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Ankota: Ushering in the Next Generation of Homecare Blog

Managing Post Acute Care Operations in a Storm

Posted by Will Hicklen on Oct 29, 2012 10:49:00 AM

How do you manage operations when disaster strikes? Technology and good planning should be your allies.

Storms threaten patient safety and the delivery of post acute care, but a little planning and some good technology can help hospitals, ACOs and post acute providers of all types to keep things running smoothly. Making sure the right patients continue to get the right care at the right time should be easy with the right business practices and technology--even during a weather emergency.

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Hurricane Sandy

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A myriad of providers must cooperate to deliver services to patients in their homes and other residential settings. Home Care Agencies, Physical Therapy providers, infusion nurses, and HME delivery organizations are some of the more common ones, but hurricanes like Sandy threaten to disrupt operations and may even threaten the lives of patients. 

We're in the throes of hurricane season now and Sandy is beating on my door in Baltimore as I type this. Readers may recall a similar post when Hurricane Isaac struck the Gulf region in early September. That article remains one of the most popular posts we've ever run and it seems fitting to share some pieces of it again here.  

Once we emerge from hurricane season in November, much of the country will face the snowy winter months and the risk to care continuity that presents. Then, tornadoes and extreme thunderstorms of spring and the extreme heat of summer... and so on. Storm Happens. It's incumbent on providers to have a contingency plan, communicate it, and activate it when the weather turns extreme.

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One of the most read articles ever on Ankota's blog discussed ways to better manage home care when catastrophes hit. "Managing Home Care in a Storm," was originally written by Ankota's CTO, Ken Accardi, and the same lessons apply to hospitals, ACOs and post-acute providers that provide services including DME delivery, Physical Therapy, Infusion Nursing, and more. 

What is your strategy

The challenges of delivering care outside of hospitals on any kind of mobile basis are exacerbated when weather disrupts operations, as we just witnessed again with Hurricane Isaac. How are patients prioritized and rescheduled? Which ones require critical care regardless of the weather? Which ones can wait? Which care plans are affected? How do you communicate changes in schedules and care plans with staff, patients, family, and support networks? Hospitals, ACOs, and post acute care providers of all types must implement strategies to deal with weather-related emergencies and utilize technology that enables care, rather than inhibits it. Dangerous and life threatening conditions can be avoided with some simple planning. 

From Managing Home Care in a Storm: 

Here are some best practices that we've observed home care organizations follow to manage their operations in the midst of a snow emergency (and some things that Ankota's software does to help):

  • Move Appointments to Avoid the Times when travel is most inhibited: Ankota's scheduling board (screenshot below) shows you all of the planned jobs for the week on a drag and drop interface. so moving jobs forward or back is simple.

  • Make Sure that the jobs with critical timing are dealt with at the appropriate time:  Visits such as "chemo finish" visits for a 48-hour chemo infusion have a very specific time frame for completion.  Ankota's scheduling board let's you know if you've by attempting to move a visit you've violated a scheduling constraint. 

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  • Communicate the Changes to the Care-Givers:  Ankota's software changes the visits to a different color when you manually reschedule, allowing you to tell your care workers what changed and what stayed the same.

  • Plan for Two people per car (in the event that it will be impossible to park and one person will need to hover): Although the Ankota software doesn't specifically have a feature for scheduling two people in the same vehicle, we have the ability to change the work shifts easily for the emergency workers and mark the others as unavailable (and to make sure that all of the time sheets come out right).

  • Keep non-essential personnel at home: Ankota's web-based software allows your office staff to operate from their home via their internet connection.

  • Communicate to the Loved-Ones of Your Patients: Ankota's FamilyConnect allows you to send a message out to family members of the people you care for.  By proactively sending a message to all of the families, you can save time for your critical staff.  Also, you can send messages to the families of individual patients/clients using the quick connect feature.  FamilyConnect messages are received by email and/or text message (as selected by the family member)

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Below is a screen shot of the Ankota Drag and Drop Schedule Board that allows you to see status and resolve issues at a glance.

Home Care Scheduling Software

We thank you for all you do to provide outstanding home care, even during the thoughest conditions!  If rescheduling was tougher for you than what's described above, please contact us so we can try to help.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services hospitals, ACOs, 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 contact Ankota by clicking on this cool orange button!

How do you mamage risk during storms? We'd love to hear from you in the comments section below.

Topics: Patient Safety, Physical Therapy, Private Duty Home Care Blogs, HME Delivery Operations, Home Care Best Practices, Care Coordination, transitional care, HME, DME, Will Hicklen, Care Transitions, Physical Therapy software, ACO, Managing Post Acute Care, ACO Technology

10 Qualities of a Successful Physical Therapist

Posted by Will Hicklen on Oct 26, 2012 8:30:00 AM

If you liked 5 Steps for Breaking the Ice with Home Care Patients, you'll love this next piece from Son Trinh, DPT. Like the last one, this originally ran in Putmebacktogether.com and is among several great pieces from Son Trinh. If you'd like to read more of Son's insightful articles, visit this link...after you read this article below, of course!

describe the imageSon Trinh Physical Therapy

If you are in the business of providing physical and occupational therapy to patients in their homes, and you'd like to learn more about the best therapy agency management software on the planet, please contact Ankota using this button 

Learn How Ankota Helps Therapy Agencies

Physical Therapists (PTs) restore, maintain and promote the best possible physical health for their patients. Sounds simple, but no. Its more than just that. There are many attributes for a successful PT and if you're in the profession or planning to be a part of it, you might want to read on.

  1. Astute. Sherlock Holmes often chided his bumbling sidekick Watson with the admonition “You see but you do not observe.” Anyone can see a hip, but an astute observer notices the vaulting. Anyone can see a baseball pitch, but an astute observer notices the trunk rotation (or lack thereof). Honing your observational skills helps you to identify problems. The next step is to solve them.

  2. Knowledgeable. If you want to find solutions to what ails your patients, you need to update your knowledge base. Whether it’s a scholarly journal, a helpful colleague, or a tattered text—knowledge sources are pervasive and plentiful. The clinical science behind physical therapy grows ever more complicated. Don’t be left behind. Become a lifelong learner. Today.

  3. Humble. Being realistic also means being humble. There’s three ways to do this. Learn from yourself, learn from your colleagues, and learn from your patients. The latter is probably the most important. If experience is education then your patients are the educators, par excellence

  4. Patient. Sure you have “other things to do” but so do the people you treat. Exposure to the suffering and pain-stricken patient shouldn’t make us impatient with seemingly “commonplace” problems. Often, patients have endured a chronic illness, waited hours or even months to see us, and appreciate our patience as much as we appreciate theirs.

  5. Positive. The same reality can be seen through different lenses.Everything doesn’t have to be rose tinted. But a successful PT knows how to accentuate the positive, redirect negative thoughts, and focus on what’s working, improving, good or (fill in the blank). You believe what you tell yourself. And if you believe it, your patient is more likely to as well.

