Ellen Ford-Barton, Senior Vice President Strategy & Operations at Care Navigation Services, LLC

Driving Down the Cost of Care with Proactive, Customized Patient Education with Ellen Ford-Barton, Senior Vice President Strategy & Operations at Care Navigation Services, LLC transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez here, and today I have the privilege of hosting Ellen Ford-Barton. She is an outstanding individual and a Senior Vice President of Strategy and Operations at Care Navigation Services. With over 20 years of experience, Ellen understands the many challenges physicians, hospitals, and prosecute providers face to prioritize quality, cost-efficient care to at-risk patients. In her role as Senior Vice President of Strategy and Operations, Ellen develops and manages low cost, large scale, patient-centered solutions focused on extending providers reached after discharge that reduce avoidable readmissions and related cost of care while affording a positive experience for all stakeholders. It’s such a privilege to have you here, Ellen, and I’m really excited to learn more about what you and your team are up to. Thanks for joining us.

Ellen Ford-Barton:
Well, thank you for having me. I’m excited as well.

Saul Marquez:
Absolutely. So before we dive into the work that you guys do at Care Navigation Services, Ellen, I would love to hear more about you and what inspires your work in health care.

Ellen Ford-Barton:
Certainly, I would say very early on I learned the value and the importance of helping others. And that obviously came from my parents and advocating for people who experience different challenges, although I can say as a young person, I really didn’t know how to do that. And then I graduated from school and I found my first health care role working as a marketing coordinator for a hospital in Corpus Christi, Texas. And that hospital actually served as the safety net provider for the county’s indigent population. And one of my responsibilities in my role was to develop the hospital’s annual community benefits report. And it was sort of through that process that I quickly learned about the variety of health care disparities that were around us. And that sort of ignited my passion and sort of organically through all my different roles in my career. I always found that I preferred working with underserved populations, even if it’s from behind the scenes. I mean, I think if I could do it again, I’d probably be a nurse. But at this point, that’s not going to happen. But even if I could be behind the scenes, you know, working with clinicians and driving change, that always inspired me. And I would say by underserved, I mean not only mean with insurance, obviously, that’s the obvious, but also underserved with access, underserved with information. You know, what next steps do I take if I experience this challenge, where do I go? What resource do I seek and underserved with that support and advocacy? And so jump in 20 years later to my current role at navigation. What kind of continues to fuel that inspiration and motivates me is knowing that we’re part of the solution and driving down health care costs by promoting the timely risk, appropriate quality, most cost-efficient intervention and positioning that only our provider partners but their patients for success.

Saul Marquez:
I love it. Yeah, it’s I could hear your passion for this population. And I love how you’ve approached your career. And now, as you call it, behind the scenes, it’s so critical to reach these folks in the most acute space. And so talk to us a little bit about how you and the team care. Navigation is adding value to the health care ecosystem.

Ellen Ford-Barton:
I love this question. I would say in short, in Care Navigation, we offer patient-centered solutions that align with those value-based principles we all know about, more specifically for those who are providing the care. And so that’s who we partner with, know we don’t work directly with just patients. We are working on behalf of provider clients, patients. So for those who are providing care, we’re impacting the ecosystem in a number of ways. Number one, we’re able to extend the clinician access beyond their four walls to when patients are recovering at home. We also our solutions can continue that relationship beyond the four walls. Providers don’t have to have patients in the clinic or in the hospital or the skilled nursing to have a relationship. We can extend that to when they’re recovering at home. We also, because we work so closely with the clinical teams, with our provider clients, we can extend and promote that care continuity. So whatever is happening in the facility, what’s in that care plan from the physician, we just continue that on at home. So it’s truly a collaborative effort. We also can extend clinician bandwidth. I mean, obviously, right now nurses and case managers are extended beyond their limits. And so we can provide education that perhaps they weren’t able to provide while the patient. Was it that when their clinic or hospital setting or reinforce it, we know that.

