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© Homecare Intelligence Canada Inc. 2016 - All rights reserved© Homecare Intelligence Canada Inc. 2016 - All rights reserved

© Homecare Intelligence Canada Inc. 2016 - All rights reserved

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0 Table of Contents

1. Executive Summary2. Homecare Intelligence Canada3. Health and Social Care System Context4. The Challenge5. The HCIC Logistics Solution6. The Benefits7. Additional Offerings8. Conclusion9. Contact Us


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Spending cuts and continued increases in demand have put unprecedented pressure on home-based health and social care services delivery in the UK

Provision of home care can be viewed as a ‘logistics challenge’ to provide the right care, at the right time, in the right place by the right provider – the current solutions used to address this challenge leave significant room for improvement◦ As an example, home care providers in the US travel an estimated 5

billion miles/year◦ In contrast, sophisticated routing solutions allow FedEx to travel only 2.5

billion miles/year globally – without these solutions, logistics companies like FedEx would not be able to survive

1 Executive Summary



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Our team has developed a solution that addresses the logistics of home care delivery - specifically, by improving the scheduling and optimizing the delivery of home care services. ◦ Increases the capacity of the current system through reducing care

provider travel and provide the ability to optimize for cost and quality of care considerations

◦ Provide opportunities to optimize resource assignment and scheduling across multiple homecare providers servicing the same area

◦ Allows logistics-related administrative tasks to be automated◦ Provide improved information and analytics (Business Intelligence) to

allow to better monitor and manage homecare system performance in real-time as well as to plan for the long-term

In addition, there is a Territory Generation tool that can help easily divide a geographic area into evidence-based territories that are equitable and can automatically respond to changing conditions

1 Executive Summary (cont’d)



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Homecare Intelligence Canada Inc. (HCIC) is a dedicated group of health and business experts focused on delivering innovative health solutions to address health system capacity, spending and quality of care challenges ◦ We have an intimate understanding of socialized health and home care

policy and operations, along with expertise in developing automated business solutions with experts around the globe

HCIC has partnered with Homecare Intelligence Inc. (HCI) to provide an innovative set of data-driven solutions specifically designed to solve healthcare service delivery challenges

2 Homecare Intelligence Canada - UK



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Increasing demand for home-based personal and health care services and growing budget constraints have put pressure on local authorities to:◦ Increase access to homecare services due to Care Act eligibility

Using their purchasing power to reduce the price paid for care, and◦ Reducing visit length such that a majority of visits are <30 minutes long,

and paying accordingly Where the burden for travel time and expense are a significant source

of concern and dispute within the sector◦ Despite shortening visit lengths, a vast majority of local councils continue

to expect travel time to be paid out of the rate paid for the visit◦ In response, many providers no longer pay care workers for travelling

time between clients◦ As a result, >25% of care workers are being paid less than the minimum

wage

3 Health & Social Care System Context

Sources:1Care is not a commodity: UKHCA Commissioning Survey 2012 http://www.ukhca.co.uk/pdfs/UKHCACommissioningSurvey2012.pdf#search=%22travel%20costs%222Pressure mounts for better pay for homecare workershttp://www.theguardian.com/social-care-network/2013/dec/04/pressure-mounts-better-pay-homecare-workers



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To date, the complex logistics of scheduling care in the community has not been adequately addressed, resulting in: ◦ Use of manual processes that rely on the knowledge of scheduling staff,

making scheduling more art than science◦ Increased care staff turnover and decreased work satisfaction from:◦ Staff needing to work longer days/hours to bill a regular days’ work◦ Travelling long distances to reach patients, including from rural staff

travelling to serve patients in urban areas or in opposite directions to other care providers from other agencies instead of being grouped to serve closer to their starting locations

◦ Reduced continuity of care as agencies focus simply on ‘just getting care’ done

The lack of a coordinated, system-wide optimization of how home care resources are deployed across the regions results in:◦ Waste of valuable and limited health human resources in the short-term◦ Depletion of system capacity to provide community-based care over

time, particularly in rural areas where supply is most limited

3 Health System Context (cont’d)



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Home health care logistics is unique and challenging◦ Unlike for other industries where delivery can be done by any personnel,

provision of care in the home requires precision – the right care at the right time in the right place by the right resource with the right skill sets

In other words, home care service delivery is among the most complex of the transportation class of problems, being:◦ Multi-depot (care providers typically start work from their homes)◦ Capacitated (care providers have limited availability)◦ Time window constraints (visits can have specific service times)

Identifying the optimal set of territories within a geography is also extremely challenging due to the infinite number of solutions that are possible

The Challenge4


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Our solution is a patient-centred heuristics-based solution to clinician assignment and routing of home care staff across a region.

