Ep. 72: Building the Right Systems to Track Key Client Outcomes

Miriam Allred (00:08):

Gentlemen, this is great to have you on here. Thanks for joining us and taking time on your day to be here.

Dave Tasto (00:14):

Thank you.

Beau Daggett (00:15):

Yeah. Thank you. Our pleasure.

Miriam Allred (00:17):

So let’s start with some introductions, Dave, you are the owner of assisting in Boston. You’re also the author of thriving at home. Tell us a little bit about how you came to home care just a few years ago.

Dave Tasto (00:29):

Sure. After a couple decades of working in engineering and product development, the corporate world across four different industries and climbing up the senior director level. I did feel that still something was missing and I had an eye out to start, start a business of my own, but my enter into healthcare or home care started after being inspired by caregivers, caring for my grandmother during a hospice period I was able to actually meet those caregivers living out in the Boston area. I, I grew up in Minnesota when I did travel back to Minnesota for her funeral. But those caregivers not only attended her funeral after only working with her for a few weeks. But they told stories and how they were able to still keep her smiling during a difficult time. I’m happy, you know, not to be impacting the lives of clients and families in our area, providing them the same level of care that my grandmother received.

Dave Tasto (01:30):

You know, those caregivers went beyond the list of tasks or ADLs and took initiative to bring happiness into my, my grandmother’s last few weeks. So we’re, we’re now in our fourth year of business and I’m as passionate as I was on day one, you know, helping grant individuals, you know, one of their final wishes is that to, to live their retirement years at home and, and for nine outta 10 Americans, you know you know, at home is, is really where they wanna live. That is part of the reason I recently published my book called thriving at home. A handbook for preventing hospital stays, which is aimed to help family caregivers perform the same non-medical interventions that our caregivers provide. And, and, you know, basically in the outcome of helping keep them healthy at home. As Miriam mentioned, an owner of assisting hands, home care franchise based out of Bedford, Massachusetts we’re supporting and clients in the Boston suburbs, north and west of the city. Also as an area rep area representative with assisting hands, I’m also helping grow the brand and work with other owners of franchise offices across new England.

Miriam Allred (02:40):

Happy to have you, Dave, thanks for sharing a little bit of your story as well. I could listen to reasons why people came to home get are all day long. Everyone’s story to get here is really impactful and, and personal. And I love that. Beau, why don’t you introduce yourself briefly?

Beau Daggett (02:58):

Yeah, so yeah, I’m part of, kind of the sales team of the access care side here and started with access care back in 2016. So I’ve been here almost six years now and you know, I’ve had the opportunity of, of helping our partners go through that, that searching and, and kind of buying pro and helping with implementation, planning that out and thrilled to have the opportunity to be here today, to, to kind of, you know, partner with Dave as he shares the impact that he’s having in his community. But also because I actually have the opportunity of working with Dave and helping him kind of decide and land in with with access care, a thrill to, to be here today.

Dave Tasto (03:41):

We go way back though,

Beau Daggett (03:42):

Way back

Miriam Allred (03:44):

Before we jumped on, we were saying that 2018 feels like decades ago. I don’t know how many of you feel that way, but a lot has changed in the last four years.

Beau Daggett (03:52):

For sure.

Miriam Allred (03:54):

So let’s, let’s jump in something that you two gentlemen are passionate about is, is client outcomes. You know, there’s a lot of reasons why we, we got into business, why we’re here today in home care, but something Dave that you, you know, are really passionate about and have been passionate about since the beginning is, is measuring and tracking client outcomes. So let’s start there, you know, why that focus of tracking client outcomes in your business?

Dave Tasto (04:22):

So we started tracking outcomes basically as soon as we started providing care back in 2018. But for sure though, our sophistication has come a long way since then. My background in engineering and product program management has taught me that what you track can be managed and improved upon also for us to, to make better operational decisions. Those decisions need to be based on data and facts. So our continued growth depends on improving all areas or all aspects of our business. So the better decisions we make, the better care we’ll be providing. So how do we get started, I guess, you know, or why, or part of it is before we even opened our doors as a business, you know, I knew that that high customer and an employee satisfaction were very important. If we were going to be able to sustainable ever growing business, we started tracking the number of referrals from clients and caregivers, as, as people in a sense will only recommend to family and friends firms that they’re happy with.

