What are the quality ratings for home health?

Medicare.gov provides resources to review your home health options. Honestly, it provides resources to review doctors/clinicians, hospitals, skilled nursing rehabilitation services, inpatient rehabilitation, long term care facilities, dialysis, hospice, and medical equipment suppliers using the Care Compare feature. If you haven’t reviewed it, medicare.gov/care-compare/ is a necessary stop on your web surfing today!

The quality of patient care is rated along 5 items.

Managing daily activities: Are patients getting better at walking or moving around? At getting in and out of bed? At bathing? Were functional abilities assessed at admission and discharge and included in the care plan?

Treating symptoms: Is patients’ breathing improving? Frequency of pressure ulcers/injuries that are new or worsened?

Preventing harm: Are services started in a timely manner? Are patients getting better at taking their medications correctly? Are patients getting their flu shots for the current flu season? Are physician directions being implemented timely? Are patients experiencing one or more falls with injury?

Preventing unplanned hospital care: How often are patients admitted to the hospital? Needing urgent, unplanned care in the emergency room and not being admitted into the hospital? Remaining in community after discharge from home health services? Re-admitted to the hospital for a potentially preventable condition after discharge? Admitted to the hospital for a potentially preventable condition while receiving home health?

Payment & value of care: How much Medicare spends on episodes of care at this agency?

Elite is surveyed in the state of Washington every 3 years. Our goal is to strive for continuous improvement. It is why we review areas of challenge, establish teams to work collaboratively from different perspectives, and believe in the power of trial and error until we get it right. While no agency is perfect, we think we take feedback seriously to improve the services we provide every day.

How do I choose a Home Health Agency?

Home health is a program created and overseen by Medicare. Therefore, programs in general will look and feel very similar to be compliant with the laws that oversee how Home Health is provided. Depending on the state, agencies go through “surveys” at a regular interval (e.g., yearly, every 3 years, etc.) that review the operation, the clinical services, the documentation, the adherence to techniques, and patient satisfaction.

According to Medicare.gov, questions to ask yourself and review before selecting a home health agency include:

  1. Is the agency Medicare certified?
  2. Is the agency Medicaid certified?
  3. Does the agency offer the specific services I need?
  4. Will the agency be able to meet my special needs, like language or cultural preferences?
  5. Does the agency offer personal care services, such as bathing, dressing, and using the bathroom?
  6. Does the agency offer support services or help me arrange for additional services, such as meal delivery?
  7. Is the agency well-staffed to give the type and amount of care I need?
  8. Is the agency respected in my community, recommended by the hospital discharge planner, my doctor, or a social worker?
  9. Does the agency have staff available for emergencies at night or on the weekends?
  10. Is the agency transparent about what my insurance will cover, what must be paid out-of-pocket, and include me in discussions of resources?
  11. Have prior patients attested to the good care received by the agency?

Some additional questions that we have found helpful for patients and families include:

  1. How soon will my services start? Specifically, for each discipline?
    • Some agencies will start services with one discipline, e.g., nursing, and wait a few weeks before starting the next service, e.g., physical therapy. If your goal is physical therapy, then this timeline might be a reason to consider a different agency.
  2. How frequent will my services for each discipline be?
    • Some agencies plan for only 1 visit per week for the disciplines involved, e.g., 1 visit from the nurse, 1 visit from the physical therapist, 1 visit from the aide. If you have specific goals and needs, this cadence may not be right for you. If there is limited flexibility, this might be a reason to consider a different agency.
  3. Am I involved in my care plan? Does my opinion affect my services?
    • Some agencies have to submit care plans for review and approval. This may or may not take into consideration your needs, health plans, and environmental circumstances. If you are not comfortable with a third-party review, this might be a reason to consider a different agency.
  4. How much choice do I have in selecting an agency?
    • In states where patient choice is the law, you as the patient can freely choose an agency that serves your area. Your provider – doctor, nurse practitioner, physician assistant – may have a preference for whom they prefer to work with, but you ultimately have the choice of your provider for home health. In states where a certificate of need is issued, there may be a restriction on the number of providers. If you are displeased with your offerings, you can reach out to your state’s department of health for guidance on other options.

