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August 4, 2022
Ask the Experts: How Has Disruptive Technology Impacted Home Care?

*This blog is a transcript of a previously hosted webinar. Since the content is still relevant, we wanted to share it in a blog post in case it can help you too!

Our theme today is essential tools, driving success and efficiency for homecare agency owners. And specifically, we're going to focus on the impact of disruptive technology, how that impacts caregiver retention, and ultimately improves patient care. So, right now, I am very excited and honored to introduce our moderator, Marki Flannery, who brings an amazing and very relevant background to our session today as an advisory board member at CareConnect. And, most importantly, recently she’s retired from VNS Health, where she served as president and chief executive officer of VNS Health. That’s the largest nonprofit home and community-based health care organization in the United States. She’s very well known, highly respected, and has published a number of articles. Marki is, most importantly, an amazing subject matter expert for these topics, so we can’t think of a better individual to be our moderator today. 

 

Marki Flannery (CareConnect Advisory Board): I’ll start by introducing our great panelists who are going to be sharing some information with you. I’m going to start with Gigo George. Gigo has been with Sunshine Homecare for over six years. He’s a highly skilled and accomplished operations manager, project manager, and IT professional working within a matrix structure and helping to change the paradigm of project management from a cost center to a value-added role. He holds a Master’s degree in Healthcare Information Systems from Binghamton University, and an MBA from Mahatma Gandhi University with a focus on Information Systems Marketing, and Project and Brands Management. 

Next, I’d like to introduce Michael Gelman. Mike is the President and Chief Operations Officer at CareConnect. He is a financial and corporate development executive with over 20 years of experience in senior roles at institutionally-backed healthcare and technology companies. He brings a wealth of experience to help CareConnect provide services to you, the homecare provider.

Next is Nancy Fitterer, who is President and Chief Executive Officer at Home Care and Hospice Association of New Jersey. Nancy has been heading the Home Care and Hospice Association of New Jersey for almost four years. Prior to joining that organization, she served as Chief of Staff to two New Jersey Attorney Generals. Nancy also served in various other capacities during her eight-year tenure in the Office of the Attorney General, including Chief of Staff of the Division of Consumer Affairs. Nancy was also Chief of Staff for Senator Jennifer Beck and Assemblyman Declan O’Scanlon, a trusted policy adviser to the New Jersey Assembly Republican Office, and a constituent relations advocate to New Jersey Governors, DeFrancesco and Whitman. She is a graduate of both the College of New Jersey with a Bachelor of Arts in Political Science and Seton Hall University with a Masters in International Relations and Diplomacy.

And last but very much not least, is John Pandolfi. He is Vice President of Client Success with HHAeXchange, where John works to ensure all home health agency customers are receiving maximum value from their software solution and achieving their goals. John joined HHAeXchange in March of 2017 as a project manager and transitioned to the client success team shortly after. He's worked with numerous home care agencies to boost their workflow efficiency and improve care for their patients. He is committed to using excellent communication transparency, thoughtful strategy, and problem solving to help HHAeXchange clients successfully grow their business. Prior to HHAeXchange, John worked as a senior consultant in the State and Local Government Solutions Division for CGI, a global information technology consulting and solutions company. John holds a BA in economics from Providence College. 

Now, let’s get started. One of today's takeaways is around disruptive technology. So, my first question is: 

What is your definition of disruptive technology? And what would you say is the best example of disruptive technology that has helped solve a problem for your clients, caregivers, and the home care industry? 

Michael Gelman (CareConnect): If you want to get academic about it, when you think about technology or disruptive technology from an academic perspective, it’s something that causes a whole new infrastructure to be put in place. A good example of that today is electric cars. You can't just have them, you have to have places to fill them up with electricity. But, historically, the big barrier to electric vehicles was that you couldn't fill up your tank, and the range wasn't that long. The fact that those types of things are now happening, now that the battery levels, for example, are longer and you can get your car charged, the world has moved towards putting charging stations all over the place. It's a good example of disruptive technology, because it's going to disrupt the energy industry, disrupt what we need to do around infrastructure in the company and in the country in general, and it's disrupting the automotive industry. It changes the way we think about doing things. And it changes the things that we need to build around it, the infrastructure around that technology to enable it. 

John and I have talked in the past about how EVV was a real disrupter in our industry, and why is that? To me, most home care agencies didn't have EVV in place before the Cures Act. As a result, home care agencies and home health agencies really had to start thinking differently about how they deploy technology in their businesses and it's opened up the world for all these other efficiencies that can come into play. 

