<img alt="" src="http://www.qpwoei2.com/100802.png" style="display:none;">

Ankota: Ushering in the Next Generation of Homecare Blog

Does your home care start-up have the right personalities to thrive?

Posted by Ken Accardi on Jul 31, 2012 11:40:00 AM

Today I read an interesting article in Fast Company entitled Building Blocks and it made me think that this article can apply to home care as well as it does to other types of start ups.  

While Ankota is not a home care company, per se (we make software used by home care companies), these personalities are certainly important to our start-up.  I'll use Ankota as a case study to talk about how these personality traits fall into our mix.  Note that in the case of Ankota (and as a general rule) an individual person can demonstrate more than one personality trait.  Let's dig into the list of 6:

  1. The DreamerEvery startup needs a dreamer. It's a motivating force in creating the company from day one and a sustaining force every day after. Most CEOs and founders have this characteristic, but it's not exclusive to management. The dreamer inspires, excites, and leads the company from a sky-high view.
    • Our CEO Will Hicklen was frustrated when caring for hisWill Hicklen wife Sandy and his mom who both died of cancer in 2008.  He dreamed that care coordination could be easier and that inspred him to start Ankota
    • Hunter YoungOur Chief Medical Officer, Hunter Young, also dreamed about better care at lower cost.  He recognized that an avoided hospitalization means a happier and healthier patient and saves money, and that better care coordination between the hospital system and the community would lower health care costs.

  2.  The Manager: The manager takes a dream and makes it Marc Ottingerhappen. He or she is pragmatic, reliable, and has the initiative to turn ideas in action items. Charisma is less important here, it's all about being approachable, trust-worthy, and forward thinking. The manager understands that while the team needs a vision, it also needs tangible tasks to execute. The manager defines roles, outlines goals, and ensures that each individual is hitting the mark.
    • Marc Ottinger, our COO, is the manager.  He's always looking for a structure and a process.  He wants an agenda and a task list.  He takes notes and goes back to them and checks them off.
  3. The BuilderThe builder thinks like an architect and acts like a tradesman. He or she has a clear understanding of the company vision and knows how to create it. The builder knows when to seek counsel and when to make an executive decision. He or she is intuitive, bright, and inventive. Ever worked with someone who, with little direction, seems to understand and create exactly what you want? That's the builder at work. I can't emphasize the value of this person enough.
    • In Ankota, I'm the builder (I'm Ken Accardi, the CTO).  I can't take full credit for "creating exactly what you want" but I'm not afraidKen Accardi to take my best shot at getting something built to fulfill the vision of our company or one of our customers.  I've found that by listening intently, I'm able to build something that is "close enough" and then adjust it to meet the need.
  4. The Workhorse: The workhorse is happy to step up and do whatever it takes to make the company engine purr. You will never hear the words: "It's not my job" come out of this person's mouth, and as a result, they will become your rock. The workhorse gets things done behind the scenes, be it ordering office furniture, assisting other team members, or following up on a suggestion you once made in a meeting. In all honesty, chances are most people in a startup will have the workhorse personality trait. Their egos don't need to be stroked, but a little recognition goes a long way.
    • I think this one is me too...  But this has to do with my role as technology leader and the fact that we're a technology company
  5. The Penny Pincher: Anyone who's been part of a founding team will empathize with the experience of boot strapping. Funding (if and when it comes) is sweet, but you can never quite shake intolerance for wastefulness and the joy that comes from frugality. I respect team members that understand the importance of being efficient with budgets. The penny pincher questions every purchase and never commits to a cost without first considering the alternative options. He or she is creative with budgets, doesn't spend unnecessarily and understands the difference between need and want (and is accepting of the difference). The penny pincher personality trait speaks volumes to me--it means he or she cares about the long-term health of my company and is committed to getting me there
    • Clearly Marc Ottinger is our penny pincher!  We love him for it!
  6. The Social Butterfly: When there's work to be done it's tempting to create a vacuum. The earphones go on, the chat is switched off, and the body language shouts, "do not disturb." Removing distraction is a vital strategy in getting meaningful work done. Yet, what happens when there's always work to be done? These individual cells of silence can kill company morale when repeated over the long term. Never underestimate the importance of creating strong morale and a fun culture. The person with the ability to create connections among team members, laugh at themselves and others, and shift perspective at the right time, is an essential ingredient to a happy team
    • Will is our social butterfly.  He loves to get out and share the vision.  
    • Marc is a great networker too.  I get the impression that he is still in contact with everyone he's ever met.
Does your home care start-up have these personality traits?  If not, which ones should you look for in your next recruits?
Fast Company
 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.

Topics: Home Care Entrepreneurship, Home Care Best Practices, Home Care

More Common Sense About Accountable Care & Healthcare Reform

Posted by Will Hicklen on Jul 25, 2012 5:24:00 PM

In today's Crain's Cleveland Business, Author David Schweighoefer of the Cleveland-based law firm Walter & Haverfield offers a common sense "User's Guide" for those trying to figure out Healthcare Reform and what it means. I'll call it "Take a Deep Breath and Keep These 7 Things In Mind..." I especially like #1: 

Separate: Strive to separate politics from the law.

These 7 points are a quick read - It is so good and so simple, in fact, that I'll run it verbatim on Ankota's blog. Enjoy!

Crains Cleveland business logo

 David Schweighoefer contact info

No one should underestimate the scope and complexity of the recently upheld Accountable Care Act. Everyone wants to know, “what does it mean?” and “what happens now?” Readers are being bombarded with explanations and projections and hypotheses. Exactly what it means depends on your age, gender, current health status and if your questions are from the standpoint of an individual or a business owner. Here are a few simple rules to keep in mind as you proceed with your analysis:

1. Separate: Strive to separate politics from the law. This legislation has become enormously politicized, and that clouds understanding of what exactly the legislation attempts to accomplish. 

