Thought Leader Podcast Series: Home Care & Population Health

Full Text Transcript

Below is the full transcript of our podcast with Ken Laliberte, Solutions Manager for Analytics and Population Health, MEDITECH and Cheryl Adams, RN, BSN, MBA, Home Health Administrator of Sparta Community Hospital (Sparta, IL) . Click here to return to the full audio podcast.

Thanks for tuning into our MEDITECH thought leader series podcast. Today’s discussion is all about home care and population health.

My name is Ken Laliberte and I am a marketing solutions manager here at MEDITECH. Our guest today is Cheryl Adams from Sparta Home Care.

Cheryl is the administrator of At-Home Health Care of Sparta Community Hospital in Illinois since its formation in 1996.  She has over 38 years of clinical nursing and healthcare executive experience. And under her direction, At-Home Health Care has achieved some really impressive results, including a history of multiple deficiency-free surveys, a reduction in the acute care hospitalization rate, improved patient satisfaction, and the successful implementation of a telehealth program which we’re going to discuss on the podcast today.


Q: Tell me a little bit about Sparta home care and specifically what your role is

We are hospital-based agency located in southern Illinois, which means we sit between St. Louis and Carbondale, Illinois, so we’re rural. We cover about a 40-mile radius of Sparta and we do full-service skilled nursing, PT, OT, speech, and medical social worker and home health aide. As you mentioned before, our home health agency was formed in 1996 and we've been very successful since its inception. I am the administrator of the home health agency and I actually opened the agency via my masters in business administration thesis process, so it was a business plan that I devised and it's kind of my baby and I’m kind of protective of it.


Q: One of the things I wanted to talk about was homecare as it relates to population health. With organizations transitioning from fee-for-service to fee for value-based reimbursement models, penalties for things like 30-day readmissions, we're finding organizations are looking for creative approaches to really deliver high-quality care and reduce costs. In your perspective how does homecare play a role in that?

Well, I think as time goes on, as we look at population health and as we look at value-based purchasing and value-based reimbursement, we're gonna see home care evolve even more within the organizations. Several years ago hospitals were actually getting rid of their home health agencies and now the thought is they need that home health agency to make that smooth transition to home for the safety of the patient and to reduce that hospitalization rate.


Q: What are some challenges with coordinating care across multiple care settings?

I think as we look at as the patient is transitioning, probably one of the most challenging things is medication reconciliation. Patients have so many meds nowadays that when you look at their medication list and what they're on in one facility, versus what they've been on at home, versus if they've been to several facilities, in our case we have swing bed and we have patients come in from tertiary facilities into our swing bed program and then they transition to home, you have a huge problem with medication reconciliation and what medicine was that patient taking before, what medications is that patient supposed be taking now, and reconciling and making sure that we got everything straight, because we all know that medication mismanagement is one of the leading causes of rehospitalization.


Q: Can you tell us a little bit about your telehealth program?

We currently have telehealth and we are using utilizing it to manage our chronic diseases such as CHF, COPD, and we can also use it for diabetes. What that means is we are placing monitors in the home—scales, blood pressure cuffs, pulse oximetry and we can also do glucose monitors—so that the patient takes the responsibility of monitoring on a daily basis or sometimes we may request the patient to monitor twice a day if, for example, we're having a COPD patient that is having oxygen saturation problems and we want to keep a closer eye on it, we could actually ask them to do it more often. So, what we've been able to do with that is to decrease our rehospitalization rate.

Now one of the things that we're getting ready to do—we all know that video conferencing can be a huge asset in healthcare and being able to have eyes on that patient—so what we're getting ready to do is implement a video conferencing portion of our telehealth program.


Q: For a patient that's new to home care, how are they reacting to the devices? Are there any issues with adoption?

We have many patients that are really excited to be able to actively be managing their conditions, and then you do have a few occasionally that are little more hesitant, but generally we do get a very good compliance from the patients.  They're easy to use, which is key, and it has gone really well.


Q: One of the other really impressive things that you're doing is leveraging creative approaches to interact with patients to impact behavior. I know at one point you noticed an increase in readmissions on the weekend and you got your folks together and decided to come up with a tuck-in program. Could you speak to that?

Yes, we do have a tuck-in program and, you know, just like you tuck your children into bed at night, we tuck our patients in for the weekend, which means that we are doing a phone call to that patient on Thursday or Friday to make sure that they have all the medications that they need before the weekend, to make sure that they have their supplies that they need, if they have wound supplies, things like that before the weekend. If they don't, then we can be calling their physician or pharmacy to make sure that they got the refills that they need, or be delivering the wound care supplies, dressing supplies that they would need. What this does is, we were seeing increased visits on the weekend because of some of these issues, so it has also decreased our overtime and work hours because that clinician does not have to make that extra visit on the weekend. What that has also done is that it's a good PR issue because the patients are really excited, you know, what better way to take care of your loved ones than to be tucking them in before the weekend.


