This article is sponsored by CitusHealth. In this Voices interview, Hospice News sits down with Melissa Kozak, Co-founder and President of CitusHealth, to learn the next level of family engagement through technology in hospice care. She also shares why, now more than ever, the care staff must be connected — and how technology can help.
Hospice News: Melissa, Citus has sponsored consumer research about patient family engagement. How does family engagement play into the world of value-based care?
Melissa Kozak: We know with value-based care that providers are going to be more favorably reimbursed based on delivering positive outcomes. In order to demonstrate positive outcomes, providers need to stay more closely connected to patients and families, giving them the support they need quickly. Patients and family caregivers need access to on-demand educational material in order to help them stay close to their treatment plans, empowering them to participate in their own care or the care of their loved one.
CitusHealth and Porter Research conducted a consumer research study, polling 300 family caregivers who had a loved one under hospice care within the past 12 months about their experiences with hospice provider communication. The results indicated that most hospice providers are using outdated communication methods to connect with family caregivers outside of the in-person visit. We learned that these methods of communication directly impact the CAHPS survey results and heavily influence the choice of hospice provider. Family caregivers would actually choose a hospice that enables instant communication through a computer, tablet or mobile device.
Why are some clinical teams reluctant to use new technology despite what you just laid out, and what are the best ways to break through to them?
Kozak: As an industry, we’re in a crisis of a lifetime due to this massive shortage of clinicians. Almost 18% of clinicians moved out of the workforce during COVID, while many others are of the Baby Boomer age where they are now becoming the patients that need the care. Those that remain are being asked to do more with less, to pick up the slack, to see the patients that other clinicians would have seen.
Clinicians in this new normal are being asked to do so much more. They’re burnt out. So asking them to think about implementing and learning a new technology can seem daunting. The way to really break through to them is speaking to the right technology that makes their lives easier, not harder. They will respond well to technology that brings efficiency, technology that helps them avoid missing text messages from patients, technology that means that when they get home they no longer have a tremendous amount of paperwork. Nurses often give out their cellphone numbers, meaning they can’t truly be off-duty. Leaders must bring in technologies that give nurses work-life balance.
Why is it important for the entire care team to stay connected, and to be able to collaborate with one another?
Kozak: In home-based care settings, there is a matrixed care team that needs to stay tightly connected in order to deliver care that is highly collaborative and that drives positive outcomes. The care team isn’t necessarily under one roof, especially during these days.
From the moment a referral comes in the door, that care team needs to know where they are in the process of bringing that patient on service, what needs to happen next, and who is responsible. It is sort of like passing the baton. Everybody needs regular updates to make sure that steps aren’t missed and efforts are not duplicated.
At CitusHealth, we look to extend the care team beyond just the staff members of the hospice health agency. For example, communicating with DME partners about equipment and deliveries is critical to ensure timeliness of care. This is true with home-infusion pharmacy partners as well. Our model is about bringing in the entire care team onto our platform so that they benefit from real-time updates.
Circling back to this nurse burnout and this clinician shortage crisis that we’re in, this collaboration is super important. When that nurse is getting to the home, they need to know, what is the latest information? What happened on the last visit? Through our collaboration tools, those nurses can quickly get those updates without having to log on in multiple systems and search for information.
For patient and family engagement, what technology tools are providers optimizing today?
Kozak: What we see today is that the primary tools of engagement are still phone, text message, email, and there’s obviously weakness with all of those methods. There are missed calls with the phone.
Then there’s text messaging. As a former home-based care nurse myself, I never wanted my patients to go without answers, so I would give them my own number. There are HIPAA security risks there. Then email, which is probably our least real-time means of communication.
We also see a lot of providers stitching together different point solutions to try to address the communication challenges of the current tools. They might find a HIPAA-secure messaging app, a secure video platform and an electronic signature tool to try to fill these gaps.
The problem is that those individual point solutions don’t integrate with each other, and staff are being asked to log into multiple systems that don’t share data back and forth with the main EMR. That is not an effective long-term strategy. There’s a lot of room out there to improve the engagement strategies that we see today with providers.
Is that changing how the industry is handling recruitment, retention and satisfaction?
Kozak: It definitely is. I just came back from Scottsdale at the Home Care 100 conference. I would say that 80 to 90% of the discussion amongst providers had to do with the clinician shortage — how we recruit staff clinicians in particular, and how we retain them. It’s amazing to see this shift in provider thinking around attracting clinicians, making sure they are satisfied with their jobs, and keeping them for the long term.
We’re seeing that technology is being advertised not as a perk, but as an attraction point of why a clinician should come work for a given agency. A key driver in satisfaction for those clinicians is that they’re having a better experience by working for that agency because the agency is utilizing the most modern integrated technology that can remove a lot of this busy work.
As a nurse myself, it’s quite wonderful to see this push toward attracting nurses and showing that an agency is looking out for what’s important to the clinician. That is not going to go away anytime soon.
We know that some stakeholders are difficult to convince on how to engage. How do you go about changing that to effectively engage as many stakeholders as possible?
Kozak: I think that the simple answer is that you have to meet stakeholders where they’re at and engage in their method of choice. These can be patients, family caregivers, clinicians, physicians, nonclinical staff members, partners — all the people we’ve been talking about so far, many of whom have different comfort levels with technology.
For example, some folks feel very comfortable using an app. Others feel very comfortable using email, or using text. We took an omnichannel approach at CitusHealth where we said we have to make all of those things available, so that whatever channel, whatever method of connectivity the stakeholder prefers, they can use it.
Most notably, I would say that app-less technology has been a huge focus of ours. That is the path of engagement that takes away the most friction. It allows the end user to fill out a questionnaire or sign a document via a link in a text message. It even let’s a physician sign an order without ever creating a login or putting in a password or downloading an app. It uses magic link technology. The patient can fill out their form or sign their document, never having to have all of the barriers, real or perceived, in terms of downloading an app.
The same is true on the physician side. We all know it’s been an age-old challenge to get physicians to engage with technology solutions. They live within their EMRs and fax and getting them to work outside of EMRs and use things like portals has been minimally successful over time. App-less technology allows them to engage where they’re most comfortable. The document can be sent to their email or SMS, they click on a link and sign the document, and in real time that document goes back into the provider’s EMR.
Rather than convincing people to engage through certain channels, as a solutions provider you have to create ways to remove all barriers to engagement and provide multiple channels of engagement.
Finish the sentence: “The hospice industry in 2022 will be the year of ______”
Kozak: Clinician and family caregiver satisfaction.
Editor’s note: This interview has been edited for length and clarity.
CitusHealth is a team of former clinicians, nurses, technology gurus and care providers working together to transform the way health care is delivered in the home and other non-acute care settings. To learn more, visit CitusHealth.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].