Scaling Home Medical Services with Ananth Mohan and Chris Mate at ServiceNow Knowledge 2024

This is Techron tv. All right, folks, we are back at the ServiceNow Knowledge 2024 conference, and we're talking about healthcare and automation and how to bring all that stuff together. We have a Nath Maan, who's chief operating Officer for a Caring, and he's joined by Chris Mate, who's CIO for Aara Care.

And we're gonna talk about what it is these guys are doing in terms of advancing the state of healthcare using it. But let's just start with some simple stuff. I don't think a lot of people know who Larry Caring is, so walk us through exactly what you guys do.

Yeah, Thank you. LA Caring. We're a national home care provider, so we, we operate in 17 states and we provide care only in the home, uh, nursing therapy, social work, per care, attendance, um, and hospice folks that are, um, uh, end of life.

And so we, um, we do about a million visits a month in the home. Um, we have about 27,000 caregivers across the country. Um, they're out there by themselves in a car driving in to visit someone.

And, um, you know, just to, just to, if you think about the scale and, and the need here as we get into technology, um, the need is only growing. We have more seniors in this country, more folks aging. Uh, people want to stay at home, people want to get healthier at home.

That's where the care is needed. Um, we have a national shortage of caregivers. It's hard to find talent.

Um, it's hard to find clinical care, non-clinical care. And, um, those folks, they want to, they want to care. That's where they're in this business.

And so they want make the job easy. They want it to be flexible. They want the independence.

That's why they come to home care. They like that. Um, and they wanna spend their time doing that.

And so you've got a shortage and a, and a and a demand of talent to bring what they're used to in their consumer and their personal lives to their jobs. Which has been a theme here at Knowledge. Sounds like the name of the game is to keep people out of the hospital, right?

Yeah, It is. Um, and the world's getting more complex. You've got, you know, more complicated care, insurance, reimbursement documentation, paperwork, um, we want them to do more.

We want them to collect more information. We want them to intervene. So no shortage of demand either.

So there is this kinda imbalance in the system between supply and demand. So working out the scheduling, how hard could that be? Yeah, Yeah.

No, it's, it's, it's a great point. I think everybody's well aware, especially since Covid, I, you know, the lack of nurses we've had and, and, and it's an industry-wide problem, so it's not something you're gonna hire your way out of. So we're really focused on technology that actually creates capacity with the nurses.

We have. So industry statistics tell us nurses spend 40 to 45% of their time on logistics, on clinical documentation administration, right? They didn't go into school to do that.

They went into school to take care of patient. So a lot of the focus of our technology are things like bringing automation with ServiceNow's field services management to do logistical planning to, to a kind of, in an uber sense, match a caregiver with a patient, and then drive them the most optimal way to get from patient to patient. How did you land on the ServiceNow platform?

There's a lot of choices out there, and we're of course here at this conference, but what went into that decision? Yeah, You know what, when I, when I look at our different service lines, we had, I needed that wrapper kind of across the top that allowed us to function as one elara, even where we had different, uh, documentation and system requirements behind that, the integrated data model and the capabilities of ServiceNow. And as they started to expand their, you know, they're not just IT tickets, right?

They're doing things with hr, service delivery, and then we've been re really leaning into their healthcare life sciences module is a way to automate patient intake and then drive things like scheduling and things for our nurses to allow them to focus more of their day on taking care of patients. How do you measure the value of that investment? Because, um, is it about onboarding nurses faster?

Is it turn times? I mean, what's, what are the metrics you're using? It's, um, it's all of the above.

Um, so let's start with productivity of our caregivers. You know, Chris started, we started with ITSM, um, how much time they interact with the back office, how long it takes them to schedule, how quickly they can change their shifts, open shifts that are unfilled, can they sign up for that? Um, so we have, we have a number, you know, fill rate metrics, productivity metrics, um, missed hours, metrics, things like that, that make, make sure we're, we're maximizing the care we provide and we're minimizing the downtime of our folks.

So that's, that's sort of the middle, um, you know, that we start to measure. Um, then you get beyond that. Um, and so we're using field service management for that.

