So hi, everybody. I'm Melissa Singleton. Welcome. I'm so glad that you could all join this kickoff call for our Florida house call project. And I know that there may not be everybody. I see more people joining. Great. Hi. We will be recording this meeting because I know we have a few people that will not be able to attend live so that way we'll be able to share after the fact. Give me my wide view. I have a few colleagues from HCCI who are on with me. And I'm going to introduce them first. Then we have a little bit of content that we will be covering. And then we will have your introductions at the end of the call. So my name is Melissa Singleton. You have received some preliminary information from me. I'm chief learning officer at home centered care institute. And I'm very pleased to see this project kicking off. It's the culmination of a project that we started talking to our funder about over a year ago. Our funder is the retirement research foundation for aging. And so I'm just thrilled to have you all on board and see this start to come to fruition. I'd like to introduce Danielle Feinberg. She's our coordinator in the education and research department. And you may have already been in contact with Danielle because she's collecting some of the key information that we need from you. She's a great conduit and great source of support for you. So Danielle, do you want to say hi? Hi, everyone. Nice to virtually meet you. I'm super excited to be here. And as Melissa said, I'm here to kind of work with you as you go through the process. Anything that you need, by all means, please reach out and I will be happy to answer any questions that you have. All right, great. Thanks, Danielle. And Danielle, I'm going to ask you a technical question. We are recording, right? And I think I'm seeing that. Yes, it is recording. All right. Thanks so much. So I'd also like to introduce Betsy Innocente. She is our manager of provider engagement. I know some of you have had the pleasure of speaking with her in the past. You know, it's her role to get to know providers from all over the country. And she took a special interest in Florida for us in order to circulate the application about this project. So Betsy, do you want to say hi? Hi, everyone. It's good to see you again. I've spoke with most of you via email or on the phone, so it's good to see you guys again. And I'm just happy to be here and help you along with the Florida House Call project. So thank you. All right. Well, thank you. You should all be able to see my screen. I'm just going to go through a few slides. And as I said, we'll be doing some more introductions at the end. I want to just spend a little bit of time sharing information with you about HCCI very briefly, talk about our mission of spreading home-based primary care, and explain further why we are beginning this in Florida. And that's important. We have not done a project like this where we've identified champions to work with us in any other state. But because our funder had a real interest in Florida, and we just recognize there's such tremendous opportunity to make a real impact in your state, we're so pleased to be able to start there. I'm going to go over some of the specifics about the project in terms of the goals, what your roles are, some of the statistics of this cohort, and also talk to you about the upcoming training and the timeline. As I said, we'll do some getting-to-know-you introductions at the end, and then, of course, take questions. So HCCI does have as its mission a goal of advancing home-based primary care to ensure medically complex patients have access to high-quality care in their homes. We recognize that nationally there are 3 million people, at least, who could benefit from home-based primary care, and only about 15 percent of those patients are receiving services because of a workforce shortage. And I don't think we could say that about anything else in this country. If 15 percent of cancer patients were not able to receive care, or 15 percent of COVID patients, or excuse me, if only 15 percent of cancer patients could receive care, or 15 percent of COVID patients, that would certainly not be tolerated. And so why do we tolerate that for our homebound and home-limited patients? At HCCI, we fulfill our mission by four, through four main pillars, education, consulting, research, and advocacy. Education, it's really all about developing the workforce in home-centered care. We provide live education. We provide online courses. We do shadowing at some of our practice excellence partner sites. And we extend that also with consulting. We'll do one-on-one consulting with specific practices, very customized approaches to make sure we're helping them to achieve their goals. And everything we do is not just about improving the quality and the volume of the workforce, but also enhancing practices sustainability. So we spend a lot of time talking about how you can manage and stay sustainable if you're trying to transition from a fee-for-service model to more of a value-based payment arrangement, or what are some other strategies you can do in the meantime. We also focus a lot on research. We convene experts and advisors to review relevant evidence-based literature. We contribute to literature in this field, specifically in areas of effectiveness of home-based primary care. We look a lot at supply and demand and identify areas where there are unmet needs. And I'm excited to kind of share with you a little bit about our plans for doing that in Florida. And then we also work very closely with our partner, the American Academy of Home Care Medicine, on advocacy efforts and working with legislators and NDC to try and move home-centered care more into the healthcare mainstream. We do have centers of excellence at six leading academic institutions around the country, and you'll notice none of them are in the southeast. So that was also a contributing