Elite Home Health & Hospice serves in both Washington and Idaho. We are the Certificate of Need holder for Asotin and Garfield counties. We also serve in Nez Perce, Latah, and Clearwater counties in Idaho where patients have choice. We are Medicare and Medicaid certified, as well as maintaining working agreements with multiple insurance companies.

We offer skilled nursing, physical therapy, occupational therapy, speech-language pathology, aide, and social work services through our home health program. We utilize qualified interpreters or a language service to communicate with members of the community whose primary language is different from English.

Our aides, or certified nursing assistants, are part of your rehabilitation program, and can be scheduled to support learning strategies for dressing, grooming, and bathing in coordination with our occupational therapy services.

Elite is proud to employ residents of the Lewis-Clark Valley, Moscow, and Orofino communities. We believe in hiring within the communities we serve, and we have been doing so since 1984. Our staff supports services 24 hours a day, 7 days a week.

If your insurance benefit does not cover services 100%, you will receive a call from our insurance team who will discuss with you the costs of your services before we send the nurse out to your home. You are a critical member of our healthcare team, and your financial health is important to us. Our customer reviews are publicly available, and we use positive and negative reviews to assess our quality of services and make changes.

Elite works with your schedule to get all of your ordered disciplines started within your first week of service. If you have a preference to delay a particular discipline, let us know, so we can accommodate that change. Our care plans are proposed and discussed with you at your evaluation session. That means, your voice helps determine how often you are seen and by whom. We do not send your care plan for review to a third-party to determine your frequency of visits from our team.

In Asotin and Garfield Counties, we are your provider. We are happy to serve and support your health goals.

In Idaho, you have a choice. We hope you will consider Elite for all of your home health and hospice needs. We are here to provide you with life-changing service.

October is Home Health & Hospice Month

Elite has the pleasure of serving both home health and hospice. Because we are a dual agency, we are able to support our patients along the continuum of their rehabilitation phases and in their end-of-life process. We believe that these relationships that we build with our patients and their families allows us to give care in a unique manner. Specifically, we are able to contextualize rehabilitation with the background of working through past rehabilitation stays and recoveries, facilitating family support or needing to hire additional aid, and building care plans based on your goals of care.

Elite does it differently. One of our key pieces of building your care plan is to discuss what your goals of care are. What procedures? What treatments? What family members? What friends? What resources? Our liaisons meet with current, prior, and potential patients to go through what your goals of care mean, and what needs to be done to make them a reality. We are intentional in these meetings to support you in making the choice for you in that moment. And, we are available to meet again if those goals change, and a different decision needs to be made.

Home health and hospice are about relationships.

This month we have the honor of celebrating the work our team does every day. Please join us in learning about home health and hospice services this month!

Healthy Aging Month

September is the month we look at how to support healthy aging. Healthy aging is a combination of physical and mental health as well as building community and resources for spiritual and emotional well-being. The aging process changes the mind and the body, and depending on lifestyle, community and social well-being may also evolve (dhs.gov).

Aging well involves learning new strategies and supporting the body’s changing abilities. Accident prevention is a critical element of this in order to best support healthy living and reduce emergency visits. Engaging the physical wellbeing often means learning new exercises and routines to safely engage in home life and access the community (cdc.gov).

Resources:

https://www.dhs.gov/employee-resources/news/2022/09/06/healthy-aging-month#:~:text=Healthy%20Aging%20Month%20is%20observed,our%20minds%20and%20bodies%20change.

https://www.cdc.gov/stillgoingstrong/index.html

Pain is a disease

September is Pain Awareness Month.

Understanding chronic pain is critical to how we support our patients on our service.

Join us in our learning:

Pain Awareness Month – International Association for the Study of Pain (IASP) (iasp-pain.org)

September is Pain Awareness Month: Complexity and Progress in Pain Research | National Institute of Neurological Disorders and Stroke (nih.gov)

Pain Awareness Month 2023 – U.S. Pain Foundation (uspainfoundation.org)

Aging as an adventure

Aging can have a negative connotation in our culture.

