Hospice News ELEVATE: Fireside Chat with IntellaTriage

This article is sponsored by IntellaTriage. This article is based on a Hospice News discussion with Daniel Reese, CEO of IntellaTriage at the Hospice News Elevate Conference in Chicago. The article below has been edited for length and clarity.

Hospice News: I am pleased to welcome Daniel Reese, CEO of IntellaTriage. IntellaTriage is a telephone nurse triage company. Daniel, thank you so much for coming out to Chicago.

Daniel Reese: Thanks for having me, Bob. I really appreciate it.


Hospice News: All right. I think we’re going to dive right in. There are tons of solutions that supposedly address burnout and staffing shortages. How does nurse triage make an impact?

Reese: At IntellaTriage, the way we think about it is if you really want to get ahead of the staffing and burnout issue, you have to really think about the big dissatisfiers of the nurses who are in the field. There’s two big ones that we hear all the time. One is charting, which I’m sure any nurse in here can relate with. Then the second is work life balance or on call. That’s where nurse triage really can make an impact.

You look at the on-call model as it is in most hospice providers today, and a lot of times you have dedicated nurses after hours who are taking the on call and they may only get four or five calls at an hour, but when your calls come in at 10:00 p.m., 1:00 a.m., 3:00 a.m., or 5:00 a.m., you don’t get any quality sleep. It’s really tough to wake up the next day and be refreshed and physically and mentally engaged, and that’s where a lot of the burnout comes from.


For IntellaTriage and others in the industry, we are able to resolve 60% to 80% of those calls with first call resolution that was mentioned earlier today. You can turn that problem on its head and the nurse is only getting one call a night and that call is actually the call that needs to be a visit. They’re not being woken up for just the sake of a family that needs emotional support. A nurse triage company can provide that support in place of that.

Hospice News: Currently, the most common after-hours model is an answering service. How is nurse triage different from that?

Reese: I’ll talk to some personal experience with answering services and hospice in this one. I think there’s two big constituents that we think about influencing after hours and that’s the patient and then also the nursing team. When you think about a traditional answering service, first off, I want to clarify, I mean non-clinical people answering the phones and really just taking the message. When you think about that model, it doesn’t particularly serve either of those constituents, the nurses in the field or the patients well.

From my personal experience, my father was in hospice, we were on service with a large national provider and called in after hours because he had a change in condition. It was my first time going through the experience with my mother and we just didn’t know what to do. We got an answering service, they answered in two rings, which is great, but then we left a message and we said, ”Hey, when are we going to hear back?” “We don’t really know. We’re going to pass it along to the nurse.”

About 45 minutes later, we got a call back from the nurse, who I can imagine being in their shoes, they probably just got out of a home visit and had five messages. They have to figure out which one to prioritize. We talked to her and she said, ”Yes, that sounds like he’s going through the dying process. Let me make a visit.” Frankly, we probably didn’t need a visit, we just needed to walk through what was happening. Now you’re pulling that nurse away from maybe someone who needs a little bit more attention.

The answering service model doesn’t serve either [the nurse or the patient] well. With nurse triage, however, you have a nurse who’s answering the phone on average and under 60 seconds, who is hospice trained, has hospice experience, has the EMR in front of them. They have a medication profile. They have the plan of care; they have the notes from the case manager that they entered at 7:00 p.m. that night. That nurse is really able to walk through what they’re going through, provide the emotional support and then execute on whether or not a visit needs to be made.

Again, it addresses a majority of the calls. It really helps both with the patient getting to a nurse quickly and the nurse in the field.

Hospice News: You just perfectly described how that’s beneficial for the patient, for the family, and for the clinician in the field. Hospice CoPs still require providers to have an on-call nurse available for home visits. If I’m a hospice provider, how does outsourcing help, if I still have to have staff for the shift?

Reese: It’s one of the biggest questions we get asked, “Are you just an additional service that we’re having to pay for?” The biggest thing that I say is, “You have to pay for this now.” If you’re a provider, you’re [already] paying for after-hours care and it’s encapsulated in a few different areas.

I would say number one benefit, though, you do have to have a nurse available in the field per the CoPs. However, that patient experience and nurse burnout piece comes with real costs associated with that. When you think about just direct wages, as an example, I’ve used the number 60% to 80% of calls are addressable by triage. If you’re getting 10 calls a night or if you have a 200-patient census, that’s about 140 to 160 calls a week, and we can address 60%, 80% of those; now that turns into 50 or 40 calls that your nurses are getting in a week. That just allows for a much more efficient labor model to reduce the number of nurses you need on call at any time or in the field.

One of our clients in Texas has a four hundred patient census. They went from seven on-call nurses to three on-call nurses, four on Saturday and three the rest of the time. It’s just direct labor savings. Additionally, one of the other areas we talk about with costs is recruiting costs and training costs. It takes on average six months for a hospice nurse to really get up to speed. If you can reduce that burnout and turnover even by a little bit, we know it’s really high in the industry right now. Then that’s a real cost savings that you’re not having to go through by training and recruiting.

We record all of our calls. We have a really robust database and we do a lot of analytics with the calls where you’re able to say, ”Hey, where are you spending money after hours, so maybe you can save some of this?” For example, we had a client in the Mid-Atlantic that had medication costs that were out of control after hours. We were able to say, “about 25% of your calls after hours are medication refills.” Our benchmark, based on millions of data points, is 18%. How do we take that back down since $50 for every after-hours refill can add up a lot throughout the course of a year? Those are the ways that you can tweak that a little bit.