factor for us to be looking at Florida and to help to spread home-centered care in a region where we did not already have that presence. So home-based primary care, I mean, home-based primary care, I mean, we know that the practice of healthcare today is in a state of tremendous transition. You know, we have changing demographics and increased costs and strains on resources and, you know, fee structures that are changing, policies that are changing. And you, the healthcare providers and professionals on the front lines, it's hard to provide that cost-effective, high-quality care for these vulnerable patients. And when we talk about the vulnerability of this population, I mean, I think you realize we're talking about, you know, an aging and chronically ill population that we know is at risk for being underserved. And this is a population that's growing faster than ever. You know, I mean, we also know that nationally, 5% of Medicare beneficiaries account for 50% of the Medicare spending. And so much of that expense can be attributed to repeated costly hospitalizations for chronically ill and medically complex patients. We know from research studies and such real-world trials as the CMS Independence at Home demonstration, that innovative home-centered care models have been effective in achieving the quadruple aim. And I was just watching a keynote that was presented last night for one of our partners, the house call providers in Portland, Oregon. And they were not only part of the Independence at Home demonstration, they were the most successful program in that demonstration project. And their cost savings, they showed that through their model, they could save 32% of costs, which is just unheard of, you know? And so it really shows, you know, it shows lawmakers, it shows public, it shows all of us how important it is to continue to advance this model of care. We know that it's, you know, home-based primary care is a model of care for that frail, complex, chronically ill, and disabled aging population. And the quadruple aim can be served through this model in terms of better outcomes, improved patient experience, lower cost of care, as I've just shared, and greater job satisfaction for you, the providers and staff. So talk about Florida a little bit. The growing population in Florida of frail and chronically ill older adults is at great risk of not having access to the health care they need. And so together with 16 other states in the southern region of U.S., what we shared with our funder when we put this project forward was that Florida's population and with those 16 other states includes more than the national average of people over age 65 and over age 85 years, and more than the national average of Medicare beneficiaries with four or more chronic conditions. So, and while our research is still in process, we anticipate statewide numbers to be similar to what we see nationally. And that is, again, that three to five percent of Medicare beneficiaries accounting for 50 percent of the Medicare spending. And again, so much of that can be reduced through effective home-based primary care. This is a map that we had put together several months ago. We shared that on our website. It's important to point out that this is based on CMS data using the home visit codes that are shared between home-based primary care and home-based palliative care. So what we have here is a representation of what we're calling home-based medical care, which includes both primary and palliative. We have on our staff a PhD researcher who's very well known in this field, Dr. Aaron Yao, and he's been active in recent months using publicly available CMS data. He's been looking at census tract, county-level data like the American Community Survey, to map selected regions and then show supply versus demand for home-based primary care. And we find that we believe this is an important step in being able to communicate to providers, payers, and policymakers in the public the geographic regions where some of these disparities exist. And this slide depicts, and you can look at it on our website too, but it depicts where there are assisted living facilities, where there are home-based medical care providers, and then the population of 85 and up and where those are more dense. And we have more maps that we will be putting together for Florida. This is an example of, and again it's static on the slides, but it is interactive on a website. We did this for Chicago. We'll be doing this for Florida, but where you can hover your mouse over the specific areas and get some information about not just the census data, but also the provider information. And this is an example of where we use some of the American Community Survey data to identify, again, those areas of great need. We, you know, looking at some of those social determinants of health that we know are so relevant to home-based primary care. You know, factors such as race and education and income level. And we can pinpoint those areas through using this data. All right, so that's quite a lot of information just about HCCI and where we are right now with our research. But I know we really want to talk about the project and then I want to stop talking and hear more from you. So if we go into the goals, again, these should be familiar to you, but we want to expand our national footprint starting in Florida, given that that's an area that's not currently being served by our Centers of Excellence. We want to increase demand, momentum, and capacity for home-based primary care while growing that workforce in Florida. We want to conduct statewide research, as I've shared, to strengthen the field and our practice. And we want to enhance awareness among your colleagues and also the public across your communities about the availability of home-based primary care. So your role, we want to, we will empower you and equip you to serve as leaders and champions of home-based