Hello and welcome to today's webinar entitled the State-Level Approach to Expanding HPPC Awareness and Access. My name is Dana Crosby, and I am the Senior Director of Engagement and Practice Development with HCCI, and I'll be your host for this event. A few housekeeping items prior to getting started, I want to remind you all that participants are muted during the call, but please use the question and answer box located on your screen to submit comments or questions throughout the event. Questions that are submitted will be answered during the last 15 minutes in our Q&A, as well as any pre-submitted questions that we have been keeping a list of. And finally, the recording of this webinar, the slide presentation, and any supplemental handouts will be available in the HCCI Learning Hub within the next few days. Our presenters today are Dr. Rita Larquente, Medical Director of Rita Larquente M.D. and P.A., who is also an HCCI Florida Champion, Ada Tapper, CEO of ACT Health Solutions and also a HCCI Florida Champion, Erin Yao, Research Director of Home Centered Care Institute, and Melissa Singleton of the Home Centered Care Institute. Our objectives today are to discuss insights and lessons from the Florida House Call Project, assess research findings on awareness and perceptions of home-based primary care in Florida, and identify areas of gaps in care and unmet need, and early project outcomes. And with that, I will pass it to Melissa. Thanks, Dana. Can you go ahead and share your slides? All right. Thanks. So it is my absolute pleasure to talk to you today about the Florida House Call Project, because it's something that had been in the works pre-COVID, and then the timeline sort of got, you know, molded and changed a little bit with COVID. But it has just been an absolute joy to work on this project. So I wanted to share with you a little bit of background about the goals of the project, some of the key players. And so to start, the Florida House Call Project was designed to grow both the supply and demand for home-based primary care in Florida, which is a state with one of the highest concentrations in the nation of older adults, and particularly Medicare beneficiaries who have four or more chronic conditions. And when we talk about supply, of course, we mean workforce. And knowing that, you know, there is a significant shortage of home-based primary care providers across the nation, and it's, you know, and that's not sufficient to meet the demand, you know, across the country. We really wanted to try to see what we could do at a local level to try to expand that model of care to the people who need it. And so you can see the project goals on this slide. We wanted to expand that national footprint of home-centered care in a high-need area and increase the demand, the momentum, and capacity for home-centered care while growing that workforce. And so there's several ways in which we accomplished this. You know, some of it played into that third bullet of conducting statewide research. So we know that nationally, only about 15% of the patients who need this model of care, who are home-bound or home-limited are, you know, only about 15% of them are actually getting medical house calls. So we wanted to better understand where the gaps of care exist within the state of Florida. And so to do that, we've engaged in research on a lot of different levels. You'll be hearing later in this hour from my colleague, Dr. Aaron Yao, about some of the research he's conducted. But we also did surveys among health care consumers in the state, as well as providers, both office-based and home-based care providers. And then finally, in the fourth bullet, to enhance provider and public awareness of home-based primary care. And in part, those surveys that I talked about, you know, helped to do that. But as you'll be hearing, we also utilized a lot of media interaction to, you know, to encourage more press information about the work that these providers are doing in the state. And bring those stories and the availability of home-based primary care to the patients and caregivers. So that they know what to look for if and when they need that care. So let's go to the next slide, Dana. All right. So a key part of this is the home-centered care champion. And so it was a little over a year ago, we sent out an RFA to providers and professionals across the country, or excuse me, across the state of Florida. Who might be interested in serving in this role. And we told them, you know, we are going to, you know, train you and equip you to serve as leaders and champions of home-based care at the state level and ultimately on a national stage, sort of like this. You will help us spread awareness of home-based primary care through those media channels and public forums. You'll get to utilize our, the HCCI resources and curriculum in your own peer-to-peer teaching of this curriculum and then lead local education of other providers and practice operations staff. So next slide. And what we ended up with was a cohort of 12 champions. And I've been personally working with them over the last year. And you're going to hear from two of them today. This cohort includes three physicians, seven nurse practitioners, and two business and operations managers. And it was interesting as we kind of look at, you know, the different