Dave Tasto (05:34):

So the, the thought was those figures, we didn’t directly indicate how happy our clients and caregivers were with us. Well, we found that the data was really lacking our performance and wanted more timely, you know, tracking of outcomes during that first few months in business, though, we did start up with home care pulse for the satisfaction management and to find that that in addition to providing our, our award-winning care, now we’re proud of it that we’re able to track our, how our employees and clients feel about us in real time at the client level, you know, and at the aggregated level, like trending over time, the other, the other reason, or why is also quality of care was important is our business grew that it was still obviously a focus but our initial tracking was primitive in that area as in that area, as well as, you know, how we’re starting to track satisfaction, but it’s difficult to objectively measure for clients that have varying triage levels that have you know, across a wide range of family or of supports, and then also with a mixed level of assistance from our professional caregivers.

Dave Tasto (06:43):

Right? So if we’re only there a few days or a few days, or a few hours of the day how do we initially assess like that quality of care, the impact on their outcome is a, is a client or a patient.

Miriam Allred (06:55):

Most agencies think that quality of care is, is a differentiator. You know, you go to any home care website right now and you see, you know, we provide quality of care. I love that from your beginning, from your foundation, you wanted to prove that, you know, any provider can say we provide quality care, but how can you actually prove that to your clients, to your employee, to your referral sources, to the families, you know, you need to pair the qualitative data with the quantitative and tracking that and measuring that is what, what actually proves the quality of care. So, yeah, let, let’s kind of keep going there. I wanna hear a little bit more about how, how you started tracking. I think lot of hang up, you know, the hang up for a lot of providers is how do I actually track that maybe in a spreadsheet that maybe elsewhere, how did you get started initially? And you know, where are you at with tracking today

Dave Tasto (07:51):

Initially for, you know, tracking the happiness was basically just waiting until we got a referral and found out that it was from a client or you know, if we got a caregiver referral, we found out that, you know, obviously who, who gave us the referral, we were tracking the number of these referrals. Like that was spreadsheet based, easy to track, you know, there’s very low statistics, but as I mentioned, it was after the fact, right. It wasn’t a, a real time impact, like, and we had targets for it. You know, I remember, you know, we wanted to have 20 in the first two years for clients referring clients, but, you know what did it mean? Were they really still all happy or were there some, you know, folks that weren’t happy? So it was hard to gauge, you know, in the aggregate, what was really going on in the, the quality of care, you know, we were tracking probably only hospitalizations.

Dave Tasto (08:46):

Did they go to the hospital? And that was it. You know what I mean? You know, we’re, we were, you know, talking to them often, like every, every agency is doing and understanding if they’re satisfied or not satisfied, but the, as you mentioned, having data to support what you’re doing and evidence of your results was, was difficult. Being objective about the data and so forth. Now I mentioned on the faction and the happiness you, we are driving, you know, in, in doing the regular interviews and home care pulses. But on the quality of care side, you know, we’ve definitely evolved. And along with, you know, access care, our operational software, but we’re, we’re tracking incidents care escalations and hospitals, a the contrasting to, you know, earlier in the, in the care quality of care was just basically, did they go to the hospital at the client level?

Dave Tasto (09:47):

The notes were sporadic, you know, might be in a profile, might be in a spreadsheet, might be, you know, it was ad hoc. We couldn’t pull a report or anything like that. So it was a little challenging to kind of get that data to, to publish your results and share those with your referral sources who were left, wanting to and driving towards and realizing that quality of care was important, but without a good way to capture it and share it and provide evidence to our, our partners. But, you know, obviously actually access care includes a lot of that standard functionality now and makes it easy to capture the data, provides the standardized reporting across all of our clients. And now having a more broad data set, we can monitor our collective performance and then still take actions to improve how we care for specifically each client.

