The Future of Healthcare

This article originally appeared on Medium.com by Christina D. Warner. 

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Emily Wiechmann, RN, BSN, COS-C, clinical program manager at ComForCare Franchise Systems, LLC. Emily has 12 years of experience in non-medical and private-duty nursing home care. Her career has led her to work in three states in the capacity of director of clinical services, administrator and various quality positions. Emily has led two organizations through developing the foundation for their clinical operations, developing policies, procedures and processes.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I was sitting in the study hall at the University of Michigan — Flint and had just decided to drop out of my special education degree path and wasn’t sure what I wanted to do. I saw a nursing student come in wearing her scrubs, and my very first thought was, “I would love to wear scrubs to work every day!” The rest was history. The funny part, though, is that I only got to wear scrubs for my first year out of nursing school; it’s been business casual ever since.

Can you share the most interesting story that happened to you since you began leading your company?

I always thought that I would be a hands-on, bedside nurse providing care to clients. Over the years though, my role has transitioned more into one that supports, trains and educates the ones who are providing the care to clients, and now more recently, I am training those who are training the ones who are providing the care.

People often ask me if I miss patient care, and my response has always been no. I get the chance to be in clients’ homes from time to time, doing things like on-site ventilator or tracheostomy training for the nurses. My two sisters are RNs as well, and we always joke that when a family member comes to me for medical advice, I always tell them to ask one of my sisters…one of the “real” nurses. But, being able to be in the patients’ homes occasionally reminds me that I am a real nurse, too, and I’m really proud to be a nurse!

Can you tell our readers a bit about why you are an authority in the healthcare field?

I was fortunate enough to sort of haphazardly fall into the world of private-duty nursing. It is such a niche within the world of home health care. There are not many people out there who know what it really is, what it looks like and how to do it. Having this experience behind me has really opened up great opportunities for me professionally.

Private-duty nursing, for the most part, is providing shift-based home nursing care to children with medical complexities. These kids have artificial breathing tubes, ventilators that breathe for them, and a lot of them can’t eat orally and rely on tube feedings. I have been so impacted by every single client whose home I’ve ever stepped into. These children and their families have extraordinary stories, and they have overcome so much. The whole experience has helped shape me into a strong advocate for these children and the programs that exist to provide them with this care.

I think I’m an authority in private-duty nursing because this calling drives me to do the best I can every single day, educate as many as I can and to grow private-duty nursing so I can reach as many lives as possible. Failure is just not an option.

What makes your company stand out? Can you share a story?

ComForCare has unique programs built around providing more holistic health and wellness to our clients that I’ve not seen from other non-medical home care providers.

We have a dementia program called DementiaWise® that is built on evidence-based habilitation therapy concepts that really allows us to make a better connection with our clients and provide meaningful activities to them every day that we’re in their home to ensure they’re living their best lives possible.

We also have an interactive music program called Joyful Memories® that has made an incredible impact in the communities we serve. We’ve had clients who are non-verbal who will sing all the words to the songs we play for them. Additionally, we’ve had clients who were refusing care such as bathing, but when their favorite music was played, their mood changed, and our caregivers were able to help them bathe. Music tends to reach clients on a level that spoken words cannot and can truly improve one’s quality of life.

In addition to DementiaWise and Joyful Memories, we are looking to expand our unique programs into areas such as movement, nutrition and art therapy.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

We seem to be in the beginning stages of a big shift from post-acute home health care to more “pre-acute” home health care.

For the first time, the Centers for Medicare & Medicaid Services (CMS) is emphasizing the importance and the cost-effectiveness of providing more early intervention, preventative and even non-medical in-home care to our aging population without the requirement for the person to have had a hospitalization first to receive the services.

This is a care model that has existed for a long time, primarily in community-based Medicaid-funded programs, but we are seeing now that CMS is encouraging other payer sources to get on board with providing in-home care services earlier in a person’s life. This shift is going to result in fewer hospitalizations, fewer high-cost skilled nursing facility stays and overall better wellness as a person ages.

What are your “5 Things I Wish Someone Told Me Before I Started” and why.