care at that state level and ultimately on a national stage. And I have some things I'll talk to you about that today. We will, you will be receiving specialized training from us to not just spread awareness through media channels and other public forums, but also how to utilize HCCI's resources, tools, and curriculum in your efforts to educate other providers and practice operations staff. And we are asking that during the 2021 calendar year that each quarter you will report to us at least two activities that you've completed that are, you know, attributed to this project. And I'll show you some examples in just a few minutes, but you know, I think you'll find that you're going to be well prepared to be able to do that. Let's just talk about the statistics of this cohort. We have a total of 11 champions in this first cohort, three physicians, six MPs, an operations director and certified MA, and business development manager. I was thrilled when we were able to count up and see that we were covering 42% of the counties across Florida. And I think that's a great start. And now getting back to those activities we talked about, there will be some self-directed champion activities, and there will also be some HCCI-directed champion activities. And all of these will happen in 2021. I think I shared with you in my initial note to you, accepting you into this project, that primarily for the balance of this year through December 31st, we're going to have you focus on on your own training, and that's pretty much it. So starting 2021, some of the things that you might do to fulfill that request is, you know, you could perform, you know, or provide on-site or virtual training at a professional meeting or a chapter meeting of AGS or AAFP. You know, whatever organization you belong to in your profession, you know, you could share information about home-based primary care and we'll help equip you to do that. You can provide in-service training at your own practice. And I know there's at least one program here, and I'll give a shout out to Hope Health Care, that they're starting home-based primary care at their hospice and palliative program. So I know, you know, it's going to be so important for you to be able to take this back to your colleagues at Hope and be able to help grow this even within your own practice, and that's fantastic. But you can also go out to another practice or health system. You can do Grand Rounds at a local hospital, you can do some sort of public awareness or speak at a community event. We have at HCCI opportunities for you to participate in media interviews or write a blog or vlog post or do something else, you know, with us, and that would certainly be welcomed. And so if there's even an idea you have that's not on this list that you think would qualify, you know, I hope you will talk to us and we'd happily support that. So those other HCCI-directed champion activities in 2021. We, after you go through some other training this fall, in around February 2021, and we haven't quite set the date yet, we will conduct a specialized train-the-trainer virtual session with this cohort. And so we're still putting that together. We will be polling you for your availability. I'm estimating it will be in February. But so that's one thing. And then we also have two great opportunities at the end of 2021, hoping that we will be in a post-pandemic world at that point where travel and in-person meetings are going to be possible. Obviously, we will need to assess as we get closer, but the American Academy of Home Care Medicine will conduct their annual meeting in Orlando, October 28th through 30th. So I would ask you to put those dates on your calendar now, October 28th through 30th, 2021, because we would like to put forward a session with our champions where we can talk to the rest of the thousand Academy members about what this project has accomplished. And again, this will be a year from now. So I can't wait to hear what we have to say. And then we also have an HCCI workshop that is scheduled in Orlando, December 2nd and 3rd. And we would like to put together a panel of champions who would like to participate in that to talk about this project and some of the things you've been able to accomplish. But more than that, the December activity and even the October annual meeting are great talking points for you as you are going out and spreading awareness of this. And you can say, hey, we've got these two meetings coming to Florida at the end of this year. Would you like to join me in going there and learning more about this? So we'll be talking much more about that in the months to come. So I know everybody has received information from Danielle about getting registered for our first training activity. It's Essential Elements of Home-Based Primary Care. It is a virtual two-day workshop. And you will earn CME credit. This is part of the benefit of you being in this cohort. You don't pay for this training. We're just so pleased that you are helping us with this work. And so we're happy to provide this for you. And if you have not spoken to or corresponded with Danielle yet, she can help you get registered for that. Same thing with the Advanced Applications Workshop. That's December 3rd and 4th. We kind of take it up a notch in terms of what we are presenting. We get into more challenging clinical topics. We have a video simulation of some procedures that providers are doing in patients' homes. So we look forward to sharing that with you. In addition, we have a library of online courses. And again, as we would like for you to be able to share some of these resources within your networks, I want you to be familiar with these courses. Plus, I think you'll hopefully find them educational and helpful in your own work. We've parsed it out so that in each of the next three sections of the project, which include, you know, from now until the end of 2020, and then the first half of 