This article is sponsored by Synchrony Health Services. This article is based on a Senior Housing News discussion with Julia Barrett, Vice President of Senior Living Services at Synchrony Rehab and Rob Leffler, Vice President of Clinical Services at Synchrony Pharmacy. The discussion took place on June 6, 2023 during SHN DISHED/WELLNESS Conference. The article below has been edited for length and clarity.
Senior Housing News: Staffing and occupancy and rising costs have made it challenging for senior care providers to provide consistent and quality care and be profitable. In a post-COVID world, we have greater demand than ever to ensure high-quality resident-centered care, keep costs low, and reduce the burden on staff while building a reputation as incredible caregivers and providers. That’s where Synergy Through Synchrony comes in. Through their integrative collaborative care programs and approach, the company’s pharmacy, rehab, wellness, and lab services work in perfect synchrony to help providers drive extraordinary outcomes.
Julia, why are integrated solutions a buzzword right now in senior living and how does that play into the changing face of healthcare?
Julia Barrett: I think it’s an important piece to start talking about because as we start to change the model for healthcare in terms of moving more towards value-based care models, it’s going to be important that you have integrated solutions. It’s going to be much easier and more cost-effective as an operator to have one partner for multiple services. That’s what we are able to offer. We’re able to offer rehab and pharmacy and lab across all continuums of care.
As the residents move through the continuum of care, we’re there along the journey with them. Whether they’re moving from independent living to assisted living, to memory care, to a skilled nursing facility, we’re able to be with them every step of the way and with the operators as well.
SHN: How does Synchrony provide wellness solutions to senior living operators through integration and care? Could you outline some of that collaborative clinical programming, because I think that’s a really important part of what you do and explain that?
Barrett: Wellness is obviously a focus of everyone these days. As we’re looking at wellness, in Synchrony Rehab we have a whole division for wellness programming – our SynchronyFIT division. We have SynchronyFIT classes, and wellness classes that really do address all the dimensions of wellness. There’s some meditative programming, and there is some cardiovascular, such as cardio drumming. We have BoxingFIT, we have AquaFIT for our communities that have pools. We have all spectrums, whether it’s more traditional yoga or tai chi. We have all different kinds of programming to address those needs.
For individuals who maybe want to work on one particular aspect of fitness, we have specialists in those areas. We also use our therapy team for SynchronyONE, which is individualized programming similar to having a personal trainer. It’s not a skilled program, it’s more of a personal trainer-type program. Then as we go further on the continuum, we start talking about the second part of your question with clinical programming. This is where integration really starts to shine and where we become more differentiated.
If we look at an example program, in most communities providers have a falls program. At Synchrony, we have a falls program that we can either bring and implement entirely or we can adapt and adjust with you as an addition to your program. It’s called SET. It’s very simple and stands for: screen, evaluate, and treat. What we do is we start as a therapy team, we take a look at people who are at risk for falls, people who have maybe had an incident with or without injury, and we start to evaluate them from a more traditional rehab sense.
It becomes different when we also collaboratively work with our pharmacists through that same program to look at what’s going on with their medications. We take a look at them from additional perspectives. Might there be something going on that we might need to bring to the lab to address? All of a sudden, what was looking at this from maybe only a PT, OT, or perhaps speech perspective, we now are adding other disciplines. We’re really making it much more integrated, not just across therapy modalities, but across other disciplines as well.
Rob Leffler: I think of another collaborative program that we’ve developed, the MAP program. This is where we have special packaging so that patients can easily administer their own medications and maintain some independence which is fantastic for brain health. And then, if the time comes, it can easily transition back into staff administering those medications from the same packaging. An example of where therapy intersects with that is that occupational therapy can work with those residents, making sure that they have the skills to open the packaging, that they know what their medications are for, when their medications are supposed to be taken – things like that. Maintaining that independence keeps those patients healthy and enables them to age in place for longer.
SHN: I think just that overarching perspective on integration is important when it comes to the pharmacy side of things, Rob, so I have a question for you there. How do you integrate between therapy, pharmacy, and labs? I’m sure putting that puzzle together is quite complicated, so would love to hear more on how you do that.
Leffler: From a pharmacy perspective, I think about the SET program that Julia mentioned. There are a lot of different things that go into a fall and that first fall is a high risk factor for another fall. When a patient falls and our protocol is in place, we trigger the therapy team to do a screen on those patients and see if there’s something that we can do with their gait or their strength, their balance.
With the pharmacy, the consultant pharmacist does an evaluation of the medications to see if there’s anything that’s perhaps interacting with another medication or singly increasing the risk of fall, and then the pharmacist makes recommendations to providers to make changes in those medications. Just because a medication may not have been the reason that this fall happened, that fall puts you at increased risk of the next fall, and so anything we can do to decrease the risk of the next fall is important.
A lot of facilities already have a great program in place, but if we can add our services on to that, it’s been a proven benefit to the patients. That’s one example of the collaboration between therapy and pharmacy.
SHN: Thank you. Julia, we’d love to know just how does Synchrony help drive an operator’s wellness-based programming? I know you mentioned a few of the offerings but would love to know just how you really guide them on that journey.
Barrett: Obviously what we do is based on the needs of the community. We are not a cookie-cutter approach. We’re not going to go in there and say, “Every community is going to be offered these same things.” We’re going to sit down, we’re going to get to know that community, get to know the culture in that community, get to know the culture of the residents who live in that community and the staff who are working in that community. Then collaboratively come up with what are the needs that you’ve identified as a provider, as an operator.
