About Me
Significant Projects & Investments
Developing the Standard for Electronic Visit Verification (EVV)
Situation - The Visiting Nurse Service of Branford, CT, was seeking a system to act as a remote time clock for their home healthcare workers. No such systems were available at the time.
Task – Faced with developing new technology, I researched manufacturers of timeclocks and found the Verifone “Zon Jr.,” a retail credit card terminal, and programmed it for use in home health. A nurse would use a credit card-type of ID that they would slide in to start a visit and again to end the visit, then use the keyboard to enter codes representing the services (tasks) they delivered.
Action - Once the Branford VNA deemed the project viable as a marketable product, I formed StatChek, Inc., with the vice president of Southern New England Telephone (a career he readily gave up to venture into the world of startup businesses.) He brought the knowledge of how to move StatChek’s product from the Verifone terminal to the telephone system.
Result - In 1999 StatChek was acquired by a public company (NASDAQ: WIT). Finally, in 2016 congress passed the 21st Century Cures Act, requiring electronic visit verification (EVV) for all Medicaid-funded in-home personal care services, respite care services, and home health care services to verify them as having been provided.
Creating A New Model for Magnetic Resonance Imaging
Situation – MRI (magnetic resonance imaging) is the gold standard for medical imaging. However, an MRI machine costs millions of dollars and can only handle about one patient per hour, making the cost per imaging session prohibitive as a common imaging technique. As a result, practitioners prescribe, and payers prefer, lower-cost, inferior options such as X-rays or ultrasounds, even though these alternate methods involve potentially harmful radiation and cannot provide the detailed imaging physicians need.
Task – A Cal Tech researcher and pioneer in MRI imaging techniques had developed a method for fast MRIs that could provide improved detailed images in under one minute. This would revolutionize the imaging market and make X-rays obsolete. My task was to figure out how to market this game-changing technology.
Action – I built a private placement memorandum for a 506 Reg D offering. I began a capital raise to bring the new technology to market as small neighborhood clinics where a person could walk in without a referral or prescription and get a whole-body MRI for $199, including the reading from the radiologist. I was able to secure financing of $660 million to establish 200 clinics throughout the 32 NFL markets.
Result – As we set up the first center in Austin, TX, the inventor was involved in a tragic auto accident that ended his ability to develop this project. As a result, MRI First was never brought to market.
The National Minority Health Association (NMHA) – Developing the Health Equity Formula
Situation – The National Minority Health Association (NMHA) was a non-profit founded in 1988 with the mission of ensuring the establishment of Offices of Minority Health in all fifty states. The NMHA achieved its mission and was recast with a new mission of advancing health equity. However, the organization had no ongoing resources or active membership.
Task – Create programs to improve health equity and develop the membership and organization. The NMHA wants to serve nine areas for minorities and underserved people, including healthcare, clinical trials, housing, food, legal, financial, education, art, and memorials. I was tasked with developing programs to benefit the targeted communities, impact health equity in the nine designated areas, and define health equity as an equation.
Action – I worked with the executive director to develop a grant application to promote COVID vaccinations among hesitant minorities and underserved populations. We were awarded one of ten grants for $11.1M from HRSA and received notification of the award two weeks after the start of the grant period.
I quickly developed an electronic health record system and marketing and instructional materials. We began a marketing campaign for home care agencies and established the program “Flex For Checks,” a 3-tier rewards system for agencies, their workers, and consumers who got vaccinated. The entire system was in place within 30 days of our award notification.
I then established an office, built the infrastructure, furnished the office, set up workstations and a phone system, hired and trained six program navigators, and directly managed the program. We also partnered with a fulfillment center to manage the rewards, requiring me to create an automated interface between our EMR/vaccine verification system and the processor of the rewards. The program was the most successful of the ten HRSA grantees, generating about 70,000 vaccinations, more than the other nine combined.
Regarding the health equity equation, I developed a simple approach as follows: Health Equity (HE) is a function of a person’s awareness of the possibilities (AW) plus their access to available services (AC). It is as simple as that… HE = AW + AC. This is the formula for health equity.
