Home health is a growing care setting because, let’s face it, what patients wouldn’t opt for high-quality medical care within the comfort of their own home? Not to mention, payers increasingly recognize the financial savings that can be achieved outside the four walls of a traditional hospital setting.
Nizhoni Health, one of the fastest-growing home health care providers in Massachusetts, employs a staff structure similar to that of a hospital: registered nurses, home health aides, and physical, occupational and speech therapists. This care team complexity means Nizhoni is not immune to the care coordination challenges that any healthcare organization (HCO) might face as they attempt to create a more seamless patient journey. In fact, some may argue that Nizhoni is more subject to it, because their care providers work remotely and service a total of around 20,000 patients weekly, according to Nicholas D’Addabbo, Director of Clinical Strategy at Nizhoni Health.
“The logistics of how home health is delivered presents an administrative conundrum. But we knew better technology solutions would hold the care coordination answers we were seeking,” said D’Addabbo, who in a previous role helped lead athenahealth’s national interoperability strategy, driving information-sharing across disparate systems for over 66,000 providers.
Even more unique is Nizhoni Health’s focus on treating patients with both complex medical and behavioral illness. The average age of their patient, at a young age of 55, defies home health norms of much older patients who are suffering from medical illness, typically with a viable support system, and/or recovering from a hospital stay. Still, Nizhoni’s patients are typically psychiatrically acute as well as chronically ill, which means they fall into the group of patients who comprise 75% of the U.S. expenditure on healthcare annually.
The U.S. Bureau of Labor Statistics says the home health sector will grow by 54% by 2026. The reasons why are as layered as these patients are complex to treat — but a leading factor is the aging patient population and reimbursement models that continue to incentivize more value-based care. Additionally, Nizhoni’s behavioral health dual focus has signaled that they are ahead of the curve — an industry leader — due to their holistic, whole-person care approach.
“We were consistently receiving high marks from our patients, but we realized the biggest breakdown we needed to address was occurring with referring providers when we started getting calls about a disconnected experience that we knew could be improved upon,” said D’Addabbo.
He is referring to the period of time when he was overseeing Nizhoni’s intake process and gauged they were at a 4-hour turnaround time, per referral per patient. He identified their intake process at the time as very “transactional in nature,” which was merely a side effect of their intake coordinators “juggling too many tasks.” This was compounded by their use of seven different platforms in an effort to accommodate all referral sources, involving up to three to four rounds of dual, manual entry per instance.
Home care and post-acute care, in general, have traditionally been siloed from provider organizations, hospitals, and health systems, due to their unique way of doing business with many referral sources spanning numerous systems — all with nuanced workflows that center around a complex regulatory and compliance environment. Behavioral health has its own set of challenges around the complexity of coordinating care across a diverse care team for many of its patients — across disparate data sources and potentially broken admissions or intake processes — all of which results in a lack of follow-through once patients are discharged into post-acute care.
Nizhoni may be at the intersection of both home and behavioral health, but care coordination is a pain point experienced across the industry, with some alarming statistics to back that up.
“Fraud and abuse costs the U.S. healthcare system about $80 billion a year,” said Josh Cotham, Director of Solution Engineering at Bridge Connector. “This is criminal, and we treat it as such.” Cotham and D’Addabbo recently discussed both the business problems associated with care coordination in the industry and how Nizhoni is arriving at unique solutions during a webinar titled, Improving Care Coordination for Fumble-Proof Patient Handoffs.
“However, equally if not more important, I would argue, are the costs for failures in care coordination which account for $78.2 billion a year — a problem with a similar price tag,” said Cotham. “When you consider how much waste we are trying to combat in healthcare, this is also criminal. Why aren’t we talking about this more?”
The common denominator with care coordination issues, regardless of care setting, is siloed data. And the prescriptive fix that is needed, industry-wide, could be described as a “digital transformation journey,” as D’Addabbo has referenced it with Nizhoni’s own efforts.
As with all journeys, it helps to think of the decision-making processes as part of a larger roadmap, according to D’Addabbo — a solutions roadmap, in this case, which should ideally be an iterative process, oft-repeated to build from one success into another. To begin, he knew they wanted to gain greater computational visibility into Nizhoni’s intake experience. Given his previous successes with the platform, D’Addabbo chose the CRM, Salesforce, as their single source of truth. Simultaneous with Nizhoni’s adoption of Salesforce, they prioritized two referral management platforms, Allscripts and naviHealth, that they needed to integrate into the CRM, which they did successfully through Bridge Connector.
Nizhoni knew that all of this new-found data was inconsequential if they didn’t surface it back to their account managers in a useful and actionable setting. So as Nizhoni’s account managers are out on the road, meeting with their 1,100-plus referring providers across the state, they can now access valuable referral data on their iPads, via Salesforce, and they are each armed with more information when they walk into a hospital or a physician’s office.
D’Addabbo gave a hypothetical scenario of how this might improve an account manager’s dialog with one of these physicians:
“Over the last month, you’ve sent us this many referrals, and we have this number of orders that are still outstanding for home care. How can we work together to satisfy all the requirements, but more pointedly, what can we do for you? We see that you worked with Amanda, our intake coordinator for most of your referrals. How’s that relationship looking for you? Do you enjoy working with Amanda? What can we improve upon?”
With patient satisfaction scores already high, Nizhoni has enabled more conversations like this one to collect constructive feedback from referral sources as well. This feedback has been identified as key with establishing patient and provider loyalty and driving Nizhoni’s continued growth.
“We took that 4-hour turnaround time that I mentioned earlier and turned it into 20 minutes per patient per referral — a 92% increase in efficiency,” said D’Addabbo. “We get to the ‘yes’ that much faster as we’re determining administrative and clinical appropriateness for patient referrals, which is significant since getting to that ‘yes’ is really every discharge coordinator’s goal.”
He adds that Nizhoni’s streamlined systems have ultimately resulted in a better experience for their referral sources, which they’ve verbalized to Nizhoni, but which they have also been able to measure. Even more importantly, though, is that the streamlined processes have also resulted in a better patient experience. Patients are discharged from facilities more quickly and their nurses are able to meet them at home in a much more expedited timeline than they previously had been able to.
“We’ve seen an increase in the number of weekly referrals that we receive and increased provider engagement,” D’Addabbo said. “And when care providers communicate better, everyone wins — including, most importantly, our patients.”
Tips for any HCO to begin digital transformation
Every healthcare organization has different challenges, which means they are likely at very different stages with how they are using technology. When asked what recommendations he might offer any HCO who is considering their own brand of digital transformation — to improve referral management or consolidate any other data systems for that matter — D’Addabbo offered three main tips that can still ring true, regardless of their specific business challenges:
“Technology is always changing and evolving, so anyone approaching digital transformation for their organization should also realize this is not a one-and-done process,” he said. “Innovation and constant improvement go hand-in-hand.”
After Nizhoni’s successful implementation and go-lives with its first two integrations with Bridge Connector, communication is ongoing to make sure things are running smoothly through software updates and to also prioritize additional solutions that solve many of the problems that contribute to poor health outcomes for their population.
“As we truly move away from the fee-for-service model and move more into a value-based care world, it’s our responsibility to work together as an industry to create a more engaged provider ecosystem,” said D’Addabbo, “where we’re able to deliver care at a lower cost, create a better patient experience, and ultimately increase the quality of outcomes that we have with our patients.”