2. Observe: Our present health care system, in comparison to other civilized nations, costs too much, is too complex and delivers sub-optimal results. This legislation is an ambitious attempt at reform and repair. Change is difficult.

3. Analyze: It has become a political issue because we as citizens do not agree on the proper size of the role government should play in our lives, and in this instance, our health care.

4. Contemplate: We have a moral dilemma. What is our responsibility to care for our fellow citizens? Should health care be a human right? In this regard, why are we so different from other civilized nations? Many European nations have successfully implemented the changes contemplated by this legislation, a task made easier by fundamental differences between those societies and ours. Many other societies have a belief that their members have an obligation to each other rather than a belief that individuals are only responsible for themselves. 

5. Ask: Ask: What does this legislation propose to do? It provides for insurance reform: (i) more people are covered with insurance; (ii) insurance becomes more accessible through the expansion of Medicaid and insurance exchanges; (iii) coverage is better (young adults covered until age 26, preventative care is covered, your insurance company must spend a certain amount of your health care premium dollar on your care) AND…..

The legislation proposes delivery system reform: (i) care will be better integrated and coordinated through a variety of new structures, one of which is named an Accountable Care Organization; (ii) this new care system will be paid differently -- rather than a fee for every service provided to you, the providers will receive a bundled payment to split among themselves, the amount of which will not depend on their respective fees, but rather on the outcome of your care; (iii) an increase in attention to the quality of your care; and (iv) increased efforts at developing innovation in the health care system.

6. Calculate: This legislation has dozens and dozens of moving financial parts and pieces. Some costs will go up, others down. Still others will shift. Political explanations of these changes are political explanations of these changes. In order to understand the financial impact on you, you will need to carefully investigate the changes as they apply to your situation.

7. Examine: It is tempting to believe that the simple operation of the marketplace can be relied upon to correct these many ills. To date, this has not been the case. Markets function best when they operate under certain conditions, one of which is when a large number of sellers compete with each other over prices that reflect the true resource costs. The other necessary condition is when the consumer has good information about the characteristics of products and their prices – information that is most easily obtained if products are well defined and standardized and if prices can be readily ascertained without excessive search. Our current market for health care does not meet these conditions.

Watch for additional blog postings in coming weeks as we endeavor to explore these guidelines in more detail. Until then, consider just one aspect that seems particularly riveting: In the long run, can the states really afford the expansion of Medicaid?


Ankota's technology is used to organize providers of all types into "ecosystems," enabling Accountable Care models with technology that helps organizations Plan, Coordinate, and Deliver services in a highly coordinated and efficient manner. To learn more about Ankota technology for ACOs or to manage Care Transitions, click on this really cool orange button!

Click me

Topics: PCMH, Health Care Reform, Care Coordination, transitional care, Will Hicklen, Accountable Care Organizations, ACO, Patient Centered Medical Home, ACO Technology

The Common Sense Explanation of Accountable Care

Posted by Will Hicklen on Jul 23, 2012 5:46:00 PM

Better Care at Lower Costs: Clearly explaining Accountable Care. Learn how ACOs are organized, what the incentives are, and how patients ultimately benefit.

Former CMS Administrator Don Berwick does an excellent job of clearly explaining Accountable Care. Learn how ACOs are organized, how they are incentivized, and how patients lives are ultimately improved. Berwick is well known as a big thinker and as the policy wonk who coined the phrase "Triple Aim," which he used to describe the goals of health care reform: improving patient experience, improving population health and reducing costs.


Berwick has been openly critical of the healthcare system and a strong proponent of reform, saying, "20-30% of health spending is 'waste' with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud." He lays part of the blame on CMS regulations.

 Fundamentally, hospitals have been paid to keep beds full and provide lots of services. "Fee for Service" means "provide more services...earn more fees." Now, under Accountable Care, hospitals and other providers are paid to keep beds empty! ACOs, hospitals, and the rest of the providers that make up the healthcare ecosystem are paid more to provide the right types of services that keep patients healthier and out of the hospital. 

Accountable Care Organizations, Hospitals, Primary Care Physicians, Post-acute care providers such as home health care, physical therapy, infusion nursing and more are engaging in programs such as Patient Centered Medical Home (PCMH), Aging in Place, and Care Transitions Initiatives to achieve the Triple Aim. 

Ankota's technology is used to organize providers of all types into "ecosystems," enabling Accountable Care models with technology that helps organizations Plan, Coordinate, and Deliver services in a highly coordinated and efficient manner. To learn more about Ankota technology for ACOs or to manage Care Transitions, click on this really cool orange button!

Click me

Topics: PCMH, Care Coordination, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, Patient Centered Medical Home


Posted by Will Hicklen on Jul 19, 2012 2:33:00 PM

New Care Coordination Payments for Managing Care After Discharge

CMS will pay community physicians and other care coordinators for the care required to help a patient transition back to the community following discharge from a hospital. This is consistent with CMS objectives of aligning incentives to drive the right kind of care that reduces avoidable readmissions, improves quality of care and lowers healthcare delivery costs.

Remington Report Care Coordination Payments

As described in the Remington Report, "Under the proposed rule, CMS would make a separate payment to a patient’s community physician to coordinate care during the first 30 days after a patient’s hospital stay. Research shows that patients who receive timely physician follow-up care after being discharged are significantly less likely to be readmitted.

 The proposed rule would increase payments for family physicians by 7 percent and other practitioners providing primary care services by 3 to 5 percent under the Medicare Physician Fee Schedule for 2013. The proposed rule, which will appear in the July 30 Federal Register, also seeks public comment on how Medicare can better recognize the services community physicians provide in office visits and in coordinating care outside of the office."

Why is CMS Paying for Care Coordination?

That's easy: by creating this role and providing incentives for those who provide Care Coordination following discharge, hospital readmissions will be greatly reduced. And more care will be provided proactively to prevent episodes that cost more later if not addressed. And that lowers costs and improves patients lives. It's really that simple. 


