Home Health 360: Presented By AlayaCare

Patient-centered care: Transforming home health with Jennifer Maxwell

• Erin Vallier • Season 1 • Episode 79

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Jennifer Maxwell of Maxwell TEC shares how patient-centered technology is transforming home-based care by focusing on how patients feel rather than just clinical measurements.

• Personalized care plans should prioritize patient feelings over diagnostic measurements
• Technology can enable real-time patient feedback through simple text messaging
• Effective remote patient monitoring doesn't require complicated or expensive equipment
• Solutions that remain available post-discharge maintain connection and prevent readmissions
• Employee satisfaction directly correlates with patient outcomes and satisfaction
• Automated check-ins with staff can identify concerns before they lead to turnover
• Family engagement through text updates keeps distant caregivers informed
• Real-time feedback allows agencies to address concerns immediately
• Technology should integrate people, process, and tools for maximum effectiveness
• The ultimate goal is to enable more people to age in place with dignity

Episode Resources:

If you liked this episode and want to learn more about all things home-based care, you can explore all our episodes at alayacare.com/homehealth360.

Jennifer Maxwell:

A lot of times. What we've found through our technology is that we want to know how the patient is actually feeling. When you think about patient-centered, you want to know what they feel, not necessarily what the diagnostics are telling you. Diagnostics can mean one thing completely different than how that patient is feeling in the moment. And if we really get that patient's words and feelings, then our clinicians can do better at the bedside and be more prompt and more effective and efficient with patient care. One of our big things we talk about is right care, right time and if we have the patient at hand, being able to direct that care, that makes our clinicians that much more able to be able to provide the outcomes that the patients are actually looking for.

Erin Vallier:

Welcome to another episode of the Home Health 360 podcast, where we speak to home-based care professionals from around the globe. I'm your host, Erin Vallier, and today I am joined by Jennifer Maxwell, co-founder and CEO of Maxwell Health Associates, or MHA for short. Jennifer partners directly with clients, empowering them to reach new levels of operational, technological, regulatory and financial efficiency. She brings a wealth of experience into this role, having previously served as CEO and Executive Director of the Minnesota Home Care Association and an Executive Account Manager at a leading home health and hospice consulting firm. In these positions, she designed and managed numerous client engagements focused on staff augmentation, acquisition support due Masionic Children's Hospital and CHAP Community Health Accreditation Program. I love that program. By the way.

Erin Vallier:

Earlier in Jennifer's career, she gained valuable experience working with the aging population through her work running adult community service programs at Mesa County Department of Human Services. And Jennifer holds a master's degree in counseling and a bachelor's degree in psychology, and previously served as an adjunct professor of psychology and sociology at Colorado Christian University. My goodness, what a resume. Thank you so much for coming on the show, jennifer.

Jennifer Maxwell:

Oh, thank you, Erin, I'm excited to be here today.

Erin Vallier:

Yeah, I'm excited to chat with you about the topic at hand, which is patient outcomes improving patient outcomes. I think you, based on your tenure and your experience, are the perfect person to talk about this, and I know that you've been speaking recently about personalized care plans, so I thought maybe we would start with a question in this particular area. I know that MHA has developed tools such as Nanaconnect Is that right? Nanaconnect? Yes, these are to enhance patient engagement through daily check-ins and customizable messaging. So I'm curious, I want to learn a little bit more about this tool. But also I want to know how do you see such technologies transforming the creation and the implementation of personalized care plans in the home, health and hospice settings?

Jennifer Maxwell:

Over the years, tom and I husband and business partner in this space we've developed a lot of tech-enabled kind of services and technology that can bolt on to an electronic medical record. It gives the clinicians at the bedside a better bird's eye view of how the patient is feeling in the moment, versus through technology that is more antiquated, like a blood pressure cuff or a pulse oximeter or something that is a delayed response. And a lot of times what we've found through our technology is that we want to know how the patient is actually feeling. When you think about patient-centered, you want to know what they feel, not necessarily what the diagnostics are telling you. Diagnostics can mean one thing completely different than how that patient is feeling in the moment. And if we really get that patient's being able to direct that care, that makes our clinicians that much more able to be able to provide the outcomes that the patients are actually looking for.

