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Business Intelligence for Your Senior Living Community

January 20, 2023
Amber Bardon and Jackie Ramieri

In this episode of Raising Tech, our host, Amber Bardon, has a great conversation with Jackie Ramieri, CEO and Founder of CareWork, about CareWork's unified operations platform which allows skilled nursing, assisted living and independent living facilities and Continuum of Care Retirement Communities to save time and money by streamlining their operational systems.

Discover how CareWork's clients have reported generating more revenue and have decreased their administrative burden by 80%, allowing more time for sales and personalized attention they offer their residents.

Raising Tech is powered by Parasol Alliance, The Strategic Planning & Full-Service IT Partner exclusively serving Senior Living Communities.

(Amber 0.05)
Welcome to Raising Tech Podcast. I'm your host, Amber Bardon, and we are doing our first episode for 2023. So, to kick us off for the year, we have a guest who is a personal friend of mine, and I'm so excited to finally have her on show. Jackie Ramieri, welcome to the show today.

(Jackie 0.17)
Hey Amber, thanks for having me!

(Amber 0.25)
Jackie, you have done something so interesting with your company, and I think the solution that you brought to the market is something that's really been needed in senior living for a long time. I think there's been a really big gap that you're filling with CareWork, which is your new company. So, to start off with, can you just tell me a little bit about your background? How long have you been in senior living, and then what led you to found CareWork and what is CareWork at a high level?

(Jackie 0.48)
Yeah, so, I've worked in senior living specifically since about 2008. Prior to CareWork, I was a fractional CIO for multiple operators,  kind of all over the country, and I was trying to buy something like CareWork. So, as a buyer I was demoing solution after solution and very quickly realized, and this was in early 2020, that what I was looking for didn't exist at all on the market. So, I was frustrated.  I reached out to my clients and just asked them if they'd be willing to be patient with me so that I could see if it was something that I could build  and have developed, and they were very, very patient to the tune of about two and a half years, which has gotten us where we are today with CareWork.

(Jackie 1:40)
So what CareWork is, it's the first ever unified operations platform, specifically designed for long-term care and senior living operators. We integrate agnostically with the systems that operators already use, tie that data together, organize it across their operational flows, but what makes us really unique is that we build in custom report automation and workflow capability.

(Jackie 2:06)
So, operators actually have the ability to add in operational data to this database that now exists. So, stuff that they could never really trend and track or have a part of their data. Picture things like how many state and federal visits have I had? We wanna be able to take that data off spreadsheets and put it into an intelligent platform so that they can use it to make decisions improve and get better.

(Amber 2:31)
That's fantastic! To help our listeners who are listening to this podcast, can you sort of, can you describe what does CareWork look like when you log in? What's the information that you see? How do you navigate through the system? Are you able to give us a, a visual picture of the system?

(Jackie 2:48)
Absolutely. So, the first thing I'm gonna start with is to say that it is ridiculously easy to use.  We designed the system to be usable without training because none of us have time for complicated, especially in long-term care and senior living. So it is a very clean layout. We do offer obviously new client, what you would call training.

(Jackie 3:12)  
We don't even call it training. We call it a tour because training implies that it requires real time and effort to learn and it just doesn't. So, the entire site is searchable. If you have a brand new DON who started in, you know, for example, day one, and she comes in and has never used CareWork and hasn't had time for her tour yet, but just wants to see everything having to do with infection rate.

(Jackie 3:17)
She can type in infection rate and the search bar just like she would do in Google, which everyone's familiar with, and it'll pop up every report that contains the search term, requested. Every report and function task is favorable. So, you can very easily access the things that you use over and over again, and everything's really organized across industry standard operational flows. So,  census labor, financial procurement, clinical quality, everything is very, very easy to find, and just super organized in a very, very intuitive way. We also have when you first log in, communication functionality, so multi-user, excuse me, multi-location users are able to broadcast notices out to specific title groups, specific  locations. We've built in some fun stuff like our, I call it the "Good News" reel.  It's basically a highlight section so that the first thing you see every day is just a reel of everything that you've done really well, either really well or every improvement you've made. We have a lot of tools inside for fostering stafflove, right? So, we want to shout out staff work anniversaries, staff birthdays, also resident birthdays. So, I think that it's really the key here, designed for the way that we should and want to operate in long-term care and senior living.