U Mass Medical School Care Coordination PaymentsCommunity Catalyst Care Coordination

From a recent Community Catalyst paper titled Special Delivery: How Coordinated Care Programs Can Improve Quality and Save Costs, published jointly with U Mass Medical School

"The delivery of health care in the United States is fragmented and uncoordinated. This adds
unnecessary risks and costs to people’s health care experience.

• Lack of coordination can be unsafe, even fatal, when abnormal test results are not
communicated correctly, prescriptions from multiple doctors conflict with each other
or primary care physicians do not receive hospital discharge plans for their patients.
• Uncoordinated care is also costly because of duplicated service

Healthcare professionals are well aware now that 20% of patients are readmitted within 30 days of discharge from the hospital, and that number increases to 30% within 60 days. It is widely accepted that this is both a cost and quality problem. In fact, Medicare figures alone peg the cost of readmissions that could have been avoided at more than $25 BILLION annually. Further, chronic diseases account for $3 out of every $4 spent on healthcare in the US. Many chronic conditions are manageable, but when left unmanaged--which is common in the fee for service model--they result in needless ER visits and hospital stays. 

So How Is This Going to Work?

It may help to understand where Ankota's focus is. Ankota's technology is sharply focused on managing Care Transitions, a strategy that is shown to improve outcomes, reduce hospital admissions, and lower the overall cost of care. Ankota's customers are doing this today and are well positioned to take advantage of new opportunities such as these Care Coordination payments that are available. 

Healthcare Ecosystems

Ankota's customers make up much of the healthcare ecosystem and are those that Plan, Coordinate, and Deliver services to patients. They are a diverse crowd, including

1) Hospitals, ACOs, CCTPs: using Ankota technology to Coordinate Care and manage Care Transitions under models like Patient Centered Medical Home and Community Based Care Transitions programs (CCTP), and 

2) Post-acute Care Providers: delivering services outside of hospitals and primary care settings. These services are growing rapidly and are provided by post-acute providers that include home health, HME or DME providers, Infusion nursing, Physical Therapy (PT/OT/ST), Geriatric Care Managers, Non-medical Home Care, Behavioral health specialists, and more. 

These are the organizations that actually provide the services for patients after discharge from the hospital. In our terms, this is the Healthcare Ecosystem. Ankota helps organizes providers into a single, integrated service model in order to Plan, Coordinate, and Deliver needed services.

For more information about Ankota's technology for managing Care Transitions, please click on the really cool orange button immediately below

Click me

Topics: PCMH, Care Coordination Payments, Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, National Association of Geriatric Care Managers, ACO, Patient Centered Medical Home

How The Supreme Court's Decision Impacts Transitional Care

Posted by Will Hicklen on Jul 18, 2012 12:34:00 PM

Supreme Court Transitional Care

"If there was ever any doubt about the importance of managing care transitions – it's gone now."

-- Daniel Day, Care Transitions Journal

The article below recently ran in Sirona Health's Care Transitions Journal, and discusses the Supreme Court's ruling on the Patient Protection and Affordable Care Act, the rise of Accountable Care Origanizations (ACOs) and Patient Centered Medical Home models (PCMH), and what the ruling does and does not do for healthcare providers.

As Daniel Day points out, "While The Patient Protection and Affordable Care Act has created incentives for organizations like yours to focus on providing high-quality patient care, they haven't provided any instructions on how, exactly, to do that."

This, appropriately enough, has been left to the best market driven economy in the world. Payment incentives are aligning around clear objectives--better outcomes at lower overall costs--and innovation will accelerate dramatically to enable new, highly efficient models of care to emerge. 

Ankota is leading the way with technology that enables the formation of Healthcare Ecosystems: collaborations of providers that coordinate care seamlessly, across all disciplines, while achieving unprecedented levels of operational efficiency. It all translates immediately into better outcomes for patients and lower overall cost of care. To learn more about Ankota's Care Coordination technology to manage Care Transitions, click on this orange button. And be sure to read the article below!

Click me


Surona Health Care Transitions Journal

It's settled. The Supreme Court has ruled to uphold the Patient Protection and Affordable Care Act.

As the nation absorbs and reacts to this landmark case, healthcare insurers and practitioners like you will be rolling up their sleeves and getting back to work.

You'll continue to improve the delivery of care to your patients – focusing on service quality over quantity – ensuring your patients receive safer, more appropriate healthcare.

If there was ever any doubt about the importance of managing care transitions – it's gone now. 

Implementing Patient-Centered Models Of Care

At the very heart of reform are patient-centered organizations like yours. Organizations that view healthcare as something that occurs across the entire continuum of care – not just during acute or chronic illness. 

You understand that being accountable for the quality of care a patient receives is the path to improved population health and financial security. Many of you will continue on this path and implement new models of care, such as Accountable Care Organizations and Patient Centered Medical Homes.

In order for these new care models to succeed, you'll be required to coordinate your patient's movement between local and national healthcare resources as their needs change. 

This means you need to have an infrastructure in place that:

  • Provides patients with 24x7 access to clinical support.
  • Coordinates clinical and administrative resources.
  • Enables continuous feedback to each patients entire care team.
  • Has relentless quality oversight; allowing for continuous improvement.

Preventing Unnecessary Use Of Healthcare Resources

If you've been in a blissful state of denial, it's time to shake it off. CMS penalties are coming. 

As a result of the Affordable Care Act, the Centers for Medicare and Medicaid Services will now be withholding payments for excessive hospital readmissions. In short, hospitals are now financially at risk for patients re-hospitalized for reasons considered to be preventable.

While CMS has implemented financial penalties for hospitals with excessive readmissions, they haven’t provided any instructions on how to successfully reduce them.

This leaves many hospitals wondering what the right approach is. And while there are indeed many solutions to consider, managing how patients transition in and out of the hospital is critically important to impacting readmission rates.

