Home Care U - Cypress Home Care Earns $400K Grant to Expand Care for Medicaid Clients (Bob Roth & James Cohen Pt. 2)

Episode Date: May 6, 2024

Cypress Home Care has received the Arizona Healthcare Cost Containment System (AHCCCS) American Rescue Plan (ARP) program award, in partnership with Nevvon and PocketRN. Bob Roth and James Cohen, CEO of Nevvon,  are here to share how they plan to expand care and drive innovation for Medicaid clients.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Welcome to Home Care U, a podcast made by the team at CareSwitch. I'm Miriam Allred, your host. Great to be back with everyone today. I'm delighted to be joined again by Bob Roth, the managing partner at Cypress Home Care. We've also got a special guest today joining us. We've got James Cohen, the co-founder and CEO of Navon Training. It's great to be with both of you. Thanks for being here today. Thank you for having us. Thank you for having us. Before we jump into the topic today, like I mentioned, we've got a new guest. So I want to give both of our guests a little bit of time to introduce themselves, talk about their backgrounds, about their companies, and then we'll get into the topic at hand. So Bob, really quickly, why don't you, we did an extended intro

on part one, but I want to give you just a minute to introduce yourself and your company. And then James will have you follow and talk about your story and about Navon. So Bob Roth, managing partner for Cypress Home Care Solutions. This month, actually, on April 28th, we'll be celebrating our 30th year. This is definitely a mission of personal experience and being a family caregiver and being a caregiver from my mother propelled us to start Cypress Home Care Solutions back in 1994. We are an in-home service or in-home supportive care service company, primarily doing private care, but we also do Medicaid. And that's what we're going to talk a little bit about today. And we're looking to innovate and really be able to provide exceptional care in the current climate

we're in. And I know you've done podcasts on workforce shortages and challenges and the cost of our service challenges, but we're always looking to innovate and collaborate. And I'm so excited that you have invited James Cohen from Navon on because that's one of the companies that we've collaborated with to obviously be able to innovate and provide care differently than it has been in the past. So thank you, Miriam, for having us on. Absolutely. Thanks for being here again, Bob. Always a pleasure. James, yeah, why don't you tell us a little bit about yourself, about your background and about founding Navon? Sure. Thank you, Bob. And thank you, Miriam. Great to be here.

So I started my career out of college in finance, actually, and got into health care, like many of us, like Bob, because of a personal need. My grandfather was looking to get into a facility, could not find a facility that suited the needs of what our family wanted. So instead of trying to keep searching, actually built one. So this was 22 years ago, built a facility in Toronto, Canada. It's a facility that has 30 beds for people with aggressive dementia and still going today, 22 years later, strong. I spent the first 10 years of my healthcare career in facilities. And I've always considered myself to be an impact entrepreneur, meaning that anything I ever did, I wanted to impact people in the best way possible. And when I was thinking about what I want to do on top of the facility that I had, I said, how could I impact more people in a better way? And clearly, technology is one of those ways. And I want to do something in home care. Home care, as we know, most people would prefer to age in place at home with dignity if they had

that choice. And I then founded a home care agency that was technology enabled called Maven Care. Ultimately, we sold it to Biata Home Care, which was one of the large national U.S. home care agencies in the United States. We serviced all of Canada, New York, Massachusetts, and Illinois before we sold it off to Biata. After selling it off to Byada, the idea was, well, what pain point can we solve in my next business and still be impactful in terms of impacting people in a good way? And clearly, we have a workforce shortage and development problem. And I thought, how wonderful would it be if we created a learning management system with all the content, all the educational content in there to make it more efficient

and easier for the caregivers to learn? What I mean by easier, multiple languages, we build everything in nine different languages, bite-sized lessons, really easy and simple to use technology. And we started like that. We are around just less than five years, but we've grown pretty fast. Currently, we have about 300,000 caregivers learning on our platform on a daily basis. We serve 42 states and of course Canada. And if I'm not to introduce myself, I am the CEO and one of the co-founders of Navon.

