This article is sponsored by ClearCare, a WellSky company. In this Voices interview, Home Health Care News sits down with ClearCare CEO Geoff Nudd to learn about how the WellSky platforms gave users a head start on fighting COVID-19, what we might see from Medicare Advantage plans in 2021 to battle the fallout from the pandemic and the COVID-born technology trends that will remain long after the peak.
HHCN: None of us anticipated COVID-19 to become what it is, but in what ways is ClearCare’s platform built for this particular challenge?
Nudd: WellSky and ClearCare power over 10,000 home- and community-based providers that, in turn, employ over one million nurses and caregivers, so we have a huge responsibility to support our clients, their employees and the people they serve during this very challenging time. Fortunately, over many years, we’ve invested in our software solutions to meet these challenges with the agility that our clients demand. Our platforms are purpose-built to improve the safety, quality and consistency of care delivered in the home.
That focus becomes even more important during the COVID-19 pandemic because the risks are higher for both care providers and people receiving care. The agility that we’ve architected into ClearCare’s personal care platform has enabled us to very rapidly support our clients with things like standardization of risk assessments for every shift and escalation to incorporate care management teams when providers are alerted of risks.
Like you noted, all your technology platforms are already suited to work during COVID. How has your focus on personal care services and home health changed with the pandemic?
We’re responsive to our clients. We have task forces set up in every setting of care that WellSky supports that collect feedback from our clients. We aggregate what we’re hearing, make sure we’re on top of the policy situation, and then we build software solutions and capabilities that are responsive to those needs. We’re constantly monitoring our clients’ biggest challenges, their priorities, and executing on new ways to help them succeed.
Beyond that, we’re proactively addressing industry needs, now and through this crisis. Since the launch of WellSky Care Coordination, we’re making sure that we’re providing connectivity to our clients for care providers, hospitals and payers that need to find rapid solutions for engaging with the 10,000-plus home- and community-based providers that WellSky supports.
You mentioned WellSky Care Coordination. Give us the background on WellSky Care Coordination. How did it come to be? And how does it work?
Sure. Amedisys was really the catalyst for launching WellSky Care Coordination. It was Paul Kusserow, CEO of Amedisys, who recognized that a combination of both clinical and non-clinical work in the home is what powers improved outcomes and reduced cost for patients with the greatest need.
Paul also recognized that executing a roll-up of the personal care industry would be very tough because of the industry’s fragmentation. Before WellSky Care Coordination, it was hard to connect personal care providers on a large scale. So Paul and Amedisys partnered with ClearCare, now part of WellSky, to enable precise, scalable coordination between Amedisys Home Health Care and the 4,000-plus personal care providers we support.
More broadly, WellSky represents 25% of home- and community-based providers in the United States. We’re the technology backbone for some 10,000-plus in-home providers. Now, we’re expanding that point of connectivity and capability. The goal is to keep people out of acute-care settings and in the comfort of their own home.
Coordination and connectivity is always important. COVID-19 raises the stakes because timely alerts and responses to condition changes can be life or death. And so, amid COVID-19 especially, this visibility is vital to our clients and the people they care for.
This is something that I’ve been thinking about, and I’m really curious to see how this plays out. How do you think Medicare Advantage plans will react in 2021, specifically around COVID-19 and home-based care services?
COVID-19 is acting as a catalyst to help support getting people out of hospitals and into the home. That’s a meta-trend that’s been developing over the last 10 years, and represented, most recently, with the expansion of reimbursement that started a couple of years ago and continues to expand. For example, personal care qualifying as a Medicare Advantage benefit for the first time demonstrates this trend in action.
Now is the time for our industry to lean in with policymakers because some of the changes they make now to support the response will still be there when the water recedes, so to speak. Changes are happening now at a pace that’s just unprecedented, that you won’t see in a normal circumstance. By way of example, witness the announcement that the federal government will pay hospitals directly for uninsured patients with COVID-19. In normal times, that would be an incredibly contested path, and it just happened in a matter of days.
As we see these new home-based models being implemented and demonstrating increased value in freeing up hospital beds, I think you’ll see long-term support for this trend that we’re seeing anyway.
Do you think that we’re going to see specific Medicare Advantage benefits that are designed around treating the comorbidities that are going to arise from COVID?