You get beyond that to the customer facing part with healthcare life sciences, we measure speed. How quickly we can say yes to a hospital that has a patient that's going to get discharged, needs home care, um, how quickly we can say definitively yes, how quickly we can get out there, how quickly we can process the documentation, work through insurance, make sure we get approval, make sure we, you know, we, we have the, the right to go see them as many times as they need. So, um, there, it's really about speed.

It's about conversion. It's about being able to say yes when you've got shortage and, uh, and when you can say no, being able to be transparent about and be predictable. 'cause at the end of the day, if you have a hospital or a patient, the worst thing in the world is for them to be waiting on care that they may or may not be able to receive.

So that's the front end. Um, and then finally, we didn't get the people, but you know, we're, we're leading into, um, HRSD as well. Um, and here it's employee experience.

So, so onboarding, hiring, retention, retention's a big challenge for us, as you can imagine. So, um, at the end of the day, you can, no matter how much you staff up your central services, 200 field offices, 27,000 caregivers, you'll never have enough HR folks to really support people the way they need. So, personalized experience, getting to the first answer, right?

Calling call center less. Um, back to being able to do their job. How did you land on the field service app for managing nurses?

Nurses? Because in my world, I would be like, there's a nurses app for this thing. I wouldn't have thought about it as a field service.

Yeah. When, when you really think, I mean, when you think of a field technician, right? At the end of the day, there's an appointment that that technician has to have the skills right?

To, to meet the need there. So what we've done is we, we, uh, profile our patients, we match their needs with the skill sets of our caregivers, right? And then it is literally a map where, where a caregiver can see, oh man, that's close to my home.

I want to provide care there. My skills match. I, I speak, it's, it's a Spanish speaking patient.

I speak Spanish. They have a big dog. I don't mind big dogs, right?

We have to look into things like that. 'cause when you're delivering care in the home, can't somebody send somebody who's allergic to a cat if the patient has three cats? So we do that matching, and then it's the same equation.

What we've done a little bit differently though, is in the technician world, you're generally having a back office schedule or drive. What we've tried to do is put more, um, into the hands of the aide or the caregiver so they can drive more of their schedule. One of the things we hear continually from caregivers at home Health, what they like is the autonomy they have in their schedule.

And so we're trying to provide tools to allow them to get to patients that work for them. If it was me and I was the caregiver, I'd wanna schedule that last appointment as close to my house as possible. Is that what Happens?

You can absolutely do that. And we see people move. I mean, people have families, they have kids, they have things going on with school.

They're able to adjust their lifestyle and move around as what suits them in many cases. And Do patients get attached to particular caregivers? And how do you manage that flow?

Because some people are specialists in different areas, but I like this one man, but that one doesn't have the skills. I mean, there's a lot of nuance in there. They Absolutely do.

Um, one of the things we pride ourselves on and we keep measuring is our NPS score. And, and we have an NPS of 93, which is sort of unheard of, right? Especially healthcare.

That is unheard of. It tells you, um, how how valuable that relationship in the home is. People really appreciate when you send someone into their home to care for them, it matters.

So they get attached. Um, and so when they get attached, how do you build inflexibility to this point of someone needs to take a day off, someone needs to adjust their schedule. Can you, can you tap somebody else to come in?

Um, can you, can you, um, provide a segue to say, someone's gonna call you while I'm away and provide remote care? So that bridge to telemedicine, if you're a senior, you may not want that, but you trust the person that's in your home to say, don't worry about it. When that phone call comes, take it, walk through it, they'll be with you and I'll be back on Tuesday to see you.

So being able to make changes, introduce virtual care in a way that they're comfortable with. Um, and sometimes they don't like their caregiver and they wanna make a change and make it that easy as well. We, we take care of some elder folks in my family and yes, you will take that call.

Very good. Yeah. Um, you cannot walk around this show without tripping over somebody talking about ai.

How do you think AI might get applied to all of this? I mean, what can we do? Yeah, I, I, I think there's a number of areas.

In some areas I look at it as more operational, right? How do we drive better pa uh, patient matching? How do we see trends?

Can we predict things like missed visits where the patient isn't gonna be home using AI that we can schedule around and, and work on. And then there's many, I will see many other, uh, I'll say more clinical applications. We see summarizations of, uh, documentation.

