Technology and Training for Continued Growth

Intro: 

Welcome to the MHA Corner Podcast, where we discuss news and developments in the post-acute space. Today, we sit down with MHA Senior Consultant Dustin Cowan alongside Allan Levine, Senior Vice President of Revenue and Growth, with our strategic partner, Nevvon. The pair discuss the current state of retention and growth in post-acute care, along with the importance of culture and upskilling in cultivating successful agency outcomes and the overall trajectory of market activity in post-acute care. 

 

Thanks for joining us today. I'll just have you both take some time and introduce yourselves, talking about your background and what you do. 

Dustin: 

My name is Dustin Cowan. I am a senior consultant with Maxwell Healthcare Associates. I specialize in clinical informatics and have a background in mergers, acquisitions and EMR transitions as well. 

Allan: 

Allan Levine, Senior Vice President of Revenue and Growth with Nevvon. This is my third stint in healthcare, now. I have a background, started my career in human capital management. Done a lot of integrations, using technology to help companies grow business operations, growth strategy, done a lot of different things in many different industries and love healthcare. And that's why I keep coming back. 

 

What are some of the key challenges that healthcare organizations face when navigating consolidation and how can they be overcome? 

Dustin: 

As I thought about this question, two main components, cultural and operational adoption are very important, as well as employee retention. So cultural and operational adoption, really procuring the right culture from the beginning and understanding what that culture is going to look like as we look to a new entity, merging and consolidating and making it clear and concise so that the employees have the key to success of the operational adoption. 

So, if they're buy-in culturally, it's going to be a much lower bar to get them to buy-in operationally and kind of build off of those new processes or those new operation management that you have. And employee retention, maintaining human capital, especially healthcare, today, nursing jobs are a dime a dozen. 

There are people going everywhere and that availability to kind of easily transition in between roles and with jobs. So, it's important that we hang on to those strong employees understanding who they are and situating them so that they can give that understanding, that knowledge and execute changes and properly manage their subordinates through the entire process. 

Allan: 

And just to build off what Dustin said, I think, you know, integration can create a lot of friction and, especially when it comes to culture, I think culture is probably one of the things that's overlooked the most when you're thinking about integrating and consolidating, especially in the healthcare field. 

You have to also think about change management strategies. So, how are you going to make this change happen from your users to your clients to your patients to your employees? Again, it depends on who your key stakeholders are. So, you have to think about change management through all of those use cases. I think there's a way that you can leverage technology to unify those systems and create seamless communication and interoperability. 

We do a lot of change here at Nevvon from a training perspective. It's always positive change, but change, and change takes work. And one of the most important things that we try to impart on everybody is it has to come from the top down. And I think when you're thinking about this question, if leaderships not bought into anything, it's not going to flow down through the rest of the organization. 

You have to think about how you're going to communicate. So, to build off a little bit more about what Dustin said, is it going to be writing? Is it going to be online? Is it going to be in person? How are you going to get that message out to people, so it resonates, and it hits home and you're able to impact that change that you're looking to make. 

And then segment your users as well. So, make sure they understand the why, but segment how are you going to communicate to your different user groups? So, employees, caregivers, nurses, patients, whatever that stakeholder is, you have to think about how you're going to communicate directly to them.

 

In what ways can technology and training facilitate integration and also interoperability within merged entities? 

Allan: 

Yeah, I mean, that's what we do here at Nevvon. So, Nevvon is a caregiver training platform. We're kind of a one stop shop for all your training needs, from compliance standpoint to upscaling to mentorship. We have this course library of over 300 pages. And we just achieved an important milestone. Last week we had over 100,000 lessons completed in a day, which is exciting for daily usage of our system. 

But to bring it back to the question, you have to think about standardization. So, from a training perspective, you have to make sure that everybody understands the proficiency in the new system and practices that you're trying to achieve. 

