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Recruitment, Retention, and Reward: Product Review

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by Kristin Rowan | Jul 19, 2024 | Admin, Artificial Intelligence, Caring for the Caregiver, Clinical, Product Review, Recruitment & Retention

by Kristin Rowan, Editor

Caregiver Recruitment, Retention, & Reward

The workforce shortage, caregiver burnout, after effects of the pandemic, and the advent of “quiet quitting” have impacted home care agencies’s ability to fully staff and care for their patients. Hiring new caregivers is not always an options. Agencies must put time and effort into recognizing, rewarding, and retaining their existing caregivers and clinicians.

The Rowan Report recently came across a company that is helping agencies do just that and we had an opportunity to sit down with their founder.

How it Started

Victor Hunt’s grandmother was a career nurse who started her own home care agency. However, the operation was too hard for her to handle on her own. She made the difficult decision to close the agency and go back to shift work. Victor realized that we need more home care agencies. But, he knew there had to be a way to help the people who have “home care heart” and can provide great care. There had to be an easier way.

Home Care Immersion

Before Victor and his team could address the difficulties faced by home care agency owners, they first had to understand them. With his co-founder Dan, Victor embedded himself into home care agencies. They took shifts, followed schedulers and recruiters, and experienced the problems up close. During this process, they got to know one agency in particular and one caregiver who was a rockstar. She picked up shifts, did training, contributed the company culture, visited patients in the hospital, and had referred more than 100 caregivers to the agency. In short, she was the home care clinician all agency owners want.

Her Name was Ava

Using this rockstart clinician, Victor and Dan set out to create a system that could turn every caregiver into an “Ava” and make every agency one that caregivers like Ava would want to work for. The mission of Victor’s and Dan’s company is to “make home care agencies destination employers.”

The Problem Statement

Home care agencies suffer from high turnover rates and performance challenges. THere is a lot of legwork that needs to be done to fill in the gaps and fix what isn’t done well. According to Victor, it comes down to a challenge of engagement and morale. Being a home care clinician is a lonely and thankless task. Caregivers can feel stuck in their career track unless they are actively pursuing higher credentials. The problem home care agency owners face is:

“How do we engage employees so their work feels recognized and meaningful?”

The Solution is Ava

The Ava team surmised that in order for caregivers to feel valued and appreciated, something had to give. The question, they wondered, was whether it would be margins or administrative overhead. AI was at the center of these conversations. But, traditional EMRs limit the implementation of AI solutions.

Recognition and Rewards

Because EMRs limit AI applications, Ava is an app but is also a stand-alone system that operates in a mobile browser. No download is required for use, yielding an 85-90% adoption rate within agencies offering Ava.

Ava connects to the existing EMR first to import data. Then, agency owners create their own rule sets. This offers incentives and engagement around specific metrics the agency wants to see. Examples include attendance, timeliness, number of hours, documentation, and completed training.

Ava will then assign, track, and reward milestones based on the rules set for the agency. Clinicians earn points that can be redeemed directly from the Ava store with more than 100 participating vendors. Agencies can also add internal rewards like branded merchandise, PTO, and raffle tickets. Rewards can be redeemed in $5 increments.

Communication

Ava includes automated messaging to recognize employees without taking valuable time away from administrators. The app sends recognition texts to all staff to congratulate clinicians for reaching certain benchmarks. Announcements can be sent by email or SMS to all employees at once. Additionally, Ava includes HIPAA compliant two-way communication between agency and staff.

Additionally, administrators can create groups within the system to send mass reminders to specific people. For example, you may create a group that includes all employees whose driver’s license will expire in the next 60 days. Within that group, reminders are sent to ensure updated information is added to the employee file. The system updates automatically each week, adding and removing employees from the group based on the criteria created.

Surveys are a great way to keep a pulse on the level of commitment and satisfaction your employees have. Studies suggest that engagement is a large factor in why employees leave their workplace. Ava includes pre-built survey templates but also allows you to crete a survey using an AI query. The survey questions and answers are customizable, can be “required”, set to “read only”, and can include a comment box to gain additional insights. Administators can filter survey responses to only see a certain type of answer.

Marketing

Referrals from employees is not a new concept. However, it is not always a visible part of your recruiting strategies. Ava has a referral bonus program with automated milestones. The bonus program spreads the referral bonus out across multiple agency milestones.

Ava also allows for manual tracking of Google Reviews or any other event or milestone where clinicians can be measured, tracked, and rewarded.

Customizable on Multiple Fronts

In addition to the custom survey questions and benchmarks, Ava includes custom naming conventions to track clinicians. One agency uses the term “activity tag” to categorize achievements. If your agency already uses different terminology, that can be added to the system.

Currently, Ava operates and switches between seven different languages. Additional languages can be added to the system and Ava can support those as well.

Recruitment processes are also customizable. Agencies can give candidates access to the system during the hiring process and they can earn points for attending the interview, completing onboarding paperwork, finishing the first training shift, or other measures. This allows the agency to reward a new employee with, for example, a coffee gift card by the end of their first day.

Track and Reward Your Top Employees

When your agency finds an exemplary employee, the unicorn, the “Ava”, keeping them becomes a top priority. Finding and training new employees is costly and time consuming. It is far easier and less expensive to reward your current high-achievers.

Badges

In addition to daily, weekly, and monthly goals, Ava has a tier system called “Badges.” Badges are long-term drivers of engagement, satisfaction, and success. The current badges are Orange (Avas brand), Silver, and Gold. There are points multipliers at each level.

Once an employee reaches a badge level, they have to maintain a consistent 90% goal completion rate in daily, weekly, and monthly goals in order to maintain their badge level. Loss aversion to lowering back down a level encourages a high completion rate of other tasks.

Training

Caregivers and clinicians should be constantly learning to stay ahead of the newest trends and technologies in the industry. Ava includes learning management system (LMS) integrations with several of the top training companies in the industry. Clinicians can access learning modules through the app or browser and can earn rewards by completing training modules based on individual agency settings.

