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Episode 18

Exploring challenges and growth opportunities in pediatric home healthcare with MGA Homecare

Jeff Howell (00:01):

Welcome to home health, 360 a podcast presented by AlayaCare. I’m your host, Jeff Howell. And this is the show about learning from the best in home healthcare from around the globe.

Erin Vallier (00:19):

Hi folks, and welcome to another episode of the home health 360 podcast, where we interview home health professionals from across the globe. I’m your guest host Erin Vallier SMB sales director for AlayaCare software. And today I’m joined by two professionals from MGA home care, Chani Feldman and Alex Koloskus to about private duty home care services in the pediatric space. Chani is the CCO, which stands for chief cooking officer in her home. But at work, she is the chief clinical and government affairs officer for MGA home care. She started her healthcare career as a nurse in at children’s national medical center in DC, and then moved into the home healthcare space. About 15 years ago, she served in a variety of roles from clinical director to clinical educator, to working with the CEO on a process improvement team, to government affairs and public policy. Wow, that’s a lot currently Chani advocates for the medically fragile population who receive care in the home.

Erin Vallier (01:28):

She’s obsessed with making a case for home care and shouts from the rooftops that this is the highest quality lowest cost setting to deliver care. I agree with you. So welcome to the show, Chani. Thanks. Can’t wait to be here. Yeah. Excited to have you and Alex, Alex has been with MGA home care for approximately a year on the government affairs team, and recently moved into the chief compliance officer role. She’s a licensed healthcare attorney who began her career representing California Medicaid clients who had been denied services for law school. She moved home to Colorado to work for the governor’s office of legal counsel, and then the Colorado’s Medicaid agency. That’s H C P F. Um, she managed the home community and maternal health benefits section for about six years at MGA. She plans to use her expertise to support the organize caregivers and delivering the best care possible to the medically fragile children they serve.

Erin Vallier (02:29):

Welcome Alex. Thank you. Thanks for having me so excited. Well, new ladies both have a really impressive resume and I can’t think of anybody else. I’d rather talk to you about what’s going on in the pediatric space today. So I’m really excited to have this conversation and I’m curious pediatrics is not for everybody. These kiddos are like really fragile or at least in my experience, it’s like, they’re good. They’re good. They’re good. And then they’re really not good. So it kind of frightens a good percentage of people away from that niche. So I’m curious about you guys, what drew you to the pediatric space? And can you share that cliff notes version with our audience today before we just dive in?

Alex Koloskus (03:19):

Sure, Chani, should I start? Sure. I think you, you covered it a little bit and, and I apologize. I talk with my hands, so it’s sometimes distracting on zoom calls, but I’m sure on a podcast but you covered a bit of my, my, what pushed me into pediatrics in that little bio. I started getting interested in health law broadly in law school which you know, that you really kind of gotta pick an area of law pretty quickly. And the health law clinic, the elder in health law clinic to be specific was an area of interest in mine. I had a supervising attorney who I really bonded with. And, and she kind of gave me that first experience with working with clients in the clinic, which was a part of law school that you don’t really see in the, in the day to day class grind.

Alex Koloskus (04:09):

So I kind of fell in love with just a healthcare space and topic because of her and because of that, that clinic ex experience. And then after that, I was desperate to get home to Colorado and ended up after you know, a couple different places at the department of healthcare policy and financing, which is Huff is the, the acronym here in Colorado where I, I started out managing the home health benefit and ended up supervising or managing a unit that’s oversaw like 15 fee for service, Medicaid benefits. Most of them very pediatric heavy and specific. So spending six years kind of running the programs there and how pediatric heavy they were, kind of kept me in the space and kept me motivated and to continue doing that hard work. And then I, you know, was introduced to ha and Brad, our, our CEO at MGA and just kind of, I tell the story that it was kind of the cosmic push in the back to kind of move over to, to the private sector and to MGA. Who’s a, a great pediatric healthcare provider. So that’s kind of how I’ve landed and stayed here.

Erin Vallier (05:23):

Nice. That’s a wonderful little journey and back to Colorado, which I don’t blame you yes. Not one day. That’s beautiful. How about you, Chani? How did you land here?