Q: Another creative approach that I wanted to discuss—I think your son came up with it—was the green medication sheet. Could you do could you speak to that?

My son is a paramedic, so he is in the homes when he’s taking patients to the hospital when they have an emergency, and one of the things that he had commented on was the fact that it was difficult for the patient to find their medication sheet printed on a white piece of paper. It blends in with everything else that they have—all their discharge stuff that they have from the hospital, all the information that we gave them—and so his recommendation was that we actually put our medication sheet on a colored piece of paper. We decided that we would use green and we did some education with the emergency services to instruct them on what to be looking for when they go into a patient’s home that we may be providing services to also and it has been a great asset.


Q: In your opinion, how does home care play a role in delivering a patient-centric approach, facilitating and encouraging healthy behaviors and taking into consideration social determinants?

I think the most important thing you have to look at, you have to do to health coaching. You have to determine why that patient is not following their plan of care or why they would follow that plan of care. If you have a patient that lives alone and they have no family in the area, how are they going to get to their medical appointments they need to get to for follow-up? You have to look at ways in order to open up that communication to that patient and find solutions. Is there community transportation that they could utilize? Is their facility-based transportation? We have to be an active part in facilitating that. Also, medications, why aren't they taking their medications? Is it because they can't afford it, because they can't get to the pharmacy to pick it up, or is it because they don't understand what they're supposed to be on and when they're supposed to take it? So, it is truly health coaching and facilitating all of that and asking that hard question of ‘what is preventing you from following your plan of care? What can we do to help you manage this?’ and communicate that to the other service providers, because they may not have a good grasp on what is going on with that patient.


Q: With your vast experience, for those organizations that are thinking about building a home care service line, what advice would you offer?

If you were actually thinking about starting a home care service, you have to have the right people to facilitate that. In Illinois, you may have problems. We have a moratorium right now that prevents any new home health agencies from being added to the Medicare program, so you really need to check your statutes in the state and see what is going to be your limiting factors. You have to have an approach of what do you expect to gain out of it. Is it the basis of managing that entire patient population and their transition to the different settings? So, making sure that you have someone that can evaluate and put the necessary processes in place to meet the patient's needs and truly be able to think outside of the box. Healthcare is no longer within the four walls. We extend out of those four walls and you have to be able to do some abstract thinking and determine what is best for your organization.


Q: In your 38 years of nursing and home care experience, technology has really taken off in the last couple of years. Looking back, anecdotally, how has healthcare changed in the last 30+ years in your in your view?

Oh my goodness, that's a big question. I would have to say that when I look at just where we've been in home care in the last 20 years, I went from literally a book of paper per patient to maybe only a couple of pieces of paper, and eventually, we’ll be doing away with that. You know, it’s so much easier nowadays to transmit information to the other service provider. I think that we can do a much better job in this day and age of making sure that the transition of care to the other service provider can be smoother and we get them the information that they need to provide good care.


Q: If you were to fast-forward to you know the year 2027,  how do you see healthcare looking in in 10 years?

I think we'll see our inpatient volume will continue to decline and will continue to expand to outpatient services. And, I think that home care, hospice, and palliative care will be a huge impact on the patient care experience.


Q: Looking at the patient and consumer point of view, 15 to 20 years ago we didn't have the term ‘patient experience’ with immediate access to information through smartphones and, you know, things like Facebook and Twitter and social media. Have you noticed patient expectations changing with regards to consuming healthcare?

Absolutely, you know, we are a transient society so that means that they don't hesitate on doing their research and finding the best providers of care. So when you look at your patient satisfaction surveys, your quality indicators being published for the public to see, patients are going to be more critical of the agencies or the facilities that they utilize. Being transient that means that they can drive wherever they need to drive or they can get the homecare provider that they request based on those patient satisfaction or quality measures, and we see that now. We have phone calls at least once a week telling us that, you know, we chose your agency because we were able to see that you are a five-star agency when it comes to patient satisfaction and your quality scores are excellent, why would we want an agency that did not meet that mark. I think that over the next 5 to 10 years you're gonna see that expand even more, especially when you look at the current age of society and how tech savvy they are.


Q: How is MEDITECH helping you deliver high-quality home care and what are some of the things that MEDITECH is working on, delivering today in time, that you get excited about?

MEDITECH has been very useful to us in the fact that that we are able to disseminate information to the other facilities and make it meaningful information for the transition of care of patients. We've been able to develop great protocols and best practices with the use of MEDITECH fairly easily. The clinicians have an ability to document on patient records via the protocols which have really streamlined our documentation process. We also have to look at how wonderful it is to be able to integrate telehealth within our medical record and disseminate that information to the physician as needed. As we look at Illinois within pre-claim, MEDITECH was very on top of it and making sure that we were able to track and maintain our pre-claim status within the Medicare clients so that we could do the proper billing that we needed to do. So, as we facilitate information, as we manage the client, we’re able to do best practices and also be very timely.