JB's primary scope of focus at CipherHealth is on the application and growth of solutions in post-acute delivery settings. JB works closely with home health agencies and skilled nursing facilities to bring a new level of quality and efficiency to care delivered.
In the video for CipherHealth, you state "Through smart, effective technology we solve fundamental challenges of the healthcare industry." To start, what are some of the most significant challenges the medical industry is facing right now?
Two of the largest gaps in healthcare today are:
1) Staying better engaged with patients, at a lower overall cost - For many decades, providers have only needed to keep an eye on patients while they were in their charge: Within the hospital during an acute episode, or for a home health agency, during the time a patient is utilizing a home health service. What we see now is that there are new regulations and incentives that require all types of providers to be more efficient with their resources, while ensuring patients receive top-notch care and have an exceptional experience.
This is where technology can come into play. It is impossible for providers to effectively engage with patients while staying cost effective without it. By efficiently reaching out to patients to understand their recovery and proactively address issues, providers are more equipped to engage with patients and resolve problems cost-effectively.
2) Another big challenge the medical industry faces is the sharing of information across providers and care settings - Due to various EMRs, HIEs, and HCAHPS vendors, there is a lot of information out there, but not enough communication between them. For instance, when a patient is discharged from the hospital and goes to a skilled nursing facility (SNF), the hospital has limited capability to understand what is happening with the patient, and the SNF has no clear ways to feed information back to the hospital.
What we try to do to address this challenge is facilitate better communication across provider teams and across care delivery settings. Bridging this communication gap is critical to ensuring that patients don't fall through the cracks and that providers can be effective at caring for patients.
What have been some of the most useful effective technologies for CipherHealth?
We launched Voice in 2009, giving hospitals a way to follow up with 100% of discharged patients. Over the last couple of years, Voice has made a seamless transition to non-acute delivery settings like home health agencies.
CipherHealth was founded with the single goal of helping hospitals reduce readmissions. How can quality in-home care help reduce readmissions?
Home-based care is becoming an integral part of care delivery as reimbursement continues to rapidly shift from fee for service to value-based care. Hospitals are being incentivized to shorten the acute episode length-of-stay and return the patient home to recover as quickly as possibly. As a result, home health agencies are seeing a higher acuity patient than ever before. Staying engaged with these patients throughout their episode, including the time between home visits, is extremely important. If home care providers can find ways to do this efficiently, they will realize great success. Also, these will be the providers who acute referral sources will want to align themselves with as they develop their preferred networks.
On your website, you use the phrase "the care continuum" several times. Can you explain what the care continuum is? How does it factor into in-home healthcare?
When we talk about the continuum of care, we are referring to the patient journey across different levels of care, and the different types of providers that deliver care to the patient. It is easiest to think about the continuum in context of an event-driven episode, where a patient transitions down the acuity spectrum from the inpatient acute setting, to a rehab facility, to community-based care like home health and their PCP.
As it becomes more and more common for episode reimbursements to be capped by bundled payments, the organizations at risk will seek to place the patient in the lowest cost setting as soon as possible, i.e., the home. As a result, they will look for the home-based provider partners who have a proven track record of high quality care.
One of the services CipherHealth offers is remote patient monitoring. How far has this field come in recent years, and how has it made in-home healthcare more feasible than in the past?
There are many flavors of 'remote patient monitoring', and as a whole the practice has come a long way in recent years as more and more types of data have become eligible to be collected remotely such as biometric data, as well as patient recovery data. That said, the largest barrier is low patient compliance and engagement with remote data collection devices. What we have found to be the most cost-effective and feasible way of remote patient monitoring is through the use of the telephone. For many home health patients, they are not comfortable with engaging with biometric devices, email, mHealth devices, or even texting. The reality of healthcare today is that patients are much more likely to engage with a telephone engagement solution that gives providers the most comprehensive view into patient status at home. This [the telephone] is a technology that today's geriatric, complex patient, is accustomed to using. Ten to twenty years from now, it will probably be a different story as new generations move into the later stage of life.
CipherHealth was started with the goal of improving the quality of healthcare. What were some issues that needed fixing that prompted you to go into this field?
Being a professional in the healthcare field, I consider my health literacy rate to be above average. Regardless, I've had several personal health events where I was left confused, and unsure where to go for help. Leaving a routine urgent care visit, with an instruction packet and prescription list for strep throat has left me with questions and no one to ask. I can't imagine how scary and confusing it can be for the co-morbid patient on 10, or even 20 medications.
In February of 2016, CipherHealth published an entry on your blog about "Why Home Health Must Focus On Quality", where you cite health statistics that show a significant difference between patient's experience rating and quality measures. What are the dangers of this discrepancy, and why must they be focused on?
While providers might be performing well on domains related to patient satisfaction, such as the professionalism of their staff, they might not be actually improving patient outcomes or reducing hospital readmissions. This is being addressed by CMS through the implementation of the IMPACT Act, and the requirement to submit standardized resource use measures such as successful discharge to community and readmission rates. Implementing a robust way of measuring post-acute providers on both quality and outcomes is critical given the goal of incentivizing - and reimbursing - providers based on better outcomes and lower overall cost.
For patients that are considering in-home healthcare, how might they determine the best provider for their needs?
I assume this question is in reference to home health care specifically. All of the data mentioned in the question above, from readmission rates to patient perception care (HHCAHPS), is being consolidated and reported through Home Health Compare on CMS.gov. Here, agencies are rated on a 1-5 Star scale (5 being the highest). CMS has made it clear that the Five-Star rating system on Home Health Compare is to serve as the primary sources of quality data for the public and for referring providers. While there are still improvements being made to this system, patients can easily reference home healthcare services in their area and determine what might be the best fit in terms of quality and satisfaction.
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