(Amber 5:07)
One of the key parts of CareWork that makes it such a great product is the integration piece and that you cross multiple platforms and you bring all that data together in one place. Can you talk a little bit about the types of systems that you integrate with, and how that data gets pulled into CareWork?

(Jackie 5:24)
So, sort of the beautiful thing about this, and this was by design, it was one of the number one things on my list of things that were important back in 2020 when we started to scope the system. So, we handled the integration piece as a service. There are operators that might use Power BI or Tableau, and those require a staff to support them or very hefty consulting fees, and we know that we wanted this to be something that was accessible to all. Operators, even smaller multi-location operators, not just the biggest of the big.

(Jackie 6:02)
So, the first thing we do is we handle the integrations as a service. So, commonly the core systems that we're integrating with are going to be electronic health, health records, H R A S or time-and-attendance solutions, ancillary scheduling systems. There are a lot of common ones, also procurement systems. You know, you have the common ones in the sy in the industry, you know, DSSI, right? That's a common one. Financial systems, a lot of times that's found in the EHR, but we're going to be integrating with actual other financial systems. So, people might use Acumatica, they might use, you know, Sage, whatever that is, right?

(Jackie 6:45)
So, the idea is to get the core business areas that those core systems are supporting, which is really gonna be, it's really gonna be clinical labor, financial and staffing business development as well. So, like CRM systems, whether or not that's part of the EHR separate system. So, we have a pretty organized way of approaching that.

(Jackie 7:05)
Many of the larger players in the space, the ones that are more widely adopted, we've already built those integrations, but when we start talking to a new client, and they are using a system that we have not yet built the integration for, we just build it. We just build it for the customer, and we know what we're doing on that, on that side of it, we also know that every system vendor may have a different way of allowing customers access to their data but we nav we navigate that for the customer. We don't want them spending time on that. We don't even want our customers thinking of care and technology almost in the same sentence. Right? Because for them, for them it's about simplifying operations and, and we'll handle all the tech stuff, you know, we'll take the complicated stuff on. We don't want our clients doing that.

(Amber 7:56)
Yeah, and that's, that's what I love about it. I've seen the system, and it's so easy to use and navigate through. It's very intuitive and simple. Can you walk me through a use case for a community? What would a community look like that would be a good fit for CareWork, and what would be the important things that they would need to know when making a decision to purchase a system like this?

(Jackie 8:20)
Yeah so, really we are a fit right now for multi-location operators. Probably, I would say more like a five location plus operator right now. I'm hoping to change that in the future, but for right now, that's sort of a sweet spot.  So, five locations and up, although we know CCRCs are sort of specific, right? So, a CCRC could be 16 locations in one. That's a different story. It's a different setup. It's a different way of operating. So,  the other thing that, that I think is important note is that when we have a conversation with a prospective client, we like to talk about what systems they're using or aren't using, right?

(Jackie 9:06)
Because, if you, so for example, we engaged with,  and we work by the way, in both, in both long-term care and senior living. So, our clients operate everything from skilled nursing to, you know, assisted living, memory care, independent living, all of the above, right? We cater to all of that. I was speaking with a larger Al operator that was almost all, it was like they were almost exclusively Al, and they have 60 plus locations and were scheduling on paper. They weren't using an EHR in a really, almost at all. They weren't, their foundational systems were not ready for CareWork, right? They had a lot of work to do internally, I think, just to get themselves to the point where they had data to work with.

(Jackie 9:58)  
So, we don't ever, you know, for us, we would never say, "okay, we're gonna install CareWork." If it's not gonna do anything for you, you need to have that data. That's really the way that it goes. If I have a conversation with a customer, and they're not, at least at the core, sort of foundationally set up, What I like to do is refer them to the companies that I think might be the right fight or maybe like a top three or share with them some of the systems that our clients  are using and liking, and then we circle back.
(Amber 10:06)
Yeah, that makes sense. Think, speaking of implementation, you know, I think sometimes people hear system implementation and all they think about is how much extra work is this going to add to my day-to-day? So, can you tell us a little bit about what does an implement implementation plan look like? What's the schedule? What do you need from clients to participate in that process?

(Jackie 10:53)
Absolutely. So, we need, we need input from. Ultimately, it's three people, whatever that title may be but typically it's at a corporate level, so it'll be director level plus is usually who who works with us. So one operations, one clinical, and one finance. So, those are the three key players in the setup. What we're gathering from them are targets, goals, and budget. So, really the first step is gonna be bringing those systems in. So, we have to work on getting the systems integrated, although we do some of this stuff in tandem, but the first step is bringing in the EHR environment because from the EHR, we're able to pull information on how the locations are set up in the EHR, and information on how, for example, AR codes are set up that tie to both census and financial data. So, we like to start with that starting point because it gives us a visual of how they're set up.

