Hello, and welcome to today's CTAC National Summit on Advanced Illness Care Virtual Pre-Conference. We'd like to thank you for joining us today, as well as thank our valued partners at CTAC for giving this opportunity to speak to you. We look forward to sharing with you our Florida House Call Project, which was a community-based model to enhance home-based primary care awareness and access. My name is Dana Crosby. I'm the Senior Director of Engagement and Practice Development with HCCI, and I'll be your host for today's event. Couple of housekeeping things before we get started. One, all participants are muted, but please use your Q&A box located on your screen to submit any comments or questions you would like throughout the event today. We will be monitoring that box. Questions that are submitted, we will answer them during our Q&A sessions, which we will have several throughout this afternoon. And then again, there will be recordings, the presentation, and supplemental handouts available for you upon the conclusion of the event. Today we are joined by multiple presenters. One, Jennifer Aery from Priority House Calls, also a Florida House Call Champion. Maditric Wood from Geriatric Solutions, another Florida House Call Project Champion. Dr. Aaron Yao, Research Director with Home Centered Care Institute. Melissa Singleton, our Chief Learning Officer at Home Centered Care Institute. And James Warda, our Vice President of External Affairs and Business Development at Home Centered Care Institute. Today we have quite the agenda or some objectives that we want to tackle. One is discuss insights and lessons from the Florida House Call Project. Two, assess research findings on awareness and perceptions of home-based primary care in Florida, identified areas of gap in care and unmet need, and early project outcomes. And then we will finish with sharing some inspiring stories from our I Heart House Calls campaign. Today's agenda is, first we'll start with our introductions, then we're going to move over into featured Home Centered Care Champions who have joined us today. We will talk about the awareness and perceptions of home-based primary care, and then we'll pivot into supply and demand, where we will view some interactive dashboards with some very informative data. Then we'll talk about our I Heart House Calls, and then we'll wrap up and adjourn for the day. As we go through the presentation today, and upon conclusion, any of these supplemental handouts, recordings, and decks can be found in our HCCI Learning Hub. The email is here. You can log in, create an account in the upper right-hand corner, and you will then be able to get to the materials from today. If you have challenges with creating an account or getting into an existing account, don't worry. You can always email us at education at hccinstitute.org, and we'll promptly reply and get you some support. Now, I'm going to turn this over to Melissa, who's going to take us through the rest of the presentation for a little bit. Sorry, unmuting. Well, hi, everybody. Thanks so much for joining us. I see that folks are even starting to introduce themselves in the chat, and please keep doing that. This is an opportunity I've been looking forward to for some time, to share with you some details regarding an innovative program that we launched over a year ago in Florida. This session is entitled A Community-Based Model to Enhance Home-Based Primary Care Awareness and Access. It's a great opportunity to be able to share with you some of the findings and lessons learned from this activity, from this program, and the champions that we've been working with for over a year. Do please go ahead and continue to introduce yourself in the chat, and we'll dive in. This project was funded by a grant from RRF Foundation for Aging, and we are so grateful for their support and everything that it enabled us to do this past year. The Florida House Call Project was designed to grow both the supply and demand for home-based primary care in Florida. We know that Florida is a state with one of the highest concentrations in the nation of older adults, as well as Medicare beneficiaries who have four or more chronic conditions. When we talk about supply, of course we mean workforce. We also know that the workforce across the country is insufficient to meet the demand. We know that 15% of the homebound or home-limited patients who really need medical house calls, only about 15% of them are actually getting them. We plan to drill into some of the Florida data to better understand where these gaps in care exist within this particular state. We went through and established these various goals to expand the national footprint, grow the workforces I shared, develop a foundation for statewide research in Florida and for future national research, but also to increase demand, momentum, and capacity for home-centered care in Florida through enhanced professional and public awareness and dissemination of our outcomes. That's kind of the what behind this project. The why is, of course, why Florida? Why the state level? Well, we've been working for a couple of years at the national level with some success, but we thought we still had a ways to go. We thought we'd try this state level, this community-based approach, sort of under the heading of, if you do what you always do, you get what you always get. We are now really encouraged by the results that we've seen and are looking at bringing a similar program to Illinois and then would like to expand to another region in the Midwest or perhaps the South. So next slide. All right, well, if I answered for you before the what and the why, this slide sort of starts to introduce the how, and that's our champions. We sought to identify some partners in this state, some clinical and operations boots on the ground who could help us by serving as leaders and champions of home-based care at the state level and then ultimately on a national stage like this one. We would work with them to equip them to spread awareness of home-based primary care through media channels and public forums. We would teach them to effectively utilize HCCI resources, tools, and curriculum, and to lead local education of other providers and practice operations staff. Next slide. And so here is our cohort of 12. So we've been working with these folks, again, for over a year. Our cohort includes three physicians, seven nurse practitioners, and two business operations managers. We're really proud about the fact that collectively this group serves roughly half the counties across the state of Florida, and I'm looking forward to introducing you to two of our champions very shortly. But let's just go to the next slide, and I want to talk about the training that we provided to the champions. So really the first several months were exclusively getting them to feel competent and confident to fulfill their role as champions. So we put them through our two featured workshops, our essential elements of home-based primary care, advanced applications of home-based primary care, and they completed assigned online courses in our library. We also did some customized training specifically for this cohort. We did a kickoff call in October where we reviewed the project and its goals. We set up an online discussion forum for them to enable their networking as a group. We conducted a leadership webinar in March that we made available publicly, but it was largely designed for this group. And then we did a full-day workshop virtually in March of 2021, and the workshop included, again, themes of leadership, clinical reasoning skills, home-based primary care community services specifically in Florida, media training. So we gave them templates for writing letters to the editor, to guidelines for doing interviews with the press. We trained and provided them with access to HCCI's curriculum so that they could take that and it could inform the presentations they were delivering in their own communities. They also had some action plans that they designed and quarterly reports that they shared with us so that we could continue to have an ongoing support for those, for their activities through the project. Next slide. All right. So our featured champions. So first, Jennifer Aery, and you'll get to hear from her directly very soon, but she's been starting her practice, I think she was just starting her practice when we first started working with Jennifer, and she's just done a wonderful job. She's working in the Central Brevard County region of Florida and focuses on delivering high-quality, comprehensive medical care in the home or in a residential facility. And I know Jennifer's going to share more about her story in a few minutes. And we go to the next slide, Maditra Wood. She's also a board certified, she's a geriatric nurse practitioner serving her community in St. Lucie and Indian River counties. And again, she's a nurse practitioner entrepreneur with her own practice, and she'll be introducing herself here shortly. So let me go ahead and turn it over at this time to Jennifer to get us started. Hello, everyone. First I'd like to thank HCCI and CTAHC for inviting me to participate in the summit this year. I think it's an amazing opportunity, and I think I can say on behalf of Maditra and the other champions, what a great chance we've had at trying to participate in initiative that helps spread awareness and access to healthcare options that are unfortunately not as well known as we'd like to think. So I think that it's a service that is got a huge potential for growth out there. So as she mentioned, my name is Jennifer Arie. I'm a board certified nurse practitioner in adult geriatric care. I've been doing house calls for a little over four years now. Initially it was to individuals who suffered from some degree of dementia, but I quickly realized that it goes beyond that to any individual who is challenged by leaving their home for quality medical care. And I serve in the Central Brevard County area here in Florida. Let's see. I opened up my practice in March