Value-Based Care in Senior Living: Technology and Data Enablement – Episode 2

Lisa McCracken: Hi everyone.

Thank you for listening to this episode of the NIC Chats podcast series. Very excited to bring to you our guest today, Sarah Thomas, and we will get to her introduction in a minute.

But I do wanna thank the sponsor of this podcast series who it's Sage. They empower senior living organizations with real time data. Proactive insights, intelligent care coordination, transforming operations, enhancing resident outcomes, and helping teams, bottom line, make faster, smarter decisions every day.

You can find out more about them at hellosage.com. We're gonna be talking a lot about some of this data and insights during our conversation today. As a reminder, this is a part of a series that we've got focusing on just value-based care, which is a very broad conversation. We've got the pleasure of having Sarah Thomas join us today to really talk about the data, the technology side of this conversation.

But before we go any further, Sarah, I would love for you to introduce yourself to folks and give a little bit of background. Sarah's a very busy person. I always ask her, where in the world is Sarah? Because she's got her hands in so many different things in our sector, and she travels a lot, and many of you have seen her out and about.

But give us a little background on who you are and some of the companies you've been involved with, and then we'll dive into the conversation.

Sarah Thomas: Sure. Thanks Lisa. I'm so happy to be here today. An important topic near and dear to my heart. I'm an occupational therapist by clinical background and have been advising and investing in age tech startups for 25 years and helping senior living operators really understand how to build solutions with the use of technology.

I led global innovation for the largest post-acute care provider Genesis Healthcare and Genesis Rehab Services designed their innovation center in China and expanded with the joint venture with China to become the largest post-acute care provider in the world at the time. So value-based care has always been really important to me. My roles now I still advise and invest in startups. I'm a venture partner at Age Tech Capital, so really focused on the age tech ecosystem and in those advisory and investment capacities.

I'm always seeing the newest technologies that are in the global ecosystem that are impacting value-based care and senior living operations. And with my senior living operators and age tech startups during the pandemic really we all know that staffing has been a challenge. So you also see that I invested and helped to bring expansion into the market for senior living operators, a remote staffing solution called Meztal, and we're based in Guadalajara, Mexico.

So this is where Lisa, you not sure where I am because I tend to travel for all of these things, but I'm really excited, always focused on aging, always focused on how we can improve outcomes and the quality of life for people as they age.

Lisa McCracken: That's awesome. And I just learned a lot of things about you that I didn't know before.

That's very cool. So you, got your background with being boots on the ground.

Sarah Thomas: Because when I talk about technology or innovation it's really from a perspective of knowing that frontline operation and also knowing that clinical importance and clinical outcomes.

And so I can truly understand rolling up my sleeves for, human-centered design of process and of products and really how we can improve this value-based care ecosystem.

Lisa McCracken: Fantastic. And we should also mention that Sarah is the co-chair of our Age Tech Committee at NIC. So we appreciate her contributions with that.

I just wanna start off with a little bit of connecting the dots. I will tell you that I don't have a conversation on value-based care, value based arrangements, whether it's the care part of it or the payment mechanisms without having the conversation around data, role of technology, it is so intertwined. How would you say senior living operators or even their capital partners, 'cause this involves investment and financial commitment, need to think about their data and their technology, if we're even going down the path of saying, hey, we know we need to be paying attention to this, or beefing up our our capacity on the value-based care side of things.

So connect the dots for us and where you see the role of data and technology playing in the conversation.

Sarah Thomas: Yeah so before you can even begin implementing value-based care data and technology really must be a part of, I think the organizational DNA it's not just about the infrastructure that you put together, but it's about the mindset.

And so, value-based care, it really thrives on accountability, personalization, and predictive insights. And if you don't have a culture that sees data as a strategic asset, then you'll never truly succeed in a value-based care model. Senior living operators to me must ask are we truly committed to transparency?

Do we have the systems that capture resident level insights? Do we track outcomes longitudinally? Can we integrate those insights into care planning in real time? And without this foundation, value-based care, to me, becomes a compliance checklist instead of a care revolution where it should be.

Lisa McCracken: Ooh. I love that. I like taking notes down here. Care revolution rather than checklist. I might steal some of the Lisa, I think this is, I steal. I do. Yeah, I mean I appreciate that. 'cause it is a culture shift. I know one of the other conversations the podcast in the series we're talking about change management.

