Wednesday, August 31, 2016

MACs, RACs, ZPICs and Home Care Services

Navigating the audit gauntlet in CMS billing is getting more challenging by the week and recently, it seems, by the day. Two things are becoming abundantly clear. First, and no matter how well intentioned and honest, the old methods of claims preparation and submissions no longer work. Second, and more than ever, you must avoid submitting what you can’t defend.
The first line of the gauntlet is firmly in place.
MACs – Medicaid Administrative Contractors
RACs –  Recovery Audit Contractors
ZPICs - Zone Program Integrity Contractors
Each of the above hired, licensed, paid and deployed throughout the country to oversee, review, process and question each and every claim you submit.
As challenging as understanding, complying and staying current with the medical and health care aspects of providing home care is and the proper ‘care coding’ and claims submission documentation is, the challenge of navigating and avoiding the deepening scrutiny of these multiple audit weapons that CMS has operational to oversee fraud, waste and abuse (FWA) is equally challenging. The ROI for CMS is provably simple. CMS spent $450 million on FWA programs and re-gained $42 billion. Without a blink they just announced a $11 billion charge back to hospitals for past over payments. So don’t expect the pressure to lessen any time soon. The authorities granted these contractors extends to being able to refer home care agencies to the DOJ or OIG for investigation and potential prosecution.
Quality assessment and control (QA) over claims documentation has now become a mandatory staffing and skill set requirement for home care services.
As Michael McGowan an experienced auditor now leading OPERACARE stated, “Poor documentation that doesn't show necessity, skill, or documentation to standards of CoP can all down grade a visit.  Or, visits are easily deemed non billable due to no orders to support the claim or even improper supervision.   So it is no longer a matter of RAP vs reality of how many, but so many other factors can down grade your therapy counts.  Even a whole chart with MUE can negate all therapy visits before they occur.  Only proper OASIS scrutiny in real time at SOC to plan for necessity and efficient treatment followed up by rock solid documentation can help you get the payment you think you are going to get.”

With the new pre authorization claim review, and with MACs, RACs and ZPICs and all the other audit teams out there, it is best to be sure of what you are doing and why, and make sure it all follows through.
So what can be done to lessen audit risk? To prevent being audited into bankruptcy? Use software that lets you see what CMS sees before they see it and don’t submit what you can’t defend.
The best I have seen is OPERACARE. But don’t only take my word for it.

Ben Galin of Galin Consulting after reviewing OPERACARE said “It is the only tool I have seen that automates some of these first steps to let you see your chart from a macro and micro and agency macro view simultaneously, in seconds, where it can take an entire QA team to do this in hours.”

The true bottom line is this: It is a new world, a new age and a new era for home care, one where your bank accounts now have large exit doors. It is time to step up to these new challenges with advanced weaponry of your own, show your worth and lessen your worries about MACs, RACs and ZPICs knocking at your door. OPERACARE can help you do that.

Monday, August 15, 2016

10 Strategic Imperatives for Home Care Services In The New Era

The avalanche of changes impacting home care services can only be described as dramatic. Home care leaders are now pressingly faced with addressing an entirely new era. A new landscape has been created that demands a new approach to protecting revenues, ensuring business sustainability, thus survivability, and the recasting of operational methods and processes that meet the needs of patients…and the business.

What defines this new era?

CMS: $42 billion dollars saved via its fraud prevention programs
The primary impetus is of course CMS. New regulations, reporting, coding, quality benchmarks, bundled payments are just a few to be highlighted. The heightened attention and regulatory oversight given to payment penalties, re-admissions, claims reviews and audits are CMS policies that stimulate the establishment of the new culture. One can only assume that this regulatory and heightened audit cultural impact will continue.

Underlying all of these actions and more is of course, the implied belief by CMS derived from the state of the industry, that there are too many home care services, serving too small a client base, that are under performing and are operationally, poorly managed. CMS wants fewer home care agencies serving larger client bases having financial stability. In addition is the ever deepening CMS/MAC oversight that seeks to ferret out fraud, waste and abuse. The consensus is that the number of home care agencies while having increased dramatically will enter a period of CMS motivated decline with 12,000+ agencies today becoming ~ 8,000 in just a few years.

Bottom line: all major categories of financial performance are under pressure. According to one recent industry survey source, “cash on hand” to operate has dropped to 33 days; median revenues have fallen; accounts receivable has slowed from 44 days to 68 days. Current asset to current liability ratio is worsening making borrowing problematic. Unless cash flow cycles can be improved the outlook can only get dimmer.

Everything taken together it is indeed, a new era.

