Voices: Trisha Cole, Chief Operating Officer and General Counsel, Medtelligent

This article is sponsored by Medtelligent. In this Voices interview, Senior Housing News sits down with Medtelligent COO and General Counsel Trisha Cole to learn why it is critical for senior housing operators to get their assessments right. Cole also shares best practices for improving NOI and explains how clinical teams can optimize assessments to increase operational efficiency.

Senior Housing News: What career experiences do you most draw from in your role today?

Trisha Cole: I’m classically trained as an attorney, but I’ve spent the past eight years working with assisted living communities across the United States to manage their risk and clinical needs. I have consulted with their corporate teams from an operational efficiency perspective, and very specifically on best practices related to assessments, both from a clinical legal risk perspective and the financial perspective. My position here at Medtelligent also gives me a unique perspective on what it takes to run a fast-growing company.

Why is it important for senior housing operators to get their assessments right?

Cole: To put it in context, the assessment is the single mechanism that companies and communities use to ensure proper staffing, and ultimately a positive net operating income for the building. It is important to understand how the assessment ties into staffing, resident health, family satisfaction — and almost everything else. Everything ties back to that assessment.

Failing to have a dynamic and agile assessment is the first pitfall many organizations face. That can be dangerous because it leads to inefficient staffing practices and overlooked changes in acuity. The assessment needs to be a living, breathing tool. A lot of the old EHRs locked down the ability to adjust assessments. They thought it was a one-and-done situation, but, for assisted living communities, it is not.

What common mistakes can trip up C-level executives in understanding assessments?

Cole: The most common mistake I see from the C-level is not knowing the appropriate level of involvement they should have in the assessment. When viewing the assessment through the lens of a portfolio’s financials, there’s a tendency to either micromanage the assessments in the building — which just isn’t a sustainable process from an oversight perspective — or completely avoid addressing assessment issues altogether if the financials are healthy “enough.”

I recommend that the C-suite set the standard and convey the “why” for the assessment, making sure that they’re giving specific market guidance on pricing points and protecting the downside from a strategic perspective.

What advice do you have for clinical teams looking to optimize assessments?

Cole: Often there’s a strong desire to have a single assessment across the portfolio, but that can create issues because of state regulations, licensure and even local cultures and markets. Having an assessment per region or market is much more effective. Be very specific about the cadence of the assessments because the exact questions on an assessment don’t vary that much. Some states only require an assessment every six months or a year absent a significant change in condition, but a community may set a different policy.

Giving the buildings a clear standard on assessment cadence is a great way to standardize procedures, so long as whatever tool they’re using for assessments is not burdensome on the nurses. An optimized cadence will promote catching acuity changes in real time and help calculate proper staffing levels.

Tell us about care level pricing trends. What are you seeing right now?

Cole: Most places in the United States still use levels of care that are loosely tied to staff time and hourly rates. The big trend I’m seeing, particularly on the West Coast, is companies testing a la carte billing. The primary advantage of this approach is that the family feels they’re paying strictly for the services they receive, which can help a lot in a competitive market.

The downside is that there’s very little wiggle room as a resident’s acuity changes. If a resident needs slightly more help within care, it’s harder, from a human perspective, for staff to flag that and put it through a full assessment cycle.

Care level pricing and a la carte pricing each have their pros and cons, and I see communities going back and forth or doing a mix of both while trying to determine what’s most appropriate for each market.

What are some best practices that you suggest providers look to in order to improve NOI and their assessment process?

Cole: Using assessments to actively drive care delivery and revenue priorities — that’s a big one. Communities that understand the value of alignment between the assessment, the plan of care and billing tend to have healthier residents and stronger financial performance. These communities, in our experience, know how to use tools to analyze where staff spend their time. They have the software, reports and policies to identify whether a care plan isn’t being followed or whether a resident’s acuity has changed. This allows these operators to manage shifting care needs – and costs – in a very personalized, proactive way.

How do you see EHRs changing to support better assessments and more accurate care level management?

Cole: I see the EHR evolving into more of an operating system, taking in data from multiple sources and using built-in algorithms to track health and risk factors against a resident’s personalized baseline.

For example, when a nurse is filling out an electronic assessment, that data will be integrated into different parts of the application and integrated third-party apps. Resident records will be updated in real time and that data will be made available to whichever integrated apps need it. A new diagnosis of diabetes would trigger an assessment and maybe a change in care plan level. It could also result in new dietary requirements.

With the EHR functioning as an operating system, a dining management or nutrition management app could find out about a change like this as soon as it’s made in the EHR, with no need for double entry of the information.

What was the biggest surprise to you about the senior housing industry in the first half of the year, and what impact do you think that surprise will have on the industry for the second half of the year?

Cole: The industry, communities and staff thought that when we survived the COVID pandemic, we would be out of the woods. The truth is that now communities especially are dealing with myriad new issues, including greater staffing shortages than before the pandemic. I’m surprised by the undercurrent in the mainstream media, even sometimes from the government, demonizing the senior living industry and reporting that people are flocking away, though that is not my experience.

Even during the pandemic, residents had clinical support. They received interactions during care and mealtimes — often more than they would have received at home. Assisted living communities and their staff truly care for their residents and they deserve emotional and financial support as they continue recovering.

For the remainder of the year and even into 2022, I hope people in the industry will be outspoken advocates to remind people that senior living environments — specifically assisted living and memory care — have been great options for seniors and baby boomers, and still are. They are only getting better. Continuing to support assisted living models in addition to home health or other settings, I think, will be crucial over the next three to five years.

Editor’s note: This interview has been edited for length and clarity.

This article is sponsored by Medtelligent, which makes ALIS: software purpose-built for clinical management, billing, and operational reporting in assisted living communities. To learn more about what ALIS can do to help your community solve some of your most important clinical and operational challenges, including increasing length of stay, visit Medtelligent.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more — shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

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