The Ankota Healthcare Delivery Management Blog

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

Firing Home Healthcare Staff: The 10 Worst Things You Can Say

Posted by Will Hicklen on Feb 7, 2012 11:58:00 AM

Whether you are part of a hospital system like Johns Hopkins Home Care Group in Baltimore or an independent Physical Therapy agency like Rehab Maxx in Chicagoland, Ankota's customers must sometimes face the very difficult task of firing people. As anyone who has mishandled a firing before will tell you: Don't mess it up. (Our customers don't mess it up...we're just sayin').

jeffhaden.bucket 11526Inc logo

It's awful and no one ever enjoys it. If you are like most people, you dread firing staff and, let's face it, you're probably not very good at it anyway (don't feel bad: no one is). There are some definite "do's and don'ts" that you MUST follow and this article by Jeff Hayden of Inc. does a good job of synthesizing a lot of concepts into "The 10 Worst Things you Can Say When Firing Someone."

Says Hayden, "Firing someone is hard -- but getting fired is always harder. Don't make it worse by putting your foot in your mouth." Hayden continues, "Never say the following..."

1. "Look, this is really hard for me." 

2. "We've decided we need to make a change."

3. "We will work out some of the details later."

4. "You just aren't cutting it compared to Mary."

5. "Okay, let’s talk about that. Here’s why..."

6. "You’ve been a solid employee but we simply have to cut staffing."

7. "We both know you aren't happy here, so down the road you’ll be glad."

8. "I need to walk you to the door."

9. "We have decided to let you go."

10. "If there is anything I can do for you, just let me know."

 

You can read Hayden's article in its entirety here, including a discussion of each of The 10 Worst Things You Can Say When You Fire Someone

Topics: Home Care Entrepreneurship, Recommended Reading, Starting a Home Care Business, HME Delivery Operations, Home Care Industry, Private Duty Agency Software, Care Coordination, thought leadership, transitional care, Home Healthcare Delivery Management, HME, DME, Checklists, Home Care Mobile Solutions, Will Hicklen, Home Care, Home Health Therapy Software, Physical Therapy software

Oral Health Care a Huge Home Care Opportunity

Posted by Will Hicklen on Nov 16, 2011 12:13:00 PM

Daibetics and Oral Care resized 600

Elderly Oral care resized 600

You may have heard about the rapidly growing Home Care dentistry industry, with businesses such as our friends at PrevMed and The Homecare Dentist becoming vitally important to overall health and contributing to reductions in healthcare costs. There are reasons that businesses like these are growing and thriving, and emerging as a vital component of the healthcare continuum. If your Home Care agency is not coordinating with other services like this today, you’re missing out on a huge opportunity to improve the lives of your clients. If you are part of a health system looking to improve the lives of patient populations and you are not considering oral health in your overall plan, you should consider integrating it into your plan now.

PrevMed Oral Care Assisted Living

First, consider the fact that oral health plays an indisputable role in overall systemic health. Regularly maintained oral health contributes to fewer ER visits and hospital admissions for the elderly, and  improves outcomes for those with the most prevalent chronic diseases:   

  • Five of the six most prevalent chronic diseases are linked to periodontal disease.
  • 89% of those 80 or older have advanced periodontal disease, according to the CDC.
  • Reduction in ER admissions: In the elderly, bacteria that originate in the mouth cause needless ER visits and hospital admissions, commonly costing tens of thousands of dollars per episode. Simple preventative care can eliminate many of these admissions.
  • Potential impact on chronic disease management: In diabetics of all ages, for example, a Cigna study showed that patients who received an initial treatment for gum disease with subsequent maintenance had lower overall healthcare costs than those who did not receive regular maintenance. Savings averaged 24% in the study, or $2483 per patient per year. Cigna is so convinced by the results that they now reimburse members with certain chronic conditions for out of pocket expenses incurred for their oral care.  Read more here PrevMed

What is the opportunity for Home Care? Simple: Medical and Non-Medical Home Care is increasingly becoming a Care Coordination business. Programs like Geriatric Care Management (GCM), Patient Centered Medical Home (PCMH) and others require the services and coordination of multiple providers to deliver a comprehensive, well planned set of services that should result in improved outcomes and reduced overall costs. Clearly, oral care must be integrated into the overall care plan, particularly for the elderly and others who may have difficulty getting to the dentist on their own.

If you are not already, consider partnering with businesses in your area that provide oral care services like PrevMed (for clients living in facilities) and The Homecare Dentist (for home-based dental services). Particularly for Private Care agencies, there is a revenue opportunity for coordinating these services with your overall care. You'll be providing a more valuable service to your clients, who will be grateful for their improved health and dignity.

