Ep:16: The 4 Data Pillars in Home Care that Will Set You Apart With Referral Sources

Miriam Allred (00:06):

Hey, this is Miriam Allred and you’re listening to Vision | The Care Leaders’ Podcast by Home Care Pulse. My guest today is guy Guy Tommasi the Owner of LIFETIME Care at Home. Well Guy, welcome to the show. Really excited to have you appreciate you taking the time. For those of you who don’t know Guy Tommasi is the Owner of LIFETIME Care at Home, out in Connecticut and today we’re going to highlight data. Data is right in your wheelhouse and you’re kind of the industry guru as far as data goes. So really excited to have you on. So, welcome to the show!

Guy Tommasi (00:42):

Thank you, Miriam. It’s a really good to be here. I’m really excited about the opportunity to share some of this information with you and your listeners. So I’m, I’m ready to go.

Miriam Allred (00:53):

Well, let’s start with value based care. It’s been kind of a buzz word in industry. So tell me what are some of the key differences when we talk about value based care versus, you know, what we’re currently doing

Guy Tommasi (01:07):

Value based care is, is really the new phenomenon, but not really new it’s been here for, or was introduced back in 2010, I believe as a way to continue to address the growing cost of delivering care. And what we’ve been doing since the beginning of time is, is the fee for service type model of care, where based on volume, how many procedures you do, how many visits you do you’re reimbursed for that accordingly? Well, it, it got to a point where it really was going to, to bankrupt the Medicare system. And CMS said, you know, we need to, we need to start looking at better ways of providing care. And the only way we’ll go into rattle that cage and get providers to start watching what they do is they introduced this value based care model and basically what it in its simplest form.

Guy Tommasi (02:18):

And cause there are multiple layers to it, but in its simplest form value based care is they we’re saying is you providers are going to be reimbursed based on the delivery of the care you provide. And then we’ll reward you for efficiency and effectiveness. And basically they were saying is your challenge now is to deliver high quality care, improve patient outcomes and satisfaction and reducing costs. That was huge. And everyone in the health care field, home care field, this was, this was a new concept and how to deliver care. And there’s multiple layers to that. You may have heard, you know, part of the driver in this value based care is called alternative payment models, APS. And, and again, that, that concept is the driver of value based care and getting providers to, again, quality value, lower the cost. And you’ve heard of accountable care organizations and bundled payments, and that’s where all the multiple layers come into play. But again, in its simplest form, it’s basically going from volume to value and value being measured by the quality of care efficiency, the satisfaction. And the whole goal is to start to bring down the cost of providing care, both in the home care world and on the in the healthcare world in general.

Miriam Allred (04:01):

Yeah, that was a great synopsis. So at a high level, what changes, you’ve mentioned some, but what other changes need to happen as an industry for us to arrive at value based care?

Guy Tommasi (04:16):

Well, I think it for our industry and, and I like the fact that you’re calling it home care as well, we’ve been called private duty and nonmedical and handle in home care for awhile. And that in itself is part of the problem. Nobody knows what to call us. And sometimes it’s hard to identify who we are when, when it’s hard to get people, to understand who we are, but home care for years since the seventies has, you know, has been in a nice comfort zone. And I, and I say that with all due respect because we haven’t, we really haven’t had any requirements on us like CMS has done with the other stakeholders. And when I say stakeholders, you’ll hear me mention that a lot, the stakeholders are home care, home health agencies, physicians, hospitals, Medicare Advantage plans. They kind of, the ACO is as well.

Guy Tommasi (05:16):

And we’ve never had that type of oversight. So it’s hard for us to try to get to where we need to be when a lot of us don’t know how to get there yet, because we’ve, there’s nothing, there’s no, there’s no benchmarks. There’s nothing that, that guided us there. Every state is different Miriam, you know, there’s some who have high requirements and regs, but nothing that to a large degree impacts on the financial implications of that respective agency as the other stakeholders. So I, you know, if, if COVID did anything positive, it opened the eyes of these stakeholders to the value that home care brings to the, to the general population during this whole COVID crisis. Our industry was in there every day. We kept their clients, their patients, their enrollees safe, independent, and out of the hospital. And that’s the last place people wanted to be is in the hospital while you couldn’t go to the hospital and three, it all kind of tied back or ties back to the whole value care concept of reducing costs.

