Thomas R. Ferry is president and CEO of Curaspan Health Group of Newton, MA.
Tell me about yourself and the company.
You’ve probably heard this before, but I think we’re a very unique company and do something that no one else does. At a high level, we try to solve problems and not sell solutions. We look for really simple problems that can provide some value to our clients and build on that incrementally.
We’ve been connecting providers to share information electronically since 1999. We do it across a platform that we call Synchronized Patient Management that has multiple uses across many related organizations. Since 1999, we’ve grown to about 4,400 providers in 41 states and continue to see good growth throughout the year and good adoption of our technology.
Since you didn’t dwell on your own biography, I’ll throw something out there. You went to Harvard Business School. What did that teach you that you use every day?
I think the interactions that we get in a classroom and talking to people from a variety of different backgrounds really gives you a broad and good perspective on different approaches to solving gnarly problems. I think you can put that in your toolset to be able to address different situations as they arise.
I’m sure you spend a fair amount of time there analyzing business processes and figuring out where the bottlenecks are. Curaspan is heavily involved with the discharge process, which seems so simple to people outside of healthcare, but those of us on the inside know what a disaster it is. What’s wrong with the discharge process and what’s changing with new expectations as far as how discharges work?
I’m glad you asked that question. That was favorite course and probably the most useful out of HBS. I really enjoyed looking at bottlenecks and driving efficiency.
When you look at the discharge process, the tools that are utilized are paper, phone, and fax when there’s technology readily available. It really detracts from those valuable resources to clinicians that are supposed to provide counseling and support the patient in their choices and direct them to the right resources. When they’re consumed with redundant administrative tasks in pushing paper around, they can’t spend that time in that more value-added situation.
We’ve identified workflow automation tools and a communication platform to eliminate those redundancies and put more time in the hands of the clinicians so they can do what they were trained to do, which is providing that clinical information and that direction to the patient and family.
What will organizations look for now the discharges and readmissions are becoming more important?
I think everyone is looking for more information to make better decisions. When you provide tools to your organization in order to share clinical information and to see the interactions between the different parties that are communicating over a patient, where they should be treated, and seeing how that interaction and relationship works, that data can help drive best practices. That data can be utilized to make better decisions in the moment.
We continue to aggregate that information and provide it in a useful manner so that people can make better decisions at the time of intervention, at the moments of working with that patient and making those critical decisions on what treatment should take place and ultimately where that patient should end up.
A free market requires free information. Both sides win on a referral from a hospital to a skilled nursing facility. Hospitals need to move the patient out, skilled nursing needs to move the patient in. It sounds like what you’re doing is just making the information available so that they can connect with each other.
That’s exactly right. That’s the underlying premise to our organization as a whole. We look for those interactions, those transactions between disparate parties and where they need to share information for a better outcome. When you find that there’s not efficiency — there’s paper, phone ,and fax around that interaction — by driving the efficiency, by driving utility to those users, you’re going to provide the data that allows them to behave in a better relationship.
Historically, the hospitals didn’t trust their post-acute care provider partners and the post-acute care providers didn’t trust the hospitals because of the absence of the information on how that interaction worked. By providing the data on the types of referrals that are being sent out, the types of patients that are available, and then ultimately understanding the outcomes of when that patient gets placed and ultimately where they end up – hopefully not in the readmission – that begins to built trust among those two disparate organizations and allows them to behave in a more equitable manner. That’s what we try and do.
We’ve expanded that capability, driven predominantly by our customers, into the case management department. Now we’re driving a better communication and interaction between hospitals and the insurance companies. In particular, we have a pilot going on with Amerigroup and some of our hospitals.
When you look at the function of concurrent review, it has very similar characteristics to the discharge planning function. Again, paper, phone,and fax; a lot of clinical information; and inherent mistrust between the hospital or acute care setting and the payer setting. By allowing them to communicate electronically in more real time, you’re driving efficiency within the hospital setting and you’re getting better response time and intervention from the payer, because they’re getting information — time of admission, the necessary clinical information, discharge summary — all in real time. They want to have a better relationship with that organization. They have more of a willingness to interact in a more equitable manner.
There are companies that offer products to help schedule schedule available community-based practice appointments for ED patients. The underlying message seems to be that the healthcare system has more capacity than it seems, it’s just not visible and therefore not used. The key for both examples is building a network to connect those parties. Do you see yourself as being in that network-building business?
Absolutely. You have 20-30% of patients that are high-risk patients, and so those community case management tools that can address that patient population is something that we’re looking to build upon. We are exploring opportunities because there are some interesting companies out there that have some interesting tools that can allow you to address that issue without pouring in too much human resources and using and leveraging technology to a certain extent. We look at that as an extension upon the foundation that we’ve started to build.
What’s your sense of how diligent hospitals are about evaluating skilled nursing facilities that could accept their referrals for on such criteria as, “Are we going to get that patient back as a readmission?” or “Are we going to transfer someone to a place where they’re going to be very unhappy and it’s going reflect back on us negatively?”