If you're rolling out a new AMS or EHR, depending on which acronym you want to use. You want to train the users on how to use that system as an example, so that you can facilitate integration and interoperability. EVV, something that comes to the top of mind that we see all the time in our world. 

So, we train a lot of caregivers on EVV adoption, which naturally will lead to higher adoption of that AMS system that that caregiver is using because we're training them how to use it every day. We motivate them, we encourage them, etcetera. You can put things like rewards and recognition in place as well. Create leaderboards, things of that nature, to really overcome that interoperability hurdle that sometimes comes with bringing systems together. 

You know how we train caregivers, that really ties back that base layer of users to use a system properly, we provide bite size lessons, I should say. So, all our content is no more than a few minutes long. That builds into a module which builds into a program which can be hours long, for example. 

So, the services would be 12 hours long in most states. We gamify it; we make it fun. So, get that user engagement high, get them pushing buttons, getting hits next, getting them to answer quizzes on the fly, whatever that is, to get them to engage with the system to ensure that that learning stays train in their native language. 

Another thing that we've learned that we do really well is we train now up to ten different languages across the US and Canada. So, giving that caregiver that comfort that we're training them in the native language that they're comfortable with, so they learn the system that you want them to learn or learn the lesson that you want them to learn. 

And then finally, I think the biggest piece of getting over this integration and interoperability hurdles sometimes is creating a seamless experience. So single sign on as an example. So, if you can give that caregiver one less username and password to remember, that's really going to help enable that system to come online. 

An example again would be an agency management system, or EHR, depending again, which acronym you want to use. But most of them have a training button. And when they hit the training button, the caregiver is seamlessly logged into Nevvon, and all of a sudden that's one less username and password that they have to remember. 

It's going to create higher compliance, it's going to train them on topics that you want them to have at their fingertips and really just lead to higher engagement on that platform, which ultimately leads to a better experience from an interoperability standpoint. 

 

What strategies would you say healthcare leaders can employ to effectively manage that cultural integration and foster a cohesive organizational culture post merge or acquisition? 

Dustin: 

I think the first thing first is identifying what commonalities that you have as far as your base culture. So, if you have or you're moving into a new organization post-merger, you have the culture that you want to achieve. First, you need to take those other previous cultures and identify what kind of similarities we have and really focus on those to bring people into the fold. So, it's a we conversation and not an us and them conversation. 

Or the old way versus the new way. So, as we start to really focus and use that approach, we find those similarities, and we're in the healthcare sector, so a lot of our culture is going to be surrounding patient care. So, we focus on that patient care aspect and use that as the building blocks. 

And that's something that we can all agree on. And once we are able to agree on that basis of what we're building upon, then we can start to pick from each of the organizations what we about this culture versus the other culture and moving towards that common goal of a cohesive culture in that new environment. 

Allan: 

A trend that Nevvon is seeing and that we're supporting through our platform is blended learning. Blended learning, as an example, is pre COVID. And then we had COVID, and COVID was really the accelerant for e-learning, and nobody had a choice but to use a platform like ours. And as we come out of the COVID world and back to whatever this new normal is, e-training is here to stay. But there is still this idea about how we want to see our people. How can we support cultural initiatives? How can we ensure that we're communicating well and effectively integrate these cultures together? So blended learning is becoming very important. 

And blending learning is this idea of one platform to support both synchronous and asynchronous learning. Simple terms, because I always get them confused, is, you know, using your mobile phone to push out e-training, but also having a platform to facilitate face to face learning. 

An example of that might be you hire a caregiver as an example. You might bring them in because you want to see them face to face. You want them to experience that culture that you have within your organization. Spend a day in the office, do some training face to face, track that in your Nevvon training platform that we've done 8 hours together today. And when we send them on their way out into the field to see some patients with some great training, they also have at their fingertips more training available to them through their e-training or on their phone as an example. So that's an idea of blended learning and how it can work to really support those cultural initiatives. 

And really, it's important that you should want to see your people make sure that they feel part of something and support that through a training initiative as an example. 