Guy Tommasi (06:37):

So we here at LIFETIME, certainly we’re, we’re recognized by our stakeholders saying that, you know, we expect the same type of care and the same data. And you’re doing a great job with that. So we’re in a great position as an industry to really now make a name for ourselves. The eyes have been open. The opportunities are there for those who want to go get it, because for many in our industry, they’re very content being where they are and doing what they’re doing. I personally believe that will not, that’s not sustainable going forward. So I, you know, one of the things is, is we need a commitment from the highest levels of our leadership owners, directors, who are willing to get out of the comfort zone and commit to establishing the metrics that are parallel to the metrics that are required by our stakeholders.

Guy Tommasi (07:44):

And because what that’s going to do is going to elevate the credibility of our, of our industry above and beyond where it is today. The second piece I, I really think is we need to establish benchmarks. We need to establish benchmarks for our industry so that the consumers can start to compare us against each other, take on online, looking for everything nowadays and CMS, you know, there’s, they have a home health compare hospital, compare physician, compare hospital, compare again, we’re the only ones who don’t have that actually they are now changing and they’re going to, what’s called and they’re going to combine all these in one called Medicare care compare, I believe say that fast track, you know, because that’s, what’s out there and that’s, you know, the Home Care Association of America (HCAOA) is actually has established a Data Committee to start working towards that.

Guy Tommasi (08:51):

So that’s exciting and ties back to the, the ownership and those to step up and, and be part of that. That’s why Home Care Pulse, thankfully, you know, provides a comparison of client and staff satisfaction metrics. That is huge. That that’s 50% of, of what. And, and, and if we get too in questions with the quadruple lane, 50% of it is there and Home Care Pulse for provides that as well as, you know, benchmarks for recruitment and retention and marketing and sales. It’s really the only true benchmark we have as an agency or as an aid as an industry. But what that does is even though it may not compare us to other agencies, it compares us to the industry as a whole. So when I get the benchmark survey, I look at it right away. That’s kind of like the Christmas gift that’s come in the mail, but he’s running the open package and we look at it and we say, okay, let you know, what’s our industry doing? And where are we in comparison to that? So I think that opportunity is here. The industry is, is, is trying to make it happen, but we need to, to really get, to get our, get all of our ownerships and our directors to onboard with it. And we need to establish the benchmarks. So then we can go to that stakeholder table saying, Hey, look it up. Now you can compare us. So that’s where I think we need to be on a high level for our industry.

Miriam Allred (10:31):

Absolutely. Well, let’s, let’s get right to it. You mentioned the quadruple aim concept. Let’s talk about the four pillars that you’ve identified as the key data to be tracking, to take to these stakeholders. Can you talk about those four pillars?

Guy Tommasi (10:46):

Sure. The, you know, we kind of coined the four pillars here at LIFETIME, just, just because we didn’t come up with them. We just said, Hey, these are the four pillars that we’re going to have to address. And basically these are the four pillars that CMS the centers for Medicare and Medicaid services established through. What’s called the quadruple aim. And if I could just take a minute for a little brief history in an attempt to, to combat, if you will, the rising expensive healthcare CMS said that we need to, we need to focus on three critical areas. We need to focus on quality value and, and lowering the cost of care. And they coined the name triple aim. And those three components were going to be the drivers to get us to achieve the value based care concept. Well, back in 2017, CMS realized that in order to achieve these three, there’s a fourth component that has to happen and they, and what they call it was clinician satisfaction.

