Streamlining collaboration in home-based care with Melissa Kozak, RN, Co-Founder and President, Citus Health

In this episode of the Post-Acute POV, our host Kerri Harpole, RN, Director of Product Specialists at MatrixCare, sits down with Melissa Kozak, RN, Co-Founder and President at Citus Health to discuss how technology is streamlining collaboration and communication in home-based care.

Join Kerri and Melissa as they discuss one provider to another, the prevalence of communication issues in home-based care, the necessity of secure mobile messaging, how to encourage adoption of mobile technology, and more. Melissa details how clinical staff are overburdened and hungry for technology that will take away busy work and allow time for clinical hands-on care. Listen to their discussion below.

Topics discussed during today’s episode:

1. [01:53 – 03:47]: Melissa provides her origin story as a registered nurse and how common pain points she experienced in the field prompted the genesis of Citus Health.
2. [04:45 – 06:58]: Secondly, Melissa describes the prevalence of communication issues in home-based care.
3. [7:44 – 10:34]: Next, Kerri presents the necessity of secure mobile messaging to continue streamlining collaboration and communication. Melissa also discusses Citus’ purpose-built solution.
4. [11:00 – 13:48]: Melissa then discusses the many use cases for Citus’ form center which uses app-less technology.
5. [13:52 – 16:11]: Melissa details how mobile technology allows patients to communicate with their nurses and caregivers 24/7 which reduces readmissions.
6. [16:52 – 21:48]: Next, Melissa describes how they’ve encouraged adoption and seen success due to a preexisting familiarity with mobile technology.
7. [22:27 – 24:27]: Melissa shares how clinical staff are overburdened and hungry for technology that will take away busy work and allow time for clinical hands-on care.
8. [24:46 – 27:47]: Melissa explains the importance of an inclusive solution that is user-friendly and helps a wide range of clinicians.
9. [27:58 – 29:45]: Lastly, Melissa emphasizes the significance of listening to customers when building a technology solution and how Citus has benefited from this feedback.

Resources

• Find out more about Citus Health: https://www.citushealth.com/
• Listen to more episodes of the Post-Acute POV

Transcript

Speaker 1

Hi, and welcome to the post-acute point of view, our discussion hub for healthcare technology in the out of hospital space. Here we talk about the latest news and views on trends and innovation that can impact the way post-acute care providers work. And we take a look at how technology can make a difference in today’s changing healthcare landscape in both home based and facility based organizations and the lives of the people they serve. Today we hear from Kerri Harpole, director of product specialist and her special guest. Let’s dive in.

Kerri Harpole

Hi everyone. And welcome to another episode of the post-acute point of view. My name is Kerri Harpole and I’m the director of the product specialist here at Matrixcare. I’m also a registered nurse with experience in home health, hospice, acute and ambulatory care. Thanks for joining us today while we talk with Melissa Kozak from Citus Health. Melissa is the co-founder and president of Citus health and a registered nurse. As the co-founder of Citus Health she created the post-acute industries first end to end digital health collaboration platform to solve the complexities of managing post-acute continuum of care. Citus Health offers home-based care providers a single digital platform on which all forms of collaboration can occur securely and in real time, making high quality care more accessible and efficient. They are transforming the way thousands of patients, family caregivers, physicians, pharmacists, community service providers, and care teams engage with each other every day.

Kerri Harpole

Hi Melissa, thanks for taking the time to chat with us today. I’m excited to speak with you today and learn about your industry insight and the problems you’re solving in healthcare. And I’m wondering if you could please start by sharing some of your background with us.

Melissa Kozak

Hi Kerri. Absolutely. And it’s so great to be with you today. So you mentioned like you I’m a registered nurse by training. So before I started Citus Health in about 2015, 2016, I spent about eight years as a post acute care nurse. Specifically, I was working in the home infusion industry where I was visiting patients and families in their home and teaching them how to operate complex equipment, administer infusions, and many of them of course had complex diagnoses. It was very soon into the eight years, in the first year, that I realized there wasn’t an effective means of communication, both with the patients and the family members.

