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Dan Hirschfeld is Executive Vice President and Chief Operating Officer, International Operations & Genesis Rehab Services. Dan will be speaking at the Aging2.0 OPTIMIZE conference this fall.
From incubating new technologies to managing staff through technology transitions, we sat down with Dan to learn about how he is working to spearhead technology initiatives at Genesis from the C-suite.
Talk to me a little bit about your interest and excitement about participating in the Aging2.0 Optimize Conference coming up in October.
Genesis HealthCare is the largest player in post-acute care in the United States. With all the transformation that’s going on in post-acute care, I personally believe that we are in need of a disruption in the care delivery model and I believe some of the things that Aging2.0 is working on and some of the companies they’ve been involved with can help provide that disruption. Whether that happens within the four walls of the nursing center or whether that happens post-discharge remains to be seen, but that’s really what excites me. We’re seeing this merging between the critical need and the emergence of all of these great technology and products that are coming from innovators. That’s where Aging2.0 brings us together and that’s why we’re members and that’s why we’re so excited about the conference.
When you talk about technologies, what interests Genesis overall? Is there a specific focus on hardware or software solutions that can add value to the services that Genesis provides as part of the ongoing post-acute care scenario?
We’re looking at two different worlds. There’s the world within the nursing center itself and then the world post-discharge. Genesis HealthCare has 32 centers where we’re now participating in Medicare demo products and bundled payment programs. We are at risk for 90 days when a patient enters our nursing center. They may come into the center, be in the center for two weeks, and then be discharged, and we still have that risk and responsibility for Medicare spent post-discharge.
With that as a backdrop, when you look within the four walls of the nursing center, I think there are both products and services that could help us in there. It may be anything from understanding the pressure that the patient may have if they’re in bed for instance, it may be something with monitoring the patient’s needs in a center, it may be with communicating back to their family, communicating with other caregivers. We’re looking at all of it because I’m not exactly sure if there’s a single solution, but all of these solutions together could change the experience of the nursing center, improve the care delivery model and help us predict or intercept any kind of acute episode that may happen while they’re in the center. Once they’re discharged it’s the same sort of scenario. When they’re discharged to home then how can we continue to make sure what we would consider a safe discharge so they’re not going to be re-hospitalized? I think it’s a combination of products and services that we look at for that patient post-discharge.
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You mentioned risk management. How do you think technology plays into that process today and how do you think it will evolve in the future?
I believe it starts with data. It’s absolutely imperative that we are capturing the right data and we’re able to analyze the data and then look for trends. In a perfect world, look for interception.
Let me give you a [hypothetical] example: If we’re seeing that the patient is in the nursing center and on day 14 they’re being re-hospitalized, we can go back and look at the data and see what was going on with that patient. Liquid intake—were they dehydrated? How was their mobility? What was their temperature? Were there any indications that we could have intercepted that re-hospitalization and change within the four walls of the nursing center?
Are we in the first inning of the ball game, so to speak, when it comes to figuring out how to capture that data as an industry? And where is Genesis today with the data capture as it stands?
This is my personal view, but I think as an industry we are in very early innings in this. I do think that Genesis has been focused on it and that we are further along than the industry at large. From my perspective, I provide the ancillary services to Genesis and third party customers so I have some visibility into third party customers in terms of how they’re operating and whatnot. I would say that Genesis is much more advanced from a technology and data point of view than the industry at large.
Back to the Aging2.0 Optimize Conference, part of the big program for the event is showcasing technologies. Have you been to an Optimize event before to see what types of demonstrations are going on?
This is my third event. We actually hosted an event, and we’re working with Aging2.0 in China as well. There’s really interesting technology there that really excites me, and our process at Genesis is we see some of these companies, and with our size—530 nursing centers and 1,200 non-Genesis locations—before we deploy anything throughout that network we have a very formalized product review committee. It’s made up of all the clinicians in the company, our physicians, nurse practitioners, nurses, therapists, social workers, activities associates, finance professionals and so forth. When a product gets into the product review committee, it’s a little bit more mature and ready for more deployment. What we’ve been able to do is work with Aging2.0 to really look at these companies that are in the incubation phase and provide them with a mentor to help incubate the idea product and try to get it to a point where it can go into our formal product review committee.
How has the process been modified to address some of those the concerns that a lot of big operators and providers have with some of these nascent startups, or new entrants to the market?
There’s always risk in regards to the functionality, but the risk from a startup perspective is: do they have the sustainability to really bring this to market. It’s a great idea, but do they one: have the financial backing, two: do they have the leadership there to take it from the concept to full execution. Some of the companies we’ve worked with have been very good where the creator/founder understands they may not have the same skill sets required say, to run the business as a CEO, where I’ve actually seen them bring in a CEO. I think that’s really helped. With these startups, that’s the biggest risk. It’s great that you have an idea, but do you have the capital to bring it to market and do you have the right team and that senior leadership who can really bring it to market?
With as large of an organization as you have—you mentioned China earlier—do you see a lot of the technologies in the U.S. leading the way in terms of the post-acute market towards rolling out globally?