One of the goals we have at Elite is to promote healthy aging. We are intentional in our community work to preserve people’s wishes for independence, their voice in their healthcare plans, and building rehabilitation around their needs. Through home health, palliative care, and hospice, we value and respect aging. Our goal is to join you on your journey.

For information on the best aging strategies, check out:
Dishman, Eric. “Inventing wellness systems for aging in place.” Computer 37.5 (2004): 34-41.

Mitzner, Tracy L., et al. “Self-management of wellness and illness in an aging population.” Reviews of human factors and ergonomics 8.1 (2013): 277-333.

Coughlin, Joseph F., and James Pope. “Innovations in health, wellness, and aging-in-place.” IEEE Engineering in Medicine and Biology Magazine 27.4 (2008): 47-52.

If you are open to a new perspective, check out…

What is Telehealth Nursing?

Nursing is an incredibly important profession that can greatly impact the health and well-being of individuals, families, and communities. Nurses provide vital services in hospitals, long-term care facilities, clinics, and other settings where they interact with and care for patients in need.

Telehealth nursing is a rapidly growing field that leverages the power of technology to help nurses provide better care. With the combination of advanced technologies and experienced nurses, telehealth programs can have a profound impact on patient health outcomes.

This blog aims to provide critical information on the benefits, challenges, and future of telehealth nursing for nursing leaders, including directors of nursing and chief nursing officers.

What is Telehealth Nursing?

Telehealth nursing is the use of telecommunications technology to provide healthcare services remotely. This includes video, phone, email, and text messaging platforms that allow nurses to communicate with patients who are unable to access in-person care due to distance, medical conditions, or other factors.

Telehealth nurses are often required to have specialized knowledge and skills to provide competent care. They must be able to assess patient needs and develop appropriate patient care plans. Telehealth nurses must also have excellent communication skills to effectively interact with patients via telephone or video conferencing. Additionally, they should be comfortable using computers and other technology to access patient information.

Nursing Informatics and Telehealth

Nursing informatics is a specialized area that combines nursing skills with communications, computer science, and information science. The core responsibilities of an informatics nurse include:

  • Improving workflows through communication and technology
  • Advancing patient safety through early identification of patient safety risks
  • Influencing healthcare policies to promote public health
  • Promoting patient autonomy and patient satisfaction
  • Improving patient-clinician relationships
  • Contributing to the construction of national data infrastructure

What Does a Telehealth Nurse Do?

Telehealth nurses are key members of the telehealth team, serving as an advocate for their patients and ensuring that patient needs are met efficiently while providing quality care.

Telehealth nurses perform some of the same functions as other nurses, but through remote communication. This includes assessing patient needs, developing care plans that meet each patient’s unique needs, monitoring a patient’s recovery progress and making necessary adjustments, coordinating services with other providers, and managing medications. They interact directly with patients via video conferencing or telephone to discuss symptoms, answer questions, and provide education.

The Importance of Nurses in an Effective Telehealth Program

Nurses are essential to the success of any telehealth program. They are often the first point of contact for patients needing specialized care or treatment options, making them crucial for providing quality care to those who need it most. Telehealth nurses also help streamline and automate processes, freeing up time for more complex clinical tasks. This can significantly improve efficiency and lead to better patient outcomes.

Telehealth in Addressing Nursing Shortages

Telehealth is an essential tool for addressing nursing shortages. As an average across clients, telehealth and remote monitoring allows a ratio of 80 to 100 patients for every telehealth nurse. Nurses can see more patients in less time by reducing the need for in-person interactions. This reduces wait times and stress on healthcare systems by allowing nurses to provide care remotely. Additionally, telehealth can help reduce the number of missed appointments due to travel constraints and enable nurses to provide care to those in remote or rural areas who would otherwise have limited access.

Telehealth Case Study – Southcoast Health Reduces In-Home Visits with Virtual Care

Let’s explore an example of how telehealth can increase efficiency and decrease clinician workload. Southcoast Health is the biggest primary and specialty care provider in southeastern Massachusetts and Rhode Island, serving local communities for over 25 years.