2021, and the second half of 2021, you're kind of working your way through several courses. And Danielle will be contacting you. She hasn't yet, but she will be contacting you with information about how to get into the LMS and see these courses and monitor your progress as you go through them. So those are the courses that we've outlined for completion in 2020. You'll see they're not very long. I mean, 30 minutes of seat time is the maximum for any one course. We incorporate some video in there. It's really, I think, pretty well done. But many of these courses are only 15 minutes long. So there's online coursework for January through June, and online coursework for the second half of next year. All right. So finally, in this section, just sort of a high level timeline. We have between now and the end of 2020, of course, we're conducting our kickoff Zoom meeting now. I've talked to you about Essential Elements, the two-day virtual workshop, and Advanced Applications, the other virtual workshop, and then the completion of five online courses by the end of this year. You can see in January through June, we've got our Train the Trainer in February, the completion of your two champion activities each quarter. So that's what the 331 and 630 arrows there in the center. And then completion of five online courses by June 30th. And then the last part of the timeline is completing those two champion activities. If you choose to join us at the Academy meeting in Orlando, those are the dates. Also, for the Essential Elements workshop, if you want to be part of our panel in December. And then, of course, we wrap up the project at the end of 2020, I'm sorry, 2021, with the completion of those last two champion activities and four online courses. So I know that was a lot. Thank you for listening to me. I am looking forward to hearing from you. And thank you all for turning your video on, because I think it would be great to, as you introduce yourself, if you're able to, to take yourself off of mute and then also show your video. For some of you, we have headshots. I did share here, this is sort of an example of what I put together for each of us. And I am going in alpha order. So just be aware of that. Oh, you know what, I got to go back. I got to see my notes here. Okay. So before I go to Jennifer, so Jennifer just heads up, if you're on. There are three things I want to know from you. Because of course, we're hearing from you about, you know, we'll show the slide that has your name and the name of your practice and the county served. But how long have you worked in home-based care? And what keeps you going? And then just for fun, because I was looking at icebreaker questions. And as I'm kind of, I've had to crank my heat on in our house today, because I don't know, it was supposed to be very warm today. And it's, I'm just so chill. So the question is, would you rather not have heating or not have air conditioning? Remember, some of us are in Chicago, you all are in Florida. I'm just really interested in just a fun icebreaker question. So how long have you worked in home-based care? What keeps you going? And would you rather not have heating or not have air conditioning? So Jennifer, are you on? I am. All right. Hello. Yeah. Hi, my name is Jennifer Airy. I am an adult geriatric nurse practitioner. I've been a nurse practitioner for about five years now. Before that, I was a nurse for 12 and a half years. And I got into house calls because I started working for a geriatrician who specialized in dementia. And she introduced me to house calls. And it was kind of like a light bulb went off. I was like, oh my gosh, how come I never did like home care before as a nurse? So many people do do that as their background, but I had never done it. And I just enjoyed it so much. So I've been doing it for, you know, almost five years now. And I just started my own practice for house calls this year. Situations changed. And that's kind of the event that I found myself in. And I decided to go for it. And I love it. And so it's growing, growing slowly, but patients are trickling in. And I really get hope to learn a lot from this program. So what keeps me going is really the patients. I just really enjoy them. So many of my patients are elderly, not all of them, but so many of them are. And I've always just gravitated towards the geriatric population. My grandmother and I had a special relationship and it's just kind of carried forward. I think they're all my grandmother or they're all my grandfather. So that's really what keeps me going. And obviously I can see the huge need for it. And it's just really a underutilized service that I'm hoping to bring some more light to it. So that's what keeps me going. And as far as AC or heat, that's an easy one for me. I'm originally from New Hampshire and I will never go back to New Hampshire to deal with those winters. So I would rather do without heat, although I do enjoy my air conditioning in the summertime, but if I had to, I'd go without heat. Okay. Thank you, Jennifer. All right. And next up is Katie. Is Katie on? And you guys are going to have to help me out because I can't necessarily see everybody. Hello? Hi, Katie. Hi, this is Katie. Hello. Sorry, I'm not able to be on video this time. Hopefully next time I will be. I'm with Mobile Physician Services. We're a multi-specialty health practice serving about 25 counties in Florida. We've been established for 15 years, but I've been with them for nine as their business development manager. Katie, are you there? Did we lose Katie? I think Katie's call dropped on accident. Okay. All right. We will come back to Katie. And Danielle, if you can help me watch for her. Let's go to Luis, Dr. Cortes. Hello, good afternoon, everybody. My name is Dr. Luis Cortes. I'm the chief medical officer for Hope Healthcare. I see the counties that we serve. I've been in practice of primary care for 16 years, and all those 