Dave Tasto (10:38):

At the client level, we are, I mentioned looking into proactive ways now to prevent the crisis situation or, or avoidable trips to the O hospital by identifying and monitoring. You know, what we’re trying to identify more of them is, is leading indicators for hospitalizations. I mentioned the incidents, you know, that includes tracking clients trips or falls when we’re with the clients or not is, is a, is a, is a thing to, to understand here because, you know, and, and our data is only as, as good as what we can glean from family members. So we have to depend on the full care continuum, but in addition to the trips and falls also emergency trips to the hospitals, even if those trips don’t end up with an admission, you know, an admission that might be triggered, you know, under a Medicare kind of Medicare level tracking.

Dave Tasto (11:39):

But we’re also, I mentioned a lot about the escalations with our caregivers or family members or other healthcare providers reach out to our office team. You know, we do take action, you know, when they, when that happens. But, you know, if we start tracking that, you know, after the second intervention in a number of weeks, we haven’t figured out the exact metrics in terms of how we’re actually going to understand if, if something else needs to happen, but we’re kind of starting to collect this data and, and looking, trying to be more proactive about addressing the quality of care instead of waiting until the hospitalization happens in, in reacting and kind of tracking after the fact

Miriam Allred (12:19):

Fantastic! Beau you are talking to providers regularly and probably here similar to what Dave is saying, you know, four years ago, it looks very different than what it looks like today. You know, providers are asking, how do I get started? How do I measure all this? What are some underutilized tools or resources that you recommend providers use to start tracking these outcomes?

Beau Daggett (12:43):

Yeah, I mean, that, that, that’s, it’s very interesting how the industry has changed and, you know, I think home care pros doing a great job of kind of communicating the value of, of hospitalization. And obviously we want more people within the network to grasp that. And so lots of times when I’m going through, you know, working with our partners, it’s, Hey, are you tracking hospitalizations? And, and that would be yes or no. And if it’s, yes. Okay. How is that being done? Well, we kind of documented, they’ve kind of hit on it where, well, it’s either in client note or it’s on a care note or we’re, we’re documenting it, but there’s no visibility there. It doesn’t really create that value or that meaning that we’re com wanting to communicate to the industry. And so some of those tools is just, you know, not only historical report on like, after the fact, but you know, act access care.

Beau Daggett (13:36):

I, I could speak for our point of care. You know, management scheduling solution is that, you know, if we’re documenting, we want that to be visible and we want that to be accessible and not more burdensome, whether it be on a, a, a case manager or a caregiver, but kind of allowing them to just go through the daily documentation they’ve mentioned, Hey, we’re having conversations with our family members, with our, with our clients, but allowing those to trigger automation for the office staff, whether it be at the end of a shift, you know, did you see a change in your client’s condition and, and the caregiver being able to document that, and that automatically kind of alerting the, the internal staff, okay, Hey, these cases need acknowledgement, you know, and, and those are just little things that can help prevent those, those initial unplanned trips to the ER, that then lead to, you know, admissions and remissions.

Beau Daggett (14:28):

So yeah, I think another one would be you know, just having clear communication with our, with caregivers, like when you about tools that are maybe underutilized is maybe changing the way we look at training our caregivers. So little plug for home care, pulse training here. Right. But really what I, what I’m thinking or what I’m hoping to communicate here is that, Hey, let’s communicate not only to each other, as owners, the value of tracking and having these stats, but also back to our staff and our caregivers, letting them know like, Hey, this is legitimizing the value of your work and, and the worth that you’re bringing into this individual’s home, you know? And so that starts with training on what to look for. Why, why are we looking for these? Why is it important that they don’t go back into the hospital?

Beau Daggett (15:17):

You know, just educating them on the, what we’re trying to learn too, like from, from an industry standpoint. And then just again, one other thing would be maybe adjusting the way we, we do our into takes in our care plans, gathering that data of like, Hey, what are prior hospital, you know, visits? And what does that look like? Putting that in the care plan is great, but going back to my first point, we gotta make sure it’s visible. And so some of the benefits of, of kind of how access care at least is thinking, right, is if Dave entering in the form, I want that to be visible to, to me as a caregiver when I’m going out to the field that afternoon, and Dave being able to track, okay, has this caregiver, you know, read this care plan for this client and being able to see some of that holistic kind of case management all leads to prevent and being able to, you know prevent those trips to, to the hospital.