  6. Intelligible. You might know what’s going on and what you’re going to do about it. The average patient won’t. The challenge is to overcome the disconnect between you and your patient. This doesn’t happen by telepathy. The PT needs to choose words that are appropriate, clear, and unintimidating. Talking to patients shouldn’t sound like a lecture or a dissertation.

  7. Well Rounded. You need to be a jack of all trades and a master of (at least) one (physical therapy). Experience in different fields, a large general knowledge base, an interest in cultural activities, art, music, science and social studies—all the above enable PTs to relate to their patients and understand the demands of their daily activities. Well rounded PTs can also better design programs that connect therapy to functional and meaningful goals. Bonus: your patient will probably enjoy your company too.

  8. Realistic. The fact remains, no matter how many lifetimes you live, there’s still more learning to do. As Dr. Seuss said “Wherever you fly, you’ll be best of the best. Wherever you go, you will top all the rest. Except when you don’t. Because, sometimes, you won’t.” But that’s okay. As long as you’re realistic about what you can and can’t do, you’ll know when to seek help, refer your patient or both. Dr. Seuss would be proud.

  9. Flexible. Patients don’t always show up on time, the computer can crash, goniometers sometimes break and the only toilet in the building might be clogged. Are you flexible enough? Can you adapt, improvise and innovate? If so, you and everyone around you will be less stressed and more impressed.

  10. Caring. If you fixed cars for a living, caring about the car probably wouldn’t be so important. The car repair probably won’t be any more successful if you say “hi” and give it a hug. But if you care about people, they will listen to your advice, return for follow-ups, say good things about you, be less likely to sue you (or punch you in the face) and, most important of all, they will feel better and get better. Mission accomplished.

Learn How Ankota Helps Therapy Agencies

About the Author: An advocate of prevention, Son encourages you to visit his site at www.coachtrinh.com. It's a one-stop, online destination for those interested in fitness, nutrition and weight loss. The programs featured at his site have played a role in the personal transformation of thousands of people, including Michelle Obama, The Philadelphia Eagles, Sheryl Crow, Ashton Kutcher, and many more.Click here to read more about author Son Trinh

Topics: Physical Therapist, APTA, Physical Therapy, transitional care, Will Hicklen, Therapy Software, Physical Therapy software

5 Steps for Breaking the Ice with Patients in Therapy & Home Care

Posted by Will Hicklen on Oct 25, 2012 8:30:00 AM



The following piece by Son Trinh, DPT, ran in Putmebacktogether.com. I thank the handful of Ankota customers who shared it with us and suggested that we run it on our blog. These customers happen to be home health physical therapy and occupational therapy agencies, but the suggestions certainly to hold true for any caregiver dealing directly with patients. Enjoy!

As healthcare professionals, we meet new patients all the time. Here are 5 tips for breaking the ice to have an effective patient communication:

1. Make eye contact (or not). As long as it’s not accompanied by a scowl and raised hackles, eye contact usually says, “I’m paying attention to you. You matter and what you say matters.” Averting the eyes may send the opposite message, keeping the proverbial ice as unbroken as ever.

On the other hand, universal rules aren’t always so universal. With patients from non-western cultures, the eye-to-eye connection might be read as intimidating, threatening or overbearing. Just as eye contact can be seen as a sign of warmth, it can just as easily be seen as an invasion of emotional and mental space.

The rule: Most of the time, eye contact is good. Just be aware of broad cultural differences as well as the individual response you elicit from your patient. After that, vary your response depending on their reaction to you. The worse thing you can do is engage your patient in a Klingon death-stare until they reciprocate.

2. Listen. As they say, we’re born with two ears but only one mouth. This should clue us in to how important it is to listen first and speak second. Great clinicians know that in the diagnosis, the key to their analysis about what’s going on lies in what the patient says.

For rapport-building, listening also helps you to identify the patient’s needs, wishes and fears. This becomes the basis for setting goals and for giving patients a chance to “tell the story” in their own words and in their own way. Patients who are allowed to speak feel validated and this helps them to open up to you.

3. Focus on the patient. This tip is closely related to number two. However, the idea is to talk, but about patients or things directly relevant to them. If you want to melt through the ice fast, listen, then ask questions or talk about things that interest your patient. Just be sure you can quickly segue into the clinical interview as it can be dangerous to wade into irrelevant waters and not have a line to tow you back. 

As much as patients want to hear a point-by-point recounting of your recent expedition to the Arctic tundra, perhaps they will be more interested in you asking them about and commenting on their hobbies. 

This doesn’t mean you can’t talk about yourself. Just keep the focus on them. For example: “Sounds like you like to travel. I recently went to Maine. Have you ever been there?” Look for common points and stick to them. Pause often, ask questions, and follow your patient’s lead.

4. Pay attention to body language. If you’re only listening to what the patient says you may be missing ¾ of the iceberg. For example arm-crossing can signal anxiety or anger, face-touching may reveal embarrassment and nose-scratching might be a sign of irritation or dishonesty. Some signals are difficult. A smile can mean openness and joy or it can be a sign of embarrassment, disagreement or it can say “you have major B.O. but I’ll be polite and smile instead of wrinkling my nose.”

As with eye contact, there are few universals and many exceptions. The message conveyed depends on many factors including posture, proximity, cultural background, tone, volume, hand position, facial expression and gesture. 

Unless you’re an expert decoder, understanding body language might seem too difficult. The key is to use all the information available, including what the patient says and the constellation of body-language cues they send. 

Of course, you should pay attention to your body language too, especially if your patient has a B.O.problem.

5. Smile. It’s not always easy to smile. Maybe today was the day cow-licks are growing like weeds on your head. Maybe your wife also ran over your foot while backing up with the Ford Explorer and the mint latte turned out to be vanilla nut and ended up in your lap instead of your mouth. Murphy’s Law may be operating in full effect today, but that doesn’t change the first thing you should do. Smile.

Healthcare means showing that we care. Nothing does that better than a smile. The irony is if you’re a little blue on the inside but choose to smile on the outside your mood can change. And when you’re in a good mood, chances are your patient will be in a good mood too.

Voila. Ice is melted.

Click here to read more about author Son Trinh

Topics: Physical Therapy, Population Health IT, Care Coordination, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions

4 Steps for Home Care to Reduce Readmissions

Posted by Will Hicklen on Oct 24, 2012 9:41:00 AM

Private Duty Home Care Industry, NPDA and PDHCA Must Measure Home Care's Impact in Reducing Avoidable Readmissions and Actively Promote Results NOW


Unless you just fell off the turnip truck, then you are keenly aware that reducing avoidable hospital readmissions is one of the primary concerns in healthcare today. Hospitals and ACOs face significant CMS penalties for higher rates of readmissions for certain diseases, which became effective last month and will quickly become more severe. Home Care is in a terrific position to be a low cost, highly efficient part of the solution -- but this opportunity will not remain open for long.