Erin Vallier:

I love that, and you are so right. It's a lot about how the patient is feeling rather than what's on the piece of paper. I know, speaking from experience. You know you go in and you talk to them and you're like nothing's wrong. That's not true. I'm feeling different, and so to be able to meet somebody where they are in their home, I think is super important and will help them stay there.

Erin Vallier:

I want to touch a little bit on something else I know you're keen on, which is remote patient monitoring. This has become much more popular and accepted since COVID and with that increasing adoption. I'm sure that there are challenges that providers are still facing when they go to integrate these technologies into their workflows. I'm curious what are some of those challenges and how can they be addressed so that we can use these technologies to improve patient outcomes?

Jennifer Maxwell:

When we think of tech-enabled care at MHA, we think of what is least invasive, least costly, a positive ROI from both, not only employee satisfaction, patient satisfaction, family engagement as well as a financial reward at the other end of it because they are a business at the end of the day along with compliance. So we develop tech that doesn't require a bunch of sign-ons, applications, downloading, things like that. We wanted to be able to use and leverage something as simple as the phone to be able to get to people. I mean, when we think about how we live through our technology of a cell phone nowadays or an iPad, even for the elderly, that's like real time, right. And so if we can make something as simple as a text message that says hey, on a scale of one to five, how are you feeling right now? And we know that if it's a three or under, we need to get a clinician to pick up the phone and call, right. So that's how we can have that real-time interaction without having to have all of the layers that normal HIPAA-compliant technology requires. So we are able to still stay extremely HIPAA-compliant because we're not exchanging any PHI, we're not creating an app that has to be downloaded and updated every time there is a new rule or regulation, every time we come out with a new rule, a lot of these apps end up having to get pulled down out of the app stores because they have to go through their compliance testing as well.

Jennifer Maxwell:

So we eliminated and circumvented all of those pieces to be real time things that are easy and accessible, that clinicians can see, that patients can see, that even remote family caregivers can see, especially when you think about working with a dementia patient. My mother has dementia dementia and so it's nice when, as a family caregiver who lives in Arizona full time and she's in Minnesota, I can get a text message saying, hey, this is going on with your mom, or hey, she said X, y or Z and her Likert scale. So then I can pick up the phone and call the assisted living and say, hey, what's going on, you know, or they can reach out to me and we have a better real live time interaction and patient intervention and care plan changes as we need them, not in retrospect, maybe a week or two weeks later, having that that care conference. That happens once a month.

Erin Vallier:

interesting, take on it. So it sounds like you're not proposing all of these complicated tools and expensive tools to be placed and monitored and all this stuff, that you can actually use some of this stuff that you already have, like an iPad, a telephone, just to create a different kind of remote patient monitoring program that achieves the same result but in a different way that is maybe less barrier to entry for a provider who's providing the service, because I think correct me if I'm wrong there's still some questions, gray areas about reimbursement for these types of programs, which make partnering with a service or buying a whole bunch of gear to place into homes that might not be feasible. Can you speak a little bit about that, not?

Jennifer Maxwell:

be feasible. Can you speak a little bit about that? Where we kind of started our journey with our tech enabled was remote patient monitoring apparatus, the setup and everything. It's really great. And the cup when you think of the blood pressure cup, the weight, the scale, all the things that it does.

Jennifer Maxwell:

You as a caregiver, coming into the home from home health agency, abc or whatever, you're going to bring in this really cool technology to this patient's home. They are going to then start engaging with that. That becomes their tool of communication back and forth, because a lot of these folks live alone and there's not a lot of interaction on the daily. So for them to be able to use their technology to have communication and interaction with their caregiver, they become very attached. Well then, if it's a home health patient and they come to the end of their episode of home health, the last thing you do is you take away that technology that they have become very accustomed to and now you don't have the patient satisfaction scores that you need post-discharge. So you've taken the patient off on the last visit by taking away their security blanket.

Jennifer Maxwell:

This doesn't do that anymore. It's always there. They can refer to it. When we look at our products too. We even look at post-discharge. How do we stay in contact with those patients post-discharge? We can keep them in a catchment area, not only for the home health agency, but also to make sure that there isn't the re-hospitalization, a fall or isolation or any of those things that could potentially cause the need for reinstatement of care.

Erin Vallier:

I love that. I love that it's a way to keep in contact, even when you're not officially serving them. That way, when they need something, they know where to go.