So, when you think about a good example of a disruptive technology, EVV was certainly one of them. It has really created an accelerated playground in this part of post-acute care to drive innovation. Historically, we saw it took hospitals 20 years to put good technology in place. It took nursing homes and assisted living 10 years to catch up. We're seeing a big inflection right now in at-home care. I think due to the EVV Cures Act technologies really accelerated that learning curve and as a result, we can put better technology and other types of technologies that we focus on today into the home. And, I love what you said, Gigo, about turning a cost center into a revenue center, and using tools like technology and disruptive technologies to help drive business into organizations first. Just taking a paper workflow and turning it into an electronic workflow doesn’t really have the things you need to be disruptive.

 

John Pandolfi (HHAeXchange): At HHAeXchange, we’re putting a really large emphasis on our partners - CareConnect is a big partner of ours and we really value that relationship. When I think about disruption, I think about EVV, which is the example I would use for this discussion. It all starts with disruptive legislation, like the Cures Act and I don’t even think the people that really pushed that through had the forethought about how it would revolutionize this industry. 

But, it gave everyone a framework. A technology framework that strongly encourages caregivers to interact with the technology at two points when they’re in the home - at the start of the shift and the end of the shift. That’s the framework that I’m talking about. Whether you’re picking up a phone and you’re using IVR technology to clock in and out; that’s one aspect of technology. The other is mobile apps - a lot of the technology vendors that service this industry are focused on putting that technology right in the hands of the caregiver to accomplish more than just EVV, but EVV is the foundation. You don’t go to the mobile app, for example, without EVV as that precursor. 

So, off of that framework, you've said to this caregiver, “Interact with me, at least in two different points.” But now that you're doing it in two different points, you just open up the world of, “Well, why can't I convey information back to my home office at any point in the shift? If there's an emergency, why can’t I convey this back to you?” So, in addition to just being able to, at a better rate, validate that someone's in the home doing the things they say they're doing, you can also expand that to making this a tool for someone's employment. That's really how we envision and think about technology in the home. It's not just about EVV - EVV gives us the framework to do so much more.

 

Michael Gelman (CareConnect): A few of us were with Nancy at the Caregiver Appreciation Day in New Jersey. The thing that struck me the most is the evolution of the conversation. Two or three years ago, when we talked about bringing technology to help, for example, with booking shifts and getting your referrals filled, the first reaction from almost everybody was, “My caregivers don't know how to use this technology. They won't be able to use their phones, they won't be able to use apps, they don't know what they're doing.” 

At that point in time, it was just a long conversation to say, “Hey, I don't think you're accurate there, let's talk about how [the caregivers] are using their phones today. They're calling folks, they're texting folks, they’re using different texting apps. They may be using different shopping apps. They have apps on their phones.” There is definitely a portion of users that are very low technically skilled, but that number is getting smaller and smaller.

The big tell to me, Nancy, was the gifts you were giving away to the caregivers. The gifts to the caregivers that were being appreciated for 5, 10, 15 years of service, were 50% technology items. There were a lot of Kate Spade bags, don't get me wrong, a lot of nice blankets. But, there was a lot of technology; Apple Watches, iPhones, iPads, Android devices, etc. 

The excitement by the caregivers that got those gifts and won those raffles, certainly, was an indicator that they knew the value of [those gifts] and how to use them. That really has changed in the last couple of years, and that's a very exciting trend that these programs have created. So, [if there’s] low technology adoption, you introduce some sort of pivotal, new, regulatorily enforced technology that both the agencies and the workforce need to get behind in order to make work. Think about the phone; it's just another platform to add tools to, to make people's lives better.

 

Marki Flannery (CareConnect Advisory Board): Thank you, both of you. Nancy, would you like to add anything to the discussion regarding disruptive technology?

 

Nancy Fitterer (Home Care & Hospice Association of New Jersey): So, two things. One, EVV: definitely a disruptive technology. When the Cures Act was first passed, and we were telling providers, “This is what you need to do,” it was a little bit like the sky was falling, because it's a change, and people are afraid of change. And while most of our aides, nurses, and therapists use electronic devices in their personal life, there was a fear that trying to train them to use it for the purposes of EVV was going to be very difficult. To an extent, it was. I mean, it wasn't easy, but it's because change isn't easy. So you have these aides going, “No, no, no, this isn't how we do things.” They didn't want to do it, not because it was necessarily that difficult, but because it was a change.