The statistics on avoidable readmissions warrant repeating: 

describe the image...All for reasons that CMS, private payors, and most providers acknowledge could have been avoided. Pilot after pilot shows that with planned, effective follow up, readmissions rates can be reduced by a third, a half or even more in some cases. Organizations that have made decisive efforts to provide patients with support and follow up after discharge are realizing these dramatic reductions in their rates of readmissions.

The common theme among them? They have a plan. And they follow it.  Call it the emergence of Accountable Care, call it Care Coordination or even a glorified version of "let's get this patient some help so they are not completely on their own."

Home Care is in a terrific position to fill a valuable role in reducing readmissions and has proven its worth repeatedly. Still, few outside of the home care industry seem to know it. Why is it that this is not being promoted more aggressively?

See related Ankota blog article here: Hospitals Looking to Home Care in Cutting Patient Readmssions

When Ankota is working with hospitals and ACOs we always ask them what types of organizations they envision coordinating within their ecosystem. They rarely mention non-medical home care on their own. Howewever, when we suggest they consider non-medical support services be coordinated in the home, the unanimously agree that home care is a great resource. Out of site out of mind. That's the issue.

Ecosystem: a collaboration of providers that cooperate to Plan, Coordinate and Deliver care. Care is increasingly being delivered outside of traditional hospital settings and requires that numerous providers coordinate in an integrated service model. 

A plan that coordinates both medical and non-medical services to support a patient after discharge has been proven to reduce readmissions, yet the Home Care industry does not do a good job of a) measuring its impact on readmissions and b) promoting itself as integral to the ecosystem that is responsible for successful results.

Even on the National Private Duty Association home page, there is no reference to the success that Home Care agencies are having in helping to reduce readmissions. Further, on the Private Duty Homecare Association web site there is no reference to the industry's role in this.  Neither organization appears to be a) engaging in pilots, b) measuring success, or c) actively promoting the industry to those who are in a position to make decisions that assures Home Care a strategic role. 

There is a limited window in which to act and Home Care is in danger of being left behind. As hospitals and ACOs drive forward, they are increasingly looking to post-acute services to help manage Care Transitions and proactively care for patients in the community. Primary Care Physicians and Home Health Care nursing are obvious partners, yet provide an incomplete picture. A complete ecosystem is required for comprehensive care. Those that provide specialty nursing such as infusion, or provide physical and occupational therapy, or deliver equipment (HME) and medications (pharmacy) are increasingly included. If Home Care waits for the leadership of others to drag them in, it will come too late and will be disintermediated. A progressive approach that initiates and sponsors pilot projects between Home Care and these other participants, guarantees to measure and publish results, and does so with complete professionalism and care will position Home Care as a vital participant in the ecosystem.

Steps that you and the industry must take now

Identify pilot Projects that require collaboration with other types of providers, have clear objectives

Coordinate care & share information with partners

Leverage technology for operational efficiency & care coordination

Measure performance & share results

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Ankota's technology organizes providers into ecosystems to better Plan, Coordinate and Deliver care across the continuum. Ankota's technology coordinates hospitals and ACOs with post acute care, and optimizes post acute operations. Ankota's Private Duty Agency Software is the most comprehensive, easiest to learn and use system on the planet.

Topics: Private Duty Home Care Blogs, Private Duty Agency Software, Home Care Best Practices, Care Coordination, transitional care, Will Hicklen, NPDA, PDHCA, Accountable Care Organizations, Avoidable Readmissions, ACO, Managing Post Acute Care, Patient Centered Medical Home, ACO Technology

5 Things No One Told Me Before I Launched an ACO

Posted by Will Hicklen on Oct 22, 2012 8:00:00 AM

"If I had known then what I know now..." 

I've always enjoyed this type of discussion, and here it is applied to ACOs -- a valueable dialogue, given the early stage of ACO development that we're in. Posed by Becker's Hospital Review, 5 CEOs of Accountable Care Organizations respond.

Beckers Hospital Review

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Becker's Hospital Review asked five leaders of accountable care organizations across the country to share a piece of advice that nobody told them before they launched an ACO. Respondents gave a variety of answers, including everything from the importance of one-on-one communication and claims-level data to the need of a cultural shift throughout their organization to make the ACO beneficial. 

Larry Anderson

Larry B. Anderson, CEO of Tri-City Medical Center in Oceanside, Calif.: It would have been helpful in modeling our ACO to know the average Medicare spend per beneficiary, unique to our service area. This would have helped produce more accurate projections of potential savings and, therefore, allow for a more accurate presentation of the ACO concept to our participating physicians.

Work with providers you know and trust. Make sure the providers have significant experience in managing Medicare Advantage members, as the ACO concept and Medicare Advantage are very similar.

 Kathryn Correia

Kathryn Correia, CEO of HealthEast Care System in Minneapolis: Do not underestimate the need for communicating the changes to all of your stakeholders. I found the best way to communicate it was face-to-face — groups of medical leaders talking to small groups of physicians seemed to work well. We also used written communication and large group presentations.

Dan Doherty, Program Director of AdvocateCare, part of Advocate Health Care, in Oakbrook, Ill.: Moving from a fee-for-service to a value-based environment requires more than the development of new programs, it necessitates a significant shift in culture for leaders within the organization.

Dan Doherty

Scott Hines, Co-Chief Clinical Transformation Officer of Crystal Run Healthcare in Middletown, N.Y.: The biggest lesson that Crystal Run Healthcare ACO has learned to date is how integral claims level data is in helping to develop strategies to reduce cost and maintain quality. As a single entity ACO comprised solely of a physician owned, multispecialty group, we felt that we had a good sense as to what the biggest drivers of cost were based on our internal billing records. However, when we received our claims data we were surprised to learn the degree of leakage from Crystal Run Healthcare to other facilities, particularly for tertiary care, the frequency and cost of laboratory studies ordered not just internally, but externally and that the largest cost item to date is post-acute rehabilitation

Scott Hines

Now that we know the magnitude of the cost involved, we are actively pursuing relationships with tertiary care centers and post-acute rehabilitation facilities that can prove to us that they can provide the highest level of quality to our patients for the lowest cost. As for the laboratory data, we have started the process of streamlining laboratory orders and focusing our variation reduction projects on standardizing what labs are really necessary to provide quality care for our most common chronic conditions.

As we receive more and more claims-level data from CMS, we are sure that it will lead to further discoveries on novel ways to improve the quality of care that we provide while simultaneously reducing cost. This is why Crystal Run Healthcare feels very strongly that all claims level data, from both commercial and government payers, needs to be available to providers. Only with such data on our entire patient population will we truly be able to provide "accountable care."