Additionally, I developed NMHA programs for partnership with for-profit entities in a new model of website I call a “transitional metaverse.” Known as “Equityville,” it is a photo-realistic metaverse design incorporating a 3-D world with immersive experiences, built on a blockchain, with a non-fungible token (NFT) called “EquityCoin” that users can earn for exploring sites, reading articles, playing games, etc. Equityville is a metaverse that does not require goggles or any special equipment. EquityCoin can be traded for digital assets and, in some cases, real-world assets such as Visa gift cards.
Another project I developed for the NMHA is Operation Healthy You™ (OHY), a mobile app that surveys users to determine their health baseline, goals, and the gap between them. The app then uses AI to match users to appropriate resources and provides an automated tracking system to measure participation. Results are used to build ML models that evolve as health issues change. OHY is a capacity extended for clinics such as Federally Qualified Healthcare Centers (FQHCs) and a way of reaching out and providing services to patients where they are without them having to travel or spend money on these services.
Result –The NMHA has established itself as a leader in health equity. The organization proudly boasts more than 70,000 members and nearly 2,000 home care agency members and has provided services in all fifty states. Today, I remain active with the NMHA and serve on its board of directors.
LivWorx – Developing the Next-Generation Phone Call
Situation – Plain old telephone service (POTS) has remained basically unchanged for nearly 100 years. LivWorx is a company created to bring new technologies to the marketplace. LivWorx has the rights to the patents that control adding video content to phone calls. This new technology, called VCallAI, is a game-changer for any business that interfaces with the public, including call centers, restaurants, support centers, technical assistance departments, and sales.
Task – Build a business to exploit the patents by selling the rights to the service to existing telephone companies. This will allow the telcos to market multiple use cases to commercial customers and require extensive consulting and programming services from LivWorx to develop and bring applicable use cases to market. In addition, build a hosted version of the technology so LivWorx can host the system servers for a business and link to their phone system via API calls.
Action – I created an agreement to acquire the patents and assets of the inventor. I then made a private placement offering of $4M for 20% of the company. (Financial projections demonstrate the potential for an exceptional return to the investor.)
I assembled a model for AI and ML to add a new intelligence layer to the existing product.
I developed a series of use cases to bring the technology to market and to demonstrate to investors the application of the technology.
Result – LivWorx has received extensive interest in the Offering from several large telcos and call center groups. This offering is live, and discussions with both groups are in progress. I am actively involved in the promotion of LivWorx and VCallAI.
Ankota – Evolution in the Home Care Market
Situation - The Affordable Care Act and other legislation opened the door for home care agencies to expand their market from private pay or Medicare skilled care to the new “managed care” model, a hybrid of traditional old models. The market needed new software to address these unique needs for such features as authorization management and multiple care plans.
Task – Build a SaaS-based system capable of handling the needs of modern home care agencies that work with multiple payers, including Medicaid waiver programs, state-based benefit programs, VA, insurance, and private payers.
Action – I purchased an equity position in Ankota LLC, a small private pay software solution. I designed it into a new model of home care management and documentation built on an expansion of the existing private pay software model. Coordinating resources here in the US and a Romanian programming group, we developed the new Ankota, a system capable of handling all visit types and state payer models.
Result – I sold Ankota systems to some of the largest provider groups in Missouri, Oklahoma, Ohio, and California. Customers included multi-site homecare agencies, Area Agencies on Aging (AAA), remote clinical trial organizations, child welfare providers, and more. I sold my interest in Ankota to my partners, who continue to run the business today.
HHA Exchange – Expanding Beyond New York
Situation – HHA Exchange was a software provider to the New York City HRA (Human Resource Administration), comprising New York City's Medicaid services. The company wanted to expand outside New York into the managed care markets in various other states.
Task – Identify potential new markets and programmatic changes needed to the software and seek out opportunistic business ventures.
Action – I identified several target states to expand out of New York. I started in Missouri (the state had just implemented several new waiver programs, and providers did not have the requisite tools for proper scheduling and billing.) I built a matrix of new features and functions needed to address the waiver programs, then worked with senior management to implement the changes to ensure we could meet customers’ needs. I also met with managed care providers in PA, NY, IO, and IL to promote HHA Exchange’s solution for the agencies and the payers.
Result – We sold all four managed care organizations in Pennsylvania, creating a unified billing and claims management system, regardless of which managed care organization the patient was registered with. Today, HHA Exchange is one of the leading providers of state aggregation systems used to manage provider claims.