The home care industry has been slow to recognize and follow the lead of hospitals and SNFs for example in successfully making operational quality and efficiency gains through automation. Hospitals and SNFs understood that outdated polices and paper based processes were not going to enable them to produce the efficiency gains and achieve the quality objectives that their new environment (and CMS) demanded. Being slow to adopt automation methods designed for the new era in home care is no longer an option given that surviving in the new era is important.

The issue is not just about running a home care business more efficiently and effectively. While adopting to the new era process may seem like added costs, industry research indicates that agencies with higher visit costs were also more likely to have high quality and satisfaction scores and be among the top performers. The new processes done correctly points to actually freeing capacity to serve more clients.

Payment Error rates (PERM) are the highest since CMS tracking began
New on-boarding methods utilizing automation can actually contribute to increased revenues. Using automated home care QA and UR pre-claims automated methods can deliver up to 50% better profit margins in many cases and actually increase the capacity of the business to serve more clients with the same staff levels.

Dealing with compliance audits and ADR requests is simply a very expensive waste of time and staff resources. Technology should be and can be the targeted solution strategy.


Let’s look at the new paradigm with Ten Strategic Imperatives as Guideposts:

#1 STAR Ratings are the new driverBench-marking outcomes are now less relevant. STARS outcomes need to be managed in real time prior to their submission to CMS.

#2 OASIS care plans have typically been written up hours or days post visit.  All care plans and service utilization decisions need to be done on site during the OASIS visits. RAP submissions should be made within 2 -3 hours of the OASIS visit.

#3 Over Utilization visits from one episode to the next need to be reduced. OASIS based data needs to drive staffing. Home care needs to use OASIS data the same way hospitals use DRG data.

#4 Outcomes data needs to be distributed to field clinicians via tools that make each field clinician accountable for the results (data) they produce.

#5 Claims submission error rate of + 40% (current average) needs to be sub 15%

#6 Hospital Re-admission rates at +27% (current average) needs to be sub 10%

What is clear from the above is that a new approach for the new era is not just needed, it is demanded. This means that new processes supported with new supportive automation methods is required.

Legacy systems built for the old era requirements
of PPS will no longer meet future needs.

#7 Avoid Being Audited into Bankruptcy

If you see what MAC sees what would you do differently?
First and most essential is the ability to avoid costly and time consuming audits. It is far too easy to be ‘audited into bankruptcy’ resulting from inaccurate, or clinically inconsistent claims. Do this enough and you are on the MAC radar screen. Having software that uses the audit analytics that MAC uses aids you in not submitting what you can’t defend.

#8 Don’t Miss Securing Additional Justifiable Revenues

Missed revenues is significantly more prevalent than most home care service providers realize. Having software that can align claims with additional, justifiable revenues is critical to survival and stability.

#9 Transition to a New Era Repeatable Process

Getting ‘real time’ claims feedback enables improved, speedier claims filing without a seeming unending cycle of ADRs. Cash flow cycles improve.

Establishing new process methods that binds field clinicians with QA staff lessens inaccuracies, speeds accurate claims and will in the end lessen staff requirements and improve capacity to handle more clients. This is a key factor as having definable repeatable on-boarding processes if the foundation that underlies stability.

#10 Win New Business Based on Facts and Data – Win with Strong ‘Value-based Purchasing’

Being able to generate outcome analytics that supports quality claims becomes the basis for new business marketing that differentiates your service and attracts new business.

The re-design of home care delivery is real. The numbers of the growing elderly population with expanding care needs is real. CMS’ new regulations and ‘submission demonstrations’ are real. Increased MAC audit pressures are real. True home care service leaders will advance to meet these realities -- the opportunity to survive and excel is real.

Michael McGowan is President of OperaCare Inc. | Michael Radice is Chairman, Technology Advisory Board, ChartaCloud Technologies LLC | PHOTO Credit:
Copyright 2016 ChartaCloud Technologies/OperaCare. All Worldwide Rights Reserved.

Wednesday, July 27, 2016

CMS Clearly Knows What It Is Doing. Do You?

Nine states are now subject to Value Based Payment modeling; five states are subject to the pre-claim submission demonstration; CMS spent $450m on building tools and staff to chase fraud, waste and abuse (key in on “waste”); aggressive CMS/MAC audits are the policy du-jour; DOJ prosecutes 300 in a nationwide health care abuse round up; round two of the OCR HIPAA audits are now underway. It would be difficult to see these actions as unrelated or random. Even more difficult not to see the writing on the wall.

Clearly, CMS believes that there are too many home care service businesses. Too many that are under-capitalized; too many that are not profitable; too many that are serving too small a patient base; too many that are operationally, weakly managed; too many that can’t make the necessary leap to technology advances and yes, too many that submit unjustifiable or inconsistent claims, purposeful or not.