Melissa Kozak

So if a patient had a question, something that they felt was urgent, telephone was really the means of communication, which we all know can be problematic. Also similar to home health and hospice, there is a matrix of care team members who need to stay in constant communication with each other to make sure that care is delivered effectively and on time and in the manner in which is safe and timely. And so what I saw was there were systems of record in place like our EHRs, but the organizations that I was working for were really stitching together tools that helped us communicate. So that’s when decided to team up with my co-founder, who is a technologist. And we launched the company, started in that home infusion space, but quickly realized that other areas of home based care like home health, hospice, specialty pharmacy, etcetera, all had these challenges. And so now this is what we do full time and very excited to talk to you today.

Kerri Harpole

Well, I have to tell you, I’m so excited about this because as both a registered nurse and having been a patient myself, I’ve experienced many issues around collaboration and communication, across patient care continuums, right? Post acute world has really struggled with this historically. So I’m very excited that you have solutions around this. And frankly, the lack of communication and the struggles around this area can be dangerous for patients, right? And for providers. So I think this is a very great solution that your team has come up with. I’m very interested to hear about your observations and experiences in these areas and your vision that led you to co-found Citus Health. So let’s talk about Citus Health messaging features.

Kerri Harpole

As we just talked about, communication is key to providing quality patient care. And so often things are missed during transitions. And how can Citus Health help solve these problems?

Melissa Kozak

Yeah, absolutely. And you’re right. Things are missed often during care transitions because unlike an acute facility where generally all of the team members are under the same roof, in post-acute or home based care, we have team members who are in the acute facilities, in the four walls of the home healthcare agency. We have staff that is in the field that is in the home. And everybody really needs to stay tightly connected, okay, in order to know what’s going on, in order to know what’s been done, what are we waiting for, what’s next, who needs the baton next, so to speak, right. So in terms of our messaging functionality, not only do we have secure messaging between patients and family and the care team, but we have secure message groups, if you will, amongst the care team members.

Melissa Kozak

And what this does is it puts all of the communication about the care of the patient on a single secure thread. And that happens from the earliest point. So when the referral is received all the way through to the start of care and the ongoing delivery of care, everyone from intake and billing and case management and nursing and social work, everybody can be on that thread to know, as I said, what’s next, what has been done, what is remaining to do, has there been any updated orders. And what’s nice about this is these communication threads can then be tagged and be made part of the electronic health record system. So that important communication can be retained in the medical record. As you know, Kerri, today if you’re a nurse in the home, you’re trying to log into your EMR, find the right screen, find what happened on the previous visit.

Melissa Kozak

Maybe go through email to see what conversation had occurred with the care team, or maybe text message, because some of us have to do that even though it’s insecure. And so what we’re helping people do is get rid of the disparate systems, put everything on a secure communication stream, include everybody who’s needed and then make sure that communication is retained as part of the record.

Kerri Harpole

I love that. I love this for a couple different reasons. I think it really helps get rid of the issue around the black holes in post-acute, right. And the black holes aren’t even just for the post acute world, but the providers say the PCPs in the community sometimes feel like it’s a black hole to them. People get discharged out to post cute and they have trouble getting information. So I think this really solves both problems. And then I love that it can be attached to the clinical record because it really does help everyone who’s involved in that patient’s care see what’s going on, not miss anything. But also it can help prove coordination of care, which is a big deal during surveys. So I think this is amazing. And then the messaging is HIPAA compliant, I assume.

Melissa Kozak

Yep, absolutely. So that what we’re doing here is giving clinicians and care team members an alternative means of that collaboration and communication, other than text message, which is efficient, but it’s insecure. So the platform is absolutely HIPAA secure. So you can feel safe communicating on it. And even if a patient needs to take a picture of a rash and send it in, that’s not saving to the gallery of their phone, it’s just within the data health cloud. And you bring up a great point about that black hole. I love that the physicians as well and our platform it’s really the more the merrier. And what I mean by that is we not only allow the care team in, but partners as well.

