With a background on the provider side and nearly a decade of experience working on long-term and post-acute care initiatives for international technology provider PointClickCare, Travis Palmquist has a unique perspective on the intersection of health care and technology. Particularly as it relates to today’s post-acute care operators who face a rapidly changing payment landscape alongside huge strides in technology, Palmquist shares his thoughts in the following interview on the ideal clinical dashboard for today’s health care providers.
To start, what are the most important data points for an ideal skilled nursing clinical dashboard? What makes them important?
The actual data points are certainly a big part of it, then having that dashboard tailored to the specific user, such as the MD or nurse practitioner or floor nurse — that’s equally as important. Key data may include patient triage based on AI algorithms. That’s the big thing. If we’re going to have an impact on changing outcomes, early identification intervention is key in leveraging some of the new predictability capabilities we have with the data we’ve got in the system. This drives being able to predict things like falls and other big events that can lead to really negative outcomes and long, expensive
hospitalizations.
These are the things that we really want to leverage technology to get out in front of. You can’t go to a conference today without seeing value-based care as a key discussion topic. It’s one of the biggest sea changes I’ve seen in the 30 years I’ve been in the industry. It can be very positive and very good for our industry. Dating back even to late ‘90s, when we first started doing sub-acute care, [this was another shift to] better outcomes, more effectively, more efficiently and more cost effectively than the hospital.
Thirty years ago, [the hospital was providing care] for $1,500 a night, and we were doing it for $500 and we were driving better outcomes. I had a chance to testify in front of CMS a while back and I said, “don’t kill the golden goose.” These are providers that are really good at driving these outcomes and doing a good job.
Now, fast forward all these years later and with the opportunity to leverage technology, we can do an even better job. We are well positioned to deliver a lot of value, through metrics like hospitalizations, emergency department visits, and reducing other negative outcomes.
Not only should the clinical dashboard prioritize those metrics — because obviously the number one metric with value-based care is avoiding those hospitalizations — but also, it should enable very timely and effective and efficient intervention.
How does the ideal clinical dashboard drive patient care decisions?
The dashboard shouldn’t just display the data, but it should facilitate quick access to pertinent patient information for all. It should enable that care collaboration to take place and for the care team to make informed and timely decisions. The primary focus is on enabling the right actions to take place at the right time to avoid those negative outcomes, such as hospitalizations. The dashboard structure and even the data presentation should exist in the right place.
EMRs aren’t like one-trick ponies. You really have to design them around the persona. There are capabilities like practitioner workspace that really drive practitioner engagement. That needs to be within their workflow. If you’ve got a tool that predicts and identifies those 20 or 25 residents in any given facility that may be more at risk for a hospitalization, you place them right in front of that practitioner that’s taking on and managing that risk, and then you give them the tools, such as secure conversations that are HIPAA-compliant, and you avoid [what often becomes] an inefficient back and forth.
If you can enable things like secure conversations, getting away from using texts and other non-compliant messaging, you’re really doubling down on your effectiveness to get at the main goal. That’s, again, to get the right people in front of that resident, in front of what’s going on, whatever changes are needed, making the right interventions at the right time to drive the right outcome.
Could we talk about reimbursement and how the dashboard can optimize that?
The landscape is transitioning from fee-for-service to value-based care, and it is moving at rapid pace. I think there are predictors that say they want everybody in a plan by 2030. Some of the data [indicates] it could happen even faster than that.
If we’re going to really make sure that the providers that are playing a key role in driving the right outcome at the right cost and reward them for that, we’re [essentially] redirecting some of the funds that may have been spent on the acute care side, and making them available to those on the LT-PAC side, which we haven’t seen a lot of over the history of our health care reimbursement models.
It’s not going to show up as simply as seeing a rate increase. The providers need to position themselves to get on that journey and thrive in this new paradigm. A key to it, obviously, is avoiding hospitalizations and emergency department visits, and it really incentivizes people to do things like wellness checks and preventative health care and get out in front of small problems before they become big problems. The clinical dashboard should absolutely play a crucial role in aligning the care team’s efforts to
drive those better clinical outcomes.