I do think the U.S. is leading the charge. We’ve seen some really creative and interesting things in China, but by far, the U.S. has been much more innovative. Then as we go to different phases, in China our operations are different than in the U.S. In the U.S. we’re focused on post-acute. In China, I’m non-acute, so I’m pre- and post-acute. I’m all ages. We do look at some different products there and have a little bit more latitude with regard to piloting projects in China based on some of the regulatory restrictions in the U.S., which can create an opportunity for us.
I think the goalpost keeps moving down the road. It seems that meeting those regulatory requirements is becoming more challenging, do you feel the same way?
I do. I clearly understand the need for them, it’s just finding the right balance so that we can have the innovation and move it at a pace that is appropriate. I think that’s a challenge. Sometimes the regulatory environment is not keeping up with the pace of innovations.
We’ve been talking about the startups approaching your organization in terms of new ideas in technology. Tell me a little about how some of the new ideas and new concepts are raised through Genesis, through an R&D process and then rolled out throughout the organization for internal innovation.
Sarah Thomas is our Senior Director of Global Innovation. She is actually working hand in hand with Aging2.0, and works out of their offices a couple days a week. We have a phenomenal relationship with Aging2.0 and that allows us to again see a lot of these companies and a lot of this technology. With anybody who approaches Genesis, we route them to Sarah, so she is the repository of all innovation within Genesis whether it’s originated by Aging2.0 or somebody comes to Genesis directly. That way we have one person who is exposed to it all and can really help us evaluate the opportunities. As I said before, depending on what the opportunity is, it may come into more of an incubation phase and if it’s a little bit more mature, it may come in through the pilot phase with our product review committee.
One of the things that always intrigues me is where do you see the immediate benefits from technology? Do you see it more as a consumer-facing or end user-facing standpoint? Where do you see that you’re getting the most bang for your buck, and five to ten years down the road would that perspective change at all?
I think near term, Genesis may be unique in what we’re doing on these bundled payment programs; we have $850 billion of Medicare spent that is at risk. There’s an opportunity for immediate savings for us, so I don’t really have to do the “what if” case about whether I can penetrate the consumer market or B2B market. It’s right here in front of us on risk management with regard to making sure to have a safe discharge and avoiding that re-hospitalization for the patients. That’s very easy for us to quantify. That’s the first bucket.
The second bucket is because of my role in Genesis in dealing with third parties—these 1,200-plus third party locations range from independent living to assisted living, skilled nursing, acute care and outpatient clinics—I think the B2B is something that as a large provider, smaller operators look to us to bring that technology to them. They just don’t have the bandwidth to be able to consider these technologies through a thorough vetting.
The third bucket is the consumer side. Now you have somebody who is post-discharge from the Genesis network living at home. How do you maintain a relationship with them? That’s clearly a big market, a big opportunity for us, but I would put that in the third stage, third bucket.
What do you think in terms of the long-term acute process in terms of end users using the technology? On a scale of 1-10 how important do you rate the training of those end users to make sure that you’re capturing the data and the systems are being used right? How can startups, such as through the Aging2.0 process, work to develop better systems and training to make that a quicker long-term success?
One of the things we’ve done—and I will state that I’m a non-clinician—is we use something called the Predictive Index, or “the PI,” as a personality profile like the Myers-Briggs. We use that to understand our employees, which by and large are clinicians. If you look at the personality of a clinician, a clinician generally does not like change. If there’s going to be change they want to understand why, and when they do make the change they want to before they actually implement it, and to be the domain expert. For instance, if we were going to roll out new technology, we’ll explain in advance why we’re doing this, we will give them a manual (step two), a sandbox to play with (step three), and then step four is they go live. We’ve really tried to imbed that discipline into the company as we deploy because we are dealing with healthcare and we are dealing with patients’ lives.
Don’t come in and try something that’s quick and that’s not thought out because we have patients that this is impacting. We have a pretty rigorous process to do that and it truly is creating that process, and I’ll tell you it takes longer to do but otherwise it’s really sort of fingernails on the chalkboard for the clinicians and the caregivers and that’s who we need to adopt it. Having said all of that, some of our caregivers have more of a personality geared towards change, so we will ask them if they want to be engaged in this pilot phase or that pilot project. There are also folks who just don’t want change and that’s not who you want, so if you mismatch the individuals with the change, you’re not going to get a good result. We try to be very rigorous about it, very thoughtful about who’s involved in change and who will embrace it. That’s really how we approach it and again most of our change is occurring within the four walls of the nursing center. It’s our own individual doing that but I’ve got to have the right person with the right personality who’s willing to try that and be that change agent.
Dan Hirschfeld is Executive Vice President and Chief Operating Officer for International Operations and Genesis Rehabilitation Services. Dan joined Genesis in 2005 as Senior Vice President of Rehab Services. Dan has an extensive background in a variety of healthcare settings, ranging from acquisitions and business development roles to management of an ancillary services business.
Interview by George Yedinak