Jennifer Maxwell:

Yeah, you're the first point of contact, right.

Erin Vallier:

They know you. You said something about patient satisfaction, which is a good segue for my next question for you, and do you have a partnership with a tool or service called Levo and that focuses on enhancing employee engagement, and this is with the purpose of reducing staff turnover? We all know this is a huge problem. We all know this is a huge problem. I'd like to learn a little bit more about Levo, like what is that, how does it work and how does employee satisfaction correlate with patient satisfaction and reduced hospitalization rates?

Jennifer Maxwell:

What have you seen to be effective in this area in working with Jason Yu and his team pretty closely, is that what we find is when you onboard a new clinician, you either have a really good onboarding process, education, support, those types of things or you're constantly doing that revolving door and it's just like get them in, get them in the door, get them through the paces and then shove them out into the home. And that's no fault of any organization out there, I mean, they're all struggling. So what Level does is it does those check-ins and so it can catch that clinician. It's almost like a satisfaction score for an employee. Do you feel supported? Do you feel you've gotten enough education? What could we do differently?

Jennifer Maxwell:

All of those things that in your first 60, 90 days of onboarding in an agency can be very overwhelming, especially with a clinician who's new to maybe the technology. The patient set any of those things, and so being able to catch that and then work with those employees up front makes for that seamless like when you have a happy employee, you have happy patients. Right leads into patient care and patient satisfaction, whether it's the patient taking the side of the caregiver in the home, right, and saying, well, this agency isn't taking care of my caregiver and I really like my caregiver. So there's two sides to that. So if the employee that's coming into the home to provide the care is happy and healthy themselves, then that's a happy, healthy interaction as well with the patient, which then yields to better patient outcomes and patient satisfaction scores.

Erin Vallier:

Yeah, all very important points. Yeah, the attitude of somebody going to the home does make an impact. Attitude is everything and okay, yeah, that's really good and I'm imagining how this works. Is it automated? So is it like 30, 60, 90 automated check-ins that are customized by the organization to ask certain things?

Jennifer Maxwell:

and yes, we've been working with some agencies where, like, there has been newer turnover, so you have younger clinicians and then there's clinicians that have also been there quite some time but maybe not as familiar with technology, and so I think you have two buckets right People who are not really used to the advancements of the technology, and how do you support them through that process, as well as those that are just new to the space. And how do you navigate that? Nurses that are coming from a clinic-based setting or brick-and-mortar setting it's a very different environment. You are now a doctor, the nurse, you're the evaluator, right, instead of getting to push the call button and have the physician come down the hallway or the group of nurses to come in and consult with. So there's a lot of pressures that can potentially be put on clinicians that are newer to the space and want to be successful. They're in this industry because they want to provide the best care possible and they also love the fact that they get to go to people's homes and make an impact that is so significant in somebody's life, and so how do we do that?

Jennifer Maxwell:

And I think what Jason has done at Levo has been very instrumental. The clients that he's been working with have seen some phenomenal responses increase in retention rates and satisfaction Technology that hit the caregiver, to say this group of people. They cared for Nana over the weekend and did a phenomenal job. The family is extremely happy. Kudos to this team. Now you've rallied and you're starting to build a culture right. When we live in a world of remote health, you have to be able to build a foundational culture that can touch people remotely, versus you and I going to the water cooler back in the day where we could all clap for each other or sit in a boardroom together. That doesn't happen as often, and so how do we keep that energy alive within organizations that are strategically growing, spreading their footprints, as well as having to constrict and do more with less?

Erin Vallier:

Yeah, I think there's so much value in a program like you're describing, be that technology enabled or if you have the bandwidth to do it yourself, because I mean speaking from experience from the provider side of things.

Erin Vallier:

Training and onboarding was one of my roles and it takes a lot of time and effort to keep up with 250 to 500 employees out in the field.

Erin Vallier:

And how do you make the time to touch them two weeks, 30 days, 60 days, 90 days after yourself to make sure that they're feeling okay?

