This article is sponsored by WellSky. In this Voices interview, Home Health Care News sits down with Dr. Lissy Hu, founder and CEO of CarePort, powered by WellSky. Dr. Hu shares some of the top ways home health providers are adapting to the increased desire among patients to receive care at home. She talks about how home health providers can ease care transitions to drive referrals and succeed in that environment, and she explains what WellSky and CarePort are doing to facilitate unique partnerships among providers to support care coordination.
WellSky recently acquired CarePort, the company that you founded while in graduate school in 2012. What drove you to start the company and what experiences led you to that point?
Dr. Lissy Hu: As I rotated through different hospitals to complete my medical training, the experience opened my eyes to how little information patients are given regarding the options for post-hospital care. What often happens is patients come into the hospital, they have their hip surgery, and a couple of days before they’re able to leave, they get a list of names and addresses of nursing homes or home health agencies.
They make decisions about their recovery with little more than a name, address, phone number and zip code. There are a lot of different abilities, capabilities, costs and outcomes to consider when making that decision, and even within the different types of providers, there’s a lot of variation.
Lack of transparency isn’t just a problem for patients and their families, it’s a problem for our overall health system. When patients end up in places that aren’t optimized to meet their recovery needs, they end up being readmitted to the hospital. This potential regression can lead to complications, unnecessary expenses and new logistical challenges for our health system as a whole.
I built CarePort to connect hospitals with post-acute care providers in nursing homes, home health, hospice, long-term acute care, dialysis, behavioral and mental health, and anything else needed after an acute stay. The scale at which we’ve accomplished that is what makes CarePort unique.
We partner with over one thousand hospitals and more than one hundred thousand different types of post-acute care providers on a national scale. When we look at the number of transitions that occur in our system, 20 million referrals are sent from U.S. hospitals to post-acute care providers, which represents approximately one-third of the patients discharged from U.S. hospitals on an annual basis.
CarePort supports a number of different health care markets, including post-acute care. What is the company’s mission for that segment, and specifically what problems are WellSky and CarePort solving for home health providers?
Dr. Hu: Our mission is to ensure that every patient who transitions across the care continuum has a safe, high-quality and effective transition. To deliver on that mission, our team ensures we’re connecting acute, post-acute and community care providers to enable the flow of data from different settings, empowering providers to collaborate on the care of a patient with full transparency.
That’s how we can take a complex system with different providers in a variety of care settings across the continuum and ensure a seamless experience for the patient. There is no reason why the transition from hospital to post-acute should be any different than the transition from emergency room to inpatient. That’s the level of seamlessness that we should aspire to achieve.
Care transitions continue to be a pain point across the post-acute landscape. How are WellSky and CarePort working to ease this process to drive referrals for home health?
Dr. Hu: One of the reasons we were so excited to join WellSky is that together, we accelerate our shared mission to connect providers across the continuum through technology, analytics and the network.
WellSky solutions are leveraged in one-in-four home-based care providers in the U.S. Together we have a significant network of community-based providers that are addressing the social determinants of health.
As we start to see more of a shift to home-based care, our clients are increasingly asking us to connect with these providers. How do we bring WellSky’s network of home-based care providers to our hospitals so that our patients can go into those home-based care settings? How do we address the non-medical, but critical social determinants of health so that patients can recover at home?
When the patient is going to a skilled nursing facility, a lot of their non-medical needs are addressed. But when a patient is going home, both their non-medical and clinical needs must be considered. That’s where health care is going and that’s where the needs of our clients are. As part of the WellSky team, we have the ability to accelerate our mission as a market leader in this space.
Our advantage is the broadness of the post-acute networks we created to connect the medical and non-medical sides, as well as the social determinants of health. As patients move out of the hospital, even higher acuity patients with more needs are living longer. With more complicated hospital stays, they need more of these post-acute services.
That breadth of post-acute services in our network is what ultimately leads to better outcomes for our patients. A patient doesn’t just need a visiting nurse, they need all these other things that can help them be successful at home, and that’s what plugging into the WellSky network can offer our clients.