This requires that you focus on improving:

Improving The Patient Experience Through Quality Care

In addition to financial incentives targeting preventable readmissions, CMS will reward hospitals that provide high-quality patient care through the hospital Value-Based Purchasing Program (VBP). 

The goal of the VBP program is to motivate hospitals to focus on the quality of care delivered, rather than the quantity of services they provide – outlined by:

  • 12 Clinical Process of Care Measures, and
  • 8 Patient Experience of Care Measures. 

Transitional care plays an important role in experience management. 

To receive appropriate care, a patient will likely require services from a variety of healthcare practitioners and settings across the healthcare system. Transitional care programs provide consistent, personally relevant guidance to patients, enabling them to successfully find and utilize these resources. 

By supporting patients as they move along the continuum of care, you reduce the likelihood a gap in care will occur – simultaneously building the patient's trust in the care they are receiving. 

The Way Forward For Building A Transitional Care Program

No transitional care program will be exactly the same.

That's because, while The Patient Protection and Affordable Care Act has created incentives for organizations like yours to focus on providing high-quality patient care, they haven't provided any instructions on how, exactly, to do that.   

What is clear is that to be successful, you'll need to create a patient-centered infrastructure that facilitates the delivery of care through customized patient interactions, guideline driven processes, clinical escalation, dynamic referrals, and real-time notifications.


Contact Ankota today to learn more about why some of the nations best respected healthcare organizations are turning to Ankota for technology to help manage Care Transitions. 

Click me 

Topics: PCMH, Care Coordination, thought leadership, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, Patient Centered Medical Home, ACO Technology

What the Supreme Court Ruling on Obama Care means for Home Care

Posted by Ken Accardi on Jul 18, 2012 10:37:00 AM

Elizabeth Hogue is a home care attorney who kindly interprets the impact of various legislations on home health and home care.  We've featured her work before such as in our posting ACO's - Final Regulation​s Issued: Home Care Coordination Needed.  In today's post, reproduced with her permission, she has summarized the impact of the recent supreme court ruling on Obamacare.

Elizabeth Hogue ESQ

What the Recent Supreme Court Decision Means for Home Care Providers


Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

Twitter: @HogueHomeCare



The U.S. Supreme recently issued its opinion in National Federation of Independent Business, et al v. Sebelius, Secretary of Health and Human Services, et al, Case 11-393, Decided June 28, 2012.  There were two crucial issues decided:


-        Can Congress enact a requirement that individuals must purchase health insurance or pay a penalty, the so-called individual mandate?


-        Can the federal government force the states to expand eligibility for the Medicaid Program by threatening to withdraw all Medicaid funding from States that do not expand eligibility as directed?


With regard to the first issue, the Court concluded that the individual mandate is not a valid exercise of Congress’ power under the Commerce Clause or the Necessary and Proper Clauses of the U.S. Constitution.  The Court said that the Constitution grants Congress the power to “regulate Commerce.”  The power to regulate commerce presupposes the existence of commercial activity to be regulated.   The individual mandate, however, does not regulate existing commercial activity.  Instead, it compels individuals to become active in commerce by purchasing a product on the ground that their failure to do so affects interstate commerce.  The Court did conclude, however, that the power given to Congress to “lay and collect Taxes” does support the individual mandate, which imposes a tax on individuals who do not purchase health insurance.


With regard to whether the federal government may require the States to expand their Medicaid Programs, the Court concluded that it cannot do so for the following reasons.  The Spending Clause of the U.S. Constitution grants Congress the power “to pay the Debts and provide for the…general Welfare of the United States.”  The Court recognizes that Congress may use this power to establish cooperative state-federal programs, such as the Medicaid Program.  The legitimacy of such programs depends, however, on whether the States voluntarily and knowingly accept the terms of such programs; Congress cannot require the States to participate.  When Congress threatens to terminate other grants as a means of pressuring the States to accept such programs, therefore, it runs counter to the Nation’s system of federalism.


The Secretary of the U.S. Department of Health and Human Services (HHS) may penalize States that choose not to participate in expansion of the Medicaid Program under the Affordable Care Act (ACA) by taking away their existing Medicaid funding.  According to the Court, the threatened loss of over 10% of States’ overall budgets is “economic dragooning” that leaves the States with no real option but to acquiesce in the expansion of the Medicaid Program.


The Court acknowledged that the government claims that the expansion of the Medicaid Program is just a modification of the existing program and that Congress has the right to modify existing programs.  The Court concluded, however, that the expansion “accomplishes a shift in kind, not merely degree.”  The original Medicaid Program was designed to cover medical services to particular categories of vulnerable individuals, such as children and the disabled.  Under the ACA, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with an income below 133% of the poverty level.  The Court concluded:


A State could hardly anticipate that Congress’s reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically.  The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion.


Consequently, each State now has the right to decide whether or not it will expand itsHealth Care Reform Medicaid Program consistent with the ACA.  What does this decision mean for home care providers? 


Many providers, including hospitals, supported the ACA because they thought the result would be more patients, especially more patients who pay.  It is unclear whether this will still be the result, especially for post-acute providers.  With regard to the individual mandate, it remains unclear whether the individuals who currently have no insurance and purchase it as a result of the mandate will have coverage for home care services.  It also seems unclear whether or not individuals who are currently uninsured will utilize home care services.


Likewise, it is unclear how many States will voluntarily decide to expand their Medicaid Programs as described above.  Individuals who are eligible for expanded Medicaid Programs may not, however, be individuals who are eligible for home care services.


Stay tuned as the individual mandate and expansion of the Medicaid Programs are rolled out!

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

 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.

