Innovations in Home Care Technology

Chris Mate [00:00:00]:

Nurses spend anywhere from 42, 43 percent to 48 percent of their day on non clinical work. We need to take this 50 / 50 split between clinical care and administration and logistics and make it 80 / 20. I think it’s one of those areas, that AI really has some opportunities for us. We’ve got a great partner that we’re working with on some clinical documentation pilots, with these AI pilots, we’re finding we can get that 65 to 70 minutes of charting time down to 15 minutes.

NARRATOR

From Healthcare IT Leaders, you’re listening to Leader to Leader with Ben Hilmes. Our guest today is Chris Mate, Chief Information Officer for Elara Caring. In our conversation, Chris discusses how aging populations are driving the rapid growth of home care services and how innovative new technologies like AI are increasingly necessary to respond to that growth.

Ben Hilmes [00:00:48]:

Chris, great to have you on the program. I spent a lot of time talking to CIOs and other leaders kind of in what I would call the poor of healthcare, of the delivery system, and so really exciting and going to be a lot of fun to hear what’s going on in the fastest growing sector in our industry, and it’s called home care. So it’s amazing to see the growth in that space. Elara Caring, one of the largest providers in the country. I’m pretty familiar with the brand because I live in the midwest. I know you do as well. But for those, our listeners who are as familiar with who you are, what you’re doing, I’d love for you to just kind of get started by talking to us about who you are, kind of what you guys do, your approach, what’s the strategy, et cetera. So I’ll start there.

Chris Mate [00:01:34]:

I look forward to it. Ben. I’d love telling the story. So Elara Caring, deliver health services in the home, as you mentioned. So really think about that across four key product lines, if you will. Personal care services, which just tends to be very Medicaid based, nonclinical type work in the home, traditional skilled nursing in the home. So wound care, infusion, post acute surgeries, those things. We also have a hospice care for the end of life and then a growing behavioral health business, which in the east, more centered in the east coast in medicine, administration, but growing along with service with our other service lines.

Chris Mate [00:02:13]:

So just to give you a sense of scale, we operate in 18 states. I tell people if you took a ruler from New York to Texas and drew a line, that’s mostly where we’re at. But on any given day, we’re taking care of 60,000 patients, approximately a little over 26,000 employees. And the number I like to use because I still shake my head. It sometimes been, we do a million visits each month into homes across those 18 states. So the scale is remarkable.

Ben Hilmes [00:02:42]:

That kind of leads me to, I mean, if you think about the major drivers, one, it’s the aging population. Two, people’s desire to, you know, age in place. So the interesting thing is when I talked to my retirement planner, he describes your retirement as being kind of three phases. One, the first one’s go go, the second one’s slow go, and the last one’s no go. So it’d be interesting to see how you guys are thinking across the spectrum of people aren’t just in one place, so they might be their home, they might be traveling, it might be in other places. Do you guys do some unique things there to allow people to be mobile at the same time, age and place?

Chris Mate [00:03:24]:

I think nearly everyone agrees that being home is the best place to get healthy. And really, our various products, it’s about meeting people where they’re at. Right. So there’s a, you know, as people come in and out of the hospital, we’re seeing patients with greater and greater acuity coming out and needing, you know, different levels of care in the home is they really just strive to be home. And I know you and I were talking before. I think as we, you know, this world went through the pandemic. Hospitals are amazing. But I think we also learned that, man, unless its a service you can only get in a hospital, youre probably better off being in another location.

Chris Mate [00:04:00]:

You know, were really leaning into that, you know, whether its those personal care services. I mentioned, we had 18,000 personal care aides in nine states, delivering help to folks in the home. That a lot of time is not clinical, but it helps them do just that. It helps. It helps that mom, that grandmother stay at home and heal there.

Ben Hilmes [00:04:20]:

That’s fantastic. So, Chris, let’s flip a little bit to the tech side of this thing. Because we’re in an industry, it’s already really constrained with resources. And so now you’re seeing this expansion and growth in the home care space. You can’t just throw more and more people at it. So you’ve got a big, big job trying to figure out how do you leverage technology to drive value across a larger. And so help me understand how you’re thinking about the leveraging of technology to deliver on the mission.