'cause at the end of the day it's, a different way of. Of doing business, thinking about your operations, it's not just a compliance checklist, as you noted. And it's I love that, that care revolution piece, 'cause that's really is how we're thinking about. And at the end of the day too there's benefit from running your operations this way above and beyond any maybe payment models and risk and so forth,

Sarah Thomas: Right, yeah, absolutely. It's a major shift and it's, it is, a culture change.

Lisa McCracken: Okay, so my next question, and it may relate to this culture shift, that may be one sort of thing on your list, but what do you see as the biggest hurdles, Sarah, to organizations really embracing this, adoption of the this discipline data and technology framework?

Sarah Thomas: Right now let me focus on the senior living operator and when we're talking about the hurdles, 'cause I know there's the capital provider too. But in this case, I think historically we were built without the medical complexity or risk bearing models in mind. I think historically, and we are seeing some shifts, but it's hospitality first, not healthcare first.

So the challenges come from the fact to me that. Around clinical staffing, on reimbursement mechanisms, on data interoperability, the systems don't talk, but technology actually can really be a great equalizer here. I think, for instance, remote patient monitoring and ambient sensors really can augment your staffing.

Or predictive analytics can help identify risk trajectories before they result in hospitalizations. And most importantly, I think tech, it also allows us to extend care without expanding the footprint, which today's. Is really critical.

Lisa McCracken: Expanding the physical footprint?

Sarah Thomas: Correct! Yes. You can actually reach more lives and support more with your resources through that tech enabled solution.

And really in a tight labor market that can go a long way.

Lisa McCracken: Okay.

I interrupted you other hurdles because I'm sure there's more.

Sarah Thomas: No, I think those are the major ones for me. I know we'll probably get into to some of the detail of the tech, but I think in general the hurdles themselves are just shifting our model and our mindset.

Looking at technology to help to provide better prediction. And then also just really extending our services beyond the walls and beyond the traditional reach.

Lisa McCracken: I think the last several years, obviously often we think of pre pandemic, post pandemic and so forth, but this sort of, we're maybe hosp a hospitality oriented housing solution for seniors versus.

Man no, we're doing, we're providing care. And this is a conversation not just for a skilled nursing setting or resident, it's, we've got independent living opportunities here. Even we see this coming in the active adult space

Sarah Thomas: Sure.

Lisa McCracken: Sometimes too, which is very care light and so forth.

So I think that our business has changed and that's one of those things where like the train left the station. So we've gotta get on board. So I guess that leads me to, the question is how much is the data and technology a nice to have versus must have?

Oh, it's a must have. It's a must have.

Yeah. It's a must have for clinical insights, for business insights to be able to actually create better outcomes and Efficiency. it's imperative at this point.

So one of the hurdles that I do hear sometimes and I will say sometimes this might be an excuse, sometimes I, think there's legitimate points with this, but I wanna talk through it, is, the financial cost of it.

So whether it's buying a system or partnering with a company on a fall prevention technology or, interoperability and how do I communicate with others? And I know we're gonna talk a little bit about that, but. Talk to me about how you, what is the ROI for the financial investment that needs to be made?

I think there's a variety of ways to look at it. I think the ROI comes truly from greater efficiency in process and systems and an outcome. And I think you're able to not just. Entice a new type of demographic to move in through the marketing ploy of having these technologies that are consumer facing and, beautiful.

And it's not just a marketing catch it's actually much more than that to be able to act more efficiently, act in a predict. Nature. and you do see, especially with these risk-bearing models, and I know we'll get into a little bit more on the tech, but with these risk-bearing models, starting to look at, greater transparency of data greater predict.

Prediction capabilities through utilizing those insights and the, it drives better care that it's all coming back to that value-based Care. yeah. I, think it the time is now to put the investment in to not only the infrastructure, but the systems change and the culture change.

Yeah. The element of value-based care, you've gotta be able to communicate your value. Yes. Whether to partners. To prospective residents and I think when it, when we talk about resident expectation, I do think there's an increasing expectation. Whether it's themselves or their adult children and so forth, that you are going to really be accountable for that whole person,

Sarah Thomas: yeah Absolutely.

Lisa McCracken: Again, like I said I definitely observed that the trains left the station. You've just gotta be on board or I think you are on the risk of being irrelevant. So, I like to take a step back and say, alright a little bit of the, how do I get started?

