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Episode 59

Predictions for home-based care in 2024 in North America with Adrian Schauer

Adrian Schauer 00:00
So I think it’s going to be a really amazing era now in terms of personalization of care. Just because the way the system is set up, it’s hard to find enough care management time to do that activity. I think we’re in for a real innovation in terms of how health care is delivered in these next decades.

Jeff Howell 00:29
Happy New Year everyone, and welcome back to Home Health 360, where we speak with leaders in home care and home health from across the globe. Every year, like your CEO and co-founder, Adrian Schauer publishes his top predictions in home base care. With over nine years of experience in the home base care industry, he and I care have been witnessed accountless trends, challenges and innovative changes all shaping and molding the industry and what we see today. For example, last year, it was anticipated that the industry was gearing up to manage repetitive tasks more efficiently With economic and resource constraints. We see the industry embracing the opportunity to achieve more with less through solutions such as Highly personalized care plans, the adoption of integrated care models and more. A few days ago, we published Adrian’s top predictions for twenty twenty four. You can find it on a lay of cares blog and it’s also linked in this episode’s description. So to dive in more deeply into those, I’m pleased to welcome our CEO, Adrian Schauer, from like and this special episode of home health 360 to hear more about his predictions for the future of home base care in North America for 2024.

Adrian, welcome to the show today. Great to be here. Just happy new year. Happy new year to you. So what did we see last year? And I’m gonna bring you through what your predictions were. From twenty twenty three, we’ve got the declaration of war on repetitive tasks, simplifying operations to become part of care delivery, offering continuous learning and growth opportunities. Number four was season a shifting model of care. And the number five was resisting the commoditization of our industry. Taking a look back, how do you think those predictions held up?

Adrian Schauer 02:17
my view on the operating context for twenty twenty three was pretty bang on. Most listeners to this in the industry will agree that we have covered in the rear view. But life is not easy. Marlins are compressed. There’s the labor shortages everywhere. So the theme of doing more with less, I think, was pretty accurate. From all the interactions I have with our customers and perspective customers, I can say the war on repetitive tasks was well timed because they’re really in this theme of how do I take Cost out of the business to make sure every possible dollar goes to the frontline care worker delivering care. That was absolutely where the industry was focused this past year. I stand by those.

Jeff Howell 03:03
I know of an agency. I love the quote that they gave. It’s like having another scheduler in the office and what I was really excited about was Really not AI, but, I’d say, the first version of what people come to think of AI or machine learning. That’s just simple automations and it’s process of Invoking some, if then, logic, so that people are actually doing a lot of their work based on rules, not necessarily on human judgment.

Adrian Schauer 03:30
Exactly, we see softwares role in this industry is taking away all the drudgery that goes with running in home care delivery. We want the people in your organization, whether they’re in the back office or clinical managers or frontline care workers, to be entirely focus on building relationships, making key decisions and getting the client and patient outcomes that they’re trying to get. And if you can express some piece of work that’s being done, as you say, is an if then statement, the human should not be doing that anymore. That’s up to the software to handle, to free up time, to do the really value added.

Jeff Howell 04:09
Yeah, love it scheduling by rules, not 100% by humans. So your first prediction for 2024 is the continued proliferation of AI and machine learning and healthcare, where you explain the different ways in which AI will continue to revolutionize the home based care industry, can you bring us through what you’re thinking is on that?

Adrian Schauer 04:30
Absolutely so. 2023 was the year that generative AI search at GPT style transformers, large language models, escape the lab and made their way into everyday consciousness and then also into business applications. So at our Better Outcomes conference in September, I unveiled Alaya Care’s virtual assistant. She’s named Layla. I’m very fond of her.

There are many problems she will solve for us and for our customers, and the exciting part about Layla is that she’s a large language model that you can interact with through our secure messaging interface. One big advantage of that is secure messaging lives in all our different touch points for all the different pursuements. So whether it’s in the back office or in the mobile app for a frontline care worker, or even in the client family portal, which can be used by the family or the entire circle of care, secure messaging is there and you can interact with Layla. And Layla has access not only to all the data that lives within our cloud so all the data relative to a client or the employee, or the schedule or the funding but you can also access the world of information and be fine tuned on specific clinical best practices Very exciting innovations.

