The impact of interoperability with Nick Knowlton, vice president, strategic initiatives, ResMed and board chairman, CommonWell Health Alliance

For this episode of the Post-Acute POV, our host Navin Gupta, SVP of the home and hospice division at MatrixCare, is joined by Nick Knowlton, vice president, strategic initiatives, ResMed, and board chairman, CommonWell Health Alliance, to explain the impact of interoperability.

Listen in as Nick and Navin review the findings from our recent survey which polled 100 health systems and physician groups, 300 home-based care organizations spanning home health, hospice, palliative care, and private duty, and for the first time, 300 skilled nursing facilities. The results show progress—yet significant gaps—and an opportunity for both home-based care providers and skilled nursing facilities to improve their electronic data-sharing capabilities.

Questions to ask your technology provider to strengthen the impact of interoperability:

1. Does your system exist in the native workflow or outside of the solution?
2. Is the documentation your system provides only in a human-readable format?
3. Can your system reconcile medications directly into the patient’s chart?
4. Can your system provide insight into mid-episode encounters patients are having?
5. How can your system help with PDGM or navigating palliative care programs?
6. How is your system able to communicate the quality of care back to referral sources both actively and passively?
7. Will your system work for my local geography and current referral source relationships?
8. Ask your vendors about the usual business questions too – Is there a high surcharge to connect? Is it part of my core software package? Is the value aligned with the cost?

Topics discussed during today’s episode:

1. [02:50 – 04:48]: What is interoperability and what problem does it solve?
2. [05:41 – 09:22]: The survey found that 95% of providers say they believe interoperability is crucial, compared to 34% in the previous year. Nick explains what he attributes this jump in better understanding the importance of interoperability to.
3. [11:36 – 14:13]: Nick describes why referring physicians are more likely than ever to switch partners to those who they believe can more effectively process electronic referrals.
4. [14:47 – 17:50]: Nick explains the four tiers of maturity in relation to interoperability: basic, moderate, advanced, and high-performing.
5. [18:54 – 20:43]: Nick talks about the types of conversations providers should be having with their technology partners if they are interested in improving interoperability. Note: The questions Nick provided are listed above.
6. [22:04 – 25:41]: How interoperability can help mitigate immediate workforce issues providers are facing.
7. [27:00 – 29:54]: How providers who are on the fence about interoperability can get started. Nick lists actionable steps providers can take today.

Resources

• Find out more about our commitment to interoperability: https://matrixcare.com/interoperability/
• Download the survey report
• 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 care organizations and the lives of the people they serve. Today, we hear from Navin Gupta, Senior Vice President of Home & Hospice Division for MatrixCare and his special guest. Let’s dive in.

Navin Gupta

My name is Navin Gupta. I am the Senior Vice President and Division Head for the Home & Hospice Division at MatrixCare. Really want to welcome you again to another episode of The Post-acute Point of View in MatrixCare podcast. Today, I am joined again by a good friend of mine, Nick Knowlton. Nick is the Vice President of Strategic Initiatives at ResMed and also is the Board Chairman of CommonWell Health Alliance, where he leads a number of Strategic Initiatives all tied with healthcare interoperability. He’s championed these inter-op projects across post-acute ambulatory and acute care settings, and really worked for many, many years establishing a culture to support patient-centric interoperability. Prior to joining ResMed, Nick ran Strategic Initiatives for Green Bay Health, really a market leader in physician practice EHR space. Nick, welcome back again.

Nick Knowlton

Thank you so much, Navin. Always a pleasure to be chatting with you.

Navin Gupta

Nick, so it’s been a decade. We talk about the federal government. They started subsidizing the meaningful use of EHRs for acute and ambulatory care providers, and they started on the inter-op journey. And as the narrative goes, it was a good strategy, but there’s an important piece left out of the puzzle and that was the post-acute providers. But that’s changing, and that has been changing pretty rapidly. We’re going to talk about the inter-op survey now running two years in a row. It’s been done… As you know, Nick you’ve been involved with it, partnership with Potter research, very, very thorough, almost 700 respondents, 100 health systems and physician groups, 300 home-based care organizations. And this year skilled nursing facilities were included as well.

