Home-based care has come a long way since 2020.
But for the industry to rise to the next level and better leverage innovative technologies, a greater degree of interoperability is needed, according to Tim Ingram, executive vice president of interoperability at Dallas-based home health, hospice, palliative and home care technology company Axxess.
In this Future in Focus interview, Home Health Care News sits down with Ingram to learn all about the criticality of interoperability and how it’s advancing home-based care. During the conversation, Ingram also discusses how Axxess is helping at-home care providers optimize their operations and strengthen their employee-training programs.
On top of all that, Ingram additionally explains how technology is helping payers better analyze their return on investment.
HHCN: To start, I’ll ask you to look back over the past few years to the very beginning of 2020. From then until now, how would you describe the overall progress home-based care has seen in the U.S. – and what are some of the best examples of that advancement?
Ingram: I think one of the great things that has happened since the beginning of 2020 is that, like it or not, home-based care providers and organizations have been forced to embrace technology. In general, almost every organization that’s providing care in the home is using more technology today than they were in 2020. And that’s a good thing.
I think an example of that is they’ve had to consider telehealth and remote patient monitoring in a different light, regardless of payment. Before 2020, before the pandemic, there was a lot of back and forth about the value of remote patient monitoring and of telehealth visits – and how much, if any, actual in-person visits those could replace. But with the onset of the pandemic, those tools became almost a necessity.
The last thing I would say is that our advocacy at both the state and federal level has really advanced, and I’m seeing more organizations that are interested in advocacy, including Axxess. I would say that we are leading the way in advocacy. I’m unaware of any other technology company in our industry that is doing things that we’re doing, particularly at the federal level, but also at the state level.
In what ways has your own organization advanced during this period?
I think one thing that most people probably don’t realize is that we’ve had incredible growth. We have more than tripled in size since the beginning of 2020. Some of that was planned, and some of it was simply because we took advantage of market demands.
Another specific one would be our Axxess Care solution, which expanded nationwide to help address the sudden impact of staffing in home care. We had Axxess Care in place before 2020. We ramped up that development and made it go nationwide because of the pandemic, and because we saw an opportunity to help organizations find caregivers in a different way.
We also expanded our online training and certification program. In that regard, we were maybe prescient because we began our online training and certification development back in 2018. That was to develop a complete online industry- and Axxess-specific training.
The last thing I would say is that we launched the only standalone palliative care solution in the midst of the pandemic to be able to address that growing market need.
Looking ahead, what is the single most important thing that needs to happen in order to further accelerate home-based care in the U.S., and why?
It’s a buzzword a little bit, but I think it’s an important buzzword if people understand it, and that is to expand interoperability. It really is expanding communication across all health care settings. It’s a lot harder than it should be for patients to have their information shared across those settings. With that expanded communication, or expanded and improved interoperability, that will facilitate greater adoption of technology. If we can have organizations adopt technology better, at the end of the day, that’s going to enable better care.
I think that’s important, particularly, because of the advent of value-based purchasing. When I can easily see my data, use my data, and I can see patients’ data who were under my care, regardless of where they were before, then patients and payers will better understand the value of home-based care.
This was evident to me in some recent health experiences that I had, where one organization could not see what another organization had done to help me, and it should not be that way. Expanding interoperability across care settings and across technologies, that’s going to be really important for us to continue advancing better care across the U.S. and, frankly, globally.
In your view, what are the top 2-3 ways that technology specifically has advanced home-based care in recent years?
I think it’s allowed for more objective pursuit of actual outcomes. When you think about value-based purchasing, or really when you think about any payer, they want to be able to see a return on their investment. They want to be able to see improved outcomes.
Improved technology is going to provide that objective pursuit of those outcomes. Improved technology is also going to allow, or has allowed in some cases — particularly for those using Axxess — better and easier in-home documentation. If I’m documenting in the home and I’m providing the care, that means the information is more accurate, and it’s also easier to share across the disciplines. That will then allow the removal of complicated back-office workflow requirements.
It’s nice to say, “Oh, I’ve got to have a workflow in the back office.” But I’ve seen way too often, from personal experience, where that so-called beautiful workflow to ensure everything happens becomes a burden more than an enhancement to the oversight of care.
With improved technology, caregivers and leaders of caregiving organizations can focus on how they’re going to improve care instead of having to check workflow boxes.
And I’ll go back to what I said earlier about interoperability: Without good technology, you’re never going to reach a healthy state of interoperability.
What emerging technology trend do you see disrupting home-based care most over the next 5 years, and why?
That to me is a really interesting question because you hear people talk all the time about staffing challenges. At Axxess, we think differently about staffing challenges. It’s more of a staffing-optimization issue than it is a staffing challenge or a lack of staffing. Automated staffing technology and the ability of non-employee clinicians to work when and where they want to will really disrupt home-based care.
Just think about how Uber disrupted the taxi market. That’s something like Axxess Care, which allows clinicians to say, “I’d like to do a visit in this area of town on these days of the week.” Our technology, through Axxess Care, facilitates that.
I think another thing that will continue to disrupt home-based care is the consumer mentality of the aging population. As we see more and more baby boomers who, maybe later in life, learn to embrace technology, they’re going to start asking more and more ‘If I can order pizza online, if I can make a deposit online, why can’t I order my care online as well?’
Something like Axxess Care is going to help us get to that.