Oh, incredible. What a rich background, James. You and I have rubbed shoulders for years and so it's a treat to have this opportunity to talk to you and just congratulations on all the success and all the growth. I hear only good things about you across the industry. We have a lot of mutual connections, mutual network, and really only hear good things. So it's a treat. And I'm glad Bob introduced us. And I want to get into the topic at hand today. You all have had a really exciting collaboration that's come to life over the last 12 to 18 months. Started last year, but there's been kind of more announcements and opportunities that have surfaced over the last few months. So for everyone that's listening, these two, in addition to Pocket RN,

have come across a grant to provide opportunities for Medicaid clients. And so today we want to talk about the why and the what behind this grant and how it's impacting your agency, Bob, and what other providers across the country can learn from this opportunity and how to innovate and really kind of cut costs for some of these Medicaid clients. And so, James, why don't you start and tell us a little bit about just the grant opportunity holistically? How did you all come across it? And really, what's at play here? Sure. Yeah. So I'll give you a bit of the overview of the grant opportunity holistically? How did you all come across it? And really, what's at play here? Sure. Yeah. So I'll give you a bit of the overview of the grant. Under the America Rescue Plan, there were program awards that were given intended to enhance the health, safety,

and member experience for the individuals who receive home care-based services. Access members, which are Medicaid members, for those who don't know in Arizona, can directly benefit, including Arizona long-term care system and non-Arizona long-term care system members like individuals who are elderly, individuals with disabilities, individuals living with a serious mental illness, and children with behavioral health needs. So that's the overview of the program. Bob, you're much more connected, obviously, in Arizona. We personally at Navone heard about the grant simply through access. They emailed us, inviting us to apply for the grant with partners. Bob, how did you hear about this?

So, you know, first I want to define these great acronyms that we have in the medical field. So ACCESS is actually spelled A-H-C-C-C-S, and that stands for Arizona Health Cost Containment System, Health Care Cost Containment System. And really what they try to do is obviously contain the costs as much as possible for the care that is being delivered to this vulnerable population, whether it be older adults or children, always been their mantra. That's always been what they've been really dealing with. Because I'm an access provider, we got noticed via email about this grant. And I also am part of the elderly and physically disabled provider lines. That's a really tongue twister if you would. It's EPDPA. And we really represent about 90% of the only

community-based service agencies that supply care to this vulnerable population. So I was well aware of it. I knew about it. For me, it was interesting. And I was like, okay, how could I pull this off? How could I be innovative and be able to do this? And it really was a phone call I got from James. And he said, hey, there's this grant in Arizona. They have some of the ARP, the American Rescue Plan dollars left, and they want to do a demonstration grant. Are you interested? I was like, not only yeah, but hell yeah, I'm definitely interested. Tell me what your thoughts are.

And you had already had a collaboration with the folks from Pocket RN. And I knew them. I knew Nancy Gillette and I'd met Jenna. But I'll let you tell a little bit about that, James, because you actually approached me with, hey, we need a provider. Are you guys interested in this? And yeah, yeah. For me, the anxiety came around not fully understanding what the different provider types are in Arizona. They number them 77s and 40s and 49s and all that.

And I remember emailing you, are you one of these? And you said, yes, you're number 40. Provider type 40, which is attended care, but you were naming like behavioral health, assisted living centers, habilitation providers, but 40 is what we are. Yeah. And Miriam, just for your assisted living centers, community service agencies, adult day help, areas of agency on aging, and so forth, and a few more. But there are about a dozen of them. So I was elated when Bob said, yes, we are one of those types, which is number 40. Awesome. You used the word demonstration grant, Bob. So I'm curious what the criteria was.

Obviously, you knew that there was this money available to you and there was kind of a broad stroke of what you needed to accomplish. Was it you basically putting together a proposal and then pitching it for this money? Or were there very specific parameters of, you know, this is how you qualify and these are kind of the criteria you need to meet? Or was there more flexibility and you presented a proposal? Well, it was more of the latter. I mean, you know, how can we demonstrate something where we can bring value to the members that are part of the Alltechs program, the Arizona Long-Term Care Service program? I think James, you know, is incredibly gifted in

terms of finding very talented people. And he's got an incredible grant writer that is with his staff. You know, I think of him as a professor and I think he is a professor, but he's absolutely brilliant. And, you know, he, you know, he sized up the grant and I'll let James talk a little bit about it, but really took a look at it, and we broke who actually cares in Arizona about providing the best type of care and the best outcomes. And that's when I reached out to Bob. I'm like, Bob's the guy at Cypress who's going to really fit into this. So we knew we were going to win before or right after we put in the application. We are 100% certain.