Topics: Home Care Industry, Health Care Reform, Care Transitions

Reducing Avoidable Hospitalizations With Home Health Care

Posted by Will Hicklen on Jul 17, 2012 8:27:00 AM

CHAMP quote

There is broad recognition that post acute care providers are vital to an effective healthcare delivery system that coordinates care for better outcomes and reductions in avoidable readmissions. The imperitive of Accountable Care is that Primary Care and acute, hospital-based care must coordinate with post-acute care providers to form "ecosystems." These ecosystems will serve as collaboratives that

      • Practice evidenced based medicine
      • Share both the financial risks and rewards of delivering better outcomes
      • Manage chronic conditions proactively
      • Support the elderly through Aging in Place and other programs
      • Lower the total cost of care.   

NAHC logo

In the video below, Mary St. Pierre, VP of Regulatory Affairs for the National Association for Home Care and Hospice (NAHC) discusses how clinicians and home care agencies can help to reduce hospitalizations and improve the quality of care for older adults. Click here to view St. Pierr's discusion.

In a related article titled Preventing Rehospitalization: Home Care to the Rescue, Mary Champ explains  that "Medicare is going to penalize hospitals that have high readmission rates.  Take it to the next step: hospitals are going to be held accountable for what happens once their patients are home."  Medicare patients who are re-admitted within 30 days of their discharge will now have a profoundly negative impact on the hospital's finances. "What used to be considered more revenue, inpatient admissions, is going to cost hospitals money starting October 2012, when a Medicare patient is readmitted in less than 30 days," explains Champ.

CHAMP logo

Further, "Preventing rehospitalization is nothing new for home care agencies.  We’ve been held accountable for a while now." Champ adds, "...hospitals will see greater value in improving communication with their home care partners now that their bottom line will be impacted. Making home care services a part of the rule not the exception in discharge planning would seem to be a logical step to address this problem."

Ankota develops technology that organizes providers into ecosystems to manage Care Transitions, helping them Plan, Organize, and Deliver care among all provider types. To learn more about Ankota's Care Transitions Technology, click on the orange button below

 Click me


Topics: Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, NAHC, ACO Technology, Video

Starting a Home Care Agency can cost $80K and Home Health $350K

Posted by Ken Accardi on Jul 16, 2012 12:26:00 PM

Expert home care consultant and our good friend Ginny Kenyon focuses on helping home care entrepreneurs get their businesses successfully off the ground.  This blog post, written by Ginny, explains the costs associated with starting various types of home care and home health agencies.  Enjoy!

The Cost of a Home Health/Home Care Agency Start-Up

Throughout the years, Kenyon HomeCare Consulting has had the privilege of assisting successful start-up home health agencies across the country. Although many thoughtfulstart up questions are asked, we have noticed that only 10% of those individuals requesting assistance have projected out the assumed cost of starting up. The remaining 90% have given little consideration to the cost of starting a home health agency. If they have thought about it, they tend to grossly underestimate the revenues needed for the first year of operation. Costs of a start up home care agency vary by state, as well as by the type of Home Care agency that an individual may wish to start. The least expensive is the non-skilled Home Care agency, followed by the licensed skilled home care non-Medicare. The most expensive startup is Medicare/Medicaid Home Health and Hospice.

One of the major reasons new home care businesses fail is because of lack of working capital for the start up phase of the business. The estimated cost to start up a non-skilled Private Pay Home Care agency runs about $40,000 to $80,000, Licensed Home Health non-Medicare $60,000 to $100,000, and Medicare Certified agencies $150,000 to $350,000, depending on the state in which you start your home health agency. Much of the cost is incurred around licensing issues and regulations requiring licensed personnel, computer software and hardware, patient care costs that are paid out of the owner’s pocket and are not recoverable, commercial space for the office and the length of time the state is out until initial review or survey. Additionally, many states now require that all Medicare start up agencies go through an Accreditation organization, which also adds cost, and time to the start up phase.

Anyone thinking about starting up a home care/health agency must first develop a working budget for the first year. There are some basic costs that all home care start-ups share: name and logo development, policy and procedure development if in a licensed state or going for Medicare, computer software and hardware, sales and marketing, recruitment andGinny Kenyon retention, office furniture, supplies, and equipment, office space rental, plus telephones, and personnel costs, depending on the type of agency and the state and federal rules. For the Medicare agency start up costs, the requirement of paid clinical staff to care for a minimum of ten patients has to be added into the startup budget cost. Those monies, considered part of the startup costs, are not recoverable from the Medicare. In addition, Medicare and the states will require a specified amount of money in a bank account to prove the financial viability of the new organization. All of these elements must be included in the startup budget.

There is one last budget element that must be added: payment to the new owner. This is the most commonly missed budget line. Starting a business is a full time job! The time and energy invested in starting up a home care agency is considerable and requires a line item for reimbursement. Some of the estimated start-up costs stated above are the reimbursement that the owner will need to survive financially while the agency is getting started. Failure to include this expenditure leads many aspiring home care agency owners to work outside the start-up to generate income while they simultaneously try to start the business. This is a sure recipe for failure.

Are you considering starting up a home care/health agency and need some assistance in developing the budget? If so, we’re here to help. Contact Kenyon HomeCare Consulting for a sample budget or call 206-721-5091 for consulting assistance.

Click me

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.

Topics: Home Care Entrepreneurship, Starting a Home Care Business, Home Care Industry, Elderly Care, Home Care Best Practices, Home Care

Protecting Patient Data: Risk Management Education Series

Posted by Will Hicklen on Jul 13, 2012 12:25:00 PM

Risk Management Education Series brought to you by Ankota and IronRisk Strategies, LLC 

IronRisk Risk Insight

by Loch Curtis, IronRisk Strategies

In our previous article titled, Risk Management: Patient Data and Your Liability, we highlighted some eye opening statistics regarding the risk of having patient data getting into the wrong hands, either through a malicious cyber attack or through the improper disposal of paper files.  Based on the responses we received, one of the biggest concerns for health care providers is the threat of a data breach.

IronRisk image

The first step to the proper execution of a risk management plan is to first analyze and understand what the particular risks are to the organization.  The nature of healthcare presents two particular vulnerabilities, or targets for those who want access to private data.  They are:

Type of Data stored – Health care facilities not only store health related information, but also highly targeted information such as: social security numbers, financial data, bank account information, etc.