Ankota's Xchange Care Coordination Portal provides an excellent platform to coordinate Home Care and Dental services like those in this article. Ankota's Healthcare Delivery Management (HDM) technology also helps individual providers to reduce costs and grow their businesses more efficiently, including Home Health and Home Care, Physical Therapy, HME, Infusion, and more.

Topics: Marketing Home Care, Homecare Dentistry, Home Care Industry, Elderly Care, Private Duty Agency Software, Home Care Best Practices, Care Coordination, thought leadership, Checklists, Home Care, NPDA, PDHCA, Home Care Scheduling Software

Home Care Goal Setting: A lesson from a Father and Son

Posted by Marc Ottinger on Nov 10, 2011 12:36:00 PM

We regularly find inspiration from Julianne Haydel, an accomplished home health consultant. We previously blogged about her advocacy of therapy management  in our posting entitled Home Care Prediction: 2011 will be the Year of Therapy and we enjoy receiving her email updates. 

Julianne recently blogged about how caregivers can set better, more realistic and more humane goals for their patients that honor their lives as fully realized adults and members of society. She tells us of her friend Bill and his father, who is a patient. But Julianne reminds us that Bill's father was not a patient first.
 
"He has had a long life filled with stories of success and failure, love and loss, happiness and sadness just like the rest of us.  I don’t think it would surprise him toHome Care Goal Setting Father and Son find out that he is approaching the end of his life.  And that man – not the patient – could probably give a flying flip about his A1c or serum potassium level." Read Julianne's full post here.
 
Through this simple photo and recounting of the sum of a patient's life, we are reminded that setting goals for health has so little to do with numbers, charts and serum levels. Setting goals for health has everything, though, to do with living life and enjoying life to its fullest. What this looks like for each individual is different based on that person's life experiences. 
 
When entering into any kind of patient relationships, caregivers will better accomplish their goal of assisting a patient if they stop to recognize who the person is and was before they became "the patient." These are people who want to heal, who want to see their families and who don't want to be defined by the parameters of their illness or injury.

It is this approach to  goal setting with a patient that honors the dignity of a life well lived. Thanks, Julianne, for this humble reminder that therapy is about the person, not the patient.
Haydel 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: Elderly Care, transitional care, Checklists

Home Care Can Dramatically Reduce Health Care Costs - Here's Proof!

Posted by Marc Ottinger on Nov 7, 2011 10:48:00 AM

The Health Care Reform debate rages unabated even as costs for employers, insurers and individuals spiral up and up.  In the current climate of health care in America, patient outcomes from one of the costliest health care delivery systems in the world are dismal--and worsening. 

As a society, we are sicker, and more expensively sick than ever before.

It seems obvious that the number one priority of health care reform should be to provide better care at lower cost.  Yet somehow, despite advanced technology and massive investment in health care delivery--not to mention widespread demand for improvement at every level--we find a deteriorating situation whose costs are felt far and wide.

Atul Gawande, Ankota's author of the year for 2010, wrote an inspiring article in the NewAtul Gawande Yorker magazine recently, a medical report called "The Hot Spotters."  In it, Gawande presents cogent arguments for a simple, human, rational yet revolutionary approach to the complicated problems in health care. 

Solid research and rich documentation make a compelling case for an approach based on care coordination.  Close examination of numerous examples show clearly that when care is focused on the highest cost patients, outcomes are improved and costs drop dramatically.

Gawande asks, "Can we lower medical costs by giving the neediest patients better care?"  He then goes on to give profiles of providers and professionals whose protocols substantiate his proposed (and, encouragingly resounding) "Yes" answer.

We meet Dr. Jeffrey Brenner, a Camden, New Jersey physician whose dedication and devotion sparked a movement to map and target "super-utilizers" of medical services.  Brenner set out to find what was going so badly, tragically wrong.  What was causing such massive waste with costly, ineffectual treatment that had some patients in a revolving door of ER visits?

Details of what happened and how it all began for Brenner's revolutionary approach take the reader on a fascinating journey through the mean streets of Camden, drilling down into root causes of out-of-control health care costs, to arrive at some simple truths about people, medicine, and our current health care system.

Exploring the new and growing field of "medical intelligence" provides insight into off-site data analysis aimed at controlling costs for companies that provide medical insurance to their employees.  Since patient privacy rights prevent analysis of employee's personal health spending, the requirement is for pattern analysis based on companies' health care payment records as a whole.  This enterprise is designed to provide its clients--among them the government of Dubai--with ways to reduce spending.

The work of physician Nathan Gunn, employed with leading medical intelligence company Verisk, yields insight into the "sweet spots of preventive care."

Radical measures taken by Atlantic City's biggest employer pools--the casino worker'sThe Checklist Manifesto union and its hospital AtlantiCare Medical Center--have resulted in marked improvement in patient outcomes with the care coordination approach of targeting the neediest cases with a level of support that pays for itself in measurable cost drops, while delivering superior care.

