This article is sponsored by MatrixCare. In this interview, Hospice News sits down with ResMed Vice President of Strategic Initiatives Nick Knowlton to learn why one of his driving mottos is “Do right,” how interoperability is helping hospice operators provide better patient care during COVID-19 and how the pandemic has changed the industry’s need for interoperability.
Hospice News: Nick, you have had a deep and varied career. What career experiences do you most draw from in your role at MatrixCare today?
Nick Knowlton: Before joining the MatrixCare family, I was at Greenway Health. The CEO there had a saying that was simply, “Do right.” That basically meant that no matter where you were in your career or what you were working on that day, always focus on doing the right thing. I love that because it is so simple, and any conscientious person could correctly interpret it for what it meant in their role.
Number two is to focus on “What is important now,” or WIN. The health care industry is changing so rapidly, so what’s important may change on a day-to-day basis, but keeping line of sight on what you need to focus on to advance a project or a business is always good advice that I’ve taken with me.
Then number three would be mobilizing stakeholders. Being able to change the industry and our world for the better very often has to come through managing via influence and great ideas and less by direct line of authority. We don’t control payer policies in post-acute care and we don’t control what referral sources do, but by advocating for the needs of our patients and providers, we can certainly achieve a lot of success.
We hear a lot about the importance of interoperability across the care continuum. How did the pandemic impact the need for interoperability in our health systems overall?
Knowlton: One of the major impacts of the pandemic is that it served as an accelerant for a lot of existing and positive health information technology trends. When it comes to interoperability, the pandemic will provide an ongoing tailwind. During the height of the pandemic, we worked across the care continuum as patients and providers themselves were both separated from traditional, physical care settings. We saw a massive increase in the utilization of telehealth, remote patient monitoring, and other technologies to collect, interact with and analyze patient data. Interoperability became a necessity to ensure this information could remain synced across care settings.
And while interoperability encompasses much more than just technology, the pandemic accelerated the adoption of modern, cloud-based methodologies for accomplishing interoperability.
During the start of the pandemic, many health systems had to deploy their interoperability resources on public health reporting, or those employees may have even been furloughed or even sent home in the early days. That gave rise to showcasing the power of modern cloud-based architecture for interoperability solutions. Existing trends such as the emergence of fast health care interoperability resources (FHIR) was one of the areas that we saw achieve a lot more rapid success for deployment during the course of the pandemic. Why? The technical solutions powered by FHIR can be activated remotely for Health IT Solutions with the right architecture.
Let’s talk about hospice specifically. Why does interoperability matter in the hospice market and to hospice providers?
Knowlton: For the hospice market, we’re serving patients at the end of their lives. It has unfortunately been sometimes up to the patients to gather their own records from multiple providers and deliver them to the hospice agency. Given how much our country has invested in digitizing health information, it’s crazy to think that it is still acceptable for the patients to carry any of this burden. The faster we can give hospice providers all the important information for the care of the patient, the more immediately effective the hospice agencies can be and the more empowered their care providers and clinicians will become.
We all know that staffing is a huge issue in post-acute care, and now in acute care as well. One of the key differentiators that we see for agencies is enabling their clinicians to do as much as they can for patients. Interoperability can vastly improve the quality of life for those clinicians.
Lastly, we see a lot more from hospice agencies that are working with palliative care patients. If they have a relationship with the patients as they enter into palliative care programs, they might be documenting in multiple different EHR systems. If those patients move from palliative care into hospice care with the same agency, it is paramount that those care records be able to follow the patient from one setting or system to another.
How have patient attitudes toward connected health solutions shifted in the last year, and what hospice outcomes have you seen as a result of that shift?
Knowlton: As patients experience high degrees of satisfaction with connected solutions in their daily lives outside of health care, the data shows that there is a higher degree of expectation that those consumers and patients have on other providers of basic services or health care in their lives. In fact, 69% of health care consumers say one extraordinary experience raises their expectations of other companies regardless of whether the good experience is in health care.
Think about the rise in the use of connected health solutions. CMS reported that in early 2020, 1% of their primary care physician visits were conducted via telehealth. In April, that jumped to 49%. Suddenly, we saw more patients who weren’t engaged through connected health solutions before the pandemic began using them for the first time. If they had a positive experience, they began to expect it in other care settings. If they could use an app to track a prescription from that telehealth encounter, they began to expect consumer-like experiences in post-acute care as well.
The hospice benefit is a wonderful care option for patients. The disparity in hospice access remains especially across racial lines. Even with access to hospice increasing among non-Caucasian patients, it remains low: 74.8% of Medicare decedents in 2020 were Caucasian, according to the Kaiser Family Foundation. What are the top steps that hospice agencies can take to increase access to care for all patients?
Knowlton: While hospice providers cannot directly mine referral sources for patients of very diverse backgrounds, as that conversation needs to happen more upstream of our industry, we do believe that hospice providers can have a very positive impact by engaging with their referral sources.
We all know that members of disadvantaged communities may not have access to the same conversations early in their care progression that would indicate they are eligible for hospice care or that they have access to this benefit. Through daily interactions with referral sources, I think everybody in our industry can be a positive voice of change by asking questions around how providers are engaging with historically disadvantaged communities around this topic.
What are the top interoperability trends that you expect to see in hospice in 2022?
Knowlton: Number one, I think we will see a lot more electronic referrals. We are seeing a general trend across post-acute and certainly within hospice, that referring providers expect to be able to send electronic referrals and interoperate with their post-acute care partners.
Number two, due to the rise in palliative care, I think we’re also going to see a lot more in terms of the transition of patients and the quantity of data that comes with those patients from more complex programs where there might be multiple different providers engaged with the care of patients prior to them entering hospice care.
Then number three, I think that we’re going to see a lot more need for information on patients flowing back to referral sources into other care stakeholders. Those other care stakeholders include groups such as pharmacists fulfilling orders or family members who are trying to help guide the patient’s care. As an industry, we need to make sure that the care data around the patient can flow, regardless of direction and use case.
Of those trends, which one of them excites you most and why?
Knowlton: I think the last trend of getting more patient data to follow the patient to suit their needs in a patient-centric manner is the most exciting. We have seen a massive rise in the build-out and efficacy of intelligent networks across the care continuum. The ability to get patient-facing and family-facing applications that are used by other care stakeholders into that patient’s care journey is going to offer a tremendous lift to the level of patient and family experience within the hospice industry.
No one knew fully what to expect in the hospice industry in 2021. What was the biggest surprise to you in the industry last year, and what impact do you think that surprise will have on the hospice industry in 2022?
Entering 2021, how the industry would continue to adapt and respond to the pandemic remained in question. COVID-19 strained providers’ ability to provide care, access patients, address staffing challenges and maintain a healthy bottom line while navigating lowered revenues and higher costs. Yet the industry improvised, adapted and overcame many challenges — that was very inspiring to witness.
While the pandemic is not over, the changes made by provider organizations will prepare them very well for 2022. We see incredible results from organizations putting clinicians first and leveraging technology where possible to solve for new problems. I think our industry will emerge from the pandemic in position for providers to tackle growth and care targets and engage referral sources and patient attitudes that are forever changed. I’m excited to work with such exceptional care organizations and see how it all unfolds.
Editor’s note: This interview has been edited for length and clarity.
MatrixCare provides innovative software-as-a-service solutions for hospice, home health, palliative care and private duty providers. To learn more about how MatrixCare can help your organization, visit MatrixCare.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].