In the absence of technology and the data on how your community providers are behaving, if you don’t have the technology in place and you can’t quickly review whether they’re contributing to your higher readmission rate, then it’s hard to make good decisions and assess whether they’re good community partners.
Our clients have used that information. They run monthly scorecards on the performance of their post-acute care community and run quarterly meetings to share that information with them and set certain expectations, goals, and guidelines. It only enhances that relationship, and ultimately it leads to better clinical outcomes. They can highlight those outliers that are not participating at appropriate level. To your earlier comment about free-market society, those that don’t perform at a certain level ultimately won’t be in business, and probably shouldn’t be in business.
Other than hospitals doing it inefficiently and manually, do you see yourself as having competition?
You’re always worried about when you have a good idea and success that people are going to come into the marketplace We’re always diligently looking at potential competition.
Our current and biggest competition is complacency and doing nothing. There’s always the challenge that CIOs and the decision-makers are looking for the big ideas to boil the ocean and solve every problem because it’s new and sexy. Unfortunately, those tend to take away a lot of resources from the executable ideas.
We’re out there trying to continue to convince people. Start incrementally. Go for the low-hanging fruit. Solve some problems. Get credibility. Drive some good, positive financial outcomes. Then incrementally build off that platform. That’s our biggest competition.
Even for those hospitals that haven’t figured out how important transfers out are, it’s been called out specifically for them in various forms. Are you getting a lot more calls now that readmissions are what everybody is looking at?
Definitely. It’s moved up the rank of priorities. When you think about building an accountable care organization or if you’re going to participate in a bundled payment pilot, you have to understand the outcomes in the post-acute care community. The patients that you’re trying to manage are going to be placed out into those community resources. You need the insight and transparency into what’s taking place within that organization and what the outcomes are going to be.
Unless you’re connected and have the access to that information, you really can’t participate in either one of those models. We provide that platform access and information to better manage one of those types of new potential models.
Hospitals used to get paid for readmissions, so the people in the hospital who cared about them were worried only about overall bed capacity. Now there’s a direct financial hit for readmissions. That should have got other hospital departments interested.
I would agree with that, but it’s also interesting in that in some markets you have over-capacity on the acute care side. They’d rather take a reduced reimbursement just to fill up the bed…
Wow. That’s your Harvard Business School again, looking at marginal revenue versus marginal cost and figuring that readmissions can be profitable even if there’s a penalty involved. Like yield management on Southwest Airlines, where filling a seat with a low fare is better than flying with an empty seat.
You got it. I hate to say it, but unfortunately the way our healthcare exists today, it still supports it. Those models are not good for the long term, but there are still organizations that think that way.
Give me a couple of examples of how customers are using DischargeCentral and what benefits they’ve seen.
The most obvious, and the one that you initially focused on, was from a throughput standpoint. If you start to hit your geometric length of stay, ultimately you add more capacity to the hospital. In many cases, we’ve seen up to 30% of additional capacity. If you’ve got the patient flow, that’s going to be increased revenue.
From a readmissions standpoint, our hospitals can identify the pain points in readmission, whether it’s internally the staff doing incorrect assessments and sending them to the wrong level of care, or community providers that are unable to handle certain types of patients. By zeroing in on those root causes, they’re able to help solve those problems and reduce their readmissions rather significantly.
We also have found that organizations are starting to leverage downstream assets and acquire skilled nursing facilities, LTACs, rehabs, home care agencies. Outcomes tend to be better when a patient stays within a particular care setting because of the better handoff of information and physicians can follow that patient through the system. Our hospitals have been able to use the technology to, while offering choice, keep patients within their own networks.
And then of course there’s still a nursing shortage. Hospitals are continuing to look for clinicians. If we’re able to give their staff more time to do what they were trained to do and less time doing the administrative tasks, they can reallocate staff into more productive and fulfilling areas.
You’re doing what a lot of companies have done, starting as somewhat of a niche offering and then rounding that out with content and other services, in your case such as providing a patient transport applications. What will your emphasis be over the next five years?
As I mentioned earlier, we’ve expanded in bringing payers online to communicate with our acute care hospitals. Our payer organizations have expressed strong interest in starting to communicate with our post-acute care providers as well, so providing a connected platform. We’ll leverage the information that we’re able to collect on the patient to be able to share through various conduits with their primary care physician as well.
We’ll also look to expand in the areas that you were talking about, from not only a community case management standpoint, but also from a consumer – I wouldn’t say consumer is the right word, but maybe the overall caregiver – and provide the tools and resources and content that we’ve developed for the professional organizations. We would make those resources available for the caregiver as well.
Any final thoughts?
As we talk to various professionals in the industry, they don’t necessarily look for best in breed. They don’t necessarily look for simple, executable solutions. They tend to look for the much broader ideas — the EMRs, the HIEs – that will solve every problem. It’s refreshing to hear someone ask more penetrating questions and more detailed questions about solutions that can be executed upon and then create a platform that you can continue to grow and expand and deliver value. I appreciate that.