Simon Prince
Simon Prince, MD, CEO of Beacon Health Partners in Manhasset, N.Y.: Look out for the vendors. Vendor interest is at a fever pitch and was underappreciated. The entrepreneurial spirit is alive and well with a seemingly endless supply of companies lined up for a piece of the ACO pie.

To read the original article in its entirety click here 

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Topics: APTA, Physical Therapy, Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, ACO Technology

Why Is Physical Therapy So Important?

Posted by Will Hicklen on Oct 19, 2012 12:56:00 PM


October is National Physical Therapy Month

National Physical Therapy Month resized 600APTA

October is National Physical Therapy Month and, because physical therapy agencies are one of our largest and fastest growing customer segments, Ankota wants to share our thanks with all therapists -- physical therapists, occupational therapists and speech therapists -- who help patients in the countless ways they do. 

In a meeting last week, a customer asked me "Why are therapy agencies so important to Ankota?" It's simple really: the work that therapists do is important to patients and we're in a position to help them improve their businesses better than anyone else, through the use of technology. That's the short answer. The explanation is this: Therapies are a critical part of the "ecosystem" of providers that Ankota's technology helps. As more care is delivered outside of hospitals, and providers of all types are compelled to coordinate care planning and delivery, therapists are one of the most common participants. Ankota's technology is used to manage the entire ecosystem, and therapy is a vital and prominent element. 

Therapists are one of the most consistently needed types of providers when patients are discharged from the hospital and one of the best ways to keep patients from going back to the hospital. Therapists also help people recover from injury and keep fit as they age. Ankota leads the market in technology for home therapy agencies, which includes technology that connects therapy providers to the rest of the ecosystem. To learn more about TherapEZ we invite you to contact us using this cool blue button

Learn How Ankota Helps Therapy Agencies

Therapy agencies, particularly those that deliver services in the home or other residence, suffer from poor autmation and this inefficiency is unbelievably costly. If you are an agency that is still using paper-based forms: stop it. If managing schedules or calculating billing or payroll is time consuming: STOP IT. If your therapists spend hours of personal time completing point of care documentation: STOP IT. If you are still managing referrals and sharing POC documentation with partners manually with phone calls and faxes: STOP IT. Your technology should automate all of this quickly and easily and provide electronic care forms that synchronize instantly so you can grow your business. If your technology does not connect you with Care Transitions initiatives, Hospitals and ACOs...then find a new vendor with the technology and vision to put you there today. And, if you are an owner or manager of a therapy agency, show your appreciation by giving evenings and personal time back to your therapists by making their lives easier with technoloy. You will retain your best people and attract more like them when they know you care enough to invest in technology that saves them time and allows them more time with patients and their own families.

From Ankota, many thanks to therapists! Let us know if we can help!

Learn How Ankota Helps Therapy Agencies

Topics: APTA, Physical Therapy, Care Coordination, transitional care, Will Hicklen, Care Transitions, Physical Therapy software, ACO

The Dalai Lama's Lessons for ACOs & Post Acute Care

Posted by Will Hicklen on Oct 17, 2012 2:20:00 PM

 Dalai LamaCBS Moneywatch

Generally Accepted Principles of Blogging, or GAPB (totally made that up), dictate that a blog post should be specific and provide something of immediate value to the reader. For the organization writing or posting the piece, it should also serve its business interests, right? Of course, but sometimes it's worth just sharing something because it's interesting. Today's post is one such piece and I hope you enjoy it. It's an article by Michael Hess on CBS Moneywatch. Hess is a contributor to CBS Moneywatch and CEO of Skooba Design (side note: Skooba makes really useful protective bags and such for electronics such as laptops, iPads and other tablets & we've often recommended them for our clients).

Of course, if you find yourself in need of technology to help manage Care Transitions or Population Health inititiaves, or post acute care operations such as therapy, infusion nursing, home care, or HME delivery, I trust that you'll still know to reach out to us. To make it easy, just use this button

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Michael Hess Skooba Design resized 600

(MoneyWatch) Tuesday night I had the distinct pleasure and privilege of attending an extraordinary event featuring a speech by the Dalai Lama. I'm a huge fan of the man and his down-to-earth wisdom, and it was a special treat to finally be able to see him live. I was initially very hesitant to write about it in my business column, thinking I might be trivializing the philosophies of a deeply thoughtful person of global importance. I thought twice, then three times, and decided there would be no insult (certainly none intended) in sharing the message in this context and forum. Hopefully I will do it justice.

My rationale for writing a business article about the Dalai Lama's speech and philosophy is that so much of it centers around human kindness, or as he put it Tuesday night, "warmheartedness." And as many of my past articles have suggested, I believe this very same philosophy is the key to running a truly exceptional business. It also seemed to be a fitting and timely coda to my last piece, about being a "mensch" in business.

The Dalai Lama describes himself as "a simple Buddhist monk," despite that his honorific is "His Holiness." Either way, it's important to note that public talks like the one he gave here tend to have no religious overtones (or even undertones). On the contrary, his tremendous popularity and appeal -- including to me -- largely come from the fact that he reaches out to everyone, taking religion out of the equation. In fact, he stresses the importance and value of viewing human relationships through a universal, secular lens.

Best business advice found in an 85 year-old poem

Is kindness a realistic customer service strategy?

Don't let burning bridges fall on you

The very nutshell version of the Dalai Lama's speech is that solutions to some of the world's biggest problems boil all the way down to the kindness and warmheartedness of individuals. That true kindness extends from the individual, to the family, community, nation, and so on. Self-centeredness and selfishness, on the other hand, stand in the way of solving problems between people, religions and nations. 

Sounds simplistic, especially when summarizing a one-hour talk in one paragraph, but try to poke a hole in the basic concept or its scalability -- you can't. And usually, the simplest answer is the best one.

And so it goes in business.

Business is obviously a subset of society, and the same rules apply. A business can do extraordinary things if it has a heart and soul, a true foundation of kindness and warmheartedness. I'm not getting all earthy-crunchy-kumbaya or pretending that a hug-fest will help a struggling business make payroll. Nor am I necessarily talking about businesses that have caring and generosity as their actual purpose for existing. Providing goods for the poor or protecting the environment is admirable, noble, meaningful and important, but I'm talking about any and every company. A company with these qualities -- with a sense of humanity -- is more likely to be rewarded by all of its stakeholders:

Customers are more likely to give their business, their approval and their good word to others.

Employees are more likely to trust and respect their employers; enjoy their work and perform at their best; treat customers and each other well; and stick around longer.

Suppliers are more likely to be supportive and motivated to provide the highest possible level of service, and to give a little extra help in extraordinary circumstances.