Miriam Allred (16:18):

Yeah. I love, I love what you’re saying. I love this concept of, you know, a lot of providers might know a point in time what’s happening, but being able to trend that over time then gives you, you know, goals and things to look forward to, and communicating that back to your team. Dave, maybe you can speak to some of this. How do these metrics, these outcomes act as you know, a, a roadmap for your employees, you know, your office staff, how do you use the numbers to then guide metrics there in the office staff or with your team in general?

Dave Tasto (16:53):

Well, you review the data regularly and, and because it’s front and center, we’re also sharing that data with our referral partners, referral sources, new contacts that we make to share about our approach, but then also the data underscores what we’re doing and using the data kind of says a lot about who you are, what your agency is doing how you’re tracking that you’re data driven your fact base and so forth. But reviewing it, keeping it top, top of mind, front and center with your, with your staff and your office helps just maintain that focus.

Miriam Allred (17:32):

Yeah. Maintain that focus when it’s easy to have your attention in a lot out of different areas on any given day, you can maintain that focus or that end goal, you know, this is what we’re trying to accomplish. We’re all working towards that. Just one other thing that I wanted to mention, you know, Beau was saying how, how so few are, are tracking readmissions from the 2021 benchmarking report? Only 22% of agencies of private duty home care agencies are tracking readmissions. That’s, that’s pretty low. You know, we’ve got a, we’ve got a long way to go as an industry to, you know, reverse those numbers, 78% tracking and 22, not, you know, we’ve, we’ve gotta work towards this. So that’s why it’s been a focus for us to have these conversations, you know, why the value of, of tracking and how to do it, you know, because, you know, we, we’ve just gotta really get started here. So, so let’s transition a little bit, Dave, I wanna hear about now that you’ve been tracking for so long, what are some of, of the, the outcomes? You know, you, you mentioned referrals coming in from referral sources, being able to provide this data to them. What are some of the things that have happened in your business as a result of tracking?

Dave Tasto (18:42):

Well, they just generally have had a very positive impact and noticeable even through the pandemic. Just thinking, thinking about what we were talking earlier, but since 2018 more than half of my business existence has been in during a global pandemic in the Northeast, you know, in the past, we’d really need to be prepared for snow storms. These days we’d rather like crazy, some crazy times and storms are not as much of a chance parts anymore, you know, like through the pandemic, but I would say three areas have improved as a result of the, you know, this data driven approach and tracking in the quality of care area, operationally, yes, we’re tracking, but are, are, we now have this three trademark thriving and home approach that you know, in to keep our clients healthy and happy at home and out of a hospital.

Dave Tasto (19:34):

As I mentioned, it’s underscored by our incident and hospital readmission tracking. We talked about reviewing and monitoring our rates, providing that feedback, incorporating it into all areas of the business as well with saying we also additional items now that we have to capture at client assessments or intakes. Also how we’re building care plans is not just focus on tasks, but more proactive measures to maintain client independence and health. You don’t have to talk about how long it takes to shower or your client. If you’re talking about where we’re really here to keep them out of a hospital, it’s a mentality shift. But it it’s, it’s, it’s got a shift, the entire office team and how you’re operating as a business. Also Beau mentioned caregiver training. Our topics are selected to improve those skills and, and increase awareness for the causes for hospital admissions and readmission.

Dave Tasto (20:34):

You know, as we educate our team on what interventions they can take proactively in the book, I talk about all the key drivers for admissions and readmissions, and those are the topics that we really try to reinforce within team. And there are non-medical actions that do not require nursing degree. And there can, there are actions that can be that, that are being, and can be taken by family caregivers, right? And are, are professional caregivers as well. If they’re aware, I’d say the second area beyond quality care is, is, is really the client and caregiver happiness, as I like to refer to it, or is, is high satisfaction. In a sense those measures have increased and they’ve maintained, you know, or remain at a high level beyond delivering undervalued proposition to clients are key. Caregivers are also seeing benefits, you know, Beau mentioned like what is in it, what’s in it for the caregivers, right?

