Voices: Nick Knowlton, Vice President of Strategic Initiatives, ResMed

This article is sponsored by MatrixCare. In this interview, Home Health Care News sits down with ResMed Vice President of Strategic Initiatives Nick Knowlton to learn why one of his driving mottos is “Do right,” how interoperability is helping home health operators provide better patient care during COVID-19 and how the pandemic has changed the industry’s need for interoperability. [Disclosure: Knowlton is also the board chairman of CommonWell Health Alliance.]

HHCN: You’ve had a deep and varied career. What are the most important lessons you’ve carried to MatrixCare, and what do you do here?

Knowlton: I’ve been with the Brightree and MatrixCare team for almost six years now, and I lead a lot of our strategic partnerships, and a great deal of our interoperability strategy as well. The most important lesson I’ve carried to this position is always do the right thing for your customers. We really believe that interoperability done right is a key to home health agencies and other post-acute providers being successful in a rapidly changing health care world.

A former CEO I worked for had a rule for working at the company: “Do right.” If you do the right thing for your customers and for their patients, you’ll be able to figure everything else out.


The second lesson I carry is a little more technical: If you want to do interoperability right, you do things that empower your clinicians and not distract them. The idea of going the extra mile and building good interop workflows into the product in a fashion that clinicians want to engage in and use is absolutely critical. If you don’t do that, you lose them before you even launch the product or service.

MatrixCare is heavily investing in enabling clients to connect better with their referral sources. It’s not just the initial care transition. How do you get actionable insight on your patients?

As the interoperability world evolves, we are going to get a lot more granular about what a proper initial care transition into home health looks like. Today, you see everything from an e-fax that just has a patient’s name and what they are supposed to be treated for, to a full-blown electronic chart with loads of discrete data that can be digested to help empower clinicians to more easily take care of patients.

So when you think about the power that you can unlock with these interoperability modalities, the content is not just a PDF. The content and the standards that we try to push for are based on the concept that a human should be able to read it, but a machine should also be able to read it. We want to make sure that we don’t degrade the content that we’re transporting. By doing this the right way out of the gate, we can establish links with the patient identity in the referral source system to enable better follow on interoperability.


Obviously in the home health world, this is becoming increasingly important. I think everybody’s aware of the reimbursement impacts of PDGM (Patient-Driven Groupings Model). But I think that the two key things for why interop is more important now would be the compression of the revenue cycle into a much shorter timeframe than pre-PDGM, and also the direct tie between reimbursement and having a full history of the patient including all of their disease states and comorbidities.

Do those referral sources typically know everything that a home health agency needs to know about a patient?

Typically they don’t. There certainly are some patients in the home health realm who have relatively simple care histories and simple needs, but let’s be honest: Our industry also sees patients who have the most complex disease states, the most number of diagnostic codes associated with them, and also high levels of comorbidities for those disease states.

The practical implications are that a patient might have been discharged from a hospital for a rehabilitation purpose but they are increasingly being seen in other care settings. The referral source may not know that the patient also has other chronic disease states associated with them, and they may not know the full complexity of that patient’s care history.

Once you have the initial referral and actionable insights on patients, how do you cast a wider net to learn more?

When we think about how to accomplish the ultimate interoperability mission for our customers and for their patients, it’s more than just that initial referral. Because these patients are often seen by multiple specialists and have multiple comorbidities and disease states associated with them, it’s important for us to reach out to others who have seen that patient and try to find their complete care history. That way, our providers can have a 360-degree view of the patient before they treat them.

We have been pioneering a lot of work through CommonWell Health Alliance and also connecting with Carequality and connecting with Surescripts medication history network to really flesh out what else might be going on with a patient. Some of these things could be identifying recent encounters with specialists and grabbing the patient’s chart from that location, or reaching out to Surescripts to find out what other medications have been filled on behalf of the patient. But the idea is to cast as wide of a net as possible, so that during that initial encounter with the patient, the clinicians run into as few surprises as possible.

A good example of this would be what we commonly refer to as “The Shoebox Problem,” where a clinician shows up at the patient’s house and there’s a shoebox full of medications waiting for them, and they don’t know what is the current and best active med list for that patient. They waste a lot of time and energy calling the provider who prescribed it or working with their home office to find out what amongst that shoebox is still supposed to be there and what might be missing from it.

We know that by enabling better interoperability from the referral source and by casting a wider net for these providers, we’re going to minimize the amount of work a clinician has to do chasing down the patient care history, and they will arrive much more comfortable knowing that they’re going to have a much more complete and accurate picture of what they will encounter with the patient. It makes them a lot more efficient, and enables them to spend more time on other tasks such as communicating with the patient’s family members about what’s going on and what the next steps would be.

How are referral sources thinking about interoperability and reacting to these capabilities?

We started pondering this question a couple of years ago. We felt that we had really good, anecdotal stories from customers and other care providers, but we conducted a survey in concert with Porter Research to find out exactly where referral source pain points were and how they felt about interoperability and its impact with post-acute care providers.

The results, which we released last year, were actually quite astounding.

Sixty percent of referral sources who refer patients into home health and other post-acute care environments indicated that they would be willing to switch their post-acute care partners if they were able to interoperate with them effectively. Being able to automate a referral to the post-acute care provider was listed as the number one thing they wanted to accomplish.

The pain points they’d like to avoid are some of those phone calls back and forth. Like when we discussed “the shoebox problem” — just as much as the clinicians in home health don’t like having to make all those phone calls, the referral sources don’t like answering them because they know that those medication lists exist within their system and they know they have the capability to transport to other care domains. Home health should not be any different.

What else are referral sources asking for?

Insight into the patient care journey. We knew this anecdotally and it was brought out in our research study as well. Referral sources have referred to this as the black hole phenomenon. They refer a patient to home health and they have no idea how that patient’s care progresses.

In a value-based reimbursement world where providers are increasingly asked to take financial responsibility for the care progression of their patients, not being able to have insight into how those patients are progressing is unacceptable. We’ve seen numerous proof points that the ability to provide on-demand insight into what’s happening with those patients is of tremendous value to not just the referral source, but hence their relationship with their post-acute care network.

How has the COVID-19 pandemic changed the need for and value of interoperability?

COVID-19 has been amplifying the trends that have been emerging for the past few years. As not just the staff of a home health agency, but also the referring physicians and their staff have been driven to remote workforce situations, interoperability has become increasingly important, and in some cases almost impossible to do without. If you don’t know how to get ahold of a referral source to track down additional information over the phone, or if nobody’s monitoring a fax line, doing it from an EHR system to another EHR system is a great way to circumvent that obstacle because these system by and large are always on now.

What do you see growing out of this increased interoperability?

Number one, there will be a much expanded use of remote patient monitoring and telemedicine technologies. The genie is not going to go back in the bottle. The other issue that might be a little less clear to a lot of folks is as soon as providers start adopting interoperability technologies, they really see the power of it and they really believe that it is real and that it needs to be further unlocked.

What we see all the time now is providers who were skeptical, and moved forward with some basic interoperability modalities, and have now become champions for using the technology. Frankly, they have become the biggest proponents of asking for more.

So there is a snowball effect for the adoption of interoperability in the industry. And I think COVID-19 has led to the recognition of the power and the value of multiple technologies from interoperability to remote patient monitoring to telehealth.

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

MatrixCare, provides innovative software-as-a-service solutions for home health, hospice, palliative care and private duty providers. To learn more about how MatrixCare can help your organization, visit MatrixCare.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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