5 The HCIC Logistics Solution

Home of Nurse for Agency 1

Home of Nurse for Agency 2

Home care Patients

Current State Future State with the HCIC Solution:



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The home care scheduling problem is in a class of computing problems called a vehicle routing problem (VRP) and is considered an NP-Hard problem (i.e. effectively unsolvable)

The multi-depot, time-windowed, vehicle routing (MD-TW-VRP) problem is one of the hardest within this category◦ A 100 point problem could take a super-computer 3 weeks to solve, if it is

even possible

Therefore, we use an heuristics-based approach to obtain a high-quality solution in minutes – not weeks

5 How Do We Do This?



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Simplifies scheduling of home care visits to a single automated function

Allows new visits to be quickly and easily fit into an existing schedule Provides care providers with a mobile application that allows them to

effectively manage their assigned visits in real-time, through the ability to set visit times, see the best routes to patients homes, and accept/decline last-minute appointment requests

Includes an optional auto-dial feature to automatically notify patients ahead of their visits or contact clinicians about changes to their schedules

Includes a suite of dashboards and reports that can measure and track performance against key metrics reflecting funder and/or service provider business objectives, such as tracking missed visits, continuity of care and other key quality and performance indicators.

Provides a single source of information on the location and availability of home care HHR resources to identify community HHR constraints across the region and in specific communities

Enhances integration efforts between Health and Social Care

5 Key Features of the HCIC Solution



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5 Logistics Product Features

We have identified 5 optimization levels that can be applied to routing in home care. The levels of optimization increase in complexity, and are based on analytical factors and your organization’s strategic goals.

0: Mapping Taking an address and calculating its place on a map. The basis for all geographic calculations in the system

1: Ordered Routing Calculates the driving distance and time for a set of stops in a given order. Does NOT put the stops in the optimized sequence

2: Optimized Routing

Given a set of stops, optimizes the sequence of the stops, then calculates the driving distance and time. Optionally, can take into account event windows (e.g. patient needs to be seen in the morning

3: Event Recommendatio

n

Returns a recommendation list for a particular event. Takes into consideration the existing clinician schedule, patient location, skills and time windows.

4: Daily Recommendatio

n

Takes a list of events for a given day, plus all available resources, and calculates to best distribution of events among the resources

5: Clinician Recommendatio

n

Also known as “Primary Assignment”, this optimization analyzes all the events for a given patient and returns a list of recommended clinicians to best serve as each patient’s main clinician for the full episode of care



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Levels 0 and 1 are basic logistics calculations that serve as the foundation for everything HCI does◦ Correctly placing an address on the map (Level 0) is so critical to all the

subsequent levels, we use multiple redundant geocoding services to ensure accuracy

Optimized Routing (Level 2) is the first level where we make a recommendation – by providing the fastest order to complete a set of visits for a day◦ Included in our solution is the ability to incorporate time constraints (e.g.

due to patient availability or clinical requirement) in determining the best route for the day

5 Levels 0-2: Maps & Routing


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Event recommendation (or Best Fit Analysis) can help you adjust quickly to urgent service requests, or if a clinician calls in sick at the last minute.

5 Level 3: Event Recommendation

Using the event recommendation tool, you will be presented with a list of recommended resources to choose from, along with their score.

The score is determined by: Distance from the Patient Resource Type & Capacity Patient/Resource Preferences

The lower the score, the better the fit!

Steve J Pancino

lower or higher??

I F

lower. It's a penalty effectively.


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Event recommendation comes with additional tools to help schedulers evaluate each recommendation before selecting the final resource assignment.

5 Level 3: Event Recommendation (cont’d)

MapProvides a quick overview of the selected resource’s driving route for that day

Current ScheduleShows the resource’s current schedule including the proposed visit to be added

Driving DetailEasily see the driving schedule for the day before assigning the visit


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Through an automated process, the scheduling algorithm compares the services required to the location and types of staff available to come up with the best overall solution for the organization for that day.

5 Level 4: Daily Recommendation


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Patient Recommendation can help identify a clinician (homecare/care worker) who can provide the maximum number of visits within the required episode of care, while travelling as little as possible.

5 Level 5: Clinician / Homecare Worker Recommendation



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Reduce scheduling effort, travel time and associated costs Improve working conditions and retention without increasing

compensation rates◦ Reduce unpaid time between visits & provide greater predictability in

staff schedules◦ Reduce paid travel time◦ More time for staff to complete required documentation in a timely

manner – improving compliance and reducing issues upon billing◦ Greater client satisfaction with “local” care providers within their own

communities◦ Reduce coordination staff which in turn produces annual savings without

reducing effectiveness Potential to optimize on other factors (e.g. pay type, skill, or to

balance schedules among staff) Improved ability to monitor and manage performance against

contractual obligations and quality indicators in real-time Easy integration with existing clinical operations and billing systems,

even for those few that have automated scheduling within their silo organization

6 The Benefits: Service Providers

The HCIC Logistics solution provides many benefits to service providers organizations:



