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

Connect with Bob on LinkedIn

Connect with James on LinkedIn

Cypress Home Care Solutions

Nevvon—home care compliance training for caregivers

[ 00:00:04 ] 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 Solutions. We've also got a special guest today joining us we've got James Cohen the Co-founder and CEO of Nevvon training. It's great to be with both of you thanks for being here today. Thank you for having us. Before we jump into the topic today; 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 Nevvon. So, Bob Roth Managing Partner at Cypress Home Care Solutions. This month actually on April 28th we'll be celebrating our 30th year this is uh definitely a mission uh of uh personal experience and being a family caregiver and you know being a caregiver for my mother propelled us to start Cypress Home Care Solutions back in 1994 we are an in-home service uh or in-home supportive care service company I

[ 00:01:25 ] primarily doing private care but we also do Medicaid and that's what we're going to talk a little bit about today and you know 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 Nevvon on because that's one of the companies that we've collaborated with and we're looking to innovate and collaborate and we're looking to innovate and collaborate and collaborate and collaborate and we're looking 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

[ 00:02:05 ] here again Bob always a pleasure uh James yeah why don't you tell us a little bit about yourself about your background and about founding Nevvon. Sure; thank you Bob and thank you Miriam. It’s great to be here so I started my career out of college in in finance actually and got into healthcare like many of us and I started my career in healthcare and I started my career in like bob uh because of a personal need my grandfather was looking to get into a facility uh could not find a facility that suited the needs of what our family wanted so um 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 buildings and it's a facility that has 30 buildings and it's a facility.

[ 00:02:56 ] that has 30 beds for people with aggressive dementia and still going today uh 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 um 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 um and I want to do something in home care um home care as we know most people would prefer to age in place at home with dignity if they had that choice and uh I then founded a home care agency that was technology enabled called maven care ultimately we sold it to Bayada 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;

[ 00:04:11 ] Massachusetts and Illinois before we sold it off to Bayada. After selling it off to Bayada the idea was well what pain point can we solve uh in my next business and still be impactful in 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 multiply languages we build everything in nine different languages bite-sized lessons really easy and simple to use technology and we started like that uh we are around just less than five years but we've grown pretty fast currently we have about three hundred thousand caregivers learning on our platform on a daily basis uh we serve 42 states of course, Canada.

[ 00:05:26 ] And I forgot to introduce myself. I am the CEO and one of the Co-founders of Nevvon. 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.

[ 00:06:09 ] 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're going to talk a little bit about that. So, let's get started. 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.

[ 00:06:52 ] Under the American 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 Nevvon 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? Well, first, I want to define these great acronyms that we have in the medical field.

[ 00:07:58 ] 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. So, it's a very important thing to know. And I think that's children. That's 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 dare if you would. It's EPDPA. And we really represent about 90% of the home and community-based service agencies that supply care to this vulnerable population.

[ 00:08:56 ] 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. And they're going to be able to provide care to the elderly and physically disabled. And they want to do a demonstration grant. Are you interested? I was like, not only yeah, 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.

[ 00:09:44 ] Are you guys interested in this? Yeah. For me, the anxiety came around. I was like, I'm going to do this. I'm going to do this. I'm going to do this. I'm going to 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, your number 40. So, provider type 40, which is a tenant care, but which you were naming like behavioral health, assisted living centers, habilitation providers. But 40 is what we are. Yeah. And Miriam, just for your audience to know, the following provider types, there is probably about a dozen of them. Bob started mentioning them. And they could be behavioral health, outpatient clinics, attendant care, assisted living centers, community service agencies, adult day help, areas of agency on aging, and so forth, and a few more.

[ 00:10:42 ] 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. I heard a 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? It was more of the latter.

[ 00:11:17 ] I mean, you know, it was, how can we demonstrate something where we can bring value to the members that are part of the all-tax program, the Arizona Long-Term Care Service program? You know, 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 on his staff, who I, you know, I think of him as a professor. And I think he is a professor. But I think he's a professor. And I think he's a professor. And I think he's a 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 it down into chunks and figured out how we could be able to bring value to this population.

[ 00:12:06 ] Yeah, we have our head grant writer here, Adam. He's a PhD in gerontology. This was right up his alley. When he read this, he was, salivating at the idea of finding someone 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, it was a perfect, as Bob, we call the triad, right?

[ 00:12:54 ] Between us, yourselves and PocketRN. Yeah. And if I can, Miriam, 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.