Multiple access points to data – Health care facilities often transmit data, or allow outside parties access to their data, through various access points such as external networks, web applications or something as simple as e-mail. 

A good starting point for a health care facility to begin understanding the risks unique to their operations, would be to first step back from their business and evaluate these two vulnerabilities.  Once you start gaining clarity on these issues, you can then begin to understand how you are prone to a breach of data, including but not limited to the following:

                External Applications and Systems
                Software Flaws
                Malicious Code
                E-mail lacking Encryption
                Insider Attack
                Physical Loss of Information

Additional information regarding each of these items is provided in the attached Risks Insights article, “Protecting Patient Data by Preventing Cyber Attack.”

The biggest mistake I see businesses make regarding any Risk Management planning, is failing to start.  The concept of Risk Management can seem daunting.  But the key is to set aside some time and begin to understand a particular risk, and then create a plan to better manage that risk.  For health care providers, the protection of private information is a great starting point.

In our next article, we will provide some insight into how a business can transfer this risk by purchasing insurance, and what to look for in these policies.

Topics: HIPAA compliance, Patient Data, risk management

Improving Care for Patients Requires Better Care Coordination

Posted by Will Hicklen on Jul 12, 2012 10:43:00 AM

A relatively small percentage of cases make up the bulk of expenses in healthcare--and that is true among all payor sources. There is much that can be done to mitigate avoidable readmissions, take care of patients more proactively in their homes, and lower the total overall cost of care. Here is a compelling story as backdrop for the conversation.

Medicare spending stat

This Wall Street Journal article The Crushing Cost of Care illustrates this point dramatically. Using the case of Scott Crawford, who, in 2009, consumed $2.7M in Medicare funded services until he died at the age of 41, author Janet Adamy tells the tragic story of one of Medicare's most expensive beneficiaries in that year. Crawford was only in his 20's when he became sick, qualified for Medicare coverage through the disability, and ultimately received a transplanted heart at Johns Hopkins in Baltimore. 

"We're always going to have patients in the Medicare program that need a disproportionate number of resources," said Jonathan Blum, deputy administrator and director for Medicare. Blum observed about Crawford's case, "A lot of the costs were driven by complications that could have been avoided," and cited an infection that Mr. Crawford aquired as an example.

I am deliberately ignoring any ethical discussion about Mr. Crawford's casefor a number of reasons, including:

1. I am a proponent of organ donation. My own wife's life was extended significantly by a liver transplantation made possible by the generosity of the donor and his surviving family.

2. Mr. Crawford's case is simply an illustration for a disussion about how we care for the sickest and costliest of patients -- and how we can improve both the outcomes and the cost at which we deliver that care.

3. As the leader of a software company that develops technology that helps providers coordinate better care, I am focused on dramtically improving healthcare delivery models.

Mr. Crawford's case is extreme, but is a good catalyst for discussion. There are millions more patients consuming healthcare services that are poorly organized and delivered. Whether it is a patient's failure to manage his own medications or chronic condition that results in an emergency room visit, or better coordinated therapy plan following knee replacement surgery that would rehabiliate the patient faster and stronger, it is clear that more can be done. What I find more interesting than the article itself is the interview with the author, Janet Adamy of the Wall Street Journal, which you can see in the video above. Maybe this is the real discussion and Mr. Crawford simply serves to make the lesson more personal. 


Aknota's technology is used by providers of all types, including hospitals, ACOs and post acute care providers to better coordinate and deliver care upon discharge, and enable programs like Patient Centered Medical Home, Care Transitions Initiatives, and Community Based Care. To learn more about Ankota's technology click here 

Click me

Topics: Geriatric Care Management, PCMH, Care Coordination, transitional care, Will Hicklen, Care Transitions, ACO, ACO Technology, Video

The Future of Healthcare Delivery Management: A Must Read

Posted by Will Hicklen on Jul 11, 2012 8:19:00 AM

The Future of Health Care Delivery: Why It Must Change and How It Will Affect You, by Dr. Steven Schimpff

Dr Stephen Schimpff The Future of Healthcare Delivery

From the author, Dr. Stephen Schimpff on Medical Megatrends

Health care in the United States is a paradox.  We have the most expensive, technologically advanced medicine in the world, Yet, even basic medical care is not uniformly available or it is much too expensive.  Furthermore, the quality of care is all too often less than satisfactory and not nearly safe enough.

Dr. Oz on Healthcare Delivery

There are many disruptive, often transformational changes coming, which will further complicate matters for the average patient.  These changes are being driven by an aging population, our adverse lifestyles and behaviors, an ever-increasing shortage of providers, our attitudes about the end of life (“Isn’t there one more treatment to try?” even when death is inevitable), and a nascent rise in consumerism (“The patient is no longer willing to be patient”). One of the most important changes is a shift from a focus on the treatment and prevention of acute illness (e.g., pneumonia, appendicitis, etc.) to chronic diseases (e.g., diabetes with complications, heart failure, and cancer), which often are lifelong once developed, difficult to manage, and very expensive to treat – yet, mostly preventable. There are also many misconceptions about what medical care delivery is and what it could and should be. For example, few people understand that true comprehensive healthcare delivery requires both an intensive focus on both diagnosing and treating diseases and injuries when they occur as well as an equally intense focus on health promotion and disease prevention. Furthermore, few in the general public understand that those with chronic illnesses require well coordinated care by a multi-disciplinary team.Healthcare reform legislation has been touted as offering us better care opportunities when, in fact, healthcare reform is not about healthcare; it is mostly about paying for medical care for the uninsured, eliminating some of the health insurance restrictions consumers face, and only somewhat about the rising costs of medical care or improved quality.

