interview, Home Health Care News sits down with ResMed Vice President of
Strategic Initiatives Nick Knowlton to learn why one of his driving mottos is
“Do right,” how interoperability is helping home health operators provide
better patient care during COVID-19 and how the pandemic has changed the
industry’s need for interoperability. [Disclosure: Knowlton is also the board
chairman of CommonWell Health Alliance.]
HHCN: You’ve had a deep and varied career. What are the most important lessons you’ve carried to MatrixCare, and what do you do here?
Knowlton: I’ve been with the Brightree and MatrixCare team for almost six years now, and I lead a lot of our strategic partnerships, and a great deal of our interoperability strategy as well. The most important lesson I’ve carried to this position is always do the right thing for your customers. We really believe that interoperability done right is a key to home health agencies and other post-acute providers being successful in a rapidly changing health care world.
A former CEO I worked for had a rule for working at the company: “Do right.” If you do the right thing for your customers and for their patients, you’ll be able to figure everything else out.
second lesson I carry is a little more technical: If you want to do
interoperability right, you do things that empower your clinicians and not
distract them. The idea of going the extra mile and building good interop
workflows into the product in a fashion that clinicians want to engage in and
use is absolutely critical. If you don’t do that, you lose them before you even
launch the product or service.
MatrixCare is heavily investing in
enabling clients to connect better with their referral sources. It’s not just
the initial care transition. How do you get actionable insight on your
As the interoperability world evolves, we are going to get a lot more granular about what a proper initial care transition into home health looks like. Today, you see everything from an e-fax that just has a patient’s name and what they are supposed to be treated for, to a full-blown electronic chart with loads of discrete data that can be digested to help empower clinicians to more easily take care of patients.
when you think about the power that you can unlock with these interoperability
modalities, the content is not just a PDF. The content and the standards that
we try to push for are based on the concept that a human should be able to read
it, but a machine should also be able to read it. We want to make sure that we
don’t degrade the content that we’re transporting. By doing this the right way
out of the gate, we can establish links with the patient identity in the
referral source system to enable better follow on interoperability.
in the home health world, this is becoming increasingly important. I think
everybody’s aware of the reimbursement impacts of PDGM (Patient-Driven
Groupings Model). But I think that the two key things for why interop is more
important now would be the compression of the revenue cycle into a much shorter
timeframe than pre-PDGM, and also the direct tie between reimbursement and
having a full history of the patient including all of their disease states and
Do those referral sources
typically know everything that a home health agency needs to know about a
Typically they don’t. There certainly are some
patients in the home health realm who have relatively simple care histories and
simple needs, but let’s be honest: Our industry also sees patients who have the
most complex disease states, the most number of diagnostic codes associated
with them, and also high levels of comorbidities for those disease states.
The practical implications are that a patient might
have been discharged from a hospital for a rehabilitation purpose but they are
increasingly being seen in other care settings. The referral source may not
know that the patient also has other chronic disease states associated with them,
and they may not know the full complexity of that patient’s care history.
Once you have the initial referral
and actionable insights on patients, how do you cast a wider net to learn more?
When we think about how to accomplish the ultimate
interoperability mission for our customers and for their patients, it’s more
than just that initial referral. Because these patients are often seen by
multiple specialists and have multiple comorbidities and disease states
associated with them, it’s important for us to reach out to others who have
seen that patient and try to find their complete care history. That way, our
providers can have a 360-degree view of the patient before they treat them.
We have been pioneering a lot of work through
CommonWell Health Alliance and also connecting with Carequality and connecting
with Surescripts medication history network to really flesh out what else might
be going on with a patient. Some of these things could be identifying recent
encounters with specialists and grabbing the patient’s chart from that
location, or reaching out to Surescripts to find out what other medications
have been filled on behalf of the patient. But the idea is to cast as wide of a
net as possible, so that during that initial encounter with the patient, the
clinicians run into as few surprises as possible.
A good example of this would be what we commonly
refer to as “The Shoebox Problem,” where a clinician shows up at the patient’s
house and there’s a shoebox full of medications waiting for them, and they
don’t know what is the current and best active med list for that patient. They
waste a lot of time and energy calling the provider who prescribed it or
working with their home office to find out what amongst that shoebox is still
supposed to be there and what might be missing from it.
We know that by enabling better interoperability
from the referral source and by casting a wider net for these providers, we’re
going to minimize the amount of work a clinician has to do chasing down the
patient care history, and they will arrive much more comfortable knowing that
they’re going to have a much more complete and accurate picture of what they
will encounter with the patient. It makes them a lot more efficient, and
enables them to spend more time on other tasks such as communicating with the
patient’s family members about what’s going on and what the next steps would
How are referral sources thinking
about interoperability and reacting to these capabilities?
We started pondering this question a couple of years
ago. We felt that we had really good, anecdotal stories from customers and
other care providers, but we conducted a survey in concert with Porter Research
to find out exactly where referral source pain points were and how they felt
about interoperability and its impact with post-acute care providers.
The results, which we released last year, were
actually quite astounding.
Sixty percent of referral sources who refer patients
into home health and other post-acute care environments indicated that they
would be willing to switch their post-acute care partners if they were able to
interoperate with them effectively. Being able to automate a referral to the
post-acute care provider was listed as the number one thing they wanted to
The pain points they’d like to avoid are some of
those phone calls back and forth. Like when we discussed “the shoebox problem”
— just as much as the clinicians in home health don’t like having to make all
those phone calls, the referral sources don’t like answering them because they
know that those medication lists exist within their system and they know they
have the capability to transport to other care domains. Home health should not
be any different.
What else are referral sources
Insight into the patient care journey. We knew this
anecdotally and it was brought out in our research study as well. Referral
sources have referred to this as the black hole phenomenon. They refer a
patient to home health and they have no idea how that patient’s care
In a value-based reimbursement world where providers
are increasingly asked to take financial responsibility for the care
progression of their patients, not being able to have insight into how those
patients are progressing is unacceptable. We’ve seen numerous proof points that
the ability to provide on-demand insight into what’s happening with those
patients is of tremendous value to not just the referral source, but hence
their relationship with their post-acute care network.
How has the COVID-19 pandemic
changed the need for and value of interoperability?
COVID-19 has been amplifying the trends that have
been emerging for the past few years. As not just the staff of a home health
agency, but also the referring physicians and their staff have been driven to
remote workforce situations, interoperability has become increasingly
important, and in some cases almost impossible to do without. If you don’t know
how to get ahold of a referral source to track down additional information over
the phone, or if nobody’s monitoring a fax line, doing it from an EHR system to
another EHR system is a great way to circumvent that obstacle because these
system by and large are always on now.
What do you see growing out of
this increased interoperability?
Number one, there will be a much expanded use of
remote patient monitoring and telemedicine technologies. The genie is not going
to go back in the bottle. The other issue that might be a little less clear to
a lot of folks is as soon as providers start adopting interoperability
technologies, they really see the power of it and they really believe that it
is real and that it needs to be further unlocked.
What we see all the time now is providers who were
skeptical, and moved forward with some basic interoperability modalities, and
have now become champions for using the technology. Frankly, they have become
the biggest proponents of asking for more.
So there is a snowball effect for the adoption of
interoperability in the industry. And I think COVID-19 has led to the
recognition of the power and the value of multiple technologies from
interoperability to remote patient monitoring to telehealth.
Editor’s note: This interview has been edited for length
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