geographies that this group serves, that we are, you know, collectively serving roughly half of the counties across the state of Florida. Next slide. So the training began just about a year ago. And in addition to participation in all of our standard education activities, because we supported these champions and going through our two-day essential elements workshops, our two-day advanced applications workshop, nearly our entire library of online courses. But we also did some customized training for them in it. We did a kickoff call almost exactly a year ago today. We set up an online discussion forum in our learning management system or the HCCI Learning Hub. We conducted a leadership webinar with them in mind, brought in folks from Primary Care Progress, which are national leaders in leadership area, leadership content in primary care across the country. And then we did a full-day virtual workshop last March. And we covered a lot of territory in this training, especially the full-day workshop. But again, one of the areas that we really honed in on was the media training. And we gave them templates and information for how to write letters to the editor about the importance of these services and making that available to the public, how to conduct interviews with the press and that kind of thing. So why don't we go to the next slide. All right. So I want to introduce our two champions who are on the call with us today. So we have Dr. Rita Laraconte. And Rita has, she's going to tell you more about herself as well, but she's the medical director for her own practice. And she founded it in 1998. She has been serving care to medically complex patients in their homes for many years and has made over 33,000 house calls to more than 3,000 patients in her 22-year career. So she attended medical school at the University of Puerto Rico School of Medicine in San Juan and completed her residency program at the Rio Piedras Medical Center. And she serves in the Orange County, Osceola, and Seminole County areas. And if we go to the next slide, I'll introduce Dr. Ada Tapper, who's a nurse practitioner. She is the CEO and founder of ACT Health Solutions, and it's a house call practice started in 2018. And she's just done a wonderful job in terms of serving patients in her home in Hillsborough County and in their home in Hillsborough County. And you can certainly read more about her on her bio here. But I want to take this time to go ahead and transition over to the next slide and invite Ada and Rita. And we'll have Ada start first, just to share a little bit about what you've done through the project, through the activities that you've personally participated in. Ada? Hi, thank you, Melissa, for the introduction. And I would also like to thank the staff, the staff of ACTI and the Florida House Call Project for allowing me to participate in this panel. As stated, I am Ada Tapper, CONA CEO and founder of ACT Health Solutions. For my first activity, I presented at a professional networking group, and this group brought industry awareness to its members and to seniors as well in the community. My presentation was about home-based primary care practice, the model, how it improved patient outcomes, reduced costs, and how it provides optimum care for patients who don't have access to health care. I also discussed HCCI and the resources available not only to the HBPC providers, but to the community and family members as well. My next activity was I mentored a new HBPC provider. I met my mentee virtually when he had just opened his practice. He is in a unique position that he was one of the few HB provider in his area, if not the only one. And he started his practice. He provides primary care and urgent care, transitional and chronic care management, as well as telehealth. He has roughly about 50 patients and is getting more referrals every day, so I am so proud of him. One of his greatest accomplishments so far is he's partnering with the city's health department, and he's providing vaccine in the community. During our mentorship, I have served as his coach, his sounding board, his advisor, and as well as just listening and giving advice anywhere I can. In the beginning, we spoke a lot about contracting with insurance and ways to market his practice, finding and connecting with the referral basis and partners. We spoke about new patient information, workflow, and again, referral partners and expectation for both, not only for the patient, but for him as a provider. Lately, we have been talking a lot about what he called healthy boundaries, and I call work-life imbalance, and basically what to do when so much is expected of you and there's only one person. He's doing a great job, and it has been a pleasure mentoring him because as much as he's learning from me, I am learning from him. It provides me the opportunity to share a lot of the skills and knowledge that I have obtained as I continue on my journey. It also allowed me to pay forward a lot of the things I learned from ACCI and from the Florida Health Call Project. The other activity I did was a media interview, and the media interview basically highlights my practice, and it provided information, build awareness, and create interest in what we do at HVPC providers. We let them know how we serve our patients and what you can do when there's