Click me

“The Future of Health Care Delivery”  provides a clear, concise overview of the main features of our current medical care delivery system, the rapid changes occurring in its landscape, and offers specific recommendations for steps and initiatives that America needs to take to move from a healthcare system that is primarily geared towards treating acute illnesses and injury, to one that focuses on health promotion and disease prevention and does a better job of managing complex, chronic diseases. 

It is clearly time for a different approach to healthcare in this country. We need a major overhaul of the entire system that realigns incentives and balances fundamental rights with corresponding responsibilities.  To do this, however, requires disruptive and transformational changes in how we pay for medical care, how we fund preventive medicine and public health, how we manage medical information, how we incentivize and pay healthcare providers, how we incentivize ourselves to take better care of our health, and how we assure that everyone has both access to care and the means to pay for it.

It will mean reorganizing medical care so that the consumer is the decision-maker, just as in any other industry or profession-customer relationship. For example, having a high deductible insurance policy owned by the individual would return insurance to what it has been traditionally while cementing the professional relationship between doctor and patient – like any other professional contract where the individual is the client (compared to our current system where the insurer is the client of the employer or the government, the doctor is the client of the insurer and the patient is the client of no one.) There will be many barriers to success, but it can be done. Indeed, it must be done or else we will continue to be a country deficient in the care that everyone could and should have while we will continue spending more and more on a per capita basis for healthcare – much more than other countries with equal or better health quality measures.

Does this mean that huge new sums of money will need to be spent? No. There is plenty of money is in the system now; it is “just” a matter of reorganizing priorities so that it can be spent efficiently and effectively in a manner that will actually improve the quality of care while reducing its cost. All parties will need to accept responsibilities along with their rights, something that is not prevalent today. This will be a major task, for sure, but it is certainly not insurmountable.

The three key themes of the book are as follows:

  1. The disruptive and transformational changes coming and needed
  2. The clarification of misconceptions
  3. The balancing of rights with responsibilities – to lead us to a true healthcare system that functions for the benefit of all.
Click me

Read excerpts from the book

This book is designed to inform the average healthcare consumer as well as the healthcare policymaker about  what works and what does not in our current medical care delivery system, how it is changing, and how each individual’s own actions can influence their health, the quality of their care, their healthcare costs, and their satisfaction with the healthcare  they receive.

Topics: PCMH, Health Care Reform, Care Coordination, thought leadership, Aging in Place Technology, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, Patient Centered Medical Home, ACO Technology

One-Third of Hospitals Will Close by 2020

Posted by Will Hicklen on Jul 10, 2012 12:26:00 PM



For centuries, hospitals have served as a cornerstone to the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to die. Across the nation, hospitals have become embedded into the sacred fabric of communities.

According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions. More than 1 in 10 Americans were admitted to a hospital last year.

Hospitals make a substantial imprint on local economies. In many communities, hospitals represent one of the largest employers and economic drivers. Of the total annual American health care dollars spent, hospitals are responsible for more than $750 billion.

Despite a history of strength and stature in America, the hospital institution is in the midst of massive and disruptive change. Such change will be so transformational that by 2020 one in three hospitals will close or reorganize into an entirely different type of health care service provider. Several significant forces and factors are driving this inevitable and historical shift.

First, America must bring down its crippling health care costs. The average American worker costs their employer $12,000 annually for health care benefits and this figure is increasing more than 10 percent every year. U.S. businesses cannot compete in a globally competitive market place at this level of spending. Federal and state budgets are getting crushed by the costs of health care entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are vulnerable as they are generally regarded as the most expensive part of the delivery system for health care in America.

Second, statistically speaking hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000. The Journal of the American Medical Association reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group, 80,000 die from hospital acquired infections, many of which can be prevented. Given the above number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to medical errors. So hospitals are very dangerous places.

It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths. Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The airlines would stand before the nation and the world in disgrace. Currently in our non-transparent health care delivery system, Americans have no way of knowing which hospitals are the most dangerous. We simply take uninformed chances with our lives at stake.

Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.

Fourth, health care reform will make connectivity, electronic medical records, and transparency commonplace in health care. This means that in several years, and certainly before 2020, any American considering a hospital stay will simply go on-line to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics. Isn’t this what we do in America, comparison shop? Our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare roofers or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost — all of which will be necessary to compete.

What hospitals are about to enter is the place Americans, particularly conservative Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers.

A third of hospitals now in existence in the United States will not cross the 2020 finish line as winners.

reprinted from KevinMD.com

David Houle is a futurist, advisor and speaker and Jonathan Fleece is a health care attorney, advisor, and speaker. They are the authors of The New Health Age: The Future of Health Care in America.

Submit a guest post and be heard on social media’s leading physician voice.

Topics: Care Coordination, thought leadership, Will Hicklen, Care Transitions, Avoidable Readmissions, ACO, Patient Centered Medical Home, ACO Technology

How Will the PCMH Model Work?

Posted by Will Hicklen on Jul 10, 2012 11:34:00 AM

Jessica Chao Copy

Sage Growth Partners Logo

Rerun with permission from our partner, Sage Growth Partners. Connect to Sage Growth Partners here

By Jessica Chao

Jessica Chao is a health system pharmacy administration resident at Johns Hopkins Hospital. A former student at The Carey Business School, she has worked extensively with Sage Growth Partners CEO Don McDaniel and will serve as an occasional guest blogger.

Is patient-centered medical home just another name for a new model for primacy care practices? Yes and no. The reason why healthcare has been the headlines for the past few years is that the United States is facing a crisis. Components of this healthcare crisis include: poor reimbursements to primacy care services, shortage of primary care physicians, fragmentation of care, and lack of accountability.

But what are the causes and what the effects of the problems? We need to understand the causes in order to fix the problems and to understand why and how the patient-centered medical home model will work.

Problem 1: Fee-for-service model
The fee-for-service model reimbursement is dependent on the amount of services provided (i.e. number of diagnosis-related groups, procedures, and/or prescriptions). The inherent defect of the model is the dis-alignment of quality with care. As a result, we are living with the aftermath of this broken model such as wide income disparities among physicians (family physicians average $173,000 compared with specialties such as $391,000 for radiology and $419,000 for cardiology)[i]. 