Navin Gupta

I believe from an industry perspective, it’s one of the most comprehensive point of view developed on interoperability within the post-acute segment. So Nick, we’re going to dive straight in. We definitely want to tease out lessons learned from the inter-ops survey, but we have a number of listeners and they may be getting a first introduction to this notion of interoperability. So help us just define what exactly do we mean by interoperability and of the highest level, what problem does it solve Nick?

Nick Knowlton

Well Navin that’s a great way to start this, level setting on the definitions always solved. So last year, for those who aren’t familiar with the first round of the survey we did in that initial go around to discover how provider organizations view and interpret the very meaning of the word interoperability. We surfaced multiple different definitions to them. And actually surprisingly to me, the most technical definition, one out here, and that is the definition used by HIMSS and for our audience members who are not familiar with HIMSS, HIMSS is the Health Information Management System Society. It’s the largest group of health IT professionals that includes members from all around the health care ecosystem and all around the world. And every year they host a 45,000 ish person gathering to discuss the latest and greatest. So they’re one of the foremost authorities on health care information technology to begin with and their definition of interoperability is this.

Nick Knowlton

It is the ability of different information, technology systems and software applications to communicate, exchange data and use the information that has been exchanged. And that definition won was providers from all care settings in [inaudible 00:04:04] survey the last year. It beat out much more simplistic definitions we sometimes use in the industry, including some of my favorites such as just get the right information to the right place at the right time. And I think, for the audience, as we jump into this conversation, really key to this definition, winning was something that I’m sure is relevant to the data presented in the survey. And I’m sure you’ll be asking me more about it later. And that is that we need to make this information useful. The last part of that definition included the phrase, use the information as an exchange. So part of the definition we have to be able to use the information as exchange and documents in and of themselves that are just human readable. That does not really surprise for a definition, true interoperability.

Navin Gupta

Nick, I love it. It’s not just interconnectedness for interconnectedness sake, but ultimately, using the data to good use and optimizing the health of individuals and populations at large. There was some really encouraging news as I study, the paper, and one of the quotes that jumped out at me was 95% of providers say they believe interoperability is crucial compared to 34% in the previous year. And then there was continuous and it talks about 85% of providers claim. They are able to accept admission, discharge and transfer feeds ADT with 72% reporting they accept clinical information in some format. Now this is almost three times a jump in better understanding of the importance of interoperability just within 12 months. How would you attribute this to Nick? What’s going on here?

Nick Knowlton

Well Navin, first and foremost, I’d certainly agree with you. This was one of the more shocking numbers that stood out to us in the data is that jump in recognition of the importance of interoperability amongst the post-acute providers survey. I think the data that we gathered in the first round of the survey predicted this to a certain extent, for any new trend, you have to have awareness before growth. And to me personally that about what this data shows? So last year we reported a gap of 60% of referring providers reporting that they would be willing to switch care providers if they were able to accept electronic referrals and only 34% of post-acute care providers understood that importance of interoperability to their referral sources. And this year, the referring provider number for demanding interoperability is up to 74%, but the post-acute providers now seem acutely aware of that need with 95% noting that it is important to their referral sources.

Nick Knowlto

And that is a huge evolution. And the industry is really catching on that. This is important for referral sources and hence for their agencies. But we also pick up in conversations that we have around the ecosystem. I would say this is more anecdotally, not necessarily captured in that data, but there’s a growing awareness of the importance of interoperability for how we want to care delivery in this country. And for the patients themselves, even the family members of those patients are starting to get it. So we live in this world of rising consumerism and healthcare and the pandemic did nothing but accelerate that trend. I literally set foot in a grocery store last week for the first time since this pandemic started. And I’m lucky enough to live in a city with Amazon, Fresh, Shipt Instacart, we have it all and I’ve grown accustomed to having those systems speak to my phone is my order accepted.

Nick Knowlton

Is it in process? When will it be here? And now that we have a taste of that in healthcare patients, I mean, I fully expect my primary care position to have electronic access to lab results. And I want to see that info, my mobile portal. I’d expect the same when I’m helping my [inaudible 00:07:41] dad navigate his own care journey, which includes a lot of post-acute care settings these days. And I expect the same from those groups so that do my health system. Patients are waking up to this potential and referral sources who deal with the patients who enjoy the power of inter-operability, assisting their care journey in a patient-centric manner and acute ambulatory care settings are already there. They are absolutely expecting it of their care delivery partners in post-acute and that data shows post-acute care providers know what to. So I really viewed that change from 34% to 95% a validation of what we’ve seen emerging in these trends for years.