16 years I've done between primary care and hospice and palliative medicine. In terms of involvement, aside from practice, as I evolve in my career and become more of an administrator, especially in the position that I hold at this point as a chief medical officer, obviously it's imperative for us to be part of the process of providing comprehensive care in all facets of care in the community. So certainly, based not just on my job description, that keeps me going in terms of providing the care as part of my duties to be able to have our organization position itself to be part of the process of decreasing resource utilization, best care possible to the members of our community. In terms of the question about heat, or if I understand it correctly, I'd rather go without air conditioning because if I need heat, it means that I'm back in the north, and there's no way that I'm going to go through the chilling, bone-crushing cold weather. So no heat for me. I rather, sorry, I rather go without air conditioning because if not, it means that I need heating. Nope. Well, thank you very much. You're welcome. Thank you. Yeah, I have family that moved to Florida from Chicago, and they say the same thing. They're not coming back. All right, so next up, is it Moses? Let me unmute myself. Okay, my name is Moses Organas. I am a nurse practitioner. I am a foreign physician, graduated in Cuba in 1987. Came to the United States in 1993, became a registered nurse, and work since the beginning in home care. I've been working in home care since 2001, and then became a nurse practitioner at Georgia Ontology, also at FIU, Florida International University, and started working in home visits, you know, Medicare. I am a geriatric, adult geriatric nurse practitioner, and I saw the need of culturally care, cultural care, to focus on the cultures that we serve in Miami-Dade County. I've developed one of the few independent practices in Miami-Dade as of today, and we are waiting for the independent practice, you know, application that's coming, and hopefully by the end of this month in Florida, that we're not going to need any more physician, I'll say, collaborators on the team. I developed the one nursing, first the one nursing consulting, and then the one medical office, and we build teams of four people. That's my model. One nurse practitioner, and three that could be a registered nurse, medical assistant, and a person who doesn't have to have medical background, but serve as a liaison between the services that we provide and the referrals. That's a very important thing, and we started doing, since Medicare started paying for the chronic care management program, we developed our own care plan. That's important for everybody, because this has changed the practice completely, how we work directly with patients and families, and how we change the way that they eat, that they take the medicines, and they comply with the referrals, and specialist appointments, and procedures, and it changed tremendously, and we apply that, and every 100, 150 patients, we develop one team of four people, and we send them either to the house or at the office. Now with the telemedicine, because of the pandemic, COVID-19, we are utilizing the telemedicine as a triage to see if we have to send the practitioner to the homes or not. Sometimes we solve the problems on telemedicine, and sometimes we have to go and see the patient. Right now, I am very, myself, very ambitious program, or we are very ambitious project. I moved myself to North Florida, and I'm starting the same module, and the same way of doing business in Volusia, Flagler, St. John's, Poundland, and Marion, the ones that you see. I put County Surf, I don't know why I have my Pound Beach there. Maybe I put it at the beginning, but I really don't serve Pound Beach. We serve Miami-Dade, and I am starting the same way of business in this area, because I saw the need that the people have here, and the amount of residents older than 65. I'm just starting in this area, and keeping Miami-Dade as we have it right now. We serve Miami-Dade and Broward, and some patients by the Florida Keys, because most of the people from the Florida Keys, they travel to Miami-Dade or to Homestead to receive services, which is out of your mind. You have to travel 160 miles to see a doctor, and that's completely out of the thing. I love serving all people in their houses. Some, they have many chronic conditions. Some others are a little bit better. We started spreading the prevention for COVID-19 way before March 16. So far, I have had 39 patients positive. Unfortunately, two of the patients died, and only five intubated in the hospital. We kept the patients out of the hospital. We kept patients out of the hospital facilities in their homes in order to prevent contagion and prevent them to be together with other people that could be positive for COVID-19. And that is the goal, yeah, keep them out of the hospital. Well, thank you so much. So what about that question about- The question about air conditioner and heat, that's an interesting one. I will say that I won't go without both. If I am in the South and temperature is high, I can have a life without heat. But if I go to North, for sure, I will select the heat instead of the air conditioner. That's my answer. It depends on where I go, where I live. Thank you. Thank you. Okay, thank you everyone. Take care. All right. So, Nicole is on? Is Nicole on? I thought I saw her. She's on. You may need to unmute her. Oh, no. Oh, sorry. I needed to unmute myself. Can you see my video? Can you guys see me? Hang on one second. Yeah, I can see you. Okay. My name is Nicole Eversley-Hall, and I'm a nurse practitioner in South Florida. I serve Miami, Broward, Palm Beach. I have been a nurse practitioner for over 13 years, mostly primary care. In 2016, I started doing home visits where I did in-home Medicare health risk assessments, and this is what