Jeff Howell 05:48
Yeah, and I was there for that demo. It was super cool. So, if I’m going to try to take the layman’s view of this, what I saw you type in was hey, I need an update on patient X. So I’m actually a subscriber to chatGPT4. I think what the average person out there that thinks about these generative AI models is that you can type something into chatGPT and it basically has learned from about 10% of the internet and it stopped learning in 2021. So if you ask who won the Super Bowl last year, it’s going to have a really hard time, but there was a large pool of knowledge that it could learn from.

Whatever topic is that you’re searching for. It should be pretty good at summarizing it. Chatgpt4 allows you to feed new information. Hey, take a look at this PDF and read it and then compare it to this website. These are brand new pieces of information that it can go and digest. And so you’re saying that we’re going to be hitting that stage where there can be something that’s typed into an EMR as of yesterday and that these large language models can go and learn off that set of data in real time.

Adrian Schauer 06:55
Yeah, so there are a couple of aspects. Definitely, there’s what’s called retrieval, augmented generation and so the large language model has the capability to converse with you, understand your intention. And then let’s say I want to know what the latest blood pressure reading was for Mrs Smith. Layla can then actually call the API within AlayaCare and say hey, for Mrs Smith’s patient ID in AlayaCare is 12345, get me the last vital sign reading for Mrs Smith and then relay it back to you in natural language. There’s been a nuance between what the model knows and what the model can do. As you say, these modern models can know a lot, but then they can also take action, and so that’s what’s unique about Layla is that we’ve mapped the entire surface area of AlayaCare’s API, so all the interactions anyone could be having with the software, and we’ve made those accessible through a conversational interface, of course, bearing in mind roles and permissions and what I’m allowed to have.

Jeff Howell 08:02
Let’s dive into your second prediction out of the five for 2024, and that is that value-based care model, expanding and pushing data connectivity. What do you mean by that?

Adrian Schauer 08:12
AlayaCare operates in many markets, many jurisdictions. In this particular domain value-based care the US has been at the forefront. We see it in home health. We also see it increasingly in the personal care market, where a portion of the reimbursement is at risk based on attaining certain KPIs. We have both the Canadian healthcare system and the various jurisdictions and to a lesser extent in Australia you have the various payers, even if it’s a public health payer saying you know what we really wanna pay for a patient outcome, not just for an intervention like an hour of care. And so there are all these iterations to try and figure out. How do you measure and quantify what good care is? And then how do we pay more for that than care that doesn’t achieve the income?

Jeff Howell 09:01
And I can see how a tool like Leila could be a valuable asset in scanning any mr Taking a look at what does good care look like, maybe combining that with outside data like icd 10 codes. The whole world needs to move to a value based care model and having that predictive ability to see what patients might need more care, what patients might be in a good position. That’s probably the solution to making sure that the dollars are spent wisely, that the patients get the care that they need exactly.

Adrian Schauer 09:32
Value based care is really just a financial incentive around the theme of whole person care, so pretty well documented now that health outcomes are highly impacted by social determinants of care, right, it’s not just what is your disease and how is it progressing, it’s really how well is the whole person when struggling with diabetes and you try and only address the diabetes without considering where the person’s getting their food and can they prep it and can they have a healthy diet? You’re gonna miss a whole bunch of the values. It’s complex to integrate social determinants, to integrate data from upstream and downstream in the health system. Right, I’m delivering care to a patient in the home and they get readmitted to a hospital and then they come back into the home for care. Really, the care delivery system in general should be taking account of all that data. When you talk about Integrating data between health organizations and providers, how, that’s an essential part to get a value based care and whole person care. That’s really what’s essential.

Jeff Howell 10:36
Yeah, I don’t know if you could ever really go back and track it to this, but to me, when I hear social determinants of care, the number one thing that I think of as loneliness is probably ultimately the number one factor in hospitalizations. It’s just, that’s what it starts with and it leads to other things.

Adrian Schauer 10:53
That’s one of the reason home care is the model and the care setting of the future is because the more you can keep, especially seniors, more you can keep someone in an environment they’re comfortable with, close to their loved ones, the better the health outcomes are gonna be.

Jeff Howell 11:06
So your next prediction is care plans will become highly personalized. I would say that at best In today’s world, care plans are built around a condition and then maybe modified 10 to 20%, and it’s based on templates. That’s Mars have. What are your thoughts on how far are we gonna get this year on having data that creates very unique care plans for clients?