It can’t be lost on the home care industry that CMS is accumulating empirical evidence that quality of care can and does improve and at a lower cost when the industry is forced to a value based payments model and STAR ratings. I would blame the capacity to be able to now demonstrate care improvements on the industry…how did the industry end up in that circumstance? Results are showing that there existed and there is room for improvement. It seemingly needed to be externally driven.

So what is the CMS strategy? Reduce the number of home care services so that fewer are serving a bigger census and doing a better job of it. The question quickly becomes strategic for industry players. Become a new era player, survive and grow or get audited or bureaucratized into bankruptcy.
The consensus forecast is that the ~ 12,000 home care agencies will end up being around ~6,000.

The four operational axioms I would focus upon to survive in this new era are:

1.       Don’t submit to CMS/MAC what you can’t defend
2.       Know your OASIS outcome analytics – deeply
3.       Be sure care plans are done actively and not at some later point in the day or week.
4.       Anticipate the re-certification hurdles

Seeing the benefits of these four axioms is not conjecture it is based on experience. If you would like to discuss that experience, please do let me know. I’d be happy to do so.

Wednesday, July 20, 2016

Humanoid Robots in Assistive Health Care

  Guest Post: Lauryn Schimmel, Managing Director, ChartaCloud Technologies

While many are aware of the uses of advanced surgical robots that perform precise roles during surgery, I wanted to take this opportunity to highlight and share some of the other currently active roles that humanoid robots are taking in healthcare today! Words cannot express the joy experienced when a robot can become a distraction, educator, and a friend to children in frightening hospital corridors. In addition, witnessing a robot bring seniors to their feet and smiles to their faces during what started as just another day in a senior living community is powerfully meaningful and illustrative of the amazing world of technological innovation that we live in.  I invite you to take a look at some of the exciting things that are happening in the world of humanoid robotics!

Pediatric Healthcare & Dentistry
Humanoid Robots equipped with proprietary RxApplicationsTM are clinically proven to reduce children’s pain by 50% and increase vaccination rates by 10%. The humanoid robot in pediatric care settings acts as a pain coach, physical companion, and motivator. RxApplicationsTM control the humanoid robots behaviors during a specific medical procedure. These behaviors are sequenced to work at the same pace as the healthcare professional who is conducting the medical procedure. The humanoid robot coaches, educates and provides companionship before, during, and after procedures using research-based cognitive-behavioral interventions. RxApplicationsTM are customized for each hospital and allow the hospital to innovate their use of the humanoid robot. Templates are used to create RxApplicationsTM when available, otherwise it is possible to develop new medical and dental procedures from scratch.
Current RxApplicationsTM in use include:
        Blood Test
        Breathing Coaching
        Dental Cleaning
        Dental Local Anesthetic
        Dental Nitrous Oxide
        Dressing Changes
        Foley Catheter Removal
        IV Start
        Medical Play
        Orthodontist Greeting
        Oxygen Tube Insertion
        Port Access
        Videofluoroscopic Swallow Study

In the Pediatric Healthcare setting, the humanoid robot provides benefit to every clinic as well as for hospice care. The robot was able to increase vaccination rates by 10% during a clinical study by calming children that were kicking, punching, and biting the nurses beforehand. The robot provides relief to children as young as two and as old as sixteen years old.

Senior Living

NAO, the humanoid robot developed and designed by Aldebaran Robotics, is currently located in over 200 assisted living communities around the world. Its first purpose to was demonstrate some exercise to the residents and have the residents imitate NAO doing the same movement to help them move and stretch. This enabled caregivers to really be by the resident’s side and help those who needed movement correction or assistance, while NAO led the show. With this great success, more and more caregivers are asking for other behaviors and applications. The elderly see NAO as a little child and often, when NAO is introduced to them, they take him in their arms like a baby and start to baby him.

One day, during a presentation, one resident named Marcel, began to talk with NAO. Using the ZORA platform, it was possible to answer through the robot to Marcel. They spoke together nearly 20 minutes. This was awesome because Marcel typically was a withdrawn resident and during these 20 minutes he spoke more than what he had done for 4 years during his life at the retirement home.
NAO can be remotely controlled by the staff; this way the robot can walk into a room “by itself” instead of being carried in by a caregiver. This way, the resident can naturally discuss with NAO and have the feeling of being “alone” with him. Of course, the whole situation is monitored thanks to video and audio streaming and the caregivers can supervise and interact through NAO. NAO helps the caregivers support residents, alleviate loneliness, and make them interact in a natural way.