Nick Knowlton

And that is that these post-acute care agencies are waking up to the fact that because their referral sources can exchange electronic information with other care providers in other care settings, they know it’s time to get on board. So you did point out that there was some data on ADT and clinical information being exchanged. We’re seeing a lot of document level exchange taking off this year. And my question starts to veer into, well, what format are those ADTs in and what format is the clinical information? And these are the big next questions. And tying that back to our opening discussion on a definition of interoperability is the power of the data in these documents being unlocked and loaded in the post-acute EHR? Is return trip of information in a format, the referring provider and other care providers that deal with our patients need?

Nick Knowlton

These are the questions I think we, as an industry next need to delve into, but I hope that gives you an overview of, I think, where we’re at with the evolution in post-acute care providers, waking up and really embracing what their referral sources want to do. And also some of those green shoots that we see for interoperability that we need to dig into next.

Navin Gupta

Yeah Nick, certainly the awareness, the education, and you touched on… I’m certainty the pandemic had a role to play in acceleration. When you don’t have access to a facility, you can’t go in, you cannot do warm handoffs. You can’t have that same sort of discharge and the transitions of care related workflows as you might have in the past. So you’re looking at electronic means to do this. And then the other really, really valid point is really the consumer mindset has much higher expectations than we expect of our own health system. So somehow we feel we are working to specialist and a primary physician, and we’re maybe doing home health and yet none of them necessarily are talking to each other and somehow we’ve settled that, that it’s okay when it’s not okay. And I think every constituent, every stakeholder driven by consumers that this got to be better and they’ve seen it in other areas of their lives.

Navin Gupta

Certainly they expect that from a healthcare as well. And then, you know, to your final point, it’s really unlocking the data, the standards that are there are all the information flowing and being consumed appropriately to drive meaningful results. I think just that awareness that’s growing is already a massive shift that’s happened in the last 12 months. Nick, another related broad macro trend that we see within our industry is this really this notion of the narrowing of the referral network.

Navin Gupt

So you’ve got more networks being formed, upstream, referral providers, referral sources, rather than not wanting to work with a large number of post-acute care settings, but want to work with them that are able to drive better outcomes. Particularly if you’re focused on risk-based contracts or value-based programs that they all may be participating in, you referenced this saying, referring physicians are more likely to change their partners. In the past, we talked about, last year the survey was almost 64% this year at 74%. This is a big shift where the demand for post-acute providers really taking inter-op very, very seriously is critical in better words for their survival. Do you see the same way Nick?

Nick Knowlton

Absolutely Navin. And I really can’t state this enough. This is a critical time for agencies and care providers in our post-acute landscape and absolutely critical time. Yeah. As I mentioned, referral sources have been used to interoperability and other care settings that’s emerging the more mature levels for years and it’s driving critical decision making for them now. They recorded in the first round of the survey last year that they disliked the extra phone calls from post-acute and the extra paperwork and faxes that is caused by lack of interoperability. Almost as much as we dislike the problems caused by extra phone calls and faxes in post-acute. It really disrupts their day and threatens how they deal with their own value-based reimbursement contracts. Now in a pandemic when post-acute providers to your point have been distanced from their referral sources in more ways than one.

Nick Knowlton

And in some instances even locked out of referral sources, physical locations to use, the one last ditch chase down the physician for a signature mechanism that we’ve had to deal with in post-acute for years and years. This problem is one they’re acutely aware of, it stares them in the face every day. There’s a ton of interoperability happening every day in other care settings, millions of direct secure messaging addresses in use, growing post-acute care referral networks, CommonWell and Carequality have hit the proverbial hockey stick type inflection points in growth and referral sources are becoming accustomed to a lot of very powerful interoperability tools or those other care settings. And they want to end what they typically saw as a gaping hole in their visibility of the patient journey. And that is what we have seen for years in post-acute. So for a few examples here, CommonWell had a billion documents for treat a few weeks ago that running rate is more clinical information moving in a week than we put through the network and one of the early years.