Chani Feldman (05:34):

Well, I as you had mentioned, I started as a NICU nurse, so that I would say, you’d think that that would be this sort of natural transition into the pediatric home care space. But I can’t really say that I knew much about home care at all when I was a NICU nurse. And if it wasn’t, you know, for a recruiter that , you know, really was very persistent in getting me to come into an interview I don’t know that I would’ve known so much about home care. Our, you know, I specialized in the, a micro Preme team. So these were like 23 and 24 weekers born, you know, months before they were supposed to, it was wow. Very adrenaline filled and high pay. It was a high paced environment. And you know, most of those kids, you know, so many of those kids don’t make it.

Chani Feldman (06:31):

I mean, there’s tremendous advances in, you know, medical technology, which, you know, a lot hand now, but often those kids, when they go home, if they, you know, if they make it through their journey in the NICU and they go home, they typically need home care services. But I wasn’t aware of that. I mean, we would, you know, get the, get the memo from the charge nurse that morning. So, and so’s going home today and we’d, you know, go to the bay and kind of see them off and, you know, wave to them in their car seat as their parents were taking them home often with, on a ventilator and, and with equipment. But didn’t really think about how do these families do it. And like I said, you know, it was recruited to a home care. Didn’t think that I would like it stayed on PRN at the hospital for a bit, but my first visit with a patient in the home.

Chani Feldman (07:24):

And I’m gonna try not to cry here, but I have told the story bunch, you walk into a home and it looks like a regular home like you and I would have, and you go upstairs. And I walked into this patient room, little boy. And, you know, I remember the, the walls were blue, beautiful furniture, and you look over at the crib and there’s this, you know, beautiful little boy hooked up, you know, with a trach hooked up to a ventilator, a feeding tube suction machine, you know, in the crib tons of medications. And it’s just, it it’s just, it was just striking to me. And I was able to, you know, look around, see the parents, see the siblings, the healthy siblings that were there. And I can’t say that it hit me at that moment, but certainly not. Didn’t take me before.

Chani Feldman (08:20):

I said, what we do in the home enables this little boy to be at home with his parents and with his siblings. And it’s not a normal life and it is not an easy life, but you know, what we do is really it, it is life changing for these families. So I would say, you know, BEAY am very passionate about what we did and, you know, really switched, fully left. The hospital switched, you know, to home care as a clinical director, did a bunch of jobs. Like you had mentioned a lot of different, great roles that switch to government affairs is a, was a big, huge switch. And I’ll, I’ll just kind of be vulnerable until my, you know, complete and utter ignorance towards the government affairs. I didn’t not know what that was, but our CEO at that time, you know, Brad Bennett, he, he kept telling me, he says, I need you in government affairs.

Chani Feldman (09:17):

And I had no idea what he was talking about. And I mean, literally had no idea. I, you know, I was a nurse , I, I knew how to start an IV and, and do a great assessment in chart. I did not know what government affairs was. And I would like say to my husband, I said, you know, people in the government have affairs. like, that was the extent of my knowledge. And, and, you know, finally I just got the courage, you know, the CEO tells you, he need you somewhere. You just say, okay, you know, okay, sure. I’ll, I’ll do that. But you know, not really knowing. And I finally said to him, I said, Brad, I’m not really sure I’m your gal for this. I said, I really don’t have any experience. And I, I says, no, no, I’m gonna, you know, just hired somebody, you know, government affairs, professional, 20 years in the industry, he’s gonna teach you everything.

Chani Feldman (10:03):

But he said at the end of the day, when we, when we wanna speak to policymakers and legislators about our patients, I want that person speaking to be a nurse because you’ve been there and you’ve in, in the homes and you’ve done this. So it was go government affairs is not common sense for, you know, for those of the listeners that, you know, are involved in advocacy. You know, they know it’s, you know, it’s a regulated field. It’s, it’s not like it’s just it isn’t common sense, but I learned you know, the rules, the ethics surrounding actual lobbying. And I’ve feel that with the, you know, you know, the great teams that I’ve worked with coalition partners with other providers in the industry, we’ve made a lot of great strides. So , it’s, it’s been a, it’s been a fun journey and I’m thrilled to be at MGA.

Chani Feldman (10:54):

I’m thrilled to have a partnership with Alex, her role as chief compliance officer, but her background as regulator. You know, for me, I’m the, you know, the passionate nurse that wants to change the world and Alex is more of the, you know, of the balanced, well, you know, these are the rules and these are the, you know, these are the obstacles we have to face. So it it’s, we we’ve had a lot of fun so far. And we’re excited to, to has continued to, to, you know, see a lot of change. Good change. Hopefully.