In addition, NAO is able to assist the caregivers. There are a lot of “cold tasks” meaning that there are some duties such as answering to frequent questions of the residents, that take a lot of time and aren’t ‘as important’ as other tasks. So the caregivers often neglect them. For instance, every day, every resident asks (and sometimes more than once): “What are we eating today?”. The caregivers haven’t enough time to answer to everyone. So, they had the idea of using NAO to do it. The robot stays on a table each morning and tells the daily menu when a resident pushes one of its foot’s bumpers. The other foot allows the resident to hear the main news of the day. This simple application makes both the residents and the caregivers very happy.

Autism Special Education

The humanoid robot can engage children with applications designed for special education. The NAO robot is especially suited to interact with autistic children because the NAO robot is interactive and fun, engaging and captivating, and adaptive to the needs of the classroom from individuals to groups. It is a great help for teachers that really appreciate eliminating monotonous tasks. The NAO robot has a pack of applications inspired by commonly practiced special education teaching methods (ABA, PECS, TEACCH, DENVER, SCERTS) to unlock deeper learning in the classroom. The applications are mult-educational and focus on educational lessons, communication skills, and daily life knowledge. The applications are structured to make children with disabilities comfortable and confident and they can be adapted to individual motivators, internal states, and personality to create the perfect match.

The NAO robot is very predictable and reduces natural anxiety, its tireless features repeat until a child understands, and it is judgment free which increases a child’s confidence. NAO is able to bridge the human and technological worlds, linking autistic children by encouraging social interaction, learning, confidence, and self-esteem. The NAO robot is able to build the following skills: time perception, imitation, theory of mind empathy, join attention, turn-taking, academic skills, body awareness, verbal communication object labeling, nonverbal communication, and eye contact.

Physical Therapy

Within the Department of Rehabilitation at the University Hospital Ghent, the robot is used to show what exercises a patient has to do, and with what number of repetitions. The NAO robot installed with the Zora solution, is a small and very mobile robot with a high feel-good factor, she gives repeated and verbal instructions, supported by music and sound. It is just this combination that encourages children and seniors to move and exercise. Custom exercise routines for Parkinson’s Physical Therapy and Cerebral Palsy are two applications that are currently being developed.
It is exciting to be able to share some of these current use cases with you all. Humanoid robots are already assisting in healthcare roles today!

For more information:
ChartaCloud Technologies

Monday, June 20, 2016

It’s Time for Enlightened Corporations to Meet the Needs of Employee Caregivers

The National Alliance for Caregiving reports that caregivers who don’t receive support from employers experience a negative impact on their careers. 

In fact:
·         66% of caregiver employees have gone into work late, left early or taken time off during the day to deal with caregiving issues
·         20% of caregivers were forced to take a leave of absence from work
·         10% of caregiver employees quit or take early retirement
·         9% of caregivers reduce hours or take less demanding jobs
·         5% of caregiver employees turn down a promotion

The negative impact on the corporation itself is more staggering. “Absenteeism” and “Presenteeism” (when I am at work but not really working- I am caring) is costing corporations millions. Furthermore, unhealthy stress on caregivers trying to balance the demands of care giving and job responsibilities ultimately adds more expense to an employer’s health costs. The day is fast arriving when employee care giving support via an Employee Assistance Program (EAP) will be the rule. Unless corporations move swiftly to craft and adopt enlightened practices and policies we will see government mandated employee caregiver support laws emerge. The numbers of employee care givers are dramatically expanding as the ‘Boomer’ population ages and retires. Caregivers will become a yet another protected class by necessity and by law.

Technology can play a vital role in lowering costs, lessening stress and reducing hospital admissions by connecting care givers and their families so that everyone can be informed of the health status of their isolated or remote ‘parents’ on any given day. If Ian employee had this technology as a benefit option as care giver they could then can more easily decide whether they need to go to ’Mom’s home’ or can actually go on into work. Or, if an employee is on a business trip, having such connectivity would allow me to concentrate on the task at hand by knowing what is happening and if a pro-active care intervention is needed.

If you are considering ‘care giver technology’ as a corporate benefit (EAP) I would like to know your thoughts.

Friday, June 3, 2016

Home Care Technology's Third Wave

I believe that we can all agree that technology has and will continue to change the landscape of home care. Most of technologies’ initial wave was focused on making business operations more efficient. Cost based decisions. We are now well into the second phase - patient-centric technologies – technologies utilized to enhance monitoring, care adherence plans and behaviors and reduce re-admissions more cost based decisions. The third wave has started – health care technology as a revenue generating profit center.

The unique impact of this third wave is that it will transform technology driven enhanced care and the attendant quality outcomes into profit centers. Like previous technology waves it will start primarily in private care. Technology will be a significant client and partner attraction. See the handwriting on the ‘government’s CMS wall’. More visibility to STAR Ratings. More pressure to give patients a voice in care. More decisions being driven by value based marketing, that is being able to prove that your outcomes’ in care giving performance is better than that of others and the restructuring of payment models to enhance the use and adoption of technology. Technology creates better health outcomes.