a need in the community and how we meet that need. That's great. Thanks, Ada. I know if you have any questions for Ada or Rita, please go ahead and put them in the chat because we're going to talk about that more in our Q&A, but let me turn it over to Rita. Could you share a little bit about your activities through the project? Hi. Thank you for being here this afternoon with us, and it's a pleasure to participate in something like this for the first time. I'm very, very busy in my practice, and so I've done things in between, and one of the things I had been doing and continue to do was be a preceptor for the nurse practitioner students from University of Central Florida. I have made it a point to teach them how to be a nurse practitioner in the home care setting, and it's odd to say, but the last two or three I've had, they've become pediatricians. It's funny because they think that an elderly patient is a child but in a bigger size, and so that's the way they're trying to assess the patient. I love to teach, so it does satisfy me that I am doing something to help educate the future clinicians that will be taking care of me and us, and I've also been participating in a monthly meeting with Orlando Regional Medical Center, and it has to do with ways to prevent patients from recurringly going back to the hospital. My practice can prevent it if they contact me, but their biggest issue is with nursing home patients, but the ones that do go home, I do get referrals once in a while. I did participate also in an introductory meeting with the County Health Department officials of Seminole County, which is one of the counties that I do service, and I do have quite a few patients on that side of town. And what I've acquired from working in the Florida House Call Project is that sometimes we limit ourselves and we think we're too small and we can't do too many things, but they have opened up my mind and have shown me that I can do a lot. I can do more than what I am doing, thinking that I'm doing very little, and actually I'm doing quite a lot, and now I'm doing even more so, in reference to the County Health Department from Orange and Osceola and Seminole counties. And the other thing I've also learned is that the activities that we've been doing as groups, they have opened my mind, too, to see that the things that we are putting together can help me in my practice to help the patients, such as identifying patients that are a higher risk for falls and what all the different types of equipment you can get them. That's the one that we're doing, and I've grown. I've grown as a physician and in my practice, and I thank you for that. That's so great to hear, because that really was an important part of this project. Yes, we wanted to help grow the workforce and expand awareness and learn more about areas of unmet need in this state, but a lot of it just came down to how can we help these 12 committed champions to even improve their practice? And what's interesting, even though this wasn't a metric that we had established, in a quick survey that we've done just this week, being that we're a year into this project, the number of patients served by our 12 champions has grown by about 35% since last year. That's really fantastic to know, and it just, I think, adds to the value of this project. I also wanted to comment, Rita, because it was so wonderful that you participated in that meeting with us with Seminole County. I just wanted to share a little bit about that, because we became aware earlier this year of some work that was being done by Trust for America's Health. They launched a successful pilot of the Age-Friendly Public Health System Framework in partnership with the Florida Departments of Health and Elder Affairs, and we saw that there were 37 participating counties in that program. Well, we had champions who were serving in 22 of those counties, so we kind of scrambled and HCCI contacted, on behalf of our champions, each of those departments and sent them some overview information about home-based primary care and offered to arrange an introductory meeting with the champion or champions serving in their county. To date, we've held two of those meetings, one with Seminole County and one with Brevard County, and it was wonderful to be able to help the champions make those connections, and I hope that we even provided some custom flyers with the champions' contact information so that the relationships could continue, but that was another byproduct. I just want to share that some of the other champions have participated in other activities. You know, they may have written a letter to the editor about home-based primary care and had that published. Some of them have represented home-based primary care at a local hospital or other healthcare organization, maybe participating in rounds and grand rounds and sharing information about this model of care. They may have provided in-service training in their own practice to either help expand, to help expand home-based primary care services within their organization. We've invited them also to create blog or vlog posts for HCCI's websites or another site that's relevant to the project. Most of our champions have submitted a story for a campaign that we call I Heart House Calls. I know Ada has participated. Rita, you may have as well in