Reporting

Reports within the system go beyond badges and benchmarks. The system consolidates reporting from various data sources and allows you to see your business health at a glance. These reports can help catch burnouts before they happen, focus performance improvement plans, and automate process than can save an agency hundreds of thousands, if not millions, of dollars per year.

Limitations

Like most software solutions, the first iteration of a usable system is never the last version. Ava has already integrated with WellSky and can access several other EMRs. As they continue onboarding customers, the team at Ava is very open to the suggestions of their users and will continue adding features.

Some current limitations we noticed in our intial demo:

The badge system has only three levels. Longer term employees may want to see higher badge levels to maintain motivation. Victor noted that AI systems can help add account-specific customizations.

The app is designed for caregivers and clinicians. There is not currently a model for back-office administrators and support staff. While some customization could make the app usable for the back-office, it is not designed with them in mind.

Mass messaging through email or SMS is limited to one-way, read-only communication. There is an option to add “likes,” but currently there is no option for a group or individual to respond, even privately to a company-wide announcement.

The two-way communication is limited to internal staff. Employees cannot communicate with patients from the app to advise them of their arrival time, reschedule an appointment, or ask questions before an appointment.

The manual tracking of Google reviews is not scalable.

When The Rowan Report sat down with the team at Ava, we asked about some of these limitations and additional ideas for future iterations of the program. Victor and his team have already hired at least one person to focus on new feature requests.

Final Thoughts

Gamification is not a new concept in many industries. In fact, most of us probably have a memory of a teacher or parent with an activity board to earn stars for tasks completed. We’ve been unknowingly using gamification for many years.

Smart phones, advancing technologies, and AI have increased the adoption of gamification and is infiltrating the care at home world quickly. The ongoing workforce shortage will make implementing these types of gamified systems even more important for an agency’s financial well-being.

Ava may not be the first of its kind, but it has shown innovation and ingenuity in it application. If your agency is looking for ways to reward employees, needs to stand out among rival employers, is looking to reduce administrative costs, or needs a simpler way to see reports and statistics from multiple sources, Ava may be a viable solution.

We see great things coming with future iterations of the app and the software and I’m sure this is not the last we will here of Ava. For more information, visit joinava.com.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Generative AI Comes to AlayaCare

Artificial Intelligence

by Kristin Rowan | Jun 27, 2024 | Artificial Intelligence, Caring for the Caregiver, Product Review, Vendor Watch

by Kristin Rowan, Editor

Generative AI and Artificial Intelligence are taking the world, and the care at home industry, by storm. Not surprisingly, there are only a few companies that are doing AI well. We’ve started reviewing the best of of them. So far, each company doing AI well has a unique solution to a pain point in home care. No two companies are approaching or using AI the same way. This week, we’d like to re-introduce you to a company we’ve reviewed before that has a new Generative AI app launching soon.

History

Practically a household name in home care, AlayaCare is a 10-year-old software company that started as a mobile workforce platform. Like many of us, once Adrian Schauer, Co-Founder and CEO, spend some time in the care at home world, he was hooked. He shifted the focus of AlayaCare to the care at home space. With parents in their 80s, Adrian found a lack of inspiring software in the industry in Canada and he felt like that was an important problem to solve.

“Care workers are doing God’s work, and they are not getting the support they deserve,” says Schauer. In Canada, where AlayaCare started, agencies combine home health and supportive care. Because of this, the largest patient base on the AlayaCare platform is on the supportive care at home side, but they now operate within home health as well. Since 2021, AlayaCare has added hospice to their network with the acquisition of Delta Health.

AI Comes to AlayaCare

Through many iterations of the software, AlayaCare has advanced with new technological capabilities. Now, AlayaCare is embracing artificial intelligence; more specifically, Generative AI. Schauer explains that the purpose of their new AI technology is “to enable the type of care we want our loved ones to receive at home.”

The new GenAI app was demoed in September of 2023 and is still in Beta testing. AlayaCare is anticipating an end-of-summer launch of the product.

Introducing...Layla

Layla is an in-app digital assistant, built on top of GenAI. It’s large language model allows the user to conversationally interact with the data in the system. It also includes a constrained internet search component. From the conversation, it can determine whether the user is seeking internal or external information.

Layla’s data exploration does more than just extracting data. The GenAi platform allows Layla to provide operational support around key metrics for employee retention.

Agency Support

AlayaCare has determined some key factors in employee retention:

Utilization
Quality shifts
Qualified Hours
Recurrent shifts
Average weekly clients
Weekday hours vs weekend hours

Focusing on these factors, Layla provides improvements in onboarding, scripting information, data migration, and scheduler use of time.

Features

Visit Optimizer

AI generated, automated scheduler that takes into account route management, skill matching, daily hours, and schedule optimization to optimize care and reduce time from referral to first appointment.

The scheduling automation includes push notification capabilities to send schedule updates to clinicians in real time. As each week’s schedule is created, Layla can send a push notification to each clinician. It asks them to verify their availability and confirm the next week’s schedule.

Additionally, Layla considers environmental factors such as pets, neighborhoods, and other family members in the home. According to AlayaCare users, the Visit Optimizer offers up to a 98% decrease in time required to fill visits, 35% improvement in visit fulfillment, and 35% improvement in data quality.

Notable

Notable transforms notes from patient visits, forms, and client records. Then, it uses AI to review, compile, categorize, and tag all the notes.

From this information, Notable compiles an activity of daily living (ADL) for each client, including whether and why a task was completed. This information is also moved to the risk dashboard. The risk dashboard shows the whole population, the risk of that population, identifiable trends, risk level, and whether the risk has remained stable over time. All of this information is compiled into a single risk dashboard with customizable reports.

Additional security measures for Notable include a grounded model to reduce the risk of AI hallucination and ensuring no PHI leaves the dashboard.

Employee Retention Dashboard

Several factors impact employee retention. Among the top reasons for employee dissatisfaction are pay and benefits, inconsistent hours, and safety concerns. The current workforce shortage means keeping your best employees is more important than ever. With a quick snapshot of your employee satisfaction and engagement, you can address concerns earlier and improve turnover rates.

The employee retention dashboard highlights satisfaction scores, client capacity, scheduled hours, number of unique clients, overall turnover rates, turnovers by location, and more.