And, I observed that we've got wide variety, and I'm sure you see this too, of where organizations are in the sector. You've got some that are like all in and they're owning their own plans and their payers themselves and that's great. Others are like, Ugh we're still first inning type of thing.

Knowing that it, it can be a little intimidating too, and sometimes complicated for people to understand, do you have any thoughts and suggestions or for people that, how did they get started? Or if they're just at early stages of this, how do they need to be, thinking about their journey?

Sarah Thomas: Yeah I just suggest starting small, start small and start smart. Choose one clinical focus area, falls, par, polypharmacy, hospital readmissions, and then I think you build a cross-functional team to own that metric. You layer the data in, gradually, you focus on the insights and not all the noise.

It's really not about building a massive dashboard from day one. It's about asking what can we do differently today because of what this data tells us now. I think it's really picking, some area that you can focus on to collect data and act on it, and really use that for actionable insights.

I also think I suggest finding a tech partner, if you haven't yet, and you're new to this, to really choose tech partners who understand both senior living and healthcare, not just one or the other because value-based care is really a team sport and I think understanding the complexity of the individual, the whole person, the social determinants of health truly is gonna expand how we're able to capture information, store information, and act on the information.

Lisa McCracken: I appreciate you brought up that whole partner thing and, questions to ask yourself, because at the end of the day, you don't have to do this yourself. There are a lot of companies out there, but I also think that's a good thing, but it brings a lot of noise too, Sarah. I think the whole vetting process.

It's a lot of work in and of itself. And, and actually I'll, just reference we've got a quick case study from on the NIC website from Ascent Living Communities. They've done great job of, they actually went and rfpd every single one and third vendor partners and for all different types of things, not even related to value-based care, but so did a total reboot and so forth.

And, but that takes time and commitment and so forth. But above and beyond just as you noted, maybe having experience in both senior living and healthcare, are there other checklist items that you would recommend for finding that right partner?

Sarah Thomas: Actually know what you're trying to solve for, what problem you're trying to solve for, what outcome are you trying to create?

Because I think if we just take a vendor driven approach, we are sold things and we're blinded by the flashy lights. I think what we really need to do is understand where are we today and where are we trying to go? What are you trying to create? And then. Set your criteria around that. As I invest, I have a whole set of criteria that we're looking at based on our thesis.

And it doesn't mean that the startup or the technology partner isn't a good one. It may not be the right fit for our thesis, maybe our, check size or our ability to support and help that startup. It's the same mentality when you're selecting technologies and solution partners within senior living.

Who, do you have an early adopter mentality or do you need someone else to try it first? Do you have the ability internally to adapt and integrate and to learn that system and process? Or do you really need it out of the box? Do you have a technical team? Do you not have a technical team? But there's just, I think you have to know where you're trying to go and what solution and problem you're trying to solve for before looking at tech.

Because otherwise you just. Get blinded by siloed solutions and it's very hard to integrate them afterwards, nevermind to actually implement them.

Lisa McCracken: So knowing that actually there's a number of folks that may be listening to this are actually the tech companies.

Sarah Thomas: Sure.

Lisa McCracken: Any advice for them to how best align?

In the operator side of things and that might be, gaps you see. Missteps among those types of

Sarah Thomas: I would say the same for them. It's a matching process to make sure that it's the right fit. Don't try to just sell in to everyone, not knowing if you are, actually solving for the problem that they have.

Learn what the operator needs are, what the clinical needs are, and understand if you are the right fit or if that's not your core offering and how can you potentially adapt to what their needs are. Understand what their sales cycle's understand what, who the decision makers are.

Try to look actually at what outcome are they trying to create? Not what you do best for others, but what can you do with this group? And if it's not the right fit know that early on and don't sell into it because it's just a mismatch from the start. And it's problematic with in, integration and implementation across the board.

Lisa McCracken: Yeah. And again, it, I think it's, I'm gonna say a good problem to have. There are a lot of solutions and companies out there, so you know that's the one thing I've, in the past done some counts, even looking at some of the trade shows and the exhibit halls and how many companies there are around rotate and technology, and it's every year it just grows and grows.

So it, it is a lot to navigate. But we do have some options. So I wanna get to the telling the story piece a little bit, and you referenced a couple, so what? What, on the data side of things, are there top things where you feel like should be priorities or would've been, is being measured?

And then after we talk about that, I wanna get into how you communicate that to sort of partners and others but, what should I be measuring as I am thinking about this value-based care environment? What are those data points that you see as priorities?