Dave Tasto (21:35):

Well, if we’re focused on hospitalization tracking and the actions we take well, when our readmission rates are low, our caregivers enjoy more consistent schedules, less interruptions in their work because they’re clients aren’t going to the hospital. These are easy, real things to convey to your caregiving team about and, and have everybody aligned around this outcome that we’re going after as a business. I would also attribute though some of our retention employee referral gains to that thriving and approach and just kind of the whole umbrella of everything we’re trying to do within our office, the third significant area to get a long winded way to get back to your question about referrals is definitely in, in our client referrals. We, we definitely share our results as I was saying, our readmission results with, with referral partners. And we’re now getting new client referrals from a key hospital in the air, as well as rehabs are now sending us client needs, right under the affordable care act.

Dave Tasto (22:37):

These, you know, those re referral sources can be financially impacted if, if their patient goes back into the hospital within 30 days of discharge. So preventing hospitalizations and driving high satisfaction, it’s meaningful to all referral sources and families, right? No one wants their loved one or patient to have a trip to the hospital, particularly those trips that can be avoided or prevented, right? So it just of the outcome that matters. This is it. As I like to say in home care are in the business of preventing hospitalizations. And it’s just something we have to all embrace and increase that 22% through the so high.

Miriam Allred (23:24):

I just want to say, I love what you’re saying about being proactive and not reactive home care is perfectly positioned to be proactive care. You think of healthcare at large or host hospital systems. A lot of healthcare is reactive, but home care and the possibilities of taking care of people in the home, you know, being proactive is an option and is what we should be striving for. So I just love the way that you put that. To be honest, we probably have people on this call that aren’t tracking readmission rates and that’s okay. That’s why we’re having this conversation. Let, let’s start with you, Beau, why does tracking client outcomes and tracking readmissions? Why is that gonna be essential for agencies moving forward?

Beau Daggett (24:08):

Yeah, I think they’ve kind of hit on it there where, you know, the incentive there for the, the clinics and hospitals to, you know, make sure that their patients are, you know, at discharge receiving quality care is just Hey, like a very tangible one, like you’re saying like, Hey, that’s, that’s actually impactful for today. And I think big picture it’s, I mean, ultimately you’re building you’re legitimizing home care, you know, and I think so often we like to distinguish ourselves, Hey, we’re not medical. And, and we are, but that’s not. That doesn’t mean we’re not part of the whole medical journey of that, that, that individual’s, you know you know, life there. So I think that it it’s, there’s multiple ways we could look at that, you know, and say, it’s, it’s so valuable for the individual location, you know, just as a being able to have something tangible to measure, Hey, every home care agency on their website says we’re committed to quality care in our community, but then we, we can, we get back to the numbers and we, and we, it really revenue doesn’t really communicate that number of hours schedule doesn’t com all these other KPIs don’t really communicate or can always necessarily be tied directly to, Hey, we’re providing quality care.

Beau Daggett (25:19):

But like Dave was saying at the very beginning of that call, it’s, it’s important for him as an agency, right. To know what the, the outcomes are of his clients to kind of legitimize the, the, the quality of care. And, and the shift in that, like the trend. And that’s kind of one thing I would kind of also encourage that, you know, Dave’s background is a little more analytical, a little more engineering mindset. He, so he, he, he is used to gathering that data. Not every home care agency owner thinks that way, or maybe wants to, we all have the desire to be there, but if we don’t have the discipline, that’s where we gotta have the tools. And so I think kind of coming back and just encouraging, Hey, start somewhere, you know, like you, the, the statistics would say that someone on this, this call here, I isn’t tracking hospitalizations. And but I don’t think it’s something that you have to necessarily figure out after this afternoon. And then it’s gonna be set in stone. It’s a, it’s a journey and a process there. So also just wanna kind of make, throw those 2 cents in there, but

Miriam Allred (26:23):

Great points. Thanks, Beau. Dave, what would you add? Why is tracking going to be more important than ever in the coming months and years for home care agencies?