We write a lot of these grants and we sort of know in our stomach when we're going to win and we knew we were going to win this. It was a perfect, as Bob, we call the triad, right? Between us, ourselves and PocketRN. If you can just envision the fact that, you know, the Medicaid world is really designed so much like it was back in the Medicare days where it was fee for service. There really is no value base at all. And at least none that I'm really aware of. And, you know, because of budgetary issues and challenges, we in Arizona have not been able to keep up with the cost of living increases, the minimum wage

increases. So literally home care agencies are falling by the wayside and they're either going out of business or getting consolidated. And, you know, it's really hard to do business in this space because you can't live on these small margins. I mean, Miriam, since 2019 to 2024, the average cost for just caregivers has gone up 40%. And, you know, how can you be able to care and make at least a couple of dollars to pay your bills if you really can't be able to make a profit? And it's been really, really hard. So I think the thing that really allured me to what James brought to the table as he called it the triad, the mighty triad, is the fact that these family caregivers, and that's who we are focused in on. We're focused on family caregivers. We know that over 50 million of them are making the huge sacrifice every single day to care for their

loved ones. They are the silent army. They're the unsung heroes. They're the ones that are making differences and the people that they care for every single day. So because of the waiver program, family members are able to care for loved ones and get paid. So we have family members that are caregivers that are part of our team.

It's a Cypress on care solution. So, you know, we have to not only run the payroll, but we have to make sure their certifications are intact. We do supervisory visits. There's definitely changes of conditions. You know, for us, you know, it was really how do we bring value base to this population, right? How do we help these folks? And many of them are in these socially economic depressed areas and they don't have PCPs and the emergency room is their PCP. And I got to tell you these managed care plans and Arizona, by the way, for those that don't know this, we were the first state that had managed care organizations managing the Medicaid

population. It is really the state that a lot of Medicaid state programs look at. And they look to Arizona to see how we do this. So, you know, we have these managed care organizations that are getting soaked and destroyed financially when these people have changes of conditions and end up in the ER and end up into the hospital and into the rehabs. So they take this mighty triad approach and have a online training platform where James and his team has pulled them together. I mean, James, you've got a library of like thousands of training videos. It's crazy how much content he has for caregivers and being able to take it in small

enough bites that you don't have to sit in front of a computer for two hours. And, you know, through the fragility of life, people's conditions change. Through a diagnosis, people's conditions change and the skill sets aren't there. So I'll sum this up really quickly. And that is for us to get one of our caregivers, family caregivers to a training program is really difficult because they can't leave their loved ones home alone. So how do we bring that to them? How do we bring that training so that when their loved one, all of a sudden condition changes and they need to have maybe, you know, some training on high lifts and transfers

or maybe how to care for someone with dementia, you know, some training on high lifts and transfers or maybe how to care for someone with dementia, you know, how do we get that to them? That is number one. Number two is the telehealth solution with PocketRN. You know, instead of using the ER as your primary care, you know, if there's a change in condition, you can dial up a nurse and literally within minutes have that nurse there visiting with you. So I'll stop now, but just say we're bringing all this to the family member so that the family member can provide care for their loved ones and not have to run off and get training, not have to say, oh, crap, how do I care for dad now? He's limping or, you know, he's got a fever or, you know,

he's got a wound. You know, I can bring in a telehealth solution through Pocket RN. Yeah. Let me, let me interject for a minute. That was perfect. I wanted you to talk about the inherent challenges in your state, what that actually looks like. And I think you just articulated that really well, Bob. So yeah, James, why don't you jump in and talk about, you got the first round of this grant over maybe eight, maybe 10 months ago. And so you've actually started the execution. I think Bob was just like overviewing the opportunity and what you all wanted to do

with that. And now you're actually doing it. So talk about what you've been up to and how things are actually going and what you're doing. Sure. I'll talk about it from the education and training portion of it. So we backed into the needs of the family caregiver, as we know in our industry, for the professional caregiver, the paid caregiver, they need to do compliance training on a yearly

basis. So much easier to get them to do their training because otherwise they can't be deployed to a job if they don't finish their annual training requirements getting family caregivers to do the training is sometimes more difficult because they need to want to do the training so we thought about what the family caregiver would want. And similar to actually the professional or paid caregiver, you know, they don't want to be in front of watching a video for an hour, an hour and a half long. So thinking about, you know, micro lessons, bite sized lessons. We do know that many Medicaid members, maybe English is not their first language. So building the education in their native language,

and this is not AI, this is not Google Translate. These are real translators with quality assurance to make sure the translations are done properly. That's extremely important to us because we know for some of us who speak several different languages um translating one word to another word in a different language doesn't always resonate or doesn't always translate exactly and and when you're teaching people how to care for someone every word matters so it really really was important for us and continues to be important for us to have that translations done extremely well.