Another thing that will continue to disrupt is online and remote training. Gone are the days where organizations are going to be able to require staff to come in and spend a week in their office, watching videos and going through training. While it may be great, it just wears the employee out by the end of their first week. Online and remote training, what we have started calling micro-learning, I think is really going to be a disruptor for organizations’ ability not just to attract staff but then to keep them when they’re there.
Because if they can do that type of online and remote training, they can also look at career advancement for those employees once they bring them into their fold.
When we think about advancing home-based care, we can talk about moving the needle with a variety of key decision-makers and gatekeepers. Looking exclusively at the policy space, what are some home-based care advancements you’d like to see turn into reality?
I would love to see the proposed palliative care demonstration come to fruition. Through that palliative care demonstration, what you’re going to see is more and more home health organizations realizing the value of palliative care, even if all they’re doing is providing home health. Obviously, there are more and more organizations that are spanning the continuum of care in the home, and not just focusing on hospice or not just focusing on home health. That proposed palliative care demonstration would allow for a better progression of the patient through the care at home continuum.
Also, advancements in value-based purchasing, such that payers don’t assume they have to have national agreements in place. Those national agreements, quite frankly, lock out some potentially excellent care from regional and local providers.
And more adequate reimbursement and accurate analysis of payment. When the Medicare Payment Advisory Commission (MedPAC) and U.S. Centers for Medicare & Medicaid Services (CMS) are reviewing profit margins, they need to consider the whole picture. I think that has the ability to move the needle as well. When MedPAC stops saying, “Every year you’ve got to cut, you’ve got to cut, you’ve got to cut.” When they realize the so-called 15% to 20% profit margins are not profit margins in reality, I think that’s really going to be able to move the needle to improving care in the home.
What degree of progress has the home-based care field made in communicating their value to payers, in your view?
I think there’s an opportunity for regional and smaller organizations to learn from the larger organizations like LHC Group, Amedisys, Bayada or Enhabit, and other organizations like them. The smaller and the regional providers can learn about building great relationships with the payers. In fact, I’m grateful that some of the leaders in those organizations have shared very openly, through some articles that have been in Home Health Care News and other places, about how they have had success with some payers. At the end of the day, the size of an organization really should not automatically mean they’re considered, or they’re excluded, when the payers are looking for preferred providers.
Generally, as we conduct this interview in mid-2023, do you believe payers currently recognize the value of home-based care services? If they don’t, or if there’s still understanding that needs to happen, how are you and your organization contributing to those efforts?
I believe the payers’ understanding is growing. I know some of the payers really see the value, and I think that’s why you’re seeing some of the payers acquire the providers. I think their understanding is growing.
Their appreciation of the true value of home-based care is growing, too, and that’s not just in reducing the costs, but in increasing the quality of care and also the quality of the lives of the patients that they’re responsible for.
At Axxess, we have a solution that provides business intelligence, and it allows, even the payers, but especially the providers, to dissect pain points for the payers and then to be able to share direct results with those payers. I know a number of people offer business intelligence solutions and business analytics, but when you have an organization like Axxess that both has a home health solution and then has the business intelligence functionality built into that, then clients can really showcase their specific value to the payers through the use of better technology.
Looking ahead again, what’s on your advocacy to-do list for the rest of 2023?
I was able recently to participate in the National Hospice and Palliative Care Organizations and the Hospice Action Networks’ combined Hill Day. What that did was remind me that not only is direct, in-person advocacy important, but then follow up after that advocacy. That follow up may be even more important.
I think it is not just important, but urgent that every organization get involved, like Axxess has, and has a better presence in D.C.
Axxess has the best presence of any technology provider, and likely better than a lot of the actual home care providers, in supporting care in the home and advocating. We even have our own political action committee that we established to be able to support and to be able to help elect candidates who are supportive of care in the home.
Continuing that is going to be really important. We have a senior vice president of public policy, Deborah Hoyt, who spends a lot of her time advocating for home health at the federal and state levels.
She helps us as an organization make sure that we are advocating based on things that are going on locally. If something is important in California, she can alert all of our California employees that they need to reach out to their state senators and representatives and we’re doing that at both the federal and the state level.
I think that will consume the rest of our 2023, doing more of that and making sure that we are as active as possible as an organization. As our CEO likes to say, if we don’t have a seat at the table, then we’re on the menu. Advocacy may be one of the most important things we can do to raise awareness and support for care in the home.
What trends, challenges or opportunities do you see helping – or hindering – the advancement of home-based care over the next 12 months?
Depending on how you look at it – it can be advancing or hindering the industry – is consolidation. Whether it’s across home health, or between home health, hospice and private duty, I think that’s probably — and has been for the past couple of decades — an ever-present trend.
It often has unexpected consequences, particularly at a local level. It’s amazing to me how often an organization will consolidate or be acquired by a larger organization and then, fairly quickly after that, see that they lose their local presence because the people that were acquired don’t like the larger organization, and so they leave and start a new organization.
That’s just one of the unexpected consequences and again, that can be helping or hindering the industry depending on the type of care.
I think the biggest challenge for the foreseeable future though is going to be around staffing. Not just finding the right staff, but then keeping them and helping them advance in their careers. I’ll refer again to our Axxess training and certification program. Things of that nature that help not just train your employees for what you’re doing today, but also give them opportunity to advance within your organization.
It’s a lot better to promote from within because you’re spending a lot less time and effort, and you already know the people that you’re promoting as opposed to always having to find people on the outside. I think that staffing challenges may be forever but definitely for the foreseeable future.