“Having a tool to predict employees who may be disengaged or dissatisfied prior to this happening is invaluable,” said Lee Grunberg, President & CEO, Integracare. “With the dashboard and algorithm behind it, we can see a caregivers’ satisfaction or engagement trend over time, and deploy preventative measures to reduce the likelihood that they’ll resign. It has empowered our coordinators to be much more retention-driven.”

On Deck for Layla

I spoke with Adrian Schauer, Co-founder and CEO of AlayaCare, during the online demo. “My passion project is…Layla. The people in your agency should be building relationships and making decisions. Anything else should be done by automation.”

AlayaCare is currently in a high growth mode to build marketshare across the personal care and skilled sides of the marketing. Schauer’s goal is to elevate a level above their existing capabilities with home based care providers. This includes how payers are set up, how EVV is operating, lobbying, and advocacy.

For Layla, AlayaCare is working on the GenAI capacity for chart completion by voice. Layla would use the conversational language model it already has to recognize and understand the conversation during a home visit and transcribe the conversation into notes, visit documentation, care plans, and codes.

Final Thoughts

As AI becomes more commonplace across care at home, we are scrutinizing AI platforms for safety, identity protection, accuracy, and ethical use. If you are looking for an AI solution for your business operations, we caution you to use discretion in your use of AI and thorougly vet the AI platform prior to adoption. We will continue to provide updates when Layla launches later this year. But, for now, it looks like we’ve found one more technology platform that is using AI the right way.

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

AI before AI

Artificial Intelligence

by Rowan Report | Jun 13, 2024 | Artificial Intelligence, New Tech, Partner News

by Tom Herzog, COO of Netsmart

Navigating the Next Era of Tech-Enabled Healthcare

While the talk is about Artificial Intelligence, the immediate opportunity is Augmented Intelligence.

Some thoughts from Tom Herzog and Matthew Arnheiter

We are living through one of the most exhilarating times in healthcare, a journey made possible by significant milestones over recent decades. As healthcare technologists deeply committed to the cause + communities we serve, we’re excited by the promise of the upcoming era of technological empowerment. This phase is set to showcase and expand upon the extensive work done in digitizing healthcare, highlighting the relentless pursuit of innovation that has characterized our field. In conversations with colleagues and clients, we have recognized the need to explore these developments as we progress collectively. Matthew and I thought a series of reflections on these conversations would be helpful for all of us, providing insights into technology’s transformative impact on healthcare and the critical initiatives currently underway. We envision this dialogue as a series of posts throughout the year, sparking discussion and reflection as we navigate forward.

Back to the Future

In 2015, we envisioned a future where the concept of navigation as we know it would be obsolete, advocating for a universal search that is nearly autonomous, informed by the known context specific to every role. By 2019, we were discussing workflow automation, using the example of Lane Departure Warning systems in automobiles as a metaphor for technology that enhances outcomes through precision responses. The pace at which these technologies are evolving is astounding, moving beyond mere speed of thought to how we can iterate at the speed of innovation itself. Before we achieve the aspirations of true Artificial Intelligence, we must start with Augmented Intelligence, which may very well be the most significant technological innovation in my lifetime.

The Gentle Guidance of Technology: Augmented Intelligence in Healthcare

Artificial Intelligence (AI) and Augmented Intelligence stand as beacon forces driving innovation forward in this fast-evolving technology landscape. Drawing an analogy to driver assistance systems in modern vehicles, we explore the nuanced differences between these concepts, simplifying their understanding and underscoring the distinct roles in enhancing human capabilities.

Artificial Intelligence: The Autonomous Navigator

Imagine AI as the driving force behind fully autonomous vehicles, adeptly navigating complex terrains without human intervention. This epitomizes the grand aspiration of AI: to emulate or even transcend human Intelligence in specific tasks, thus granting machines the ability to function independently. It’s a prospect that is as exhilarating as it is intimidating, reminiscent of scenarios depicted in futuristic films. Such advancements bring to light profound questions about the limits of technology and the ethical considerations it entails. While we marvel at the potential, apprehension about the unknown shadows our enthusiasm. As we venture into this era, it’s imperative that we tread thoughtfully, balancing our ambitions with caution, as we unlock new realms of possibilities. Together, we must navigate this journey towards outcomes that are not only innovative but also meaningful and ethically sound.

Augmented Intelligence: The Co-Pilot’s Nudge

Conversely, Augmented Intelligence mirrors the driver assistance systems in vehicles – providing “nudges” or guidance while ensuring the driver remains in control. These systems bolster safety and efficiency, complementing human Intelligence with technological support. This partnership epitomizes the collaborative synergy between technology and human skills for a safer and more efficient driving experience.

The American Medical Association (AMA) aligns with this vision, emphasizing Augmented Intelligence’s role in enhancing human Intelligence rather than replacing it. The AMA advocates for the use of AI in healthcare as a means to augment the capabilities of medical professionals, not to substitute their critical thinking or clinical judgment.

Augmented Intelligence in Healthcare: Enhancing the User’s Ability

Reflecting on the transition from conceptual frameworks to tangible applications, we’ve initiated the Augmented Intelligence family. These solutions are meticulously designed to support clinical, operational, and financial workflows across all healthcare roles. Aimed at simplifying user experiences, these tools provide the best available context and automate information for validation and use as needed. This initiative marks a significant step in harnessing the potential of augmented Intelligence, enabling transformative shifts in healthcare practices and outcomes.

Michelle Donelan MP, reflecting on the U.K.’s commitment to AI in healthcare, highlights the transformative impact of augmented Intelligence, “AI will revolutionize the way we live, including our healthcare system. That is why we’re backing the U.K.’s fantastic innovators to save lives by boosting the frontline of our NHS and tackling the major health challenges of our time”. Donelan’s statement emphasizes the government’s support for utilizing AI to enhance healthcare delivery and address pressing health issues.