Erin Vallier (11:22):

That’s awesome. It sounds like I have the dream team though, on the line today. So that’s super exciting. And the CEO, he had some wisdom there who better to, to advocate for the industry than somebody who’s been in it and know, knows it inside and out and can share that passion, cuz it, it is a special thing that you guys do. It’s, it’s hard. I can’t, I don’t have a special needs child, but I just, I can’t imagine how difficult or nearly impossible it would be to, to care for someone without the proper team and that proper team needs to be integrated into the home. And I know that MGA home care is a provider of private duty nursing services and also some therapy, correct like PT O T S D in the home. So share with our listeners, what exactly do these services entail? And can you tell me a little bit about the types of patients that you guys care for?

Chani Feldman (12:22):

Yeah, absolutely. It’s so private duty nursing, I would say it’s, it’s definitely a misnomer. I had, you know, many meetings with different legislators. That’s what do you do privacy to nursing? Is that like private pay for rich people? I mean, I’ve literally had those comments. Doesn’t really describe the care that we provide. We look at it as hospital at home type of care. Okay. Hospital at home has actually talked about these days a lot as a new concept. And I, I, you know, we kind of get frustrated. We say, we’ve been doing this type of care for forever. Not forever, but since Katie Beckett’s parents brought her home from the hospital and I don’t know if you know, but Katie Beckett, but she was a three year old girl who was stuck in the hospital because Medicaid wouldn’t pay for her care.

Chani Feldman (13:17):

And just like the patients that MGA cares for, she was ventilator dependent. But then in 82, president Reagan with bipartisan legislation pass by Congress created this Medicaid waiver that allowed for this type of care in the, and really the cost of keeping Katie Beck in, at home was a fraction of what it was to keep her an institution. It’s typically a Medicaid benefit and the, you know, the regular employees sponsored plans or commercial insurances typically don’t offer this type of care. There are exceptions, but quickly not. So our patients are usually technology dependent as like in my example of, you know, before with that first patient, I saw requiring a trach to breathe feeding tube or an IV for nutrition a lot of medications to manage this, you know, their condition that they have. They have serious medical complications genetic conditions that are not expected to improve.

Chani Feldman (14:25):

The exception are our kids from the NICU who were the Preese they had a lot of complications. So like I had, you know, shared earlier, they came home with these, this, you know, technology dependency. But we love watching them grow up and grow out of needing our services and we celebrate their graduation from home care and that is our favorite type of business to lose. The other types of patients we serve are those needing intermittent type of skilled nursing services. So, you know, often not, you know, they don’t need the hourly type of care, the eight or 12 hour shifts that we’re providing for those technology dependent patients. But they need certain skilled nursing services. So we’ll in our end to a home to do those visits, you know, 1, 2, 3 times a week, whatever it is. And as you had mentioned, we provide OT, PT, and speech for pediatric population. And we’re about to start a behavioral health service line. So lots of great things we’re doing in that space.

Erin Vallier (15:31):

That’s exciting. So you, yeah, you’ve got a, a like the whole gamut, right from the medically fragile that requires some intense care to the ones that just require a little bit of help a few times a week. And you said something that maybe Alex can expand on that most of your, most of the benefits in this, in the pediatric space come from Medicaid and rather than like private insurance, why is that Alex? Like, why, why doesn’t private insurance get on board here? Like what

Alex Koloskus (16:01):

In well you for experience? I mean, it’s, it’s a very complex question and answer actually with a lot of his historical components, but I mean, I would say the, the, the long and short of it is Medicaid is the only payer that will provide, you know, continuous or pay for continuous one to one nursing at that hospital hospital at home level of care. I think that’s because of kind of the, the history of private duty nursing and how it developed as, as a, a benefit it’s an optional benefit. So not all state Medicaid programs have to cover it. States can elect to cover it or not most do because it’s cost effective service delivery model as, and keeps kids out of institutions. But I think, you know, the private pay space hasn’t picked up on it largely, I would say because Medicaid has been so robust in this service model in its reimbursement structure for so long that they don’t really feel the need to, to kind of dabble there. They can pick up sort of the acute and the intermittent side. But they really leave it to Medicaid to cover the, the private duty nursing one to one continuous like high level of care.

