Some entrepreneurs struggle to develop a vision for a product or service that will launch their company toward success. Whether their goal is market domination, providing themselves a secure income, or eventually selling the business and starting another one, developing and following a business plan becomes the center of their life.
Other entrepreneurs get a business going only to have a hard left turn imposed on them by unforeseeable events. Whether that interruption in their plan leads to an opportunity or disaster depends on how they react to it.
Neil Tantingco is in the latter category. The founder and CEO of Connected Home Living, a Silicon Valley company that provides remote patient monitoring services to home health providers and hospital systems, did not start out with either that mission or even that company name. He started out with one Assisted Living Facility in Visalia, California. Then, he told us, the unexpected happened.
"I wanted to give telehealth a try, just to collect vital signs on our residents from time to time," he began. "Soon we began to share those measurements with their physicians and, once in a while, physicians would modify a treatment plan here or there. Before long, we noticed that we were experiencing fewer moveouts, which led to a waiting list to get into our facility."
Tantingco was not sure if this reduction in his ALF's moveout rate was a factor of increased patient satisfaction due to the telehealth services or if the telehealth-enhanced physician involvement was delaying their need to move from Assisted Living to a higher level of care in another institution. Not knowing, however, did not stop him from jumping on the opportunity.
"We started caring for people on our waiting list in their homes until we had room for them," he continued. "Before you know it, we had a full private duty home care agency. So we began a remote monitoring program with those people in order to keep our hours and costs down. We supplemented the taking of vital signs with reminders via video visits, placed by people on our ALF staff. Almost right away, we noticed that people who had not been especially compliant between visits were suddenly staying true to their diets, their exercise routines, and their medication regimens."
A kind of cooperation began to develop between the ALF staff, who were monitoring telehealth data and talking to patients on video, and the patients' professional healthcare providers, either home health nurses or primary care physicians or both. "If a patient's vitals fall outside the range their physician had established," Tantingco said, "we call the patient to make sure the reading is accurate, then we call home health nurse."
The hard left turn
And then it happened. The owner of Wilshire Home Health in San Luis Obispo saw what was happening and asked Tantingco if she could pay him for this coordination service, "to be our extra eyes and ears." "I had never thought of that business model," Tantingco laughs, "but I thought, why not?"
First, though, he had to ask Tricia Ritchie why she did not want to just do the same thing with the home telehealth equipment Wilshire already owned. Her answer taught him a new term.
"She told me that time restraints were making it difficult for her nurses to stop and look at the telehealth data," he told us. "They felt bombarded by too much data too frequently — she called it "alert fatigue" — and did not have the time to stop and assess whether the data called for an unanticipated intervention or might be a false positive. She said they get a lot of false positives from their in-home monitors. Her nurses were telling her they 'just wanted someone to tell them when their patient is about to go sideways;' and they did not want to learn 'yet another app' or 'yet another tool.'"
Thus was born Connected Home Living. Those ALF staff members who had been making video calls to patients became "Remote Care Coordinators." Communication was formalized between them and Wilshire's nurses. They relayed patient conditions back and forth between them and to patients' primary care physicians. Quality of care improved dramatically.
Then word of mouth kicked in. It did not hurt that Wilshire CEO Tricia Ritchie is active in CAHSAH, the California Association for Healthcare Services at Home, currently serving as Chairperson. Without hiring a single sales person, CHL started to take on more and more HHAs as clients, first nearby in the Bay Area, then in a widening circle that extended from Sacramento to the Mojave Desert.
"Each HHA client gets home telehealth services and a dedicated Remote Care Coordinator," Tantingco explained. "Telehealth data and patient video conversations triage each event so that nurses are only alerted when their skills are needed. The workflow we proved with Wilshire now serves nearly 600 patients, mostly your typical home health patient in their late 70's and above with one or more chronic conditions."
From HHAs to hospitals
In April, 2016, CHL went "out of stealth mode," Tantingco continued, bringing his story up to date. "This was still before we brought on our first sales rep but we were signing one new HHA per month and had sufficient data to demonstrate a 1.77% hospital readmission rate among our monitored patients."
The event that precipitated the decision that this was a viable new business with a valuable mission was winning a contract with nearby El Camino hospital. "They were looking for ways to add efficiencies to their bundled payment program," he said, "that went beyond telehealth equipment and other tools to a system for using them. We identified the hospital's own patients that were already under our care and prepared a presentation that included their specific outcomes and readmission rates."
What sealed the deal was what sales people dread, the live demo. Tantingco and company pulled off a live video visit, during the demonstration, with a discharged El Camino patient in his home. "They chose us and we started in December with stage 3 and 4 COPD patients, expanding to CHF and pneumonia when that worked well. Now they are ready to expand our service beyond BPCI and into all departments. We have found that their hospitalists like getting only pertinent telehealth data only when a case rises to the MD level."
Getting to 1.77%
In addition to remote patient monitoring and assigning Remote Care Coordinators, Tantingco cites services that free up nurses' time as one of the reasons HHAs are gravitating toward CHL. "There are what I call 'external factors' that, if ignored, could lead to readmissions," he told us. "For example, if a patient runs out of a medication and can no longer drive, somebody has to help refill that prescription. Often, there is a family member or friend available but, if not, you can't be tying up RN time for errands like that. So our coordinators make sure it gets done by someone at a more appropriate skill and salary level.
"Also, sometimes the patient just needs somebody to talk to. If you don't treat that isolation, over time it leads to depression, which leads back to the hospital. HHAs do not have the time or bandwidth to provide these services. So we do that too."
Connected Home Living is headquartered in Los Gatos, California.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org