Voices: Craig Mandeville, CEO and Founder, Forcura

This article is sponsored by Forcura. In this Voices interview, Home Health Care News sits down with Forcura CEO and founder Craig Mandeville to learn about the gaps he saw in the referral and order management process that led him to found his company, how home health providers are tapping into data to address the changes brought by the Patient-Driven Groupings Model (PDGM) and how soon we might see a unified payment model.

HHCN: You founded Forcura in 2012. What did you see that year that led you to launch the company?

Mandeville: The idea for Forcura came from my wife’s experience managing the relationships of the Mayo Clinic here in Jacksonville, Florida, and discharging patients from Mayo’s acute care setting into home health or hospice. 

She was often handed a stack of referral paperwork that could be 100 to 200 pages, that included the discharge summary, health and physical information and everything that had happened with that patient in the hospital. They would fax this information from Mayo Clinic to the agency, and many times all the pages wouldn’t even go through.


So then she’d be driving that information over to the care planning team, and it would sit there sometimes four to five days without being scanned and uploaded into the EHR (electronic health record) patient chart.

By that time, the post-acute clinicians had already gone out to see the patient, and they didn’t have any insights into what had happened with that patient in Mayo Clinic. I just thought it was unbelievable that the transition of care was so backwards, and there was such a lack of technology.

There was also a similar gap where in order for these agencies to get paid, they were heavily reliant on the signature of a primary care physician, which normally is not the same physician who had written the orders for home health or hospice. It was the same thing — stacks of orders, and waiting for signatures to get paid.


That’s where the light bulb went off. I knew technology could solve the worst of these problems.

To what do you attribute your rapid growth over the past several years?

Definitely the relationships with our clients and how we collaborate with them to understand their gaps today and anticipate what they need to be successful tomorrow. We then innovate around those needs, building viable, ROI-driven tools that are aligned with our mission: to empower better patient care.

We’ve also partnered with the EHR leaders across the post-acute market, and have been augmenting their EHR capability to help our customers optimize their EHR experience.

And most of all, our culture is unmatched. We hire the best people and we have been consistently voted to be an amazing place to work. When you pull all those ingredients together, it really is the secret sauce that has delivered exponential growth year over year.

What direction are you taking Forcura in 2020 and beyond?

The industry is still thirsty for workflow automation, so we’ve automated many of those referrals and order management processes or gaps that I described. This still leaves interoperability, and the desire from post-acute providers to have the best information possible to make smarter business and patient care decisions.

In 2020, we’re freeing the data locked in today’s PDF transmissions and moving the industry from being document-driven to data-driven, to ultimately connected and truly interoperable. We’re excited to offer a new integrated platform called Forcura Analytics, where our clients can determine at a glance the health of operations across their enterprise. We’ll also be enhancing our core platform to optimize our clients’ revenue cycle management. Finally, we continue to deepen the relationships we have with our technology partners to make our clients’ user experience as productive and intuitive as possible.

Ultimately our vision is to help our customers make really smart decisions in terms of onboarding the right patients at the right time, and ensuring that patient care is at the forefront of every decision that we make. Through business intelligence, analytics and machine learning, our mission is to empower better patient care by being more prescriptive with our decisions.

Last year, while acknowledging the impact of PDGM in 2020, you predicted that, “The lasting legacy of payment reform will be home health providers tapping into their clinical, operational and financial information like never before.” How are home health providers doing in that regard?

We know that for the home health agencies that we have as customers — and we have the majority of the industry using our platform — much of the coding was happening post-care planning. With PDGM, you get one shot at coding, and it has to be done upfront. That means teams must really understand what has happened to that patient, including the patient’s co-morbidities. Teams must be able to assign the appropriate diagnosis codes and other factors that will impact care planning and reimbursement.

The other thing under PDGM is looking at the data in terms of who was being sent out to do the visits, with therapy being a big concern. I think agencies well-prepared for PDGM are going back and analyzing the patient conditions, outcomes and who conducted those visits. Now, based upon the analysis of that data, we’ve seen programs put in place where visits that don’t produce better outcomes are being trimmed back. And there’s more proactive telehealth visits done by phone or by video.

PDGM poses challenges to many areas that Forcura addresses, including transitions of care. What is the biggest transition of care pain point for providers today?

To me, the biggest challenge is getting the right information at the right time to that post-acute provider so that the right care plan can be organized and implemented. It was a challenge pre-PDGM, but now, with PDGM, it really brings this to the forefront.

There is very minimal metadata being exchanged. A lot of it’s coming over in a PDF file, and expensive staff — typically with a nursing background and degree — are the ones analyzing these documents and trying to peel out all of the appropriate diagnosis codes and prospective comorbidities so that the right diagnosis is identified upfront. That ties into a huge roadmap item we’re bringing to the market this year, which is natural language processing and tools that read and understand these unstructured documents. The tools then automate much of the manual process of inputting all this information into the EHR.

We have some customers that can spend as much as four hours on that referral process per patient. We want to drastically reduce that time. Hours are unacceptable. We’d like to see that done in minutes.

Going along with that, what is the biggest opportunity?

Clearly, I think some of the main benefits of getting that information upfront is the opportunity to make really good patient care decisions from the outset. That’s good for patients and the care teams delivering that care.

There’s opportunity, too, with orders management. I think the entire billing format change of going from 60 days to 30 days is an opportunity for companies to get a better handle on their cash flow. Prior to PDGM, true optimization of processes and tools were more of a “nice to have.” Now, with payment reform, I think they’re looking at it in that “necessity” column.

Interoperability is vital, as we’ve said. How proactive do you think the home health industry has been in this area?

I haven’t seen much proactive innovation in this industry. There are a lot of reasons behind that. There’s a lot of legacy technology that still exists across the industry. And that goes for the EHRs and a lot of the ancillary tools.

We see this as a major opportunity and we’ve made some huge investments in it. We’ve made a significant investment deploying our Forcura Connect platform, which allows us to connect seamlessly with any of these legacy systems. We believe this platform is one of the most innovative ways of connecting and moving secure data back and forth.

How close do you think we are to seeing a unified payment system become a reality? And how important will technology be in that landscape?

This is a big topic. I’m on the board of the Partnership for Quality Home Health and Hospice, and there’s a lot of work being done with CMS on the unified payment system. Several of our board members provide feedback as technical experts.

I’d hope that more post-acute leaders will try to understand CMS’s viewpoint and lobby groups like MedPAC to make the right recommendations here. I believe CMS would like to see unified payment happen in the next couple of years. I think it’s more like a four- to five-year horizon in terms of getting it done right.

In one word, describe the impact PDGM will have in 2020.

I think one that resonates with me is “transformative.” This is the biggest reform that the industry has seen in many, many years. It’s really a building block on more transformation that is coming, especially with a unified payment model for post-acute care.

Editor’s note: This interview has been edited for length and clarity.

Forcura is a technology company 100% focused on health care, driven to innovate and dedicated to powering your organization through better patient care, improved cash flow and reduced administrative expenses. To find out how, visit us at forcura.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com

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