1. One thing I wish someone had told me is that we can’t cure everyone; not all patients are going to get better. However, it’s equally important to maintain or improve a patient’s current health, and more often than not, that’s what ComForCare is in the business of doing. We are providing long-term care to clients and keeping them safe, which allows them to age in place and live their best life possible in their own home.
2. Everything isn’t so black and white like they teach you in nursing school. While there are standard policies and procedures for most situations, each person is unique so you have to develop a customized plan of care and techniques. Sometimes, you have to try different interventions or methods of care delivery before finding the right fit. Not everything can come right out of the playbook.
3. Be picky with your hires. Be incredibly picky. Having the right people on your team can make the difference between achieving your goals or failing. Leave a position vacant until you find someone you’re really excited to have join your team!
4. Nurses can have agendas that support both clinical and financial success. It doesn’t have to always be clinical vs. operations when it comes to the big decisions. Nurses can work alongside their operations team and sales team to help grow their organizations, and they should! Set great quality and clinical standards within your organization as the foundation for your organization to grow and see better financial success. I always say compliance breeds quality, and quality drives revenue.
5. Ensure there is a clinical voice in the upper levels of leadership within your organization. We are in the business of providing care to people! If your organization does not have the clinical representative sitting at the board room meetings, be the voice for your organization to ensure quality clinical care is never given a back seat to other motives.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

I think our health care system has been mostly a reactive system when we should have been thinking about proactive health and wellness from the beginning.

Another issue we face in the U.S. is a complicated billing system. An example of this would be a person who is hospitalized to deliver a baby, and they receive 12 different bills for that two-day hospitalization. It can be extremely hard for a person to know what they’ve already paid for and what they haven’t, making it difficult to identify mistakes in billing. This leads to inaccurate claims and consumers overpaying for services.

I think as a nation we are taking steps in the right direction with financial penalties to big cost centers for things like rehospitalizations. We are starting to see some reform with billing practices from hospitals, which I think is going to help us identify some of the poor billing practices we’ve had in place that need attention.

You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

I would:

1. Raise the Medicaid reimbursement rates in almost all states for home- and community-based services, such as private-duty nursing. This will help to right the caregiver recruitment issue that is currently plaguing home care providers by allowing in-home care providers to better compensate their caregivers and aides.
2. Create a Medicare-funded wellness program that is community-based, that would cover screenings associated with common chronic medical conditions such as high blood pressure and cholesterol. Easy and accessible monitoring can lead to better outcomes.
3. Simplify billing. As stated earlier, our system is complex. More straightforward billing would cause less confusion among consumers and may encourage people to be more compliant with their health care if they don’t have to worry about complicated bills or overpaying for services.
4. Require insurance providers to cover non-medical in-home care. For someone to successfully live in their own home as they age, they often need assistance with everyday tasks, such as taking a bath, doing the laundry, shopping for groceries or preparing a meal. However, traditional health care insurance doesn’t cover this type of care, despite emerging evidence that keeping people happy and healthy in their homes can lead to fewer high-cost hospitalizations and overall better wellness as a person ages.
5. I would create a mandatory Health Information Exchange (HIE) system for all the big players to participate in (hospitals, skilled nursing facilities, home health care agencies, etc.). Much like the clearinghouses we all use to submit claims, one organization’s HIE would talk to the state’s HIE, which would talk to a federal HIE, and so on. This would ensure that information like medical history, advance directives, surgeries and care received are accessible to those who need it. Imagine getting a notification from your HIE that your home care client has been admitted to the hospital, and it tells you exactly where they are and why they’re there. We share information about childhood vaccinations, why aren’t we sharing more information through the use of global databases?

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

Anyone can approach their state legislators to help them understand the changes we need. One way to do this is to join your state’s home care association, which will give you the voice and the platform to get these important messages along to the right people at the right time.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I’m an active participant in my state home care association — the Michigan Home Care & Hospice Association (MHHA). Through this organization, I am able to stay updated on things like regulatory changes, reimbursement models and clinical operations. I can also network with some of the best-of-the-best in Michigan’s home health care industry. It’s a great community, and although by definition many of us are competitors, we all work together and take on the big issues as a united front when they arise.