WellSky CEO Miller: Hospice Will Evolve With Interoperability, Analytics

Emerging technologies such as predictive analytics and interoperable electronic medical records (EMR) will become an essential part of how hospices and other providers do business, particularly as the system moves closer to value-based payment models, according to Bill Miller, board chairman and CEO of the post-acute technology company WellSky.

WellSky is jointly owned by two private equity firms, TPG Capital and Leonard Green & Partners, per an agreement made in July 2020. WellSky serves more than 15,000 client sites globally.

Miller recently sat down with Hospice News to talk about trends in the post-acute space, the importance of addressing social determinants of health and the future of interoperability and data analytics in the hospice field.


What do you see as the most important trends coming in the hospice space during 2021?

During the next 10 years, you’re going to see 36 million new people become older than 65. The sheer volume of people who want to age at home and to die at home is going to increase. Coupled with COVID, it’s going to put more emphasis on people using their homes as their primary care setting, whether that be in home-based hospice and or home care in general. I think COVID has actually sped it up.

More care will move to the home during and after the pandemic, because the health systems just can’t handle the volume. We as a country got caught unprepared in terms of dealing with pandemics like this and how we could have used the home health network and other ancillary care settings to offset some of the inevitable volume. 


I think those who pay for care are interested in [new value-based payment models] and the economics of people aging and receiving care at home. There are also consumer trends where patients are showing much more of a preference to stay out of a hospital or nursing home as long as possible. That’s going to be further enabled in that we are going to know more about patients and comorbidities and the likelihood of when they need hospice and when they don’t.

We’re also starting to understand as a country how social determinants of health impact overall care. In the past we’ve bifurcated clinical diagnosis and the need for hospice versus all the other things that are relative to someone’s immediate health functions — someone who is isolated or lives in a food desert, or who is not mobile, someone that isn’t toileting regularly. Those things can be just as impactful to someone’s health as their clinical diagnosis.We’ve now brought in our personal care business to work with our home health patients and work with our hospice patients.

I don’t think that genie is going back in the bottle either. Connected to this is the handoffs between these different care settings as someone goes from a hospital back to their home, maybe to hospice care. Having coordination between caregivers as they hand patients off has been a real problem historically; it’s one of the reasons [WellSky] invested in interoperability.

You’ll see us continue to make those kinds of investments, and that will be important to deliver better care and lower costs. As a country we are spending better than 22% of gross domestic product on health care, and that is just not going to be sustainable. We have to find where these ancillary care settings are as part of the solution.

When you mentioned that people who pay for health care are interested in new models, are you referring to the new payment models that emerged this year, Primary Care First, direct contracting and the Serious Illness Population model?

Yes, I think the new payment models that are emerging this year, whether they be coming from [the U.S. Centers for Medicare & Medicaid Services] or solutions from commercial payers, are based on the idea that care would be managed and monitored by outcomes as opposed by volume. Those waves are now crashing constantly on the beach of post-acute care. That will continue to pick up.

For our clients who are not very big, the idea of taking risk is scary to them because historically they haven’t had the analytics to understand how they could thrive in an environment where they might be taking on risk. They won’t have a choice though; payers in the federal government are going to continue to accelerate this.

It takes information and data to actually do it at scale. Great caregivers can be enhanced by great data and great systems. Traditionally, hospice; and I would argue home care, home infusion, all these post-acute environments; have been relegated during the past couple of decades to homegrown systems that were not highly sophisticated at leveraging analytics. We’re changing that, and we’re not the only ones. We have competitors, but I would say we are swimming faster than anybody to keep up with the pace of innovation. This is going to be a revolution and an evolution in the post-acute space, hospice included, like we haven’t seen before.

In regards to those payment models, a number of them require certified interoperable electronic health records for participation. What can you tell me about the current state of interoperability in the hospice space and what do you see as the next steps and that evolution?

Interoperability requirements are a really good thing. Some of it is learned and conditioned by what happened in the early years of reform in the hospital space. In some ways, it’s echoes that are coming down the line to the post-acute space.

This move toward interoperability and data sharing will go much faster in the post acute space. That’s just part of how we’re going to get better as a country. I think the leadership of most of these post-acute companies are open to the concept where that wasn’t necessarily prevalent in the acute environment 10 years ago. I know that sounds a little pollyannaish, but I know I’m right, because I know all the players, and I know the people and I know the personalities. There’s not the resistance that there was to share data.

It’s the only way you’re going to get a more fluid view of [a patient] and their morbidities so that your providers can take better care of them and know where they should be discharged.

Care transitions are a sensitive time for patients, as you mentioned. How can improving these interoperable systems support more seamless transitions?

It’s a key element. If you don’t have systems that are interoperable and share data elements, then you run the risk of a single point of failure of a great provider. Those care transitions are where you introduce the most risk, because you may not know something obvious about this patient and taking time to gather information that you should already have is time wasted.

There’s more subtle things too. This is where the social determinants of health become a part of these integrations. You’ve discharged somebody home, but you don’t know that they live alone, and they don’t have a vehicle, or they don’t have their glasses and they can’t read their medication labels. There are a thousand things that now we can incorporate into the care plan that weren’t there before. But you have to have a system of record, and that information has to flow from one care provider to the other. 

You’ve spoken about analytics. A number of hospice companies are embracing predictive analytics as a way to engage patients further upstream. Could you speak more about the business case for analytics?

Most people don’t want to ask about the business case, they tend to focus on what predictive analytics do. The way we think about analytics may be a little bit different than others.

If you walked 10 steps back from WellSky, you’d say we are an [electronic medical record (EMR)] company in the post-acute space. I would bristle at that because where we put most of our energy is in that interoperability layer, because we’d like to leverage our virtual network and really focus on patient care so that they can make these transitions without these challenges.

The other area where we spend most of our capital is investing in analytics. Because the more you know, the better your EMR systems can be. It’s not the other way around. It’s hard to build a really intuitive EMR system if you don’t have great analytics. The one actually feeds the other.

I think what you’ll see happen is that there won’t be this bifurcation between using analytics and EMR; it will be one thing. As we start to introduce analytics into the hospice setting and into the home health setting, you have to demonstrate a return on investment back to the client. It costs a certain amount on a monthly basis, and then let’s monitor three months from now to see how it is improving outcomes. Because that’s really the business case for them: Do your predictive analytics help me focus my caregivers on the patients that need the most care at the right time?

If I can do that I’m more efficient with my staff, and my stats will go up. I will get more volume from referrals. Inevitably, I think it will just be part of who we are and what we do.

How can you put caregivers in the right location? How can you see someone crashing before they do? How can you find out whether someone is suitable for hospice or palliative care way in advance of what you normally would have done? It has an economic return, but it also has a patient satisfaction return to it. I think those two points are, frankly, the most important.

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