Voices: Joe Ebberwein, Founder and Chief Financial Officer, Corstrata

This article is sponsored by Corstrata. In this Voices interview, Home Health Care News sits down with Corstrata Founder and Chief Financial Officer Joe Ebberwein to learn how home health agencies have been redefining the standard of in-home wound care throughout the COVID-19 pandemic. Ebberwein also shares insight into the role technology has played in that transformation, and explains what the future of in-home wound care will look like moving forward.

Home Health Care News: Joe, what career experiences do you most draw from in your role today?

Joe Ebberwein: Although my background is accounting and finance, I worked for a regional home health and hospice provider that was an early adopter of remote patient monitoring. As reimbursement shifted from per-visit to the Prospective Payment System (PPS), it was a sentinel moment for us, because it showed that technology was the answer to providing optimal, efficient care in the home. We recognized the return on investment as we doubled our patient census without adding any additional nursing staff.

The other experience that ties into my work today is the core principle of investing in the latest and greatest technology. Technology is futile — if it does not fit into the workflow of the clinician. But you also need leadership’s buy-in to be successful with that technology.

Our readers are familiar with Corstrata, but can you give us some background on the company, its mission and who it serves?

Ebberwein: Corstrata was born out of a mission to improve wound and ostomy care for patients and help them live fuller, more enjoyable lives. We also set out to provide support for community-based providers of wound and ostomy care, utilizing technology to create access to those wound and ostomy experts. My co-founder, Kathy Piette, and I worked in home health and hospice for many years, and we lived the pain point of always trying to find certified wound and ostomy nurses. If we found them, we strove to retain them and utilize their expertise efficiently.

At that time, we did not have the technology that Corstrata currently utilizes to create that access. Now, we’re working with providers in home health and hospice who are not equipped to care for patients with complex wounds, either because they lack access to certified wound expertise, or they’re just not using those resources very efficiently. We bring a full complement of both the technology and nursing expertise to drive optimal care.

We see issues around proper identification of etiology — 30% misidentified — staging, with 50% mis-staged, and under-utilization of advanced dressings, all of which can reduce in-home visits if done properly. A lot of agencies don’t have a mechanism to monitor the progress of a wound. Through our Corstrata platform, we’re able to do that and aggressively change treatment plans to move these wound patients toward healing.

We’re seeing a number of new innovative care models in home health, such as hospital-at-home and SNF-at-home. What are you hearing in terms of patient demand for these programs? Do people really want a hospital in their home or an SNF in their home?

There’s nothing new under the sun. In actuality, we’re moving toward in-home models of care that were the norm until the middle part of the last century. People were cared for in the home, whether it was the birth of a child or the death of an elderly family member. People were very used to care being provided in the home as the base.

The difference now, I believe, is that we have technology that enables both primary care and specialist clinicians to care for and monitor the progress of the patient in the home, which we know is where they want to be.

Last year’s pandemic accelerated the adoption of in-home care, especially utilizing telehealth and other technologies, because patients were reluctant to go to the ER for fear of COVID. Also, because the systems were overloaded with COVID patients. I think it’s very encouraging that CMS responded quickly to the immediate needs and relaxed what could be done with telehealth and care as evidenced by hospitals-without-walls.

Interestingly, we saw about a 50% growth in our consult rates at Corstrata due to the fact that outpatient wound centers on hospital campuses were deemed non-essential. Care had to be done in the home or in some cases, not at all, which has led to other complications with wounds not healing. Other in-home models like Contessa Health and DispatchHealth experienced significant growth along with some of the big telehealth companies like Teladoc and MDLive.

What impact have the hospice and palliative care movements in the home had on people’s comfort level with home health services earlier in their care journey?

Ebberwein: I’ve been very fortunate to work in the hospice model of care in my career, but also I’ve worked at the national level and would like to give a bit of a plug for the Hospice and Palliative Nurses Association and its credentialing arm. I’ve seen a heightened level of commitment by both national and regional organizations to educate their staff as well as certify their staff in the latest evidence-based palliative and hospice care.