And ultimately, what we built is we built two learning tracks for the family caregivers, as Bob is talking about. And each one is five hours long. So two five-hour programs. And they are translated into different languages. They are torn up or into bite-sized lessons. So it's very easy to consume. And we have finished building the training. And now for the second half of the year is when we're going to deploy the training.

So we're really excited to see the outcomes of um the family caregivers they do lack a lot of training going through it with my own family even with my own family a lot of us don't know what to do when we're seeing our family go through the aging process so to have something like this at your fingertips on your phone in your own language in a two to five minute video. We're hoping that will be really helpful for the family caregiver. And the challenges that James brought up with family caregivers for us that are providers of Medicaid to this family caregiving population, just doing the electronic visit verification, part of the Cures Act for all of our home care agencies, that population is the hardest.

And it's the hardest because you're using your device that's supposed to be a GPS tracker, and that person's actually living with their loved one. So trust me, for all of us, those that are listening, we beat our heads sometimes because it's hard for us to get them to comply to check clock in and clock out yeah so i'm curious both of you have referenced just yeah this challenge of getting them to complete training you know we all know it's a resource for them and it can help them provide better care i'm curious bob you you've been working if i'm not mistaken with family caregivers for a long time what What are some ways that you educate them, incentivize them to complete training?

You know, or how are you going to better approach that? Obviously, James talked about, you know, this bite-sized learning that will be more conducive. What other ways are you planning on, I don't know, incentivizing them to complete training? I don't want to be able to have to pay somebody more to be able to do their job. You know, for us, more than anything, it's, you know, look, it's not my saying, but it's very appropriate. Technology makes things possible, but humans make things happen. And you and I have talked about this, Miriam, and by utilizing these types of partnerships gives us the opportunity to have more human time. So what I'm looking for more than anything is through my supervisory team is to spend more time with the family members.

Being able to have that one-on-one contact and being able to see the patient or, in our case, the member that we're caring for and where they are in their journey. So really, I think for us is to have that more human time and more encouragement and certainly having the collaboration, not only with partners like James and Pocket RN, but having the collaboration with the case manager from the managed care organization and really looping them in. So that to me is, you know, the fundamental thing. I don't ever want to be able to be in a position and my team knows that I'd rather, you know, reward something for what's doing someone, you know, doing something really great, right? What gets rewarded gets repeated rather than incentivizing somebody to do their job. Does that make sense? Yeah, totally. And Bob, you inspired a memory of mine that when we built our technology or

learning management system, because I had the luxury of operating and owning a home care agency, I knew technology adoption was difficult. It wasn't something that I came into this business naive with. And one of the things that we do on a yearly basis is we do that human touch. Well, we'll go out and fly out to talk to caregivers and have focus groups with them. And I remember in one of them, we asked them a whole bunch of questions and we spent about an hour with all of them in a group of about six to eight. And we were asking them, what are the most popular apps on your phone? And one of the people was asking us, like, why do UI of what apps they're using on their phone right now and build Navon in the same way, that it will feel very familiar to them when they go into Navon

and they don't feel like they're going into a new technology or a new app and they don't know how to use it. So the two most popular apps in that group or in all the groups actually that we did that year were WhatsApp, which made a lot of sense to us because you can video chat. Many people are from different countries and Instagram. So when we looked at the sign in page and the login page and the reset the password and how you move from page to page, we very much mimic the user experience and the user interface of those two apps to make it feel familiar to them. And they were mind blown when we were told in that they were so, if the word is honored, that we're actually making it so caregiver centric, the technology to make it very easy. And then on top of that, just to talk about,

we're not paying them more or incenting them more, but we do have gamification around it. We know many apps have all those crowns and you get points when you finish lessons or you log in. That is something that we continue to develop and it does work. It doesn't go from zero to 100, but it does boost people's want and ability to do things because they do feel rewarded around that. It doesn't have to be money all the time. It could be simple things like crowns or numbers or something like that.