Ellen Ford-Barton:
Patients are getting so much information upon discharge and the nurses may have spent the time educating the patients, but patients may not always retain that or hear it or understand it, whatever that may be. We can reinforce that at home. So, again, we can extend what they’re doing to the home. We also really with our provider partners, wherever we develop a workflow or a process, we know that it’s fluid and it’s going to change. So we’re constantly looking at how we can optimize workflows to extend their program’s reach, because the more patients we can impact, we are going to see those outcomes. And we know there’s a direct correlation between that engagement and the outcomes. There’s also the patient satisfaction, the patient satisfaction aspect. You know, obviously, that’s always key. We focus on the patient and we know that they are going to be happy with their provider because we’re just behind the scenes. Like I said, there’s that market differentiation with our solutions. Again, they can white-label everything we do, but we’re there to position our provider clients to be a market differentiator among their competitors in their market. So we know that we can be that strategic partnership to drive those improved outcomes. And because our solutions are low cost and large scale and provider partners invest in our solutions are going to see a return and we’ve demonstrated that.

Ellen Ford-Barton:
So for those who provide care, that’s the benefit. Then those who receive care, which is again where our passion lies, we impact them by providing holistic education and coaching. A patient may have had hip replacement surgery, but they may have a history of a bunch of comorbidities. They may also have challenges at home that could negatively impact their recovery. So we address all of that, the whole person, which is obviously very key. I would also say our main focus is self-health efficacy. We know that if we empower patients to be the active participant in their health care management, not in the back seat, not in the passenger seat, but truly in the driver’s seat, that we can position them for long-term health and wellness. I mean, most risk periods are 30 days, 60, 90 days. We look beyond that. We want to set up patients for success beyond just the risk period where a hospital might have a penalty. We want to position them for long-term health and wellness. Also, for those who receive the care, it’s the right care, the right place at the right time, and educating patients to truly what’s the appropriate care level for them. Patients may have a challenge. They think immediately they need to go to the emergency room. We know that’s not the case. I mean, sometimes it is, but most likely it’s not.

Ellen Ford-Barton:
So to truly impact avoidable readmissions, we need to ensure that patients have that knowledge and education as truly. When do you go to the doctor? When you engage your doctor, when you engage your home health nurse or your specialist, when do you go to urgent care or when do you truly need emergency care? So that’s important for us. We also like to promote that and enhance the whole experience and that seamless and safe transition once they’re at home and providing them that support. And then lastly, obviously, those who are funding the care, whether it’s a paper or self-insured employer, we’re all our solutions are focused on mitigating those avoidable readmissions, which I’ve kind of spoken to, which then directly decreases overall spend. Again, we’re promoting long term health and wellness. And I’m not just right after they’ve discharged home, but for the long term. Again, member satisfaction the ROI again investing in us. Our solutions are low cost. So you’ll see that return. And also, you know, all our solutions are payor agnostic. A lot of focus most recently has been on the traditional Medicare fee for service. But we can manage self-pay patients, Medicaid, managed care, commercial, whatever it may be. Our solutions are payor agnostic as well. So that’s how we’re trying to drive change and positive outcomes throughout the ecosystem.

Saul Marquez:
I love it. And so you guys are taking the long term approach to this. How would you say what you guys do is different or better than what another company is also offering this type of service?

Ellen Ford-Barton:
I would say so. Shannon Clifton, the president of Care Navigation and I have worked together for a long time. And together we have about over 20 years of experience on the provider side, particularly working with a large health system. I think having that experience allows us to understand the challenges, gaps, and kind of different competing priorities. But only do we understand and we’ve lived them and we’ve addressed them. We’ve worked to address them. We’ve learned a lot through our experience knowing that the director of case management might have one priority, your operations leaders, perhaps another. But then the CFO, a completely other priority, and then, you know, if you’re working for a faith-based organization, you also have to balance the mission. And so I think it’s truly our understanding and having had that experience different differs us from our competition. I would additionally say that at Care Navigation, we prioritize a truly customized and cost-efficient process. We are not here to come in and say, listen, whatever you’re doing, stop. We have the answer. We’re here to say, let us take a look at what you’re doing and what you’re doing well, and where are there any opportunities that we can augment our solutions with what you’re doing? Well, we want things to be scalable and sustainable. And we know providers have a lot of wonderful programs that are working. So we’re not here to just take over. We’re here truly to partner and be collaborative. And we focus on financial stewardship. They’ve invested in these programs. People are now investing in telemedicine. How can we optimize the programs you have with some of our solutions? That’s I think also what differs us. We’re not we’re not here to just walk in and take over, because Shannon and I have had so much experience on the acute side, managing and implementing remote care or transitional care programs.

