Latest / Becker’s Payer Issues Podcast / Healthcare Trends: In-Home Assessments

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Healthcare Trends: In-Home Assessments · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
0:02
Becker's Healthcare Podcast.
0:04
Thanks so much for tuning in today. We're
0:06
joined by a special guest. Catherine Tabaka is
0:09
the CEO of Matrix Medical Network.
0:12
Catherine, thanks so much for taking the time
0:14
to be with us on the podcast today.
0:17
Thanks for having me, Jacob. Look forward to
0:19
the discussion.
0:20
Likewise, Catherine. And before we dive into everything
0:23
that we wanna talk with you about, can
0:24
you tell us a little bit more about
0:26
yourself, your your background in health care, and
0:28
what you're doing today at Matrix Medical Network?
0:32
Sure. Pleasure.
0:34
So I joined Matrix
0:36
3 years ago, Jacob, and I was appointed
0:39
CEO of Matrix Medical Network in July of
0:42
2022, so just over 2 years.
0:45
I came to the organization
0:46
with just under 20 years of experience in
0:50
health care, though
0:51
it's fair to say that I grew up
0:53
on the med tech and med device side
0:56
of the industry, as well as the provider
0:58
side of the industry rather than the payer
1:00
side where Matrix operates today.
1:03
In a way, though, I will say closely
1:06
with payers and risk bearing entities today brings
1:09
me back to the first part of my
1:11
career, which started in financial services,
1:14
where enabling consumers
1:16
and managing financial risk is not widely different
1:19
from how health plan offer health and care
1:22
benefits to their membership and manage the financial
1:24
risks associated with the utilization
1:27
of those benefits.
1:30
Fantastic. Well, I appreciate you taking us through
1:32
that, Catherine. Let's get going by talking a
1:34
little bit about a trend that we continue
1:36
to see,
1:37
increase every single year, health care services
1:41
moving more into patients' homes.
1:44
How would you say that in home assessments
1:47
factor into that shift? And you brought up
1:49
payers and and the space that Matrix operates
1:51
in. What opportunities here are most important for
1:55
payer organizations
1:56
to be considering?
1:58
So before diving into that question, Jacob, let
2:00
me maybe walk you through what the company
2:02
does. Matrix was founded nearly 25 years ago,
2:05
and it actually pioneered the 1st national in
2:08
home clinical network.
2:10
Today, and based on continued healthy
2:13
merger and acquisitions
2:15
activity in our category of the industry, we
2:17
are the only independent,
2:19
truly independent provider of in home health assessments
2:22
across the nation.
2:23
So we operate as an extension of our
2:25
client partners, those risk bearing entities that I
2:28
mentioned earlier.
2:29
And what we do is really caring for
2:32
individuals where they're the most comfortable, which is
2:34
in their home.
2:36
And in that way, we enhance and we
2:37
activate access to the benefits that health plans
2:40
and other risk bearing entities extend to their
2:43
members.
2:43
So to the question around,
2:46
the health care services moving towards the home,
2:49
the first thing I would say, Jacob, is
2:50
that the pandemic certainly
2:52
did accelerate
2:53
a trend that frankly had already started
2:56
well before 2020.
2:59
And in households or in home assessments
3:02
are not really a new concept
3:04
post pandemic.
3:06
And it's really related to how health care
3:08
is incentivized
3:10
by the regulating agencies in the US
3:13
based on
3:15
how health care is incentivized, the health plan
3:17
or any other entity really that bears the
3:19
risk of the total cost of care for
3:21
an individual
3:22
needs to ensure that, 1, they understand,
3:26
and, 2, that they are appropriately
3:28
covered financially to
3:30
attend to the specific care needs of that
3:32
individual.
3:34
And that's true for any health plan program,
3:37
but especially for government programs such as Medicare
3:40
Advantage or Medicaid.
3:42
So through the summer, I'm sure that you,
3:45
have seen that in home health assessments and
3:48
in Medicare Advantage health plans specifically,
3:50
made the the headlines of several publications
3:53
nationwide.
3:54
And I think the argument is less so,
3:57
Jacob, about the benefit of an in home
3:59
health assessment as a complement to other potential
4:02
touch points in the health care ecosystem of
4:05
an individual.