I know that we have many ‘payment’ hurdles to overcome. But I believe that home care will have little choice but to get on technologies’ third wave and manage it not just as a cost center but also as a revenue center. So why wait. Today, many of the technologies can start out as self- funding profit centers. Offering such services and not only differentiates your service but can be crafted to earn a profit.

The balance is shifting to where home care services will need a robust IT inventory of customer oriented technology services and a concurrent delivery and support capability to remain competitive and profitable. My forecast is that the solutions/revisions to existing ‘payment hurdles’ will outpace home care’s ability to adopt, deploy and manage future technologies.

What do you think?

Mike Radice serves as Chairman of the Technology Advisory Boards for and

Wednesday, May 25, 2016

Health Care Tablets 'and' Robots

For many decades I have been working in the technology convergence space. Health care technologies are my current focus. Many years ago I was in a meeting and was struck by the simplicity and insight voiced by Steve Wozniak the Apple so-founder. His comment: “Innovation is about the ‘and’”, he said. It’s not about pulling something completely new out of the ether, it’s about identifying how and when the convergence, the ‘and’ of technologies provides an innovative opportunity. When ‘this’ and ‘that’ are thoughtfully understood and combined into what then becomes something new and innovative.

Currently robot assisted health care is typically thought of as ‘that’ and challenged as striving to replace human care givers. No one that I know has replacing human to human care as an objective. Lessening the burden of care delivery, increasing the available resources that can be dedicated to care, more attentive care, more aware care, more customized care and care that enhances the quality of life- yes. And, good objectives they are.

But we have now reached the moment whereby many will now begin to more fully understand that robots are the new interface to knowledge – and action. Having successfully created an ‘and’ by bringing together what was only tablet based software with robots convinces me that robots will indeed win their place – in health care. Now we have an attentive robot that can move and ‘seek and surmise about’ a health situation and reach out and suggest to a care giver that something needs attention. At the most basic level, see if someone is moving or static. Is that someone responsive to queries? Is that someone happy or sad? Most critical is the do something about it aspect - like move around - to deliver medicine, do an infra-red scan on body temperature or measure heart rate or launch a video tele-presence call to remote care giver.

Yes, it will take a while to achieve robot price points that broaden consumer use which is why we should continue to focus so intently on understanding and delivering the benefits of tablet based care giving systems. Not only are they effective, they are inexpensive. Tablets have moved the needle in health care and as they move from the social arena into meaningful care delivery they are the stepping stone to the next great ‘and’.

So I agree tablets are the right move today but it is… ‘and’ robots tomorrow.

If you would like to discuss the impact of tablets and robots in health care feel free to reach out to me at 

Wednesday, May 11, 2016

Medicine for Care Givers

There can be little doubt that family centered care giving is becoming now a consuming activity for three generations. The Boomer retirement generation is now caring for their parents. The ‘sandwich generation’ will need soon to care for the Boomers. No need to re-visit the facts of the rapidly escalating numbers that are impacting all generations. I am sure you are well versed in these numbers at the top level. It’s a big deal. But the issues and challenges we are facing are broadening beyond the numbers with each passing day. Experience brings further discovery.

What needs to be kept in mind is that care giving is a one to one relationship. Child to parent for example. While the ‘big numbers’ matter, in the end, the real issues get reduced to ‘my family’ to ‘my parents’. Does it really help knowing that millions of others face similar issues? The choices, the decisions and the options all need to be ultimately decided one family at a time.

The stress and burden of being a daily care giver is only further exacerbated with the ever present challenge of knowing what is actually happening, where to start next and when to start doing what. Each day sits on the precipice of bringing a totally unanticipated and expected care giving event. As time wears on, so does the stress, weighing ever more heavily on the care giver. Most of us were never schooled or trained for this role in life. One day it just fell to us.

Being dedicated to embracing care givers with technology solutions that they can use to embrace the ones they care for has become a life mission for me – more than a business vision. I have carefully chosen the word embrace for use here and in my other writings because in no way is technology going to replace human to human care. But technology used to embrace the circumstance can help to manage, control and expedite care. Technology can lessen the burden. It can reduce the likelihood of hospitalizations. It can improve quality of life. And, yes, it surely can make care giving just a bit more manageable and bearable.

What we have learned is that for the technology to be correctly helpful, it needs to be defined - one family at time. It needs to be able to work for that family – and for that care giver.
So, just like any medicine, technology has its place and proper use. Just like the care giver’s oath to “do no harm” technology needs to help. It can be a cure for the debilitating effects of isolation. Properly dispensed it can aid in recoveries. And, it most certainly can help improve the quality of life for all involved. 