Sandata – Building New Markets
Situation – Sandata provided time and attendance services for the New York City HRA (Human Resource Administration), which comprises the Medicaid services for New York City. The company wanted to expand to deliver its services outside New York into other states.
Task – Identify and pursue new markets to grow the company’s footprint and capabilities.
Action – I identified an opportunity in CA for a system to help automate case notes for child welfare agencies. Working with Sandata’s president, I devised a strategy to pursue this market. I convinced the largest child welfare agency insurer to offer a 15% discount to agencies using Sandata’s automated notes system, as it would result in more accurate documentation and more timely visits. Using the insurance discount as a tool, I sold the state on a $10M per year program.
I also developed a strategy for responding to state RFPs that resulted in Sandata winning the state of Florida’s Medicaid business.
Another service I provided for Sandata was managing the infringement of certain patents the company owned. I identified infringers and negotiated penalty payments and, in some cases, the complete takeover of the infringer’s businesses.
Result – Today, Sandata is the US leader in state claims aggregation, providing electronic visit verification (EVV) and comparing claims against authorizations.
AccentCare – A New Home Care Model
Situation – AccentCare was a venture-backed startup created to be a national solution for people seeking home care for parents and loved ones. The company needed to implement a technology model that was not currently available, which tied together their centralized intake system, eleven locations in four states, to a central phone system, the ability to transfer calls seamlessly between sites, and to centralize the reporting and analytics from all branch offices.
Task – Create a unified technology solution that meets all departments’ and offices' unique needs. This included a 30-person call center, the central administration office (about 40 people), and eleven branch offices in four states. This was before advanced phone switching was available.
Action – I came in to serve as the first VP of Technology for AccentCare. I first contacted Lucent Technologies and purchased their Definity system, a large-scale telephony solution. I then worked with CISCO to build the first telephone switch that allowed for real-time interstate transfers of phone calls. This allowed every field office to appear as a local extension before calls were sent over IP.
I set up an internal data center to address the data and reporting. I then researched and selected Carekeeper software. I then developed an add-on to Carekeeper that integrated worker time and attendance from all locations into a single payroll system.
Result – AccentCare continued to use the model I designed and built until it was recently modernized to newer generation systems, including HHA Exchange. AccentCare is approaching $1B in annual revenue and employs more than 30,000 people. Carekeeper continued to use and resell the EVV system I developed for them and AccentCare. Sandata eventually acquired Carekeeper.
ContinuLink – Expanding into the Medicaid Market
Situation – Continulink, a homecare software product, and the company spun off Interim Healthcare, focused on the skilled Medicare market. The company needed to move into “managed care,” systems run at the state level, often managed under contract by healthcare insurance providers.
Task – Moving a skilled Medicare software product into the Medicaid waiver program space. This involved changing the scheduling, billing, and authorization processes from the physician-driven “485” care plan to the managed care service authorization model, a vastly different agency working method.
Action – I researched all of the state and waiver program requirements and compiled them into a unified and workable plan of attack. Continulink’s development group developed the features and functions needed for managed care services and brought the product to market.
Result – Continulink was successful in marketing its system to a variety of agencies providing Medicaid services. Continulink was acquired several times, most recently by Complia Health, which continues to expand, develop, and market Continulink as a complete revenue cycle solution.
KanTime – Developing the Managed Care Market
Situation – KanTime was an India-based provider of private pay software to the homecare industry. The owner wanted to expand into Medicare skilled care.
Task – Create a business development and marketing plan to bring KanTime into the skilled care market. KanTime had over 200 programmers based in Mumbai, India, and the owner was a master software developer with extensive technical capabilities.
Action – I built business, sales, and marketing plans and designed collateral materials and go-to-market strategy. I then hired and trained sales staff.
Result – KanTime is today one of the leading software systems for skilled providers in the Medicare, pediatric, and specialty disease markets.
American Telecare – Expanding the Remote Patient Monitoring Market
Situation – American Telecare (ATI) was the leader in remote patient monitoring and did most of the original research into telehealth and telemedicine. The company needed to expand its sales.
Task – Create a business development and marketing plan for ATI to correct the current profitability. I was working with a group of industry specialists, and together, we needed to identify and fix the problems and revenue issues.