Augmented Intelligence promises to extend the partnership between human capabilities and technological advancement to medical professionals. Vincent Liu, MD, from Kaiser Permanente, elucidates this synergy, stating,

“There is a stage at which regulations can stifle some of the innovation [that AI might advance] … There is a role for providing a safe harbor [from certain regulations] so that we can use our best data to improve our patients’ care.”

This perspective underscores the potential of augmented Intelligence to enrich patient care by integrating comprehensive data analysis within the regulatory framework.

From the inception of conversations at our annual user conferences in the early 2000s to the present, we’ve witnessed the evolving landscape of healthcare technology. The decades-long journey of healthcare digitization has set the stage for today’s advancements, where Artificial Intelligence and Augmented Intelligence solutions leverage data to significantly improve care and operational efficiency.

Navigating Ethical Considerations

The integration of Augmented Intelligence in healthcare navigates through a maze of ethical considerations. Upholding the sanctity of the caregiver-patient relationship, ensuring patient privacy, and addressing potential biases in AI algorithms are paramount. The objective is to leverage Augmented Intelligence in a manner that respects these ethical boundaries while enhancing patient benefits.

A Future of Collaborative Care

Looking ahead, the promise of healthcare augmented by Intelligence offers a landscape where clinicians are equipped with unprecedented tools and information. This era does not diminish the essence of human judgment or the significance of the human touch in medicine but serves as a potent ally to these irreplaceable elements of care.

A Journey of Human-Machine Collaboration

Augmented Intelligence in healthcare symbolizes the collaboration between human Intelligence and artificial capabilities. This collaboration is not about relinquishing control but about enriching human expertise to tackle modern healthcare challenges. As we continue to integrate this technology, it heralds a future where healthcare is more personalized, predictive, and precise. The path forward, illuminated by the gentle guidance of Augmented Intelligence, promises a realm of endless potential for improved health outcomes for all.

Our immediate focus is three-fold 1) providing the communities we serve with the benefits of Augmented Intelligence, 2) ensuring we achieve Meaningful AI for every role, and 3) doing so through incremental progress so that AI now is a reality.

Final Thoughts

If you are reading this, you are likely one of the pioneers helping forge the path we are on today. If it were not for the initial efforts to digitize the ecosystem, we would not be talking about this today. Thank you for making this happen, for your perseverance and tenacity to find a way. Now we are at the transition from AI as a futuristic concept to its current role in shaping healthcare practices marks a remarkable chapter in the ongoing story of innovation in healthcare. It reaffirms the importance of digitization as the foundation upon which AI and other emerging technologies are built, enabling a future where healthcare is more informed, more empowered, and, ultimately, more human.

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Augmented intelligence Tom Herzog Tom Herzog is responsible for leading solution and technology strategies focused on person-centric design to optimize workflow, efficiencies and outcomes. His teams work in collaboration with both clients and partners to deliver comprehensive solutions for the human services and post-acute care communities.

Tom oversees multiple business units, including Netsmart consulting organization, solutions, development, engineering, technology, innovation, product development, IT, support, human resources, legal and operational functions.

Tom’s additional experience includes leading teams to automate systems and integrate financial, document management and information systems. He has been recognized for his ability to create innovative approaches and strategies that deliver results through vision and building strong teams.

Tom earned a bachelor’s degree in business management and human relations from Mid-America Nazarene University. He serves on the boards of the Overland Park Chamber of Commerce and the United Community Services of Johnson County.

Curantis Solutions Partners with Amazon HealthLake

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by Kristin Rowan | May 30, 2024 | Admin, Artificial Intelligence, Vendor Watch

by Kristin Rowan, Editor

Having a lot of data can help grow your business, streamline processes, improve efficiencies, and make your agency more profitable. But, if you don’t know how to use the data, or simply don’t have the time and man-power to analyze the data, then those hidden treasures waiting in all that data remain hidden. Understanding the value of that data, Curantis Solutions partners with Amazon HealthLake to help you harness it.

Curantis Solutions is a Texas based company delivering value to hospice and palliative care agencies. Their cloud-based management solutions help you increase operational and financial efficiencies while still offering well-coordinated and high quality patient care. The platform works to address two common pain points in our industry: siloed data and software systems that operate separate from each other. Curantis Solutions re-imagines workflows to reduce hours spent on tasks outside of direct patient care.

The Impetus for Change

New CMS regulations and the HL7 Fast Healthcare Interoperability Resources (FHIR) create standards that providers and health care plans must meet. This could help home health and hospice agencies with clinical data issues. FHIR imagines a unified EMR system for greater interoperability. Facing FHIR compliance, Curantis Solutions turned to AWS to help centralize their data. Using Amazon HealthLake, a fully managed FHIR service, Curantis was able to make their client data interoperable.

The Solution for Curantis Solutions

Using Amazon’s Working Backwards process, Curantis found a customer-centric solution. AWS helped Curantis work through:

Business objectives
A free, introductory program, “Gain Insights”
Cloud set-up and solution design

Curantis also implemented Amazon Kinesis to help collect, process, and analyze real-time data. All of Curantis’s data is now easily accessible, opening the door for AI, analytics, and business intelligence.

Curantis Solutions and Amazon HealthLake Data Processing and Analytics

Using Amazon, Curantis Solutions can build visual dashboards and reports. The visual reports help agency administrators understand and apply the data at a glance without spending hours analyzing the data points. The integration allows data analysis in almost real time. The Amazon suite of services aids Curantis in growth and enhanced data processing for their clients. It also allows Curantis to highlight powerful industry and patient data trends. These key indicators will help with critical decision making for continued high quality patient care.

This new platform adds expanded abilities to meet customer needs:

Enhanced partner integrations
Diverse way to prensent a patient-focused view
The power to make predictions about a patient’s decline based upon chart data
The ability for customers and internal stakeholders to easily explore data

About Curantis Solutions

Curantis Solutions was born from a desire to put hospice and palliative care first. With a genuine culture of caring, our team is dedicated to creating a refreshingly simple software experience that utilizes emerging technology, smart design and a cloud-native/serverless architecture to create an experience that is congruent with the technology you utilize in your everyday life. It’s time for hospice and palliative care software to make life easier vs creating arduous workarounds and added frustration. It’s time you experience Curantis Solutions!