caused me to be in love with home-based primary care. So, in January, I started my own... Well, February 1st, I would say I started my private practice where I'm focusing as well on home-based primary care. What was the question? What keeps me going? Faith. Faith. Despite everything that's been going on this year and seeing that there's a great need, this project excited me because it's a need that I saw that needed to be fulfilled that I know I couldn't do on my own. And pretty much, you guys said and aligned with the same desires that I have. So, I'm very thankful to be able to take part. Not only that I know that I'm going to learn, I know that I'll be able to grow what I see as a goal and a vision for my practice going in the direction of home-based primary care. As far as not having heating or AC, I would rather not have AC. I'm an island girl. I live in South Florida. I do not like to be cold. I left New York for that reason. So, I would rather not have AC. But I would like on a different note to connect with Jennifer because she may be an answered prayer for my sister who lives in Brevard County that I cannot care for myself while I'm looking for a home care provider for. So, I'm thankful. Please reach out. Thank you. Please. Oh, yeah. Absolutely. All right. Take care. That's exactly what we'd love to see with this group too, you know, is that you guys, you know, can refer, you know, if there's patient needs that you're aware of that are outside of your service area, now you're kind of connected to a network of other providers around the state. We can learn from each other too, you know. I mean, Moises was talking about, you know, a care plan that's kind of really transformed his practice. Well, what, you know, can that, can, what can we learn from him, you know? So, I think this is going to be very, very exciting for all of us. So, thank you. All right. Let me, I got something on my. All right. Then next we have Shijia. Shijia? Hi, everyone. My name is Dr. Shijia Kenichiro. I work with Hope Healthcare. Graduated medical school in 2004 and have been with Hope the past seven years and kind of doing a mixture or hybrid of home healthcare. Since that time, I did the PACE program, which is our, it's, there's national things, but all inclusive care for the elderly. It's mostly of a center based program, but we were, had the opportunity to do home visits. And then for the past two years have been working as the team hospice physician and kind of the area I grew up in and then also live in. So, that's really enjoyable. In terms of why for home based healthcare, I feel like it's kind of our old time medicine, the way that medicine used to be. So, it's kind of exciting that you get to go into people's surroundings and really get an opportunity to connect with them. And living in Southwest Florida, I would rather be without heat. Well, thank you very much for sharing that introduction and we look forward to seeing the program grow at Hope. So, thanks. Next up is Dr. Rita Lara Quentin. Hello. Nice to meet you all. I'm here in Central Florida. I've been doing this since December 1998. I graduated from medical school in 1981. I did a surgical residency, which was not completed, but that makes me very aggressive in the treatment of my patients. I do tracheostomy changes, gastrostomy changes, cystostomy changes, and I do wound debridement and I do excisional biopsies of wound lesions, of not wound, of skin lesions. So, I am very uncommon and a lot of the people can't believe that I do all these things and I do more than, I probably do more than that. My reason of doing this is that I see that there is a very big need of doctors going to patients' homes because I honor the nurse practitioners because I have one working for me, but a lot of them don't do all the things I do and are capable of doing. So, I guess maybe that makes me a bit unique, even though a lot of the other companies don't like me very much and I do get a lot of referrals from patients from under their services because I speak Spanish and I speak English. I wish I spoke Chinese and all the other languages, but those are the only two languages I can speak. Oh, and then about the heat, I like the heat, but I hate it when it hits the high 90s. It's horrible, but I do welcome when I go into homes that have air conditionings, but there's a lot of these elderly patients that love to have their air conditioning set at 80, which is terrible for us and very exhausting, but the ones that have it a bit at a lower setting, that is very comfortable for me. And of course, I have the car, but usually by the time I reach my next destination, that's when the air conditioning has finally cooled down the car, so then I have to get out of the car. And by the way, the reason why I started my business was I did my medical training in Puerto Rico and back then it was very, very common doing home visits and that was in the 90s. And here in Central Florida, there was no one doing home visits only for maybe their own old patients. So me coming here and only doing home visits, that was out of the ordinary. I even had problems with Medicare getting certified to be a Medicare provider because of this. And I actually was even audited twice because of this until someone from American Home Health Care Medicine called me and he asked me if I was being pointed out and being harassed by Medicare. And I asked him, how did you know that? I'm just asking you, have you been harassed? And I said, yes, I am. Do you want my help? Yes, I do. And then after that, they stopped harassing me. So I've been doing this since 1998. This is, I am going to have, it will be 22 years in December, and I just love it. And that's all I have to say. Oh, thank you, Dr. Laraconte. And I, so two things, I want to apologize, there is an error on this slide. Nicole, I've got your website. Yes, the hall, inhallmedical.com, I don't work for that. Yeah, I know. Oh, was that