that. It's been great to collect our champions' stories for that campaign. Why don't we go to the next slide? For this, I just asked if we could have Ada and Rita comment on what were some of the outcomes of having done these activities. I know some of them you may have touched on, but maybe we can just go into this. This was the list that we all came up with. Do you want to comment on that, Ada, maybe to start? Well, as an entrepreneur and a medical provider, there are so many challenges in trying to build a practice. Definitely, the House Calls project and HCCI was very instrumental in helping me build my practice. There was so much activity. There were some opportunities and programs that I didn't know about. I do have to give a shout out to Brianna, who was, every time I have a question about anything, she was always willing and able to help me. Even through some of the classes that we had, the essential home-based practice classes, they laid the foundation down for me. When I stumbled on HCCI, I had just started my practice, literally. Throughout that, I have definitely, with a lot of the information and knowledge I've gained, I was able to increase my referral partners. I expanded a lot of my community resources, not just from HCCI and the House Calls project, but when I gave the presentation, there was individual there that came up afterwards to ask questions. Today, we're still working together. They are both referral partners and also colleagues. The other thing I did like is a lot of the education that we got, the hands-on that we got on the second part of the program from the House Calls project. There were things that I didn't think of that we could do in a home-based practice. That gave me a lot of insight of ways how to open my practice and do more. Definitely, the Florida House Call project, for me, it just gives a unique opportunity to breathe new life into an old concept and make me a part of it. Thanks. Rita, any outcomes you want to specifically call out? Oh, you're on mute. The only thing I can tell you is that I wish that when I started my practice, I knew about you, because I thought it was going to be a really small practice. Then it caught me by surprise that each year that went by, the patient load was duplicating itself. It's hard to do things without knowing what you're doing and you're playing it by ear, but I have to say my practice is very mature. One of the things that really, really helped me was the community resources, because I learned something about Seminole County that I didn't know they were doing. Actually, I even caught them at one of my patients' house when they were giving the COVID shot. I had never seen that before in any of the other houses. That was very, very interesting. The enhanced clinical competence, I already spoke about that. The additional patients, I did get for a while, a lot of patients, and then now it calmed down, but I'm sure it's going to go up now with the new Medicare enrollment thing. I'm sure it's going to go up again at the end of the year and in the beginning of the year. The media attention, I haven't done that yet, but now I have because this is media. I'll have to tell you about that one next month. All right, great. Well, thank you. Dana, can we go to the next slide? I want to thank both our champions and we'll come back to them at the end, but for now, I wanted to quickly just cover for you some of what our survey findings were. Again, our first one was the statewide consumer survey. We sent this out to actually 502 adults who were 50 years or older living in Florida. We had a good split of women to men, household income was split. We had respondents who were living both in North Florida, South Florida, and Central. The majority were living in suburban communities and fewer living in urban and rural parts, but 84% of them reported in the survey that as of now, they can leave home whenever without help or difficulty, but 15% of them care for someone with mobility issues and 28% care for someone who does not have mobility issues. Let's go to the next slide. Our key insights here in serving this group, first, we found out that the term house call is more recognizable than home-based primary care. I know in HCCI's communications, we tend to use both terms so that we can make sure that we're hitting both of those terms that could be recognized, but house call was definitely more familiar for folks. If you are a home-based primary care provider, you may want to think about the fact that in your awareness efforts, how house calls is a more recognizable term. The second one is perceptions about home-based primary care or house calls are largely positive. That's one of the things that really helps is to make sure that you provide a clear definition of what it is and what it isn't, because these respondents said that they would consider it for themselves or a loved one once they understood, once we explained in the survey what it was about. Then the third one is mobility issues are a primary influence for seeking out this kind of care. You definitely want to target caregivers who may be dealing with this with a loved one and have some concerns about how am I going to get medical care for my loved one if I can't get them out of the house. That's important. Also, that our existing primary care providers who may be office-based are the preferred resource for getting information and referrals. That's where they're going to go. To the extent that a home-based care provider can get a connection with office-based providers for referrals and partnership, that would be great. Let's go to the next slide. We also did a statewide provider survey in June. We surveyed 48 Florida providers. 