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Home and Behavioral Health Integrates Referral Management for 92% Faster Intake

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Connect the Dots to Scale Up

A recent study concluded that “the current system of community-based primary care does not adequately meet the needs of medically and socially complex homebound people.” Nizhoni Health is an organization with a unique fix that is committed to meeting their patients “where they are,” serving their patients in 26 languages in the comfort of their own homes. They are one of the largest home health providers in Massachusetts, but they also offer home health therapy, addressing behavioral health as well. 

With a background in patient care, Sonia Kuo is passionate about Nizhoni’s mission and joined the organization as their Director of Clinical Program Development to further their reach. In order to do that cost-effectively, Sonia researches the best technology solutions, so they can best serve their 3,000+ patients a week. 

Most of Nizhoni Health’s patients have chronic mental illness combined with complicated medical factors that are typically chronic as well, and given this special niche, Nizhoni has experienced a rapid growth trajectory. Since 2017, the company has grown from a network of 650 to 700 nurses, physical therapists, and occupational therapists who deliver up to 21,000 visits per week. 

The flexibility of the home health setting on the patient’s side can often be paired with administrative challenges on the business’s side. Those 700 nurses essentially have rolling offices — in their cars. Most of their patients have 3-4 different providers, if not more. When you consider these patients’ comorbidities and frequent transitions of care, tracking and managing information to properly care for these patients can seem daunting. Additionally, in order to serve as many patients as possible, Nizhoni Health has seven different referral management platforms for patient intake. This made for a dizzying case of “swivel chair syndrome” and a lengthy referral intake process with unnecessary duplicate data entry.

Because of these inefficiencies, Nizhoni began to notice a trend with feedback from their referring providers — that Nizhoni wasn’t responding to referral orders quickly enough, which was negatively affecting their experiences with the organization. One of Sonia’s first tasks in her role was to turn this around. Nizhoni needed a platform to connect all of their back-end office into one system.

Once we established a main source of truth for our patient information, I knew that securing an integration partner would be just as important for us to be able to get rid of the dual, manual entry among so many systems,” she said. Nizhoni started their integration project with the two platforms that brought in the most referrals, NaviHealth and Allscripts.

“I’m constantly looking to reduce IT systems, so that we have a better user experience for our caregivers and staff,” said Sonia. “When you don’t have programmers on-hand but know that integration is imperative to be able to scale up, that’s a pretty good indication that you’re going to need a full-service integration vendor. To keep our limited internal IT resources focused, we needed to outsource all of the heavy lifting up-front, then all of the subsequent maintenance and updates. That winning solution for us was Bridge Connector.” 

Sonia’s colleague, Nicholas D’Addabbo, is Vice President of Strategy at Nizhoni Health. And while he was tracking consistent high marks from patients, he too identified Nizhoni’s referral provider experience as their biggest breakdown. But he and Sonia both knew this was an area that could quickly improve with the right digital strategy of connected technology.  

In the first month of the integrations being live, Nizhoni was able to reduce their referral to intake turn-around time from four hours to 20 minutes — a 92% time reduction.

“Our referring providers, overnight, noticed this improvement, which facilitated some other challenges we were having with lag times as well,” said Nicholas.

“Our engagement with Bridge Connector, coupled with the power of Salesforce’s platform, really set the stage for all of the possibilities that exist for digital transformation for our organization,” said Nicholas. “We were so inspired by our first couple of integrated platforms, why stop there? We are always looking for integrations that will improve efficiencies, including bidirectional integration with EMRs. The sky is the limit.”

With razor-thin margins in home health, Sonia adds that Bridge Connector’s pricing model — a predictable, all-inclusive subscription fee, unique among other integration vendors she was considering — made the difference for Nizhoni. 

“When you’re dealing with the home care model, which should be more cost-effective for our patients, the last thing you need is a tech vendor to bust the budget with added costs, whether that’s monetary or by unexpectedly draining your internal resources. It was important for Nizhoni to avoid hidden costs, while nailing predictability,” she said. “That’s what allowed us to very quickly realize that ROI with Bridge Connector, in time and money saved.”

“Nizhoni Health has long been known for its excellent patient care, and these technologies all working together allow us to deliver on Nizhoni’s reputation for excellence with cutting-edge business practices as well,” Nicholas said. “We now also deliver a world-class referral partner experience — less administrative waste and more revenue for them, which builds better partnerships with our referrals.” 

Happier staff providing gold-star service to more patients is a win-win that Nizhoni hopes to replicate — with even more wins as part of their ongoing digital transformation journey. 


Post-Acute Care


Medford, Mass.

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