Chris Mate [00:04:51]:

No, I love talking about this. Right. And you’re right. There’s no cavalry of nurses on the horizon. That’s about to, we know there’s a nursing shortage. So when you look at industry statistics, and this is including nurses in hospitals, those stats tell us nurses spend anywhere from 40% to 43% to 48% of their day on non clinical work. So it’s administration in my world, getting people home to home, it’s logistics and those things. So we have people that went to school to take care of people that are spending about half of their day not doing that.

Chris Mate [00:05:25]:

And I tell folks all the time, I’ve got a daughter in nursing school. She never calls me to go, dad. I learned this neat trick in the EMR at school this week. I learned this cool way to chart. She’s calling to tell me these very real stories about the gentleman she took care of that had dementia and thought that she was his daughter. Right. Those are why those people get in the business. And Scott Powers, our CEO at Elara’s, challenge us to go.

Chris Mate [00:05:51]:

We need to take this 50 50 split between clinical care and administration logistics and make it 80 20. We want to let caretakers spend 80% of their time. So that’s a lot of my focus, is how do I get friction out of the job and create nursing capacity? By making this really the best nursing job in the world to do. So what do we bring? I think it’s one of those areas that AI really has some opportunities for us. We’ve got a great partner that we’re working with in Oklahoma, Apricot AI, on some clinical documentation pilots, where with start of care for a skilled home health patient, we typically spend an hour or more in the home doing assessments and over an hour charting afterwards. With what CMS requires with these AI pilots, we’re finding we can get that 65 to 70 minutes of charting time down to 15 minutes.

Ben Hilmes [00:06:40]:

Fantastic.

Chris Mate [00:06:42]:

Yeah, it’s really game changing for nurses who in home health have often spent their entire day on the road going house to house, right. And then they go home and why? They’re trying to be a mom, a wife, a husband, a father. Those things they’re charting in between helping with homework. And so my real passion is I want to get these nurses so they take care of patients, then go home at the end of the day and leave the tablet in the car. For me, it’s, we’re not going to hire our way out of labor shortages with nursing, we’ve got to create capacity by using technology to move the non value added stuff to whether it’s AI or other technology platforms.

Ben Hilmes [00:07:21]:

So you bring up a good play. I mean, you think about your geography, the ruler from New York to Texas, and hundreds and hundreds of hundreds of people in the field every day. As a CIO, that’s got to create some headaches and some challenges and just the logistics. I know you guys are big users of ServiceNow and aspired and use really strong technology, processes, procedures, etcetera. Talk to me about how you’ve had to bring the rigorous to a different level to ensure that you are able to one deliver that patient experience. But at the same time, I mean just as important as your provider experience. So you seem to have a lot of passion for that. So how are you doing all the things that you know and the tools at your disposal to achieve that?

Chris Mate [00:08:11]:

I’ve got 9000 mobile devices out in the field easily, let alone other devices, you know, the folks use. So I’ll use this term with you. And that technology has to be like dial tuned to. If you remember today is when you pick it up. It’s got to work and it’s got to work right the first time. It’s got to put down because my folks are out in the field. There’s no safety net, there’s no going down to the nurses station to get a different tablet, laptop, those things. It has to work.

Chris Mate [00:08:38]:

So it really is a lot of focus around process. You mentioned servicenow. We’ve done quite a bit to automate our IT support processes using the servicenow service management products. My nurse may have 1520 minutes on a drive in between two visits to make a call or a pull to the side and do a chat session. She’s got to be able to get her answers now, get her problem solved and moved on. We’re also in the beginning of rolling out for our HR services a servicenow product. Same kind of thing. That nurse who needs to find out has a question on benefits or payroll or PTO policy.

Chris Mate [00:09:14]:

We’ve got to get that information to them very quickly because their day needs to. I got to get to that 80% where they’re really focused on their patients. They’re using these tools to just get the information they need in a way that they can consume it wherever they are.

Ben Hilmes [00:09:30]:

That’s fantastic. So, question I would have if I think about one, you talked about AI a little earlier, but then I start thinking about some of the most important things around. Monitoring, censoring inside these patient homes. And then in the traditional setting during COVID we saw this massive migration to virtual remote care. Have you guys seen the same kind of pendulum back tick that we saw or seeing in the traditional healthcare? Or have you guys continued to lean into the virtual, the remote monitoring, those kinds of things.