4:06
Because at the end of the day, as
4:08
an industry,
4:09
I think we need to meet individuals
4:11
where they are physically and in their care
4:14
journey. And and many, especially the senior population,
4:17
values that undivided
4:19
attention that they receive when we meet them
4:21
in their home.
4:22
So the controversy that that, was pointed in
4:25
those articles
4:26
was really around the utilization,
4:28
by the recipients of those government program dollars,
4:31
namely the health plans,
4:32
in, how that
4:34
reimbursement is is used in delivering care that
4:38
truly improves the outcome of those members.
4:41
So to the question,
4:43
Jacob, of what opportunities are are most important
4:46
for payers and payer organizations to consider with
4:49
care moving into the home
4:51
and how in home health assessments
4:54
factor into this shift,
4:57
I would say in this highly scrutinized environment
5:00
that we operate in, I'll put a plug
5:02
for matrix. I would say partner and lean
5:04
on a company whose core business it is
5:07
to perform those visits.
5:09
So during a matrix comprehensive health and care
5:12
assessment, Jacob, our clinicians see each patient
5:15
in the context of their living environment wherever
5:18
they call home. And the way I like
5:19
to think about our assessments is really a
5:22
head to toe, turkey head in a complete
5:24
3 picture of an individual.
5:26
Everything that our experienced, highly trained and board
5:30
certified nurse practitioners
5:31
observe and diagnose is is thoroughly documented.
5:35
And that information is shared with the patient's
5:37
BCP and the health plan, obviously, to help
5:39
better coordinate and enhance the patient the patient's
5:42
care management.
5:44
In in that way, Jacob, our organization really
5:47
operates as an extension to the broader care
5:49
ecosystem of an individual.
5:51
We
5:52
we are what I like to think of
5:54
the eyes and ears in the home of
5:57
that patient on behalf of their everyone else
5:59
who cannot be in the home of that
6:01
patient.
6:03
The other piece
6:05
to think about is is because we spend
6:07
quality time with people in their home, Jacob,
6:09
frankly,
6:10
probably more than most other key stakeholders in
6:13
the care ecosystem of that individual is able
6:16
to spend with them.
6:17
We develop a trusted relationship
6:20
with each of those
6:21
patients that we see, which really allows us
6:24
to get people to take action.
6:26
So not only do we thoroughly assess and
6:29
document what a patient needs, but we also
6:32
connect them to medical and nonmedical
6:35
services and resources
6:37
that can improve their health, wellness, and overall
6:40
their quality of life.
6:42
So I like to think about our clinicians
6:44
and our organization
6:45
as kind of a health companion in a
6:48
way.
6:49
You know, that little trusted voice on your
6:51
shoulder, that trusted resource that empowers you to
6:54
navigate, to take action, to stay on track
6:57
with your health regimen,
6:59
help optimize resources, and and potentially improve outcome
7:02
and and connect
7:03
the care that is delivered in the home
7:05
with the rest of the care network for
7:07
everyone that we touch.
7:10
So the most
7:11
the more sophisticated
7:13
maybe payer organizations
7:16
look at the in home health assessment, Jacob,
7:18
as what I call
7:21
or what I like to think of as
7:22
the first domino.
7:24
The domino that will tilt all other dominoes
7:27
in the care ecosystem of that individual that
7:29
we see in their home
7:31
in a much more personalized and in a
7:33
much more orchestrated way because of the level
7:36
of specificity that we're able to provide
7:39
through that comprehensive assessment that we perform.
7:42
So in home health assessments are sometimes, you
7:45
know, contested in terms
7:48
of being one additional step,
7:50
in lieu of a relationship with a PCP
7:53
or a relationship with a specialist.
7:56
That's not what they are.
7:58
When they're purposely organized
8:00
in addition to other scheduled care encounters,
8:04
they really serve the purpose of seeing, recording
8:08
things
8:09
that we see in the home that cannot
8:11
be seen in an office or in a
8:12
hospital setting. So in many ways, the in
8:15
home visit
8:17
has the ability to become that activation point
8:19
for more personalized care delivery
8:22
and the point of coordination for many other
8:24
actors that need to be part of that
8:26
care ecosystem to really coordinate
8:29
and partner better
8:30
to enhance the outcome.
8:33
Understood. So I really appreciate the thoroughness of
8:35
your answer there, Catherine. And overall, really, it
8:38
seems like the opportunities here for health plans,
8:41
is is going directly into the member's home,
8:43
meeting the member where they are, seeing the
8:46
things that impact their health, like you said,
8:49
developing that that trusting relationship, and then leading
8:52
them to those potential touch points within the
8:54
broader health care system,
8:56
to then improve their health overall.