Guy Tommasi (12:17):

Basically what they said is, Hey, if we’ve got clinicians burning out and not being able to do their jobs, then this whole concept of value based care doesn’t happen. So they introduced this fourth quadrant. If you will, that’s called care. It was called clinician satisfaction. And then what we did on our end is we just modified those four to fit the parameters of home care. So instead of clinician, we called ours caregiver or staff satisfaction. And instead of patient satisfaction, we call our client satisfaction. So those four pillars, quality value satisfaction, both for clients and for caregivers became the structure of what the stakeholders are now measured against. And that’s why I’m excited about this being here. And when I did the other presentation, because I really, really strong about let’s not reinvent the wheel, the wheel’s really been invented. It’s called the quadruple aim.

Guy Tommasi (13:42):

Let’s not go, come up with some crazy, Hey, look at what we can do because the stakeholders don’t know enough about us to begin with. If we start introducing things that they’re not even in tuned with, all we’ve done is waste time and resources. So if we in our industry adapt to this quadruple aim and measure the same data points that our stakeholders are doing, then when we put that data together, we’ve got to go to the table with something they then recognize. So if we start talking quality or rehospitalization or satisfaction, they know, Oh, that makes sense because that’s what we gotta do. So let’s see what they’re doing. So now you begin to talk the talk, you think like them, you talk like them, you act like that because it’s, it’s really about them. And if you assimilate like that, then you become kind of the favored referral slash you become that favored source for business, because for them now, now they see you as one of them. So this quadruple lane was really the, the the goal of getting to value based care using those four metrics.

Miriam Allred (15:14):

So, so tell me about the results you’ve seen taking this data to stakeholders. I know some of the results that you’ve driven, but tell our listeners, you know, you’ve been doing this for some time now and tell me what was it like when you first took this data to these stakeholders? What was their initial reaction and what results have you seen since then?

Guy Tommasi (15:38):

Well, the hard part to that was they, they looked at us like we had five heads. We’ve been doing this for the past four years and it wasn’t easy. Initially we had to a lot of trial and error. And that’s why I said a few, few seconds ago, don’t, don’t try to be creative and invent the wheel use. What’s already there. And the first jump out of the gate, we, we were like, Oh yeah, this is probably a work. This, this might work. And, and we really got a rude awakening. When we did try to introduce some of this and got zero feedback, not even negative feedback, I would have been fine, but we got no feedback. And that quickly said to me, we’re not doing it right. And that’s what forced me and my staff here to say, forget about looking internally to change.

Guy Tommasi (16:45):

What are we going to need to do externally? And that’s where we took the time to find their pain points is what I like to say. What were the pain points that the stakeholders were experiencing? That we could be a supportive partner with what that once we said, okay, this is what it is. It became easier to develop our data points. Once we saw that 50% Miriam of what they were looking for, we were already collecting with Home Care Pulse we were 50% ahead of the game because we had been working with Home Care Pulse. We started working with, with the, with the questions and the questions are on the stakeholder side. You may have hear Oasis. You may have heard about HCAPS. All those are questions that asked the patient about their satisfaction scores, her satisfaction experience. The Oasis is just a scale and talks about their basic mobility, able to change.

Guy Tommasi (18:06):

17 of the 35 requirements are ADL related, ADL related. And then we were able to take the age gaps, the satisfaction piece, and work like with home care pulse, and say, okay, we need to get questions that are similar so that when we present our data and what they read, they can say, Oh yeah, I get it. We have to do that too. And Oh yeah, I get that. We have to do that too. And came for, for the other two about value. Our value was keeping patients, their patients out of the hospital and under quality, ours was functionality score. Why functionality, because that’s what we do the activities of daily living because in home care, we’re about chronic and stable care. And so when, when we get clients, if they have multiple morbidities and our goal is to at least keep them stable. And in other cases, simply try to show the improvement.