of last year, right at the beginning of the COVID pandemic, and also the same day that our governor granted us full authority to practice. So it was a blessing that I was able to do that. I joined HCCI when I was selected to be part of their initiative as one of their 12 home-centered care champions. And that has been really an amazing opportunity for myself through their opportunities for education, through their virtual workshops, their online courses, their webinars, even one-on-one coaching. Anytime I've had a question, I've been able to either send somebody an email, and they've always been extremely willing and helpful to help me navigate through whatever it is I was trying to get through. They've helped increase my clinical competencies through some of their virtual workshops, showing me procedures that can be done safely within the home, right at bedside. And by doing so, not only do you increase your revenue, because yes, you can bill for those services, but it really helps decrease avoidable ER visits, or having the patient go see a specialist for something, when maybe it's something that I can manage right there in their home. And patients and their families are beyond grateful for those types of situations. They've taught me more than I can imagine about billing. That was something that I did not know about, and boy, that has really helped me immensely. Not only what to bill, how to bill, but how to document appropriately so that it supports the billing codes that I submit to Medicare. So reduce my chance of any denials and any audits. So I've been very grateful for that, and again, anytime I've had a question, I can just send someone a message, and they're right there to answer me. So it's been great. They've required us to, not required, but as a participant, we were asked to participate in quarterly activities, and that's been a nice little push for me as an independent practice owner. I didn't really know where to go from there, but over the past year, I've participated in media interviews, which I probably would not have done before. I've met with county health department officials. I've had meetings with hospital executives to discuss opportunities to develop their health care network, expand that, because here in Brevard, the health care networks that we have don't offer medical house calls. So while it's nice that we have some independent practitioners that are doing that, it's still a service that's highly underutilized. So trying to get my name out there to do that has been good. Doing various networking and community education events, I've had meetings with various palliative and hospice care providers so that we can figure out what we can do together to meet our patients' needs in a better, more efficient way. I've mentored a future house calls provider, and I've written several letters to editors of local newspapers and online publications to kind of help spread awareness. So that's really been wonderful. And as a result of all of that, over the past year, I've increased my patient referrals. I've identified my primary referral sources so that I can focus my attention on building those relationships and where to focus my attention when I want to try and grow my patient census. You know, I can see other home health care agencies and focus my attention there. I've doubled my patient census. I've increased my revenue by nearly 80% just by knowing what to bill and some of the advanced coding opportunities that I didn't know I could bill for. So doing that correctly has certainly helped my business grow. It's enhanced my clinical competence. I've gained favorable media attention. I've expanded my resources. Just by going to these networking events, you start to meet other either providers that are doing house calls or just other specialists and other services that are out there that help my patients. And I've become more recognizable throughout my community. So people are telling me that I have a good reputation and they're starting to hear about my name. So I think that that's been as a direct result of being a member of the House Call Project, Florida House Call Project. And I just love doing house calls. I think it's a great opportunity for nurse practitioners. Happy Nurse Practitioner Week, by the way. And it gives us independence, flexibility in our scheduling. It's a nice, calm environment. I'm not seeing patients every 15 minutes that are in the office. So I can get to know my patients on a much more personal level. They, I get to see them in the comfort and security of their own home, the convenience that it provides them and their caregivers. And I just like the feeling of actually like being welcomed into their home. They look forward to my visit. They take me in as a trusted friend or a family member. They pick fruit off their tree and give me that, or they make me something special that they've made in their kitchen that day. They, we share recipes. It's really such a gift to be able to develop those types of relationships with my patients because trust is huge. And I'd like to say that my patients trust me and that's a lot for me, a true gift. So again, thank you very much for having me today. I hope that any of you who are considering doing house calls really looks into it because I think it's a very rewarding opportunity in so many ways. So good luck to you and thank you. Thanks, Jennifer. And I wanna also welcome Maditric. Maditric Wood, are you there, Maditric? Yes, I am here, Melissa. Hi, so can you go ahead and just spend a little time introducing yourself and you can talk through a little bit about the activities that you've participated in through the project? Sure, thank you, Melissa. And thank, I would like to thank the house call, the participants that are on the call now for joining us and allowing us to speak with you this afternoon. Thank HCCI, as Jennifer stated, we are so grateful as champions to have had this opportunity to enhance our knowledge, those of us who make house calls to just be able to increase our knowledge and skills on how we can better care for our clients. I have been doing house calls since 2010. So that puts me at 11 years now. I've been an independent provider and a business owner since 2010. So 11 years is the timeframe that I've had of experience in doing this. And boy, can I say it has evolved over this time period. And I would also like to add that had I not had this experience in this extra training through the Florida House Call Project, there would have been so much more I would have been missing out on. I would have been doing, but certainly have not had the increase in revenue as Jennifer stated, because I learned so much through the Billing and Coding Seminar and just from the online tools have expanded my knowledge. And so for that, I am grateful. I started small with just seeing patients in a skilled nursing facility. And then I had a family asks me about following their loved ones at home because here in Florida, we have so many snowbirds. We have individuals that come down and they're only here for four or five months out of the year and just didn't take the time out to find anybody or just didn't think that they had the need to find a primary caregiver in the area. So that's how I originally started evolving into the home care setting is through my relationship with patients I care for in the SNF. And then eventually started expanding to the home environment. And then eventually the assistant living because many of the patients lived in not only single family resident homes, but they were also moving into ALFs. And from the ALFs, my name grew, relationships grew. And then three years ago, I opened up an office. So now I see patients in the office, ALF skilled nursing facility and home, but by far my home business is the largest. Since participating in the Florida House Call Project, my census has nearly doubled. My community relationships has doubled. My champion activities have included radio interviews. I have been a guest speaker with the local council on aging. I have also spoken at a caregiver seminar with a private organization. I preset multiple nurse practitioner students. I've been doing that for years, but here lately I've been allowing my students to go more into the home setting just so that they can get that extra training and boy, does the students, they get that experience and they determine quickly whether the home, doing the home visits are good for them or not, whether they like it or not. I've had some students tell me it's just not for them. And I've had students tell me that they can do it forever. They just love it since they've started getting the experience. So the experience is certainly different for everybody, certainly not cut out for everybody to do, but certainly your love for your patient and caring for them in the home and making sure that they get that quality care must be something that you do having in your goal as your number one goal. So as Jennifer stated, the webinars, the online tools or virtual workshops were invaluable. We still have access to them. And boy, can I tell you that that is just a resource that we can always fall back on and access if needed. So had it not been for my participation, I would not have had that instruction. And so certainly that has been a tool that I've been able to reach back on, participating in the online activities, going back to them as I need to and saving, downloading some information and being able to just refer back to them. I've even required my students to review the manual that was recommended on the website. There's a house call manual that lists the supplies that goes in your house call bag, infection and disease, infection control information, some building and coding information. I've compiled all that information into a binder. And that is one of the things that I have my students read and review before we start doing house calls so that they know exactly what to expect and what the expectations of providing that care is and what it means. And that certainly have been a valuable