[ 00:13:41 ] 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 dollars to pay your bills, if you 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, you know, these family caregivers, and that's, that's who we are focused in on, we're focused on family caregivers, we know that are over 50 millions of them are in the care system. And we're focused on family caregivers, and we're focused on are making the huge sacrifice every single day to care for their loved ones.

[ 00:14:24 ] They are they’re the silent army, they're the unsung heroes are the ones that are making differences, and the people that they care for every single day. So, if because of the waiver program, you know, 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 home 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 they're in the emergency room is their PCP.

[ 00:15:14 ] And, and I got to tell you, these, these managed care plans, and in Arizona, by the way, for those that don't know that, don't 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 in the, and into the hospital and into the emergency room. So, they take this mighty triad approach and have an online training platform, where James and his team has pulled them together.

[ 00:15:58 ] I mean, James, you 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 are really difficult, because they can't leave their loved one’s 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 change, and they need to have maybe, you know, some training on high lifts and transfers, or maybe a, you know, how do we get that to them?

[ 00:16:51 ] That is number one. Number two is the telehealth solution with Pocket RN, 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 worry about, you know, 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, that was perfect, actually.

[ 00:17:37 ] 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? I bought the first round of this grant over, you know, maybe eight, maybe 10 months ago. And so, you've actually started the execution, you know, what 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, you know, 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.

[ 00:18:12 ] So um, 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 want to have, 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.

[ 00:19:01 ] So thinking about, you know, micro lessons, bite size 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 and 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, translating one word to another word in a different language doesn't always resonate, or it doesn't always translate exactly. And we're, and then 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 those translations done extremely well.

[ 00:19:58 ] 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 size 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 the family caregivers, because 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.

[ 00:20:48 ] 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 ones. So, trust me, for all of us 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.

[ 00:21:39 ] 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've been working, if I'm not mistaken, with family caregivers for a long time. 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.

[ 00:22:22 ] 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've talked about this, Miriam, and, you know, 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, it's 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.

[ 00:23:18 ] 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, 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. We'll go out and fly out to talk to caregivers and have focus groups with them.

[ 00:24:15 ] 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 you care what apps are on our phone? For us, it was really important, because if we can mimic the U.S. and U.I. 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.

[ 00:24:56 ] 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 log-in page and the reset the password and how you move from page to page, we very much mimicked 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.

[ 00:25:40 ] 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. So, we know many apps have all those crowns, and you get points when you finish lessons, or you log in. So that is something that we continue to develop, and it does work. You know, it's not, it doesn't go from zero to a hundred, 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, you know, crowns or numbers or something like that. Right. Yeah. That's making me think of the curriculum itself. You're talking about kind of like the format and the experience.

[ 00:26:25 ] 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 all of you approach 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 while they're in the hospital or skilled nursing home. So, it's a lot of different things. So, we've been working with the family caregiving 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.

[ 00:27:22 ] 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. So, it's 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. Okay. You mentioned, if I'm not mistaken, has this been rolled out yet or you have spent the last few months or months in the hospital? 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?

[ 00:28:10 ] 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, you know, to motivate the employees to utilize this? You know what? It goes back to the human connection. You know, I know James had a little bit of a hard time with this. He 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.

[ 00:28:59 ] You know, a little bit of handholding 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 James and Pocket RN to do a lot of things that they hadn't done that were on 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 Pocket RN here with us, but you've mentioned it a couple of times.

[ 00:29:44 ] 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. But we are in that space, and, you know, we cannot make any clinical, you know, 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.

[ 00:30:24 ] So, it's really nice to be able to have this partnership where we can, you know, for lack of a better word, triage it over to 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, you know, just some real quick stats that we have here. And I'll give you just, you know, just some real quick stats that we have here. And I'll give you just, you know, 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.

[ 00:31:19 ] We've avoided, 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 have been two occasions where we've had Dispatch Health go out and be able to remedy the situation that was at hand and avoid an ER visit. So, I mean, those are the things that we're looking to try to get from them. But you know, one of the things, and I don't really have the PocketRN 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.

[ 00:32:13 ] But I will tell you this, you have a nurse, you can have a nurse for life, if you would, through PocketRN. 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 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 PocketRN, which is really important. And then I can really speak to PocketRN 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.

[ 00:32:52 ] 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. That's a great point. And I think we have a lot of people in our skill set. And that totally relies or totally lays upon our pocket RN. And for us, we just follow the direction.

[ 00:33:43 ] 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 the world before pocket RN. You're talking about 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 maybe a nurse or a clinician on staff, but it sounds like there were both limitations, maybe some knowledge, and then also concerns of volume. As you scale a business, if you have one or two clinicians on staff and you've got 50 hundreds of, 50 to hundreds of family caregivers, there's just limitations and there's also kind of the volume concern.