Yeah. That's, that's making me think of the curriculum itself. You're talking about kind of like the format and the experience. I'm curious, James, the curriculum that you've built, family caregivers, obviously the dynamic is a little bit different than maybe traditional compliance training. How well have you approached the curriculum itself? You mentioned these two tracks, the bite-sized learning. Does the curriculum vary because of the demographic or the kind of circumstances of these needs. Yeah, we backed into what Bob mentioned a few minutes ago around the value-based care.

So we backed into all the value-based care, looking at all the chronic diseases of why people go to the hospital or why people leave home. They have to be leaving home to go either to the hospital or skilled nursing facility, looked into all the symptoms that come out of these chronic diseases, and then built bite-sized training to help find the signs and symptoms of those. So hopefully the family caregivers can intervene early, but also not use the emergency department as your primary care physician, because that's obviously very expensive and not something that we want to do. We want to keep people home as long as possible, as long as they're safe.

And this helps them a lot of backing into the value-based care and understanding what are the reasons that people go to the hospital and how can we intervene early with really good education and training. You mentioned, if I'm not mistaken, has this been rolled out yet or you have spent the last few months kind of building up to this and the execution is yet to come or it's already in place? Execution of building the training has happened. And now in the next few weeks, we're going to start rolling it out to the actual family caregivers. Yeah. Bob, could you speak to what the rollout will look like? What's kind of the intended plan to get this out, to educate, to motivate the employees to utilize this? You know what? It goes back to the human connection. I know James has had a chance to meet Adela Giancola and she oversees our all-tax business.

And it's being in constant communication with them and really helping them understand where they are or their loved one is in the disease process or in the aging fragility process and letting them know what programs that are available to really help them and help them through that journey. And, you know, a little bit of hand-holding and certainly more of that human connection. You know, as much as we want to rely on technology, we still need to be connected to the caregivers

and the clients that we serve, in this case, the members that we serve. So, you know, it's just really having that open dialogue and letting them know, you know, the grant, you know, enabled, you know, James and Pocket RN to do a lot of things that they hadn't done that were on, you know, their roadmap, if you would, and we're able to do those things now. And certainly they'll live beyond this grant and hopefully we can continue on with this demonstration project beyond that. We don't have Pauk and RN here with us, but you've mentioned it a couple of times. Bob, why don't you talk a little bit about the telehealth piece? What's the intention there?

Well, the telehealth piece for us is to have access to a clinician. We make it really clear, and James knows this too, having been in the space, is that we're non-medical. In the first episode, we talked about that term, non-medical, and it tells the world what we're not, but it doesn't tell the world what we are in that space and, you know, we cannot make any clinical decisions or do anything clinical to our clients, even if it is really technically a family member, because that person's employed by us and we are not clinicians. We're not medical. can, for lack of a better word, triage it over to them and have them be in contact with the member directly through the family caregiver and really discern where they are in whatever health care situation that they're in. You know, we have demonstrated and with this grant where we have saved these Medicare or should I say these managed care organizations money because we've avoided the events from happening. And I'll give you just some real quick stats that we have here. The client base that we are definitely, what we have affected, we have 91%.

91% of the members are fully engaged on the Navon and PocketRN platform and this grant. Since we've started, we've avoided five escalations and we've saved approximately about $70,000 to the health plan just in the last quarter alone. And I'll tell you what, what's really nice is that the health plans here, and I don't know what it's like in other states, have a partnership with Dispatch Health. So there've been two occasions where we've had Dispatch Health go out and be able to remedy that situation that was at hand and avoid a ER visit. So, I mean, those are the things that we're looking to try to get from them. But one of the things, and I don't really have the pocket RN mantra, if you would, or the value proposition down to a T.

I will tell you that Ryan, the grant writer that James employs, he's really up to speed on it. But I will tell you this, you have a nurse, you can have a nurse for life if you would through Pocket RN. And that's really important because you don't want to have just, it's just like a primary care person. You don't want to have a revolving door or a caregiver. You don't want to have a revolving door or caregivers. So if you've made a connection with a nurse, you can have that nurse for the entire length of that engagement with Pocket RN,

which is really important. And then I can really speak to Pocket RN. And that is if you do have an ER visit, or if you do need to go into a specialist, the nice thing about it is you can take your nurse with you. You can take your nurse with you on your, with your device and be able to have that nurse be set up for that appointment. So when you walk into the exam room, turn it on and the nurse will be able to confer with the clinician and be able to discern what is going on, be able to ask questions, be able to, you know, give information about what's happening with the member that's at hand. So that is really the secret sauce to all this is to be in having that clinician available in a non-medical environment because we're not helping.