 

How can healthcare organizations ensure regulatory compliance amidst consolidation and the ever-evolving regulatory landscape of home care and healthcare? 

Allan: 

So, compliance means a lot of different things. So, I'll just define it from our perspective. And when I put our Nevvon hat on, it's training compliance. So be it. You're in services, orientation waiver, Department of Labor, Department of Health. Whatever sort of training requirements one of those or all of those entities have, that's what we do. 

Staying on top of compliance, frankly, is difficult for a lot of home care agencies. We have a team dedicated to staying on top of compliance and regulations. So, I think it's really important that if an agency is not going to stay on top of their compliance, because it's so difficult, you have to pay attention to so many different things. 

How do you stay on top of it so you can work with somebody like us? And we're always on top of whatever sort of requirements are coming from the state, from the city, from waiver programs, whatever that is. Because we're plugged into every single state and we have customers across the United States, we have to make sure that we're staying on top of it. 

Other things that agencies should be doing is staying on top of their training programs again. So, if an auditor ever walks in, make sure that you've got your documentation ready to go, making sure that you've got the technology that you can easily report on. So, a great example is we worked with a customer recently where they had, before they were using our system, everything was paper based. 

And they were in a scenario where an auditor came in and they said, show us all your training completions. It literally took them almost three weeks to consolidate a year's worth of training completions for the auditor when they moved over to us. That's one report that's drafted for them as a CSV or an export in excel, or we can push it into their agency management system. So, think about using technology to solve this problem. 

From a compliance standpoint, staying on top of what those training requirements are is definitely another thing. So, with us specifically, you have a dedicated account manager. Their job is to make sure that we're recommending whatever training you need from a compliance standpoint. And then ultimately, how do you make sure that that training gets completed?

So, we were proud to say that we were able to get our customers to about a 90% completion rate when it comes to compliance. And how are you going to make sure that that happens, be it engagement, motivation, rewarding, recognizing them, pushing them to do it, incentivizing them to do it. 

There are many different ways that you can get caregivers to do training. It's not easy. And that's, those are a lot of different things that I think agencies should be thinking about as these regs are constantly changing, is make sure you have somebody, a partner that you can work with that can help you stay on top of it, because it can get pretty overwhelming to do it on your own. 

Dustin: 

To add to what Alan is saying, when I think about it, I think about from a competency standpoint. So, when we're looking at our staff, our clinicians, we have ever-changing regulatory requirements that go along with training. So, using competency testing to see and meet your clinicians where they're at and then have targeted learning that goes with that based off their competency testing. 

So, working with a partner like Nevvon to build those training platforms and tests so that you're giving your clinicians the confidence to continue and to grow in their career, and that's going to help to retain your staff. They're going to be a lot more satisfied with their job and that confidence is going to be given to their patient as well. So, when they're interacting with their patient, they have had the learning, they know what they're saying is true and is proven to work, and that's going to translate to the patient and translate to better outcomes all around. 

 

What role does talent development play in driving success within centralized systems? And how can e-training platforms like Nevvon support this. 

Dustin: 

So, I'll take this one, Alan, to start with. I think talent development is extremely imperative for the long-term viability of any organization. As I kind of mentioned before, retaining that human capital, keeping those clinicians, especially as we begin to consolidate and merge, is very, very important. So, if we are able to use the talent development to reduce nurse turnover, as regulatory burdens increase, we want to decrease the, the time that it's taken you as a clinician or as an employee to maintain up to date, information as it relates to the regulation. 

If we streamline that using small bits of information at a pace that is driven by the user, then we're going to then make them feel empowered, make them feel knowledgeable. And, you know, with power and knowledge, we can kind of get rid of the fear of change of what's to come. We feel more stable where we're at and we're able to maintain those individuals. 

Allan: 

Yeah, if I could add to that, I think there's a stat that we've got. I think it's something like 93% of employees would stay longer with a company if they invested in their learning and development. People want to feel like they belong and part of that is a company that says, hey, I'm going to invest in your learning and development. 

