In this Clinical Dashboard Series interview, Skilled Nursing News sits down with PointClickCare’s VP of Value-Based Care Innovation, Anthony Laflen. With more than a decade of experience in health care, and working with both providers and technologies, Laflen has developed deep expertise in value-based care. Laflen shares not only the details of his “ideal” clinical dashboard, but also the real-life examples that have led him to create clinical dashboards in his work today with PointClickCare.
Skilled Nursing News: What are the three most important data points for an ideal skilled nursing clinical dashboard?
Anthony Laflen: After building a few of these in my career, here are the top three:
The first would be a data element around patient health status encapsulating vital signs, heart rate, blood pressure, active medical issues, and chronic conditions. I would also include changes to the patient’s condition, allowing staff to drill down and see how they can intervene.
The second would be a metric around medication adherence or medication management. In any setting, especially in a congregate setting, ensuring that medications are distributed quickly is important. The same is true for any medication omissions and drug interactions. Medication management can have implications for the root causes of readmissions.
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The final piece would be utilization metrics. Examples of these are hospital readmission rates, frequency of doctor visits, and use of specialty care services. I might also include staffing levels and bed availability. Imagine if you had awareness of not only what’s going on with your patients and medications, but also when you might have a bed open and how to staff accordingly.
How does this ideal clinical dashboard drive patient care decisions for operators?
It really boils down to proactive care management. When you integrate real-time health data and use predictive analytics, a dashboard can generate alerts that let people see the appropriate person in the setting, so they know where to spend most of their time. We do this with dashboards not only for our own facilities, but we also do it through tools and resources for ACOs, risk-bearing entities, and even hospitals that might want to track their most acute patients.
Imagine this dynamic: you’re the risk-bearer and you’re in Chicago, and there are 87 skilled nursing homes in the market. How do you follow your members across all 87 campuses and know which ones you need to intervene with? Predictive, proactive care management is key, along with enhancing interdisciplinary communication and collaboration. When you centralize data access, you can then create a central repository for patient information and a way to communicate with the staff and caregivers. Ultimately, most decisions in the settings are made by the staff on site. But back to my example of the risk bearer, imagine a world where you could see not only patients that might be declining, but where you can communicate directly with the frontline nurse about his or her care decisions.
Individualized care plans become very plausible with data. You can get detailed patient data including genetics, or lifestyle factors. Clinicians can use that to tailor plans to the individual needs of that person.
One of the last things I find a lot of people miss out on is self-awareness. What if you had insights into your own care? What if you knew what your world looked like, and had a dashboard to help you understand where you sit in terms of frailty?
I can think back to many care collaboration conversations I had with family members where one of them said something along the lines of, “I think Mom’s ready to leave the facility.” We’d respond with, “Actually your mother, although she’s only 77, has the frailty index of somebody who’s 90.”
Having a dashboard also allows me to benchmark my performance and my ability to thrive on my own compared to folks across the entire 27,000 skilled nursing homes within PointClickCare. I can tell a person even though her age is 77, conditions are presenting in a world where they’re hitting the data model at a 90-year-old level. Or the inverse could be, “Hey, it’s time for you to leave. You may be 90, but you’ve done a great job of taking care of yourself and you can ambulate and we’re looking at your risk factors across all the datasets and you are appropriate for a discharge.”
How does the ideal clinical dashboard help optimize reimbursem*nt for operators?
Some of this is already in play. Centralizing the data in a clinical dashboard allows an operator to start to achieve quality metrics. My team and I recently did an analysis of every state in the U.S. to get a sense for which Medicaid offices are offering additional dollars for achieving certain outcomes. Those outcomes could be related to staffing, clinical efficacy, or patient outcomes. If you do a good job as a facility, you can earn additional dollars. The dashboard guides the care team on when and where to intervene to drive down a rehospitalization, which would hit a specific metric and allow the team to earn additional dollars from a Medicaid perspective.
Medicare Advantage is a fantastic product, but unfortunately, I don’t think that it truly understands the value that can be brought to bear by a well-run post-acute operator. Here’s what I mean: Many Medicare Advantage plans will try to negotiate rates in their best interest; it makes complete business sense. However, applying the same rubric to every one of the operators in a market is not the best practice. What they should be doing is looking at dashboard data to understand which of the facilities are driving needless utilization. If I look at those 87 buildings in the Chicago market I mentioned earlier, it is likely going to be that 20% are doing a fantastic job of reducing needless utilization — for example, haphazardly sending patients to the Emergency Department or needlessly readmitting patients late at night. Those clinical dashboards will then allow health plans to look across an ecosystem, see the good providers, and reimburse them at a higher rate because they want to encourage better behavior.