I'll come into us on the patient, but you, you get a 60 page referral document. We see AI being able to give us a crisp one page summary or two page summary to nurses to help them get up to speed quickly. And then we've got a number of areas where I think AI will greatly reduce the documentation burden, right?

By doing voice driven things that can pull in documents, uh, to allow us to complete assessments much more quicker. And the great thing with ServiceNow is connected platform. I can use their ai, but I can also connect out to specific, specific purpose clinical ais for parts that I need in the workflow.

So there's gonna be a lot of opportunity here. How hard is it to onboard somebody who's new, a new healthcare worker? I mean, it seems to me that that might have taken months before.

Is that coming down to like weeks and days? Um, It is. Uh, and it's, it's coming down to days, uh, now and, um, there's a standard, you know, making sure that the qualifications, certifications or different state regulations, you've gotta make sure in our, you know, or scale to understand what it means for someone to be able to, uh, go see a patient.

Um, but in today's environment, they want ease. I mean, in that, that, you know, that's part of the job interview process as well. How easy it is to, uh, get introduced, apply and onboard is a measure of where I, whether I wanna work there.

Um, if I come to home care, because I think it's going to be more flexible and autonomous as a nurse and I discover the onboarding process is terrible, I'm gonna change my mind. There's a lot of jobs out there. Does that go into your recruitment advertising?

You know, we got less overhead and paperwork than anybody else. We have to prove it along the way. Yeah, Well, and I think it definitely does word of mouth, right?

Yeah. We wanna be the kind of places where nurses can focus so much on the patient, right? Yeah.

And I, and I say this to CIOI think a good day for technology is when nobody notices there's technology, right? That's true. Because they're just able to focus on that.

Nurses will wanna stay and work at Elara Caring. 'cause we gotta let them spend the majority of their day doing what they went to school for. So you walked around the show, you're a ServiceNow customer.

Mm-Hmm. What's at the top of your wishlist from these guys? You know, I mean, you're gonna hear what I list.

What do you want them to do for I hope, Man, it is, it is a long list. Um, you know, we use so many of their workflows. I think their continued ability to integrate with outside systems and, you know, outside workflows is really important.

And then we, we, what we are seeing today is we're seeing this world where every product has a flavor of gen AI is how do we make those work together? Well, and we saw some demos of that today, so excited to see how that'll, how that'll come to fruit fruition in the future. Alright.

Top of your wishlist, not just for ServiceNow, but for him too. Yeah. Um, move faster.

We need it. We need it live. Um, I think the promise is real, but we've gotta put it to practice.

Um, at the end of the day, we are a, a human care driven organization. So that's the part where you need a human providing care physically in the home. Everything else we want to get rid of.

So, so for us, AI is about the back office interactions, all the nonclinical time that's spent. And the more seamless we make that the better off we'll be. Are you in the process of trying, or, I mean a lot of healthcare organizations, there's a lot of platforms and a lot of tools.

Are you trying to rationalize some of that a little bit? You know, there's definitely some rationalization in removing systems, but also service outlets us kind of obfuscate that, right? They may interact with four or five different systems in a workflow, but never have to leave ServiceNow during that time.

And so in some cases, we'll use both strategies, right? As CI fewer systems is always simpler, but in some cases where that can't be the case will use ser ServiceNow as kind of that wrapper to make it feel that way to our end user. One of the things that they talked about here at the show is they have a no code tool that lets end users go build applications, no help from it required.

Um, um, is that something you guys are interested in? Is that something you're excited about? Yeah, I, I definitely am, right?

I I I think the CIO of the future isn't so much a digital operator, but an orchestrator. So as we can put the digital tools as close to the front end of the business as we, as we safely can, that they're still robust, they're still secure, right? You we're not gonna let you get in trouble with it.

I am all for the more digital levers in the operator's hands for them to pull business changes day to day. Nobody likes to put in a request and wait for it to respond. So if they can respond on their own, yes, and at ServiceNow that's where they're headed.