We're not home health. We don't have that skill set. And that totally relies or totally lays upon our pocket RN. And for us, we just follow the direction. We follow the care plan from what that is established through pocket RN and a primary care or specialist that that member is seeing. I hope I've explained that well enough for you and the audience to understand that. Yeah. I think to drive it home a little bit more, I want to talk about, you know, like the world before Pocket RN. You're talking about, you know, as a home care agency, we're non-medical and I don't like that term either, but I'm assuming the family caregivers would call Cypress and you

had, you know, maybe a nurse or a clinician on staff, but it sounds like there were both limitations, maybe in knowledge, and then also like concerns of volume, you know, as you scale a business, you know, if you have one or two clinicians on staff and you've got, you know, 50 to hundreds of, you know, family caregivers, there's just limitations and there's also kind of a volume concern. So before Pocket RN, I'm assuming maybe those were some of the challenges. And now with Pocket RN, there's just, you know, way more, there's speed and there's scale in it. And there's also more knowledge and understanding from these trained nurses.

Am I kind of painting that picture correctly? So the speed and follow through, absolutely through Pocket RN. You know, I will say this, Miriam, it is different for every state. And James knows this better than probably anybody because he operated a home care agency at multiple states. And now he's in like, as he said at the beginning, like 40 states and he's providing training solutions for them. You know, in my state, there's no requirement for a nurse.

So I don't have a clinician on my team that can do any of that work that you're talking about. So we would have to, in the past, we would have to elevate it to the case manager. And the case manager has home health care solutions and providers that are part of it, and they would intercede. So it would fall outside of my scope. And I could not do that any longer. So when you think of a cost standpoint for the health plan, now the health plan has to take on more costs by

dispatching, not to say dispatch health, but dispatching home health to go out. So in this case, part of the demonstration is that now they don't need to dispatch home health. We've got a clinician literally available on a device that can discern what's going on and make recommendations. Yeah. So unlocking a lot of opportunities with accessibility to these nurses. And I'm sure people can, you know, understand, I think telehealth is becoming, you know, more of a household word and it is quite literally through the device. They can call, video call, access a nurse in real time. And so there's just a whole lot of opportunities to unlock there. Well, I will add this. As you know, I host a radio show and podcast, and I've had a number

of doctors on. And the number of doctors that were using telehealth pre-pandemic was in the 20% number. We are now in the post-pandemic era, and it's still above 70%. And they don't plan on leaving it. And I want to thank CMS because they were discounting it prior to the pandemic in terms of what the reimbursement doctors get. But now they were able to get the full reimbursement. And it's really good. I mean, when you think about it, we're caring for very fragile older adults. And for us to transport a 90 or 100-year-old or even an 80 or 70-year-old that has mobility issues, I mean, that's like an act of God that we've got to get them ready, right? And there's like an hour to get them prepared, and then you've got to drive them, you've got to get them ready, right? And, you know, there's like an hour to get them prepared,

and then you've got to drive them, you've got to get them there, and then you're sitting in a waiting room, and then God knows how long you're going to be in the exam room, and exposing them to all kinds of germs and stuff when they just needed to be checked out because they take a blood thinner like Coumadin, and they need to be seen on a quarterly basis. Now they can do those visits telehealth wise. So I think what's happened with the pandemic, one of the good things that has happened is

healthcare has really, really adopted technology like never before. Yeah. And I don't think that's going away anytime, anytime soon. The accessibility, you know, I think all of us are experiencing it in different ways through primary care, you know, specialty care. It's just at our fingertips. And it is, like you said, a much, much, you know, smoother experience where you can get help in a matter of minutes rather than, you know, an hour long visit. And the practitioner gets a chance to see them in their home environment. And let me tell you,

some of the doctors tell me that they walk through the house showing them their home and showing them their dogs and their cats. And I mean, it's a more intentional visit rather than going from exam room to exam room to exam room and only getting seven minutes or five minutes from a practitioner. Yeah. Talk about whole patient care. You know, you get a much better look at their life, at their day today rather than just, you know, kind of that quick visit in an office setting. Bob, you were talking about some of the statistics. I want to give both of you some time to talk about, you know, just like your hopes and dreams. What are the outcomes that you want to achieve? What are you most excited about achieving with this program? James, maybe you could start and talk about, you know, what you're seeing, but also what you hope to see and what you hope to get out of this.