Nick Knowlton

The emerging OMC MCMs interoperability roles are going to amplify what those care providers are used to from other care settings and post-acute care providers. You can differentiate themselves and match suit for their referral sources, standards benefit greatly. And we see this all the time, of course, with all the great stories, our care providers report out about gaining visibility into the patient’s journey, providing valuable insight and ultimately solidifying and growing those referral source relationships. The opportunity for those agencies to choose to move forward is tremendous timely. And I really think they’re for the taking. So as the referring physicians have gotten a taste of this, I think that’s why that number moved up from 68% to 74%. Those who are able to communicate well with post-acute, they want more of it.

Navin Gupta

Yeah. And they find themselves better positioned as well. This year’s research is the maturity map. And I think this is helpful to think about it from that framework, because sometimes we can treat inter-op as this one single monolithic thing, but to really view it as maturity levels is very helpful to help us… The paper talks about these four tiers in terms of maturity that is this basic, moderate, advanced, and high-performing. Nick, help us understand the differences just broadly the differences between these four levels.

Nick Knowlton

Sure. Happy to do so Navin. So, for basic maturity, I think this is really a fundamental level of interoperability. We already touched a little bit on the 85% of respondents claimed to be able to accept ADT information and 72 accepting some sort of clinical information. That’s up dramatically from last year. But we also see this high level of dissatisfaction reporting amongst referring physician when it comes to their post-acute care partners. So obviously the ability to just exchange an ADP or accept some sort of clinical information in some format is not viewed as quote unquote, getting the job done. And I think that goes back a little bit to my comments about we need to start digging into, “Are those just really document level exchanges and the like?” So as we move into more moderate maturity, we’re moving just beyond patient demographic and clinical data and [inaudible 00:15:44] format, we can start alleviating other community workflow problems by moving physician orders and patient forms, visit notes, medication information, or even patient status updates.

Nick Knowlton

I think one of the things that survey did point out is that there’s still a small amount of post-acute care providers that say they can automatically send status reports back to their referral sources. And I think that that’s, once again, indicative that this area is an area that most post-acute care agencies need to at least move into, if not into the advanced level which I think we best define that as plugging into national networks so that they’re not relying on just a point to point interfaces, getting connected to the Commonwell and Carequalities and direct trusts out there, but between those scalable networks to provide surrounding surfaces, such as patient record locator services. So knowing that the Nick Knowlton you just admitted to the local ER, is the same Nick Knowlton that your agency is treating, you need to be able to gain an insight to that.

Nick Knowlton

So we view that as falling really into that next category. And then finally, when we end with high-performing maturity, really at this highest level, this is accomplishing all of those things that we talked about from being able to get basic demographics and clinical information to the type of documentation our providers rely on for reimbursement to plugging into national networks. And I think it really ends with embracing the future using more discrete levels of communication, using more community enabled workflows to move that information at the right time. So all those evolutions that we see coming out of OMC and CMS, were are setting the rules for the nationwide interoperability conversation and other care settings, really having the ability to plug into those Firebase resources that they mandate so that providers in post-acute and acute and ambulatory care settings are leveraging the same discrete information when they’re working with the same patient.

Navin Gupta

Nick, very, very helpful just to understand these four tiers in terms of maturity in every organization, as they think about the inter-op strategy, just figuring out where do they sit today, just doing a baseline assessment. “Okay. We can do A-B-D right basic, but aspiration. How do I move to modern? How do I move to advance? And ultimately moving to a high-performing when it comes to driving interoperability within the organization, this was really something that stood out. And I really believe it’s going to serve providers as they think about these various levels. Now technology partners play a very crucial role in enabling reach inter-op would be for providers. Providers can’t do it on their own. They rely on their technology partners. And yet the survey indicated 79% are not satisfied with the EHR or the agency management system. What sort of conversations should the providers be having with their technology partners if they’re not really satisfied with them? They want to push the inter-op strategy. What sort of conversations should they be having with them?

Nick Knowlton

Well, that’s a great question Navin. I really believe in turning these conversations into things that are actionable. And I think some of your question relates back to the interoperability definition we have. How much are they getting in terms of data? How actionable are the documents and the data? How much is it inherently in discrete format? And I think we can take this a bit deeper than asking just about a maturity level. I think we can discuss how we can do this a little more directly. So in my opinion, I believe providers should be asking their vendors better questions on how people feel their systems are and workflow enablement and content support of their interoperability solutions.

Nick Knowlton

And it doesn’t even have to be technical in nature if it’s done right. So I hope the words don’t scare the audience. Just a few examples here would be, Does the interoperability solution exist in my native workflow in your IT solution or outside of the system? Is the documentation only in a human readable format, or can you do things like reconcile medications from those documents directly into a patient’s chart? Can the system give the insight into mid episode encounter your patient is having with community care providers?

