We at Ankota strongly believe that care coordination and home care are the keys to improved health care.  The math is simple:

• 5 percent of the population account for 50% of healthcare costs
• Many of those 5 percent are elderly people with multiple chronic conditions
• It is better for everyone if the person is at home instead of in the hospital.  Better for the patient - comfortable surroundings and less chance of infection.  Better for the hospital - use their beds for procedures.  Better for cost - much less expensive

Achieving this goal requires coordination among care providers, which requires changes to the way health care is paid for (to encourage coordinated care).  These changes are coming in the form of penalties for hospital readmissions and reward sharing for lowering health care costs (such as via Accountable Care Organizations - ACOs).

Changes like this require software (which Ankota is focused on) and process change.  Focusing for now on the process change side, I came across an article by the home healthcare-oriented attorney Elizabeth Hogue, Esq. entitled "Why Do Post-Acute Providers Need Access Prior to Discharge?".  The article is reproduced in its entirety on the website of CareAnyware (a home health and hospice software provider where a former colleague of mine, Joel Sholz, works).  You can read it here.

Elizabeth, being a lawyer, chooses words quite carefully and delivers stongly composed narrative.  So you should read her account.  But here are some key points she makes:

• Patient risks are escalated during "transitions of care" and as such visits by post-acute providers prior to discharge can help plan the transition
• Meetings with family members, especially in the care when a family member is the primary care provider for their loved one, is an important supplement to hospital provided care transition information
• Care providers with an ongoing relationship can provide bettwe care with more knowledge of current conditions for a hospitalized patient.  A key example is in the case of hospice where the hospice order stays in effect during the hospitalization
• Home care agencies get referrals from sources other than hospital discharge, giving them a strong reason to be on patient floors
• Although solicitation of patients is not permissible, there are many other legitimate reasons for care providers to be on patient floors in hospitals

In support of the necessity for coordination, Ankota has developed care coordination software that enables sharing of care plans, visit schedules and other relevant information that can aid in achieving the goal of reduced hospitalizations.  The software is live with a few early adopters, but we're actively searching for others interested in improving care coordination.  Please contact ankota if interested (we even have a basic offering for free).

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