tool. It's been very valuable to me. Also my office staff, I've been able to download some information and make a resource, make available to them in the office as it pertains to building and coding. Also, as far as client phone calls, there's some information on the website as it relates to triaging patients. And when there is phone calls that come through that your office staff can certainly benefit from. And so I thank the staff for making sure that we have that information as well. So I can go on and on about how the HCCI has helped my practice not only grow, but just give me the knowledge that I need to continue to be a successful medical provider. It has also increased my visibility in my local community. I have a great relationship with many of the local geriatric providers, physicians in the area, which I'm very proud of. And I've been able to relate to them that I've went through this extra training and got this added information at my disposal. And it sets me apart from the other individuals that are pretty much providing the same services that I am. But the fact that I was a house call champion and I've gotten this extra training and extra information at my disposal, it pretty much lets the competitors know that there really isn't any competition when it comes to providing the house call care in the model, the home-based management model that I currently provide to my patient. It's a step above in my book. And I've actually been told that from my patients that they can actually see the difference when they call me after receiving care from somebody else. So that really makes me feel good about the care and the training that I've received from HCCI. Thank you, Medetric. And Dana, I know you're gonna show the outcome slide now. And I just wanna say that Jennifer and Medetric and the other 10 home-centered care champions, honestly were champions before we started working with them. And I'm just reminded when I hear them talk today. I mean, these are two skilled and highly qualified clinicians, but they're also two entrepreneurs. They are two mentors and educators. And they are also doing so much out in their communities to raise public awareness and the perceptions of home-based primary care. So I wanna thank you. I know you're gonna hang around. Hopefully you can, because we're gonna be talking a little bit later in the session about your I Heart House Call stories. But for now, why don't we go ahead and move on? And I'll turn it over to Dana. Or actually, no, I keep going, don't I, Dana? Yeah, you're fine. You can leave the question session. I don't think we have any at this current time. Yeah, so if you have questions, I encourage you, questions for Madhidrik or Jennifer, to go ahead and submit those to the box. And we'll be touching base on questions throughout the session. So go ahead and add those in. But yeah, this is my opportunity to talk about some of the things we did specifically around awareness and perceptions of home-based primary care, because it was really important that we understood, better understood the current awareness of home-based primary care among both the public and the medical community in Florida. And through the process of surveying, both the public, our healthcare consumers and providers, it was our hope that we might be able to raise their awareness of home-based primary care. So on this slide, you can see that we did conduct a survey in March of 2021 with 500 Florida residents. We wanted to assess their awareness level and perceptions of home-based primary care. And it was like a five to seven minute online survey, you know, with the appropriate balance of demographics and so on. But here's some of the takeaways that I can share with you. Let's go to the next slide. There we go. So a few things that we found out. When we asked them their familiarization with various terms, house call was notably more recognizable of a term than home-based primary care. And so, you know, we found that, you know, while only about 22% of the respondents recognized and were familiar with home-based primary care, 41% knew, you know, knew what they were thinking of when we said house calls. So, you know, the takeaway here for those of us, you know, those of you who are trying to help spread awareness in the same way is that in your awareness efforts, make sure that you keep in mind that the term house calls has a much higher recognition. And then the second takeaway was around perceptions, you know, being largely positive. You know, we, you know, after the respondents were given the definition of home-based primary care, they were asked if they would consider it for themselves or a loved one. And so we saw that almost half of the respondents said they would consider it as an option. And so that was very encouraging, but it really was important to explain how one qualifies or is eligible to receive home-based primary care in order to, you know, improve uptake and awareness. And then the third key insight here with this survey was that mobility issues were a primary influence. So we asked respondents to select, you know, we asked them to consider if they would be more likely to utilize home-based primary care if the respondent or someone they provided care for experiences mobility issues. You know, and we asked about a number of other things and it was, you know, the willingness or interest in participating in home-based primary care rose to 46, rose from 46 to 65% when talking about somebody with mobility issues. And so then the last insight here is that, you know, was existing primary care providers are the preferred resource for information and referrals. So we asked them, you know, where would they want to find out about home-based primary care options in their community? And 47%, I'm sorry, 63% said they would ask their primary care provider and 47% said they would go to their insurance company website. So, you know, we know that collaboration with those office-based providers is really important networking if you are running a house call program to make sure that those office-based providers know how to first identify the patients in their practice who might benefit from this care, but then also to whom they might be able to refer them. So the other survey we did, if you go to the next slide, was a statewide provider survey. And we interviewed, I'm sorry, we surveyed 48 Florida providers, 70% of them were in home-based care and 30% office-based care with the idea of wanting to learn more, you know, what their interest was in learning more about home-based primary care, how to identify those homebound patients in their practice. And then also we wanted to try to create a profile of patient characteristics and so forth among this group. So if we go to the next slide, some of the key statistics we learned were that more than half of the respondents reported that 80 to 100% of their patients are 65 years or older. So we know that while there are younger homebound patients who require house calls, the majority are older adults, 65 and up. And one third of the respondents reported that between 20 and 39% of their patients are receiving home health. And one third reported that 40 to 59% of their patients are receiving home health. So again, collaboration with home health on referrals and care for these patients is paramount. And then almost 40% of respondents did share that more than half of the patients in their practice are homebound or home limited. So we were speaking with some practices who had a pretty high prevalence of homebound patients. Then the next slide, we saw that more than two thirds of the respondents or 68% reported that they were extremely or very interested in learning more about home-based primary care. And so that's encouraging. Again, recognizing that 30% of the providers that we were surveying were in office-based practices and they wanted to know more about how to serve these patients who can't get into the office to see them. You know, and then even existing house call providers, you know, to whatever degree they're doing house calls, wanting to learn more was very encouraging. Next slide. This is about the payer mix. And we did see that, or the respondents reported that they were 82.5% in fee-for-service. About 15% reported having value-based contracts, 15% ACO-affiliated, and 42.5% reporting self-pay, including concierge. And so that gives you an example of their payer mix. And then the next slide is about referral sources. We saw some of the greatest percentage of referrals coming from home health and hospice agencies, 72.5% in this group, 62.5% coming from assisted living facilities or senior living communities. But other sources of referral to always think about, word of mouth, so your current or previous patients, social services, meaning your AAAs, your senior daycare, hospitals. So for example, discharge management, care coordination. And then finally, those office-based primary care providers or specialists are making referrals to house call programs. So I know I'm gonna be turning it over very shortly to Dr. Erin Yao to talk to you about some of the other data analytics that we've done in Florida. And I don't see any questions in the question box, so you can certainly hit me up for questions later on, but why don't we spend this time going and I'll turn it over to Dr. Erin Yao, who's a research director for HCCI. Hello, thank you for attending this session. And I'm going to talk about data. I hope you like data like I do. So we have a lot of data about Florida. Actually, we have data for the whole country, but I'm going to show you some of the data we created for Florida on home-based primary care. So on the left, this is a map of the fee-for-service providers of home-based primary care. I know this map look a little small to you, but after break, I'm going to show you the real data in an interactive way. So you can hover your mouse and see the actual data, who are these clinicians and member of house call visits, et cetera, okay. And on the right, you see this little table. There are, so in this