Nick Knowlton

How can the system help me with PDTM or navigating my power of care program?, How can I surface the quality of care back to referral sources and active and passive manners?, Will your strategy work for my local geography and those referral source relationships? I think these are all timely questions and natural questions in an agency and technology relationship. And this isn’t all just technical and workflow related, ask your vendors about the usual business questions too. Is this a big surcharge to connect or is it part of my core software package? Is the value that I’m going to get really aligned with the costs?

Navin Gupt

Nick, very helpful. You know, what I’m going to recommend is that we take those lists of questions that you highlighted and we make that accessible to our provider. So hopefully in the podcast link that I’d like to have a link where we can post those questions because just as the upstream referral sources are demanding, as you can see, 74% want to work and have certain expectations with post-acute providers, post-acute providers must be driving the expectations with technology partners and having these conversations because ultimately their ability to serve the communities and be able to grow will dependent on the maturity of interoperability and what their vendors are able to do for them. So very, very helpful. One of the big things that we talk about that makes care resident is just market trends.

Navin Gupta

I think that’s really important that we seek out insights and foresights. And as you do Nick, I’m talking with our clients multiple times a week and inevitably the number one problem that exists within our space is the issue of workforce challenges or labor issues. And I know you and I we’ve chatted about this. Interoperability plays a big role. Now we can solve all aspects of workforce challenges, but certainly interoperability plays a big role in being able to mitigate the sort of immediate labor issues at providers are facing. Nick, can you add some color to that?

Nick Knowlton

Yeah, absolutely, Navin. Just to put a fine point on some of the problems that I see out there, we hear from post-acute care agencies all the time that the nurse shortage is a real thing. That’s on their radar as of now and based on the data and trends that they can study, it looks like we’re going to meet more nurses, not fewer. And we look at this as a challenge for talent retention at its core. So when I think about how to encourage those clinicians to stay adopted with health IT solutions and how an agency or other post-acute care provider can encourage that clinician to have as good of an experience as possible when working with their agency, I believe that technology and interoperability specifically can play a key role in that. So I like to think about this a little bit as in terms of a day in the life of a clinician. If a clinician has grabbed technology and doesn’t have access to interoperability, they may get a referral.

Nick Knowlton

And from a referral source, they have just a very thin sliver of care history on that patient. They may drive out to that patient’s house, discover a shoe box full of medications, and they don’t know what that patient’s supposed to be on. They don’t know what the rest of their problem was, is because they weren’t properly informed. So what does that clinician do? They spend the next couple of hours on the phone, talking with a referral source, talking with other specialists at that patient’s bend to see, trying to reconcile that medication list, trying to complete the picture of what’s going on with that patient. And in the meantime in home care, they are not spending that time with the patient. They’re spending it on the phone. And they also in terms of hospice based care, that’s toughest day in the life to the patient and their family members who are present.

Nick Knowlton

So we really want to leverage these types of tools. So while the clinician that interacts with the patient, the way that natural caregiver relationship is supposed to work. So if we’re continued beyond that initial encounter, what’s that clinician doing at the end of the day, instead of being able to focus all their efforts on the patient, they were chasing down information that they already should have. So now they’re required to go back and document in their systems what happened during that encounter. It’s probably four or five hours or more since that encounter and the quality of data, isn’t quite as good as what it could be if it was entered in real time while they’re working with the patient. So that’s distracted the clinician from spending time with their families, enjoying their hobbies, enjoying downtime. And I really think that if we leveraged these IT tools and interoperability appropriately, we can allow those clinicians to do their job in a much more efficient manner to do their job in a way that they were trained to originally do it.

Nick Knowlto

And it gives them such a better quality of life. I know you and I’ve been involved in a few case studies about this and the numbers absolutely back up the concept that if you allow clinicians to get involved in decision-making around interoperability and IT solutions in general, you are going to end up with much more satisfied clinicians. And I think we all see that these trendlines for number of nurses available to the industry and the type of problems we hear about for clinician satisfaction and retention, interoperability can be one of those powerful tools in a given agency’s playbook for how they’re going to differentiate themselves and attract and retain talent.