(Jackie 11:59)
Then, we take that and we have to work on mapping. So, targets, goals and budgets, and then how do we want the information to display? So, payer-type mapping because we wanna bucket that you might accept, you know, you might have 20 different insurance types, right? We don't want, we don't want 20 different rows of data. We want all of that to flow to a category called insurance or managed care. However, we wanna set that up, right, or both. So, the, the configuration, or excuse me, the effort from the customer is really what do you want it to look like? But we have that very structured, we run with all of the sort of hard work.

(Jackie 12:34)
So, once we get that information, we  first build the environment, and, you know, load out the locations and then we take it section by section and work on mapping. We also roll it out to the customer. Section by section, but in a three phased rollout. So, the first rollout is rolled out to the corporate users. So, it's really the key stakeholders. They use it for a couple of weeks, make sure that we don't need to do any final tweaks. Did we, you know, miss this in mapping or was there a code that should be there that isn't there? You know, just kind of the stuff that when it's brand new you have to deal with. So, they use that for a couple of weeks.

(Jackie 13:17)
Once they say, oh, nope, this is pretty good. Then, we roll it out to the regionals. We want the regionals to get comfortable with it before it's rolled out to the facilities and the communities, because by the time it gets to the facilities and the communities, it needs to be just solid. The regionals are already using it and they really only need to use it for a week.

(Jackie 13:34)
I just want them to get used to using it. The other thing that we do is we provide customers and ourselves with a utilization tool. It's built right into the system. So, we manage closely monitor the planners for the first couple of months and then once a month thereafter, the utilization down to the actual job title at each location, because the idea here is the users of CareWork are all management- level plus employees. So, the idea is that it should be used Monday through Friday consistently. So, we can actually drill down to that usage, and we can drill down to what is being used by what job title, because we CareWork as a company, and this was a huge peeve of mine in my CIO days, rolling out a system that wasn't being utilized or adopted. We're paying for it. I don't wanna have, my personal goal is I don't wanna have a single customer inside of CareWork that isn't actually using this system. You know, 80% to 90% across the organization, because, you know, you're gonna have some people that you have to maybe, maybe train a little bit more, but generally speaking, we wanna see 80% plus utilization as a standard average.

(Amber 14:43)
Yeah, definitely system optimization and usage is a goal to work on for all clients of all their major prize enter systems, and I would even say it applies to some of the systems that would feed into CareWork. You need to be able to fully utilize PCC or your financial system or whatever to have the accurate data go into care work as well.

(Jackie 15:04)
Can I make a point to that? Because that was a really good that, I'm so glad you brought that up. One of the, it was like an unintended afterthought bonus, right? Of using something like care work is that it shines a spotlight on incorrect data in the source systems. So on the clinical side, You know, it very easily points out when things aren't charted properly, right? Or aren't charted at all. On the financial side, it points out when things are maybe incorrectly added on the, I mean, everything, right? So, it's such a shortcut to say, "oh, this is incorrect in the source system. We really need to fix this. Or we really need to train our teams how to input this correctly because we wanna have good data."

(Amber 15:47)
Yeah, absolutely, and I think that leads to a bigger question about ROI. So, obviously CareWork is a system that that you have to pay for, but I think, the bigger picture is that there's so much process efficiency that you're gaining and so much more information that you have at your fingertips in addition to reducing a lot of manual and paper processes. So, can you talk a little bit about how you see CareWork replacing some of those inefficiencies, and how do you really sort of capture that full return on investment with this system?

(Jackie 16:18)
Okay, so I'm gonna talk about this in two directions. One is opportunity-cost savings. So, we're talking about saving time, doing more with less and then the other piece I'll talk about is hard- dollar savings. Our goal as a company is for CareWork to always pay for itself plus, plus, plus, right? So, from an opportunity- cost perspective, I'm gonna give you a few examples, but I'm gonna start with we believe that the system will reduce the administrative burden for management level plus employees by 80% or more.