Financial stakeholders are more likely to be trusting, patient and supportive. Certainly this last group is, understandably, driven mainly by objective facts and figures. I am a business owner and, again, I'm not living in the land of rainbows and unicorns. But "money people" are still human (despite what some may think or say), and any good banker or investor will tell you that the character of a business or owner does affect their behavior and decisions at some level. A self-centered business owner, or one who puts up barriers to trust and good faith, is going to have a harder time getting checkbooks to open.

Just as the Dalai Lama's view of the world distills to the attitude and behavior of the individual, sooner or later most of what happens in business similarly comes down to relationships and transactions between people. So if a society functions best when its people are kind and unselfish, and obstacles to quality relationships are eliminated, a company with those traits will perform at its best, too.

© 2012 CBS Interactive Inc.. All Rights Reserved.

One Question for Ankota readers: What is the Dalai Lama's golf handicap?

Write it in the comments section below and one winner will be drawn for a $50 gift card (be sure to provide your email address & organization name)

Topics: Recommended Reading, Population Health IT, Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, ACO, Managing Post Acute Care, ACO Technology

Accountable Care Must Learn from Other Industries

Posted by Will Hicklen on Oct 15, 2012 4:01:00 PM

Boeing Ford Toyota

If you know Ankota, you know that since 2008 we've endeavored to develop technology to manage healthcare delivery and bring lessons to healthcare that are inspired by other industries. We often hold up global standouts such as Boeing and Toyota as examples from which healthcare must learn. If Boeing and Toyota can coordinate thousands of engineers around the globe, manage concept through design, manufacturing, and distribution, and service cars or aircraft for the entire lifecycle, then health care can learn from that model. Global manufacturing businesses like these have relied on very advanced coordination among providers for decades while being ever mindful of quality.

Consider further that these industries have progressed through multiple generations of technology to manage processes and optimize the use of staff, equipment, and resources. Think healthcare is too complex to manage this way? We don't-- and that inspires our development of technology every day. Boeing can tell you every single person who was involved in the design, manufacture, assembly and service of its aircraft. They've predicted material properties, failures, ride quality, and more based on quality measures of the parts, assemblies, human involvement and finished product. These companies leverage highly coordinated networks of organizations that, while otherwise unrelated, share common goals for quality and performance, on time delivery, and more. They have long employed progressive financial models that healthcare is only just beginning to explore with terms like shared savings, bundled payments, and more.

Think they haven't tackled the same business and process problems already?

Care Transitions and Discharge Planning? Think: Supply Chain Management. 

Avoidable Readmissions? Think: Peformance Management. Total Quality Management (TQM). 

Post Acute Care? Think: Supply Networks, Distribution & Service Networks.

Think: Healthcare Ecosystems 

This, by the way, is the future of healthcare delivery. Coordinated networks of providers performing services that are increasingly delivered outside of hospital settings, many under models like Accountable Care. As population health initiatives take hold and promise to take better care of patients by keeping them healthier and out of hospitals longer, networks of providers are already developing that intend to coordinate care for better results. Ankota's technology is used to organize providers into "ecosystems" which coordinate services and drive better outcomes at lower overall costs.

Much like Toyota's world-renown Toyota Production System (TPS), Ankota's approach to automation leverages Lean Manufacturing priniciples while maintaining the vital human element of control. Afterall, it's the lives of people that we're all trying to improve. 

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In a related Decision Health Hospital Impact article titled, "What Healthcare can Learn from the Car Industry," Dr. Frederick Southwick observes, "By modeling the healthcare delivery system after successful business practices, we can help prevent medical errors." He continues to relate key concepts of Toyota TPS to healthcare oranizations:

Set protocols: Define the work that needs to be done, how it should be done, and who is responsible for its completion. Standardize this practice for all healthcare staff and all potential diagnostic situations.

When a caregiver works with multiple physicians, they are required to learn different protocols to achieve the same goal. In the absence of a single best-practice protocol for each disorder, all processes in hospitals and clinics are random and ill-defined. When there is an error or a delay, there is no single protocol that can be modified, making lasting improvements impossible.

Identify and support customer-supplier relationships: At Toyota, the assembly line worker's most important customer is the person next in the assembly line. Physicians too often regard themselves as the customers and nurses as the suppliers of respect and ego gratification.

Following this example, physicians must identify themselves as the supplier and nurses and support staff as the customers. They need to listen closely to the concerns of bedside nurses who experience the dysfunctional delivery systems all day, every day, and then supply them with clear instructions for patient care.

Use the scientific method: Caregivers should be encouraged to implement changes by using iterative cycles of planning the change (plan), trying out the change (do), measuring the effects of the change (study), and then if deemed a true improvement, implementing the change on a broader scale (act).

Often administrators discourage adaptive change for fear of breaking a regulatory rule. A command-and-control administrative structure discourages front-line leadership and any sense of autonomy.

Those with higher administrative authority must reduce formality and flatten the power gradient, because hierarchical power structures deter open communication and increase the chance of errors. When errors do occur, the individual reporting the error should be supported emotionally, and in most cases punishment should be avoided. Those with administrative authority need to understand that most errors are the consequence of bad systems, not bad people.

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TPS to improve communication and prevent errors

Treat everyone with respect. Everyone has an important role to play in managing the care of our patients. Humility, friendliness and empathy go a long way in lowering the power gradient.

Become an effective team leader. Teamwork acknowledges the value of all members of the care team and encourages reciprocal communication, that is, every idea from a team member is a good idea. Teams reduce errors because you have many eyes, ears and brains focusing on the same problems. Great teams develop a team identity that gives everyone a sense of belonging and greatly increase job satisfaction.

Embrace a systems view of healthcare. Understand that in modern healthcare delivery, you as an individual will not be able to manage your patients alone. You will need to depend on fellow physicians to create shared protocols to create consistent ways of doing things.

By creating operating standards within your healthcare institution for specific diseases and problems, you will allow those working with you to be more efficient and reduce the likelihood of errors. This is not cookbook medicine, but rather the best approach for creating good habits that will free everyone to focus on events that are unexpected and which require high-level decision-making.

Frederick Southwick, M.D., is a Professor of Medicine at the University of Florida and manages New Quality and Safety Initiatives for the University of Florida and Shands Health Care System. He also is the author of Critically Ill: A 5 Point Plan to Cure Healthcare Delivery.

Read Dr. Southwick's entire article in Decision Health's Hospital Impact

Learn more about the Toyota Production System (TPS)

More about Toyota Production System on Wikipedia 

Learn more about Care Coordination technology and managing Care Transitions by contacting Ankota or using this fun orange button  

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Topics: Care Coordination, transitional care, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, ACO Technology

Care Transitions: Moveable Feast wins Henrietta Lacks Memorial Award

Posted by Will Hicklen on Oct 11, 2012 10:38:00 AM

Johns Hopkins Urban Health InstituteMoveable Feast logo

I am especially proud to share today's post for a number of reasons. First and foremost, Ankota is proud to celebrate the accomplishments of Moveable Feast and congratulates the entire team for receiving the Henrietta Lacks Memorial Award, awarded annually by the Johns Hopkins Urban Health Institute.