Other things that really optimize reimbursem*nt are documentation and coding accuracy. Many operators don’t realize that the data they collect on a day-to-day basis drives the coding for health plans. Capturing the appropriate codes for the patient will translate into dollars that may have been missed through mismanagement and mis-coding. Again, those clinical dashboards go beyond just following what’s happened to a patient to also guide proactive behavior and optimize reimbursem*nt.
How can the clinical dashboard improve staffing efficiency?
Real-time data drives awareness around when you need to staff up or staff down. Having a dashboard that keeps tabs on those data elements will help inform decision-makers in the facility. For example, it may show a facility’s census is below where it should be at a state-mandated level, so the facility can send a CNA home. Or, as an operator, I can make decisions based on historical trends. For example, I may know that most of my referring physicians have traditionally taken vacations during August. This means the frequency of seniors having elective surgery is diminished during that time of year because the physicians aren’t in the market to do the surgery. This tells me I don’t need to staff as heavily in the month of August, as compared to December through February when pneumonia typically hits. This would be plainly visible through a clinical dashboard.
How would you like to see the clinical dashboard integrated with predictive analytics tools?
Here at PointClickCare, we’re already beginning to risk stratify and deploy resources that allow for early intervention. Integrating predictive analytical tools with the clinical dashboard can enhance the ability to stratify patients based on risk of adverse outcomes.
Imagine if you were in my facility, and I had access to your complete clinical record. I would know your age, your weight, and your BMI. I would also be able to see whether you took your medications this morning. I could factor in your ability to ambulate, and I could look at food consumption along with all the vital information that’s collected on a day-to-day basis – the risk stratification and early intervention become plausible when you put a predictive model around the data. We’re already beginning to do things around a very successful AI resource that we’ve recently deployed in the last 18 months. This predictive return-to-hospital tool allows a facility and upstream partners who might be taking the risk on the population to see who is actually declining, and more importantly, the reasons why.
What are the most important roles in a skilled nursing organization who need access to the clinical dashboard?
First and foremost, the clinical staff: the nurses, the outside physicians, the internal physicians, and anybody involved in the clinical efficacy of the patient — including the care coordinator from a health plan or an ACO. These frontline providers need access to the patient data so they can make informed decisions and monitor patient progress. Secondly, administrative leadership needs access. These are the department managers or administrators. A clinical dashboard allows them first thing in the morning to log in, see the state of the population, and know where they need to direct their efforts and energy. This becomes critical when you think about facility chains of 10, 15, 20, or 100 buildings. If I were a regional administrator and I didn’t have a tool like this, I would spend most of my day on the phone or emailing back and forth trying to get a sense for how things are happening in a facility. Clinical dashboards make that regional oversight plausible and achievable.
In some organizations, there are quality improvement teams that not only need the clinical data to see what’s been happening, but also to look back in time and understand what trends have been occurring and how that benchmark against metrics in a specific market. Without a clinical dashboard, Medicaid, certain quality improvement programs, or even the CMS Five Star rating systems, have no idea where they sit. Their reputation, reimbursem*nt, and visibility into the general populace is tainted when they cannot see if they’re trending up or trending down around a Five Star quality metric.
The last team near and dear to my heart would be the IT and data analyst teams. These are the folks that really need access to this data. They can use the clinical dashboard to look at ways to integrate other systems.
What are some things you think SNFs could do to improve the collection of patient health data?
First and foremost, be on an electronic health record. I have my own bias working where I do, but believe it or not, there are still operators out there that are on paper or a platform that is run off an on-site computer. When you move to a cloud-based EHR system, you open yourself up for a level of sophistication that you may not have experienced in the past. With an EHR, the data collection becomes easily unified. Building dashboard access becomes plausible.
At PointClickCare, we don’t believe that we need to build everything and own everything. We’ve gotten large enough to realize the value of a marketplace where other vendors can bring resources to bear for post-acute operators. Allowing that data to be commingled with our own data brings tremendous value and begins to open up a landscape that would have taken us decades to create on our own. We like partnering with outside data sources. We encourage it.