This to me is, you know, talent development is another way of saying retention and recruitment. So exactly what Dustin was talking about and the way we look at it is if you don't have a great retention solution, then recruitment is going to be not a waste of money, but you're going to be spending a lot of extra dollars on that you don't need to.

It's almost like a leaky basket, right? If your basket that is retention is not, you know, put together well, then people are just going to be going out the back door, in through the front and out back, or water through the basket is going to leak out the bottom. 

So, think about it that way. We just did a study in Massachusetts. We were working through one of the state associations there with 27 home care agencies, representing about 3000 caregivers across the board. Through eleven months of this program that we were working with, we rolled out a training mentorship program in Knowhow. 

And the numbers are insane. We had a 96% retention rate after eleven months on the program. So, most of the caregivers that started with them eleven months before were still there. We had about 150 people go through the program. And this idea of a mentorship program is one way to provide a leadership opportunity to your employees. 

It improves job satisfaction. It's a career ladder opportunity for experienced caregivers. There're all sorts of benefits that it has, but it really ultimately is a retention solution. So, if you think about that from a dollar and cents standpoint, NAC has a number. It's about $2,500 to $3,500 to replace just a caregiver. 

That's a non-medical caregiver. So, an HHA or PCA job title like that. And if you're hiring 100 people a year, it's a lot of money. If you're at 60% retention, that means it's 40 times $2,500 per person that's going to leave your organization. In other words, $100,000. So, if you're able to improve your retention and, say, 80% and cut that number in half, you're saving $50,000 right there from an ROI perspective. 

  

What are some kinds of caregiver or patient centric approaches that organizations can adopt to enhance the overall patient experience in a centralized environment? 

Dustin:  

We keep coming back to the same point of culture, because culture is really the key to everything moving forward as we go into these mergers and to these consolidations. So, if we have a patient centered approach and we're focusing on the patient's experience, you have a team that sees the patient for more than just the patient. 

That's, they see the patient as your neighbor, as their family, as their friend, and they're able to kind of invest more in that patient's care and that the care that they're providing as well. So in order to get that culture, you really have to understand your employees and also be able to educate them on the culture you're trying to establish and trying to build. 

Allan: 

Nevvon's motto is better training, better care. So, we believe the better that caregiver is trained, the better that the care they're going to provide to that patient or client. From a training aspect, it should be relevant training for sure. So, you know, going beyond just compliance in terms of what's required, we see a lot of agencies now investing in looking at their population, looking at their patient population or client population and saying, hey, where do I want to upskill my caregivers here? 

So, things that are coming top of mind are dementia, fall prevention, communication, as an example, which ties very much into value-based payments, keeping people at home and providing better care to that patient. And how can we make that caregiver better at their job and using the tools around them? 

And then I think patient centric approaches tend to involve personalized care plans, better communication feedback mechanisms as well. We see a lot more surveying now. So caregiver surveying and taking that feedback and not just reporting it to the state as an example, but maybe there's an opportunity to make yourself better and create a flywheel internally around constantly taking the feedback that you're getting from both caregivers and clients through surveying and enacting that into your organization as a whole to make it better for everybody, to provide ultimately better care to that patient. 

  

How can solutions-based firms like MHA and e-training platforms like Nevvon collaborate to support organizations while navigating the challenges of consolidation? 

Allan: 

We are a technology company. We're a content company. We create all our content for training, but we're also a tech company. And with tech company comes ROI. What type of administrative and operational efficiencies can an organization achieve by integrating a platform like ours benefit things that we see a lot of agencies able to achieve through us is automation, through APIs, as an example. So, we have an open API. I reintegrate with pretty much every EMR out there these days, or HR systems and payroll systems and whatever the 

So, thinking about it from an ROI perspective on training, I'll give you an example. We just did, an ROI for a provider in a state, pretty much large state, multi-location, across the state, represents just under 5,000 caregivers. And through automations that we were able to do for them, we were able to save them about half a million dollars a year just on training expenses alone. 