70% were home-based care, but 30% were office-based. If we go to the next slide, we'll talk about some of the key information that we got. We sought to get some statistics about patient characteristics and others. Among the respondents, more than half of them said that 80% to 100% of their patients are 65 or older. One third of those respondents said that between 20% and 39% of their patients are receiving home health. A second third reported that figure at 40% to 59%. Almost 40% of respondents reported that more than half of the patients in their practice are home-bound or home-limited. Next slide. In terms of interest in home-based primary care, more than two-thirds of respondents reported that they were extremely or very interested in learning more about home-based primary care. That was encouraging to us. The next slide talks about payer mix. You can see that almost half are in fee-for-service, or excuse me, 82.5% are in fee-for-service, with 15% in value-based, 15% in ACO-affiliated, and 42.5% in self-pay. Let's go to the next slide. This is where, oh, I'm sorry. Referral sources, again, the majority of referral sources were coming from home health or hospice agencies at 72.5%, but then it's assisted living or senior living communities, just word of mouth, social services agencies play into, like your AAAs, hospitals, so making those connections with discharge managers and so forth is important. Then office or clinic-based providers reported being the referral source for about 50%, and then office-based specialists about 22.5%. I am going to go ahead and turn it over now to my colleague, Dr. Aaron Yao, and he'll talk to you about what he found with the supply and demand of home-based primary care and so on. Thank you, Lisa. So we have some data to show you. We have more data, if you ask me. So I'm going to go over some slides. This is the first slide. So we have the most recent data from CMS, the first half of 2021. In the fee-for-service program, this table shows you how many home care physicians, nurse practitioners, and physician assistants. So that's the first column. We call this providers. So you look at to the last column, that's by the number of visits per year. So over 500 clinicians are doing 500 or more visits in the first half of 2021. And here, it says sites, but it's probably practices. I think for older data, we call it sites. Now it's practice because I have the text number for all the practices. So there are 250 practices are doing 500 or more house call visits in the first half of 2021. And you can look at other volume groups. Next slide. And I can show you a little bit later, but we have data on home health agencies and hospice agencies in the state or all 50 states, actually. So this is just a screenshot for you. So we know where are the home health agencies and their quality review, or it's not called review, it's rating by the CMS and the satisfaction score from a survey CMS conducted. Some other quality measures is not shown on this map. Similar to hospice, we can see how many of their hospice admissions are actually provided at home. And do people like their services? So we have a net promoter score for that and their daily census, et cetera. Next slide. And this is a map I'm going to show you later. We have the DCE data for all 50 states. Actually, Florida is the largest state, or I should say the state with the largest number of DCEs. So we have 16 DCEs in Florida, much more than any other states. So we have some information of some data for these DCEs, but we're getting more as time moves. It's just got started this year in the spring. Next slide. Next slide. So we have our ways to identify high cost patients in an area or in a health system. This slide only shows you in three counties of Oregon, Portland, Metropolitan area of three counties. So we use the most recent data to identify. There are a little over 100,000 patients are enrolled in part A and B. And we have their historical data of healthcare utilization. So we found out over 8,000 of them were hospitalized at least once in 2020. And these are some characteristics of this hospitalized patients. And we have their Medicare expenditure for 2022. I think on average it was a $45,000, something like that for these 8,000 people. And we can go back to 2019 to look at their data again, to identify so-called persistently high cost patient means that they were hospitalized twice, like in two years. Okay. And I don't have the data with me, but I guess it will be around 4,000 of them in these three counties. And on average, they probably spend $65,000 a year. So we're in healthcare. We know what the value-based care is about, right? For payers, it's mostly about controlling costs. And then it's about patient outcomes and health experience. But we are able to identify these patients and we know where they live and who are their primary care providers. Next slide. So this is just a example that we might be able to identify the