So yeah, great question. And as you guys were just talking in the last few minutes, I was thinking a little bit about that. So we write a good number of these grants and we win a good number of them. And I almost think of it like the gym membership. You can buy a gym membership, but if you don't go, you're not going to be in shape. You're not going to be healthy. I feel Bob and Cypress were the perfect partner. We've had other grants where we've won and people are like, okay. And they don't really invest their time and their network and their resources into it. With Bob, we've been speaking to payers.

We've been speaking to their family caregivers. We're always in communication. It's been such an excellent partnership that if I think about my blue sky, we are in the blue sky with this partnership over here because we are trying to take good advantage of everything that ARPA gave us and Axis gave us and really demonstrates that we can keep people home for longer with dignity and save on cost, which is what we want. And we really are in blue sky here with Bob. So thank you for that.

It's been excellent. Yeah. I'll add and just say that, you know, I shared with you the acronym of access, right? Arizona healthcare cost containment system. And, you know, we want to be able to move the needle from the fee base way they pay us as providers to a value base and shared savings. And the way I look at this partnership, that's what I want to do. I want to stay a Medicaid provider. I mean, look, we know the data. We know that the 85-year-old population between now and 2050 is going to nearly quadruple. In Arizona alone, by 2030, we're going to have more people 65 and older than 17 and younger.

So this population is going to only grow. And if it stays fee-for-service, I'm not sure as a provider, I can stay in this because the margins are really low. And thank God I do private care because it is a margin blend. And people God I do private care because it is a margin blend. And people have said to me, why are you doing Medicaid? There's a business out there. But more importantly, there are people that need care. And, you know, why not? I mean, we should be doing that. So my hope is that through this demonstration, Graham, we can show that we have brought value to the members, the family members that are doing the care, having them have access to training in bite sizes so that they can be

better caregiver for their loved ones. Having a telehealth solution in their pocket to be able to discern a change of condition and whether or not they need to go to an ER, and in this case, maybe have dispatch health to avoid that ER visit. So, I mean, for me, my long range view on this is to be where access adopts training platforms and telehealth solutions. I mean, I'm a little biased. I would love it to be Nivan and I would love it to be Pocket RN, but it could be anybody. I mean, but for us to be able to show that and show that value is something that I'm really excited about. And I'm even more excited about the fact that we're going to find out any day now if whether or not we won the second round. And I think the

one piece that I think that we've left out, and I really want to make sure I close the loop here. So this demonstration grant was $40 million that they put out there. They put out $40 million for people like us to be able to take down. And through the $40 million grant, they were going to pay it out in either $10,000 or half a million dollar increments. And we publicly brought the cash that we got over 400,000. So we almost got half a million. But I think the thing that I really want you to understand is that there were over 800 applicants, 800. There were only 61 awardees. And Navon submitted three and all three of them were awarded.

Mine was the only one that was a non-medical HCBS entity. And we believe that we were the only one in the entire state that got that grant. So this is big. I mean, this is, you know, I feel like I have the weight of all the HCBS providers on my shoulders to be able to demonstrate to access because we all need to move this way. This isn't all about Cypress and Navon and Pocket RN. It's about the future. It's about where we are.

And I'm really glad we talked about how telehealth and how the pandemic really brought out a lot of good in the fact that health care is adopting technology. But at the end of the day, I mean, we started off by talking about the 50 million family caregivers. They're the silent warriors out there, the unsung heroes. And we need to give them the tools. And I think this is a great way to do it. And I couldn't be prouder to be partners with James and Jenna and Nancy over there at PocketRN. You said it really well, James. You talked about there's a lot of grant opportunities out there.

And to be honest, I've heard of a lot of them. I've heard of people winning them. But you said it really well of you're actually doing something with it. And I want to just say thank you to both of you and to Pocket RN for taking initiative and finding the grant, but putting in all of the work that it takes to execute on a vision like this. And I think how this, I want to close with asking you how, you know, why this matters to other providers, people listening to this conversation, but I think you all are building a model. You keep using this word demonstration. How do you

build a model in Arizona through SIPUS, through this collaboration that can draw eyes, can draw attention, you attention, create something that works and does drive value. And obviously, it can have a ripple effect in Arizona. But how do people around the country see this model and notice it and then re-implement it maybe in other states that struggle with low margins for Medicaid? And so you all are pioneering these concepts. And hopefully, it draws a lot of attention so that it can be replicated in other markets.

