Revolutionizing Home Care With Electronic Visit Verification Technology

Julian Hagmann, vice president of Caring Professionals, and Stephen Vaccaro, president of HHAeXchange, discuss how electronic visit verification technology can enable more patients to receive home care, reduce hospitalization readmission rates, combat loneliness, and provide operational efficiencies for providers. 

Please share a little about yourself. 

Hagmann: My name is Julian Hagmann, currently vice president of Caring Professionals. We're a large area home care provider in New York State. I've served in home care for over a decade and have been working with HHAeXchange almost as long. I'm very excited to be here.

Vaccaro: And I'm Steve Vaccaro, president of HHAeXchange. I've been with HHAeXchange for 8 years now, and I spend a lot of time working with our clients such as Julian and others in about 14 different states.

Why do many patients today not feel comfortable living in a nursing home? 

Hagmann: I speak to patients all the time regarding their hesitancy to join nursing homes. I think COVID-19 highlighted the risks of entering nursing homes when you are elderly and your immune system is weakened. But even before the pandemic, people wanted to stay with their family and their communities. Research suggests that staying in the community where you interact with friends and family will prolong your life rather than being entered into a nursing home where you may not have that familial or friend contact to keep you engaged. People choose to stay at home if it's an option and from the state and federal perspective, it's a huge saver. 

Vaccaro: From a societal standpoint, we have been moving away from facility-based care to more home and community-based care. A similar example is how emergency rooms were the standard until urgent care became popular. Right now day surgeries are also happening more and more outside of hospitals. I think home care is another phase of this and I fully agree with Julian's point on the financial impact. The reality is society can't afford to pay for nursing homes and most people cannot afford to be in nursing homes.

Even personally with my family, my parents want to stay in their home as long as they can because that's where they're comfortable. Being able to have a home care worker come into their home and help with the activities of daily life makes a big difference. Just because they're in their home doesn't mean that they're still self-sufficient. 

In what ways can home care enable more patients to receive care, reduce hospitalization readmission rates, and combat loneliness? 

Hagmann: Preventable hospitalizations are something that we look at daily. I'm not a clinician by any stretch of the imagination, so I don't want to overstep here, but I do work with my clinical team to prevent these hospitalizations from happening. At the end of the day, preventable hospitalizations are what's costing the state and federal government a lot of money. 

As an agency, we go above and beyond. We do extra nursing visits, and our care coordinators speak to everybody almost every day to maintain communication with their families and to make sure that that person isn't lonely. When somebody becomes lonely, they become distressed, and their mental acuity starts diminishing. So we want to ensure that they stay active and engaged every day of their lives so they can continue living in their home.

Vaccaro: I would also add that as electronic physical verification has come into place via the Federal Cures Act, a downstream benefit is that the industry is forced to change behaviors and establish an infrastructure that enables access to the caregiver in the home in real-time using mobile technology and other technologies that are available today.

We now can have observations coming from the home from that caregiver about social determinants of health and food insecurity. Caregivers can now note bruises or other concerns and can report that back to the agency which reports to the payer who communicates with the care team. 

We see real-life examples of this all the time. A caregiver shows up and there's snow and ice on the front porch and a patient needs to go to a doctor's appointment that day. Thanks to the caregiver, that's a risk that now can be addressed. We hear many other examples such as trip and fall hazards that are easily addressed because of having a caregiver in the home.

Could you share some background on Electronic Visit Verification technology from HHAeXchange and how it can fulfill patient care needs? 

Vaccaro: Our technology is a mobile app-based technology and we also have a telephone version of it for individuals who don't have access to mobile technology. When the caregiver gets to the home, they're able to check in and verify what time they arrived. The plan of care is always on hand and caregivers can communicate with the agency to document when tasks such as baths and meal preps are completed. At the end of the visit, they're able to check out. Mobile technology is also GPS for location accuracy as well. 

Hagmann: I’d like to walk through the history of home care: where it started, where we are now, and where HHAeXchange is taking this in the future. Think back to the '90s when there were no apps and instead, we were using paper time sheets. We had to depend on people to send their time sheets in, sheets got lost, and it was complete chaos.

HHAeXchange was the first software provider to offer a full suite of EVV services. That allowed us to start getting a 1,000-foot overview of a home care visit in real time. The adoption of the technology took a while, but I think we're fully there. Nowadays, we can use technology to ensure our caregivers are fulfilling the clinician-directed plans of care. And if our clinician needs to get involved, they easily can. 

Could you elaborate on how the Electronic Visit Verification platform can automate the collection of homecare service data, care plan information, changes in condition notes, and social determinants of health observations? 

Vaccaro: There are many benefits to the concept of Electronic Visit Verification. We don’t think of it just to check in and check out. The core value proposition of Electronic Visit Verification is access to the caregiver in the home in real-time and ensuring that the caregiver is an important part of the overall care team. The caregiver often knows the most about the patient because they spend the most time with them. They're with them more than doctors or nurses and sometimes even family members.
In the past, I'd say the caregiver has always been a little bit of an afterthought when considering care teams as a whole. With Electronic Visit Verification, now caregivers can notice behavior changes and gather information, including photos, to make actionable observations. 

How does this platform benefit payers, providers, and caregivers?

Vaccaro: Operational efficiency is improved for providers because they’re not dealing with paper time sheets and manual data entry. Also, payers now have more insight into visits. Research also suggests that this care model may increase job fulfillment for caregivers and retention. A benefit for payers is the ability to compare membership plans to visit data. They have the data to know if caregivers are fulfilling their duties and avoiding possible situations of fraud, waste, and abuse. 

Hagmann: Three main advantages for a provider in my mind are operational efficiencies, the ability to monitor compliance across the board in all aspects, and streamlined billing processes. Without those core pieces for a provider, they’re going to be lost in home care. 

Is there anything else you would like to add that we have not discussed?

Hagmann: I can talk about home care forever, but I'd just like to highlight the importance of the caregiver and HHAeXchange’s ability to adapt to the caregiver. When we first rolled out EVV and the app, adoption was 5%. We listened to our caregivers and brought it to HHAeXchange to share our struggles and adoption roadblocks. HHAeXchange takes the time to work with you to evaluate caregivers and pilot new programs. HHAeXchange is a great partner in worrying about the agency and the caregiver. 

Home healthcare is the biggest line item across the budget across most states and while there's a lot of money going into home care, I always feel that the home care worker is overshadowed. We need to elevate these individuals because what they do is much needed and beyond words. 

Vaccaro: I would also add that I've come to realize in this industry that when you speak to folks, many people don't understand or appreciate home care until they have a loved one impacted. We want to increase awareness about the value and importance of home care and the role of caregivers. If you spend some time with a caregiver on a visit, you see how difficult their job is and how professional they are. Shout out to caregivers for all the work they do each day, we appreciate it.