Erin Vallier (17:21):

That’s interesting. I wonder if that, that trend will continue as we continue to focus more about care in the home. And I know in conversations that we’ve had, you know, back and forth a little bit before this podcast, I’ve, I’ve heard you say Chani, that the quality metrics and regulations that you guys are held to in the pediatric space don’t really mesh, or they’re more an alignment with adult home health. And even though on the surface level of what you’ve described to me sounds a little bit like doll home health. You’ve either got some people who are medically fragile. They require a lot of attention, or you’ve got the intermittent like three times a week, wound care chain, you know, or whatever. So on the surface level, it kind of appears like they’re similar, but what you were telling me is at the regulations and the requirements and documentation that are applied to you guys are, are just not appropriate. So I’m wondering if you both can describe to the listers how pediatric home care differs from elder care in the home, and how do you believe the quality metrics and regulations? How do you believe those should be tweaked so that you guys can operate more efficiently and more effectively for your clients?

Alex Koloskus (18:34):

Sure. I, I can kind of cover the first part of that question. Then I think Chani’s best to speak to our kind of work on how we’re trying to tweak them and make them more appropriate to pediatrics. But to, to start out, I mean, skill to care in the home, basically established as a benefit and the regulations and the quality metrics that follow with establishing that benefit. We’re all designed for adult the adult population. So 65 and older and as payers kind of started expanding the coverage to include to pediatrics in, in the home health space, because of cases like the Katie Beckett case that Chani mentioned as well as the Olmstead Olmstead and the ADA different, you know, whether it’s litigation or acts of Congress or whatever it was that kind of opened the doors for these services to children.

Alex Koloskus (19:30):

Combination of them really what happened was the existing regulations and the structure, the billing structure, pretty much everything quality measures as they existed for adults were just kind of pulled over and applied to children. There wasn’t a new development of a regulatory framework for children, even though these programs were expanded to allow them in. And what that’s basically meant is we’re left with acuity se assessments, for example and other regulatory requirements that were created for adults that don’t really match the pediatric space or the needs of pediatric clients as you described Darren. So I think two, I always give these two examples cuz they’re clear and kind of show, show what, what the issue is, but one is the Oasis tool. So I think most listeners would be familiar with the the Oasis, the out outcome and information assessment set as that eligibility, a tool that gateway functional needs assessment tool performed for Medicare home health patients.

Alex Koloskus (20:39):

And that needs assessment tool goes into questions like, you know, did the client read the newspaper today or this week is a client home bound? Are they able to independently leave their residents without significant assistance kind of questions like that? And those questions obviously answer a functional needs question for adults. So if so, so if an adult can’t read the newspaper and they answer no, or they do need, you know, they’re unable to leave their house without assistance and their home bound, then we know a bit more about that person’s needs for skilled care in the home. But obviously those questions aren’t applicable to children, children can’t read the newspaper and they leave the home all the time with the assistance of their parents. So that’s just kind of that, that is one example of there’s this federal acuity tool for the home health benefit, but it’s really only applicable to adults.

Alex Koloskus (21:33):

And in the, in the vacuum then for, for the pediatric side states have kind of been left to establish their own assessment criteria for the home health benefit and the private junior nursing benefit as it applies to children which has kind of led to like a patchwork effect. And then I think another example is the 60 day re-certification, this is, this is one that kind of highlights the regulatory framework. So I’m sure a lot of listeners are familiar with the, the 60 day reer. All, you know, Medicare certified home health is have to comply with the conditions of participation. One of them is that we complete a recertification of the client every 60 days, which essentially it means we’re reaching out to their ordering pH the ordering physician or the nonphysician practitioner to have them review the plan of care and the case file and kind of say, yes, this person is still home bound or this person is still, you know, needing X, Y, and Z services as you have them laid out.