table, so you see, we categorize house call providers by number of visits, home visits they have done in the first half of 2021. So there are 250 practices have done a lot of home visits and over 500 clinicians have done lots of house call visits. And we also have the number of house call patients in the fee-for-service world in traditional Medicare. And the median number of house call visits is four. Well, it's median, it's a statistical term, jargon. Conventionally, I would say typically a house call patient has got four visits in the first half of 2021. Okay, next slide. So we also compared the data between 2017 and 2021. So originally I only have two columns of data, 2017 and the first half of 2021. Melissa didn't like that I'm comparing a whole apple to a half apple. So I created also the half apple of 2017. So first, so you look at the, on the right two columns. So that's the half year data of 2017 and half year data of 2021. And so you see the number of patients. So we have more house call patients in 2021. If you look at the bottom row, bottom line of the data is actually the number of fee-for-service beneficiaries. As you know, all over the country, we have more people joining Medicare Advantage. So actually we have fewer fee-for-service beneficiaries, but even we have fewer fee-for-service beneficiaries, now we have more house call patients. So, which means you can call this house call penetration rate went up. So in the last four years, and if we look at other numbers, most of them went up. Number of clinicians have done over 500 visits or had over 100 patients, et cetera. But if you look at number of practices, it looks to went down a little bit, but I would think it's mostly probably through merge and consolidation. I think it's house calls are booming in the United States, especially actually, it's also related to COVID. And of course, if you're interested in this and you can look at the full year data of 2017, okay. I think you will have access to this PowerPoint slides, right? Next slide, please. And we also have data for Medicare Advantage. I don't show you the direct comparison between Medicare Advantage and the fee-for-service Medicare, but I can tell you that we have many more house call practices in Medicare Advantage because of the value-based arrangement. It makes more sense to provide home care in the value-based care world in comparison to the fee-for-service world. Jennifer said, we love our job and seeing patients at home, but same time, we don't see as many patients as in the office setting. A lot of times I think the fee-for-service payment is not very fair. So that's why I think in the value-based care world is different. And see, this is some key numbers for 2019 Medicare Advantage program and the house call programs in Florida. Susie, if you remember the numbers from the last slide, you know these numbers are much bigger, right? So we were talking about hundreds of practice, hundreds of clinicians, but here we are talking about thousands of practices and clinicians, okay? Next slide, please. And we like to mention DCE in this slide too. I don't know if all of you have heard of DCE, direct contracting entities. There are a few different types of DCEs in the Medicare program, but there's one type is called high needs DCE. So in the high needs DCE, they take care of high cost patients like our house call patients. And it's worth mentioning that Florida is the state with the largest number of DCEs more than any other states, okay? So if you look at this list, like the first one, AIP, Advanced Illness Partners, this is a high needs DCE, okay? This is the first year of the DCE thing. So DCE is replacing other innovation models in traditional Medicare. If you haven't looked at DCE, I would encourage you to look at that. And maybe in a few months, is we're going to have more data on DCE and what patient do they see and what are the outcomes and performances, okay? And many of the high needs DCE patients are very good candidates for home-based primary care. Next slide. So not only we have data on home-based primary care, we also have lots of data on home health agencies and hospice agencies, which I'm going to show you a little later. And we have detailed data of their quality, satisfaction, et cetera, all 50 states. And we want to provide you the access to some of the free data we're talking about. And we have a link on our webpage later. I think Melissa probably will talk about it again. We have a handout for you, also have some data on Florida about the household providers and assisted living facilities, et cetera, okay? Next slide. Next slide. This is the, so I'm saying welcome after the five minute break. I'm going to take you through of some of the free data we'd like to provide to all of you after break. And you will have a link to the webpage too. So we're going to cover a look at the needs and demands and the penetration of home-based care, assisted living facilities, et cetera, okay? And Melissa. Yeah. Well, I just wanted to jump in for a minute and remind people how this data really is so essential as part of this project. So the Florida House Call Project was, yes, in part about utilizing these home-centered care champions to work with us to help spread awareness, you know, on the ground and at the boots on the ground level. But we also needed to better understand what we were looking at in Florida. And this is really, I think, one of the first, if not the only comprehensive analyses of Florida in terms of supply and demand and, you know, the frailty of the population and being able to pinpoint at a very granular level where some of, you know, where the greatest needs exist. And so we did want to take a five minute break in just a few minutes here and then come back and Erin Yawa is gonna show us a dashboard, an interactive dashboard that's available on our website right now to show you some of this data in Florida. And so you'll come back in five minutes and do that. But Dana, I know we did have some questions submitted in the chat. Do you wanna take a few minutes since we're a little early? Yeah, absolutely. So we did get some chat questions. So one of the questions is, in cases where the referral for house call comes from the PCP, how does this relationship continue with a house calls NP? Jennifer? Yeah, Jennifer, maybe? I think you were- Marma Dietrich, yeah. Dietrich, we're gonna have to go. Yeah, no problem. So the way I generally work that is I share my notes. I'll send my notes to the primary care doctor and request his or her notes so that we can at least see what their thoughts and plans are comparatively to mine. And I will continue to include them in that. I've had physicians that I've called on the phone and we've talked periodically when there's concerns that have come up. So the collaborative relationship is there. I will say that it tends to wean off, that once they have a house call provider coming in and doing most of the work, they tend to not go back to their primary care physician. Some of them like to hold on to them and see them once a year or twice a year. But most of mine that that's happened, I've ended up absorbing that entire role. And the same here, I've been acting, I've been that primary care provider. I will collaborate with the cardiologist, the pulmonologist, the specialist. I do tend to send them my documentation. And likewise, if I see the patient in the home and there's a cardiac issue, before I make any changes cardiac wise, I do like to reach out to the cardiologist, also the pulmonologist, or if there's another specialist involved, I like to call or psychiatrists. I like to call and make sure that we're on one page because I'm in the home. They may not necessarily have assessed a patient recently or know what's going on. And I'm not sure if Jennifer is running into the same issue that I'm running into. I've actually been doing in-person visits and I've noticed that a lot of the specialists are still doing virtual visits and may not necessarily be back up full force. So a lot of the times they may not have assessed a patient. I've heard those long sounds or the heart sounds. And so I'm able to contact the office and let them know, hey, I was in the home, this is my concern. I think that we need to make some changes here, some changes there. And for the most part, I've not run into any issues. I've had the specialists thank me for that extra eye. And so it's certainly not been an issue with me. We just, a reminder here, all the materials are gonna be available in the HCCI Learning Hub, and you should have received an email with that information, but we're gonna talk about that in a slide here and some follow-up. So you guys will get all of this information for you. We do have one data question. I'd like to hold that, Melissa, until maybe we get through the second session because I think it might get answered then. So with that, I think we are gonna take a five-minute break and I'm going to ask that you return because Dr. Yao is going to take us through some more data information that I know you will all find extremely valuable. So with that, let's keep us on schedule, Melissa, and I'll just have us come back at 3 Central, 4 Eastern. That was our normal time. Yeah, and don't even worry, stay connected to this session. We just thought two hours was a long time to go without any kind of break. So we'll just a real quick bio break and leave your, you can turn your camera and your mute is already off, but panelists, you can turn off your camera and mute, and then we'll be back at four o'clock Eastern, three o'clock Central. Great, thank you all. We'll see you again shortly. I'll give everybody a minute to come back. All right. I'm going to get us started. I'm going to pass control to Dr. Yao, who's going to walk us through some more insightful information with data. Thank you. Is my screen visible? OK. Before I show you maps, I'd like to show you the table. In case you are interested in like, actually, who are the largest household practices in the country? So it's kind of just for