About Amazon HealthLake

AWS HealthLake is a HIPAA-eligible service offering healthcare companies a complete view of individual and patient population health data using FHIR (Fast Healthcare Interoperable Resources) API based transactions to securely store and transform their data into a queryable format at petabyte scale, and further analyze this data using machine learning (ML) models. Using the HealthLake FHIR-based APIs, healthcare organizations can easily import large volumes of health data, including medical reports or patient notes, from on-premises systems to a secure, compliant, and pay-as-you-go service in the cloud. HealthLake offers built-in natural language processing (NLP) models to help customers understand and extract meaningful medical information from a single copy of raw health data, such as medications, procedures, and diagnoses.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Telehealth and AI in Home Care: An Interview with Dr. Pamela Ograbisz

Artificial Intelligence

by Kristin Rowan | May 23, 2024 | Artificial Intelligence, Clinical, Telehealth

by Kristin Rowan, Editor

Telehealth’s evolution includes the dramatic shift to at-home and hybrid healthcare models post COVID-19 as well telehealth’s role in program management and staffing. From telehealth’s earliest models to today’s automated systems, Telehealth and AI have future implications for care at home. I recently sat down for an interview with Dr. Pamela Ograbisz, a nurse practitioner with expertise in telehealth spanning almost two decades.

The Rowan Report:

First off, thank you for taking the time to talk with me today. Can you give our readers a brief introduction about you and your background?

Dr. Pamela Ograbisz:

I have been in telehealth for about 19 years now. I’ve been a nurse practitioner for 25 plus years. My specialty is cardiothoracic surgery and critical care. I have it was started out as a nurse in CT surgery, went back to school, became a nurse practitioner, then worked in CT also my entire career in critical care. We had an opportunity roughly 17 years ago when I was working in a cardiothoracic unit where we were connected by bridges and tunnels and water.

RR:

And, how did you come to be involved in telehealth?

Ograbisz:

We covered seven different sites and we weren’t able to get to all of our patients in a timely manner. We were struggling. We were trying to figure that out. A nurse reached out to us and was on a flip phone. She was taking photos and sending things and we were able to piece together a plan because of that. We literally all sat down that night after around and said, we need to do something like this. And we were attached to a medical school. And so we got them involved as well. And we built one of the first ICU bunkers in the classroom for telemedicine. And it was really sort of the beginning of something amazing. And I saw how well it worked. And I had the privilege of going around and building more of those programs.

RR:

And this eventually brought you to LocumTenens.com?

Ograbisz:

I was recruited by LocumTenens.com. When I first joined them, they had roughly 7% of their business was tele[health] and it was all behavioral health and they were really trying to expand their footprint. And of course, this was prior to COVID, we were still dealing with a lot of legislative issues and not everybody necessarily believed in it. It was still very scary for people and we were trying to sort of showcase what we could do. And so I came in and wrote a lot of policy and procedure and then COVID happened and we had to flip everything over it and we were poised to do so, which was fantastic.

So overnight we started turning on just loads of programs, 100% virtual. And then honestly, a lot of them never went back or they’ve come to a hybrid model. So now you can then convert those programs from traditional boots on ground all the time to more, you know, expandable, flexible models that have a hybrid option that includes telehealth.

RR:

Are you still operating the telehealth programs for LocumTenens.com?

Ograbisz:

My role now is I run LT Telehealth, which is a company inside of LocumTenens.com. We’re not a stand alone, but we do run all of the telehealth programs inside of the company. I also oversee all APP (advanced practice provider) relationships and how we’re growing that business and then our legislative arm.

RR:

LocumTenens.com is a full service staffing company, right? How are you finding the workforce shortage right now?

Ograbisz:

So, I would say that probably for a while, we commiserated with the health systems. But, filling the gaps from workforce shortage is our business.

I will tell you this, I graduated school a long time ago when I got out, it didn’t matter if you were a doctor or a nurse practitioner or a PA, your goal was to join a practice. You wanted to become a partner and you wanted your name on that building and you wanted to own a piece of that building. Nobody was owned by the hospital groups. I felt like with the evolution of the electronic health record, everything changed. People were asked to do a whole lot more. All of a sudden it became a lot of boxes to check a lot of things to tick. You sat on more and more committees. It became more and more about the paperwork. And then of course, with the advent of EHRs, billing changed; CMS codes changed how you got paid. People started bucking the system. And so what we saw then honestly was a shift. Now people coming out [of college] are like, yeah, I’m not joining a practice or I’ve left my practice. This gives me a new creative way to be part of medicine with flexibility which no one ever promised you when you got out of school. Right? No one ever said, “You want to be a cardiothoracic surgeon? Work, life balance is for you!” No, right? 80 hour weeks and sleeping in the hospital. You signed up for it; you knew it. And now people have been given a glimpse of what it can be and what it could be. And so I think that the physician shortage 100% exists, but COVID forced the gig economy. And so what we’re seeing is people wanting to work on their own terms and 1099 contracting does that for them.

RR:

How are you seeing telehealth working in care at home?

Ograbisz:

So, we’ve been working on the medical hospital-at-home pieces trying to figure out how we can sort of fit into that model. We’ve seen a lot of really wonderful pilot programs come out of Mayo and Hopkins and what they’re doing. I think the biggest problem right now is they’re not reimbursed well. That is making it very hard for other systems that don’t have deep pockets like those two facilities to scale those programs to any kind of large extent. What we would say is we know that it’s better. If a patient is too ill to leave home, we can facilitate a visit with the doctor right from the house. We’ve found it is especially helpful in the oncology program we launched when a doctor has to deliver bad news. The pushback we got was the patients are not going to be able to adapt and get that kind of news through a screen. But the patients really proved that wrong. It was the patients who said, “If someone’s going to tell me that I have six months [to live], I don’t really want to hear that in a sterile, cold, doctor’s office. I really am much happier if I could be in my own environment and process that information.”

RR:

What is standing in the way of a robust telehealth system for hospitals, physician groups, and home health?