Problem 2: Primary care physician shortage
According to a Kaiser Family Foundation report published in April 2011, 56% of patient visits in America are primary care, but only 37% of physicians practice primary care medicine, and only 8% of the nation’s medical school graduates go into family medicine.  With the number of Americans over age of 65 reaching to 19% by 2030 and a slowed population growth since the Great Depression, this is quite concerning when comparing at the population who requires healthcare the most compared with those able to provide the care[ii].

The concept of medical home needs to focus on three main components: (1) revolution in reimbursement incentives, (2) improvement in the quality of care, and (3) cost savings.  In the next few years, there will be many “medical home” models emerging.  The important part is to make sure the three components are present since the mode might differ.  In short, I don’t really care what they call it as long as our patients are receiving accessible quality care without burning their wallets and having to jump through 10 hoops to get their questions answered.

ankota logo no tag[5]

Ankota commentary: There are several concepts including PCMH that are aimed at providing better care, more practively, with the objectives of improving results and reducing total costs. Variations on Patient Centered Medical Home models are already in use and many are generating impressive results, even despite a usual lack of automation. Pilots show that readmissions can routinely be reduced 10-30% using early screening and proactive care of chronic conditions. Pilots typically lack technology to support the necessary scale, but reductions in avoidable hospital admissions by as much as 40-50% are possible on a very large scale by leveraging technology that better manages Care Transitions, coordinates multiple providers and services, and helps them operate more efficiently. Ankota's technology enables Patient Centered Medical Home and other models that promise better outcomes and lower total costs to the system. Contact Ankota here to learn more about Care Transitions and PCMH technology:


Click me


[i] Halsey, A. June 20, 2009. Primary Care Shortage May Undermine Reform Efforts. Washington Post.

[ii] USA Today. Economic crisis slows US population growth. February 16, 2012.http://www.usatoday.com/news/nation/story/2012-02-16/us-population-growth-slows/53157486/1

Topics: PCMH, Care Coordination, Care Transitions, Accountable Care Organizations, ACO, Patient Centered Medical Home

Care Coordination and Checklists are How We Heal Health Care

Posted by Ken Accardi on Jul 9, 2012 9:02:00 AM

One of the people I've come to greatly respect is Atul Gawande.  He's a doctor andAtul Gawande an author and we've featured him numerous times on the Ankota blog including as the author of Ankota's book of the year The Checklist Manifesto.  Some of the key themse that we strongly embrace at Ankota are as follows:

  • Coordinated care systems work better than isolated efforts
  • It's not necessarily true that the most expensive care is the best care
  • Checklists can vastly improve the quality of care

Today we bring him to you in video, courtesy of TED talks.

If you enjoyed this post, you may enjoy some prior posts inspired by Atul Gawande, as follows:

If you enjoyed the TED talk video, here are some other TED talks that have been featured on the Ankota blog:
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.

Topics: Health Care Reform, Care Coordination, Checklists, Video, Learning

Home Care Software Geek shares some internet tips

Posted by Ken Accardi on Jul 2, 2012 9:43:00 AM

The Home Care Software Geek posts in this blog don't talk about Home Care Nursing Software, Private Duty Telephony, DME Delivery Software, Home Infusion Care Management or the other topics we focus on regularly at Ankota. Instead, these posts are intended to keep our readers up to date with technology trends that might be useful to your agencies, such as social media technologies, mobile devices, and what's happening from the big-boys like Microsoft, Google and Apple.

Most of my work day is spent on the Internet and the key applications that I use during the day are in "the cloud" (which is currently the popular term for software applications that are hosted out in the internet as opposed to on your local computer or inside your company).  In addition to using the Ankota software in the cloud, I use other things like gmail, google calendar, Facebook and LinkedIn, and I do most of my shopping on the Internet at places like Amazon.com and others.

Cloud Apps

A lot of the home care people that we work with aren't as familiar with the internet and don't use it every day.  We meet them on-line to train them on Ankota or perhaps give them a demo or a feature.  During these sessions we expect to inform them and we hope to wow them with what we show them inside our hope care software.  But sometimes I'm surprised by the things that wow our users that are simply part of their internet browser.  Here are two tools in your browser that people really appreciate:

  • Search within a web page using Ctrl+F: Sometimes you're on a web page and you need to find something within the page.  Like youI Love CTRL F searched for something in google and it took you to a page where it seems like you can find the answer.  But once you get to that page, you still can't find what you're looking for.  By pressing "Control F" (or "Command F" on the Mac) a search window will appear (usually in the upper right but sometimes in the upper left) where you can type what you need and find it on the page.  Try it out.
  • Duplicate the Tab: Sometimes I hear complaints about computer applications (on and off they web) that only let you do one thing at a time.  For example, you're in the middle of doing billing and then aDuplicate Tab scheduling question comes in.  You don't want to lose your place on the billing page, but you need to check the schedule for one of your caregivers on the phone.  In many cases, you can "duplicate the tab" that your in.  Your web browser will make an identicle copy of your session and open it in a new tab.  Then you can deal with the scheduling issue in the new tab without losing your place in the other tab.  Some applications might prevent you from doing this but it works in most cases.  Note that the way to duplicate your tab varies by browser.  In windows, right click in your current tab and look for an option like "duplicate tab" or just "duplicate".  For Mac people (who generally don't have a right mouse button, you might need to push the command button then click.
If you have some tips for using computers that might help other nurses, therapists, and home care administrators, please respond with comments to this post.  We'll see what feedback we get and will consider follow up posts.
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.

Topics: home care software geek, Home Care Technology

Subscribe to Email Updates

About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

Follow Ankota on Twitter!

twitter bird white on blue

Most Popular Posts

Posts by Month

New Module

Add content here.