Nicole? Okay. Yeah, anyway, so that's an error on the slide. My apologies. So let's move on. Amy Peterson? I'm here. Can you hear me? Yes, go ahead. Very, very nice to meet everyone. My name is Amy. I have been a nurse for almost 30 years now. I've been a nurse practitioner for 10 of those years. I graduated in 2010. I started out as a hospital's nurse practitioner. I did that for two years. And for eight years, I've actually been doing the home care medicine. I've absolutely loved it. All of my friends said when I was in nurse practitioner school, they said that they didn't think that I was going to do well because I don't do well in an office. And I said, well, you know what, I'll figure it out. And I figured it out, and I love it. Right now, I work for a very large company down here, Millennium Physicians Group, and we are a part of the ACO, and we're very big in that. Originally, when I first started doing the house calls medicine, it was basically doing the primary care visits. With Millennium, we are a little bit more aggressive with our visits, and we try to prevent hospitalizations since we are a large ACO company. So we do a little bit more of the aggressive stuff, like Rita was saying, and I love it. I absolutely love it. And I'm looking forward to working with everybody in the next year and how we can spread the word about home care medicine because I think it's wonderful. And here in Lee County, we just don't have enough practitioners doing it, whether it be with our company or other companies around. And there are so many elderly people, frail, chronic disease, that just can't even get out of their house. And so it is a much needed thing, for sure, in the state of Florida. What keeps me going is I think I am extremely close to my family. My parents are baby boomers, and that population is growing tremendously. And I always treat my patients as if they are family members to me. I get pretty close to them, and they get close to me, and they are so appreciative of the care that they get in the home. And I just love to see that. And I absolutely could do without heat. I like to be cold. Which is hard here in Florida. Well, thank you, Amy. I appreciate your introduction. Next up, we have Lilania Robertson. I didn't, well, actually, I'm going to start with the heating and air conditioning question right away because I'm sitting in the mountains right now on our deck, and I'm absolutely freezing. It's about 50 degrees here. So thank you so much for allowing for me to be part of this group. I was introduced to House Calls about 10 years ago. I did a lot of volunteer work in my lifetime with my husband. We've owned many companies together. And when I went back to school to finish my nursing degree, I felt like I needed to get on to the business side of medicine. That's really where I excelled. I was introduced to a doctor. He was a DO out of Cleveland. He was a professor there, and him and I just got along so well. He asked if I would help him build his practice, and so I did. I fell in love with House Calls. I loved going into a patient's home and not only helping the physician care for them in their home, but changing their entire environment and making it a better place when we left. So I really, with the providers that work for me, that's really our goal. We don't go into a home and find that it's a mess and things aren't being done and their nutrition is poor. We really try to make a difference in all of their lives, and we have a ton of resources that help us do that. With the cost of everything, it's been quite challenging the past couple of years with COVID, too. So we've expanded into remote patient monitoring, which I fell in love with that I actually have just brought into our area, and that all stems from the COVID pandemic. We all were faced with, okay, we can't go to any of these ALFs or SNFs or homes. What do we do? So we quickly started TeleVisits, and we were able to do, I don't know, we've done several thousand now. So with that, we came up with a remote patient monitoring program, and that program has been amazing for our patients. I've joined with a company called Vivify, and we have technology for our patients. And you'd be surprised, even if they're in their 80s, how well they do with reporting their vitals to us. And so that's been great. We joined an ACO this year, which I'm excited about. And I'd like to talk to Dr. LaCourte a little bit more, because she sounds like somebody I would love to work for, because we just started a wound care program, and she's doing it all. Everything she said, I'm like, that would be awesome. So anyways, I'm looking forward to the education. That's going to be great. Having the support, oftentimes I felt alone out here. I'm like, where do we get our governing body from? And so it's been really nice to have HCCI. And I would just say that, as Melissa said at the beginning, to provide cost-effective quality of care, that's really been my goal also. And to bring our local mobile physicians together, oftentimes we tend to compete against one another. And to me, I feel like that's, if we are going to come together, we need to start, you know, I refer to mobile physician services, that's up in the Tampa area. And so, you know, I think that, I think it's going to help us in the long run, the more we can all work together. Yeah, absolutely. Thank you. Well, I know we're, just have a couple more folks. Ada, can you introduce yourself? Did we lose it? Oh, there you are, Ada. Yes. Hi, I'm Ada Tappert, and I live here in Tampa, Florida, and I see patients in Hillsboro, Sun City, and some of the areas in Hillsboro County. I have been in nursing for close to 30 years also. I've been in several different positions, LPN, RN, nurse practitioner, now doctor of nursing practice. And throughout my career, I have been in the home, serving in those different roles. I've used, I've usually done it as a part-time job when