This article is sponsored by PointClickCare. In this VOICES interview, Home Health Care News sits down with PointClickCare EVP and General Manager Mark Tomzak to learn how he learned to build the best remote culture, how the definition of “appropriate care setting” changed in 2020 and why the home-based care industry sits at the center of the new normal of care transitions.
Home Health Care News: What career experiences do you draw from most frequently that inform you in your position at PointClickCare?
Mark Tomzak: We’ve always been a big proponent of culture at PointClickCare. We can separate ourselves, not by feature function, but rather the value we provide our clients with our solutions and by the people doing the work to bring the best that we have to the market. And I think in 2020, that changed. Not the emphasis on culture, but how we keep a culture going when we’re remote. Everybody is working from home. Unfortunately, some people may be out of sight, out of mind. How do you collaborate together to have that common vision?
I’ve lived in Minnesota for the last 32 years. Neither of the previous two companies where I was CEO were in Minnesota. One had two offices: Charleston, South Carolina, and New Jersey. The other company was based north of Toronto. I was the only remote person of those companies when I ran them. I’ve really latched into that right now, of how I felt, being external, and wanted to be included in the day-to-day operation.
This goes beyond just setting up traditional meetings. How do you have those happy hours which bring people closer together? How do you have coffee chats? How do you help people get to know each other, and know each other’s private lives? We focused on that a lot this year.
2020 was perhaps the most difficult year any of us have experienced, and the home-based care industry played, I think, an interesting role in it. On a tactical level, what impressed you most about how home health and home care responded to COVID?
Tomzak: I think it was just the frontline workers across any care setting. It was an interesting year, and everybody had to change and rally. From the home health perspective, many of our clients started forming those bonds a lot with hospitals and nursing homes to help them get through their crisis of, especially on the hospital side, having too many people that they couldn’t service. Those were strategic partnerships, not just for financial gain, and helped people survive the year and manage their care needs.
I was also impressed by how everybody bonded together to make sure PPE was available. I know several people who took that upon themselves, whether they actually made PPE themselves or purchased it out of their own pocketbooks. They made sure that those frontline workers had the equipment they needed to feel as safe as they could. It was exciting. You could go through story by story by story of people who stood up just to do the right thing because they just felt it was right for them.
In your view, how did the concept of the “appropriate care setting” change in 2020?
Tomzak: I started to look at care no matter the setting. “Where is that person now, where could they go next, what’s the best spot for them to be?” I think that really broke down the barriers of the silos of, “I’m in a skilled nursing facility,” “I’m in a hospital,” “I’m in a home.” It was really, “Get people to where they want to be.” In many cases, the safest environment was their home. If they’re there, how do we keep them there? If they’re not there, how do we get them back in the home but not take a step back in the care that they’re receiving?
I think some of the organizations or agencies out there did a good job of making sure they’re creating certain groups so they travel together, like therapists, clinicians and aids. It’s like the herd mentality of this group of people visiting this patient so they could monitor better while making sure that other people aren’t included to avoid increasing the chance of spreading the virus even more. There are stories after story of how the blurred lines, or the significant lines of separate environments of care would not separate anymore. It’s, “Where should that person be for the appropriate care and to get the safest care?”
What was the most important operational change that you saw in home-based care in 2021, that you think will change the industry in a lasting way beyond the pandemic?
Tomzak: In home health, the care provider who visits the patient was very accustomed to working remotely. In many cases, they wouldn’t go into the office ever. That was their job. I think one of the things that changed is the office staff. In many cases they were running skeleton crews, and they had to learn to actually work together remotely. That was a big change for them, and they had to figure out how to do it.
One of the big tactical things that happened which was a change in the right direction is that we’ve seen telehealth and remote care utilized more and more. That’s something that we don’t feel will take a step backwards. There are different things on the market right now, like the HEAT Act, that they’re trying to push through to get reimbursement for these types of services in the home to offer more hands-on care but in more of a remote fashion. Telehealth and remote care will be a huge proponent moving forward.
What are the top ways in which PointClickCare is helping home-based care providers in 2021 keep seniors at home and out of the hospital?
Tomzak: Everybody wants to stay at home, and if they’re not there they want to get back home, but we know all care settings are vital for specific types of health care conditions. Nothing is going away. Our population is getting older, so there’ll be more need for SNF, assisted living and home health care. One of the things that we’ve concentrated on, and this has been over the last two to three years, is those cross-continuum capabilities. No matter where that patient is, we want to make sure that the data that they have — around medications, or allergies, or diagnosis tools, or demographic information — is leading the patient to that care setting, not following them.
We are very well-positioned with our large market share in the SNF market, the assisted living market, and now with our newer acquisition of Collective Medical in the health care market as well, to make sure that we have that information no matter what care setting they’re in. That information is then shared with wherever they are next, so that people can make the right decision for providing the correct care and have that information on their fingertips.
Why are care transitions so important in 2021, and what role do you think the home will play in those transitions this year?
Tomzak: Transition of care is huge right now. We’ve seen this through this COVID time frame. We’re going to see it more moving forward even without COVID, that no matter where that care occurs, that appropriate information needs to be at the fingertips of the clinician and anybody providing care. There has to be a seamless process. It doesn’t work well in a non-automated fashion.
For example, if you discharge from a hospital, and the next site is to a nursing home, often that person doesn’t end up in the nursing home. They could end up in home health. Those care transitions have to lead the patient where they’re going, so we not only know where the patient is, we have to know how the patient is doing. And then we also have to know where they could go next. These are the buckets that are vital for the success of each person, no matter where they are.
What is the most important step a home-based care provider can take this year to ensure that the company has robust financial health?
Tomzak: A year ago, home health went through PDGM. It was a change in how they provided care and how they were paid for care, a huge transition for everyone, a huge drain on cash flow, on how people were paid differently on a slower time frame. Many of the agencies actually were very fortunate. We had the stimulus money from PDGM because it let them actually offset some of those cash flow shortages to get through that time frame. Now, we come into this year and we have no-pay RAPs and other regulatory things that are actually constraining how you get paid and the pace that you get paid.
Knowing how to handle those as an organization, staying in front of that and managing against that, is key. No one has business the way it was back in 2019. Moving into 2021 with no-pay RAPs, business will not be conducted the same as it was in 2020. To keep that financial health going, you have to stay ahead of that pace. You have to understand all these Medicare Advantage programs. We’ve also seen a lot of the home health agencies, to offset some of these reimbursement payments and slowness, are betting into the hospice market. It’s a little higher reimbursement in that area. It seems like a natural extension from the home health side of things.
As bad as 2020 was, what makes you hopeful for the home-based care industry in 2021?
Tomzak: If you look at the numbers from 2020, census was down for everyone in that March, April, May, June time frame. It was kind of like, where you are is where you’re going to stay for that time frame. Later in 2020, the home health census numbers went up to where they were prior to that year, and at the end of the year 2020, they were actually higher than they were in the previous year.
There have been more referrals from the hospital not to the SNF, but rather into the home, and that’s some of the cause of this. Referrals from hospitals into home health care were up 109% in October 2020 compared to October 2019. One of the causes of it too is that we knew the population was aging to begin with, so we knew this market was going to explode. COVID may have just put this on steroids a little bit more, with SNF at Home and Hospital at Home allowing for higher acuity patients to receive care where they want to be: in their home.
Editor’s note: This interview has been edited for length and clarity.
The home-based care data you collect on a daily basis needs to be accurate, accessible and actionable. To learn how PointClickCare can help you simplify transitions in home health care, visit pointclickcare.com.
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