Ograbisz:

I mean, CMS obviously needs to catch up with the telehealth. They were doing it during COVID. We need to extend that so that those payments, as long as the coding is all there, those payments need to come through for telehealth. But when you combine it with home health and hospice, you have that in person touch point. So the whole visit then is reimbursable, which is why a lot of hospitals and physician groups are partnering with home health, hospice, and palliative care or organizations now because you get that in-person visit, but everything is sent back to the physician to oversee changes in care, oversee changes in medication. At home care and physician care combined, the reimbursement goes into place because you have that touch point there, a face-to-face visit. They can verbally and visually see everything that’s going on, but then it goes back to the physician and they can then also get reimbursed for that. So there’s a lot of that with telehealth that is crossing over. Home health and hospice agencies need to start using telehealth and they need to be partnering with the ACOs and they need to be partnering with physician groups and now they have to partner with payers, especially as we move to the value based system. They have to partner with them because there’s only a certain amount of money that each patient is going to get. Some of it’s going to go to the hospital, some of it’s going to go to the physician and some of it’s going to go to the home health company and if there’s no partnership then there’s no money. So, you know, they have to take on some of that risk, but telehealth is the way to do that.

RR:

We’ve been talking a lot the last year or so about the rapid advancements in AI. What we’re seeing is that AI is impacting interoperability, telehealth, direct patient care, and so much more. What do you see happening in health care with Ai?

Ograbisz:

Yeah, I think it’s a huge unknown. I think everyone’s afraid to commit. I think there’s more scary stuff than there is positive stuff. So right now, what we’re worried about is someone taking on my identity, somebody being able to give advice in my voice with my likeness and put that out somewhere. So I think when you talk to providers, they see more of the scary side and how are we going to control it? But then you look at the most amazing pieces which is I can use AI to help me form a better diagnosis, to cultivate more ideas for how to treat things for each how process and procedure, right? How do we go about garnering information, which is what I think AI will help us do better in the telehealth space. I think it will be interesting to see where all of the programmatic goes. I think more towards like holographs and literally like Star Trek lead people into rooms, you know, life size images where it’s not just we go from just a 2D flat screen to really look at 4D, you know, being able to really see and perhaps even with scans and patient monitoring and you can hold the scanner up and I can see your liver, who knows? I think the possibilities are endless. But I think right now in all honesty, I think it’s fear…until we figure out a little bit of the regulatory side of it.

RR:

You’re also working on advocacy for telehealth on state and national levels. Will you follow up with us on how the next round goes as far as extending the reimbursement for telehealth?

Ograbisz:

Absolutely! I’ve written a lot of pieces that I’ll share with you. We’re always happy to collaborate.

RR:

Thank you, again for your time. Your insights were wonderful.

# # #

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only.
editor@therowanreport.com

For more information on Locum Tenens visit: https://www.locumtenens.com/

Pamela Ograbisz

Vice President of Clinical Operations

Pamela Ograbisz, Associate Vice President of Telehealth for LocumTenens.com. With 20 years of experience in cardiothoracic surgery and internal medicine, she is passionate about delivering quality healthcare in a timely manner. Dr. Ograbisz is confident that telehealth programs are the key to improving health and the overall patient experience

Constant Therapy and Elara Caring form Partnership

Artificial Intelligence

by Kristin Rowan | May 16, 2024 | Artificial Intelligence, Clinical, Vendor Watch

By Kristin Rowan, Editor

Care at home has expanded in the last twenty years to include care that was previously received in hospitals, SNFs, and therapy centers. As care at home is increasingly recognized as a more cost efficient way to provide care with better outcomes and lower rehospitalization rates, we can expect more services to be offered in the home. We recently received report of one such expansion with the announcement that Constant Therapy and Elara Caring have partnered to offer speech-language and cognitive therapy support in the home.

About Constant Therapy

Led by Founder & CEO Veera Anantha, PhD, Constant Therapy offers an AI-driven platform for speech-language and cognitive therapy. The recommended dose of these types of therapy is high. With fewer therapists available, most patients aren’t receiving the recommended frequency of patient care.

Constant Therapy decreases the number of needed in-home visits using a digital program with 500,000 customizable exercises. The app also provides insights into patient performance and improvements. The AI tracks accuracy and speed over time and naturally progresses the patient based on that performance.

Delivery of Care

Constant Therapy is a personal assistant for the therapist to provide more care to more patients. It also has a time saving component. Constant Therapy automates all of the documentation and home exercise programs a therapist has to keep up with, in addition to providing updates to physicians.

Mobile App

The patient app can include family members who can log in to track their loved one’s progress. The app also includes RPM to track whether the patient is adhering to the homework assignment. The app tracks how long the patient spends on a task, how many tasks are completed, and progress over time. Additionally, the therapist app can link multiple clinicians, caregivers, physicians, and hospitals to increase continuity of care.

Direct and Indirect Care Sessions

During a care session, Constant Therapy acts as a digital workbook. The workbook is used to standardize delivery of care and objectively measure progress. Outside of direct care appointments, the app acts as a homework tool for the patients. It provides assignments for continued progress when the therapist is not present.

About Elara Caring

Elara Caring is a home health agency that operates in 17 states and has 200 locations. They offer skilled home health, hospice, personal care services, behavioral health, and palliative care. Elara’s mission is to expand home care access by embracing the industry’s most innovative technologies and models. They strive to hire compassionate people who believe in taking care of their patients, clients, care providers, and each other.

From the Source

Mark Salley

VP of Innovation and Rehabilitation at Elara Caring said, “Since our inception, Elara Caring has utilized patient data insights – more than 120M data points annually, in fact – to drive our strategic decisions that improve quality care and patient outcomes. This has brought us to Constant Therapy. They have similar values and a shared goal to incorporate data into their evidenced-based, treatment platform. With Constant Therapy, our patients are seeing quicker recovery of speech, cognitive function, and language deficits following healthcare incidents including stroke, TBI, dementia, and more. We are excited to start this new chapter in close partnership with Constant Therapy. This will be a gamechanger for our patients and clinicians.”