8:59
In that vein, Catherine, can you share an
9:01
example of of how these in home assessments
9:03
can help identify
9:05
health related issues that that might not be
9:07
apparent to clinicians during traditional
9:10
on-site visits. You mentioned being that companion to
9:13
your members
9:14
on the ground. What what does that mean?
9:16
Can you can you give us an example
9:18
of a patient that is really seeing how
9:21
these in home assessments can can improve
9:23
their health outcomes?
9:25
Sure. And maybe I'll start by sharing a
9:27
statistic with with our audience, Jacob.
9:30
Last year, for one of our large client
9:34
nationwide,
9:36
25%
9:38
of the membership that we saw in their
9:41
home on behalf of that health plan,
9:45
didn't
9:46
seem to have any other encounter with the
9:48
health care system
9:50
that year.
9:52
So when you talk about things that may
9:54
not be seen
9:56
at another point of care being the PCP
9:59
or specialist for 25%
10:01
of those members that we saw for that
10:03
health plan last year,
10:04
those members didn't see any other PCP. So
10:07
we truly are,
10:09
the eyes and ear, and it's sometimes the
10:11
only
10:12
health care encounter for
10:14
a certain population and specifically for underserved, rural,
10:18
and sometimes dual eligible or,
10:21
people that are not as literate with the
10:24
health care system and sometimes afraid of the
10:26
health care system.
10:27
So we've got many, many stories,
10:30
Jacob, which which we, are found of internally,
10:33
stories from patients who have called
10:36
the organization to thank the nurse practitioner that
10:39
that came to their home for the excellent
10:42
care that they provided.
10:44
The the visits are really impactful
10:46
in in the sense that in many cases,
10:50
they
10:51
really
10:52
help people in in in a way that
10:53
they were not expected as our nurse practitioner
10:56
enter the home. So I'll give you a
10:58
couple of examples.
10:59
One of the patients,
11:01
that I that I remember,
11:03
will name that person, Claude,
11:06
said that the nurse practitioner
11:09
who visited my home was efficient.
11:12
She was amazing.
11:13
I have an amputated leg and struggled to
11:16
get out of my home. After the visit,
11:19
she reached out to some contacts, and I
11:21
will soon be receiving a ramp for my
11:23
home at no cost.
11:25
Understand
11:26
benefit from the health plan. And Claude,
11:29
finishes
11:30
by saying, I'm grateful because my life will
11:33
be improved now.
11:35
So that's one example, Jacob. Another example,
11:38
that I have here from a patient,
11:40
named Doris.
11:41
Doris said the nurse practitioner was very thorough,
11:43
very professional,
11:45
and very attentive.
11:47
Using a stethoscope,
11:48
she heard an irregular heart sound and recommended
11:51
that I see my primary care provider.
11:54
The primary care provider then ordered a Doppler
11:57
of my carotid artery,
11:59
and the results showed that I had 86%
12:02
blockage.
12:03
They immediately took me to surgery, and it
12:05
was successful.
12:07
I truly believe the matrix nurse practitioner saved
12:10
my life.
12:11
So those are examples, Jacob, where really,
12:15
again, they're they're
12:17
stunning examples of of how being in the
12:19
home at that moment in time, spending the
12:22
time,
12:23
having a conversation,
12:24
observing people in their contextual environment, in the
12:27
case of Claude, where a ramp would have
12:30
made his life easier,
12:32
activating the benefits within the health plan really
12:35
changed the trajectory, the enhance the quality of
12:38
life of of Claude, and in in the
12:40
case of Doris, probably saved our life.
12:43
Wow. I mean, those are some amazing testimonials
12:45
that you just shared, Catherine. And and to
12:47
your point, you the the statistic you shared
12:49
earlier, about 25% of your membership not interacting
12:53
with any other part of the health care
12:54
system before Matrix,
12:57
visited them in their home. It's it's an
12:58
amazing number.
12:59
And something that we hear about from from
13:01
health plan leaders constantly is that their their
13:04
organizations
13:05
are always striving to meet quality care access
13:08
and health equity goals and metrics.