[ 00:34:34 ] So before pocket RN, I'm assuming maybe those were some of the challenges. And now with pocket RN, there's just 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 of 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, you know, we would have to, in the past, we would have to elevate it to the case.

[ 00:35:35 ] So I think mobile required recitation needs to be done at least three years. To do it, and then Organization, there needs to be about 5 something years to do and really solid that thing. Right. And we don't have to, you know, implement any more than 10 years. And that doesn't close to 12, if you think about it that well, there is that reason that we're going to run out of food doctor or there isn't going to be any more care. And in the next 10 years, in the next two and suddenly somebody's came on and they go, is this the cued? There really isn't a forgiven 18 years for your baby dressed or that you're saying? 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 understand, I think telehealth is becoming more of a household word and it is quite literally through the device. They can call, video call, access a nurse in real time.

[ 00:36:22 ] 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. And they're now discounting it prior to the pandemic. And they're now discounting it 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 a hundred-year-old, or even an 80- or seven-year-old that has mobility issues.

[ 00:37:14 ] I mean, that's, that's like an act of, of God that we've got to get them ready. Right. And, you know, there's like an hour to get them prepared and then you're going to drive them. You got to get them there. And then you're sitting in a waiting room and, 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.

[ 00:37:53 ] 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, and, and let me tell you, some of the doctors tell me that they, 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.

[ 00:38:35 ] Yeah. Talk about whole, whole patient care. You know, you get a much better look at their life at their day to day, 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.

[ 00:39:11 ] So, you know, we, we, 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 the 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 a communication. And 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.

[ 00:40:05 ] Because we are trying to take good advantage of everything that ARPA gave us and access 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. And we really are in the blue sky here with Bob. So, thank you for that. It's been excellent. Bob, yeah, jump in. Yeah, I'll add and just say that, you know, look, 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-based way they pay us as providers to a value-based 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.

[ 00:41:02 ] 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, you know, 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 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.

[ 00:41:45 ] 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 caregivers 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. 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 Navon and I would love it to be Pocket RN, but it could be anybody.

[ 00:42:29 ] 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 I 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 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, you know, we publicly brought.

[ 00:43:11 ] The test 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.

[ 00:44:01 ] It's about where we are. And I'm really glad we talked about how, you know, telehealth and how the pandemic really brought out a lot of good. And. And the fact that healthcare 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, and Jenna and Nancy over there at pocket RN. 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.

[ 00:44:39 ] But you, 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, and I think how this, I want to close with asking you how, you know, why these matters to other providers, people listening to this conversation. But I think you all are building a model. You keep using this, this word demonstration. How do you build a model in Arizona through Cypress through these, this collaboration? And how do you build a model that, that can draw eyes, can draw attention, you know, create something that works and does drive value.

[ 00:45:16 ] And obviously it can have a ripple effect in Arizona, but how do people around the country see this model and, you know, 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 these matters. But from both of you all, what's, 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? James, why don't you start? I think, I think I've had the opportunity because ARPA or American Rescue Plan funding was given to every state.

[ 00:45:58 ] Every state asked for the funding in somewhat of a different way. But ultimately it was all the same things. How do we keep people home safe? And create better unit economics for everybody for as long as possible. And what I found is, you know, taking that analogy of the gym, going to 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 Cyprus. 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.

[ 00:46:57 ] 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. Great. 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, you know, for me, I knew about this grant. And I was excited about the grant. I just didn't know how I could do it. You know, 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.

[ 00:47:45 ] 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, you know, can derive a demonstration-like value base should be something people should consider. You know, the ARPA grant, you know, I mean, we were very fortunate. And, you know, James has seen it in other states. You know, 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.

[ 00:48:31 ] They want to get it out there and utilize it. But beyond just, you know, stabilizing people and making sure they're keeping their employees in place, doing stuff like this that's innovative. And, you know, 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. You know, my wife is a big fan of Hamilton, right? And, you know, the Schuler sisters. If you know that song that they sing. 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.

[ 00:49:15 ] It's a little scary. Don't get me wrong. But, you know, what's happening in health care 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 agree. 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'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.

[ 00:50:01 ] 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, you know, something 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 their families. And these family caregivers, there's so many people that in just your two networks, the amount of people that you work with. 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.

[ 00:50:39 ] Great, 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. Be different. And the collaboration 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 for putting us together. It 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.