Alex Koloskus (22:36):

And that was really that 60 day cadence really is built on and tracks the 60 day episodic care model of Medicare’s home health benefit. So we have to comply with that. We have to do that for our pediatric patients, even though and Chani can speak much more eloquently to, to the clinical component of this, but we kind of know in the pediatric long, long term care home space that these, that these children, aren’t experiencing a lot of differences in their care plan in a 60 day episode so that we know when they come to us, that they’re probably gonna be on services for a while. And, and reviewing their care plan every 60 days, isn’t leading to any better outcomes. It’s kind of just causing us to have this administrative, to, to comply with this administrative burden, even though it’s not, you know, directly tied to something that’s providing leading us to provide better quality care. So those are kind of two examples of how I don’t Chani, do you wanna expand on that? Yeah,

Chani Feldman (23:43):

I, yeah. I mean, I’ll just Alex and I could say it eloquently. I, I kind of get irritated because I’ve been complaining about this in a very constructive way and also non constructive way for, for a bunch of years. That 60 day reassessment, you know, I it’s an RN has to go out to a home and do this assessment and come back, you know, go, go log on, you know, to the, into the EHR, fill out the assessment create a new care plan, send that to the prescribing practitioner. We have to wait for the prescribing practitioner to sign. There are rules around, you know, how many in some states there are rules around how many days it needs to be signed by an order for, you know, the, the, the, the plan of care to be effective. And it is a it’s paperwork.

Chani Feldman (24:34):

We don’t gain, you know, Alex said this, right, but it’s just, I can’t tell you all of the wasted time on this particular effort that could be best spent better spent on act care coordination, communicating with the payer, communicating with other, you know, social support services. And yet we have to go through this process every 60 days, we are not reimbursed any bit extra for that process. So the sending of the RN out to the home and all of the administrative burdens that are associated with that, and it is just, you know, it, it, when we look at what’s kind of dragging us down and we, and we look at burdensome regulations, I mean, this is, this is the example. And I’ve had this conversation, as I said, with legislators, with Medicaid directors. And I have never once had anybody say, I disagree with you.

Chani Feldman (25:26):

I mean, I’ve the director say, I wish we could switch this. This makes no sense. It, this is the, this is the, the best example of square peg, you know, trying to jam it into a round hole. So anyway, we’re, we’re, we’re working, we’re trying to work with the different states to implement these, you know, changes in regulation, quality metrics to address the pediatric population. And, you know, we’re also trying to be engaged in a federal initiative, which will create a pediatric portion of the conditions of participation, which governs, you know, governs the care that, that we talked about. And, and if we could be successful in that these we would eliminate things like the 60 day research, which, you know, doesn’t make sense. I just wanna mention one other you know, advocacy effort that we are a part of there’s this ACE kids act, which is a bipartisan piece of legislation passed in 2019 and with a goal to improve care for children that are medically complex.

Chani Feldman (26:34):

And those children who rely on Medicaid for their healthcare coverage and under this ACE kids act state Medicaid agencies are required to develop a set of quality metrics for children that will ultimately get approved by CMS. And we’re really trying to get a seat at that table to be a part of that, to, to, you know, help craft these quality metrics because you know, children’s hospitals absolutely are just, you know, experts in, in, you know, knowing, you know, what is quality for these medically complex children, but, you know, home care providers need to be a part of that conversation as well, because we’re, you know, we’re such a huge part of, you know, care for the children in the community.

Erin Vallier (27:16):

Absolutely. And MGA is sort of a, a force to be reckoned with, and they have a really good team of people who are passionate about advocating. So I’m curious, is there a way for anybody listening that might be involved in with a pediatric agency? Like, it seems like we need to band together on this initiative and have a really loud and unified voice if we’re gonna make some changes. Is there a way for folks to get involved with you or with the initiatives that you’re involved with?

Chani Feldman (27:51):

Yeah. I mean, Alex, do you wanna speak, you know, from the mind of a regulator or , you know, I could definitely also speak after,

Alex Koloskus (27:59):

Well, I, you know so there’s a lot to tackle with the regulatory for framework kind of being designed for adults. And how do we, I it’s federal, I mean, I think the, the answer for some of the C O P stuff and that, and that kinda level is obviously we need some federal legislation. We gotta bend the ear of, of Congress to say, this was established back when it’s, it was designed for this Barbara relation, like, look at the ways in which it doesn’t make sense now. And here’s some alternative ones that we’d like. So I think I don’t know that we, we have a specific, like we are working with our lobbyists to kind of, you know, craft one pagers and get all sorts of historical information in, in place so that we can have this concept land, because it is a nuanced, you know, there’s a lot to take in the history of Medicare and Medicaid and then how it doesn’t work for children in our current space. But I, I think other than that, reaching out to your representative, you know, if you’re a family member and if you’re a provider, think some of these coalitions that we’ve been a part of have been super helpful and just kind of having providers understand the regulatory landscape, share with each other, what’s creating a pain point and then, you know, getting, getting kind of traction with initiatives to change things in a, in a cohesive way. So,

Alex Koloskus (29:26):

Yeah, that’s basically how we’ve made our most headway so far.