I think, going back to the discussion about the electric car -  when we first heard about an electric car, people were like, “Yeah, yeah, sure, there's going to be an electric car, we're going to have a flying car next.” Now, there are so many people I know that have electric cars. I mean, there is an evolution and slowly but surely, people get there, but to me, the thing that people are most afraid of is that you're required to change. Again, changing in a job is a little bit harder than when you're changing in your personal life. It’s your job, and you feel like, “Okay, this person is making me change.”

I think the other thing is COVID, right? In the middle of all this, COVID happened. Think about all our grandparents that were never on a zoom call in their entire life, right? Now, we're going on Zoom calls to see family. There were people like my mom, who was on FaceTime for the first time during COVID, because no one could see each other. So, I think when you add the layer of COVID on top, you realize that not only were [people] going to have to learn because EVV required them to, but they were forced to learn, even in their personal life, that you had to utilize technology.

While it was something scary and disruptive, in the sense that they didn't know how to do it before, people embraced it. So now, I think I don't know anybody that hasn't been on a Zoom, a Teams, or WebEx call in some way or another, even for a very personal reason, because you want to see your family, you want to see your grandkids, you want to see people that you can't see. 

So, it was disruptive for the “phase one” of personal care. It'll be disruptive when we move to home health, but there are so many benefits, and I think originally, people only see the “disruptive” as the “bad,” not the benefits that are going to come. But at some point, we're going to get all of the really amazing information you can get from EVV. We're not quite there yet. It's just trying to implement it at first, but we'll get there. I think people, at some point, are not going to remember a time when we didn't use EVV.

 

Marki Flannery (CareConnect Advisory Board): Thank you. Gigo, would you like to add anything?

 

Gigo George (Sunshine Homecare): Yes. Thank you for inviting me, it's great to be here. Change is needed and is also scary; it takes time and a lot of training, a lot of process improvements to go through whenever there's a change. An ongoing question when it comes to a disruptive technology, is what the actual operation requires on a day-to-day basis. Definitely, it all depends on the caregivers’ utilization of the system, because otherwise, whatever the technology the agency's going to integrate, it will not be effectively utilized. 

So, the gap between the caregivers and the systems that we use is going to create a lot of issues internally. This includes manual follow ups that each person has to do to get the information that they need and then take the next step. When it happens on an ongoing basis, it becomes an inefficient process. There's a lot of delays in getting the job done on time. So, understanding the requirements of caregivers, while keeping track of their technological capabilities. So, something like technology, we need to understand from a caregiver’s perspective, because they are the one who's going to the patient's home and the one who's taking care of the patient.

When the information has to be relayed back to the agency, the communication that needs to happen between the agency is only through phone or text messages, because that's the easiest way for them to actually do it. The gap is the accessibility to directly connect with the nurses, who already have a list of pre-planned tasks for the day, due to priority changes because some other priority comes in their way. Eliminating that gap is a priority and understanding the user requirements and implementing the technology makes it more efficient in the process. 

Now, as Michael mentioned, when electric cars came into the picture, they didn't have options to see where they could get electricity for the car. So, those kinds of changes require the agency to make sure the caregivers know what they have to do when there is an issue. Let's say they couldn't clock-in or out today, what are they supposed to do? Now, the timesheets are not accepted, we will get to a point where we need to figure out how we can validate the timesheets. How can they do timesheets remotely? 

That gap has always been challenging for the agencies in terms of continuing with the day-to-day operations, so we need a simpler portal where agencies can reach out to the population, individually, but at the same time as a group. They can make sure they don't get frustrated with the technology that they use, so they can connect with the coordinator or the nurse. 

So, it makes it simpler and more efficient for them to inform: “Hey, I spoke to my nurse, this is what’s happening.” The challenging part is effectively communicating with the caregivers remotely. From the operational perspective, that's the disruptive technology because we have gone through a lot of software and different systems. The problem all the time is, how efficiently can we utilize the system and how many caregivers are able to utilize it? That's where we're gonna see a change, with this EVV mandate and the ongoing expansion, even with HHAeXchange, with other partners like CareConnect and other software. So, it's challenging, but it is a good change.

 

Michael Gelman (CareConnect): Gigo, I think when I'm listening to your response, as a technologist, I'm hearing, “Hey, this technology came into place, EVV. There’s a change management issue that when you bring anything in like this, that people need to think through, some people have a better process than others, right? You have the ‘laggards,’ and you have the ‘early adopters,’ and you have all the people in the middle trying to cross the chasm and all those good things.” 

To me, the thing I get out of the conversation is, everybody's thinking about, “Wow, there's this opportunity - we have technology in the hands of the workforce, how can we leverage that to do more things?” That's the core of the inflection point that EVV and its disruption created in the industry. CareConnect became a company because we saw a way to expand on, “Hey, there's a phone in someone's hand, what can we do with that to create value for the caregiver or the agency and all the other constituents in the process?