Hospice News: Do you have any other examples of providers working with IntellaTriage to enhance the patient experience, but also help when it comes to clinician burnout? Clinician burnout and reimbursement are two of the biggest topics that I think we’ve talked about today.

Reese: I’ll use CommonSpirit Health at Home, one of our clients, as the case story for today. They have home health and they have hospice. On the home health side, they were able to completely eliminate after-hours. IntellaTriage is their one-stop shop after hours. We’ve seen a lot of benefit from that. We’ve seen ED disposition rates go way down with them because we’re trained in how to do telephone triage.

On the hospice side, though, they were able to reallocate a ton of resources. They had an entire star center that was acting as their internal triage function. With IntellaTriage supporting that function now, they were able to relocate those labor resources and really start minimizing the burden on the clinicians after hours. We’ve heard literally from every branch we’ve talked to at our monthly meetings, about how their nurses are so thrilled that they can actually get rest at night.

They know if they get a call, that it’s going to be a home visit, but when they don’t get calls (it’s much more rare now that they get calls), that they can actually sleep soundly and are not being woken up every couple hours. Actually getting a well-rested sleep.

On the patient experience side, they [CHI Health at Home] had really good data. Most of the people that we bring on don’t have great data, but since they had the internal function, they had really good data. Speed-to-nurse for them was somewhere in the four and a half to six-minute range. Now, it’s around 30 seconds. Just the patient experience piece is really, really powerful.

Again, coming from my own personal experience, five minutes waiting for someone to pick up the phone can feel like five hours when a family member is in need. Just that little example really highlights both the value prop for the nurse and the patient.

Hospice News: Something that we really like to do here at Hospice News during these conferences is to leave attendees with very concrete things that they could go back to their office and implement, to take action. Whether it’s nursing triage or whether it’s something else to improve the patient experience or the clinician experience. What’s a very actionable step that our audience here could take right away to better address some of the pain points that we’ve been discussing?

Reese: I think one thing that myself and my entire team at IntellaTriage say is “get to know your after-hours a little bit better.” Often, after hours is an afterthought. It’s not the core business case management. Managing those hospice patients during the work week is the core business, but after hours is 75% of the hours in the week. In hospice, it doesn’t matter if something happens at 3:00 p.m. or 3:00 a.m., when you’re in need, you’re in need.

Getting to know your after-hours numbers, how long does it take to get to a nurse on average? What does your resolution rate look like on the first call? How many visits are you making? How does that compare to the industry with regards to road time, travel time, gas, mileage? All these things add up. Then digging in a little bit on your data. Looking at what calls you’re getting after hours, are there any things you can do during the day to impact those calls?

One of the big metrics we look at is calls per patient per week. If we get above a certain amount or below a certain amount, we want to make sure that we’re informing our customers of that, so they know where to potentially engage. I think the one piece of advice is just to get to know your after hours, and we’re happy to help with that. We like to go through that discovery process with you.

Even if you don’t go through with us, I think it’s worth just spending the time understanding what you’re doing after hours and how that’s impacting your patient care.

Hospice News: I know you’ve been tuning into a lot of the sessions today, has there been a theme or maybe two or three threads that really stand out to you?

Reese: I will say that the one thing that has stood out to me the most today, and in conferences in general, is we’re starting to focus on, as an industry, a lot of different aspects and we really are keying in on nurse burnout, staffing shortages, reimbursement. Obviously, those are huge challenges that are going to be something that we need to tackle as an industry – as a whole – going forward.

What I would love to hear a little bit more on and more of the discussions and panels around is how do we make sure the patient care doesn’t suffer because of those dynamics? They’re not easy questions. No one provider, no one partner is going to have the answer, but it’s going to take the entire industry to come together to figure out how we ensure we continue to provide a really quality end-of-life process, in spite of the challenges of reimbursement and staffing that we’re facing.

Hospice News: It almost reminds me of the comment that I think Carla Davis had on her panel. We spend so much time thinking about innovation and VBID and what’s next as far as reimbursement, and how could technology augment visits, that we forget about the basics sometimes. We’re so focused on Hospice 2.0, that we’re not really thinking about hospice 1.1. Is that something that you agree with?

Reese: I don’t know if I’d say it exactly like that, but I do agree with the sentiment of right now, we have a pretty good system as far as caring for people at the end of their life. Yes, there’s going to be huge changes that are going to change the industry over the next decade, but we can’t lose sight of continuing to provide that quality end-of-life care.

Everyone you talk to in hospice, any provider will say, you only have one chance at hospice. After that, that’s your experience, and we don’t want to miss that one chance for any family or patient or caregiver to have a positive experience because what we are doing is providing a ton of value. As our chief nursing officer always says, “Hospice providers, you don’t realize how much you’re the angel for the family and caregiver and the home.” We have to continue to put that first to make sure we’re delivering the best care possible.

IntellaTriage uses a tailored approach to after-hours nurse triage by delivering compassionate clinical expertise through registered nurses. A blend of customized protocols and leading-edge technology provides the best possible patient experience to hospice and home health facilities and providers nationwide. To learn more, visit: https://intellatriage.com/.

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