In the world that lies ahead for all too many, the ‘first patient’ to be considered is the care giver and for them technology can be a powerful medicine.

Mike radice is Chairman of the Technology Advisories of and and his blog can be read at

Thursday, April 28, 2016

An Observation About AARP’s Project Catalyst Report on Caregivers and Technology

At the outset, let me start by saying that I am a biased reader of this report and that in no manner has AARP or the report’s authors endorsed the claims I make below. The report’s developers did a first rate job at synthesizing the data, the findings and surfacing the issues and trends. This report will be must read and an oft quoted source of statistics for anyone involved in home based care and care giving. My appreciation also extends to the sponsors of the report.

Why am I a biased reviewer? Over the last two years as an innovator in this market place I have become deeply involved with the technologies available. I can confidently state that the survey’s response statistics accurately reflects my real world experience interacting with end users.

Based upon that experience, and now substantiated by this report, our MyHomeReach product, a tablet based system for care givers and care recipients, could accurately have been included as the ‘poster child’ for a recommended solution. Point by point, MyHomeReach surpasses the stated expectations and requirements recommended for consideration by technology providers by the report’s authors. We have done more that consider them we have done it.

To state it another way, this report could easily serve as a blueprint for why MyHomeReach was created.

If you want to read the just published report it is, as of this writing, currently available at:

If you want to see the solution, see:

So, thank you AARP and the report’s Sponsors. At ChartaCares we are profoundly encouraged and will innovate on!

Wednesday, April 20, 2016

Loneliness Is A Real Killer - Scene 2

While I am continually saddened by the impact of ‘loneliness’, I am pleased to share an article just published in the LA TIMES written by Melissa Healy and just published on April 19.

I first wrote about this growing scourge because of the firsthand impact I have experienced with providing technologies to reduce the impact of loneliness especially on seniors. Aging is challenging. Aging at home more challenging. Aging alone, nearly un-challengeable. And now, the data is in. loneliness kills.

I am unabashed in offering you awareness of two technologies that can be transformative in the lives of seniors -- our MyHomeReach and Selfhelp systems. I intend to offend no one using this forum to increase awareness. If I can help even one life, it will have been worth being bounced from some user groups.

I can be reached at or by phone 603-580-5497 if you would like to learn more.

Mike Radice

Monday, March 28, 2016

How New Era Assisted Living Communities Are Increasing Their Relevancy

 First mover assisted living communities with an ‘eye on’ and a plan for the future are underway with and aggressively moving to position themselves to be ever more relevant to future clients. My engagements with these communities clearly points to two prime motivators. First, recognition that the age-at-home desire is serious and very real. Second, that advances in technologies can indeed provide a cost effective manner with which to engage and establish ‘early’ relationships with future clients.

My previous blog on “The Rise of the Virtual Nursing Home” attracted unprecedented traffic and stimulated a wide range of discussions. That was a good thing. What has been the takeaway from those discussions thus far? Let me share –

1.       There are active projects underway to set up technology demonstration centers located at the ‘brick & mortar’ communities that show how those ‘aging-at-home’ in the surrounding geographic areas can become part of the community.

2.       These centers will show how to improve the quality of life, security and social engagement while ‘aging-at-home’.

3.       They will serve as a provision centers (show rooms) for technologies that the community can provision to ‘boomers’ thereby engaging with them actively as future residents during their ‘age-at-home’ stage.

By taking these actions assisted living communities not only making very smart ‘marketing move’ but positioning themselves for new revenue sources not just for the technology services but for additional care giver and social services than can then naturally flow through their now established ‘virtual communities’.
Two technologies are at the starting point epicenter:

Unified care-recipient/care-giver tablet based communications – like MyHomeReach, custom branded to the community. This technology establishes a sense of community, allows for constant health status and security monitoring and is designed to embrace everyone involved with community news and events – including remote family members.

And, the use of (specialized for seniors) telepresence (video links) as in home video consoles to facilitate tele-health and social engagement. And, if permitted to view the health ‘situation’ and living conditions of those at home. The products have become very cost effective and are simple to set up

As we at ChartaCares are actively working to frame them out, I can assure you that these initiatives are moving forward – aggressively. If you would like to discuss this subject further feel free to call me at 603-580-5497. I’d be happy to share what we have learned.

Monday, February 29, 2016

Virtual Nursing Homes On The Rise

We all understand the drivers for what is about to happen to skilled nursing facilities and retirement communities. Rising numbers of elderly, the desire to age at home, the challenges of affordability for additional staff, the capital costs of new or expanded facilities, the need to differentiate among competitors, shifting payment and reimbursement models are to cite but a few.

