This article is sponsored by Brightree. In this Voices interview, HME Business sits down with Chris Pugliese, Head of Product, Interoperability, at Brightree, to discuss how HME providers can use AI to create new opportunities around interoperability. As head of interoperability for all residential care solutions across the Resmed portfolio, including Brightree, MatrixCare and Citus Health, Pugliese lays out the best ways for HME providers to set themselves apart with referral sources in value-based care. And he shares the story of how his mother’s health brought him into the space.
HME Business: So many people in the aging industry have a personal story that brought them into the aging space. What brought you to your position today?
Chris Pugliese: I really became fond of HME providers when I got to experience the work that they do directly. My mother was having significant and invasive surgery, and one of the things that jumped out to me about connecting these different care settings was our HME provider delivered all the equipment she needed post-discharge from the hospital right on time. They had my dad’s cell phone number and coordinated the whole way. But somehow, the home health agency only had my parents’ home phone, but they don’t use their home phone.
So no one answered their call, and although the HME was delivered, the home health organization did not come until the following Monday. My aunt and my father were left figuring out how feeding tubes and wound vacs work on youtube. The basic coordination between hospital, home and HME providers, which should be a given, wasn’t there. Maybe more importantly, relating to my role with Resmed, there wasn’t any kind of technology to support connections between these disparate settings of care.
These diverse care settings have varying access to technology and business operation access. Helping ensure that technology works for them in a more harmonious way, on behalf of these seriously ill patients, is a driving focus in my career.
HME Business: You oversee interoperable solutions spanning an array of different long-term and home-based care segments, including Brightree. What’s most similar and what’s most different?
Pugliese: I’ve worked in each of our different business lines, and while certain key operations and behaviors have different outcomes and goals, the actual activity and behavior is the same. Intake is probably the clearest example. If you were to see the intake team at a skilled nursing facility or a home health agency or an HME, you couldn’t immediately tell which setting they worked in.
They’ve all got 400 tabs open on their web browsers. They’re all scanning through insurance eligibility pages or other processes either inside their billing system or on an insurance page. They’re looking in hospital portals for documents to drive the next step in their process. They’re all generally engaging in the same activity, but for different purposes matching their market segment.
What’s different is the general organizational structure and volume records. For example, HMEs and home health agencies work pretty well together because they are operating in a similar way. Their distribution network for care and products is diffuse — you’re going to people’s homes or other residences. With no central brick-and-mortar location where services are rendered, HMEs and home health providers tend to centralize operations where one office may serve many key areas of operation — such as intake or revenue cycle — across multiple regions or even states.
A skilled nursing facility (SNF), though, is relatively self-contained. This dynamic makes a SNF a particularly challenging organization for an HME to work with as it’s a centralized org trying to work with a decentralized semi-independent network of nursing facility buildings.
Even if all of the SNFs are owned and operated by one company, they may have a lot of operational variation between locations. It’s tremendously difficult to maintain a process when you are working with 400 nursing facilities and each of them operates in their own unique way with significant staff turnover year to year.
HME Business: Knowing all of that, how can they all relate to each other and work together?
Pugliese: Put the patient at the center. All of these organizations have different businesses to run with different needs, but the heart of those needs is the patient. In that context, each organization can arrange both technology and operational tools to meet their business needs while delivering a positive patient experience — far better than my family experienced in my example earlier.
We always encourage organizations to hone in on the problem they want to solve. Providers should assess the financial impact in terms of revenue and/or cost reduction, set new goals, determine the right technology tool and implement it.
HME Business: How is Brightree building an interoperability strategy for HMEs that takes into consideration the proliferation of AI tools in spaces traditionally considered “interoperable?”
Pugliese: That’s a great question. We believe that the gold standard of AI models in the near term is going to remain the exchange of workflow-driven discrete data, meaning if a clean order can be passed with no interpretation — a mode that modern HME ePrescribe apps are getting closer to perfecting. Unfortunately, a majority of orders remain phone- or fax-based, so many providers are not seeing the benefit of a clean electronic order landing in their management solution. This is one area where we’re seeing language models and other tools.
These big, broad solutions distilling high volumes of information into automated or assisted action are amazing, but they aren’t without their downsides. Brightree can support all the workflow-driven integrations we want it to, but if the data from the source doesn’t match the destination, manual intervention will be required. The same tools we’re seeing scrubbing documents for compliance data or other operational tasks can be re-applied to the narrow definition of “tell me which payer in my system best matches what the referral source sent.”
Take 10 narrow solutions like that, strung together harmoniously with user workflow adding value by eliminating small problems in the process, and that is how I see AI and interoperability forging into the future: narrow specific value that helps ease the flow of complete information that doesn’t need review.
HME Business: With ever present pressures around new regulations, reimbursement and staffing, how can HME providers use technology to do more with less?
Pugliese: That’s a challenging question because there are so many different avenues that an organization can pursue. But specifically in the way we think about it, we are trying to orient ourselves as a platform that is modular — something that things can plug into. The reason we believe that’s important is that there will always be waves of innovative solutions that pop up.
We’re in the midst of a global event with AI, but there will always be general trends that move through different industries and market segments. In order to move quickly to support innovation trends, Brightree must be able to rapidly deploy homegrown solutions as well as foster innovative applications emerging in the market.
Our overall vision here is that we want to act as a switchboard where innovation can be enabled in minutes. If we fulfill our vision, HME organizations will be able to select the right solution to meet your needs and seamlessly integrate into your management solution. An integrated ecosystem lifts all ships, and that is best for our customers, partners, Resmed and Brightree.
HME Business: With value-based care continuing to be an industry focus, what is the best way for an HME provider to set themselves apart when interacting with referral sources?
Pugliese: This is something that we field from all the different care settings and business lines we support in Resmed. The biggest emphasis we always communicate to our customers is to engage your referral sources, 93% of whom said, in a recent survey we conducted, that they would change who they sent referrals to for better interoperability. Keep going up the ladder until you find the right contact to help deliver a new process and help strengthen your relationship with them to secure your referral pipeline.
Our goal is to support organizations with technology as they build relationships with referral sources and other providers in their network, winning value-based care contracts along the way. Engagement with referral sources is key. We often forget that our referral sources have their own pain points working with HMEs — they are just as interested in solving these problems!
Reach out to them and share the technology you have available. From there, build and expand. Figure out the right way to work with your various network partners that you engage with. I won’t say it’s easy, but if you put in the time to communicate and establish technology-based relationships with referral sources, navigating value-based models becomes far easier.
HME Business: In HME, 2025 is the year of…?
Pugliese: The year of the acceleration of interoperability, intake, and AI.
This Voices is sponsored by Brightree. To learn how Brightree can help your organization, visit www.brightree.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].