entertainment. But you can see the number of large practices by the number of clinicians, patients, visits, et cetera. OK. And it's not free data, unfortunately. But you can see we have some of these data. And this is a map of the high volume household clinicians in the fee-for-service program. And this is based on the first half of 2021. Like I said, this is the interactive dashboard. I don't know if any of you have used the Tableau before. So it's very intuitive. It's point and click to find what you want. And if you move your mouse, you hover on some data point. It's going to show you who is this person. And contact information, how many patients, visits, et cetera. And we also have data on quality, costs, et cetera. How many ER visits, how many hospitalizations, readmissions, and total Medicare payments for a certain time period. But I'm not going to show you all the data. And this is all over the United States. And we had a question about the data source. Basically, we use the federal government data from CMS. And we have research services at HCCI. If you're interested in our research and analytics services, you can email me at research at hcciinstitute.org. And you can use search functions. Say we are talking about Florida. So you can type Florida. It will zoom in for you. Or we'll talk about one specific area. Then we can go to Tampa. Or we're talking about a zip code area. We can type a zip code area. Let's go back to Chicago. And you can zoom in, zoom out. These are the high-volume providers. Nurse practitioner, again. Happy Nurse Practitioner Week. OK. So this is the data of high-volume clinicians in fee-for-service Medicare. And this one shows you the Medicare Advantage Program. This is very similar. But it's based on Medicare Advantage data, in case you are interested in working with any Medicare Advantage companies. And I think this is a good segue. Let me show you this Florida data. So we actually have the payer mixed data. So for, let me go to this tab. For any county, we have all the Medicare Advantage companies. And we know their market share. Sorry, we messed up some of the data points. And so you can potentially talk to Medicare Advantage companies and try to establish some collaborations. And this data is very recent. It's October of 2021. It's last month. And we have every county of the United States. And let me go back to the needs and demands of home-based medical care. We have a data population or demography, like the very old population. And you can see the number of very old people in every county. We can go down to zip code or census tract if we want. And here it talks about disability data in every county. See if we can look at mobility difficulty. See this is the number for Palm Beach in Miami. And we also have some data on social determinants of health or socioeconomic status data, minorities, and educational level, and income, et cetera. And again, we can go down to lower geography levels. And this one, this map tells you a little bit about the penetration of home-based primary care. We borrowed the idea of Medicare Advantage penetration. So you see any Florida county here, we know how many of their fee-for-service beneficiaries have got home-based primary care and how many visits they have got. And then we calculate a penetration rate. I think it's still pretty low. Based on my prior research, I think about 7% or it can go to 10% or 15% of Medicare population really need home-based primary care. But you see this number is per 1,000 beneficiaries. So it's still very low. We still have lots of unmet demands for home-based primary care. So we need more champions, not just in Florida, all over the country. Again, we have data for the whole United States, but this is free data you can get for Florida. And assisted living facilities, I know it's very important for our household practice in fee-for-service world. If you have a collaboration or established a relationship with a large assisted living facility, it means you can cut your windshield time and see more patients at one visit. So we have data of assisted living facilities of Florida here. And I'm not going to zoom in and zoom out, but you get it that you can do that on your own. And we have lots of data information about these assisted living facilities, a number of beds, their web address, and their contact information, profit or ownership status, et cetera. And here, home health, it's important. You can work, collaborate with home health agencies. You refer patients to them, or they refer patients to you. So we got lots of data points of home health agencies. But here, we only show you their quality, satisfaction, and the hospitalization rate of their patients. And I can maybe do one, just look at, say, Tampa. I like Tampa. So here, there are many home health agencies. There are good ones. Some of these have low ratings. It depends how you, which one you want to work with. And if you click this little house, well, it's not going to send a doctor or a nurse. But it will go back to the default view. OK. OK. And hospice, many of us will need to work with. Many of you are palliative care and hospice. So here are some data for hospice. We have it for whole country. And average daily census, number of patients at home, and their net NPS score. So this is just some snapshots of what we do in our research and analytics department. And happy to help all the people want to promote home-based care. Thank you. Any questions or later? You know, Aaron, let me, I just want to jump in. And then I know there may be some questions still submitted to the Q&A box. The, you know, we're fortunate through the grant from our Foundation for Aging to be able to share this information, this data with you from our website. We're going to share with you the URL. And I think Sarah put that in the chat earlier. But you can go and you can look at, you can view this data. And it may help you. You know, as if you're in Florida and you are working to either connect with one of our champions or to expand your practice or consider a new service line in home-based primary care, we hope that this is resources that can help you and that you'll continue to stay in contact with us if there are some research questions or data analytics needs that you have that aren't represented here. But no, it's our pleasure to be able to bring that to you through the grant. And then, Aaron, I know I did see a question about, can you please elaborate on the sources of these data sets? I know we use a variety of federal sources. Yes. The data source are the 100% Medicare fee-for-service claims, 100% Medicare Advantage encounter files, and 100% Medicaid analytical files. Well, we haven't talked about Medicaid at all. But yes, we have these data. And the follow-up question on the social determinants of health. So as I list these data sources, you can imagine that we don't have a whole lot of social demographic variables in Medicare. We only have, like, sex, age, race, and ethnicity. But we have zip codes of our patients. With their zip codes, we can look at area-level social determinants of health, like education, income, housing, et cetera. So if I know your zip code, I basically can predict people's life expectancy. You have seen news on a lot of news media. So basically, we use some of these social demographics from Medicare, from these insurance data. But then we link it to the zip code-level data we can get. So that's how we're going to create this social determinant of health. And I'm in the process of creating the Social Vulnerability Index for household patients. And we will build on what the CDC has created. So CDC, the latest version is the 2018 Social Vulnerability Index. But it's on county and the census tract level. And it's hard to use. We're going to create something at the zip code level. So it can be easily, but we're going to charge for. For the purposes of this, for this discussion, Aaron, I wonder if you want to go back to the first tab, Areas of Need. And I think that's the one where we, or is it the second tab, where we talk about the, where you can identify like the different age and then the different reported self-difficulties. I know you showed a little bit of mobility, but can you go back to that tab? Oh, yeah. If you go to the right, we talked about self-reported difficulties, but then the sociodemographic characteristics. Did you want to pull up an example on the right? Here, so here you see education, race, ethnicity, and income, but there are more we can create at the lower geographical units. So here it's just for the demo purpose. And a related question here, we have a question here, David Long, you have a data. You have a question about why I'm only showing you volume. Yes, we have data on outcomes. I mentioned this. So we have data on your visits, on the hospitalization, stays, number of hospital days, readmission rates, and Medicare payments, et cetera. But we, this is research and analytics services we provide. So yes, we have that data, not just on home-based home care patients. Yes, we can compare to office-based practices. We can look at DCEs, their performances, et cetera. We can look at other process-based measures, like their AWV rates, depression screening, et cetera, pneumonia vaccine rates, flu shot rates, et cetera. Any other questions? I think we've addressed the ones in the Q&A box, as well as those who have put them in the chat. All right. So now, Aaron, did you have anything additional? I think we're ready to go. Let me, we, the data, the data have 200 million lives covered. All the household practice, the clinicians in Medicare and Medicaid program. But of course, if I like to look at the hospital's health systems, yes, we can do that. I was doing that a little bit today for some of the collaborators. So basically, as long as a health care organization bill Medicare or work with Medicare Advantage or Medicaid, we will have their record to evaluate performance, et cetera. OK, thank you. Thank you, Dr. Yao. Thank you. All right. All right. Hopefully, you guys can still see