Adrian Schauer 11:33
This is the kind of problem that is ideal for AI and specifically for these large language models like air. At any given time, we’ve got over a million patients receiving care on our software, and so if you look at the whole set of data we have in the cloud, it’s 10s and hundreds of millions of interventions. All that were delivered in the context of a care plan, with a lot of knowledge about the condition of the client and with some insight into what the actual outcome of that care was. So you think of that data set and then you think of the task of hey, I’ve got a new admission, and who does this patient look alike? What has been tried, what is effective and really delivering a personalized care plan.

I just want to be clear we’re not replacing the role of the care coordinator. The nurse. Doing that admission is still a very human Job and there’s a lot that you get out of the human interaction with the client. But you can now substantiate that with data and with models that say, on average, if you apply these types of interventions, you’re more likely to achieve the patient goals that have been expressed in the context of everything we know about the patient. So I think it’s gonna be a really amazing era now in terms of personalization of care. Just because the way the system is set up, it’s hard to find enough care management time, do that activity without tools to help a case manager bring more fit.

Jeff Howell 13:01
Yeah, it’s the uberization of healthcare, where hospitals are really from an industrial era.

Adrian Schauer 13:07
Yeah, 100%. The get sick, then get tuned up, then go back until it doesn’t work anymore. That was built for a different era with a different set of tools. I think we’re in for a real innovation in terms of how healthcare is delivered in these next decades.

Jeff Howell 13:24
The older I get, the more movies that I thought used to be science fiction are becoming a lot more real, but this is all in a good way. Now, turning a focus to the Canadian home-based care market, the fourth prediction is Canada to evolve care models into integrated care models, so an increase in public and private sector partnerships. We chatted a bit about this in the past episode, where we spoke about Canadian provinces like Manitoba and Saskatchewan. Can you explain your prediction and how the Canadian market is forming a more collaborative care approach?

Adrian Schauer 13:54
That’s actually, one of the interesting benefits of a single payer market is that you don’t have the fractioning of care and fractioning of reimbursement that you get under some other models, where you might have one payer for your personal care and somebody else managing your clinical care, and is that a lifetime commitment to the patient, not necessarily in a privatized healthcare system?

So in Canada, in general it’s a single payer model, but in most provinces at least some portion of the care is delivered via public-private partner.

So what’s interesting there is that from a population health level, the payer right the regional or provincial health authority, can take a long view on the health of the patient and overall lifetime costs of healthcare and overall patient outcomes. But then the individual interventions are very often outsourced to the private sector, and so the opportunity is how do we align the service delivery with the long-term goals of the patient and how do we break down the silos that exist between nursing care, therapy care, personal care in the home setting and then also the care that patient might be receiving in other settings? Luckily, technology has come a very long way From day one. Alive Care was built with open APIs to interact with other entities in the health system, and it’s been a bit of a disappointment to see how slow the flow of data has been to catch up, but now we’re starting to have standards established and incentives put in place so that the data flows better.

Jeff Howell 15:33
Yeah, I love that thought because really, when you centralize the prescription for care and the standardization for care, but then the private sector, you can help to outsource the work because there’s not enough resources per se within the public sector, then the system is all working together as one.

Adrian Schauer 15:50
That’s it. You get some competition so that innovation flourishes and the best care provisions. Per dollar spent, you get the benefits of competition, but then you also have universal access. So I think there’s a lot of promise in this model?

Jeff Howell 16:06
Yeah, and it all starts with that centralization of pairs.

Adrian Schauer 16:09
And what you can’t have is a whole patient journey that’s digitized and then gets interrupted at a care transition by trying to put everything into a fax that goes out from one care setting to another. So it’s really about getting that structured data flowing properly.

Jeff Howell 16:25
Yep, that makes so much sense. The last prediction focuses on the home infusion industry in North America, where you predict that there’ll be an amplified collaboration with infusion nursing agencies and home infusion specialty pharmacies. What do you mean by that?

Adrian Schauer 16:41
Yeah, this model has existed for a long time, where the specialty pharma will be responsible for getting the particular molecule infused, but then, because they won’t necessarily have full geographic coverage everywhere, they’ll outsource the nursing to subcontracted agencies. Now, what’s different about 2023, leading into 2024, is the Cures Act has now hit the skilled home-based care industry, and so I need an electronic visit verification to get paid for my intervention. But if I’m the billing entity, I’m the specialty pharma, only my care is being delivered by a subcontracted agency. How do I capture that EVV punch? How do I get that data back upstream, et cetera, et cetera.