Erin Vallier:

And just having conversations with these providers over the years and some of them work for multiple agencies and the onboarding and some of them work for multiple agencies and the onboarding and communication of the organization has a lot to do with if they're going to stay there or not. I mean, if they feel thrown to the wolves and they're out there and they feel alone and isolated, they're not going to stay with that organization. They're going to lean towards and pick up more shifts from the people who are telling them they're doing a good job, checking in with them, making sure they know how to use the technology. Are they feeling comfortable? What do they need? So that's a very important point you made. I know you also are a big proponent of family involvement when it comes to care planning and execution of that care plan. Considering your background in counseling and your experience with adult community services, I'm curious how do you believe that family involvement impacts patient outcomes and are there any best practices that providers can adopt to foster family involvement?

Jennifer Maxwell:

In my time at Human Services and Adult Protection, family involvement can be so sporadic, depending on where the individual lives, how many family members are around, and what typically happens is those that are three states over. It's not until there's a crisis that they find out. And that's where it wrenches at my heart as a former clinician is how do we stop that from happening? There's a lot of technology that's been out there over the years Basecamp, other communication platforms but again they are applications you have to download, you have to log into and then it's like this exchange of information and if you're not at your computer or if you don't have the app installed correctly, the feedback isn't real time. But when you can customize a text-based message that not only goes to the patient but goes to family to say hey, jennifer showed up for Nana's visit today at 10 o'clock she wasn't feeling all that great or whatever, there is a message that they can click on and see versus them saying did she come Right? Because a lot of times you'll have the elderly folks are forgetful and they won't remember that I came to the home and then you've got family calling up the agency saying why are you not coming to see my mom. We've been there four times this week, erin, you know, and they're like mom's saying you haven't been there at all, erin, you know, and they're like mom's saying you haven't been there at all. And this way it gives a sense of comfort to those who can't be in there day in and day out.

Jennifer Maxwell:

Right, and if there is a visit we have visit reminders. So the night before we send a text. You know, all clinicians are supposed to make sure that they verify their visits for the next day. So if we don't get a response back, it sends another text and says are you going to be there tomorrow, yes or no? And if they say no, then we have a scheduler being able to call and reschedule the visit. And then the family knows okay, that visit got rescheduled. Once the visit is done we send a confirmation. Visit has been complete. And then we ask them how was your visit?

Jennifer Maxwell:

The other thing is, it's one thing to show up. Let's just say you're showing up, but what if you know the patient doesn't care for the caregiver? What if they don't like their five cats or their smoker? You know, there's just all those little things. Because you're coming into their home, right? You know how complicated it can be to have caregiver match. This way, we send a text at a scale of 1 to 10, how was your visit? And if it's anything less than an 8, we're picking up the phone at the agency level to say what could we have done better? And now you're catching it right at the source of when the problem is happening, so that they don't go through their whole caregiver cycle or you know their episode of care and give you bad scores.

Erin Vallier:

Yeah, that's super important.

Jennifer Maxwell:

And then they didn't have a really good experience. And when they do need health care or home care again, they're less likely to want it. No, yeah, I like that, just take care of it in real time.

Erin Vallier:

And you're right, Like it's difficult to find a good match. I like that. Just take care of it in real time. And you're right, Like it's difficult to find a good match. I mean, there are tools out there that help you select the right caregiver based on skills and proximity and interest and stuff like that, but even then you can still get it wrong. Personalities sometimes clash. I'm curious you've mentioned a whole bunch of automated text messages and stuff like that. How do you guys facilitate that? Is there a service that you're using a tool that you built yourself? What does that look like?

Jennifer Maxwell:

We built the platform. It's very easy. It's extremely customizable too to agencies. We have products for home health, hospice, private duty, because they can be used kind of interchangeably. But we have a main portal that the products live in and then, depending on if it's Notify Nana, nana Connect, nana Reach, nana Bereavement any one of those products we can customize how many texts, frequency of texts, what do you want we can embed links into the text so like when we've gotten if you've gotten a referral, you can then send out a welcome text saying hey, we've got your referral, we're processing it, and then there's a little welcome video it could be the CEO of the organization to say thank you for choosing Home Health ABC.

Jennifer Maxwell:

We are so excited to provide care for you in your home and we're really looking forward to you having a wonderful experience. This is what you can expect, because, when you think about it too, people get discharged from the hospital, a nursing home or whatever. It could be a little bit of time before services truly start. So how do you keep them engaged in it? Because by the time the clinician comes out, they're like I did what? Who are you? Yes, what were we talking? Because there's so much being thrown at patients when they're discharging from any care setting right.