Further, the spectacular work that Moveable Feast does for the community not only helps patients, it hits right at the heart of one of the biggest imperitives in healthcare today and where Ankota is squarely focused: reducing avoidable readmissions. The avoidable readmissions problem is calculated by CMS to cost taxpayers $25 BILLION annually. With one in five patients returning to the hospital within 30 days (and 30% returning within 60 days), it's a problem of epidemic proportions. Not surprisingly, patients with HIV and cancer tend to be among the costliest of all in terms of readmissions. The good work of Moveable Feast helps patients live more comfortably, and helps solve significant healthcare problems. Look for traditional healthcare models to increasingly cooperate with community support services like Moveable Feast and Home Care to improve patients' lives and lower costs.

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Executive Director Tom Bonderenko stood before a packed auditorium on October 6th to receive the 2nd annual Henrietta Lacks Memorial Award on behalf of Moveable Feast. This award recognized valuable work with Johns Hopkins to deliver healthy meals to severely ill patients after they leave the hospital doors. The award comes with a $15,000 grant that will be used to strengthen the organization's collaboration with the Oncology Center at Johns Hopkins and to deliver more life-saving meals to men and women with cancer. 

More than just a charity, Moveable Feast is making a direct and measurable impact on the lives of cancer and HIV patients in the state of Maryland. Managing Care Transitions with planned, quality nutritional care in the home is delivering more than just meals: it's delivering results. Hospital readmissions are reduced significantly when nutritional support is combined with traditional medical support (we could tell you the numbers but we'd have to shoot you).

A large number of their many thousands of clients receive their healthcare through state funded Medicaid. With the intense focus on reducing readmissions--especially in higher cost populations such as those with HIV and cancer-- it is clear that Hospitals, ACOs, Managed Medicaid programs would do well to integrate nutrition services. Programs like Population Health initiatives, Patient Centered Medical Home (PCMH) and other Community Based Care programs can benefit immediately by coordinating services like this that already exist in their communities. 

To learn more about using Ankota technology to manage Care Transitions like this, contact Ankota 

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Congratulations Tom & the entire team at Moveable Feast! We're very proud to know and support you!

About Moveable Feast We deliver nutritious, healthful foods to homebound people living with HIV/AIDS, breast cancer, or other life-threatening conditions...and are the ONLY such meal delivery program for People Living With AIDS for the Greater Baltimore Metropolitan area. We also provide numerous services and programs for the homebound and homeless, including a transportation service and a culinary training program. We service Baltimore City, its five surrounding counties, and nine counties on the Eastern Shore of Maryland.

For more information, please visit our website at mfeast.org.

Topics: Care Coordination, transitional care, Home Care, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, Patient Centered Medical Home, ACO Technology

CMS Penalties for Avoidable Readmissions Have Started

Posted by Will Hicklen on Oct 2, 2012 12:00:00 PM

The entire healthcare world has known for a long time that yesterday was coming: the day that CMS started penalizing hospitals for what are called avoidable readmissions. That's right--THAT just happened! 

The problem is massive, and now, very well documented: 20% of patients are readmitted to hospitals within 30 days of discharge, and 30% are readmitted within 60 days, for reasons that are considered to be entirely avoidable. The costs are staggering: CMS reports that this problem costs taxpayers $25 BILLION annually. Clearly, it's a cost and quality problem that has to be addressed. 

Avoidable Readmissions Rates

Some hospitals have already been working towards improvement through projects to better manage care after discharge, often called Care Transitions projects, and by undertaking Population Health initiatives that attempt to provide care to patients proactively in the community and at lower costs before their health results in a costly ER visit. Programs such as Patient Centered Medical Home (PCMH) are aimed at addressing these problems, too. CMS has encouraged systemic innovation by funding $1 BILLION in grants such as the CMMI Innovation Challenge Grants that are also aimed at addressing this problem. The $20M Johns Hopkins Community Health Partnership, or "JCHiP," is one such example of community based care management (CBCM) models that are gaining traction. Contact Ankota to learn more about the technology used to manage innovative care models like JCHiP.  

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As this related AP article describes, the economic impact of the penalties is clear.


The penalties start at 1% of a hospital's medicare receipts and rise to 3% over time. CMS has anaylzed hospital results for the years leading up to & which determine the penalties, and calculated that many penalties will start in the high six figures to low seven figures in the first year alone. CMS estimates that about two-thirds of the hospitals serving Medicare patients, or 2,200 facilities, will face penalties averaging around $125,000 per facility this coming year. For an industry that typically operates on 1-4% margins to begin with (with many hospitals losing money every year), these penalties are a punishing blow and escalate quickly to force continuous improvement. 

"There is a lot of activity at the hospital level to straighten out our internal processes," said Nancy Foster, vice president for quality and safety at the American Hospital Association. "We are also spreading our wings a little and reaching outside the hospital, to the extent that we can, to make sure patients are getting the ongoing treatment they need." Foster is referring to the many programs and collaborations among provider institutions to provide services proactively in the community in an effort to keep them healthier and out of the hospital longer. This is especially important for those with chronic conditions that are better managed at home, anyway. As the chart above indicates, chronic conditions account for $3 out of every $4 spent on healthcare today. These programs require new care delivery models--and technologies--that allow providers to share care plans and coordinate roles and responsibilities among multiple providers, including hospitals and ACOs, Primary care physicians, and the entire world of post acute care.

Collaborations of providers are organizing into "ecosystems," and Ankota is leading the way with technology that helps them Plan, Coordinate, and Deliver care that reduces costs and improves patients' lives. To learn more about how Ankota is helping Hospitals and ACOs and coordinating needed post acute services (such as home health care, physical therapy, infusion nursing, HME delivery and Home Care), contact us using the fun, orange button below

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Topics: Health Care Reform, Care Coordination, transitional care, Will Hicklen, Accountable Care Organizations, Avoidable Readmissions, ACO, Managing Post Acute Care

Population Health IT for ACOs

Posted by Will Hicklen on Oct 1, 2012 3:26:00 PM

Accountable Care News Population Health IT resized 600

Population Health IT for ACOs: A Patchwork Quilt

by Ron Parton, MD, MPH, Chief Medical Officer of Symphony Corporation 

Learn How Ankota Technology Supports Population Health Projects

The new ACO rule has big implications for information technology. In the final rule
on accountable care organizations (ACOs), CMS has included 33 measures that
report overall performance while allowing providers options to share in any
savings. Because the new ACO rule will no doubt steer payors and providers to
improve quality and reduce costs, the need for population health information technology
to support ACOs has dramatically increased.