Ultimately, that’s where the real savings will take place. Even around health care transitions, or as the market transitions into these value-based models, providers are now being rewarded for delivering better outcomes. I think that’s the way it should be. I think that’s why a lot of the data suggests that these models are really driving the desired outcomes.
What are your thoughts on how the clinical dashboard can improve efficiency around staffing?
As a former operator, I would love to say that we’ve got the silver bullet that can just save hours and hours and hours of nursing time. What we can do is provide technology that enables efficiency. Clinical dashboards can absolutely enhance efficiency.
How we’re doing that is by integrating with technologies that alleviate the administrative burden, including the amount of time involved in managing care transitions. We may not ultimately reduce the full-time employee count, but we can get at some of those costly aspects that can help overall performance and health of a skilled nursing facility or an assisted living community. We hear from the marketplace that the right technology can make a difference in recruitment. It can make the work more effective and efficient.
It’s interesting you mentioned the administrative burden. Who do you think in a skilled nursing organization should have access to the clinical dashboard?
Historically, the direct caregiver team in the community comprised those who needed access. I think increasingly, there are stakeholders outside the walls of that community that need to have access. I think we’re really starting to see movement, especially as you look at who’s driving value-based care and managing the risk where we need to enable that practitioner, and the pharmacist. Some of these individuals are outside the walls of that community, but yet play a key role in managing and collaborating in the overall care experience and driving the desired outcomes. We need to also give them
efficient access.
Whether it be the payer, the referral source or the hospital, having the confidence that they’re working with a partner that is driving the desired outcomes and having access to that information is becoming key. The connectivity to that greater health care ecosystem is an absolute differentiator.
Do you think there’ll be any pushback in terms of trying to democratize access in that way?
Not for the providers that understand what the opportunities are to evolve and thrive under some of these new reimbursement models. You need to have the right data, the right technology that enables the right data, and you need to have the information and the skills to go and negotiate for the right rates. The other part is you need to actually build really strong working relationships and leverage and enable those practitioners to manage risk effectively so that you can share in the savings. The rules are changing, the foundation is changing, and technology is really enabling that to happen.
How would you like to see the clinical dashboard integrated with predictive analytics tools?
I think we’re just scratching the surface on how we’re going to be able to leverage these large language models from an AI. It’s not a big secret. People can download a ChatGPT app on their phone. We’re seeing some of the earliest versions of things that we’re getting to market, whether it be a return-to-hospital predictor, or a falls predictor. I think you’ll see those use cases continue to grow and you’ll see additional things come to market.
One of the biggest things that I think we’ll see evolve over the next two to three years is a lot more of those predictive measures come to bear. You’ll see providers really orient their business around those and adjust to that and leverage that data to hone their craft and do better than what they’re even doing today.
What are some things that you think skilled nursing facilities could do to improve the collection of patient health data?
LTPAC is not flush with margin; it never has been. [The industry has] operated on some of the tightest margins in the entire health care ecosystem and they’ve done an incredible job with what they’ve had to work with. At some point, those that make decisions around reimbursement and funding need to recognize what resources they have, how good they are at delivering quality outcomes with a really high risk population and how they’re able to do that really cost effectively.
Then they need to think about how much better they could do if we propped them up and gave them the funding they need to really drive technological advancement in their facilities and communities. It’s really hard when you’re looking at the razor-thin margins that they’re forced to operate on. You look at some of the staffing challenges that they have. It’s hard to get your head above water and think about the future, especially when the money’s just not there to invest in it.
First and foremost, when I think about what we can do to help them improve the collection of patient health data, it is to get the funding needed and direct it toward investments that really can have an impact, and make a long-term difference in providers’ ability to deliver quality care at cost-effective rates. I would say in addition to that, it’s crucial to invest in advanced technologies — whether it be remote patient monitoring, capturing data passively or other ways that can drive efficiency.