But with, you know, just the feature you mentioned, you know, if, if HR needs to run a survey on a certain issue, it's certainly a lot quicker If they're talking to a chat bot, set up the survey and execute it, then go through an IT procurement process. We hear a lot about digital transformation and it's been hard in healthcare and a lot of times, um, you go to the doctor's office and digital transformation equals, you know, here's a tablet, fill out your thing again, and it's the same thing you filled out last week except it's on a tablet instead of paper. What does it take to kinda re-engineer the processes and kinda get in there and, and, and provide that level of, you know, moving beyond just putting a mobile front end on something?

Yeah. Um, you'd be amazed how many faxes we still get. Yeah.

Um, has to lead with experience. You know, the, the, the, I think, uh, the moment there's a disruption in the experience, the technology becomes secondary and then you find people just circumvented and say, it's not worth it. You've got physicians that are difficult to change.

You've got patients where you don't get a do over if you provide bad care. Um, you have caregivers that came into the business to care, and you have insurance companies that, you know, want massive amounts of data. So at the end of the day, um, if there's any point in that experience that fails, we end up with lack of adoption.

And it's, and it's too easy to kind of override and say clinical care comes first and then you just kinda end up with a lot of stuff on the shelf. So I think the, with ai, with the way ServiceNow is approaching things, if, if we can, we can be experienced first. We've got a real shot and we reiterate about it as well.

So don't wait for the big bang go along the way. In healthcare, there are these electronic record systems that are not particularly well known for being flexible, right? Um, how do you kind of make that front end and backend thing work together when those back ends are kind, really formatted?

Yeah. You know, you know, um, integration's always the biggest challenge in it. Some work better than others.

We continue to work on those, right? To make that as seamless as we can and pick the right spots. Change management with clinicians is always a challenge.

They, they like to move by consensus and there's good reasons for that, but, uh, yeah, that'll be a challenge we'll continue to tackle as we go forward. I think AI's got some promise for helping in that intermediation between those systems as we go forward. And we keep hearing about standards, right.

You know, and the standards are as standard as you'll use it, but Three decades in counting. Yes, Exactly. Um, there are a lot of rules and regs in healthcare.

Mostly it's generally well men, but, um, compliance can be difficult. So how do you guys navigate all that? There's so many regulations, so many different cities, states, countries, whatever it may be.

How do you kinda like, sort that in a way that brings, um, it doesn't tie your hands to the point where you you can't do anything? Yeah, yeah. Um, I say a couple things.

Um, one configurability really matters because the world keeps changing. So by state, by regulation, what's in place tomorrow is different from what's in place today. So if we can't, um, make things easily configurable for our people to change and adapt as the world changes, then we get stuck.

Um, so, so I think that's, um, that's one. The other is, um, it does mean for healthcare in particular, the idea of completely automated is always, you know, one inch further than where we are today, right? So how do we make things, um, semi automated decision support, you might still need a human to sign off, but how do you make it easy for them to decipher 50 pages of documents and sign off?

So it's still a human being looking at it, saying yes. Um, but they can do it in a fraction of the time and they've got support, right? And then you've got examples left on record.

I mean, I really think some of what we're seeing with ai, there's more documentation on the other side of this and every humanly possible today. And you've got records now that give you way more insight into how a decision was made, what might have been said in the conversation, what the reading was than someone might write today in a chart. So there's a bit of a fallacy that if we go semi-automated, it's worse.

It's actually better in many cases. And there may have been multiple doctors and nurses have come and gone since that last question. Is your best advice to your fellow healthcare CIOs as you kind of think about what you see every day and what they experience?

Um, 'cause it requires a certain amount of Perseverance, at the very least. Yeah. I, you, you know what?

Um, you know, I, I think, and every day I think about those that, and I've got a family, I've got, my mother's a retired hospice nurse, I've got a daughter in nursing school. The reason they get into the business is to help people heal. And so I try to keep in mind every, how am I advancing that?

How am I making that job easier to let them focus? And I think that's, as long as we keep that focus there, technology for technology's sake can be fun. But if it's not changing what that equation is for those folks at the front line, um, but that, that's where I, I, I every day wake up thinking how do, how do we take friction out of that environment?

How do we take that and let those folks focus? And I, I think that's where we want to be. All right folks.

You heard it here. A wise man named Demming. I think one said, if you can see a process, it's broken.

So let's not see the process. Gentlemen. Thanks bud.

Thank you. That Good deal. And we'll be back in a minute.