Action – I polled, surveyed, and spoke directly with customers to understand the issues. There were many… who paid for the equipment? Who warehoused it? Who delivered it, set it up, and trained the patient on its use? Who fixed it when it broke? Who picked up and cleaned the equipment when it was no longer needed? I discovered that the metrics (readings) from the devices were not really that accurate or helpful. But what was useful were the questions asked of the patient before and during the telehealth sessions. From that information, I devised a new model whereby the company used a call center staffed with nurses to survey patients instead of using the equipment.
Result – ATI was successful in selling its telehealth equipment. Every member of the Veterans Integrated Service Network (20+ agencies) bought more than $1 million worth of telehealth equipment each. Unfortunately, the company’s move to the call center model came too late, and ATI could not sustain operations.
National Memory Impairment Institute – Developing A New Homecare Model
Situation – I had just co-founded a new home care agency in Sacramento, CA, Better Living Homecare, with two former AccentCare co-workers. Once open, we discovered a glut of homecare providers in Sacramento and could not get referrals.
Task – Create a model that would promote case referrals sufficiently to generate profit.
Action – I discovered a shortage of providers servicing the dementia market. I went to the local Alzheimer’s Association (AA) only to find that they did not have a program for training caregivers to care for dementia patients. So, I convinced the director there to quit her job and join me in creating the National Memory Impairment Institute, a 501C3 non-profit, to develop a training program and train providers and instructors in caring for the memory impaired.
I co-wrote a program with the former AA director and took the program to the University of California at Davis, CA, where neurologists were trained. I got the program endorsed by more than 20 neurologists, gerontologists, and medical doctors. I then trained my staff at Better Living and took the program to the state for official recognition.
Result – The National Memory Impairment Institute program was approved as the “official” state training program in California and was subsequently approved as the only alternative program for the state of Florida as well. The National Memory Impairment Institute trained more than 16,000 caregivers and 4,000 instructors in the first year. The organization later became a part of the Lisa Gibbons Foundation, another non-profit organization dedicated to helping train dementia care providers.
CareMaestro – An Improved Model for Post-Discharge Patient Management
Situation – Kaiser Permanente spent over $25M to reduce their 60-day readmission rate to about 12%. Since Kaiser is entirely “at risk” for all patient costs (as a Medicare alternative), readmissions cost the company tens of millions annually. Kaiser tried to implement post-discharge programs but found that most patients were multi-morbid, meaning they had several disease states simultaneously (e.g., CHF, COPD, diabetes, hypertension, and a hip replacement). Since they felt they could only put patients in one program, they picked the one disease most likely to kill the patient (e.g., CHF) and referred to all other issues as “complications under CHF” (or the primary disease state.)
This caused a real problem as last year’s claims data was used to determine the allocation of resources for the following year. So, for example, CHF emerged as the primary and most significant cause of readmissions. Likely this is the result of calling every readmission for a patient with CHF “a CHF readmission,” even if the readmission was for a hip infection in the CHF patient. This skewing of the data made claims data essentially worthless to Kaiser, or worse, misdirecting.
I had come up with a model for ATI that I could not bring to market due to the company’s demise, and we at Better Living Homecare decided to try to build that product and offer it to Kaiser. Better Living already had a contract to provide services to Kaiser’s patients post-discharge and thought it could leverage that relationship to propose a new solution.
Task – Create a post-discharge model that would address a patient’s comorbidities, reduce readmissions, and minimize post-discharge interactions with the hospital.
Action – I studied the various disease states. Working with the Kaiser physicians, I built a system, CareMaestro, that would allow us to load in a patient’s comorbidities and output a survey designed specifically for that patient. That allowed us to identify specific issues and handle most of them without involving Kaiser staff.
I then worked with Kaiser’s legal and technology groups to create a system for channeling patient discharge instructions directly to CareMaestro upon the patient’s discharge. That input created the plan of care (call survey) and an automated outbound contact schedule for the patient. CareMaestro would initiate the outbound surveys to patients and send responses and alerts as indicated to Better Living, which administered the program for Kaiser.
Result – In the first 120 days, Kaiser reduced 60-day admissions from 12% to 1.5%. They then purchased the CareMaestro product and took it in-house. Unfortunately, Kaiser allowed the doctors to change the program, and eventually, the surveys became so complex that patients would no longer complete them, and Kaiser dropped the program.