Melissa Kozak

So if an agency wanted to keep their referral sources, their physicians updated on status, how the patient’s doing, any changing condition, they can loop them in, they can loop them into the messaging thread. Or they can just send them updates via an appless form or something like that as well. So it really, I love the way you said it with the black hole, we are trying to close that gap as much as possible.

Kerri Harpole

Yeah. It’s such an important thing that we need to focus on these days. And then at the same time, organizations often struggle to get information out to field staff, which could include many things like an update on a patient, staffing needs, organizational announcements, emergency broadcast messages. The list can go on. Does CITUS offer features to help with this issue through their messaging?

Melissa Kozak

Oh, absolutely. So both our messaging and beyond, we also have some forms capabilities that I’ll talk about. But you’re right. I mean, as a formal field nurse myself, I would sometimes arrive at a patient’s home and not have information about the previous visit and what clinician did. And has there been any updated orders? What else needs to be coordinated amongst therapists et cetera. And so with our message groups, what we call patient discussion groups or PDGs, that nurse in the field prior to walking in the home can click on that PDG and just find out the most important information within 30 seconds. It’s not searching in this system, in that system and trying to piece together a story, calling in the office, waiting on hold, getting transferred, then that game of phone tag and ensues. All of that is precious time that’s spent on non value added activity.

Melissa Kozak

And so we’re helping these clinicians, right, who are already overburdened because of staffing shortages, as we know, get the information they need at their fingertips so that they could just get right into the care delivery, which honest to goodness is why we all became nurses in the first place.

Kerri Harpole

That’s right. And nurses in the field and other clinicians in the field as well, really just need the tools to do their jobs well. Right. And so [inaudible 00:10:45] it’s been a real challenge. And I also know that Citus is one of the few virtual patient care solutions that enables appless technology to expedite documents and signatures. So could you talk about out some of the use cases for appless technology?

Melissa Kozak

Yes, absolutely. And when we looked at putting together this solution, we really wanted to develop an end to end remote patient support platform. And that’s kind of a fancy word for what are all the areas that are still happening either over the telephone or still pieces of paper are being circulated about and chased down for signatures, right? And so we have our message center, but we also have our form center, which is appless and which is what you’re asking about Kerri.

Melissa Koza

So, a great use case here is that with physicians, right, we all know that physicians are some of the most challenging folks to chase down for signatures, right? Let’s say for a home health order. And many providers that we talk to are sending out staff to a physician’s office to track those signatures down. Obviously that takes time away from other responsibilities and it could still take hours to get a single piece of paper signed. Now there are online portals, physician portals out there, but the problem with portals is physicians generally don’t want to operate out of their EMR and that would require them to remember another password, another login. And that adds too much friction to the process. And so what we did is made it easy with our appless e-signature. And what that is is you can literally just send a secure link via a text message or an email, and that physician can click on the link.

Melissa Kozak

They don’t have to put in a username. They don’t have to put in a password. It brings the document up and they can just sign there with their finger, right. And so that is pretty much removing barriers to engagement as much as you can. So we’re doing that. And our customers are telling us that it’s saving valuable time, right, because they don’t have to send staff members out to those physician offices to track down signatures, which during COVID, in some cases is not even allowed. And then medical records loves it because once that document is signed, we then automatically send it, let’s say into the EMR, to be filed. It doesn’t have to be printed and then scanned. So we’re taking out several more steps in order to get that signature.

Kerri Harpole

Wow. That really does sound like a game changer. As a former home health administrator, I remember having to send out liaisons to go obtain orders that hadn’t been signed in a timely manner, et cetera. So this a very big improvement.

Melissa Kozak

So Citus also offers the ability to chat directly with patients, which can be extremely beneficial in the post-acute setting when there isn’t a staff member with the patient 24/7, right.

Kerri Harpole

Can you please describe how this works and the problems you’ve been able to solve?