Details of independent economic corroboration of value increase with lowered expense (in the range of 40% drops) are given, with specifics on how the Special Care Clinic in Atlantic City did it.  Gawande explores scale and sustainability in depth.

Gawande looks closely at the impediments to progress, among them the fact that "one man's cost is another man's income" and the status quo can prove paralyzing to even the best of plans.

Though the path to a more perfect system is by no means strewn with rose petals, hope abounds, expansion awaits. 

Find the full article here

How can your home care agency reduce cost of patient care by focusing on patients with the highest needs?  Share your own stories in the comments.

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: Elderly Care, Care Coordination, transitional care, Home Healthcare Delivery Management, Checklists

Include Care Coordination in Your Next Home Care Technology Update

Posted by Will Hicklen on Oct 3, 2011 8:54:00 AM

Care Coordination technology

The Home Care Software Geek is often a guest blogger on other blogs, and most recently collaborated with Kenyon Home Care Consulting's  Ginny Kenyon on a piece entitled "Include Care Coordination in Your Next Home Care Technology Update." This article is a big hit and I thought Ankota's readers would appreciate seeing it too:

When you acquire technology for your home care organization, you need to consider a five year life for the technology. As such, it’s necessary to anticipate how care delivery will change in that timeframe and choose technology that prepares you for the future. Some changes in your care delivery operations are merely evolutionary changes. Examples of this are new OASIS forms and new coding rules. While I’m not implying that these aren’t difficult changes, they don’t represent the need for a fundamental shift in the technology systems that you use. By contrast, other changes are revolutionary and may require fundamental shifts in your technology needs.

The need for coordinated care can drive the need for a fundamental technology shift. Today we all try to coordinate care, but in the near future care coordination will be mandatory. This is due to the necessity of sharing electronic medical records, mandates to lower readmission rates, the need to communicate with family caregivers and other family members, and incentives to lower the cost of care, such as Accountable Care Organizations (ACOs).

You should anticipate the need to share care plans, meds, and visit results with hospitals, primary care givers, home health aides, geriatric care managers and other specialists involved in a care team.

In addition, you should look at consumer technology trends and make sure that your home care technology has plans to catch up. Here are some things you should look for:

  • Will my software run on tablets like the iPad?
  • Will it run on mobile devices like iPhones and Android phones?
  • Will my vendor keep me up with changes automatically the way Google or amazon.com evolves?
  • Will my technology enable sharing (i.e., care coordination) with family members, hospitals, care managers and more, as described above?
  • Can my nurses, therapists and/or caregivers access the system from their homes?

If the answers to these questions are mostly “no” then your technology is holding you back. Technology can be a great enabler for your organization, assisting you to deliver better care at lower cost. Don’t settle for software that will require manual processes outside the system for something as important as care coordination, or software the puts extra burdens on your staff.

click here to read "Include Care Coordination in Your Next Home Care Technology Update" on the Kenyon Home Care Consulting web site.

click here to read more articles from the Home Care Software Geek, Ankota CTO Ken Accardi
 

Topics: Recommended Reading, Starting a Home Care Business, Home Care Industry, Home Care Best Practices, Care Coordination, home care software geek, Checklists, Will Hicklen, Home Care, Home Health Therapy Software, Product Information

5 Percent of the Population Accounts for 50% of Health care costs

Posted by Ken Accardi on Aug 9, 2011 12:20:00 AM

Only 5 percent of Americans accounted for roughly half of all U.S. health care spending in 2009, according to a report from the National Institute for Health Care Management Foundation.  Conversely, the 50 percent of Americans with the lowest health care costs accounted for just 3 percent of the total cost of health care in 2009.

What does this mean for the world of home health?

More and more evidence (both anecdotal and clinical) is proving that managing care for the sickest and/or costliest patients results in less hospitalizations and other complications for them and reduces their health care costs significantly.  There's a great (althrough somewhat long) article in the New Yorker on this topic by Atul Gawande who authored Ankota's 2010 Book of the Year, the Checklist Manifesto.  Click the article below.

Hot Spotters Atul Gawande New Yorker

Home health and private care companies can play a key role in the ongoing care of these individuals, monitoring their health and making sure that they're capable or have the necessary assistance with their activities of daily living (ADLs).  This can improve outcomes, lower overall care costs and be reimbursed under the Accountable Care Organization (ACO) model.

Other Findings:

The report also found:

  • U.S. health care spending reached $8,100 per person in 2009. Approximately $2,500 went to hospital services and $1,600 went to physicians and laboratories. The balance of the spending went to a variety of other sources, including retail prescription drugs, home health and HME
  • A total of 15.6 percent of the U.S. population recorded no health care spending at all
  • People with chronic conditions (one or more) were two to four times more likely to end up in the top 5 percent of health care spending.
  • Total 2009 U.S. health care spending reached nearly $2.5 trillion, accounting for 17.6 percent of total GDP.