Ellen Ford-Barton:
We know how burdensome it can be to take on the operations of the programs. And so we position ourselves to take that lift. So when we’re when we are when we’re adding a program for a provider, we’re not just here just to develop the program and walk away. We obviously operationalize it. We manage the whole program. We manage the resources. We do all the data management, analytics reporting, we’re writing case studies, we’re promoting our partner. We’re doing all of that so that the clinicians and the physicians can remain focused on patient care because that’s they shouldn’t be having to call the technology person because something’s not working. We take all that lift. And last they saw it, I would say that we’re a smaller company. You know, we’re based out of Dallas. We serve patients in Colorado, Oklahoma, and Texas, but we’re a boutique-style company. And by that I mean our clients can be assured that they’re going to work directly with the Care Navigation leader. We don’t just simply pass on to another team member and we just kind of provide peripheral oversight. And we are 100 percent fully engaged and invested in our client’s success, service excellence as a priority to us. And we’re timely. We’re collaborative, and we’re committed to ensuring a positive experience for not only the provider, but the patients that we’re very honored to manage and they’ve trusted us to do so. I think those are the things that deliver us from what’s available today.

Saul Marquez:
That’s fantastic. Yeah, and it’s that touch, that high touch that that experience that you guys have. And so talk to us a little bit about how you’ve improved outcomes or improve business processes, any stories or examples you’d like to share there?

Ellen Ford-Barton:
Absolutely. I will say we’ve improved outcomes and in business, I would add even during the pandemic, which, you know, has been so challenging for so many health care providers and patients, Right. the pandemic didn’t make chronic conditions go away. So people were still trying to manage the conditions they already had. And sort of the solution I’m going to focus on is our care connect solution, and that is our nurse call center program. And this program, it’s a proactive, telephonic health check-in program that’s staffed by registered nurses. We have found that registered nurses are truly the best resource to provide this service. They have the expertise, they have the knowledge and the scope to truly provide education and advocacy. And in our program with our nurse call center, they’re providing that holistic education and coaching. And it kind of focuses on addressing all the different recovery challenges either that they’re able to identify or that patients report to them. And this is all post-discharge once they’re there recovering at home. And it truly alleviates the burden of that post-discharge coaching that might have fallen upon the provider. Clients already extend the critical resources, which I touch to a bit earlier. So, again, we’re extending their bandwidth to make business better. We also engage all key stakeholders in that health management decision making. So it’s truly a shared and patient-centered process because sometimes we’re not working directly with the patient.

Ellen Ford-Barton:
We’re working with their caregiver, particularly if it’s someone with a cognitive deficit. We are we’re working with a family member and we want to make sure everybody is engaged and we provide meaningful data that our providers can share with they are referral sources or whoever that might be, to kind of guide their strategic business planning, promote best practice, develop preferred partnerships again, where we’re trying to position everybody for success. And then we also try to make business better by being sensitive to kind of financial challenges. But everyone’s experiencing the uncertainty of reimbursement, particularly with telehealth, and by offering a low-cost solution as far as outcomes. I’m going to highlight one particular program. We’re working with Stonegate Senior Living, which is an operator of senior living and primarily skilled nursing facilities throughout Texas, Oklahoma, Colorado. And one of the things that we’re proud of is the patient engagement rate. We have found with our Aaryn call center by prioritizing the engagement of their patients has a direct impact on improving overall patient health outcomes and the efficacy of patient care delivery. And so for their Medicare fee for service population, we have an 84 percent engagement rate and our managed care is a little bit higher. It’s at 90 percent.

Ellen Ford-Barton:
And this is by constantly looking to see how we can improve it. We’re not going to settle for eighty-four. We’re going to keep going higher and we work closely with either their facility teams or their leadership to see how can we further increase the reach of this program, be that a high engagement rate correlates directly with a low patient-reported readmission rate. And as I mentioned, our programs are focused on mitigating avoidable readmissions. We know that has a direct impact on the cost of care. Medicare fee for service. We’re at an 11 percent patient-reported readmission rate. And I’m going to compare that to a study done in twenty eighteen by Harvard Medical School, which demonstrated that about one in four patients discharged from a skilled nursing facility will readmit. So we’re very proud of that outcome. Managed care, it’s a bit lower. It’s at seven percent, patient-reported. So again, where we don’t just settle for that, we’re going to see what we can do to further impact. So and then regarding the appropriate care level, as I’ve talked about, Right care, right place right time. And it’s empowering the patients to know what that is. And again, our goal is to always educate and coach the patients back to their physician-directed care plan when a recovery challenge is reported or identified or perhaps to their home health or their specialist, whoever they may be working with.