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Expand system capacity to support patients at home, especially in resource-constrained rural areas, by:◦ Reducing HHR time and costs lost to travel and scheduling gaps◦ Enhance the use of lower-cost resources to provide services where they

can safely do so◦ Dramatically improving capacity

Improve working conditions for homecare CA’s, nurses and therapists and enhance retention in the homecare sector without additional cost to system

Single source of information for understanding location and availability of homecare Health Human Resources (HHR) to identify true HHR constraints within the funder’s service area

6 Benefits for Home Care Funders

The HCI solution, applied regionally, enables the funder to:



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Additional information and reporting to monitor agency performance, manage plan execution and adjust in real time to optimize capacity and provision of care

Ability to directly influence how care resources are assigned, including changing the balance between competing priorities (e.g. consistency of provider vs. costs)

Improve agency service availability and enable monitoring of care staff availability as they assign referrals

Ability to track and measure individual clinician and provider care when used in concert with historical outcome data

6 Benefits for Contract Management

Additionally, the HCI solution can help contract management groups identify the agency that can provide the best provider for each visit for the best price amongst existing contracts by providing:



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Reducing scheduling effort, travel time and associated costs Improving working conditions and retention without increasing

compensation rates◦ Reduce travel time and associated costs◦ Reduce unpaid time between visits & provide greater predictability in

staff schedules◦ More time for staff to complete required documentation in a timely

manner – improving compliance and reducing issues upon billing◦ Greater client satisfaction with “local” care providers within their own

communities◦ Reduce coordination staff which in turn produces annual savings without

reducing effectiveness Enabling the ability to optimize schedules on other factors

(e.g. pay type, skill level, or to balance schedules among staff) Improving ability to monitor and manage performance in real-

time With easy integration with existing clinical operations and billing

systems

6 Benefits for Provider Agencies

Use of the HCI Solution by home care provider agencies can help improve patient and staff satisfaction while reducing administrative costs. This is achieved by:


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Results of a comparative study in Atlanta found that, to schedule 130 visits on a single day using conventional methods vs. the HCIC solution:

6 Benefits: Comparative Analysis

Conventional Scheduling

Scheduling using theHCIC solution

Scheduled Visits: 100 130 (+30%)

Unscheduled Visits: 30 0

With total provider travel

required:2080 km 1760 km (-15% )

Required Scheduler Time

of:2 people x 8.5 hours 5 minutes (-99.5%)



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7 Additional Offerings

In addition to the Logistics Solution, HCIC also offers a Territory Generation solution and healthcare-focused Data Analytics Services.



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7 The HCIC Territory Solution

The HCIC Territory Solution supports three potential ways to divide a geographic area into territories, each with its own set of benefits and drawbacks. Postcodes provide a pre-defined and relatable set of boundaries, and

as such are a common method used to define territories. However, post codes were not designed to represent geographic areas, and many have strange shapes or are non-contiguous

Free-form generation usually yields better territories than post codes but is extremely time-consuming

Algorithms can automatically generate a set of territories that are designed to optimized for designated variable(s), and can dynamically flex to adjust to changing demandsOnce the territories are generated, the HCIC Territory solution includes an

intake tool that identifies the appropriate territory for any given address.



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7 The HCIC Territory Solution (cont’d)

HCIC’s territory generation solution can combine the “art” of free-from adjustments with the “science” of the algorithms to easily yield a set of territories that are fair and operationally efficient.



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As experts in collecting and managing Big Data analytical systems, we have experience building data warehouse solutions for service providers, EHR vendors and tele-monitoring companies

Our experience with the nuances of home care enabled us to create advanced, multi-dimensional business intelligence solutions. ◦ The architectures were based on traditional DW strategies involving

periodic ETL processes and pre-processing the multi-dimensional cubes.

While traditional data warehouse architectures are well established, tried and true methods, we feel the future of big data is not based on these architectures, rather using new Big Data architectures.

7 Data Analytics Solutions



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8 Conclusion

HCIC’s solutions can enhance existing home care assignment, scheduling and routing processes for an entire region, as:

An Analyzer – assessing the myriad of scheduling and routing combinations to provide the best daily, weekly schedule for care providers

An Optimizer - determining the best clinician to perform visits in the best order and on the best days to ensure patient care needs are met ensuring continuity of care

An Efficiency Expert – by improving mileage efficiency, the same amount of work can be done with fewer staff, without the perception of staffing shortages

A Watch Dog – to help benchmark and measure productivity, accurate invoicing, automated visit verification and financial governance

A Tree Hugger – reducing home care’s carbon footprint through reduced travel

An HR Manager – analyzing for HHR staffing efficiencies to create the capacity needed to meet growing demands

A Strategy – to improve home care system effectiveness, reducing costs while improving quality of care


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9 Contact Us


Or Contact Us At:E-mail: [email protected]

Canada: (561) 506-4613USA: 1 (800) 763-1957

[email protected] 66 909234

For more info, find us at:http://homecareintel.co.uk


http://homecareintel.ca/

http://homecareintel.ca/

Steve J Pancino

add link to white paper??

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