Jennifer Maxwell:

And it's overwhelming, Like you don't know what's going on during your eligibility finding your caregiver match, getting all of that set up and being compliant as a business, but also staying engaged with that patient up front so that they know, yes, your referral has been received. We are working it. We are going to be out to see you In the meantime. This is what you can expect from your experience with us.

Erin Vallier:

I really like that. I know it's a little cliche, but I like to say sometimes that an ounce of communication is worth a pound of forgiveness and, as we all know, like there's hiccups in this process of onboarding somebody or even finding the right caregiver or care worker it might take a couple of different times and scheduling snafus, but if you're in constant contact with your clients and your employees and you just make them feel heard and you recognize like something's going down, we apologize for this whatever.

Erin Vallier:

That goes a long way to not only satisfaction but in retention and outcomes, so this is a great tool. I want to switch gears a little bit and ask you sort of a more personal kind of question. I know that some of your reflections on the challenges and opportunities in the post-acute space these really do highlight your commitment to innovation, so I want to know from your personal experiences, how has that shaped your approach to both?

Jennifer Maxwell:

patient care and organizational leadership needs right. And so how do I stay relevant, how do I stay ahead of what is happening? How do I put technology and tools in place, as they come out, that help me be more engaged with, whether it's my consultants, my teams across the nation, the organizations I work with, the organizations I work with, and what I found is when I had less of that connection, we had more difficulty with execution. And so when I think about a patient in a home, a family across the nation, it's about connecting them right to everything. And so that's been my sole plight throughout my career is to be innovative, creative, listening.

Jennifer Maxwell:

As a counselor, I spend a lot of time listening and having over 100 consultants, I get to hear a lot of stories about what they're experiencing at the organizational level, listening to our clients talk about I have 40% of my C-suite going to be retiring in the next two years. What do I do? And so I think about innovation. I think about proactively getting folks ready for the next generation and iteration of healthcare needs. We're moving more and more to the home right. It's where patients want to be, it is more cost-effective, it is personal. So how do we stay relevant?

Jennifer Maxwell:

And that has been my experience. I want to be able to age in place in my home with my little you know my well, they're not very little, but my big dog at my side, right, yeah. So when Tom and I talk about what do we want to do for healthcare, it's like I want a space by the time. It's our time that we can have our friends, our family, our loved ones, our pets, our everything around us and be able to transition in our own homes and that be the norm versus hospitals, nursing homes, facilities where, yes, there's great care and I will never say that that's not necessary or needed in this space but I think that there's a more compassionate way to do this and that's where my heart lives and will until I retire, if I ever retire.

Erin Vallier:

That's such a beautiful answer, thank you. Thank you for sharing that and also thank you for coming on the show and sharing a lot of your insights with us. I just have one final question for you. I'm just wondering if there's anything you'd like to say about MHA and what you guys do and how to reach you, in case someone listening today is curious about how they might engage with you personally or one of your consultants or some of your tools.

Jennifer Maxwell:

I encourage you guys all to come to our website. It's maxwellhcacom, and I am available at any point in time. I'm jennifer at maxwellhcacom. I'm always very interested in hearing what's going on in the industry. I love having conversations with you like this, erin. I think that the more we can get the word out, the more we can do, and there is something to be said for taking tech enabled, which is tech but also care right, and so we take our consulting services and intermix that with people, process and the technology. You know you got to have all three. If you leave the people out, like we talked about earlier, you're not going to have the people. If you put in all the tech in the world but you don't train them and you don't have the right processes, it's just wasted money. So I feel that we at Maxwell we've done a really, really great job of being able to connect those three and feel that we are the leaders in the space that allow us to do all of those things.

Erin Vallier:

Fantastic, and we'll make sure that your contact information is in the show notes so people can get in touch with you. Again, thank you so much for coming on the show. This was a really fun conversation for me and maybe we can do it again sometime.

Jennifer Maxwell:

I would love to Love to Erin.

Erin Vallier:

Fantastic Home Help 360 is presented by Alaya Care and hosted by Erin Vallier. First, we want to thank our amazing guests and listeners. Second, new episodes air every month, so be sure to subscribe today so you don't miss an episode. And, last but not least, if you like this episode and want to learn more about all things home-based care, you can explore all of our episodes at alayacare. com/ homehealth360 or visit us on your favorite podcast platform.