zip codes areas of health system, well, the patients for health system. And also we know who are their primary care doctors. Next slide. And we can calculate their Medicare expenditure. So this is the data for those 8,000 patients in Portland, Oregon area. Okay. So see here, on average, their Medicare expenditure was $42,000 in 2020. And you can see the breakdown by your visit, the hospitalization party, et cetera. Next slide. Oh, okay. Now I can share my screen. Some live demo. Okay. You can stop me if you have any questions, if our panelists. Or for our audience, you can leave your questions in the Q&A box. I can address that later. So we have a platform. We put a lot of data in this platform. You can see these projects or folders, like direct contracting entities, home-based primary care. Under these folders, there are also some subfolders like HPVC billing or home care clinicians, home care patients, practices, et cetera. I'm going to show you some of these. And we also have something like home care demand, home health, home modification, hospice, hospitals, payers, et cetera. And we are adding data almost every day to our platform. And to show you what it looks like, we have so this is the DCE data. We had a screenshot. So you see NAVIDA has these DCEs. And Florida, we have these. So this is the simplest dashboard we can share. This is a dashboard of the supply and demand in Chicago area. We support rush at home program. We did a driving distance analysis for the house call program, basically how far you can go in 20 minutes, 30 minutes. So if I uncheck some of the boxes, you see the service area will actually shrink a little bit. It helps a little bit, right? And there are some data about the demand, like the older population and the disability data, et cetera. And we can provide all the providers and practices on the map for you to see. So like here, you see this home care provider made almost 300 visits in 2018. So this is old data. But we have more recent data too. Like I just showed you the 2021 data. And we can show practice information. So we're working with local related agencies to provide public data too. Farron, do you have any of this? Well, not necessarily the drive time analysis, but can you show Florida specifically? Okay. Let's see, Florida. So Florida, see we have three tabs. So first, so if we look at their frailty, we know how many of frail population in each county. And on the right, we can see how many of these frail people have got or not got home-based primary care, home-based medical care. For example, let's look at what county, Orange County, or let's see. You can see that, right? Because our video blocked my view, I can't see. So this is a Tempa, you see the rate on the unmet needs. And we can look at, we have recent data, but this is a demo. And it looks like we have a question. You can leave your question in the chat box or Q&A box and I can address it later. Sorry, I have to follow the rule that Sarah or Dina has set it for me. And population data, okay? The 85 year and older were self-reported difficulties, hearing or cognition or mobility, et cetera. And some socioeconomic data too. And I know house call providers are interested in assisted livings. So here's the data. We have the most recent data too, not here. You can find all the assisted living facilities here. And is it a big assisted living or a small one? So number of beds and their contact information, et cetera. Of course, I didn't show the zoom in and zoom out, but you can do that. And I'll also use Tempa. Maybe the city name is shorter, so it's easy to type. So if I type Tempa, it will zoom in to Tempa area. And you can see more detailed information. And hover your mouse and you can see these facilities. And you can type zip codes or a county name. It will work fine. Let me see if I have more Florida data. So this one is about home health providers. If you need to collaborate someone, I already select the Florida, but of course you can select the other state. And I can rank these home health agencies by satisfaction score or by quality. And you will see, if I click, I think it will show up on somewhere here. And of course I can, in the map view, I can type and zoom in to an area that interesting to you. And same thing that you can look at the data based on home health agencies. If you want to collaborate with them or refer your patient to them, et cetera. And what else? We have too much data. So let's see this one, if this shows up. Sorry, this is not the Florida, but we have the Florida, but just take a look. This is North Carolina. So we have the hospital data. I think in this map, we just show the number of hospital beds. Of course we can show more data. Let's see. This one is about the Medicare Advantage Penetration. So it's all over the country and we can zoom in to look at Orlando. So you see what is, basically Florida has very high Medicare Advantage Penetration rate, as you know, much higher than Chicago. And so this is Orange County. And the rate we have now the most recent data we have, it's October, this month actually. But this is showing you the June data. So the largest one, it's Care Plus and then WellCare, Humana, UnitedHealthCare, et cetera. Okay. What else? This is another one, but so I'm going to stop here. Let's see. Is there anything, Melissa, you want