never intended to provide the proactive care required for chronic conditions such as diabetes, heart disease, and high blood pressure. A handful of chronic diseases account for more than three-quarters of US healthcare expenditures. This is an obvious place where patient care can be improved and hospital costs can be reduced dramatically.

It is clear that the healthcare system already has appropriate medical expertise to take care of patients better and more efficiently. What is lacking is focus on the process of coordinating and delivering that care. A focus on "Healthcare Delivery Management" will help the system achieve better outcomes with greater efficiencies, while leveraging available skills and resources.

The legislative attitude seems to be, "cut one, cut all," without regard to efficiency and efficacy. Cutting reimbursements without addressing the inefficiencies in the system simply puts greater financial stress on the model we already have.

Why not reward those who take action to reduce costs like hospital readmissions?

Why not reward those that find better ways to care for chronic diseases?

Why not simply reward the models that are the most efficient and effective?

Why not invest in programs that better manage the process of delivering care and show financial improvement?

 

For more about Healthcare Delivery Management and company case studies, go to http://Ankota.com.

For more about Ankota's exhibit and the conference, click here:

http://www.ankota.com/releases/bid/27034/ANKOTA-WILL-EXHIBIT-AT-THE-2009-NAHC-MEETING-AND-EXPOSITION-BOOTH-1448

 

Q & A With Ankota CEO Will Hicklen

The following is an excerpt from a recent Q&A session at the Healthcare Connectivity Summit:

Q: (interviewer) Sandy was sick for three years before cancer finally claimed her life. What did you see that gave you the idea for Ankota?

A: (Will) I saw two things. First, I saw skilled, professional health care workers who were committed to doing their jobs well. Second, I saw a terribly inefficient system that forced these people to spend significant time doing things other than caring for patients. This wasted time and resources cost the healthcare system--and the companies in it--billions of dollars each year.

 

Q: (interviewer) Give me an example of one of the problems you saw.

 A: (Will) Just one? (laugh) Okay-an appointment scheduled in the morning for a nurse to visit Sandy at home. She was given a window and the nurse missed that window, showing up later in the afternoon. This is not uncommon because home care companies often schedule appointments in a very manual fashion, there is frequent change, and schedules are very difficult to manage.  Mistakes like this are common. Sandy could have spent that day at the kids' school or out enjoying the day with friends--living her life. Instead, millions of home care patients just like her are forced to wait around for the system to catch up with them.

I'll give you another example: A nurse arrived one day to find that the equipment and the feeding supplies she needed for the visit were not delivered. That was a wasted visit for that nurse, it cost everyone money and delayed the care that was needed. There are consequences to this besides just a wasted appointment. At this time, Sandy could only be fed intravenously. The company delivering the supplies now had a delivery crisis that upset other deliveries and added mileage expense, and the nurse then had to work overtime that day. This was entirely because the planning and scheduling of the people, equipment, and supplies was not well coordinated. That one example cost the system thousands of dollars and wasted tremendous time for everyone.

 

Q: (interviewer) Clearly, this frustrated you. How does Ankota approach this?

A: (Will) It was incredibly frustrating--the lack of coordination, the lack of communication between the providers, the manual planning--these are problems that are common to many industries that are equally complex and they have been solved. We can solve this in healthcare.  

The problem is that many of these efforts have been treated as separate tasks and managed in "silos," so they have remained highly fragmented. The result is an uncoordinated, inefficient system as we just discussed.

Healthcare needs to be managed as a "delivery model." There is a tremendous opportunity to improve operational efficiencies and to improve the efficacy of care.  Ankota is doing this by providing technology that enables "Healthcare Delivery Management," or "HDM."

 

Q: (interviewer) Can you give me an example of the types of efficiencies you are talking about?

A: (Will) Sure. For example, we find that a company that schedules home care workers or delivers equipment or supplies can reduce the number of miles driven by 25-35% simply by using Ankota's route planning and scheduling. Companies should look at their fuel costs and ask, "Would I like to cut that cost by one third?" They can also increase their capacity by about 10-20% simply by recovering time that was previously unproductive. That increases their revenues and reduces their operating costs.

 

Q: (interviewer) I get how that improves the business, but how does your example improve the quality of care for patients?

A: (Will) First of all, anything that improves the profitability of the provider's business and helps them compete is ultimately good for patients and improves the healthcare system in general. Secondly, Ankota's HDM solution is more than just a tool for scheduling and optimizing certain resources.  HDM is a platform that coordinates the many people and resources into an efficient operational model and enables a "best practices" approach to delivering care. This is what enables real care management with protocol-based approaches to managing care. It provides a model that measures efficacy and enables continual improvement. It is a paradigm that has been very successful in other industries like aerospace, automotive, defense, and so on. These industries also have very complex supply chain networks that have to be coordinated and run efficiently. Health care can definitely learn from them.

AARP Releases terrific article about transitional care

One of the biggest opportunities for healthcare reform comes in the arena of care coordination.  This article from AARP Bulletin Today shows a great example of care coordination in post-acute transitional care.  By looking at and serving the patient's full set of needs after they leave the hospital, readmissions drop significantly.  Please see the article at http://bulletin.aarp.org/yourhealth/medicare/articles/transition_care.1.html.

Ankota's Chief Medical Officer Dr. J Hunter Young has driven home the importance of care coordination in all aspects of our product line.  Our care management pilot system incorporates Medical Needs, Recovery Needs and Social Needs into the protocols and assessments used for care management.