the question slide, Melissa. All right. So the next slide here, I can tell just from the discussion in the chat and the questions, this is where you could go and get some more information to assess the Florida dashboards. And I think we'll also give you some additional information on our research services. So you'll be getting this. And with that, I am going to turn it over to James Warda. Thanks, Dana. A lot of good info there. And if you can't tell, Dr. Yao loves data. So thanks for that, Erin. And so what we've heard so far today, and Melissa started by talking about the what and why and how behind house calls. What I want to talk about is the way house calls make us feel. And that means for patients, for providers, for caregivers, practice staff, everyone who's touched by this really unique, special type of care and what it means in the moment for people. Now, before we get into that, before we get started, just want to make sure that we're all thinking about the same thing when we're talking about house calls. There are all different types of house calls, of course. but we wanted to show you one type of house call, a home based primary care house call simulated, but with Dr. Paul Chang, who is our senior medical and practice advisor. And he's also the head of Northwestern Medicine, home care physicians in a suburb of Chicago. So we did some film shooting with him, and with some of our actors, and you're going to see a simulated house call within 90 seconds. So Dana, if you could take it away. All right. Hopefully you guys can see the screen. Melissa, just to check on your end. Can you go back to the beginning? It looks like you're about 11 seconds in. Yeah, I have it that way. No, it's got to go back to the very beginning. Okay. Yeah. Thanks. Great. And one thing I didn't mention, but that was the world premiere of that trailer. So you're the first people in the world see that trailer, right? You know, if we were in person, there might I put a little ticket under your chairs, and you could reach down and maybe get a free car or something. But for today, I'll just, we'll say, thanks for thanks for taking part in that with us. We were really proud of it. And, and Dr. Chang and the others. So if you as you watch that, again, think about the fact that there are many different types of house calls, right? So that was a home based primary care type house call. But, you know, obviously, hospice, palliative, home health, you know, counseling, counseling at home, we have interviewed, you know, dental dentists who do their work in the home, podiatrists, and on and on. And, and even, you know, telehealth, obviously, so critical during the pandemic. But, you know, it's still a yes, it's virtual, but it's still a line of sight into the home. So that's obviously really important. For myself, when I've when I've kind of shadowed a couple of our, of our doctors on house calls, one of the things that really stood out for me, besides the people were the pictures on the walls. And you don't, you're not going to see that, obviously, when they come into the office, but you get to see their history, the things that matter to those patients. And you get to see the bond between them and the caregivers. So there's a lot, a lot of things you can see. But again, you won't see any of it if there's not awareness, if you don't know they exist. You know, if you go out and your neighbor says that their, their husband is at home, and they just don't know what to do to get them health care. And house calls may be available. But if they don't know about them, they may not be available. So that's what we wanted to talk about today. It's a campaign started really back in 2018. When our leadership, our Director of Marketing, Jim Nahneman would sit down and interview people at the interview providers and leaders at the different conferences and ask one simple question. Why do you love house calls? And, and so we've continued that campaign, and it's actually expanded. So whenever we interview anybody for HCCI, we ask that one question, why do you love house calls? And what's so powerful about that question, is that when you ask that simple question, what comes next, which is always amazing, you know, it never fails, you just get amazing answers. And we want to show you some of those answers today. We're not going to read through every slide, we've highlighted some of the key points. But you will get these slides, you'll be able to read through them yourself. First, we're going to share some, some stories from our own Florida champions, including some, you know, from Jennifer and Maditric. And you've already heard a hint of that already. Then we're going to share, we were going to share a few slides from you. Ahead of the pre-conference, we asked, we sent out an email through our partners through CTAC, and asked for your stories. And we got several in and they were very powerful. So you'll hear those. After that, we're going to open it up. And we're going to, we're going to ask you to raise your hand. And we're going to ask you to share your stories. Because that's really where this gets very powerful. If we can do it live here. We'll also do that. And then at the very end, I'll ask, I'll let you know how you can share your stories kind of formally into our campaign. Let me tell you a little bit about the campaign. And then we're going to go ahead and share the stories. So the campaign, as I said, started in 2018. We've been partnering with the American Academy of Home Care Medicine, CTAC, obviously, the John A. Hartford Foundation has been a great partner, the National Home Based Primary Care Learning Network. And, and it really just goes on and on. We've got such great partners. Again, it's increased awareness, not just with patients and caregivers, not just with the field, very important, right with payers, policymakers, investors, the public, this is the way we get the word out that this actually exists. And focusing on all types of care, not just home based primary. Yes, that's our main focus. But we help hospice and palliative care organizations every single day, and work closely with home health, etc. Next slide, Dana. And what is this? Some of the side benefits here is that it also enables us to spotlight individual providers and practices in local communities and media. So you've got a hint of that with the Florida champions, right? We've seen some wonderful stories coming out from the Florida champions. And every one of those stories, not only spreads awareness to the public and to others, it really does shine the spotlight on that provider and practice. So it's a great way for you not only to share your stories to help others, it really does help yourself too. And our campaign includes a number of things, a dedicated web page. If you go to hccinstitute.org, you'll see a dedicated web page for iHeartHouseCalls, articles, videos, flyers, the social media campaign, and a new online store. And with the holidays coming up, I know exactly what everybody would like to get, right? Wait till you see their eyes light up when they open that iHeartHouseCalls t-shirt. Really exciting stuff. Better than jewelry. I won't tell my friend. And we're already sharing many stories from your colleagues. So you're going to see some of those here. Dana, you can move forward. So, Jennifer, this is a part of her story that she shared. Again, talking about getting really comfortable with the family and the patients in a way that you just really can't do it in office, obviously, right? I love that she says she talks way too much for a 15-minute office visit. That's great. I think that'd be my issue too, as you can probably tell. And many of her patients accepting her as part of the family, picking mangoes, and she takes it very seriously. It's a gift. And so remember, as we walk through these slides, think about how house calls make us feel, right? So each one of these slides, think about what is the feeling behind it. So that family is doing those things, because Jennifer is showing them compassion and care. And that means a lot, especially when you're not in a good place health-wise. Next slide. Medetric, again, really powerful stuff here, right? So this patient in their 70s, and so the daughter would get scared and take her to the ER. And anyone who has had to take care of a patient understands this, right? How, who's had to take care of a parent understands this. You get scared, you don't know what to do. It's like having a newborn in some ways. I remember taking care of my own parents. And, you know, you're not going to, you don't want to be cautious at that point. You just want them to be looked at. So Medetric told the daughter, you know what, before you make that call, call me. And look at that. They've been able to keep this woman at home. And I'm sure that's where she wants to be and her family wants her to be. Next slide. Moises, again, another one of our Florida champions. And there it is right at the very beginning, right? Building the relationship in the home. And again, it's how they, how it feels. So building a relationship as opposed to being in a 15 minute office visit, and those providers, they want to build a relationship. They mean well, right? But it's very hard to build a relationship when you're sitting with a computer for 15 minutes in an office, and you have to go see your next patient real quickly. So this gives you some time. And you can feel it when you watch one of these house calls, you have a little bit of space and time to actually connect. Next slide. Nicole, again, and able to take care of all of these different things, right? So this woman, this patient needed care for a number of different things. So first of all, she got hers, was able to help her get stable. Then they brought in other services, you know, physical therapy, a hospital bed, and now she has some autonomy. And anyone who doesn't have that sense of autonomy, to all of a sudden have a sense of autonomy, of control of your own life. Very powerful, right? So again, just thinking about how this woman, this