Current reporting technology and electronic health records (EHRs) may be able to
provide basic reporting on the measures, but they are woefully inadequate at meeting
the ACO requirements for improving care, enhancing the patient experience and
reducing costs. New population and care management systems will be required to
support primary care medical home models, care coordination, case management, and
transitions of care. Advanced health care delivery will require the adoption of new
information systems and tools that:

• Provide rapid, flexible and continuous performance reporting

• Promote the proactive identification and management of the “highest risk” patients

• Accurately attribute patients to physicians and care teams

• Allow care teams to coordinate care across the entire continuum and
systematically manage multiple chronic illnesses

• Integrate information and work flows across population & care management
systems, EHRs, care teams, providers, community resources, and health
information exchanges (HIEs)

• Support “real time” decision making and population surveillance using evidence-based guidelines

• Engage, educate and support patients in self-care, prescription drug adherence, lifestyle improvement and prevention 

• Aggregate and manage data from multiple disparate data sources (clinical, administrative & financial) with a reliable master patient index functionality

An array of technologies and information tools to piece together: A patchwork quilt

Integrated delivery systems such as Kaiser Permanente, Geisinger and Group Health Cooperative have incorporated population health information technologies to varying degrees to improve quality, reduce costs and enhance patient experience. These leading organizations found their EHRs insufficient for population health management. Since their electronic health records lacked this functionality, they ultimately developed and/or bought, and then pieced together their data, systems, tools and reports. In fact, these systems have spent a considerable amount of time and money on creating these tools themselves. These collections of support tools, registries, and systems are far from perfect, but have allowed these organizations to accomplish impressive results that have set them apart as national leaders in managing quality and cost. Organizations of physicians and hospitals that are striving to create ACOs can build on the experience of these integrated systems to improve their performance under healthcare reform. Building on top of an EHR, the following components create a population health IT system:

Data warehouse/data repository – Integrating multiple data sources including ambulatory and inpatient EHRs, labs, scheduling, billing, health information exchanges (HIEs), insurance claims, remote monitoring, patient selfreports, research, demographic, administrative and financial data

In general, the data warehouses that are included with EHRs are not designed for integrating financial, clinical, research and administrative data from multiple external sources or for use in tracking health care interventions and outcomes for populations. To improve and report on performance, an ACO will need to create a data warehouse and/or repository to store all available data on its patients and services and make these data available across the enterprise to support the population and care management initiatives.

Population health and care management system – Including an enterprise multi-disease registry with measures and reporting; work flow support & tools for case management and health coaching; care team performance tracking with an embedded rules engines to support follow-up tasks and reminders; creation and sharing of care plans that include longitudinal care views of goals and progress.

Learn How Ankota Technology Supports Population Health Projects

Chronic illness registry tools typically have been developed for single diseases and have produced lists of patients that need follow-up or have “care gaps”, but do not include case management tools or health coaching functionality to manage and/or document the work in coordinating care and assisting patients with their illnesses. These tools help to facilitate identification and can report the results, but they do not manage the workflow across multiple diseases or support case management/health-coaching. New population health and care management systems are now available that are multidisease and can help care teams with role-based task management, care coordination, prescription drug adherence, patient letters and reminders, life style tracking to goals, and comprehensive clinical and financial performance reporting. These population health and care management systems are complementary to and can integrate with EHRs. They are designed to be flexible and accommodate different work flows across the care teams and also allow for the inevitable changes in measures, definitions and guidelines that will occur from time to time with medical advances.

Population surveillance rules engine – To monitor care process and outcomes using evidence-based guidelines, with links to both a population and care management system and the EHR

Most EHRs will facilitate reminders that “pop up” during a patient encounter to flag the need for routine preventive screenings, immunizations, lab tests and care gaps, but they are not very flexible and do not connect to a follow-up tracking system that facilitates role-based work flow for the care team. Since EHRs are visit-based, they generally don’t trigger actions between encounters, don’t allow flexible workflows for follow-up across the care teams, and don’t document interventions or communication attempts. Evidence-based rules engines that exist outside of the EHR can support population management by the care teams for actions that are triggered, often avoiding the expense of a face-to-face visit with the practitioner. There are population health and care management systems that incorporate evidence-based rules engines for population surveillance and support care teams in closing the care gaps that are identified.

Clinical integration of systems - Integrates population health IT with
EHR functionality and work flow

While much of the routine population health and care management work can occur outside of the typical physician encounter, freeing up physicians to concentrate on the more urgent issues, difficult medical problems and complex patients, the complete set of information about each patient must still be stored in the EHR. This requires that new information generated in a population and care managements system be fed back to the EHR, so it is available at the point of care for decision-making and follow-up. In addition, there may be actions that are triggered in the population and care management system such as scheduling a lab appointment, a change in a prescription drug and/or a follow-up physician appointment that can be executed in the EHR. The work flow between the EHR and the population and care management system must be optimally integrated to help assure efficiency and access to the data. Over time, some of the population health functionality that isn’t available now may be incorporated in the EHR itself. However, EHRs are usually structured around encounters rather than populations, care teams, or non-encounterbased workflows. This may ultimately limit the capacity of most current EHRs to incorporate population health IT functionality.

Advanced reporting - Tracking financial, administrative and clinical performance

Decision making to support improved quality and reduced cost requires a full set of internal financial, administrative and clinical performance reports that measure their own performance against benchmarks as well as a full set of external reports for pay-for-performance programs and reporting to third parties including HEDIS, PQRS, ACO measures and statewide quality collaboratives.

Analytic tools – Focused on predictive modeling, episode grouping, severity & case mix adjustments 

Predictive modeling tools (i.e. Johns Hopkins ACGs or Medicare’s HCCs) support proactive identification and stratification of the highest risk patients for potential referral to complex case management. A parallel methodology is also needed to measure cost and utilization with case mix adjustment, typically through episode groupers (i.e. OptumInsight’s Episode Treatment Groups or Thomson Reuter’s – Medical Episode Groups).

Remote monitoring technologies – Home-monitoring that interfaces with care management and EHRs

High-risk patients with certain chronic illnesses such as congestive heart failure, diabetes, hypertension and chronic obstructive pulmonary disease may benefit from utilizing home-monitoring devices that allow them to track their own illnesses and work interactively with a case manager and/or health coach that can also follow and track their outcomes in “real time.” This information can be sent back to both the population and care managemen systems and the EHRs.

Patient and family engagement technologies – Including web-based portals linked to personal health records; life style tracking tools; handheld technologies for education, tracking, reminders and interactive learning; webvideo technologies for virtual provider visits, health coaching and case management; and interactive assessments, questionnaires and connectivity to measure patient outcomes and provide feedback on patient experience

Patients are now being provided access to their own medical record information and encouraged to learn more about and manage their own health risk factors and chronic illnesses. Mobile and tablet technologies, web-based patient portals and web-video technologies are allowing patients to have better access to their care teams, medical knowledge and tools that help them to improve their lifestyles and achieve better results in managing their illnesses. These can be linked to both their population and care management tools and their EHRs. Patient experience questionnaires, interactive assessments for depression screening, assessment of activities of daily living, pain management follow-up, etc. can be administered using email, patient portals and/or handheld technologies. This information can be stored and tracked in the data warehouse and the EHR as needed. Families are using some of the same technologies for social engagement and monitoring.

