This article is sponsored by Enclara Pharmacia. In this Voices interview, Hospice News sits down with Ryan Krout, PharmD, VP, Clinical Management, Enclara Pharmacia, to talk about the future of predictive analytics in hospice care, and the steps providers can take to get the most out of this evolving technology. He breaks down the different use cases for predictive analytics and the key areas where AI-powered tools are impacting care. He also offers a look at what’s to come for Enclara and its clients as they explore new ways to deliver value in the hospice pharmacy environment.
Hospice News: We talked previously about your extensive experience in hospice pharmacy — what excites you most in the industry today?
Ryan Krout: The explosion of artificial intelligence (AI) has started to affect nearly every industry in some way or another. While AI has been a very popular marketing term, what we’re actually beginning to see are some valuable predictive analytics tools making their way into the hospice world, particularly when it comes to disease progression.
There are many reasons to have a better handle on how and when patient needs are likely to evolve so providers can be more proactive in their care strategies. Proactive care reduces stress on staff and improves the experience of care, but end of life is an entirely different set of challenges.
In 2016, CMS introduced the service intensity add-on, or SIA, which incentivizes visits during a patient’s final week. The problem is that we can’t always predict when death will occur. We can usually tell when it is imminent, but by then, we’re talking about days, not weeks. Marshaling the resources to increase service intensity overnight can be difficult, especially for smaller organizations, so predictive analytics can help care teams plan better and make more efficient use of their resources.
Where do you see Enclara adding value with predictive analytics?
For Enclara, predicting disease progression presents several opportunities to help our hospice partners improve quality while managing expenses. When evaluating any predictive analytic tool, Enclara always ensures that a clinical expert makes the final determination when predictive data are involved to help mitigate bias and verify the accuracy of information.
We are currently assessing some mechanisms to find out what works from clinical and integration perspectives, and we have seen promising results. One method is simply giving nurses a nudge when they are about to make an ordering decision. For example, when they view a patient in E3 Pro™, we can incorporate end-of-life predictive information to remind them that the patient’s needs may be changing, then share best practices or recommendations on how to proceed. It’s just a reminder to stop and think because it’s easy for nurses to fall into autopilot with these tasks, and this helps to ensure they have the information they need to make appropriate decisions when ordering medications.
How will the ability to better predict disease progression affect pharmacy utilization?
The most obvious one is medication waste. It’s an expense, there is diversion risk, and disposing of unused medication can be an unnecessary stressor for caregivers. If a patient is likely to pass away within a week, a 15-day refill is not the answer. Instead, it’s best to perform a medication inventory to see what is in the patient’s home, then order smaller quantities on an as-needed basis. At the same time, providers may want to be proactive with new medications if there is a high likelihood of new or worsening symptoms. That way, they can keep the patient comfortable without needing to call in a prescription in the middle of the night.
Are there any areas beyond that last week of life where predictive powered tools can improve care?
The last week of life is just one area of focus for Enclara. We apply our business intelligence and clinical capacity to every stage of hospice enrollment. There is a myriad of opportunities to positively impact patient care and the nurse experience. We always say, “You deliver the care, we make it easier.” And whether that’s workflow technology, pharmacist expertise or a combination of the two, predictive analytics can play a role.
This complements our efforts around caregiver education. Anyone who has cared for a loved one with advanced illness knows how overwhelming it can be to keep up with all the medications on top of everything else they’re facing. We’re running a promising caregiver self-service educational pilot with a small number of hospices to help reinforce the medication administration instructions nurses provide. Ultimately, there is the potential to leverage our comprehensive clinical pharmacy resources to create an AI-powered interactive experience that fosters confidence in caregiving.
How does Enclara’s approach to this differ from or align with other offerings?
There are already several players in this space, and I expect we will see more come and others go over time. Our goal is to develop something that is vendor-agnostic, building upon our existing interoperability with over a dozen of the top electronic health record systems. I can’t say exactly what that will look like at this stage, but the key is to have something flexible and agile enough to grow with the rest of the providers’ technology as hospice evolves.
What advice do you have for hospices looking to get started with predictive analytics?
Right now, a lot of hospices are looking at all the new offerings and wondering when they should jump in — and frankly, whether it’s something they can afford. Whatever they ultimately decide, I would recommend taking this time to get their charting up to speed. Some of these tools use hundreds of data points to make their predictions, but where is that data coming from? Diagnosis codes, assessments, clinical notes.
No matter how smart the technology gets, it’s only as good as the information providers put into it. We know charting can be time-consuming and detract from the experience of care, so this is a good time for providers to take a fresh look at their documentation requirements. It’s not about entering more data; it’s about determining what is most relevant and prioritizing that. The human element is fundamental to the success of these tools.
Finish this sentence: “In 2025, the hospice industry will be defined by…”
… innovation as a pathway to operational stability in changing times.
Editor’s note: This interview has been edited for length and clarity.
As the nation’s leading pharmacy services provider and PBM for the hospice and palliative care community, Enclara ensures timely and reliable medication access in any care setting through a comprehensive network of retail and institutional pharmacies, a national patient-direct dispensing program and dedicated inpatient services. To learn more, visit www.enclarapharmacia.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].