So that's kind of my take on why this matters. But from both of you all, what's kind of a call to action for other owners hearing this? What can they do based off this information or what should they be doing? I think I've had the opportunity because ARPA or American Rescue Plan funding

was given to every state. Every state asked for the funding in somewhat of a different way, but ultimately it was all the same thing. How do we keep people home safe and create better unit economics for everybody for as long as possible? And what I found is, taking that analogy of the gym,

buying a gym membership, going to the gym, Bob is at the gym every day, three times a day, right? Probably in real life, but also for Cypress. Really care about your business and care about the people and the care recipients that you're caring for. And of course, the workforce that you're managing. I think bottom line, it all comes down to that. It is a human business. The technology we use is just enhancing it and maybe making it more operational efficient, but it is a human business. And I think it comes down to just the pure basics,

really care about what you do. And if you do, you can use these demonstration projects to do very well. Right. Bob, what do you think owners, yeah, what can owners do with this information? What actions do you want them to take based off hearing this conversation?

Well, I think first of all, they need to be aware. And for me, I knew about this grant and I was excited about the grant. I just didn't know how I could do it. For me, I was just like, how do I do this? How do I make this work? And the fact that, you know, James called me up and he discerned that I was number 40. He was like, I've got a great idea. So, I mean, you know, hopefully, you know, home care owners can maybe think outside the box, maybe learn a little bit about what we learned together. But, you know, for me, I think every grant opportunity that is out there, especially one that can derive a demonstration like ValueBase, should be something people should consider. The ARPA grant, I mean, we were very fortunate. And James has seen it in other

states. There's money left over from the pandemic. I mean, that's exactly what these states have done. And the states are using the money, I mean, with fear, obviously, that there's going to be an administration change next year and that money will be clawed back. sure they're keeping their employees in place, doing stuff like this that's innovative. And I think for me, my message to home care owners is that, hey, you know what? In order to be here 30 years and be here beyond 30 years, you need to think to the future. My wife is a big fan of Hamilton, right? And the Schuler sisters, if you know that song that they sang, they said, look around, look around, what a great time it is to be alive right now. And I am telling you, I think this is a great time for us to be alive. We're doing some incredible things. It's a little scary, don't get me wrong. But what's happening in healthcare with the adoption of innovation and technology and staying very

human, I think will help home care agencies transform into agencies for the future. You both embody innovation and you shared some of the statistics. The statistics are staggering. The demand is not going away anytime soon. And I think both of you emulate just balancing this human connection mixed with just technology and innovation and embracing both. And I think that's, you know, kind of the tone of this conversation is there are, there's money out there, there's opportunities out there, seek out the right collaborative partners and, you know, do something about it. And I think that's what both of you

are doing. We'll have to do some future episodes with Pocket RN to give them an opportunity to talk about their piece and about telehealth and about some of the innovation there so um you know something for for me to make note of to bring them onto the show later on but i just want to thank both of you for all that you're doing you both work so hard day in and day out to make a difference in the lives of so many caregivers and also clients and and their families and these family caregivers there's so many people that in just your two networks, the amount of people that you're supporting every single day is remarkable. So thank you for what you're doing.

Thank you for the innovation, for the drive that you have to push this industry forward. Great conversation today. And I look forward to giving the opportunity for other owners and operators to listen to this and to learn from it. So thank you both for being here. Thank you, Miriam. Appreciate the time and the opportunity. And certainly thank James for being my partner and certainly trying to innovate and be different. And the collaboration is, is so appreciated. Bob, I always have fun with you. Everything we do,

we always have fun together and Miriam, thank you so much. It was actually great to finally meet you and thank you you for putting us together here was a great time yeah absolutely well thank you everyone for listening to this episode we'll look forward to seeing you back again next week we'll go ahead and wrap there thanks again that's a wrap this podcast was made by the team at care switch the first ai powered management software for home care agencies. If you want to automate away the menial of your day-to-day with AI so that you and your team can focus on giving great care, check us out at careswitch.com.