Sarah Thomas: For me the, it's not really the, if you're looking at.

Saying What types of data are the most valuable? I would say it's really the fusion of the data types that matters. Understanding clinical data gives us the what, and then you have to look at social determinants of health that gives us the why. If you're looking at. Engagement data, for instance, to tell us how a resident experiences their environment and their and their services that, that we offer.

So when you bring these together, you're getting this 360 view of the resident, and not just as a patient, but a whole person as we talked about earlier. That's so important. And that's really where the power of the value-based care really comes alive. That 360 view of, all of that. So for value-based care as well, we need that, that clinical, that social, and to me that engagement data.

Lisa McCracken: I love the social determinants of health conversation. We could talk about that one forever. Gosh, it's so closely linked. And, but we'll, maybe do another conversation on that one someday. Interoperability, and I might be using that term wrong, but I think you'll get the point of where I'm going.

Data interoperability integration. Knowing that part of the value-based con care conversation is gonna involve partners, whether that's with a physician group a payer, what a CO network, I all the above. And then, some. What do we need to be doing to set ourselves up for that communication front and integration?

Sarah Thomas: This is I think where we stumble most and, often where we maybe select partners that are not the best for our future of value-based care. I'd say too many systems, they just don't talk. They speak different languages or worse, they guard their data like it's this proprietary gold.

And we, I think we need a new ethic around open APIs, shared standards, and really like partnerships based on transparency. Let's be honest, tech's not gonna do that alone. It's not gonna solve it. It really requires contractual alignment as well, understanding and aligning governance around how we're managing that relationship.

And then I think an inherent shared belief that the resident owns their data and not the vendor. Because if we're not looking at. Actually true transparency and true alignment of this information, we're not gonna be able to act on it together in a way that's interoperable. Interoperability for me is not a feature.

It's almost a moral imperative in value-based care.

Lisa McCracken: I feel like I need a big amen for those of you who are just listening, which as soon as she said that, I stuck my finger up because we hear that. A lot about, you said about guarding the data. That is one of the frustrations that we hear often from operators and they're it's, Hey, it's our data.

But it's interesting you take it to the next level. It's actually the residents data.

Sarah Thomas: Yeah, I think so. I I, Appreciate. We need full visibility in order to support the care and service that and hospitality that we provide for the resident. But I also feel like we are at a shift, and I think we'll talk about this a little bit more, but I think we're at a shift where.

People don't wanna just be monitored. They want to be supported for greater independence. They wanna have better purpose and autonomy and engagement. And if we can use the information to provide better person centered care and care planning and, alignment with their own goals as individuals and as whole people, then we're much better off.

And so the data, I think needs to have full transparency.

Lisa McCracken: And having the partners that are willing to do that and not for lack of better term, hijack the information.

Sarah Thomas: Yeah, exactly.

Lisa McCracken: Guardrails. 'cause I knew that, I know that can be frustrating. And we hear that often. So, you've planted the seeds of this a couple times, but I wanna talk about the shift from reactive to preventive to predictive.

And I would still argue, and you have a better pulse on this than I do, that a lot of the data's still probably looking back. Maybe we're making some progress with real time, we'll, however you define real time, what the guardrails are with that. I still think we've got a ways to go on the predictive front, but my goodness there's such exciting opportunities, if you could know, 'cause all these pieces are talking that Mrs. Smith is a 10 for fall today. 'cause something happened in the last two hours. Or what I'm just making stuff up, but, i'd love your thoughts on that. Where you think we are as a sector where we need to go. Obviously this is under the umbrella of the value-based care, but I think it's bigger than that too.

But I'd just love to spend a few minutes chatting about that one 'cause it's exciting.

Sarah Thomas: Yeah. I think this is really where the magic happens. Finally, predictive analytics allow us to see signals like decreased mobility, disruption, sleep, changes in speech that precede the clinical deterioration.

And we're moving from a care at a point of crisis to care at a point of signal. And when we pair this with relational insights such as. Social withdrawal or changes in engagement levels. We can intervene in a way that's not only medically sound, but emotionally intelligent. And we're actually able to be much more proactive, I think, in, in senior living.

Lisa McCracken: Yeah. And I, just think that's so exciting. Can you give some examples of like where that would come into play? Something that might be, again, more predictive or proactive? What would be a scenario?