Chris Mate [00:10:09]:

No, it’s a great question. I was in the hospital when we watched all the doctors visits go to virtual and then come right back. We are definitely leaning to that where we can, in some cases, the reimbursement models don’t yet support well enough those kind of tools. I will tell you there’s a number of places where, you know, where we can get into kind of risk sharing type agreements with certain providers that we definitely have leaned into, the pulse ox, blood pressure, those kind of monitoring, those kind of things. But I also tell you, with doing as many visits as we have in the home, it’s also collecting that data. If I’m putting a PCs aid into your home three times a week, I’m collecting data that we bring in and we’re constantly looking at ways to refine on, hey, are we seeing any changes in condition? How early can we see those? Is there an opportunity to bring a different care intervention to let you, as we talked about beginning stay at home, right? So there’s a number of places we’re calling in a lot of data. We tell people commonly we probably pull 100 million patient data points a year from all the visits that we’re doing, and we’re constantly looking at how we use those to identify when a change in care is needed.

Ben Hilmes [00:11:21]:

Question on cyber because I’m sitting thinking about all these distributed geos, you’re in all of these devices that you have either in the home or on your providers. I imagine as a CIO, that’s got to weigh heavy on you. It’s probably a topic that’s discussed at every one of your ELT meetings, your board meetings, etcetera. What additional layers of strategy do you have to put in place given your overall model around cyber?

Chris Mate [00:11:48]:

You’re doing them all, if you will. I think you’re thinking about that defense in depth. What are those best practices around the device? The hard meter, the device, the multifactor authentications, all those things. The awareness, the awareness and training are big things. As you look at most of these ransomware hacks have typically started with social engineering. So you can never educate too much. We’re doing all those things. But you’re right, a lot of sleepless nights.

Chris Mate [00:12:13]:

You know, healthcare has been quite the target the last couple of years. And, you know, I’ve been asked a couple of times, what do you do to stay ahead? I don’t know if you ever stay ahead. You just try to do everything you can is you’ve got bad actors that are exceptionally motivated. I think cyber is one of the first areas into AI. If you look at years ago, with the things that the abnormals and those folks, the world and the things they do to help us deal with Spam, we’re seeing the bad actors use AI to improve their social engineering. So it’s one of those, not to quote a movie, you want me on that wall? You need me on that wall. It’s forever diligent on there. And a lot of it still is the basic blocking and tackling of training and awareness, because that’s where so many of these exploits start.

Ben Hilmes [00:12:58]:

Yeah, that’s right. The layer effect seems to be kind of a very natural strategy in the cyberspace. So I’m also thinking about, as somebody says, they want to age in place. And we believe, you guys believe that, that the best places at home, unfortunately, and inevitably, sometimes that’s not at home right there, they will need to seek care from a hospital. So there’s probably this migration out of the home into the hospital, back to the home. And at that same time, those providers want to see all this data, all this information, and patients want to have their information present on encountering of the health system. You guys work with a lot of health systems. How do you partner to share data and ensure that as providers are changing or patients are changing hands with providers, they have what they need to provide the best care?

Chris Mate [00:13:47]:

It’s something that we’ve been challenged in healthcare for forever, it seems. And there’s probably still more promise around interoperability than traction at times. There’s a number of things. When I think of the front end of the process, getting referrals in interacting with, whether it’s a payer, whether it’s a health system on can we take your patient? Do we have the right arrangements with payers? Do we have the right geography, right skill sets, those capacities? And we’re continually looking at how we use the data. We’ve got a couple of active projects going on now is what’s the best way to use that data in a way that impacts our ability to take care of those patients. So I think it’s something that’ll continue to grow as we all lean into that. We plug into some hie like networks and those things for knowing where our patients are and those things, but we’ll continue to lean into that.

Ben Hilmes [00:14:41]:

Do you see a day where it’s seamless? You know, because one of the things we used a lot when my time at Cerner is a tagline, it’s, you know, healthcare is too important to stay the same. And secondly, ultimately, it’s personal. So do you see a day where you can go across the continuum and not have to worry about this thing called interrupt?