Melissa Kozak

Absolutely. And this was one of the inspirations for starting Citus. I was an on-call nurse for about eight years. I answered the phones at night and never, even the nights that I wasn’t working, I wanted to give my patients my phone number because I wanted them to get a fast answer. And I think a lot of clinicians feel that way. And so what this does is first of all, a patient or their family member has access to start a chat at whatever time of day. Even if it’s in the middle of the night. But there is message routing that’s going on underneath where the system knows who is the on-call person and routes that message accordingly.

Melissa Kozak

And if for whatever reason that on-call person doesn’t answer, that message will then escalate to somebody else. So we’re really preventing messages and outreaches from getting missed, which of course then can lead to the next number is 911 that that patient or family dials and they’re sitting in the ER, they get re-hospitalized. And that’s a problem for everyone. So some of the use cases that we’re able to solve is let’s say a patient has a rash, right. They can send a picture through the Citus Health platform. It can go to that on-call nurse. That on-call nurse can take a look at it and instruct the patient, hey, just keep your eye on it. And then that communication can be tagged and made part of the medical record. Or if it is very serious and needs treatment, then we’ll go ahead and send somebody out.

Melissa Kozak

Or maybe the family caregiver is with the patient and isn’t really sure which medication should be given now. A video to can be started and we can eyeball, is it really the little blue pill, right, that could be given? So the way to think about it is it’s bringing a line of sight into a patient’s home. So a clinician doesn’t necessarily need to drive out to that home in order to triage or to assess. And it’s also giving faster access to clinicians because they don’t have to wait for the half an hour or hour plus for that clinician to get out there. And absolutely family caregivers and patients are saying that they want faster methods of communication like they see in other facets of their life. So this really is a win-win for everybody.

Kerri Harpole

I think this is such an important part of your platform, just because I think reducing those emergency room visits and re-hospitalizations is a win-win for everyone, like you said. And then during COVID you really don’t want your patients venturing out and going to even the urgent care if they don’t have to, right. Because they could put potentially be exposed to COVID and catch it there. So I think being able to do some of this video chat and using photos could really solve a lot of different problems. And not to mention that it’s less taxing on the staff as well. So how do you get patients and families to actually use the technology available to them?

Melissa Kozak

Yeah, I think actually patients and families, especially the younger generation and the millennials are demanding it. I mean, if you think about pretty much as a consumer, right, because patients are also consumers. In almost every other area of consumers lives, they are using an embracing technology, whether it’s retail through Amazon, whether it’s transportation through Uber, food delivery through door dash, and you can think of a hundred other examples. This has just become the way of everyday life for people. And they’re expecting this from their healthcare providers as well.

Melissa Kozak

And in fact, we asked family members and family caregivers this directly. Earlier this year, Citus Health commissioned a research study via Porter Research. We actually pulled 300 patients or family caregivers who received home healthcare. And then we did another survey with hospice family caregivers that received the care within the last 12 months. And we asked these folks what really goes into your satisfaction scores, right, your cap scores? And what came out of it was fascinating. 96% of home healthcare consumers, the patients and the family caregivers said that if a provider enabled real time communication via a smartphone tablet or computer, just like in these other aspects of their lives, they would be more likely to choose that home health provider and give that provider higher HCAP scores, right. So again, this came from the mouths of the patients and family caregivers themselves.

Melissa Kozak

So I don’t think we really have to convince anymore. But in order to actually get them to use it once it is available to them, what we encourage our customers to do is offer what we call an omnichannel approach. And what that means is meet the patients where they’re at. If they want to use a mobile app, great. If they want to use a computer, that’s fine. If they prefer appless where they never have to log into a mobile app, that’s great as well. And so you’re offering really a multi-channel strategy to remove as much friction as possible so that these patients and family caregivers can engage in the way their most comfortable in these other areas of their life.

Kerri Harpole

Yeah. I love that because I think it’s so important that we meet them where they are going to be able to communicate, right. And it’s not a one size fits all. So are there other features that patients and family members use within your platform?