 

Marki Flannery (CareConnect Advisory Board): Mike, that's a perfect point, as we think about the pandemic, it was impossible for aides to get trained, for them to continue in service education or be able to obtain work, and the smartphone enabled that. There was this disruptive technology that started out to support EVV and became a tool for employment, that truly helped the workforce be able to do many of the things that they would normally have relied on in-person or telephonic communication with their supervisor. Everyone was now home. This was a way to be able to communicate with the workforce in an efficient way. I think it just opened the door for more to be able to.

 

Michael Gelman (CareConnect): I think it's the responsibility of the technology companies, in collaboration with providers and workers, to really identify the problem you're trying to solve and create tools that specifically solve that problem. Now, that could mean a very targeted tool; it could be a combination of tools that holistically move the needle in a direction to solve a problem you're having, and depending on the problem, you need to create something different.

We look at things from a holistic workforce perspective, like, why do the agencies care so much about delighting the workforce and for us, our interpretation of that is, “They want to fill as many shifts as they possibly can.” People tend to not keep their data online up to date, so we can use this platform to really understand people's behaviors, and the best thing that comes out of high tech today is that you can scale a personalized experience. 

Originally, manufacturing was very customized. Then, the assembly line came into place, and we had the same parts - such as Ford, everybody gets the same Model T. These disruptive technologies can use the data that we get just from people's activity in a system, not just from people having to put stuff in. We can use the data on people's behaviors and historical stuff to create a scaled, personalized experience between that caregiver and the agency. So, now that you have technology in place, you can say, “Okay, what are the behaviors we're seeing that are exhibited by a worker or caregiver, based on their interactions with the agency and the scheduling coordinators?” We can start to personalize the things that the caregiver wants and optimize the number of shifts that occur, that an agency is actually filling and turn fewer away. That stuff only really happens with good collaboration with other partners in the ecosystem, right?

John and I often talk about what other data we can exchange that's going to create, not only meaningful outcomes for the agency, but let them measure it. That's the benefit of our HHAeXchange and EVV integration - we're combining all the agency AMS information that we need to do our job with caregiver information. We’re creating that personal relationship between the agency and the caregiver, enhancing it, and then ultimately solving the goal. This allows agencies to fill more shifts and increase their margins.

In our case, we want to influence the number of people that need care and are getting access to care. We want to drive value for the agencies that are providing that care and we want to drive value for the caregivers that are producing that care. These partnerships with associations, providers, and other software companies allow everyone to exchange that information in a meaningful way to achieve those goals. It's not just a one-pointed thing.

 

Marki Flannery (CareConnect Advisory Board): So, in the meantime, there was a question in the chat question to ask. For Mike and John: Speaking of disruptive technology, what areas do we see coming up next in home care, and how can the CareConnect-HHAeXchange relationship help foster this?

 

John Pandolfi (HHAeXchange): Well, I think it's really around the care management side, and that is about leveraging the caregiver in the home, and the basic abilities of every human being [to be able to] see what's going wrong with the person they're caring for. If [the caregivers] don't know, on a clinical level, they certainly know at an observational level. So, take the tools that we both provide, the technology behind those tools, the algorithms, the logic, and be able to affect outcomes even greater, right? Just by simply taking the observational data that the EVV framework has allowed us to capture.

 

Michael Gelman (CareConnect):  First, go back to the last conversation that John was saying about making sure you get that data to the state. That data is not only about checking up on you, right? That data gets incorporated into aggregated data, it goes into a lot of de-identified but publicly available datasets that allow folks like me, and John, and everyone else to create tools to analyze the data and create tools that are going to make your businesses more threaded and more effective. When I think about the data exchange with HHA and what's unique about the opportunity there, John and I talked about this a little bit, we're really focused on enabling agencies to fill more shifts, right? Or about, “How do we allow agencies to fill more shifts and drive their bottom lines, get meaningful work into the hands of the caregivers,” and HHA is uniquely situated in this region of the country, because they process most of the referral information through their system, and starting to collaborate on the number of referrals, versus how many are being filled, when they get dropped out, when they don't get dropped out? Who picks them up? How much time is going by? All that stuff can just add into the effectiveness of what we're doing together, right? So, the more data we exchange, and we have a very robust integration that I feel like is better than I've seen in a long time on two technology products. A lot of work went into it. I think the more data we get in exchange, in both directions, is just going to allow us to put better decision support in front of the operators to do their jobs.