Navin Gupta

Yeah, Nick. So within our space, very high double digit attrition really that happens in terms of [inaudible 00:25:49] for us, we’re going to be short of millions of caregivers in the next five years. So to your point, if we can use technology to drive improved productivity, that certainly is going to help mitigate some of the immediate challenges. But also I love what you’ve touched on is the quality of life. Clinicians are giving of themselves really heroically and caring for patients. If we can remove that friction that they experience daily and give them a smoother experience, I think it’s going to serve certainly the patients, but certainly the caregivers as well. So very well articulated there Nick in terms of how interoperability and workforce challenges can be tied together.

Navin Gupta

I Love to always leave the listeners with a couple of actionable insights as they listen to this podcast. Maybe my final question to you is for those providers that are still on the fence, they hear at a hearing about interoperability, they’ve heard you really talk about the survey, how important this is. It ties to really emerging as preferred providers that helps with labor issues. It helps with driving better patient outcomes. They’d love to get started. How do they go about doing this?

Nick Knowlton

Well, Navin, I love this question. Let’s bring it home and make the rubber hit the road for the listeners today. So I view this as five key things to navigate the journey. And this, I believe works for any post-acute care provider organization, but especially our home health and hospice agencies. So the first recommendation of course, is to move that common definition of interoperability. This is how your referral sources think about interoperability. It includes that definition of being able to use the data. So number one is make sure that you’re using the same terms as the rest of the industry. Number two, I firmly believe that all interoperability begins with a simple conversation. Like your listeners should recognize that this is real. It is possible today and begin that conversation with their referral sources about interoperability and talk to your vendor about their strategy and how they can support your journey.

Nick Knowlto

Number three, I’d recommend that everybody evaluate the financial implications of their strategy or lack thereof. For the home health agencies out there. PDTM’s obviously very topical. You have a compressed revenue cycle and reimbursement is now directly tied to how complex the patient care journey is going to be if you know their complete history. So these are easy ways to look at it and say, “Wow, we know that we’re going to be in a better financial position if we embrace this than if we do nothing.” And for the hospice audience so many examples from our conversations for the requirements of palliative care. And there’s a lot of examples of what interoperability can do. This helps move those rails for them eliminating duplicate data entry, giving referral sources, more visibility to clinical data. Those can be very impactful to the bottom line of the hospice agency.

Nick Knowlton

Step number four, we recommend that you leverage your strategy, differentiate your business. The timing is perfect to take advantage of this remaining interoperability gap between what your referral sources want and what is actually happening out there in practice. So take the opportunity to move forward before your competitors do. That differentiation opportunity for today is tomorrow’s necessity to really be in business in this space. And then last but not least, I would recommend that everybody talk to their vendor for support and to stay abreast of the industry changes. [inaudible 00:29:24] I’m incredibly proud of the work that we do within ResMed and certainly at MatrixCare to drive connected care and advocate for the needs of our partners, working with provider organizations, referral sources, technology vendors, and national interoperability policymakers to drive for change for our providers. And I know that we welcome that conversation, and I certainly hope that the other technology vendors in the space do too. So lean on us. That’s what we’re here for and we want to help you as a post-acute care provider, navigate your journey.

Navin Gupta

Very helpful, Nick. And we really hope that providers will take advantage of engaging us in this conversation. And hopefully this dialogue will serve them in getting started or just evaluating the maturity levels and having those conversations with their technology partners, to be able to really deepen what they can do with interoperability. We really fully believe that interoperability is this non negotiable secret sauce that drives improved care, transitions, and care coordination. In what we know is a fragmented healthcare system. Thank you, Nick, really for your insights, passion, your advocacy for solving crucial component of the healthcare system. And we really wait for the day. We won’t discuss inter-op as much. It becomes table stakes considered fundamental in terms of healthcare delivery. But until then we have some weeks to go and we’ll keep driving this message. We really encourage our listeners and providers to download this paper that’s been published. And hopefully we continue to have this dialogue. So thank you again, Nick, this has been excellent.

Nick Knowlton

Thank you Navin. I really appreciate it.

Speaker 1

That concludes the latest episode of the post-acute point of view from matrix care. We have a lot of guests and topics coming up that you won’t want to miss. 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 matrix care and our solutions and services, visit matrix care.com. You can also follow us on LinkedIn, Twitter, and Facebook. Thank you for listening be well. And we’ll see you next time.