Noah Poskanzer

Director of National Accounts at Constant Therapy said, “Part of being a home health clinician is to set the patient up to be as successful at home as possible. Not just in the U.S., but around the world, the number of people trained to provide therapy are [sic] going down but the number of people needing therapy is going up. Constant Therapy is providing patients with additional therapy when therapists are not present in the home with their patients.”

Constant Therapy Pilot Program

Prior to the full-scale partnership, Constant Therapy and Elara Caring launched a pilot program in June of 2023 with 115 patients across three markets. The results of that pilot program include:

Constant Therapy and Elara Caring Outcomes<br />

Increased Time Savings
- 10-15 minutes per patient session
- 60-90 minutes per day for a clinician with a six-patient caseload
Increase Patient Access
- 115 patients performed 92,000 additional exercises independently at home
Improved Patient Outcomes*
- 17% average increase in task accuracy
- 54% improvement in task processing speed (latency percentile)*

*Patient outcomes calculated using Constant Therapy task performance

As Constant Therapy expands to include more agencies and more patients, they expect to continue to see improved patient outcomes, better access to care, and the ability to serve more patients. We will continue monitoring their progress.

# # #

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Veera Anantha, PhD, is the Founder and CEO of Constant Therapy. Veera is a hands-on technology executive and business leader with a passion to bring positive change through the power of data and AI. He created Constant Therapy, an award-winning mobile app that uses artificial intelligence to help tens of thousands of people living with neurological conditions regain essential life skills.Veera also successfully built a number of innovative products at other startups, including at a company acquired by Apple that developed the world’s fastest digital signal processor.

He began his career as a Lead Engineer at Motorola developing mobile software and hardware products, and later, as Vice President of Engineering at a startup acquired by Motorola, developed software products that are now used worldwide to manage wireless networks. Veera has six technology patents and recently won TiE Boston’s Entrepreneur of the Year Award. He is an expert mentor at MassChallenge HealthTech and Insight Data Sciences, is a Charter Member of TiE Boston, and is a guest lecturer for Entrepreneurship at Questrom School of Business. Veera holds a PhD in electrical and computer engineering and a master of science degree in physics from Northwestern University, as well as a bachelor’s degree from the Indian Institute of Technology in Bombay.

Mark Salley, Vice President of Innovation and Rehabilitation Solutions at Elara Caring, has been a Physical Therapist

since 1995 and has worked in the homecare sector since 2003. His journey has been marked by his commitment to integrating data into the decision-making processes, revolutionizing the approach to clinical and operational challenges at Elara Caring.

Throughout his 25-year career, Mark has focused on enhancing patient care. His early years as a Physical Therapist lend to his understanding of the intricacies of healthcare delivery, particularly within the homecare landscape. Transitioning into leadership roles, Mark recognized the transformative power of data in shaping the future of healthcare, and at Elara Caring, he is spearheading initiatives that leverage data-driven insights to drive meaningful change.

The Right Way to Use AI in Healthcare

Admin

by Tim Rowan | May 16, 2024 | Admin, Artificial Intelligence, Clinical, New Tech, Outcomes, Product Review, Vendor Watch

by Tim Rowan, Editor Emeritus

For better or worse, healthcare has begun the inevitable adoption of Artificial Intelligence. Before you consider adopting AI technology, know that there is a wrong way and a right way to use AI in healthcare. In a companion article this week, we describe the criticism insurance companies are getting for deploying AI in healthcare to harm patients. As a balance, here is a review of a product that we find to be using AI in healthcare to help both patients and Home Health Agencies.

The Problem

Home Health referral documents from physicians or hospitals can consist of more than 100 electronically transmitted pages. Some agencies report occasional packets exceeding 1,000 pages, often in a variety of data formats. Some are standard data formats, such as a face sheet, but most are unstructured, consisting of images or narrations, sometimes in paragraphs, sometimes in incomplete sentences. Worse, patient data interoperability can be limited by unstructured data. Too Much Paperwork

More often than not, most of these pages are never read. Thoroughly interpreting that much data is nearly impossible for a human. Consequently, nurses too often approach an admission evaluation visit with an incomplete picture of a patient. The result can be gaps in care or treatment, inaccurate OASIS assessments, incomplete or poorly sequenced diagnosis codes, and improper care plans. These obstacles can impact both patient outcomes and agency revenue.

One Newly Available Solution for the Right Way to use AI in Healthcare

We recently attended a product demonstration and followed it up with updated descriptions to learn details about new product developments. Over the next three months, Select Data, in full disclosure one of our sponsors, will be introducing an AI-powered suite of products that has been designed over many years of development to support clinical, data driven decision-making. One by one, it addresses the problems described above.

The new system, SmartCare, empowers clinicians to harness previously hidden insights while reducing bias and cognitive overload. It enables them to steer their decisions with enhanced precision while maintaining their pivotal role in patient care, eliminating one of the common reasons many Home Health administrators hesitate to invite AI into agency processes. It does, however, make the care team’s job easier and facilitates better decision-making.

AI can read those 100 to 1,000 page referral documents in minutes, where a human may require days.
SmartCare uses AI to synthesize relevant medical history to provide a care snapshot highlighting the key diagnosis, focus and considerations for care, and recommended OASIS clinical discipline. It highlights any areas for clarification needed from physician or admitting nurse.
Clinicians can search and index specific words in unstructured data, such as narratives, to instantly identify any detail of a patient’s condition in an easy-to-read interface. Nurses approach the initial OASIS visit armed with all of a referring clinician’s relevant care findings.
Recommendations for diagnostic codes strictly follow Medicare PDGM guidelines.

Suite of Tools

1 – RISE stand for Rapid Intake Summary & Evaluation. This component of the suite summarizes all clinical data from referral sources and your EHR. It compiles this data to provide clinically relevant diagnoses, focus of care, and recommendations for skilled disciplines. This is the part of the tool that reads referral documents and supports informed decision-making. The advantages we detected go a bit beyond the technical.

When clinicians, reviewers, coders, and office staff all have access to the same patient information, it would seem that communication among disciplines would improve and that care coordination would be enhanced. It also seems logical that continued experiences of advanced access to previously hard-to-find physician comments would gradually break through the AI fear barrier reported by so many clinicians and other professionals. Select Data will provide us with actual client experiences to verify our assumptions once they have been compiled.