Chris Mate [00:15:02]:

I’m going to believe then that the days out there, I’m not sure that I’ll see it. Healthcare is such an interesting story in America. The way we pay for healthcare drives a lot of behaviors there. So I think that’ll always be the case. But I think it’s something we continue to strive for. I mean, I’m doing a couple things now with different partners based on a fhir interoperability model that felt like something that was just really futurists not too long ago. I think we’ll continue to see growth in that. Will it ever get to where it’s perfectly seamless? I don’t know.

Chris Mate [00:15:36]:

Then at the same time, I should be careful because I watched Elon Musk land a rocket crazy and catch it with some chopsticks the other day. So I’m sure the know how’s out there, it’s probably more about the will to do it. So.

Ben Hilmes [00:15:50]:

Yeah, no, I think that’s right. I still believe the days out there. I just think we got to a little bit of choose to go to the moon mentality, fix the problem, and I lean in to do it. Let’s pivot a little bit to. Every time we do one of these Leader to Leader podcasts, we talk about leadership. It’s important. The industry needs more and more good leaders like yourself. And you spent a lot of your time at BJC and you were leading a big there, running all the apps, BPA applications there, thousands of apps, I’m assuming.

Ben Hilmes [00:16:23]:

If you had to count them all, how did that experience kind of prepare you for what you’re doing now? And just love to hear how that transition went.

Chris Mate [00:16:33]:

BJC, what a great brand here in Missouri. Just awesome. Hospitals, children’s Hospital, Barnes Jewish. I think you learn a lot of things in healthcare, whether it’s folks asked, it’s not a 24/7 job, it’s kind of 25 eight, I call it. And I had a health experience where I was in for several days. And I remember in my brain thinking when they were taking this blood test, boy, I hope the integration with Cerner is working. You think that way. It’s really.

Chris Mate [00:16:59]:

You personally identify with that. I learned quite a bit. Great team there. Jerry Fox. I work for BJC and a number of us have moved on to CIO roles. They came from Jerry’s team and I still stay in touch with those folks and constantly learning. And BJ sues one of those, has an academic medical center, has community hospitals, has home health, has hospice. So I got to see healthcare in a lot of different models, got to see how those things need to work together.

Chris Mate [00:17:27]:

And I think that’s really informed me as, you know, as I move forward into the Elara caring role and you see that kind of longitudinal view come to fruition when you see we need all these parts of healthcare, we need the primary care physicians and those more predictive and proactive care. We need the hospitals for amazing events like childcare bursts and other not so hip replacements and cancer and those things. Then we need home health. When you look at, there’s just not enough capacity in the hospitals at time. But also how do we help people get better? The easiest and getting better is often a team event for folks that home, their family is all involved in that. And really I learned a lot of those things at BJC that the, we, I think we had over 3400 beds. You can see a little bit of everything there and really proud of my time there.

Ben Hilmes [00:18:18]:

You seem to have this demeanor that’s kind of service oriented. You want to take care of your customers, you want to take care of your providers, you probably definitely want to help them take care of their patients. Where does that come from? Chris? It’s hard to teach. And so when I come across people like you, you just seem to have that. It just seems natural to you. I’m just curious where that came from.

Chris Mate [00:18:40]:

Well, you know, I appreciate that and you’ve got a great healthcare career, Ben. There’s so many of us that get into healthcare and then you just can’t get out. Right. The mission is so self evident in here, right. And it’s hard to imagine. And I work for a top ten bank. I’ve worked in freight, logistics and some neat things. But once you get in here, the mission’s so self evident.

Chris Mate [00:18:59]:

I think for me it’s also very personal. My mom’s a retired hospice nurse. The number of hospice stories I’ve heard from her over the years, as I mentioned, I’ve got a daughter in nursing school who’s going to commission as an officer of the army and go work as a nurse and an army hospital. Those kind of things really resonate. And people, when they find out where you work, everybody’s always got a story. I worked at BJC or I work at Elara Carey and I talk about we have hospice and people tell you with a tear in their eye about what this hospice nurse did for their family at the end and those things that makes this really personal. And for me, it’s been really neat and real big advocate in our world, getting my it folks out on ride alongs with nurses and into branches and when they see the connectivity and the real impact that they have. And it’s one thing to set up a tablet in the back office before it leaves the depot, it’s another thing to go out and see a nurse who’s quarterbacking care, social work, family dynamics in the home in a tough health situation and see that when the tablet just works the way it supposed to, she could focus over there.