I think the adoption of hospice care in the home has been normalized. It enables other in-home models to be more acceptable or adopted. You see organizations like Aspire Health that have built a primary palliative care model in the home. It’s become quite acceptable for that kind of care to be delivered in the home.

How do you see these models evolving for the remainder of this year and into next year? What does that evolution mean for home health providers?

Ebberwein: It sounds cliche, but care is “moving home.” I believe we’re going to see that across every age cohort. Telehealth certainly was accelerated by COVID, which enables care in the home to occur so much more easily. We’re seeing a surge of direct-to-consumer models that facilitate telehealth using off-the-shelf equipment. I follow Best Buy and some of their health initiatives, and it’s very interesting to see what kind of monitoring and telehealth equipment you can buy off of the shelf and then plug into the health service providers.

For many health conditions, I believe that technology is plug-and-play, but for more complex, comorbid patients, care can still be delivered in the home through technology. Where in-person care is still critical, I believe home health is uniquely positioned to care for these patients in the home, and this could be done in partnership with organizations that are moving toward primary care or more complex services in the home. For many years, home health has demonstrated that it is the lowest cost alternative to complex care, whether it be compared to SNFs or certainly, in-patient acute care.

Corstrata is a leader in helping agencies build wound care programs of excellence. What does a wound care program of excellence look like in a hospital-at-home model?

Ebberwein: It’s not unlike building a wound program of excellence in any care setting. At its core is access to clinical expertise — a scarce resource. Only 1 in 10 certified wound specialist nurses practice in the post-acute setting, so there’s a heavy concentration in acute care settings and outpatient wound care centers. Imagine Cleveland Clinic trying to become the international cardiac center of excellence that it is without access to the top cardiologists in the world.

Similarly, hospital and SNF-at-home models need access to clinical wound specialists to create a wound program of excellence. Creating seamless and timely access to the best minds in wound care is possible through technology, and that has been Corstrata’s focus for the last five years. The clinician in the home presented with a complex non-healing wound needs access to wound experts who can recommend the best patient-centered care plan. Technology is key to the e-consult world, as well as the ongoing wound monitoring for timely intervention.

What are the key adjustments agencies must make to their wound care program to fit into hospital-at-home?

Ebberwein: Home health agencies have an opportunity to provide hospital-at-home or SNF-at-home complex care services because they understand the unique challenges of caring for wounds in the home environment. Adjustments to current practice would include immediate access to wound care experts to assess the patient and collaborate on an evidence-based care plan. It would also include the deployment of telehealth and other patient communication technologies for quick response times, as well as patient monitoring capabilities between in-home visits.

Wound care is best delivered as a team with each person practicing at the top of their license, and technology enables communication between virtual team members.

Entering this year, no one knew fully what to expect. What has been the biggest surprise to you so far in the home-based care industry, and what impact do you think that surprise will have on the industry for the remainder of the year?

Ebberwein: I think we all know that government programs are often slow to respond. but at the same time, it’s very encouraging that CMS remains committed to new models of in-home care, even post-pandemic, as evidenced by the expansion of the hospital care at home program and others through CMMI and some of the innovation models. I believe we will continue to see a lot of consolidation in the home health and hospice industry as both national and regional companies refine their strategies.

There’s also a keen interest by payers and providers to focus on that in-home care. We see evidence in Humana’s acquisition of the remainder of Kindred, and we work with some of those large national agencies at Corstrata. We’ll continue to partner with those tech-enabled companies from a care delivery perspective, but also for the ability to have refined data analytics that ensure delivery of the highest clinical quality outcomes at the lowest cost per patient.

I think regional and smaller agencies will either grow their referrals by having these programs of excellence, or we’ll continue to see acquisitions by larger agencies through consolidation.

Editor’s note: This interview has been edited for length and clarity.

Corstrata brings tech-enabled, telehealth for the care of those with wounds and ostomies. From hospital-to-home to medical home and other care settings, Corstrata’s experienced, board-certified wound care clinicians work with healthcare providers to provide the best in class wound care at a lower cost. Visit www.corstrata.com to learn more.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected]

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