I see it as a catalyst. In the weeks ahead, WellSky is going to share some research that we’ve executed — really, first of its kind, with the actuarial consultancy, Avalere. Since starting in this business when I founded ClearCare 10 years ago, there’s always been this dearth of data on the impact of home-based interventions for comorbid populations. The challenge has been that you need a comprehensive view of medical and medication claims, overlaid with the personal care intervention data in order to draw those kinds of inferences.
Just to give a sneak preview, when we overlay claims data with our personal care intervention data, specifically for personal care, there was a $530 PM-PM (per member per month) difference. That’s well over $6,000 per year lower cost when comparing a population receiving home care, personal care, and a similar population not receiving that intervention. In a payer context, that is a massive financial impact, and that impact increases for specific functional limitations.
We know functional limitations act as a 3x multiplier for cost in comorbid populations, so whether caused by COVID or not, the financial and outcomes impact of home- and community-based interventions is significant. In the context of a value-based care world and in the context of being at risk, whether caused by COVID or otherwise, we will inevitably see increased deployment of home and community-based care as a lower cost, more desirable substitute for hospitalizations and acute care.
To date, through the ClearCare platform, Amedisys has connected more than 1,300 personal care agencies with more than 320 home health agencies in 34 states. What are you hearing from these agencies in terms of outcomes?
For example, one of our personal care clients, Senior Solutions, headquartered in Tennessee with about 20 locations, has been leveraging the WellSky Care Coordination program since we initially launched it. And so far, that agency has received about 200 requests for coordinated care sent to them from Amedisys patients, and they’re building more momentum as they work with the payer resources in their area.
They’re based in Tennessee where the program launched. Other states are still ramping. But the impact on the quality of care can’t be understated. It remains the first program of its kind to really break down those silos between home health care and non-medical personal care at scale.
What is the most important way that data can empower home-based care providers in the age of COVID?
The first questions that payers ask, whether it’s the national payers like United, CVS-Aetna, Humana or a local Blue, as they try to build their new supplemental benefits, are, “Where do I target my interventions? How do I design the benefit so that it helps differentiate my plans, and impacts medical expenses across my population?”
Even the largest plans in the United States struggle to find that data because it’s the same challenge of, “How do I overlay claims data with data on functional limitations, social determinants, and home care intervention data to prioritize and target members to maximize impact on outcomes and costs?”
WellSky has millions of patient-years of home care intervention data, and we’ve now found ways to overlap it with the claims data. That helps us answer those questions and show those specific disease states for which home- and community-based care can deliver the highest impact.
These solutions are only enabled by data, but just having the data by itself isn’t good enough. You also need the data to be integrated into workflows and operating platforms that are used day-to-day. This is more important than ever. And stay tuned because we’ll be previewing more of the actuarial work in an upcoming webinar with Home Health Care News.
Looking ahead, how do you foresee the role of technology changing in senior living once COVID is past its peak? What COVID-borne trends will remain?
COVID-19 has certainly been a catalyst and wake-up call for all stakeholders to be more proactive across the broader healthcare industry, and much of that necessarily applies to home- and community-based providers. I think one of the things that this crisis has highlighted is that for the most vulnerable parts of our population, there are challenges around the social determinants of health.
Things like access to food, access to household supplies, and access to medications are really critical. And a lot of the largest distribution mechanisms in the United States are actually not traditional health care providers — they’re organizations like Walmart, Walgreens and CVS-Aetna.
You start looking at models that integrate food, household supplies, medications, along with home- and community-based care delivery, and you start seeing the potential for transformative models for our most vulnerable populations.
There’s often this tendency in the mass media to focus on healthier populations and care models that impact those healthier populations. But the top 5% of patients in the United States drive 50% of health care costs, and many of them are characterized not only by their clinical conditions, but also by functional limitations and social determinants.
Some of them have trouble leaving the home or getting their own food or simply taking care of themselves day-to-day. When a patient can’t self-care, the costs multiply by 3x on average and outcomes worsen. And so, I think we’ll see the emergence of highly integrated and coordinated care models, leveraging telehealth, home health and personal care networks, as well as non-traditional players such as the largest retailers, to meet the long-term challenges of patients with functional limitations and social determinants.
Editor’s note: This interview has been edited for length and clarity.
ClearCare, a WellSky company is the leading web-based operating platform for home care agencies. Check out the ClearCare COVID-19 Resources Page to see the latest product information and business resources that are most helpful to personal care agencies during this time and register now for ClearCare’s webinar May 7 on the new evidence of the value of personal care.
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 email@example.com.