Chris Mate [00:20:08]:

Right. And so it’s, it’s really neat. You know, I tell my folks a lot of time, Ben, if, when we’re really good in healthcare technology, we’re almost like referees at a football game, right? If, if you leave a football game talking about the referees, you probably, they probably didn’t have a good night. But if my nurses and our caregivers can go in and out and not even think about the tablet very often, man, that’s about one of the highest compliments we could have.

Ben Hilmes [00:20:31]:

Well that’s a great, that’s a great story. I love the. Just getting your folks to get that real firsthand experience connection. I used to do that at Cerner is we had, you know, we’d have a lot of engineers, we’d have a lot of folks that never left the, you know, the four walls. You know, let’s, let’s go on a little visit. Let’s take a walk. Let’s go meet some docs, let’s meet some nurses. Well, this has been great.

Ben Hilmes [00:20:52]:

My daughter’s all, she’s a sophomore in high school, but she wants to be a nurse. So I’m excited to hear that your daughter’s going down that path. I love the fact that she’s leaning into the. To the military. That’s great. I noticed Elara caring has a tremendous focus on veterans.

Chris Mate [00:21:08]:

Yes, absolutely.

Ben Hilmes [00:21:10]:

You guys do a lot of amazing things. As we wrap. You know, we talked a little bit about interop as something we hope we both can help solve down the road. But in just this broader continuum, the space you’re in around home care, what does it look like three, five years down the road? Are there a couple big things that kind of stand out that, hey, me, Chris, my, we’ve got to go get solved.

Chris Mate [00:21:34]:

I’m really interested is we’re at the very front end, but the impact that AI is going to have, and I kind of look at two buckets, Ben. Really, this kind of operational logistics, things where we know the answers, but AI can help us get there very quickly, dealing with sometimes the healthcare intramurals between payers and providers and patients. I think there’s real opportunities for that with AI to clean that up. I mentioned the pilot we have going on in clinical documentation, but I think there’s that other bucket that will grow where AI really becomes a resource in clinical triage, developing care plans, those kind of things that’ll be exciting to watch and be a part of. Because again, as we watch that growing aging population, if the nursing population isn’t growing to meet that, we’re just going to have to get better at doing this. And I think AI shows a lot of promise there, some nerves at times, but I think a lot of promise and helping us create capacity there.

Ben Hilmes [00:22:32]:

I think those are two big things that need to help get solved, and AI can certainly help us solve a number of those things. I think people are just dipping their toe into the use cases right now, and it is probably the most promising thing I’ve ever seen in my career that truly has the capacity to fundamentally transform. So it’s really exciting to see how people are using those tools and those capabilities to reimagine delivery. So that’s really, really neat. You guys are in front, front end of that. Well, Chris, this has been great. I appreciate your time. I know you’re a busy guy, got to get you back on your day, but this has been fantastic.

Ben Hilmes [00:23:11]:

Thanks for joining the program and I’d love to have you back at some point here to see your continued progress and success.

Chris Mate [00:23:20]:

All right, well, I appreciate the opportunity and absolutely, let’s definitely talk again in the future.

Ben Hilmes [00:23:25]:

That sounds great.

Ben Hilmes [00:23:29]:

I hope you enjoy my talk with Chris. There are several great takeaways from our conversation, but here are a few that stuck out to me. One, our aging population wants more options for healthcare in the home. That is great news for home health providers like Elara. Two, Chris thinks AI can alleviate nursing shortages by making providers more efficient and reducing their administrative tasks. In short, he sees technology as a tool to create capacity. Three, Chris wants his team members to ride along with caregivers in the field. It’s a great way for it staff to connect to their mission and to better understand the needs of home care providers.

Ben Hilmes [00:24:08]:

So what did you think? What are your big takeaways from this episode? I’d love to hear from you on our social media channels or drop me an email from our website at healthcareitleaders.com.

Ben Hilmes [00:24:22]:

Thanks for joining us for Leader to Leader. To learn more about how to fuel your own personal leadership journey through the healthcare industry, visit healthcareitleaders.com. don’t forget to subscribe so you don’t miss any insights, and we’ll see you on the next episode.