Melissa Kozak

Oh, definitely. I mean another feature that we have is called the education center, and what this does is it gives patients and family caregivers a digital library of education, if you will, that they can access from anywhere, any device, not just that printed packet of information that’s in the initial start of care box that they have to kind of dig up. But it’s giving them access to let’s say their family members, what the diagnosis is, what the side effects of the meds, how to administer the meds. So no matter where they are, they can really look at this information and feel more empowered, feel more able to help themselves if they’re the patient or help their loved one if they’re the family caregiver. And one of the measures at cap scores around communication is that family member was kept updated on the patient’s condition, right.

Melissa Kozak

And so if you offer an education center, then you actually have the documented information there that you can look back and say, we absolutely provided this family caregiver or this patient with this information and really providing almost like a trail or an audit trail of all the wonderful things that you’re doing for patients rather than if it was done telephonically, which is good in a way, but it’s tough from a retention of information. And it’s hard to go back and say, well, we did inform our family caregivers of side effects of medication over the phone. If you have it in the education center and you have it there in the messaging, then it’s retained. Another feature is appless signature with the family members and the patient so they can sign their admission paperwork, the EOBs and the ABNs.

Melissa Koza

We actually had one story of a hospice customer who the family wanted to revoke the hospice benefit. And they went to the ER. And that instead of the normal way of things, which is the hospice provider sends a staff member out to that ER at 2:00 AM to get the revocation form signed, they actually just sent appless form over to that family caregiver and got it signed to revoke that hospice benefit. So many, many different use cases within the platform that just improved that patient experience tremendously.

Kerri Harpole

Oh, I can definitely see that. And just thinking about the education piece, right. Education is such an important part of what all clinicians do, right. When you think about even nursing and home health, for instance, or hospice, they’re always educating. And in home health, a big part of why they get referred to home health is disease management. And so to have a way to be able to track that, but also have that library available to that patient or caregiver so they can go back and look at it, right. Like, we taught this, but here it is again, if you want to review it again. So I just love that.

Kerri Harpole

So are clinical teams reluctant to use new technology? What are you seeing in that area?

Melissa Kozak

I think there are some, but I also think we are at such a critical point with staffing shortages that we all know that we’re in across the country so that clinicians are being asked to do more because there’s less staff to do it. I think what we’re seeing is that clinicians are really starving for ways to get manual sort of non-value added work off of their plates. So anywhere where they’re getting to a patient’s home and they need further information and that game of phone tag ensues, rather having that information at their fingertips in these secure message threads. Or instead of having to send that nurse liaison, like you were talking about Kerri, out to the hospital to get a document signed, reduce that windshield time, right, and just send it applessly.

Melissa Kozak

Or the overburdened clinician who after a long shift then has to go home and answer the phones for on call rather than having to send somebody out to go assess that rash or go out themselves to assess that rash, they can do it through a virtual visit. So I think what we’re seeing is if organizations all the way from the C-suite level are letting their clinical team know why are they bringing in this technology and that it is here to help them scale, help take away busy work, help them to just do the clinical hands on care that they want to do, then that reticence really abates, right. And you see this willingness to adopt where it makes sense. It’s not just bringing technology in for the sake of technology, but it’s bringing in to deliver better care in a more effective and efficient way. And we’ve just seen wonderful adoption as a result of that.

Kerri Harpole

Yeah. I couldn’t agree with you more about that. I think once people realize how much technology will help them and be the tools for them that they need, so they can actually focus on the patient, they’re much more excited about it. So how inclusive should a collaboration tool be when it comes to a care team?

Melissa Kozak

Yeah, I mean, I kind of said before the more the merrier and that’s really how we feel about it. It should be completely inclusive. To truly collaborate in home based care where that care team is multifaceted and not everybody is sitting in the same room, you really have to have a solution that can bring everybody into a circle to communicate. So that’s everybody from the care partners, whether it’s physicians, looping in the DME, the upstream and downstream care settings, it could be the infusion pharmacy.