Chani Feldman (29:30):

Yeah. And we’ve been doing as far as coalitions, we are part of PDN coalition, which is, you know, one of the, you know, committees of home care association of America led by executive director, Vicky Hoke. She’s been hugely she’s a, also a huge passionate advocate for home care and has you know, enabled PDN providers to work together on you know, just advocating for our medically fragile population. So our work you know, as part of that coalition has been terrific, but yeah, we’re I, I love receiving emails and phone calls from, you know, from, from providers and from families who, you know, want to make a difference, wanna make some noise on social media. I mean, because, you know, as Alex said you know, for a couple of years I worked trying to advocate through CMS and HHS. It’s, it’s, it’s hard to, to gain any traction there. So it would need to be a piece of legislation that we could get past to make those changes.

Erin Vallier (30:42):

Yeah. Sounds like an uphill battle, but if there’s some outlets that people can get in involved in coalition started the, the, like the state agency, like the home care associations or whatever to get involved definitely some homework for people listening to this podcasts when you guys do a lot for the industry and it’s it’s is really cool. And I know that you offer some really interesting service like programs for your, your patients. And I think that there’s at least one of ’em for sure that, that our listeners would benefit from hearing about can you describe the relative caregiver program concept and what initiative you guys are involved in at MGA?

Alex Koloskus (31:25):

Sure. So I, I, I kind of take this question sometimes by default because when I was at the department of healthcare policy and financing, Colorado is one of the states that, that has really been had this program up and running, or this allowance of relative caregivers for quite some time. So kind, kind of leading, I would say the country, at least in the Medicaid space on that front. But generally the, the relative caregiver concept is it’s, it’s just a service delivery model. It’s kind of divided into two steps in my mind, but, you know, essentially it’s, we are acknowledging that parents are already providing some level of skilled care in the home to Hanny’s point earlier, you know, when clients are discharged, when children are discharged from the hospital, the parents are given instructions on how to care for their vent and their trach, and how to do a lot of this skilled care that requires some significant, some sign training and practice they’re, they’re required to do that on their own.

Alex Koloskus (32:28):

So we already know that they’re doing it, that they’re being trained to, and they’re, they’re shouldering this responsibility. So the model is let’s allow them to become let’s advocate to allow them to be licensed as certified nurse aids or licensed health aids, whatever the license is in the applicable state to get them that regulated cohesive training, make sure that they’re undergoing all the same trainings that a certified nurse aid coming in to provide the care would, and then once their license trained, certified and kind of supervised overseen by those regulations. The second part of it is allow changing whatever reimbursement rules there are, are working with a payer a private payer to allow those parents who are, are now licensed caregivers to be reimbursed the regular certified nurse aid rate that they would pay a nonrelative to provide

Alex Koloskus (33:28):

So that’s kind of, that’s kind of the concept in a nutshell, and it it’s a little bit that would encompass, I guess, both consumer directed models and not so Colorado’s is actually a fee for service model that, you know, is just their home health benefit and they pay CNAs to provide skilled care. There’s no prohibition from that CNA being a parent, and that’s kind of how Colorado left it. So that that’s been one option there’s consumer directed, and there’s a lot of different ways in which this plays out, depending on the regulatory framework or the payer, or what’s kind of happening in the state, but that’s, that’s, that’s one, one kind of fee for service model is where we’ve, I would say got, gotten our feet wet is we have a heavy footprint in Colorado, a of our families. We have, we have a lot of relative caregivers relative CNAs here. And then in Arizona, we ran some legislation a couple years ago, and then some cleanup reg legislation recently to get a similar program kicked off there, which is hopefully gonna be actually, you know, walking here with legs soon. They received approval from CMS and we’re kind of working with the, the state Medicaid agency and licensure down there to get, to get this off the ground.

Erin Vallier (34:50):

That’s really cool. And like speaking from like a consumer standpoint, I had an employee who actually took advantage of this particular program at she, there would be no other way that she would’ve been able to like have care given to her kid, or even like function as a single mom, if she didn’t have the opportunity to have these funds, you know, for providing that care and then upskill to take care of her medically fragile child. So it’s a, it’s a really cool program, but made a couple comments that makes me believe that this may not be something that is universally accepted across the state. So does it exist everywhere? And if not, where can people find out about it or how can agencies get involved? Like talk to me about this program. It seems,

Alex Koloskus (35:42):


Erin Vallier (35:42):

It seems like a good one for the industry.