13:11
So given given the examples you just shared,
13:14
Catherine, given the numbers you just shared,
13:16
why are these in home assessments so important
13:18
for health plans in terms of meeting their
13:20
their care access and other broader goals?
13:24
Well, in many instances, you know, we talked
13:27
about medical
13:28
circumstances in the two example, but in many
13:31
other
13:32
circumstances
13:33
or situations,
13:35
we
13:36
provide
13:37
care and help and assist members,
13:40
when they are not always able to shop,
13:44
cook, or feed themselves. So insecurities
13:47
for food, for shelter, for violence,
13:50
We help members
13:52
by
13:53
identifying problems related to to housing, to economic
13:56
circumstances,
13:58
and and,
13:59
some some of them,
14:01
in terms of their limitations
14:03
in activities and of daily living.
14:05
So that that in home encounter, again, because
14:09
we do spend anywhere between 45
14:13
to 60 minutes
14:14
minimum
14:15
with that individual in their home,
14:18
and having been on ride along with myself,
14:20
Jacob, with our clinicians,
14:22
it's fair to say that the first 5,
14:24
10 minutes, it's not different, very different from
14:27
probably
14:28
the encounter that you would have with your
14:30
PCP in in office setting or in any
14:33
other health care setting.
14:35
But with time passing and the conversation
14:39
or or the encounter taking more of a
14:41
conversational
14:42
style,
14:43
you get to understand
14:48
circumstances
14:48
a lot better
14:50
than, again, maybe the 8 to 10 or
14:52
15 minutes that you'll you'll spend with a
14:54
specialist if you're lucky. And if you're lucky
14:56
in the case of of Claude, right, if
14:59
you if you're not able to actually get
15:00
out of home, the chances that you get
15:03
access to that care, that you get access
15:05
to the resources that health plans
15:08
absolutely look to provide to their membership.
15:11
But if you don't have
15:13
information as to what is relevant and what
15:15
will help this person return to living the
15:17
best possible life, no matter
15:20
what
15:21
condition, health condition, and or life circumstances they're
15:24
dealing with,
15:25
it it's really an enhancer to everything else
15:29
that's already in place for that person
15:32
in the way they, they take care of
15:34
themselves on a day to day basis.
15:36
Absolutely. It's such a great point. And I
15:39
I also wanna ask because you brought up
15:41
going to some of these assessments yourself and
15:43
and seeing how your clinicians operate with patients.
15:47
How would you say then, Catherine, that technology
15:49
is helping to benefit your clinicians during these
15:52
these in home assessments?
15:54
And is there anything further on the horizon
15:56
that you'd add in terms of rapidly evolving
15:58
technology that you really think is going to
16:00
make an impact,
16:02
during these assessments for your clinicians?
16:04
Yeah. Absolutely. The technology technology at Matrix is
16:07
really an enabler
16:09
to the in home health assessment and delivery
16:11
of care.
16:13
What is most important to us though as
16:15
an organization is that our clinicians are able
16:17
to use their clinical judgment to evaluate
16:21
the whole person that is in front of
16:23
them and to drive
16:24
all care decisions.
16:27
The technology that supports our clinicians
16:30
is meant to be intuitive.
16:33
It really needs to empower them to apply
16:35
their expertise.
16:37
And it needs to enable them to perform
16:38
at the top of their license
16:40
when they face the patient in their home.
16:43
Currently and through the end of the year,
16:45
we are in the process of deploying a
16:47
new proprietary whole person care management platform,
16:50
Jacob, at Matrix.
16:51
And this new technology platform
16:54
really, will allow our provider to deliver a
16:56
comprehensive health assessment,
16:58
care assessments,
17:00
but would also make sure and ensure that
17:02
they stay focused on each patient encounter and
17:06
have that encounter really be tailored to what
17:09
matters the most to that individual at that
17:11
moment in time in their care journey.
17:14
Specifically, the the technology
17:17
provides compared to what we were using before,
17:20
enhanced functionality and, more importantly, interoperability,
17:24
which enable
17:25
our clinicians to participate
17:27
in the care planning
17:29
of each of those individuals in a much
17:31
more in a much more meaningful manner.
17:34
Will,
17:35
enable our clinician to assist members with accessing
17:39
those benefits that are essential to enhancing their
17:42
care,
17:43
outcomes and their health outcomes
17:45
and also appropriately connect their those patients to
17:48
their personalized care ecosystem. Again, it's rare that
17:51
somebody doesn't have a caregiver or trust their
17:53
pharmacist or maybe their
17:55
their church association.