Guy Tommasi (19:23):

So we were able to match up the questions, both on satisfaction and quality. And then we were able to take that data and go to each of the respective stakeholders and, and the best part about not reinventing the wheel is the data that you ended up collecting, Miriam can be used with all the other stakeholders. It gives it because I like to say data tells the story. Data tells what you do. It it’s your, it allows for accountability. It gives you credibility. It’s easy for me to say, we give great care and you know, that case manager, she loves us. Well, now I can say here it is. Here’s my proof. And as, and especially for a competitive advantage here in Connecticut, it’s extremely competitive because it’s a non licensure state for home care. There is almost 700 of us, but I want to, you know, no one here in Connecticut, at least that I’m aware of has the breadth of data that we’ve collected.

Guy Tommasi (20:44):

And I take a dashboard with me and I say it, it was discharge planner. Hey, listen. Yeah, I have 668 of us, probably not going to end you. Don’t just ask for their dashboard, ask what their outcomes are, makes a huge difference. It makes it, I say to them, that would be the fastest meeting you ever have because our industry isn’t that, that hasn’t done all that yet. Because again, like I said earlier, it’s not forced to, but it’s given us such a competitive advantage that it’s really made a difference. You know, I like to say there’s three major things. We could be that great supportive partner. It’s going to help bottom line. And it has, and to it, it’s a differentiator as a competitor. So, you know, you, you take that a week ago to see the data. And every one of the stakeholders have different pain points.

Guy Tommasi (21:49):

And what I mean by that is they all, they all need help with something. So, and the home health world, for example, you know, back in January, they started introducing these, these PDGM the patient driven groupings model. Huge. This was, this is a a reimbursement a new reimbursement model for them. That that is hasn’t been done in over 20 years. Well, one of those requirements is functionality and every one of those functionality questions are all ADL related, everyone. So, you know, I can go to a home health agency, which I have and partnered with. It says here, here’s how we can help you with that piece of the groupings model functionality scores. They’re like, Whoa, haven’t seen this before. And I’m thinking, well, this is what we do every day is it’s talks about grooming, bathing, the things we do every day.

Guy Tommasi (23:01):

So, you know, you go to that home health that you can go to a hospital. What’s the pain point for hospitals? Well, patients who come back within 30 days with the same diagnosis, Medicare dings them a fine, could be up to 5% of their Medicare reimbursement. Our data. We show 30, 60, 90 day readmissions. I go to a hospital administrator and say, here’s what we can do to keep your patients from coming back within 30 days. Also, there’s the, there’s a high level of patients who are discharged from hospitals, call it high risk patients who do not qualify for the Medicare conditions of participation, which means they cannot get home health services, but they’re considered high risk falls, nutrition, gate transportation. Those are huge. Those are reasons why they ended up back in hospital. Again, we do that every day. So you share with them that pain point, they pay attention.

Guy Tommasi (24:12):

Absolutely. So even with, with the Medicare Advantage plans, we’re still in the infancy stages with that. There’s a whole reimbursement issue, still being developed and watched, but they look for things like client satisfaction. Why? Because their whole world evolves around enrollees and star ratings. Every one of our care, every one of our stakeholders live and die on these star ratings. Zero to five. I was reading 77% of Medicare beneficiaries in 2021 are gonna pick a Medicare advantage plan that has four stars or more 77%, I think 52 million people. Well, if we say, Hey, look at our satisfaction scores. Look at our rehospitalization scores. They start to pick notice because they don’t want people coming back in the hospital. They want those four stars, five stars, because they’re also reimbursed through CMS, dumped better to stars the better the reimbursement. So the data that we collect you, I just shared three or four different stakeholders that you can go do specifically hitting those pain points that you could be a supportive partner for.

Miriam Allred (25:48):

And I love what you’ve continued to drive home is that in home care, we don’t have to reinvent the wheel. You know, we can look to these what I call sister industries or these stakeholders and take what they’re doing and apply it to our industry, to drive the results that will get us noticed, noticed, and, you know, really help us become part of this continuum. So I love that point of just, you know, it’s simple. We, you know, we can do it. We just have to really implement it and put it into practice.

