What is Simply Connect?
Simply Connect is a robust care-management platform, personal health record (PHR) application, and referral-coordination solution with certified health information exchange (HIE) capabilities. The Simply Connect approach empowers individuals and their supports to identify needs, make referrals, and share customized event notifications amongst a unified care team on a robust, user-friendly, alert-based, and HIPAA-compliant service planning solution. Care team members choose what is most important to them based on their unique role, enabling the right professional to respond to the patient’s specific needs at the right time.
Simply Connect supports a diverse clientele including community-based social service organizations, hospital systems, EHR vendors, labs, pharmacies, assisted living facilities, skilled nursing facilities, behavioral health supports, home care, HUD providers, youth and family services, foster care services, physicians’ groups, and managed care organizations.
How did Simply Connect start?
Simply Connect was a result of two people trying to solve a problem in two separate ways and meeting after a couple years of efforts. Craig Patnode, CEO of Simply Connect, wanted to find a way to help the customers of another company he owned and operated — Eldermark, an assisted living software company — be prepared for the push for interoperability. At the same time, Nate Tyler, now Simply Connect’s Chief Strategy Officer, was working with several innovation programs looking at how to share data and impact lives in community-based settings. A Minnesota State Innovation (SIM) program was what brought these two initiatives together. Jump-started by work with additional innovation programs and groups like the Robert Wood Johnson Foundation’s Data Across Sectors for Health (DASH), we have been able to drive a unique solution in the community.
Fueled by a team of passionate industry experts, we dove deep to engage with healthcare and service providers across the country to identify care gaps, care-management challenges, and crisis-management pitfalls. The stark reality that emerged was that care team communication is fragmented, siloed, and cumbersome. Armed with this research, we committed to creating an approach to simplify care management. Our primary mission was to enable effective data sharing and efficient real-time communication in community-based, acute, and post-acute settings.
Responding to the reality that individuals with declining health often have multiple care team members, Simply Connect has placed considerable effort in developing a mechanism to share information across care settings. Each team member understanding their role in managing the care of an individual is pivotal in creating accountability and our solution is rooted in this principle.
Why are health information exchanges (HIE) so important?
Health information exchange technology allows healthcare and service providers access to the most up-to-date information on an individual. Having the right information when they need it greatly assists care team members in making informed decision, creating efficiencies in care delivery, and improving individual/organizational outcomes. While traditional health information exchanges have focused on hospital systems as the anchor, Simply Connect has become an industry leader by paving a new way. By creating an infrastructure where those closest to an individual — home- and community-based providers, family, and other natural supports — and formal care teams share information with the goal of keeping an individual anchored in the community through early needs-identification and a closed-loop referral system, this approach creates confidence that individuals receive the right services at the right time.
Managing the social determinants of health (SDoH) has rapidly emerged as a way to improve outcomes and lower costs. How does Simply Connect accelerate the integration of SDoH into the healthcare system?
Fueled by a team of industry experts, Simply Connect provides consulting services to define and understand the unique value proposition of home- and community-based service providers (HCBS). HCBS providers are equipped best to inform and address social determinates of health (SDoH) factors for the healthcare sector. We work alongside customers to position the technology to fill gaps in current care management strategies and to develop unique partnerships and collaborations to grow revenue through productivities and the development of alternative payment models
Simply Connect has multi-dimensional screenings/assessments that address physical, social, and behavioral health issues, as well as tools for other areas (e.g., spiritual, emotional, etc.). Screening/assessment thresholds can be configured to include conditional/branch logic and have the capability to generate alert notifications to the appropriate care team member if an risk is identified through an assessment/screening. The ability to trigger alerts increases care team member accountability and engagement. Some examples of our screenings/assessments include:
- Current socioeconomic issues like literacy,
housing, transportation, safe living environment, or available financial
resources
- Person-defined risk stratification vs. payer-defined risk stratification reconciliation
- Person-centric graduation criteria created by establishing baseline vs. ideal margin for improvement over the course of participation
- ADLs/IADLS abilities
- Co-occurring Mental Health concerns
- PHQ-9 (Depression)
- GAD-7 (Anxiety)
- Mini-cog
Why is being in Medical Alley important to your business?
With the rapid pace of change in health/community services and with incentives starting to align appropriately for providers, the time is right to collaborate with people and organizations that are trying to solve these problems. We feel Medical Alley can provide us the connections to these like-minded groups or others looking for a solution.
How are we seeing aging Baby Boomers forcing the senior care industry to change?
The biggest change is that most Baby Boomers want to age in place. The idea of spending time in an assisted living or skilled nursing facility isn’t something that most want. This has caused some significant shifts in how services are delivered and how needs are identified.
Also, the volume of the Baby Boomer population has created a health and service provider workforce crisis. Providers who are not focused on developing rigorous strategies around technology to address workforce shortages through workflow efficiencies will struggle to remain solvent.
Additionally, Baby Boomers themselves and their care partners are more technologically savvy then yesteryear’s population. Today’s Baby Boomer craves information and is accustomed to having it at their fingertips. Immediate access to personal health record data will encourage individuals to participate more readily in their care. The capability to record and report biometric data, such as weight and blood sugar levels encourages individuals to take and active role in care-planning and adherence.
What makes collaborating on patients in need of complex care so difficult?
Challenges in coordinating care between multiple healthcare and service providers is prevalent. Major contributing factors include poorly defined care teams, a lack of transparency and communication between healthcare systems and community-based providers, and the absence of workflows to identify needs, make referrals, and ensure the person receives the intended services. Without collaborative efforts, care is often fragmented, duplicated, and not delivered by the person best equipped to address needs. Simply Connect creates clarity and efficiency in multisector care by providing a solution-based approach that focuses on data consolidation, service planning, care team accountability, analytics, and alert-based triggers.
Shannon MacKenzie was also a contributor to this interview.
Shannon MacKenzie is the Clinical Operations Consultant for Simply Connect Care Management technology. She has a foundation of 15 years in health and human services, a core team on the NASUAD Business Development Learning Collaborative, an advisor and steering committee member of the Altair Accountable Care Organizations and was the Principal Behavioral Health Consultant for Data Across Sectors of Health (DASH) grant through the Robert-Wood Johnson Foundation. Shannon is passionate about developing alternative payment models and assisting organizations in finding creative solutions to weather an ever-changing landscape.