Melissa Kozak

And we do this and our model is we don’t charge per user or anything like that. We do that on purpose because in a collaboration platform like Citus, the more partners, staff members, patients, family caregivers, you have communicating, collaborating the better off everybody is. In fact, our tagline at Citus Health is when we’re better connected, everyone wins. And we mean that, everyone. So to answer your questions, absolutely bring in everybody that is a member of the care team, whether they’re part of the organization or external to it.

Kerri Harpole

Yeah. I think that that’s really so important and both as, like I said before, as a registered nurse and I’ve been a patient myself. And it seems like the difficulties with communication, particularly in the post-acute world, they’re really challenging. And as a patient, you can see it too. So I think that more that we can do to get rid of that black hole and improve that, it’s going to be a win-win for everyone.

Kerri Harpole

So are the there any other areas you’d like to share about the product that I haven’t asked about?

Melissa Koza

I would just say that what we’re really passionately focused on right now is the critical nursing and clinician shortage that we’re all in. And retaining, retaining talent. And we want to help agencies right now implement solutions, again, that reduce the burden that these clinicians are under so that they can have some sort of balance in their life that they can go home and actually recharge their batteries and not be bogged down with paperwork and additional phone calls and writing notes and things like that. And so we’re hopping in every conversation we can right now about clinician shortage, because if you can’t get more clinicians into the workforce, which I know everybody is working hard to figure out how to do that, what you can do is figure out a way to give hours back to the clinicians that are already in the workforce.

Melissa Kozak

And so that’s what we’re doing along with helping providers improve their cap scores through better patient and family caregiver satisfaction. So those are the two things that we’re really focused on now and would love to help anybody who’s interested.

Kerri Harpole

And then Melissa, so as healthcare is evolving rapidly and the needs of the industry seem to be changing constantly, how do you stay in touch with current needs and trends?

Melissa Kozak

We really listen to our customers and what they’re telling us. When the first few years of the company, we didn’t have the appless technology for example yet. And so we heard our customers loud and clear. Not everybody wants to use an app, right. And so the trend was how can you remove barriers to engagement? And so we put a lot of focus from a product roadmap perspective, right, on appless.

Melissa Kozak

Now what we’re hearing as we go to conferences and we listen to our customers, we know that value based purchasing is around the corner. And we know that cap scores are really going to matter. They already do matter because they feed into star ratings and better star ratings means more referrals essentially. But now we know that agencies are going to be financially incentivized or penalized based on those cap scores. And so how can we help them to improve that? Right. And so our focus is on assisting with patient and family caregiver satisfaction and communication, and making sure that information is shared and these folks feel heard. The other industry trend that there’s not a conference that we’ve gone to. Now that conference season has kicked off again, that we’re not hearing about the shortages of clinicians. And so it’s just keeping our ears open. What is happening with legislation? What is happening with these associations? What are they talking about?

Melissa Kozak

What are the big agencies focused on and talking about? And then we want to stay right there. Technology can’t solve everything. And we know that, right, but there are some major challenges that only technology can solve. And so that’s how we decide what to focus on and stay updated with current industry trends.

Kerri Harpole

Great. Well, thank you so much for taking the time to chat with us today and share your insights. You’re clearly an industry visionary, and we’ve learned so much from you today. Do you have any closing thoughts you’d like to add?

Melissa Kozak

I just want to thank you too Kerri. It was a pleasure to speak to a fellow clinician who is passionate about technology as I am, and just thanks to Matrixcare for inviting me onto the podcast today.

Kerri Harpole

Thanks Melissa. I really enjoyed it as well.

Speaker 1

That concludes the latest episode of the post-acute point of view from Matrixcare. We have a lot of guests and topics coming up that you won’t want this. So be sure to subscribe. If you’ve enjoyed today’s podcast and if you have a topic you’d like us to discuss, leave us a review. To learn more about Matrixcare and our solutions and services, visit matrixcare.com. You can also follow us on LinkedIn, Twitter, and Facebook. Thank you for listening. Be well and we’ll see you next time.