2 – ACE, or Admission Clinical Evaluation is SmartCare’s clinical support summary tool. It deploys AI to understand accepted OASIS assessment criteria. It then uses this knowledge to extract assessment and narrative data from nursing and therapy evaluations. With streamlined, pertinent data at the point of care, the entire care team has the same patient data. Having the same patient data enables more informed decision-making.

ACE links all patient data back to its source assessment. Doubt about the AI’s credibility should gradually diminish, even among the most AI-resistant users. Every analysis and recommendation is explained in clear language so that clinicians are likely to understand the rationale behind them. The goal is to replace every “I’m not going to let a machine tell me what to do” with “I’ll take this information into consideration with my human insights.”

Pricing

We are honoring Select Data’s request to allow them to build personalized price quotes to every prospective client. They will be represented at several state and national conferences this year. Alternatively, interested HHA representatives can contact EVP Ted Schulte at Ted.Schulte@SelectData.com

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

The Wrong Way to Use AI in Healthcare

Admin

by Tim Rowan | May 16, 2024 | Admin, Artificial Intelligence, CMS, Medicare Advantage, Regulatory

by Tim Rowan, Editor Emeritus

Lawsuits are beginning to pile up against insurance companies participating in the Medicare Advantage program. The complaint? The wrong way to use AI in healthcare is with faulty algorithms to approve or deny claims. While AI can be extremely helpful in streamlining administrative tasks — comparing physician notes with Home Health assessments and nursing notes or reading hospital discharge documents — it seems not to be any good at deciding whether to approve or deny care.

The Wrong Way to Use AI in Healthcare Example 1

The Minnesota case, November, 2023, UnitedHealth Group:

- An elderly couple’s doctor deemed extended care medically necessary
- UnitedHealth’s MA arm denied that care
- Following their deaths, the couple’s family sued UnitedHealth, alleging:
  - Straight Medicare would have approved the extended care
  - United uses an AI model developed by NaviHealth called nH Predict to make coverage decisions
  - UnitedHealth Group acquired NaviHealth in 2020 and assigned it to its Optum division
  - nH Predict is known to be so inaccurate, 90% of its denials are overturned when appealed to the ALJ level
  - UnitedHealth Group announced in October, 2023 that its division that deploys nH Predict will longer use the NaviHealth brand name but will refer to that Optum division as “Home & Community Care.”

The family’s complaint stated, “The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because [UnitedHealth’s] AI model ‘disagrees’ with their real live doctors’ determinations.”

The Wrong Way to Use AI in Healthcare Example 2

The Class-Action case, December 2023, Humana:

- A lawsuit was filed on December 12, 2023 in the U.S, District Court for the Western District of Kentucky
- It was filed by the same Los Angeles law firm that filed the Minnesota case the previous month, Clarkson
- The suit notes that Louisville-based Humana also uses nH Predict from NaviHealth
- The plaintiffs claim, “Humana knows that the nH Predict AI Model predictions are highly inaccurate and are not based on patients’ medical needs but continues to use this system to deny patients’ coverage.”
- The suit says Medicare Advantage patients who are hospitalized for three days usually are eligible to spend as many as 100 days getting follow-up care in a nursing home, but that Humana customers are rarely allowed to stay as long as 14 days.
- A Humana representative said Humana their own employed physicians see AI recommendations but make final coverage decisions.

What Makes This Possible

According to experts we speak with, there are many ways to use data analytics. The insurance companies named in the lawsuits use predictive decision making. This way of analyzing data compares a patient to millions of others and deduces what treatment plan might be suitable for one patient, based on what was effective for most previous patients. Opponents of this method have called it “data supported guessing.”

A superior analysis method experts are coming to understand is prescriptive decision making. This is taking all of the available historical and current data surrounding a patient and making a clinical decision specifically designed to that patient’s age, gender, co-morbidities, doctor recommendations, and treatment records.

Until recently, predictive analysis was the preferred method because of its resource efficiency. Examining the data of every individual patient used to be prohibitively labor-intensive, requiring hours of reading hospital records, physician notes, and claims. Today, however, AI tools are able to do that work in seconds, making prescriptive analytics and customized plans of care possible.

Fix May Be in the Works

In a February 6, 2024 memo to all Medicare Advantage Organizations and Medicare-Medicaid Plans, CMS explained the difference between predictive and prescriptive analytics. The memo said these plans may not make coverage determinations based on aggregated data but must look at each individual:

“For Medicare basic benefits, MA organizations must make medical necessity determinations in accordance with all medical necessity determination requirements, outlined at § 422.101(c)1 ; based on the circumstances of each specific individual, including the patient’s medical history, physician recommendations, and clinical notes; and in line with all fully established Traditional Medicare coverage criteria.”

In response to a request for clarification, the CMS memo laid out its rule in specific language: Wrong AI in Healthcare Prescriptive Analytics

An algorithm or software tool can be used to assist MA plans in making coverage determinations, but it is the responsibility of the MA organization to ensure that the algorithm or artificial intelligence complies with all applicable rules for how coverage determinations by MA organizations are made. For example, compliance is required with all of the rules at § 422.101(c) for making a determination of medical necessity, including that the MA organization base the decision on the individual patient’s circumstances, so an algorithm that determines coverage based on a larger data set instead of the individual patient’s medical history, the physician’s recommendations, or clinical notes would not be compliant with § 422.101(c).
(emphasis added)

“Therefore, the algorithm or software tool should only be used to ensure fidelity with the posted internal coverage criteria which has been made public under § 422.101(b)(6)(ii).”

In further responses to questions in the same memo, CMS made it clear MA plans must make the same coverage decision original Medicare would make. The only allowable exception is that plans may use their own criteria when Medicare Parts A and B coverage criteria “are not fully established.”

Knowledge of this CMS directive may give Home Health agencies one more arrow in their quiver when going to battle with powerful, profit-oriented insurance companies over harmful, illogical AI algorithm decisions.

For information on the right way to use AI in healthcare, see our complimentary article in this week’s issue.

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com