me to show or? Yeah, Aaron, so I know the question and answer box is blowing up with questions, including like, how do I get this? And I just want to kind of let people know, this is a subscription-based platform that we're still in prototype for. So you guys are among the first to be able to see some of us. We had shared it earlier this year with our champions so that they knew that we have the availability for this. But HCCI has always offered research services. And so I put in the chat information on our webpage where you can see the kind of reports that we can produce and also Dr. Yao's email. But anyway, so you can see the various capacity of things that we can track and we can do that for any county in the whole country, including Florida. I didn't show you the largest house call practice is Florida. I have all the data. Basically, I didn't talk about billing. I forgot to talk about billing because I know it's important to a lot of you. Basically, I can look at any practice, the billing profile, like how they bill. Because I know the frequency of the billing codes they're using for the first half of 2021. I know the largest ones, like the Bluestone Physician Services, they are the largest house call provider in Florida. I know how they bill. I know how VPA bills, et cetera. And I know the patient profile or characteristics of what chronic conditions they have. And I know their referral sources, like where they get patients, what are the specialists they are working with, et cetera. Yeah, so that's part of a market analysis that we can do as well. So I know you all are just getting a taste of that, but I wanna go ahead and turn it back over to Dana for the Q&A. Great, thank you guys. Great conversation, great insights, very valuable time. I am gonna pivot us to the Q&A portion. We will be joined in this time by Dr. Paul Chang, Senior Medical and Practice Advisor for HCCI and Medical Director for Home Care Physicians, as well as Brianna Klintzner, Senior Consultant and Manager of Practice Development for HCCI. They will join this call to address any other questions that may be a part of this topic or outside of this topic. I'm gonna start us off with some questions that were already pre-submitted at time of the registration. I will work to try to get through all of these questions. If we do not get to your question, please email help at hcci or hccinstitute.org. And I'll leave that slide up in a little bit so you have it. But I wanna start with the first question of how many older adults have been reached through this project to date? And what are plans for future expansion? Not sure who maybe wants to take this one. Yeah, I can. So I alluded before to the fact that, this project is not about direct patient care, but we have seen growth in the champions. And so we've seen about 35% of growth in the practices that they are personally or through their practice serving, which is wonderful to see. And then as far as expansion, we are currently looking at bringing a similar program as the Florida House Call Project to Illinois, where we are headquartered. And then we would also like to expand to another region either in the Midwest or the South. So stay tuned on that. All right. Next question is, are you working with health departments in Florida? Okay, I think I did talk about that when I shared about our meetings with Seminole County and Brevard and identifying those that are participating in the age-friendly public health systems. Okay. Next question. How would Florida's home-based primary care seem different from other states? For example, Michigan. Aaron, I know you had some ideas about that. Yes. So Florida has a higher Medicare Advantage penetration rates. So lots of house call program in the Medicare Advantage system. And also Florida has a very large older population. So we have the largest number of house call practices and clinicians. And that's also why we have so many DCEs in Florida. So it's basically, it's a booming market in Florida. But even with the increase of home-based primary care in Florida, we still have lots of unmet needs in Florida, especially counties with smaller population size. We understand why Miami or Orlando or Tampa, Jacksonville, they have lots of practices, but smaller counties, they still have a shortage. Okay. Next one here are what options are available for remote scheduler or remote case manager for a sole practitioner with no other staff? Several providers here. Does anybody want to take a stab at that one? So I can start a little bit, and then Ada and Rita, I would invite either of you to maybe share if you used any of things like this in your practice. But especially with the pandemic, we've seen a lot of practices starting to employ remote workers, remote practice managers, nursing services, whether they're inside the U.S. or unfortunately, because of the hiring challenges, sometimes there's companies outside of the U.S. that you can use for nurses and care managers, especially with the use of EHRs and all of the communication systems like Zoom that we use, you can still have a highly productive employee, whether they be full or part-time or even a contract employee. Rita and Ada, did you want to share anything specific about your practices, how you've used remote employees? I've been using remote employees since I started