What are some of your pain points? How can we help with that? Then also, what are the interests of the residents who live in your building? I can make the best program, but if it’s not of interest at all, because the demographics of that community are inconsistent with the scope of that program, then it’s all for nothing. Really taking a look and saying, “We want to get to know you. We’re integrated into your communities. We operate clinics in your communities. We’re part of the fabric of your building.”
While we’re in your communities, we attend your morning meetings, we attend your at-risk meetings, QAPI meetings, whatever you have that’s going on. We really get to know the residents and we get to know the operators, and together we build programs. We often start out with a program. We may adapt the program for different reasons to make it more appealing to the community at large. We also can offer a program that’s adaptive throughout the different parts of your campus. Let’s take for instance DrumFIT, our cardio drumming class, you might think, “How would that work in memory care?”
That repetition of movement is really important to them, and so maybe the patterns are less complicated. How we do it is different from what we would do in an IL where we have people walking between drums and pivoting and beating on different drums and doing more complicated patterns, but we’re still doing DrumFIT. I think that’s part of getting to know the community and really taking our lead from the community as a whole.
SHN: We would love to really dive into the integrated solutions aspect, because I know that’s central to what you both do. How is Synchrony developing integrated solutions specific to its customers?
Barrett: I think one of the things that’s really nice about us is that we have a shared EMR. As a therapy clinician, I really appreciate being able to go in and take a look at a pharmacist report or to see where those labs are, because sometimes we don’t always get that information in a timely manner and so we can quickly see what’s going on. So we can adapt our plans of care to be more effective and to meet the needs of that resident at a given point in time.
I think that that’s a big part of what we do. The fact that our company is truly run by clinicians really makes a difference. Whether it’s pharmacy clinicians or rehab clinicians or lab specialists, we have people who really have been out in the field and understand what it’s like to be in a community. I think that that brings a different perspective when we’re talking about integration and talking about being part of that larger community.
SHN: Then Rob, on the pharmacy side, we’d love to know how that integration really works into what you do.
Leffler: A lot of time in senior housing, there isn’t a consultant pharmacist that reviews charts. In skilled nursing, we’re used to that monthly review. In different states, there are different regulations. We have a lot of success in organizations that want to have pharmacy consulting, but I’m going to give you an example where there was a recent situation where pharmacy and rehab collaborated on a patient where the resident had a ton of falls in the Carolinas. This resident fell 55 times in just one month.
Barrett: We had modified the environment and community was all in. The community was part of solving this issue. We had looked at everything from strength and cognition and time of day and places of falls and modified everything that could be modified. I even went down to that clinic. They called me in and asked me if I would come in and consult. We went through everything and talked about everything and I’m like, “Oh, we need to look at pharmacy.” I immediately called a pharmacy consultant.
Leffler: So even though we’re not the pharmacy at that location — well at the time we weren’t the pharmacy for that particular building, she worked with one of our consultant pharmacists. They did medication review and looked at all of the medications to see what the risk factors for falls for those medications are. Through that collaboration, even though the patient continued to fall, the amount of falls drastically reduced. We discussed that particular case in a meeting Julia and I were recently at in the Carolinas.
SHN: I would love to really dive into just one last time, just talking about how Synchrony is able to help businesses really get to be integrated. Because as we mentioned at the top of the panel, sometimes talking about integration is just that, it’s just talk. We would love to know what sets Synchrony apart in terms of being able to offer integrated services that can improve overall resident wellness but also just help guide their mission towards that integrated model.
Barrett: As we look at independence and everybody wants to age in place and that’s our shared goal with operators is to help people live independently in place. From a therapy standpoint, as we’re moving people through, we can have them in skilled programming. We can have them in maintenance programming. We can have them in wellness programming. As we’re doing this, we’re looking at that resident. We are also partnering with the home health companies that come into those communities and we enter into agreements with them.
If I’m the occupational therapist who’s treating that resident, whether they’re getting home health occupational therapy or they’re getting outpatient part B occupational therapy, I’m the OT. I know that resident, I don’t just come into your community once a week, go see them for 30 minutes, and leave. I know who they are, I know what they do in between, I’ve seen them walking down the halls, I’ve heard what staff are saying about them. I know who they are. The outcome there is much better. We also partner them on the other side of the spectrum with hospice.
We’re providing therapy when patients also receive hospice services, because those residents who have extended hospice stays may still need therapy. They need to still be able to have bed mobility and to be able to transfer on and off the toilet and get in and out of the chair and assist with their ADLs and things like that. We are there to help them at that point in their wellness journey. We’re there all the way along in all the settings, working with all the partners. Of course, we’re working also with physician groups, we have physician groups that we work with all the time.
We have regular meetings and we have shared dialogue with them so that they know who we are, we know who they are and we’re working again, towards those common goals of keeping people healthy and in the community.
Leffler: It’s that continuum of care and knowing those residents. It’s not that their therapist just sees this patient one time and then we’ve got a different group of people in the building taking care of those residents the next time. You get to know them as individuals, you know what they need, you know when they change and through working collaboratively across the organization, we can address their different and unique patient needs and treat the individual resident. That’s really what we’re talking about in healthcare right now. Residents as individuals.
It’s not one size fits all. It’s not cookie-cutter. It’s – what does Julia need as a patient? What is it that Rob needs as a patient? With an organization that has a lab, therapy and pharmacy, we come to our customers with a combined quarterly business review and look at the services that we’re providing across the organization. You’re not having a meeting with therapy and a meeting with a lab and a meeting with a pharmacy. We can address all those things at once and hopefully meet your needs.
Synchrony’s health services work together to ensure a continuum of quality care for your residents through a collaboration of clinical solutions and efficiency of costs. To learn more, visit: https://synchronyhs.com/.