I'm, whether I'm looking for extra money, extra experience. But as, about two years ago, I had another company, and I didn't want to lose my medical skills. So I started doing it again. And I like interacting with patients at home. And after we closed that business, I was still working with another homemade health agency, and they, home-based agency, and they went under. So I decided to just start my own. So a year later, a year and a half later, I am running ACT Health Solutions. And just like everyone else, we see mostly psoriatic patients in the home. So I've been doing this now for about a year and a half on my own. And yes, I do feel lonely out here, a lot of time. And what keeps me going is the patients. I like feeling like I make a difference. So many times when you walk into the home, you can have a bad day, and you walk into the home and, you know, they light up, and you know their history. You know when they're not eating right, when they're not telling you the truth. And so that keeps me going, just seeing that I can make a difference. And sometimes even with the hospice patient, you know, just knowing that when you leave them, they're feeling that somebody cared for them. What would I do without? I am an island girl, so I can do without the AC. I hate to be cold. I totally, totally hate to be cold. So I will go without AC any day. All right. Thank you so much, Ada. And Medetric, am I saying your name right? You're on mute. There you go. Yes. Can you see me? Okay. All right. I'm sorry. I'm sitting here listening and multitasking, charting and listening at the same time. I am Medetric Wood. I'm owner of Geriatric Solutions. I've been self-employed through Geriatric Solutions now for 10 years. I celebrated my 14 year anniversary this year, this past June. I have been a nurse practitioner for over 14 years and have been doing house calls. I actually, I was listening to everybody else's bios and what they did. And I know everybody does house calls. I do house calls too, but I also do assistant living. I do nursing home and I also do office. I have my own office too. So I am in, I guess, all settings. I gave up my hospital privileges so that I can focus on the subacute and then the primary care. I love it all. What keeps me going is the fact that I do make a difference. My patients and my patient's family members has complimented me on several occasions about how I just go above and beyond. I'm very proud of that fact. I do give everybody, all my patients and their family members, my work cell phone number so they can get in contact with me so that the continuity of care continues. I pride myself in keeping my patients out of the hospital and being able to attend to their needs. And by not only treating their medical needs, but also their social needs and psychological needs as well. I try to deal with a multidisciplinary team, although I am from the medical standpoint, I do try to incorporate a psych. In my area in St. Lucie County, we have very few psych specialties that go into the home. But I do get dietitian involved if needed and also the therapy discipline as well. But I also have the ability to bring in mobile medical dental and podiatry and some of those other things along with x-rays and phlebotomy. So I look forward to working with the other professionals in this program and learning how much better I can serve the needs of my patients. Thank you so much. And as far as going without, I'm always a cold person. My husband tells me all the time, but I cannot go without the heat. I mean, the AC, I think I can bear being cold, but I just cannot stand being really hot. So I can go without the heat. I need my air conditioner, especially in South Florida. Okay. Thank you. So I know we're right. We're a few minutes after the four o'clock. Were there any questions that you all had? Well, you certainly know how to reach well here and I'll even put it up. Well, there's several ways to stay connected to HCCI. We would encourage you to follow us on all the social media. We have a LinkedIn group for you. It started with COVID-19, but we've kind of morphed it into just another sort of online community. Betsy can share you more information about that. Maybe I'll ask her to send out the link to that to all of you. And then of course our website, you've got phone numbers for me and for Danielle and our emails. Please contact us if you have any questions. In the meantime, what we're going to focus on is getting you registered for your fall training. And also Danielle will be reaching out to you just to make sure that she's collecting. If you have a headshot that we can share on our website and to make sure that we have all the correct information. A lot of that was requested on the survey that we sent out a few weeks ago. So I apologize for going five minutes over, but it is a real pleasure to meet all of you. And I am so excited to be working with you on this project. You're an outstanding group of professionals. Excuse me. I just have one quick question. Is there going to be like a group email or a group chat or some type of forum that we're going to be able to reach out to one another if we have questions? I was actually thinking about that as we were going through our introductions. And so let me go back and figure out if there's an opportunity to do that in our LMS or certainly we can start kind of a group email. We'll figure out the best way and be in touch with you before the November training about that. Okay. Any other questions? All right. Thank you all so much. Have a wonderful evening. And I look forward to working with you. Thank you, Melitta. Thanks. Bye-bye. Thank you. Thank you, everyone. Thank you.

Florida house call project

Melissa Singleton

Chief Learning Officer

Home Centered Care Institute

Retirement Research Foundation

home-based primary care

Danielle Feinberg

Education and Research Department

Betsy Innocente

Manager of Provider Engagement