because I didn't think there was a good use to have an office space if I'm never going to be there. And so, and that saves me money because my office is in my house. So I started having someone answering the phone because that was taking a toll on me, having the patients calling me constantly and instead of having someone picking up the calls and then I'll address the ones that need to be addressed immediately. And so my receptionist is in her home. And then as I started getting bigger, then my receptionist became my office manager. And so he's in his home. And then my receptionist, she's in her home. She lives in St. Cloud, he lives in downtown Orlando. So, and it works out beautiful because it helps both of them because in her case, she had to be taking care of her mom so she could be doing two things at the same time. And it worked out great. So if people think that they won't work, it does. If you have a responsible person doing the job. I don't know what else to say about it, but it has worked very, very well for me. And like Rita, I also started with remote receptionist. And after about a year, my receptionist left. And as the practice grow, I needed more of a receptionist and more of a nurse. And of course this was at the height of the pandemic and I was unable to get anyone. And so I went online and I started looking for remote individual and I encountered several companies that actually hire remote individuals. And so the person now that I have, she lives in the Philippines. She is a nurse in the Philippines and she answers the phone, run or call in orders, obtain the records. She basically does just about call patient, help me with my chronic care management. And so it's working very well for us to the point now that I'm probably gonna hire another one to help with the workload. I'm gonna move on to the next question. How do you address medication adherence? Not sure, Paul or another provider. Rita, you wanna take that one? That's a very difficult one because even with the ones that live in assisted living facilities, there's no way they're not gonna be compliant, but they are, especially the diabetics and their diets. And you can tell them 10 times a day to follow their diet and they won't. Usually what I do when I see there's a problem with compliance at the home, I get a home care, a home health agency with the nurses to go there and I use the therapists and then I use the nurses to help to assist with the medication compliance. And besides that, me telling them, but it goes in one ear and comes out the other. You guys know that. I'm sure you've been through that too. So- Yes. They are technologists, but if they don't want to comply, you don't want to listen to a reminder system. You can't do much about it. Exactly. I have a diabetic, she's a diabetic and she's on Warfarin and now her cell phone doesn't work. So now I have a problem. Every time I have to adjust the Warfarin, which is almost every week, because she forgets to take it because she falls asleep. Right now she's on home care, but once that finishes, I don't know what to do with her. So- You know, if I can just add, I think this is the beauty of home-based medical care. We get to go to people's homes and we get to not only just look at the list of their medications, but actually have the patients bring them out for us to take a look at whether they're taking it or not. What are the fill dates on the bottle? But more importantly, to have the opportunity to address maybe some of the barriers related to compliance. Is it a financial issue? Is it a knowledge-based problem? Do we need to explain more why you need to take this? Is it because of a language barrier? Or is it some other factors or simply they don't understand? For example, when we teach the class, we often say, you know, patients don't use their inhalers correctly and they don't need more inhalers. They just need demonstration on how to use the ones they have now. So I think home-based medical care is a beautiful place to be in terms of trying to help our patient be more compliant with their medications. Great. Well, thank you all. I know that we had a lot of conversation. We had a lot of questions, great answers. Again, I'm gonna go through just two more things so you know how to get ahold of us. I do invite you to join us in December where Brianna will be talking all about the 2022 coding and policy impacts with the Medicare Physician Fee Schedule, final rule. So we welcome you to join us. You can visit our HTC Intelligence Resource Center page for that information. And if your next question is, how do I do that? We do have an HTC Intelligence Resource Center. We do have webinars like ones you're participating on as well as a virtual office hour, a plethora of tools and tip sheets to help you and a hotline. You can call, you can email us. There's the help email. If we didn't answer any of your questions today, you wanna connect with anybody here on this call or network with us, we would love to hear from you. And we thank you all for joining us today and we look forward to seeing you again in another time. Thank you. Bye. Take care everyone.

webinar

State-Level Approach

HPPC Awareness

Florida House Call Project

home-based primary care

supply and demand

unmet needs

public awareness

peer-to-peer teaching

expanded community resources