(Jackie 16:51)
So, what that means is 80% time, 80% less time spent sitting at a computer, and 80% more time focusing on fostering, developing and retaining staff and spending time with residents and family members. So, from an oppor, that's a high broad statement, right? So, let me give you a couple of real world examples. One of my VPs of clinical 27, facility-skilled operator, so she's a VP of clinical. She spends a day and a half, this is her quote, not mine, a day and a half every month, compiling one quality measures report. So,  a day and a half of VP of clinical time, yes, there's a hard-cost savings there, right? You're paying a VP of clinical to sit in her in front of her computer for a day and a half, but she has other things to do.

(Jackie 17:42)  
So, we automated that report and now all she has to do is click it. So, it is five minutes to review the report, not a day and a half of manually compiling it. So, when I talk about custom report automation, our goal with CareWork is for these organizations to completely ditch the spreadsheets. We want them gone.  So, we want, we want over time zero spreadsheet and document-driven reports being emailed back and forth across departments, in between regions and up to up to the corporate level. So, we start by saying, "alright, let's talk about what reports on a spreadsheet or a document. Do the department heads at the facilities or communities owe the regionals every month or every week or every day?"

(Jackie 18:27)
We start with that, and then we say, "alright, we're gonna build those over time into CareWork. So, the idea becomes that any of those reports, here's the, here's the typical way those are completed, I open up my spreadsheet, I dig in three different systems to pull out all this information from a bunch of systems I have, I add in my notes and thoughts and feelings, and then I send it to my regional. My regional gets it from a bunch of locations. They roll it up and they send it to corporate. Next week, I go pull all the same information over and over again, and I might do three different reports that ask for 30% of the same information that I just had to do over and over and over again, right? So, when you build that same report inside of CareWork, what what we've found is 80% to 90%, I would say 80% on average, 80% of the data that li, that is requested in those reports, lives in a system somewhere. About 20% is what we call observational data.

(Jackie 19:24)
It's my thoughts, my feelings, my notes. How many state and federal visits did we have? So, when you build that report inside of CareWork, the 80% that already lives in the systems, auto-populates for the person who is required to submit the report. So, that report we call a "task" in our system. So, if it's a clinical report, it's due every Wednesday, 80% of it auto-populates.

(Jackie 19:46)
I enter the 20% that didn't, and I click submit. So, it just took me 80% less time to complete that report. So, those are, those are examples of opportunity-cost savings, and there are more than that. Just analyzing your data can bring tremendous opportunity-cost savings in, in, you know, things like overtime and all of those things, but I actually asked three of our clients to give me in their own, what they felt the cost savings would be just, and I mean, it was like a quick conversation and I put them on a slide. So, here's what they gave me. Reducing labor costs, reduced waste, revenue loss prevention, and faster time to cash increasing revenue, and this is what they said about that allows us to do more reporting than we could do manually, which allows us to be proactive and more responsive. This results in better star ratings, making us more attractive to potential patients and residents, which leads to more revenue. They talked a lot about clinical insight, and I had one operator tell me the less time our ED has to spend doing administrative work and digging for information, the more time they have to focus on sales, and lastly, they said a reduction in fine by reducing clinical errors. So that's just kind of a short list. I didn't want to as CareWork answer that question. When people ask, I'd rather have our customers answer it in their own words.

(Amber 21:07)
I'm so glad you spent so much time diving into that because when I first met you and you described what CareWork was, I, this is what got me super excited because I know you're, you're talking a lot about bigger communities, but our clients are mostly single sites. They still spend so much time on these manual processes that you're talking about, and I think the ability to just move all that to be completely automated is such a gift to the industry in general, which is why, you know, I'm so glad that you've developed CareWork and that, you know, you came on this podcast to talk about it.

(Amber 21:36)
So, do you have any other words of wisdom or advice or anything else our listeners should know about CareWork before we wrap up?

(Jackie 21:44)
No, I would just say with regard to words of wisdom, technology has historically been kind of a scary thing in our space for operators and for, you know, employees, but I would say that we're at a point in, in our history in which it, it has to be adopted, and there are clever ways to do, but I would say make sure you're looking at your core systems. Make sure you have the right ones in place, and once you do, you should be looking at unifying your operations to be more efficient.

(Amber 22:19)
I love that! I agree a 100%. Jackie, thank you so much for joining me today! It's been really a pleasure to speak with you.

(Jackie 22:26)
Thanks for having me.

(Amber 22:27)
Listeners, you can find us online at www.parasolalliance.com and go to our Resources page where you can see all of our past episodes. If you would like to submit an idea or feedback or a topic you'd like to see on the podcast, please reach out to us on our website, and as always, thank you for listening!