My prediction is that the rising numbers of seniors of the ‘boomer generation’ will re-write the healthcare landscape just as they have re-written every previous social issue they have faced. Trust me, this new dialogue is happening and it will re-cast healthcare. Being stimulated by this dialogue are a few critical considerations and insights that health care service providers, especially those that operate skilled nursing facilities and or retirement communities should deeply reflect upon.

What I am about to suggest is an enormous opportunity, not a forecast of doom.

Smart operators will move rapidly to construct the ‘virtual nursing home’. What is the ‘virtual nursing home’? Most simply defined it is a ‘operator’ that reaches out with technology to embraces the ‘age-in-place’ client. They will understand that their geographically located ‘brick and mortar’ facility will be transformed into a service ‘hub’ for human and technological resources that will embrace near-by private homes as an extension of their facilities. Private ‘age-at home’ homes will become integrated into the operator’s landscape. And it is all very do-able now.

Imagine connecting a private home to a centralized skilled nursing home control center. Each home can now have a video station, an alert link, a health vitals monitoring station, scheduled care visits, scheduled meal delivery and more. Back at the skilled nursing control center are monitoring stations capable of instant connections by voice and/or observations by video with protections for enhanced privacy. Human care givers can be easily and quickly dispatched. Medication and packages (read: oxygen tanks e.g.) delivery for the age-at-home client can be made to the central facility versus suppliers showing up on their doorsteps and subsequently delivered with assistance if needed. And yes, therapy robots can now be placed in homes to aid in care, surgical recovery and for use in cognitive impairment therapies.

There is no reason to not weave private ‘age-in-place’ clients into the fabric of existing and experienced care giving facilities. The age-in-place home becomes another ‘room’.
If you would like to discuss the rise of the virtual nursing home and what I call MyHomeReach, as it moves from concept to reality, give me a call, I’d be happy to share what we have learned.


Monday, February 8, 2016

Connecting The New Dots In Home Health Care

As in any industry, the playing field and the rules of the game are constantly evolving. And perhaps nowhere more so than in home care. Changes are galloping ahead at an ever increasing pace. It is becoming increasingly difficult to identify and connect the right strategic dots to set a solid, secure and profitable path forward. Well no more. Escalating senior demographics, new and additional regulations, new policies, the new HHS STAR RATING disclosures and the new emerging models of home care businesses are revealing a clear picture.

There are two ‘dots’ in that picture that are inextricably connected. The ‘dot’ of achieving high HHS STAR ratings and the ‘dot’ of the vacuum that exists in care recipient unified communications that contributes to poor HHS STAR Ratings. Failure to connect these ‘dots’ and eliminate the vacuum will not bode well for home care businesses that disregard the connection.

Experience does teach some things:

To date, the adoption of technology by conventional home care services has been severely hampered by three major factors - (1) budgetary constraints (2) high levels of staff churn and (3) lack of internal IT resources. The new home care business models, especially those being funded by deep pocketed new venture investors, are moving to use technology to fill the vacuum. They will use technology to give them a competitive advantage, as they should. And, they are moving aggressively forward to seize the high ground of that advantage.

When technology does come upon the scene in traditional home care, it most typically arrives, internally focused, on only how to make the home care business more profitable. Now, I fully understand that this is not a bad historical choice of an objective for technology spending. But, as I said at the outset the landscape is changing.

With the ‘age-at-home’ momentum and with hospitals driving patients, under their new economic model, to choose hospital visits less frequently. The rules for home care competitiveness are changing.

Home care clients and their families now want and are being driven to take greater control by adopting a self-managed care philosophy, a desire to more positively impact and control the quality of their lives and enhance their abilities to engage with families, friends and their social community more robustly.

So what does all this mean to the conventional model of the home care services business?
To be future viable, home care businesses must move to offer a ‘unifying technology’ that positions them against their new era competitors with a solution that embraces their patient base ever more closely. To achieve and sustain reputable HHS STAR Ratings means that the new IT (technology) objective for home care needs to be one that enhances client/patient engagement and communications. This needs to be put at the forefront and it needs to be done quickly.

The choice made by future patients and their families will be significantly driven by access to a unifying technology for THEM being offered by the home care service they will select. While fee rates will always be significant factor in care provider selection, HHS STAR RATINGS and unifying technologies will dominate fees in importance. The competitors of the new era will see to it that this is what happens. Central to great HHS STAR RATINGS and thus survivability, will be the advancement and utilization of robust patient and family communications. Care giver/patient communications can no longer rely upon a cacophony of scheduled visits, phone calls, text messages, voice mails and e-mails – those times are over. The future of home care will be defined by a unified communications platform that is easy to use, is always ‘on’, enhances the quality of life, and one that enables your home care business to demonstrate a true differentiating value to your future clients.