patient probably felt about all this. Okay, next slide. I love this. This one's really wonderful. This is from another of our champions. And it seems very simple, right? An older patient tripping and falling. She knew she loved cooking, she went to her home and found out that this patient used the stool. It's not it's not really funny, because the patient was falling, right? And so she moved the seasonings within reach. Very simple, right? But this is the power of house calls, right there. You wouldn't see that in an office, obviously. So you'd be seeing a patient who kept slipping and falling, and you'd be wondering what was happening. And yet, if you take one visit, you see this resolved patient can go on with their lives and have well seasoned food. Next slide. Rita, again, this one I have to read. The last time I saw him was two days before he passed away. When I realized he needed crisis care. I called hospice after I medicated him and said goodbye. Before I left, he told me he was grateful for everything I did for him and his wife, then repeated then he repeated what he said. Yes, he was on his deathbed. But he took a few minutes to let me know that what I did made a difference in their lives. And that's the power of house calls. Again, not just for patients, and caregivers and family members, but for providers, right? We see increased satisfaction for providers. Many say it reminds them why they went into health care in the first place. Next slide. And now we're getting into some of the stories that came in from you from our pre conference participants. So this is from Ken, the Executive Director, Health Council of East Central Florida, his company, Karamedics has paramedics certified paramedics go out and make house calls. And when you see this story, one paramedic went out to visit an elderly patient. He found these people standing around outside her apartment. When he went into her apartment, the shelves were bare. So he went out and he bought food for herself, stocked her shelves, went back a few days later, and only once one can of soup was there. So he knew something was wrong. He notified the authorities, they came remove the people who were taking her food. And they rekeyed the woman's apartment. She was able to settle back in their routine. And the unneeded visits to the ER stopped. Again, you know, the power of house calls, right? Next slide. Jamie shared this wonderful story. And again, her firm, they help people with advanced medical directive paperwork through telehealth visits. Talk about feeling, right? I mean, that's a pretty intense emotional moment in a patient's life, in a family's lives, in a caregiver's lives. I remember taking care of my mom, when she was doing her last wishes. And that's, that's where you need people who care, who are there for you. And during the pandemic, when it was, it's really tough, you know, to be able to do that through telehealth is again, powerful, right? They're making these really important choices and changes. And it also gives, it gave, you know, Jamie's talking about how it gives them this opportunity to really understand where their client is, right? And reading them. Very hard to, you know, read a patient if you don't have time to spend with them. And it's a yes, it's a lengthy as if you look at that last line, a lengthy and emotional conversation, which often gets overlooked in kind of a fast paced healthcare setting. Next slide. Maybe this is our last one here. And this is from Jerry. And he this is a little little different. He's a lawyer and an advocate and he volunteers, right. And he went on house call. And he promotes other programs, house call providers in Portland, is one of them here. And he says, you know, it's about the healthcare professional saying, why aren't we going to the homes? Let's go back to that model of you know, 100 years ago. And the thing is that I remember getting house calls as a kid. So that probably means I maybe that means I'm 100 years old. Not sure. But powerful stuff. Next slide. All right. So now it's your chance. And we are 72 strong here. There's many on still on the line. And we'd like to hear your story. And we can do that in a number of different ways. If you could, you know, if you feel like it, I love to see raised your hand. And then you'll be made a panelist, you'll be able to actually be on camera and speak. If, if you don't feel like doing that, you could put it in the chat. And then myself or our able assistants like Melissa, Dana will help me and we'll get your your story read. And then after that, after today, what I would invite you to do is go on our website, go to the iHeartHouse calls page, there's a small form there, submit your story. And you know, we'll get back to you and just make sure all the details are right. And we'll share it in different ways. And you will get a beautiful iHeartHouse calls mug suitable for gift-giving at all times. So with that, I'm going to, we're going to open it up. And do we have any, anyone who wants to share a story out there? This is like being the first person dancing. Yeah, it's like, who's the brave soul to go first? This is pretty cool. When we get this started. Oh, here we go. He's raised her hand. So I'm going to do trick. Thanks for getting us started. Yes. Thank you. I will share another story. I already shared a story, but I have so many that I can share, but one that touches my heart is when I've been caring for a gentleman who has just been having exacerbations for CHF off and on, off and on, and you know, you get the phone calls, you get him settled, you get a phone call, oh, he's having to increase shortness of breath. You can get him settled, then a week later, you're getting a phone call again, and it's not only shortness of breath, it's the swelling. You know, it's the coughing. So it's just being just unstable. So after going into the house, I can't tell you how many times and actually discussing the diet, actually going through the cupboards and going in the room and seeing what he had at the bedside, because you could tell me one thing, but then it's always something else when you actually go there and you evaluate and you see. So the family's thinking he's eating what he should be eating, which is a low sodium diet, because that's what they're getting him. But unbeknownst to them, you know, he has his snacks, his chips and stuff at the bedside that I discovered that was possibly causing the recurrent exacerbations and shortness of breath. So had I not took the extra time to look and to investigate a little further, I wouldn't have never known that. It would have just been a hit and miss. And so we were able to educate him once again on how important it is to not order the takeout and the other things that he should meet, at least not so much of it, so that he's having problems breathing. And so, so far, so good. Maybe one or two more episodes, but not nearly as many as we had before. So, Medetrick, I didn't mean to turn this into an interview show, but you said one thing in there that I wanted to focus on. You said, I took a little extra time. What is it like to know that you have a little extra time? Oh, it means a lot because I don't, I don't put myself on a time schedule and I let my patients know that the ones that I do see in the day, that's one of the things that I learned through going through the training is don't give your patients a time. So typically I would tell them I'm either going to see them in the morning or the afternoon. So if I don't get them, get to see them at the scheduled time that they think I'm due to be there, it's not a big deal with me. So I can take that little extra time at one that I may not need to take with another. So it makes me feel good knowing that I'm not giving myself a quota or putting myself on a time constraint when I see my patients. I'm able to stay there and do what needs to be done. Thank you, my teacher. I see we've got a, I see here we've got a story that just came in. Someone just shared their story here. And I don't know if, if, if people are okay with their name being used, please, please let us know that too. If not, I'm not going to share, share Always careful about that. We had one said, I had colleagues who had medical students with them at a geriatric house call in Baltimore where the patient pulled a loaded gun out from under his sofa as a response to their question about his safety living in his dangerous neighborhood. Marian Grant shared that. Marian, I don't know if you feel, maybe you can just, did that turn out okay? We hope everything was all right. If you can just share there in the chat or I assume it did, you probably wouldn't have shared that a house call and obviously safety. We all know really critical piece of, of house calls and Melissa, do we do, this is not meant to be an infomercial here, but I'm really asking the question to address that. Do we talk about safety with our, in our education, tell people what to do in cases like that or what, how to avoid it? Yeah, we absolutely do talk about provider safety you know, because we realize that can be a big concern and a potential barrier for someone to enter the workforce. And so you know, even I know Jennifer and Maditrick, as you've precepted nursing students, I, I hope that that's something that you've conveyed to them as well, you know, about some strategies to make sure that they're keeping themselves safe. And, and I wanted to also thank Marian for sharing that story. It's a good reminder about, about safety, but Julie Sax had also asked if anyone could share a story about how valuable house calls are or were for the caregiver. Obviously, I mean, when, when a house call provider goes into the home, they're not just treating the patient, right? They're, they're, they're, they're there for the entire family, for the caregiver, and to help support them. So does anybody have a story like that? And as we're waiting on that story to hopefully come in, I do want to point out, I think I missed one thing with Marian's story there. She said these medical students