17:57
How do we make sure that
17:59
inter interoperability
18:01
and the,
18:02
information
18:03
and data that every point of care
18:06
collects is made available to the broader ecosystem
18:09
so that everybody is always
18:11
up to speed as to what's
18:14
happened the most recently and what the next
18:16
appropriate
18:17
next step should be.
18:19
So when we think about advancement
18:21
to technology,
18:22
Jacob, I think of it in in mostly
18:24
two ways. 1, we need to continue to
18:26
focus on continuously improving that provider patient experience.
18:31
So the technology being in the background, the
18:33
technology being an assistant and enabler, but
18:37
the really unique vantage point that we have,
18:39
spending as much time as we do in
18:41
a patient's home, on a in an individual's
18:44
home to really turn the technology to facilitate
18:48
the most the best possible experience,
18:50
during each of the encounters that we, that
18:53
we perform every year.
18:55
And then the second area for for us
18:57
in terms of advancements
18:58
and continued enhancements to technology will certainly be
19:02
in terms of the interoperability
19:03
that I mentioned
19:05
to really make that real time information,
19:08
available at the the the tip of everybody's
19:11
fingers, everybody who's part of the care ecosystem
19:13
so that each encounter is personalized
19:16
and that each encounter is
19:19
net accretive
19:21
in the way I like to think about
19:22
this to the rest of that individual care
19:25
ecosystem.
19:27
There is a lot of waste today in
19:29
the health care system,
19:32
which which comes in the form of repeating
19:36
activity
19:37
because we don't have the information available. So
19:40
how do we make that information circulate a
19:42
lot better?
19:44
Technology should be what allows the aggregation of
19:47
all that structured
19:48
and unstructured data and information that we have
19:51
about an individual, which could be care medically
19:54
related, could be social, could be whatever it
19:56
is. But that
19:58
aggregation of information
20:00
should then allow
20:01
every actor in that care ecosystem
20:04
of every individual to be informed to be
20:06
up to date with the latest development of
20:09
the health situation or the the the environmental
20:11
situation
20:12
and really more importantly, educated as to what
20:15
to do next.
20:16
So
20:17
to me, technology, Jacob, is what makes that
20:20
end of 1
20:21
a reality.
20:22
It it adds specificity.
20:24
It adds context, precision
20:26
to the health care system the way we
20:28
know it today and the way it operates
20:29
today, which is mostly based on averages.
20:33
Absolutely. Well, clearly, a lot of exciting things
20:36
coming down the pipeline for both the matrix
20:38
and in home care
20:39
more broadly.
20:41
But before we go, Catherine, what else are
20:43
we missing? You you have the ears of
20:45
a lot of health care leaders nationally.
20:48
What else would you like to share with
20:49
them?
20:51
I am personally excited, Jacob, about the future
20:54
of health care. I think the health care
20:56
industry in the US has a unique opportunity
20:59
to to reinvent
21:00
care delivery models, and and home is definitely
21:03
the place where people,
21:05
want to consume,
21:07
health care, more of it to the extent
21:09
that they can.
21:11
And and home is is where we will
21:13
be able to meet individuals and patients,
21:15
where they are and and where they wanna
21:17
consume that care in the home, in the
21:19
community.
21:21
Technology has transformed many
21:23
aspects of our lives,
21:24
and it can, and I think it will
21:26
continue to push the boundaries of health care
21:28
in the way we know it today.
21:29
Matrix touches about a 1000000 lives every year.
21:33
And,
21:34
in this context of being in the home
21:36
of a 1000000
21:38
patients every year in partnership
21:41
with health plan payers as well
21:44
as health systems and providers around the country,
21:47
the organization I and the organization look forward
21:50
to really be part of that revolution
21:52
that
21:53
will empower every individual to live their best
21:56
life no matter who they are and wherever
21:59
they call home.
22:01
Wonderful. Well, Catherine, thank you so much for
22:04
your time and for sharing your insights with
22:06
our listeners today. We truly appreciate
22:09
it. Thanks for having me.
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I'd also like to thank our podcast sponsor
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for this episode, Matrix Medical Network. You can
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tune in to more podcasts from Becker's Healthcare
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by visiting our podcast page at beckershospitalreview.com.