Ellen Ford-Barton:
And we’ve been able to do that. Forty-six percent of our patients had been directed back to their existing resources. Another thing we have uncovered and this is kind of more organically with our R and call center, particularly with working so closely with a skilled nursing provider, is that let’s say patients have contacted their PCP, home health is engaged, all that, but they’re experiencing falls. They’re still experiencing a decline in health status or weakness. We can identify those patients who might be appropriate for direct sniff readmission from home back to the skilled nursing facility and get a few extra skilled days to increase their strength, increase their mobility. We know that readmitting back to a skilled nursing facility such as Stonegate is less expensive than going back to the hospital. So we’ve developed a proprietary workflow to facilitate that process in which our friends can advocate for the patient and then the skilled nursing provider can be involved and make that a seamless transition for them from home back to the skilled nursing. And then once they’re home again, we’ll be providing those follow-up calls. So we’re excited about the fact that we actually are able to mitigate readmissions and impact the cost of care.

Saul Marquez:
Yeah, that’s fantastic. The numbers speak for themselves. And being able to touch these patients at the right point at the right time is fantastic. So as you think about setbacks and challenges you’ve run into, what would you say one of those key setbacks has been and key learning that came out of it?

Ellen Ford-Barton:
I’m going to take you back about eight years when Shannon and I were working for the large health care system and we were managing community outreach programs and someone came to us and said, hey, listen, we have this technology company. They have a remote patient monitoring solution. Can you all make this work? And had we known then what we know now, we would have run screaming out of the room, but we didn’t know we were naive and make sure we can do this. And actually, the program worked very well. And but the setback was that we were working we were piloting this study at one of the hospitals in our health system, and it was an institutional review board study. So it was very strictly governed and a lot of eyes to dot and T’s to cross. And we were following all of that. But a very high-risk patient ended up choosing to want to participate in the study. And basically, it was using the vendors, home-based remote care technology, a tablet, and peripheral devices, and are our Aaryn transitional care nurse. And the technology failed and our nurse noticed it because she had a portal that she would check into and the patient had an answer to that question. So she was calling and calling and couldn’t get a hold and. Finally, when she did, we learned that he passed away and obviously that was extremely sad and a devastating setback, obviously, for the family. But, you know, this is nothing we had experienced before. And our study ended up being put on hold for five months to allow us to kind of delve into that root cause analysis.

Ellen Ford-Barton:
And I think the key learning for us is we were very… We had our protocols in place. We had a nurse who noticed that this patient hadn’t responded and quickly engaged in trying to do a telephonic program. But we learned that the vendor, our telehealth vendor didn’t have that same protocol in place at the time. So the key learning is to ensure that all technology programs we know there’s a lot of telemedicine right now that’s being adopted, telehealth, whatever that is, that they have a clinically-based approach to managing patients at home and that that is key. And so the focus can’t just be on the technology. It has to also be on clinical protocols. And we ensure that even now with our Aaryn call center, we work with our partners and we work with their clinical teams to ensure that there are escalation processes in place so that ours is telephonic. So the chance of anything going wrong are very, very slim. And that’s why we’ve been able to continue this throughout the pandemic. But we are happy to partner with technology providers as well that they really have to have there has to be a true commitment to that clinically-based approach and just ensuring everybody has a contingency plan. Shannon and I will say we always plan for worst-case scenario because we want to really minimize risk and we want to ensure patient safety. We want to promote a positive patient experience. And we want to ensure our clients get the outcomes that they want. So I think that was our key learning experience. And luckily to date, we haven’t had anything as tragic as that was.

Saul Marquez:
Yeah, wow. Tons, tons to pull from there. And, you know, the challenges are those that really help you become stronger, wiser. And obviously, you guys have gone through many, many challenges as far as any health leader has. But now you’re able to work these into the offering that you have today. And with that, what is it that excites you most today about what you guys are doing about the environment we’re working in today? What excites you the most?