Alex Koloskus (35:45):

Sure. No, it’s been great for, you know, it’s, it’s got a lot of benefits. It basically it gets parent, it gets parents acknowledged for doing care that’s above and beyond way above and beyond what we, what we cons consider normal parental duties. I mean, these, the, these types of tasks are something that payers would be paying a licensed person to conduct if it wasn’t being performed by that parent. So acknowledging that parent’s capabilities, train them, kind of have that already existing discipline of provider, be able to take some of the, the brunt of, you know, the care that we need delivered in this nursing shortage. I is a great service delivery model and a great cost savings and a safe way to, to kind of get the right level of in the home. When, when we’re in the middle of a public health crisis, especially, but yes, not a lot of states, you know, have something fully up and running.

Alex Koloskus (36:48):

We have the program in Arizona’s is almost there in Colorado. And then we have a bill going forward in Florida right now. There’s a pilot program in Missouri there’s legislation in Maine. So we’re really gaining traction nationally mostly by bills, mostly by the legislative efforts, but there’s been some cases you know, in Virginia, their state Medicaid agency kind of undertook it themselves. I believe if to study this to kind of a feasibility study and see what it would look like. So depending on the state, there might be something already underway or not, but we’re definitely, we’re definitely doing our best to kind of bring this to the states that MGA is already providing care in and just to the country at large. So we’re super passionate about it.

Erin Vallier (37:42):

That’s really exciting. And Chani being a nurse, I don’t know if, you know, like if, if there is additional benefit, I’m assuming there would be of having like a family caregiver versus a stranger caregiver for a especially fragile child. Is there any data like that, that you guys have collected to support this?

Chani Feldman (38:02):

There, there is. I, I would say there is unsubstantiated data currently floating around in the industry that there is a lower hospitalization rate for kids receiving services through a relative caregiver. But it’s, you know, it’s not published, it’s not peer reviewed or anything like that. I would say that it is a really tough labor market right now in healthcare mm-hmm , and it’s really tough getting nurses. And it is when a relative caregiver is providing that care. They don’t call off they show up to work and you don’t have the same kind of struggles with client satisfaction that you do sometimes when a stranger comes into the home. We we’ve seen when the, a child receives, you know, care that’s, you know, typically delivered through, you know, an R or LPN in combination with relative caregivers kind of filling in those tough to staff hours.

Chani Feldman (39:08):

It is, it, it, it, it really, really is, is, is such a great model of you know, of care and good outcomes. And like I mentioned, you know, patient satisfaction, it just, it just works. And it’s it’s really a good tool in the toolbox. It’s not you know, in conversations that we’ve had, it’s not like we’re saying we wanna get rid of private duty nursing. No, at all, , there’s a place for that. Not every family not every patient, it’s not gonna work, you know, for every single patient to have either all of their care delivered through relative caregiver or even some, you know, mm-hmm, , it’s not, everybody’s not everybody’s appropriate for that type of service. So when it can be used in conjunction, you know, again, one of these tools in a toolbox, you can have a complete, full set of tools to provide care, to keep kids at home safely. And you know, out of the hospitals, it’s just a win-win.

Erin Vallier (40:12):

Yeah. It seems like it would be solve a whole lot of it issues like lessen the, the shortage of nurses, for sure. Which you brings me to a question that I wanna ask you, but gosh, time is flown by. I, I only have time for one quick more question. Maybe one and a half since you, you brought up the nursing shortage yourself, I am imagining that pediatrics has been in impacted just with the same severity as personal care in adult, you know, an elderly home health. Do you, what have you been doing? There’s actually, there’s one and a half questions. What have you guys been doing to combat that? Do you have any like good ideas for people who are also experie the same pain that you’re willing to share? And I’m sure that folks listening to this podcast will be interested in getting involved in some of these advocacy programs or things that you’ve got going on. And I, I want you to tell ’em how to get in touch with you before we say goodbye.