Guy Tommasi (26:17):

Right. And it is, it is a commitment. I, you know, I don’t want anybody to think, Oh, this is, this is pretty easy. We could just take those four pillars. And it’s a commitment. And if agencies are out there not willing to put the time in this will blow up in your face. I believe that’s where I said in the beginning, the top, the owner, the administrator who’s ever the top person in that organization has to be committed a hundred percent to making sure that this data collection, those four quadrants are done every 30 days, 60 days, 90 days in order to build that data because you miss one day, your data is technically screwed is skewed. So it’s now become a way of doing business here. You know, the first year it was like, come on guys, I’ll forget, 30 days, not 31.

Guy Tommasi (27:23):

Come on guys, get up here. And now it’s day 29 is coming up on, you know, mrs. Jones. We’ve got to get ready for, for day 30 and I’m, and on that next day, we do our evaluation. And even though we had COVID, you know, that the caregivers were great because people are like, Oh, I don’t know if I want another person in the house. So what we were doing is the caregivers were taking laptops or tablets, or even iPhones sit with the patient. And we were doing face to face and FaceTime. So our care manager was doing a visual evaluation and asking our caregiver, okay, help mrs. Jones up, let’s see her mobility, let’s see her functionality, let’s see her get dressed. And so she was able to still maintain that level of data collection. So that’s, that’s where, you know, we’ve learned some lessons then, you know what I mean? And again, I go back to data tells the story and it’s, it’s your, it’s your calling card.

Miriam Allred (28:39):

Definitely. Before we launched into this conversation, you were mentioning that one of your biggest challenges right now as a provider is staffing. I’d love to hear how you’re using data on the recruitment front. You know, are you are using this data to attract new clients and caregivers as well?

Guy Tommasi (29:00):

Yes we are. Actually, we have it. We have it split up two ways. When we’re we’re recruiting and and we use as a retention, but as recruiting, when we bring, we talk about are our outcomes from the home care pulse survey, we’ve been fortunate to have to be awarded the Leadership In Excellence (Best of Home Care Award). Now the past two years, we’ve got awards up on our walls. It it’s a visual stimulation of the credibility of coming to work here for us. We use that in our promotional material. When we recruit that we have been an employer of choice for the past four or five years, we’ve been doing different things to address training and recognition. So our recruiter is armed with that data. And then when they come in from orientation, all of our numbers are up on a white board into, in our conference room.

Guy Tommasi (30:08):

And we go over that with new employees that say, this is what we do every day that we need your feedback. And we talk about that. So from a recruiting standpoint, that data, the surveys satisfaction surveys that are done every month by home care pulse is huge. In our recruiting efforts, we take that same information when we talk to our referral sources and when we go to talk to clients, so if we get a call and say, mrs, so and so mrs. Jones is interested in, in coming on service, our care manager that goes out and kind of does that initial evaluation and talking and this and that. And both of them have a little binder and it has our outcomes in it. And it has our satisfaction scores in there. And it says, here’s our client satisfaction. Here’s what our clients are saying. And here’s what our caregivers are saying.

Guy Tommasi (31:13):

And we’ve always been in the 90 percentile and it goes again to data tells the story. So we show them that and we let them kind of digest it, ask questions, but it’s telling our story saying, here, we didn’t come up with this. This is a typical Home Care Pulse that we use independent. This is what they do. Here’s our, here’s what they’ve come up with. And as a result, here’s our awards that speak to it. And again, I’m the, I’m the other two sides of the contract. That’s where that the clients again, look at, Hey, we’re good. We can help keep you out of the hospital. Here’s the functionality. Here’s how we hospitalization. So that, so the data for recruitment retention and referrals is, is huge. You know, it’s easy now, Miriam looking back and I say, how did we do this without the data?

Miriam Allred (32:18):

Yeah.

Guy Tommasi (32:22):

Now it’s just getting, trying to get bigger and better as far as, you know, I want the rest of our industry to stay. Yeah. We need to do this and really, really step up our game.