were there to see the patient. He pulled out the loaded gun when they asked what it was like living in the neighborhood. I didn't quite catch that. So again, think about how he felt. He had a loaded gun because he was afraid, and yet there were these medical students there to help him, who for whatever amount of time, he didn't have to be afraid. So that's pretty powerful. It looks like we have, let's see here. Yeah, you know, we also have, Julie has asked, she'd be interested to hear any barriers that you're encountering. Are there patients or populations that you would like to be able to see and think need house calls, but find it difficult to reach them? And in the meantime here, oh, no, teacher. Yes. As an answer to that question, the veterans, that would be my difficult patients to get to would be the veterans. I would love to serve more and help more, but I'm just finding it so difficult to be able to service them. And it's mainly because of insurance. And if, thank you for that, Manditric. And if you look, Jim Nahneman, our director of marketing, just put in one of our online courses. It's called Safety Strategies for HPPC Providers. So that's something you might want to look at. We, we have another question in the Q and A. This one is how do you schedule each visit approximately? How long do you schedule a visit? So there's multiple people on here could take that one. So Jennifer there. Yeah. Jennifer, are you there or Manditric? I'm here. You know, I generally plan for about an hour for each patient. Some takes a little more, some take a little less. I try to map out where I'm going to go to maximize my time, whether I start furthest out from my home and end up closest to my home or vice versa. But I do try to map them out so that it's less driving. And, you know, my patients are always real flexible. Like Manditric, I try to tell them I'll be there around this time. Don't hold me to it. So they're always really flexible. One, they generally aren't leaving the home. So you've got that, you've got that cushion with them, you know, and it's not like they're sitting in a, in an office waiting in a waiting room and just looking at their watch and counting the minutes and feeling uncomfortable. They're in the comfort of their own home. So it's like, oh yeah, well, she'll be here this afternoon. You know, when they're, they, they can count on you once in a while, if I'm running really late, they might give me a call just to make sure I'm okay. But that's generally how I, I try to schedule them out. That's great. It looks like we've got a story. Did you want to add on to that? Oh, oh no, thank you. Jennifer pretty much summed it up for me about 45 minutes to an hour. Okay. So Julia, I think David Longnecker has asked, has his hand raised. We want to promote him and have him have a discussion. Click to promote to panelists. David, are you there? Can you, are you able to? I can't quite see. Does David have the ability to? He's still showing up in the, in the attendee list and not the panelist list. So I did click promote to panelist. Oh, and now you're muted, David. Try unmuting yourself. Okay. Can you hear me? Yes, we can. Okay. I'm a physician and I, the house call aspect of this, I think is incredibly important. Let me just make one quick analogy to an experience that I had. I live in a, an apartment building here in Washington, DC. And it's a rather upscale building and has a lot of very prominent people in it. One of whom is truly nationally recognized. And to cut to the chase, I realized he was having problems. He was a friend of mine. He was having problems. I started, instead of meeting him in a common meeting area, started meeting him in his apartment. And I think the most telling thing that I experienced was finding that the difference between well-meant services and what actually happens is oftentimes a giant chasm. Let me give you a simple example. This man weighed almost 300 pounds, about 280. You can imagine that he could not get around very well. In fact, hardly at all. He spent almost all of his time sitting in the same chair. He had a number of provided services. One was Meals on Wheels. They came in every, whatever this, the, the interval was every twice a week or so. They were in to deliver food for him, which they put in the refrigerator every time and left. That man could no more get out of his chair and get to the refrigerator than he could go to the moon. It was impossible because of his girth, his weight, and his lack of mobility. So one of the things that I did every time I went in, which was typically three times a week, was to get the food that was a well-meant effort out of the refrigerator and get it to his table. I think we see these kinds of things all the time that just really underscore the value of a house call for people who are seriously incapacitated in one form or another. Thank you. Thank you very much for sharing. Appreciate that. Brianna, I see you have something here in the chat. Can we promote her to share her story? All right. Hi, everyone. Can you hear me? We can. Okay. So from the Julie's comment about wanting the caregiver perspective, I mean, I've been so fortunate to also have the opportunity to work with providers and practices during home-based care, but also from just a personal experience with my own family members. There would be no way my grandmother, who is 94 and still at home and thankfully has a very wonderful home-based primary care office following her, would be able to do what she did. Oh, did we lose? I think we lost her. It was switching me to a panelist. Sorry. Can you hear me now? Let me hear you now. Okay. Long story short, she's fallen quite a bit in the early months of this year. One was pretty significant where she was really actually in so much pain. She was not able to get out of bed. We were worried she broke something and debating taking her to the ER, but her home-based primary care office was able to order a same-day x-ray at home, which showed negative fractures. So then she was assessed by a home health nurse because luckily she was active by home health and we were able to make the decision that it was safe to keep her at home and manage her pain with medication and a follow-up that week later in the week when the house call provider was in the area. So just also showing the unnecessary utilization and from a caregiver perspective, not having that resource and not having an office-based practice that may have community resources like a house call practice does can really make a huge difference. Great. Well, thank you, Brianna. And Dana or Melissa, do we have anyone else in the chain here? Otherwise, I'll go ahead and wrap up. No, we do not. Great. Okay. Well, thank you to everybody for sharing your stories. Very powerful. I'm sure there's a thousand more just with this group. And again, if you'd like to share your stories officially with us, again, go to our website and submit them. And that beautiful I Heart House Call mug will be on its way to you. And most importantly, you'll be helping to spread the awareness. I'm going to just end with one quick little story here. If you want to know the importance of awareness around house calls, I just put a link in the chat there. We worked with Hospice News. They interviewed Brianna, who was just speaking, and Dr. Yau about palliative and hospice organizations adding or partnering with home-based primary care to take advantage of value-based payments, et cetera, and just ensure that the continuum of care is covered for their patients. After that article ran, the reporter called me the next Monday and said a hospice CEO had seen the article and decided to add home-based primary care to their offering. That's why we have to get the word out. Again, if people don't know about it, it's like if a tree falls in the forest. So thanks again. I'm going to turn it back over to Melissa. Thanks for joining the segment. And sorry, I'm actually going to turn it over to Dana to help us out. Great. All right. Thank you again, everyone, for sharing your stories. They are very valuable. I think keeping the feeling in it is exactly the intent of home-based primary care. We've talked a lot. We shared a lot of information, data and information. I know you guys are going to want to go back and digest it. As a reminder, you can go to our education.hccinstitute.org, which is our HCCI learning hub. You can either create an account or you can use an existing account to access the recording, this deck, as well as any supplemental handouts that we'll be able to provide for you. Again, if you are having trouble accessing that, you can always send an email to education at hccinstitute.org and we'll be able to help you. And as we wrap up today, I just want to remind you all some of the events that we do have coming up here at HCCI. We will be conducting our central elements course for home-based primary care in December in the very warm Orlando, Florida area. We will then be hosting our advanced applications for home-based primary care in the not warm Schaumburg area this December. And we will also have an upcoming HCC Intelligence webinar based on coding and policy impacts from the past year's final rule. And one last place for some very important information or resources for you here is at our HCC Intelligence Resource Center. You're welcome to use our hotline, join our webinars, our office hours, and utilize our tools and tip sheets all free for those who wish to go. And last but not least, we hope you stay connected with us and you continue to share your stories and you continue to allow us to go on this journey with you. So with that, it's going to conclude today's event and I want to thank you all for joining us and have a great rest of the conference. Thank you all. Thank you. All right. Bye-bye. Thank you.

house calls

healthcare

positive impacts

benefits

personal connection

convenience

patients

families

home environment

specific needs

social factors

patient outcomes

hospitalizations

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