Chani Feldman (41:17):

I’ll say that, you know, like I had mentioned in the beginning, I did not know about home care. And so when I say when I, I, I had a conversation once with governor and he, he, he basically, when I started to give him the quick pitch of what home care was, he said, oh yeah, yeah, I, I know what it is, or I know what private duty nursing services, you know, and I was very respectful, but I wanted to say, no, you don’t, I didn’t even know what it was when I worked in the NICU. So we have to do a better job at educating nursing students about an actual career home care. There’s about a quarter of a semester. That’s devoted. I have a daughter who’s in nursing school right now. And, you know, I looked, I have like obsessed with looking at her curriculum and it’s like a quarter of a semester if maybe even an eighth and it’s like barely touches on it.

Chani Feldman (42:06):

So we have to do a better job at educating nursing students. Home care is a viable option. People wanna receive care in the home. A pandemic has certainly shifted that move towards receiving care at home. It’s a real option it’s fulfilling. It’s incredible. We have to figure out a way to, to, to introduce home care as an option earlier and, you know, to, to, that can possibly help with the, the workforce. And we just need to be more creative and not even more creative. We have to ensure that licensed professionals are working to the top of their license. And so just like we talked about the relative caregiver program, we’ve gotta start making some, you know, real tough decisions, but clinically sound decisions on delegating care utilizing CNAs and home health aids, you know, even outside of a relative caregiver situation, but looking to, to delegate care. And because that workforce is so limited and, and we are just gonna have to use technology and telehealth in ways that hasn’t been done before and, and come up with, with new models of care and, you know, at MGA, we’re, you know, we talk to payers about that. We talk to policy makers about that. We’re trying to be creative because we’re limited. And so we have to, we have to, you know, do the best with what we have right now.

Erin Vallier (43:33):

And there’s so much to unpack in that answer that you gave, maybe we need to do, like, you know, a, take two on this or part two on this Alex, do you have anything you wanna add here?

Alex Koloskus (43:46):

No, I’d love to do a, take two. Now that I’ve done a take one, like already ready for my next podcast, but I, I think Chani mentioned it or earlier, but in terms of getting involved, it’s, it is kind of a nebulous, like how do you get in there as a parent or as a provider. But I think on the provider side, it’s a lot easier to kind of band together. We’re all providing services together and we speak, but on the parent front, if there’s any family listeners, I would say, you know, those, those get in involved with your local community, the other parents I know there’s tons of forums for that social media and otherwise, but get vocal, get loud because you are the best advocate for your care. And that means coverage. That means getting rid of these administrative burdens, whatever it is, that’s impeding barriers to bedside as Ashan says. But yeah, I think when parents get loud and families get involved, payers, listen, and regulators listen, and obviously providers listen. So I, I think that’s the best way we can effect rate change.

Erin Vallier (44:49):

Awesome. So for the listeners get involved at, with your state associations with any of these other entities that will advocate, but just be loud and don’t stop talking cuz we got some work to do. That’s my key takeaway from this conversation and it’s been, it’s been lovely. There’s so much more I wanna talk about. So possibly we’ll have a, a part two to this but real quickly how can people find you? Is, is LinkedIn a good place or how, and if they have any questions about how they can get involved with some of these initiatives you got going

Chani Feldman (45:29):

On. Yeah, definitely. Linkedin, that would be great. MGA,, but yeah, LinkedIn and email or call. It’s just, as I said before, I love to hear from families. I love to hear from providers. The more voices we have as Alex said, the latter will be, we are, we are gonna move. We are going to make changes. We are making change. As we’re seeing progress. We have a lot more to do.

Erin Vallier (45:55):

Mm-Hmm awesome. Well, it’s been a pleasure ladies.

Alex Koloskus (45:58):


Chani Feldman (45:59):

Thanks. It’s been great.

Alex Koloskus (46:01):

Thank you for having us

Jeff Howell (46:04):

Home health 360 is presented by a lie care. First off I wanna thank our amazing guests and listeners to get more episodes. You can go to a like health 360 that’s spelled home health 360 or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on apple podcasts, Spotify, or wherever you get your podcast. We also have a newsletter you can sign up for on health 360 to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening. And we’ll see you next time.

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Episode Description

Children’s needs differ to adults when it comes to home care, yet regulations for adult home care are the same for pediatrics. The pediatric home care space is expanding and undergoing their own challenges amid the pandemic. To talk about the challenges and growth opportunities in pediatric home care, we are joined by guests Chani Feldman, Chief Clinical and Government Affairs Officer and Alexandra Koloskus Chief Compliance Officer at MGA Homecare.

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