The non-digitized or semi-digitized version of emailing out a case to be taken care of that just doesn’t work anymore. There’s a regulatory push. There’s also a benefit in efficiency and patient care, but this is where we’ve used our Liya Market product to really pitch together the specialty pharma and the subcontracted nursing agency to make sure the referrals can go out, get accepted, the care can be delivered, the documentation can happen at the point of care and then everything flows back upstream so that the revenue cycle works well.

Jeff Howell 18:08
So there’s still agencies say I’m a specialty pharma, I’ve got a client that needs chemotherapy delivered at home. I do my piece and I would send you an email referral. You would have an infusion nurse, go deliver the chemotherapy and clock in and clock out with a paper or time sheet and the Cures Act. It means that you have to have electronic visit verification. So now that nurse has to have a mobile app to be able to punch in and punch out of that visit. I need that data back from you so it makes sense for us to just be on the same platform. Then I can send the referral to you electronically and I can have visibility into all the charting and I can see when people are clocking in and clocking out. And then this ally market concept allows me, as the let’s say the vendor in this case, I can have multiple agencies that can pick up these caseloads from time to time. So it’s an efficient and competitive market. In that sense. Did I nail everything?

Adrian Schauer 19:05
there you got it. Excellent summary. That should be me interviewing you.

Jeff Howell 19:10
Well, we’re almost up against our time, Adrian. I’ll get you out of here on a couple of questions. What are you most grateful for from 2023 and what are you most excited about for 2024? Thank you.

Adrian Schauer 19:20
Yeah, so 2023, it wasn’t the easiest year for tech companies out there. It’s kind of well publicized. The bubble burst when interest rates started rising and there was a real focus on tech companies getting back to, or getting to, profitability. It was a tough operating year on the tech side as well, but I’m incredibly grateful for our customers and how they’ve partnered with us to create value in their business and help us build a really sustainable 100-year business that we’re after. So that’s what I’m grateful for.

What I’m excited about in 2024 is everything getting a little bit easier, and that’s for our customers, but it’s for us as well. So there have been massive investments that have been made, both from the technology side in the market and then from us as a technology provider. I feel like 2024 is the year we’re going to start really reaping what we’ve seen and tools like Layla yes, we were able to put that out quite quickly based on the progress all these large language models have made, but we benefit from a nine-year investment in open APIs and the modern technology architecture, and so all of that’s coming together to deliver really massive value for our customers, and I’m really excited to see where that’s going to go.

Jeff Howell 20:36
Adrian, I was thinking the other day. One of your greatest skills is you have the ability to make everyone feel like everything’s going to be okay. It has been a tough few years for a lot of people and I agree with you. I think that hopefully this year things will be a little bit easier and I’m happy to have you as my first guest for 2024. I’m feeling pretty good about things and everyone out there. I wish you the best for 2024. And, adrienne, thanks for doing this today.

Adrian Schauer 20:58
Thank you, Happy New Year everyone.

Jeff Howell 21:05

Home Health 360 is presented by Alaya Care and hosted by Jeff Howell and Erin Valier. First, we want to thank our amazing guests and listeners. Second, our episodes air twice a month, so be sure to subscribe today so you don’t miss an episode.

Erin Vallier 21:16
Home Health 360 is presented by Alaya Care and hosted by Jeff Howell and Erin Valier. First, we want to thank our amazing guests and listeners. Second, our episodes air twice a month, so be sure to subscribe today so you don’t miss an episode.

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Podcast - Episode 59 - Landscape

Episode Description

Embark on a visionary journey with us as Adrian Schauer, the CEO of AlayaCare, introduces his 2024 top predictions for the future of home-based care in North America focusing on specific trends emerging in home health, home care, and home infusion in the US and Canada.  Listen as we unpack the promise of AI and machine learning, the ‘uberization’ effect that has paved the path for integrated care models, the revolutionary impact of open APIs and standardized data, and how the North American home infusion industry has adapted to regulatory tides. As these trends continue to gain momentum, they will redefine the dynamics of home-based care, creating a more efficient, personalized, and holistic healthcare system for all. 

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