You’ve talked in the past about the ease for consumers who are booking flights and hotels, and how health care needs to offer a more similar process for patients who are choosing post-acute providers. What do you see as the biggest challenge in getting post-acute care to adapt to those consumer needs?
Dr. Hu: Many hospitals are still largely reliant on manual processes — faxes or phone calls — to place patients in a skilled nursing facility or home health care. CarePort takes the post-acute referral process online, and our software is integrated directly within the hospital EHR to streamline a patient’s transition to post-acute care. On average, our referrals are accepted electronically within minutes – a sharp contrast to the hours or even days it may take for hospital staff to coordinate the process via phone call or fax. Through the CarePort platform, patients can also view more than just a printed list of facility names and addresses; they can view the quality and spectrum of care offered by each provider.
While we now have hospitals and post-acute providers working in our system to transact, collaborate and transition these patients from point A to point B, we also need to apply intelligence to the process. That’s where we’re taking our clients next. We’re not just helping providers transition patients from one setting to another, we are optimizing that transition to make sure that patients are getting the right care in the right setting at the right time, then closing the loop on that transition.
With the shift to value-based care, home health providers, health plans and conveners are entering into unique partnerships to support one another’s care coordination initiatives. How do WellSky and CarePort fit into this space and enable success in these types of arrangements?
Dr. Hu: As home health providers, health plans and conveners start to work together in value-based care, one of the things that we’re seeing is a need for technology that enables them to collaborate. With real-time, cross-continuum data, CarePort and WellSky offer these entities enhanced visibility into care coordination across different settings of care. This increased collaboration between different stakeholders on a shared platform allows for course correction before adverse events — such as readmissions or unnecessary hospital admissions — occur and appear in claims-based reporting.
CarePort and WellSky enable home health providers, health plans and conveners to increase payer-provider collaboration for engagement with members when they’re most vulnerable and ready for care, decrease post-acute spend and utilization, and improve care management processes and member engagement.
Home health discharges dipped at the beginning of the pandemic, but those discharges are roaring back. With more patients being discharged to the home, what is your advice to care providers looking to drive referrals and succeed in this landscape?
Dr. Hu: We’re seeing tremendous demand for patients and their families to recover at home. As providers rise to that challenge, they need to think about how they’re going to help the patient be successful in the home. This can include post-acute care providers servicing the patient in a timely manner and accounting for all of their needs from meal prep, dialysis and everything in between. Missing any one of those factors can lead them back to the hospital.
Do you see permanent changes resulting from the pandemic with respect to consumers’ desire to receive care at home? And if so, what would those changes be?
Dr. Hu: Yes, absolutely. I think we’re going to see a continued shift to home-based care. Though this was accelerated by COVID-19, we were already seeing an increased desire from patients to recover at home rather than in an institutional setting. I think this is just the beginning of a huge wave, given what we’re seeing in terms of the demographics around this country and the number of seniors and their health care needs. As the population continues to live longer, we will see an increase in more post-acute needs.
Based on our own data, we saw that home health referrals were at nearly 116% of 2019’s baseline, as of March 2021. Considering this trend represents millions of referrals and one-third of patients being discharged from the hospital, a 16% increase is significant. I think we’re still in the early part of the wave and we’re going to see greater demand for home-based care.
Entering this year, no one knew exactly what to expect for home-based care. What has been the biggest surprise so far, and what impact do you think it will have on the industry for the remainder of 2021?
Dr. Hu: I think many providers saw that home-based care was going to be really important. People have been surprised by the increased focus and visibility that home-based care has received at the federal level. Home-based care is being funded, and we’re addressing health equities and the social determinants of health — that has given folks a lot of optimism. They see new trends and potential ways to fund them, which has created a ripple effect.
It’s also not just in home health, but in hospitals, too. On the physician side, they’re figuring out how to partner with these home health agencies. I think this will have a ripple effect throughout the entire healthcare ecosystem. It will lead to different models of care and a lot of innovation in the space. I’m really excited about that, and I think a lot of the folks in the industry are as well.
Editor’s note: This interview has been edited for length and clarity.
WellSky is passionate about helping home-based care providers successfully increase their efficiency, grow profit, improve communication and coordinate care for patients. To find out how, visit wellsky.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 [email protected].