Ellen Ford-Barton:
I would say, Saul, it really has to be that providers and patients are embracing a new way to kind of bridge the gap and provide the services at home. And that providers also embrace the importance of developing a deeper relationship with their patients by connecting with them at home, even if it’s through a third party like us. Because like I said, we’re all white label. So patients really we’re calling that we’re the provider and just that they’re kind of prioritizing that commitment to extending the care and the relationship beyond the four walls, I think is what truly excites me and about us for Care Navigation. And we recently had an article published in Skilled Nursing News, and it highlights a lot, a lot of what I’m talking about. But, you know, our nurse call center, as I keep saying, is a low cost, large scale solution and it’s for a full continuum of health care and technology providers. And we remain one hundred percent focused on program management and kind of commitment to improved health outcomes. We know that when providers implement a program, again, as I spoke about earlier, it’s the operations that can be overwhelming and that’s what makes things difficult to sustain. So we can take care of that because our program is telephonic. We don’t have to worry about peripheral devices and connectivity and any of that. People don’t have to have a laptop. They don’t have to have a smartphone. They can have a regular telephone. We can continue our program, particularly during these uncertain times.

Ellen Ford-Barton:
And I’m excited about the opportunity for a physician practice. Our on-call center can really increase their patient capture and retention rate. So for specialists who are doing consultations and hospitals and, you know, part of the care plan is, OK, follow up with me in a week. A lot of times they don’t. We can be that bridge to ensure that patients follow up and retain the patients, capture the patients that are going to the practice, and engage the physician and his team as appropriate for those timely escalations. And it’s because of that we can make physician practices more efficient rather than physicians or patients go into physicians and just going there unnecessarily, where maybe a phone call could have resolved their issue. We can take care of that. So we’re there to truly partner with physicians for acute and post-acute providers. I’m excited about the fact that our telehealth solution can truly impact avoidable readmissions and the cost of care and that we can promote care, continuity. And like I mentioned earlier about. Technology partners, we would we’re excited to serve as the patient education arm to complement the remote care services, all these different technology providers and our solutions are technology agnostic as well. So whether it’s an app or a Web-based program or a tablet or whatever it is, we can augment all of that. And when we’ve done so in the past, in our experience. So that’s what I’m excited about.

Saul Marquez:
Yeah, definitely lots to be excited about, Ellen. And, you know, it’s really neat just to hear the versatility of the offering and how folks can augment what they’re currently doing with the programs and capabilities that you guys offer. So many times you have firms wanting to just throw out the entire solution. You guys are coming in and saying, hey, let’s work with what you’ve got. Let’s optimize it where you could and let’s keep doing more of what works. So that’s really, really nice to hear.

Ellen Ford-Barton:
Yeah, we know that differentiates us. And again, like I said, we’ve taken a lot of hits, Shannon and I, and we have learned a lot. And we’d love to just pass on that experience and learned lessons. And here’s what works. Here’s what we want to avoid. And we’re excited to partner with those who would welcome us.

Saul Marquez:
That’s excellent. And folks, if you want to learn more about the amazing work that Ellen and Shannon are up to, you could visit them at care navigation services dot co. Just incredible work being done by then. Different ways to answer your questions right there. Just go to care navigation services dot com. Ellen, this has been great. I’d love if you could just leave us with a closing thought and then the best place for the listeners could get in touch with you or your team to learn more.

Ellen Ford-Barton:
Absolutely. I would say we understand that there are many challenges facing health care providers. I mean, there’s COVID, which is ongoing, and of course, reimbursement and the uncertainty of all the different challenges. However, prioritizing those home-based connections with patients continues to demonstrate positive health outcomes, which benefits the entire health care ecosystem. So we are looking to partner with provider clients who demonstrate a commitment to wanting to work with a certain population and improve those outcomes. And we are very well positioned at navigation to be your low cost, high results partner in providing quality, cost-efficient care with a scalable, sustainable, patient-centered solution. And as far as wanting to get in touch with me, I can be accessed through email on our website. I’m also available on LinkedIn Ellen Ford Barton. So please connect with me or reach out. And I’d love to answer questions or provide any more information as needed.

Saul Marquez:
I really appreciate it. And listeners take advantage of the opportunity to connect with Ellen. We’ll leave links to all of the contact points that she mentioned instead of the show notes just go to Outcomes Rocket dot health type and care navigation in the search bar and you’ll find all of those contact points there, as well as a full transcript and resources that we’ve discussed today with Ellen. So, Ellen, I just really, really want to say thanks for spending time with us. This has been really insightful.

Ellen Ford-Barton:
Thank you as well, Saul. I appreciate the opportunity.

Saul Marquez:
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