Miriam Allred (32:35):

Great information. I’m really glad we got to that, that, you know, the data isn’t only for the stakeholders, but it also is, you know, heavily involved in the recruitment and retention piece on the client and caregiver front. So I’m glad you could touch on that and highlight the importance of that to kind of wrap up the conversation. And, you know, you’ve talked about this and I just want to hear a little bit more, what, what do you see on the horizon for the industry? You’ve talked about getting everyone on board with this idea, but what else do you see is on the horizon or hope that’s on the horizon for the industry?

Guy Tommasi (33:13):

Well, I, you know, I think the, the, the horizon is bright. It really is. I hate to say that coven played a part in that. Unfortunately, but it did in the most ironic way at it did open the eyes. So in a way, COVID allowed our industry to show what we’ve been doing. Since we started this back in the seventies, as an industry, it said, look at, look at what we do. Now. The onus is on us to take that and elevate it to another level where we have to do that by willing to look at again, externally, we’d have to look at remote client monitoring. Clients are going to get used to being at home, not a lot of people around it. So we have to be willing to do that with the virtual visits, the whole thing with interoperability. Again, our stakeholders are, are partnering with, with partners who can provide that interoperability with data and client information can be shared so that it’s not in silos.

Guy Tommasi (34:34):

So our industry has to start looking internally at our software platforms. Our software companies are the, so are the software companies that we’re currently using capable. And if not capable, willing to address the use these issues of interoperability, are they willing to partner with us and learn what we need? And I will go so far as to say, you know, if they’re not, then you, then you need to move on to another software company because you’re going to get stuck behind the eight ball. This thing you, you, you know, the hospitals and home health agencies have, what’s called the revised conditions of participation. And one of those revisions include using post acute care providers who can demonstrate that they have quality measures, quality outcomes, and that’s who they have to start referring to. So I’m just going to send her a business is rapidly disappearing because they have auditors coming in from CMS saying, show me the information that you gave to your patients to make a good sound decision of a quality provider.

Guy Tommasi (35:58):

If they don’t have that, that’s the same. That’s not going to be very happy, but we have to have the software data to provide that. We have to have the willing partners to provide that. And if, and for those agencies who choose to step it up, and then the horizon is going to be going to be filled with, with good stuff. And we’ve seen that we’ve seen the returns on our bottom line as a result of that. So we’re, we’re on that springboard now. And for some agencies, they’re going to say, you know what I like doing what we’re doing and we’re fine. And that’s, that’s okay. But for those who really want to step up their game and, and take their agency to another level, the opportunity is now the willingness has to be there. And you have to be able to have the right partners to partner with you to help get you there. I think if you pull that together, it’s, it’s a, it’s a, that’s a home run.

Miriam Allred (37:02):

Yeah. I love that Guy. Thank you so much. This conversation has gone by in the blink of an eye, but really that’s all, I’ve got time for too. Thank you so much for taking the time and sharing your perspectives and just your story. You said, you know, we’re sharing the story, you’re telling the story, but thank you for sharing your story and talking about the data collection that you’re doing at LIFETIME. We at Home Care Pulse are huge fans of yours and appreciate the example you’re setting for the industry when it comes to data collection and upping your quality of care. So thank you so much for taking the time today.

Guy Tommasi (37:33):

Well, thank you, Miriam and I really appreciate the opportunity afforded me to use this as, as a way of getting the word out. So thank you and thank Home Care Pulse for all that they do for us and helping us get to our final mission.

Miriam Allred (37:49):

Thanks for tuning in. As Guy mentioned today at Home Care Pulse, we survey clients and caregivers and provide third-party detailed feedback and reports for individual agencies. If you’d like to learn more about how we can help you collect this data for referral partnerships, reduce client and caregiver turnover, and earn Best of Home Care Awards, visit our website and jump on a demo with our team to see how we can help your agency. We’ll see you next time.