So, things, they used to mark quizzes manually as an example. So, they'd have a class of caregivers come in, they'd leave their quizzes, with the RN at the front of the room and they'd leave an RN, or somebody would have to mark those quizzes before they could start working. And this was a long competency type test. So now through our platform, we can automate all of that for them and do it and give them the results in real time. So, we can get that caregiver working faster. But at the same time, take that administrative burden off of the agency and roll it out quicker. 

We could get that into a payroll system for them right away in real time so that pay would be included on the next payroll, assuming that's the way that they wanted to do it. Training assignments, calling caregivers to start training and complete training. All of these efficiencies we were able to create for them, which led to this tremendous ROI from an operational and administrative savings standpoint. 

It's not just training. There's a lot more to rolling out a tech platform like ours within these organizations, be it small, medium, large, or enterprise, where you have these tremendous efficiencies that can be created and to. 

Dustin: 

To build off that. As consulting firms working with healthcare organizations, we help them to identify deficiencies through an assessment-based approach. And as we find these deficiencies, we can get them partnered with an e-training platform like Nevvon. And work with Nevvon hand in hand to say, okay, here are the things that we've identified that are grossly outside of where they need to be as far as regulatory, or compliance based and help them to integrate that into their internal processes so that they have a streamline. 

Because a lot of companies, especially in healthcare, they do healthcare, they're not so versed in the IT portion of it. And so, it's just another process that gets layered on top of an old process, and then we don't have cohesion among the organization. We can really help them embed that e-training platform into their internal processes so that they ensure that that's flowing across their whole state or the whole country and it's with some of our clients. 

So, I think it's very important for us to have that hand in hand approach so that we can identify, they can have the content, and we can help them not just deliver, but adoption. Adoption is key. We suggest lots of training platforms, we suggest lots of, technologies, but if they just sign up for a year contract, or two years or three years, if they're not deeply embedding that into their internal processes, then at the end of that three years, what do you think they're going to do? They're going to be looking and say, hey we spent x $1,000 on this. Are we really using it? Half are half or not? So, if we're going to make cuts, right, there's your cut.  

We don't want that to happen. We want to embed it where you have to have it, air. You've got to be able to have it to breathe as an organization and keep that continuous flow of education and knowledge throughout your entire organization. 

  

What emerging trends, if any, do you foresee shaping the future of healthcare delivery in the context of continued M&A activity and centralization? 

Dustin: 

I don't foresee it to slow down at all. I think that we have the opportunity to really share EMR electronic records among different facilities and different providers, and we can provide that same training among all of the staff. So, your pharmacy knows what your skilled nursing facility is doing and what your hospital is doing and what kind of education your home health company is providing. As we continue, this is going to be more of the norm and less of the big news for the week. So, I think mergers and acquisitions are here to stay, and they're just going to get larger and more frequent as we continue.  

If we look at value-based purchasing, it's really in order to get the biggest bang for your buck is going to be spending money internally so that you can increase your outcomes throughout your entire program and everything that you offer. 

Allan:  

I agree, M&A margins are getting squeezed across healthcare, and M&A, I think, is one scale helps with margins, for sure. I think that will, to Dustin's point, only continue to accelerate. Think about things like the 80 20 rule that, legislation, but it's got a six-year runway. I'm not an expert on it, but I definitely know that there's a lot of talk about it on the Medicaid side of things, in terms of what impact that has, if it even comes to fruition. 

There's a lot of consolidation happening in the industry from an M&A perspective. The topic du jour is AI things to predict patient trends, to predict what's coming. Value-based payments are a topic that will lead to more centralization. When you're thinking about, well, how can you achieve that through economies of scale? You do it through consolidation as well. To sum it up, centralization, adaptability, scalable solutions from a technology standpoint to help manage your workforce and create that, ultimately, that interoperability for you is where we see the world going perfectly.