Dave Tasto (26:33):

I think today outcome based focus is just essential. There’s a trend towards more outcome based healthcare. And it’s, I, I see it only continuing, right. It started five, 10 years ago, or, you know, really focused on it more five, 10 years ago. But particularly as, you know, coming outta the pandemic, there’s so much more of an emphasis in the legitimacy of home care and being able to impact these outcomes. Well, if we have the ability to the outcomes we should as well, to just track that and publish how we’re doing, just the fact that we are helping families. In addition to family caregivers, it’s very likely that our rates are lower than the national average. So we have something already behind us that we could probably talk about. You know, as we talked about our partners in skilled care home health, what we’re gonna, they’re gonna look to more agencies that are focused on quality of care and have the day results to validate their performance in areas that are meaningful to our partners, right. And can even affect or impact them financial, like the readmission rates.

Miriam Allred (27:48):

Those are great points. We’ve got a quiet group today. We’ve got an question. That’s come in from Michelle here. She’s asking, when you start talking to hospitals, how do you approach or overcome the barrier for the case manager who classifies you as a non-medical provider? That’s kind of tangential here, but Dave, what would you on to that?

Dave Tasto (28:12):

Well, we work closely with the medical providers our advantage, and we talked earlier about being proactive, have the ability to impact outcomes. We have more data than any other provider in the continuum we have every day, we have the up, up to having every day or multiple shifts per day. So how are they progressing in between PT visits? We know, in fact, we can provide that data back to the physical therapist to understand why they’re not regaining their strength. Okay? Cuz we we’re tracking their diet. We know if, how much they’re eating. If they’re getting enough liquids, we know if they’re taking their meds, the physical therapist, the nurse coming once a week, they don’t have the verification of the plan of care. We have the verification, the data that says they are on track and still they’re not progressing. Then that is escalation to a physical therapist. Maybe in this case that we’re talking about, they need to come up with something different or, or maybe a different regime or different exercise, whatever doing to understand what it, why aren’t they progressing? We have the data. I’m just like, say it, sorry. I’m passionate. I get, keep going on.

Miriam Allred (29:26):

Thanks for the question, Michelle. I wanna kind of wrap up in talking a little bit about your book, Dave, you know, everything that we’ve talked about today, you are so passionate about that. You wrote it all down and have this compilation of all of these concepts and the why behind them. Do you wanna just talk briefly about, you know, the reasoning behind the book and where people can access that?

Dave Tasto (29:50):

In the early days of the pandemic, we saw some of our clients that were on, you know, like low triage levels, moved back in with family, you know, to avoid the risk of, you know, exposure to the virus. But those family caregivers started shouldering more of the burden, but they didn’t have the professional training that our caregivers had. You know, within a few months, some of them were thrown in the white towels and saying they need help. But also some of the clients did end up going into the hospital. At the same time, I was looking to really put more and more in place about track outcomes and realize that that same scenario with a family caregiver covering if we’re only there till 5:00 PM or 8:00 PM and, and our client trips or falls at night, our last logistical mile, you know, to get to preventing a readmission, goes through the family caregivers.

Dave Tasto (30:50):

So if we, as an agency really want to affect outcomes, many of our clients in between shifts have family caregivers or friends helping out if we’re gonna impact those outcomes, why we should just inform those family caregivers as much as we’re dream in our caregivers to help keep them out of a hospital. Even our caregiver shifts when we interrupted, if the, if, if all happens during a family caregiver shift. So the book is intended really to help family caregivers do the stuff. As I mentioned earlier, the stuff that our caregivers can do, the intervention that they can take. So, so I, I wrote the book to really provide that knowledge with, with shared knowledge. There’s likely gonna be improved outcomes for everyone. That’s really the rationale behind it. The book is available on Amazon or I have a book website at thriving, [email protected].

Miriam Allred (31:52):

Gentlemen, thank you for taking the time, you know, to be here today and sharing your passion and your ideas and your experience on this topic. It, it can’t be understated, the importance of tracking client outcomes and tracking readmission rates. And it starts with the example of the two of you, you know, the organizations that you’re at and the value of tracking, you know, we’ve, we’ve gotta start somewhere and I, I love your passion. I love your excitement for this topic. So thank you for joining us and sharing your expertise on this.

Dave Tasto (32:19):

Thank you. My pleasure. Yeah. Thank