Data is often a driving force in helping home-based care providers demonstrate their value, improve clinical outcomes and land deals. But providers sometimes encounter gaps in data availability — instances where critical patient or operational information cannot be collected, accessed, or analyzed.

Identifying and resolving these gaps in data availability, which some home-based care companies refer to as data deserts, can lead to cost savings, improved patient satisfaction and enhanced outcomes.

For New Day Healthcare, the data desert most in need of solving is the lack of information available after patients are discharged.

“The concept is — what critical and indicators are we missing when we don’t have eyes on the patient,” G. Scott Herman, CEO and founder of New Day, told Home Health Care News. “When we see patients in our service, we have a plethora of tools, we understand their conditions and needs. When we discharge them, we lose all transparency in their condition and their habits. For example, we’re seeing a chronically ill senior. We’re checking medication, compliance, ambulation and diet at every in-person visit or virtual encounter. When the patient is discharged, we lose that firsthand eyewitness encounter.”

Fairview, Texas-based New Day has roughly 33 locations across Texas, Missouri, Kansas, Illinois and Missouri. The company offers various home-based care services, including home health care, personal care services and hospice and serves nearly 150,000 patients annually.

New Day collects thousands of clinical and demographic data points through mostly commercial EMRs and state reporting systems. The company aggregates that data through its own platform, Carelytics. The platform combines data from EMRs, patient records and payer systems nationwide.

“We’re focused mostly on activities of daily living that impact long-term health of predominantly chronically ill seniors, those are proven to be our most leading indicators of chronic disease exacerbation,” Herman said.

The data deserts Avid Health at Home has identified include patient-specific information that is not accessible through traditional or existing data collection methods.

“It is usually unstructured, kept in the mind of the patient or their family, or only accessible through observation or routine intervention,” Avid Health at Home CEO Jennifer Lentz told HHCN. “This data can be signs and symptoms of decline, risk factors in the home environment that can pose a negative impact on a patient’s health outcomes, personal and cultural preferences, or a real-time assessment of a person’s capacity vs. performance in their [activities of daily living/instrumental activities of daily living].”

Chicago-based Avid Health at Home is a multi-state home care provider that offers personal care, companion care, private duty nursing, respite care and Alzheimer’s and dementia care services. The company is backed by private equity fund Havencrest Capital.

Solving data deserts

Avid Health at Home leverages its partnerships with third-party vendors — such as AlayaCare, Paylocity, Activated Insights and more — to collect data. Across these partnerships, the company looks at everything from patient diagnoses to employee data.

“We live and breathe data, and it has allowed for us, in real time, to metabolize and analyze our patient care plans to make sure that they’re appropriate,” Lentz said. “We’re responsive when adverse events happen. How are we adjusting our care afterwards, and what are the outcomes of those adjustments? We look at caregiver retention as being critical. Operational efficiencies definitely get called out when we analyze data.”

Avid Health at Home built its own software solution to address its data deserts. The company also addresses gaps in data by training its staff to prioritize data collection, according to Lentz.

“How do you help your caregivers in the field structure that mindset, that’s through training,” she said. “Between building data mining solutions to collect it, and then being able to shift the mindset of our workforce through training content, those would probably be the two biggest things.”

On its end, Carelytics has been a key driver in addressing data deserts at New Day.

“Because of the way we built Carelytics, we can bring any data in, and we can look for any function,” Herman said. “We literally discover data deserts every day. Then we have to define and categorize the clinical value of having that data. The bigger thing is not just having it, but what are we going to do with it? We’re a data collection unit that creates pattern analysis and begins to look for trends.”

Herman explained that addressing data deserts has allowed New Day to intervene early and offer care. It has also helped the company lower medication and equipment costs, and has contributed to fewer hospitalizations – a significant financial advantage for the company.

For Avid Health at Home, addressing data deserts has resulted in increased patient and employee satisfaction scores.

Another bright spot is that this puts Avid Health at Home in a good position for value-based opportunities.

“We’ve started conversations with different players on our [value-based purchasing] (VBP) readiness,” Lentz said. “We have actually built out our entire internal structure. We operate as if we’re under a VBP that is by design. We are pushing ourselves forward into alternative payment models and successfully having conversations about those types of contracts, particularly on the dual eligibles.”

Herman believes that collecting data is, ultimately, a commitment to patients.

“We’ve been committed to the collection of data, and the commitment is understanding patience over time in a longitudinal way, rather than just in those increments,” he said.