Monday, January 25, 2016

Amazing Technology Enabled Health Care From Around the World

 I see through the lens of 40+ years of experience in global technologies that the evolution of technologies to aid, assist and enhance the quality of life and the delivery of care for a globally aging population has arrived a significant inflection point. Aging, by the way, is not just a U.S. issue. The UN’s Report on Aging has stated it is a global issue of great magnitude. The world’s older population will grow to more than 2 billion people! The ramifications of this eventuality are as broad and challenging as any socially driven global demographic issue we have faced. As it relates to healthcare technologies, the challenge being addressed presents as it always does, a unique opportunity to harness global innovation.

It is time to advance health care technologies created worldwide into readily accessible domestic solutions that are crucial to our quality of life, the purpose in life and delivery of care experienced by Seniors.

Thus far my experience in searching worldwide for technology enabled healthcare technologies and services has already led me to powerful solutions from Australia, Canada, China, Belgium, France and Ireland.

By looking abroad, we at ChartaCares have already made available a number of these very exciting technologies and services:

A unified senior touch screen friendly communications platform being deployed for Seniors, their care-givers, family, local service organizations, charitable entities and volunteers.

Humanoid robots that are actually at work, assisting with healthcare in Senior care facilities

A Social engagement service that reduces loneliness and enhances the quality of life via a very unique video services platform and a repertoire of ‘session professionals’ that lead discussion groups and take Seniors on web based tours and provide Senior’s with educational opportunities.

Remote Patient Monitoring systems that are critical to a healthy recovery or managing chronic illnesses.

Intelligent, automated behavior modification plans that enhance results achieved.

I also see advanced technologies being innovatively crafted for use by the Senior population such as ‘voice bio-metric’ signatures for healthcare related transactions and governmental interactions. Anti-microbial computer tablets for use in active care scenarios.

My point is that there exists an enormous source of creativity and innovation worldwide for health care technologies and services that needs to be cultivated. The time has come to begin to aggressively identify and share the work of global technology enabled health care developers. At ChartaCares we are working to do just that.

Many believe that the potential for the ‘future’ of health care is actually still some time off…well it is not, it is underway, now, and from locations around the world. We all can benefit from that.

We at ChartaCares are committed to advancing technology enabled healthcare from sources around the world . If you know of any such technologies or services you think we should review, please send me that information at I will be sure to reach out to those sources. Thank you.

Monday, January 11, 2016

Two Big Mistakes Health Care Providers Are Making

We all can agree, I believe, that the era of patient engagement i.e. self-managed care is coming upon health care providers like a tsunami. It starts with the recasting of the dynamics of the health care delivery model which are being ever more driven by changes in payment models, quality of care metrics and technology. The more important drivers are, however, are that patients are seizing ever more control over their desire to manage their own health care and while doing so are becoming more representative of conventional consumer behavior, as they have been conditioned to it in other technology driven service sectors. Their experience in these other sectors has cultivated them to want open choices and self-managed, instant interactions via technologies. 

To express it another way - we will see an ever increasing trend in patients (read: consumer) moving (read: shopping) amongst care providers driven by their perception of the availability of and the quality of the patient engagement service component. The number of patients moving amongst providers, a number which I will call ‘customer churn’ is driving upwards toward the same percentage levels as in other technology driven subscription service industries. I expect to see a 10% churn rate to quickly become the new norm in health care. This means millions in lost revenues if not managed.

The mistakes start with care providers not having a proprietary, robust mobile patient engagement system. The studies I see, put the availability of such proprietary service applications being offered at less than 15% and sadly, they for the most part have poor satisfaction ratings versus the externally provided solutions. Bridging to the home in a proprietary manner will be critical.

Here is the real mistake. If care providers do not develop their own high quality proprietary patient engagement applications and rather chose to proceed to continue to outsource this function to third party external vendors, then the technical wolves of healthcare will soon be poaching their patients to the add-on health care services they plan to offer once the patient base that the health care providers have given third party providers is big enough. After all, now that they have your patients in their database and connected now as customers of theirs, why not then offer them tele-medicine services? Good bye customer! Call a traditional taxi owner about UBER and ask them how’s that going? Make no mistake about this, healthcare providers must take a proprietary approach to patient engagement. At stake are millions of dollars of revenue that you need to protect from ‘churn’ and from future poaching.

At ChartaCares we encounter these phenomena every day and our advice is always the same, adopt and deploy your own private labeled patient engagement application service. Keep your customers close to home. There are wolves out there.