Sarah Thomas: Yeah, so I think, you know what, when we're looking at, maybe look at the application of how kind of analytics tools have improved or personalization or wellness. So if you look at AI driven and conversational platforms, we can learn residents behavior patterns. We can flag an economies. An anomalies in their speech or their affect, their mood and that's critical for early signs of depression or cognitive impairment.

We can actually look another example is the machine learning platforms that adjust medication recommendations based on real time vitals and risk profiles that are taking into consideration. So the, that is really powerful when you're managing chronic conditions or polypharmacy. We're really seeing this personalization move from what was aspirational to.

Really something automated and precise. It takes that human guessing out of it and allows us to be acting on that data and the systems themselves improve that personalization.

Lisa McCracken: Yeah and, I know we're not getting into the labor stuff a whole lot, but it's all connected with some of our labor challenges too.

I think it is. Those things help the staff do a better job.

Sarah Thomas: Oh yeah.

Lisa McCracken: And focused on where they are needed.

Sarah Thomas: Absolutely. Yeah. Much more precise and personal care planning and, being at the right place at the right time at a point of need. And automating and augmenting certain tasks so that you can actually alleviate staff time and, labor time to, to be at the right place at the right time.

Lisa McCracken: So I would love for you to comment on the technologies that you're most excited about.

Sarah Thomas: Yeah. We took a little while to talk about AI in, in the conversation, but really with without a doubt, AI no question is the most impactful technology driving value-based care today. Especially when you're layering in natural language processing and passive monitoring systems, it's just game changing.

We're also seeing impact from wearables and smart room sensors and computer vision technologies that really detect micro movements and gait changes. It's become that these are not just gadgets anymore. They're early warning systems for conditions like cognitive decline and dehydration or fall risk, and they're scalable, which is what we desperately need.

And so a combination of these things really allow us to be much more impactful in value-based care.

Lisa McCracken: Yeah, those are all super exciting. So I would just ask for you to paint a picture of where you hope we are as a sector five years from now, 10 years from now, where however you, how far out you wanna go.

Like what's your vision of where you hope we progress to?

Sarah Thomas: I could I'll take the next three to five years first.

Lisa McCracken: Okay.

Sarah Thomas: I think this ambient intelligence that we just talked about is about to transform senior living. I think that smart rooms that respond to a resident's physical and emotional.

State in real time. Also think about the smart rooms capturing movement of the staff and the ability to automatically bill or automatically document movement and service. The, smart room is becoming smarter for both sides of the equation. I think that's gonna be transformative.

Digital biomarkers from voice and movement and facial expression. Now being able to come this. Become the standard of care planning. I think that's gonna automatically help us to look at that voice change and affect change, cognitive change movement to predict how people are going to behave because of changes of behavior.

It's gonna become the standard it, to me it's in a three to five year mark. I also think since we're talking about value-based care. We shouldn't overlook the payer provider convergence right now. I think more senior living operators may soon become risk bearing entities themselves if they aren't already.

And I think that the organizations that are preparing for this now, either data wise or culturally, really will lead in the future.

Lisa McCracken: Yeah. All that stuff is, some of that stuff's wild for me to get my arms around. And you'd live that more than I do every day. I've sat in some demos of some of this stuff and it's, pretty cool.

Sarah Thomas: Yeah it really is. And I think. If we wanted to jump to the 10 year mark in this data and the tech adoption in value-based care, if we were just bridging what I think will happen in the next five years compared to 10, I really don't wanna be having this conversation anymore in 10 years.

I don't wanna talk about tech adoption.

Lisa McCracken: Yeah.

Sarah Thomas: I want, I don't want it to be a separate thing. I want it to be baked in like electricity. I want every care plan to be dynamic and data driven and personalized, and I want really residents to move from being these recipients of care to kind of these co-authors of their wellness journey.

I want them to really, be on just fully inclusive in and, their, in their environments and in their, In their journeys. And then if I had a dream for 10 years, it would be that senior living communities are finally recognized as true clinical partners in the continuum and not just custodial settings.

And not that I believe that we are that today, but I want the perception to be that we are really recognized as clinical partners.

Lisa McCracken: Yeah, that's an awesome vision. I hope we're there, Sarah. Yeah. Thank you for sharing your time. Sarah Thomas again with us on the NIC Chats podcast. And we thank our sponsors at Sage, so you can check out more of our podcast at nic.org.

Thanks for being with me today, Sarah.

Sarah Thomas: Great. Thanks Lisa.