Melissa Ramirez, MSW, LCSW, CT, ACM serves as the director of Case Management & Social Services for Providence St. Joseph Hospital in Orange, Calif. She has an important job that requires her to ensure the care of our most fragile population, the elderly. She carefully places Providence St. Joseph’s patients in the best place for continued healing after their hospital stay. “It can be difficult to ascertain which place would be the best to recommend when transitioning a patient,” says Ramirez. “We’d often receive multiple calls from numerous skilled nursing facilities (SNFs) to at least six different case managers to update us on their availability. Therefore, it was difficult to keep track of availability, quality of services, and which SNF would be best for each patient based on their specific needs.”
Ramirez says she always thought that with modern technology there should be a better, more streamlined way to confidently place a patient to recover or live with some assistance once they are discharged from the hospital.
Then she heard about what Michelle Thai, MD, at Providence St. Jude Medical Center in Fullerton, Calif. was doing. Thai said she had been experiencing the same struggles to place her patients and saw how broken the process was so she teamed up with her son Johnathan Thai, a grad student; and Dan Bailey, Executive Director of Skilled Nursing Facility Collaboratives for Providence St. Joseph Health, to create Koazie.
Koazie is a real-time one-stop source for finding SNF bed availability and comparisons with other SNFs, all at your fingertips. No more reason for the SNF to call five or six case managers to tell them what they have available. Now SNF staff can upload their information to Koazie without having to duplicate their efforts calling dozens of hospitals and staff members, bringing their updates and information together into a single source.
The innovators partnered with the Innovation Lab, a health care incubator based in Newport Beach, Calif., that works with hospitals across the U.S., to scale the Koazie platform and increase its offerings.
Ramirez and her colleagues at Providence St. Joseph Hospital served as part of the pilot team along with Providence St. Jude Medical Center staff members, to test out the Koazie concept from the very beginning. She says pilot team participants were given iPads to show Koazie to families and staff. “The pilot team tried to be very strategic by demonstrating Koazie to department staff from Emergency and Orthopedics who discharge a good number of elderly patients,” she said.
Ramirez says that the Koazie site also features their partner facilities. These are the facilities they’ve vetted through their SNF Collaborative program, a program consisting of the hospital and several local partner SNFs working together to streamline the patient discharge processes to local SNFs. She says the patients and their families tend to trust a SNF that their own hospital has a relationship with. “They prefer to go somewhere that the hospital knows and partners with,” says Ramirez. “So it is our job to educate the patient and their family on how the SNFs work, and ensure the patient and family have a choice to determine their best placement based on quality and services that would best serve the patient.”
During the pandemic, Ramirez says that transition of care was very challenging because patients wanted to go home but could not because family members were often infected with COVID-19. Or the patient was infected with COVID. Then when they had surges of COVID, the health department would not allow patients to go home and SNFs were not prepared to take patients with COVID either. At this point, there was no choice but to accept patients with COVID. During this time, having photos and other visuals of the facilities on the Koazie site was an especially important feature because in-person tours were not allowed.
Some families may decide to send their loved ones home to be cared for by home health clinical workers (RN, physical therapist, etc.) that are covered by insurance. Ramirez says their hospital helps place an average of 15 to 20 patients per day. For home care providers not covered by insurance, families are required to secure that care on their own but often rely on the hospital’s own home private duty non-clinical caregiver service. They place about 15 patients per month for this type of home care. She says it’s nice that Koazie is building a list of home care providers that patients and their families can search.
Koazie helps the case manager engage patients and their families prior to discharge with a reliable and trusted source for post-acute care provider information, including Medicare quality and resource use measures. Ramirez says hospitals are now required to provide quality measures so having this information available on Koazie is extremely helpful. Only a few years back, hospitals were only required to provide SNFs in their geographic area. “With tools like Koazie, everything is right in front of you and you can show the family the Koazie website instead of having to sort through a pile of brochures,” says Ramirez.
“We need to be good stewards of our hospitals by getting our patients to the right place at the right time, always,” said Ramirez. She says that being in a hospital is not what it used to be. “It’s good when you need a doctor or nurse, but there are only sick people in a hospital.” Ramirez says her team strives to look at the spiritual and mental health needs of their patients to be among loved ones and move forward with their continuum of care.
She explained, “If there is a lack of efficiency in getting the patient to their next step in care, it can create a financial burden for everyone while creating more of a health risk for our patient as new and more sick patients are admitted. This is why Koazie is so important to us as we strive to expedite a safe and comfortable transition for our growing population of elderly.”
Roslyn Ausina, RN, serves as the director of Case Management at Providence St. Jude Medical Center. She has been a nurse since 1997 and a case manager for the last 8 years. She says her team’s first priority is to secure a safe place for their patients to go to heal and recover, and Koazie is the first comprehensive solution she has ever seen that facilitates doing just that. She and her case management team helped pilot Koazie.
Over time, Ausina’s team helped fine-tune Koazie to make it more user friendly for patients and case managers. She says she especially loves the fact that Koazie now provides her team with an automated daily report that they receive at 11 a.m. every day that breaks down availability for each SNF. As an example, one SNF may report that they have five beds available for senior males and six beds for senior females, while another will have no availability. This saves them time in making a selection.
“Our case management team is made up of 37 registered nurses (20%) and social workers (80%). Together, we have to be creative and innovative every day,” says Ausina. “This involves a multi-disciplinary approach, a willingness to tap into new resources, and an ability to give and take feedback in order to perfect and improve upon products and services such as Koazie that ultimately benefit our patients.”
She says that during COVID, the Koazie team gave them printed index cards with a QR code that family members could scan to go directly to the Koazie site to begin their search for post-acute care options. “The families also appreciated that we could pull up a comparison of three facilities for them, then simply forward the links to them by email without them having to Google everything,” said Ausina. “They also liked having online facility visuals and tours since they have not been allowed to tour facilities in person during COVID.”
Ausina added, “Koazie has become a great source and comprehensive way for us to navigate by location, programs offered, languages spoken, quality ratings, and insurance accepted.”
Bailey explained, “As we begin to get back to normal, some hospitals like Providence St. Jude and Providence St. Joseph are equipped with Koazie to help them provide all the background information they need to ensure the delicate balance between the right level of care at the right time and place for their patients.” He added, “Koazie provides virtual tours, which help replace ‘in person’ tours and this feature can speed up the discharge decision for placement and can save a tremendous amount of time for the patient, family and care managers prior to discharge.” He concluded, “Koazie allows SNFs to share key details about their facility that area easily accessible to patients, family members and hospital staff. It allows them to share their location, contacts, amenities, services, quality scores, video tours and bed availability instantly.”