Population Health Information Technology is Complex to Implement but Critical for ACO Performance

All the pioneering organizations participating in the Medicare Physician Group Practice demonstration, such as Marshfield Clinic, have significantly redesigned care workflows and introduced population health information technology that makes clinical data more readily available to the practitioners and care teams, including additional “add on” disease registries or embedded tools within their EHRs. 

It may be disappointing that after having spent significant amounts of time, effort and money to implement electronic medical records across your own organizations, there is more work ahead in assimilating a complete set of population health information technologies to become a successful ACO. The consolation is that none of these pioneering organizations have used all of the population health and care management tools that are now available and yet most of
them accomplished positive results.

One of the keys going forward will be to prioritize the functions that are most likely to achieve results and implement those first. See the Appendix below for a matrix of Population Health IT and functionalities:

Population Health IT Components resized 600

Dr. Ron Parton is Chief Medical Officer of Symphony Corporation, a global technology solutions provider based in Madison, WI. He may be reached at ron.parton@symphonycorp.com

Symphony Care Solutions



Accountable Care News is a publication of Health Policy Publishing, LLC.

Learn How Ankota Technology Supports Population Health Projects

Topics: Population Health IT, Care Coordination, thought leadership, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, ACO, telehealth

In Home Care: The Times They are A-Changing

Posted by Ken Accardi on Oct 1, 2012 11:04:00 AM

A lot of the people who read our blog are new to home care, just like we were some years ago when we started Ankota.  Along our journey, we've met some great people and mentors.  One of them is Ginny Kenyon from Kenyon Home Care Consulting.  Today's blog post comes from Ginny's site.  Another great mentor, who authored today's post is Pat Drea, Chief Operating Officer of Visiting Angels.  I've met Pat twice and have shared previous blog posts based on Pat's presentations.  Pat is a fantastic presenter, and what's most impressive is that she seems to know almost everyone in home care and during her presentations she shares anecdotes relevant to her points and using real examples from people in the crowd. Great lady!

The Times They are A-Changing

Come gather ’round people, wherever you roam, and admit that the waters, around you have grown!

Just like the Dylan song said, The Times They Are A-Changing in private duty home care. What are the issues that will impact how we conduct our business of home care over the next 5 years and what strategies will serve us as we await clarification on those issues? The home care industry is likely to be significantly affected by Patient Protection and Affordable Health Care Act (PPACA), changes to the Companionship Exemption and the introduction of licensure in states that have not had licensure in the past.

Most Home Care employers are likely to be paying penalties under the PPACA. UnderPat Drea clarifications issued August 30, 2012, employers with 50 or more full-time or full-time equivalent employees will be required to provide minimum essential health care coverage for their full-time employees or pay an annual penalty beginning in 2014. Although the statute defines full-time employee as one who works an average of at least 30 hours per week in any given month, much uncertainty remains in the calculations affecting variable-hour and seasonal employees.

Elimination of the Companionship Exemption?

Since early 2011 the Department of Labor has issued proposed rules that if adopted will significantly change regulations defining “companionship services” to eliminate the exemption for home care aide/personal care attendant services. The proposed rule would also eliminate the so-called “live in” exemption for caregivers employed by third-party employers.

According to the study Companionship Services Exemption Survey, January 23, 2012 conducted by PDHCA and NPDA , The summary of findings of the 1428 home care companies representing all 50 states reported:

  • Moderate to significant increases in business costs
  • Agencies expecting to restrict overtime hours
  • Quality of care impact including loss of service continuity, and weakened staff competencies
  • Costs would be passed onto the elderly, infirm, and special needs clients/patients in private pay
  • Clients/patients will seek out services from underground economy through untrained, unsupervised and unskilled workers

Companionship Services Exemption Survey, January 23, 2012, page 22.

Spread of Licensure Requirements

Many of the states currently without private duty licensure are actively moving toward mandated licensure in the near future. These states have studied the licensure frameworks available in other licensed states. Their proposals show evidence that they are incorporating more of the features and language of licensed states that have gone before them.

Responding to the Changes

Home Care managers and owners are advised to apply lean operating methods to their business. With overarching regulatory changes to the industry that are likely to add moderate to significant operating business costs, owners and managers must focus on running a leaner operation.

We can identify the budget categories in which home care companies tend to overspend:

1. Print advertising without a proven ROI. Often the agencies continue prior printchange ahead advertising strategies out of habit but are these investments still paying off? The internet has changed how people shop for goods and services. Boomers, the main decision makers for care for their elderly parents, are very comfortable seeking information and services on the internet. Home Care print advertising continues to be a category of diminishing effectiveness although costs have risen considerably in recent years. In office staff and caregiver recruitment, classified print ads tend to be more costly and less effective than internet online job recruitment resources.

2. Expenditures on marketing personnel and materials without significant results. If that investment doesnt lead to a significant increase in revenue in a reasonable period of time (3 to 6 months) the personnel and/or approach need to be changed to yield results.

Does your marketing staff know: Who to call on within each type of referral source? What questions to ask and how to overcome possible objections? When/how often to meet with each referral source?

4. Old contracts for telephone, cell phones & internet services? If you havent shopped for the best plans and services available, chances are you could upgrade your service and save a significant amount by shopping around a little.

5. Inefficient processes. Building greater efficiencies in processes can save cost while building higher productivity. The processes that you should examine include:

  • Lead management, intake, start of care
  • Scheduling, rescheduling
  • Billing, payroll & collections
  • Management of complaints & incidents
  • On call
  • Employee application process
  • Orientation, supervision,
  • Customer, employee and referral satisfaction
  • Caregiver turnover and performance issues
  • Record management

The approaches to re-engineer your processes include: Develop the first 90 day plan, Measure and report improvement results, Conduct periodic reviews, Compare results to goals and Reward team members.

What are the strategies agencies should consider when details about change are slow to be issued? Keep track of the clarifications as they are issued. Attend association events and learn from industry leaders. Participate in on line industry chat forums to hear the approaches being considered by others in the industry. Engage your team in planning and preparation as information unfolds. Continue to build a lean, well functioning organization.

Last, heed Dylans lyrics:

For the wheel’s still in spin, and there’s no tellin’ who that it’s namin’ For the loser now, will be later to win, for the times they are a-changing’.

Kenyon Home Care Consulting

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, Home Care Best Practices, Care Coordination, transitional care, Home Care, Accountable Care Organizations, ACO, Home Care Blogs

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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.

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