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, Elderly Care, Health Care Reform, Care Coordination, HME, Checklists

Ankota's 2010 Book of the Year: The Checklist Manifesto

Posted by Ken Accardi on Jan 31, 2011 9:42:00 AM

Before January is over (and yes this is hours away) we wanted to take care of unfinished business for 2010 and one exciting part is to name our book of the year.  The winner for 2010 is The Checklist Manifesto, by Atul Gawande.  Also, the book is now available in paperback for only $9 on amazon.com.

The Checklist Manifesto

Dr. Gawande is a terrific author and storyteller.  He's also able to convey difficult medical topics in a very easy to understand manner.  Home caregivers and nurses have provided better service as a result of checklists but for some reason (maybe egotistical pride) doctors have been less willing to adopt this best practice.  The book makes compelling arguments for why this should change.  One example is the way that Johns Hopkins Medical Center began using checklists in intensive care leading to significant improvement in outcomes (a link to a more detailed story is available below).

Rather than recounting all of the other information and the book, allow me to refer you back to the following previous articles on the Ankota blog:

Before closing, I'd also like to point new readers to Ankota's Book of The Innovator's Prescriptionthe Year for 2009, the Innovator's Prescription.  This fascinating book explains how the US healthcare system evolved and goes on to describe how innovation can transform the industry to provide better care at lower cost.  In my humble opinion, this should be the playbook for implementing health care reform.

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: Recommended Reading, Elderly Care, Checklists

Execute on the “Dominant Vector” of Home Healthcare - 2nd of 6

Posted by Marc Ottinger on Jul 11, 2010 11:29:00 PM

Question -

Do you have the structure to execute on the “Dominant Vector” of your Home Care Agency?

Preface

The focus of the first posting was identifying your Home Care Agency’s “dominant vector.”   What do you need to do now the dominant vector has been identified in order to be that high performance business, and create the competitive advantage that generates cash?  No one needs to tell you Home Care is a highly competitive environment.  Operational excellence offers the opportunity to increase quality, reliability, flexibility, speed, and customer value.  This is the second of six blog posts hiliting the five characteristics that facilitate operational excellence. 

 

Creating Operational Excellence

To achieve operational excellence owners need to take a step back and look at how is the business set up to achieve the established goals, and how is work organized and executed.  This, the second characteristic, brings organization and execution to a more concrete level - 

2.  Establish the correct structure that creates an advantage.  This requires a clearly defined operating model, which in turn needs to describe how the company is organized to execute the “dominant vector.”  

The focus of this series is that high performance businesses put a premium on operational excellence.  The first installment was on creating operational excellence.  The link for this is http://bit.ly/cyShNI.  The third installment will ask the question, do you have the understanding, drive, and alignment to out-execute Home Care Competitors? 

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: Recommended Reading, Home Care Industry, Private Duty Agency Software, Home Care Best Practices, Home Healthcare Delivery Management, HME, Home Care Technology, Checklists, Home Care Scheduling Software

Operational Excellence Home Care Agency? - 1st of 6 parts

Posted by Marc Ottinger on Jul 9, 2010 4:33:00 PM

Having worked in logistics for approximately fifteen years one of the industry rags I pick up on a regular basis is Logistics Management.  Recently there was an article titled “The Five Hallmarks of Operational Excellence.”  It was written by Mark Pearson, who is in Accenture’s Supply Chain Management.  This article applies equally as well in home healthcare including DME, Infusion Therapy, and Respiratory Therapy. 

Preface

The focus of the article is that high performance businesses put a premium on operational excellence.  Why?  It creates a source of competitive advantage and generates cash benefits.  In today’s difficult economic times operational excellence offers the opportunity to increase quality, reliability, flexibility, speed, and customer value.  Home healthcare operates in a very competitive environment.  How do you create operational excellence? 

Creating Operational Excellence

In order to achieve operational excellence owners need to step back and look at the big picture.  First, how is the business set up to achieve the established goals.  Second, how is work organized and executed.  There are five main characteristics.  This is the first characteristic that facilitates this -  

 

  1. Identify your companies “dominant vector,” defined as that internal capability that creates customer value more effectively than your competitors.  To put this another way, what mechanism distinctively creates economic value for you and your customer.  This characteristic should change only when the company’s underlying value proposition changes.  

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: Recommended Reading, Home Care Industry, Private Duty Agency Software, Home Care Best Practices, Home Healthcare Delivery Management, Home Care Technology, Checklists, Home Care Scheduling Software

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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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