Its Visiting Nurse Association (VNA) partnered with Health Recovery Solutions (HRS) to improve clinicians’ workload and patient care transition through telehealth and remote patient monitoring. Patients enrolled in the program are monitored daily, with clinicians responding to risk alerts based on vitals reported through Bluetooth biometric monitoring devices and patient symptoms.

Results

  • Saved an average of four in-home nursing visits annually
  • Generated $500,000 in cost savings
  • Achieved a 7% 30-day readmission rate

View the complete Southcoast Health case study

Challenges in Telehealth Nursing

There are many proven benefits to telehealth nursing but there are also some challenges in the field. Adapting to new telehealth technologies can be a challenge for nurses, especially those who are not tech-savvy. Another challenge is the shift from bedside nursing to remote monitoring. Since time spent directly interacting with patients is a huge component of the nursing profession, interacting and building rapport online can be a struggle. Some nurses also worry about the administrative burdens that come with the introduction of new technologies.

These challenges can be overcome with the right training and engagement strategies. The knowledge that remote patient monitoring increases patient safety and improves health outcomes can also help nurses overcome reservations around adopting telehealth. It’s important to communicate openly and regularly about the positive impact of the RPM program to keep key stakeholders engaged.

Nurse Training and Clinician Engagement

Nursing directors and chief nursing officers can boost telehealth engagement among nurses by using these training and clinician engagement strategies:

  • Provide early education to ensure that nurses are confident and comfortable using telehealth
  • Test nurses on their knowledge and utilization of the technology from time to time and reinforce education where needed
  • Share the positive outcomes of telehealth and its industry-wide adoption with the nurses
  • Streamline the logistics and administrative processes to eliminate all and any roadblocks to the adoption

Improving Patient Outcomes through Telehealth Nursing

Telehealth is here to stay and continues to grow in popularity. Telehealth nurses play a vital role in ensuring a telehealth program’s success. There may be roadblocks and hesitancy to adopt new technology at first, but understanding the impact telehealth can bring to individual patients, their families, and the larger patient population as well as its role in reducing nurse burnouts can help in embracing the technology.

Elite Home Health & Hospice is sharing this with you through a partnership with Health Recovery Solutions.

Transitional Care Management

Transitional care management (TCM) is crucial to improving outcomes for patients with complex healthcare needs. Patients with comorbid conditions often struggle with managing their health during episodes of acute illness, leading to high readmission rates and poor patient outcomes.

TCM addresses these challenges by administering support throughout the entire care continuum as patients move from one healthcare setting to another. Whether transitioning from a hospital to a long-term care facility or returning home after a prolonged hospital stay, TCM ensures patients receive the care they need when they need it – in a setting that best suits their unique needs.

This blog will cover everything you need to know to deploy an effective transitional care management program, including:

Care Coordination and the 30-day Transition Period

The 30-day transition period begins when a patient is discharged from the hospital. During this time, the patient’s care is coordinated by a transitional care manager who must provide interactive communication, both virtually and in-person.

By the end of the 30-day transition period, the patient should receive the care they need to adjust to their new care setting. There are three key components that determine the success of this transition.

  • Patient education and support: Patients and their family members, caregivers, or guardians should be educated on the care plan, the patient’s diagnosis, risk-specific interventions, and self-management tips.
  • Monitoring and evaluation: Diagnostic tests and follow-up on results from previous appointments should regularly be reviewed and monitored to assess if there is a further need for treatment.
  • Coordination of care: Care coordination is the most crucial component in your TCM program. It involves communicating the patient’s needs and preferences amongst interdisciplinary teams to ensure high-quality and high-value healthcare delivery.

Clear and effective communication is key in coordinating care among your inter-professional care team (IPCT) members. A lack of communication between care providers can lead to potential delays in care delivery, avoidable hospitalization, and overall poor patient satisfaction. That’s why it’s so important to close communication gaps by ensuring interdisciplinary teams have full access to the patient’s care plan.

With regular communication between everyone involved in care delivery, comprehensive patient care coordination can be facilitated to ensure your patients are receiving the right care at the right time, as well as receiving the resources to properly manage their conditions.

How to Provide Transitional Care Management

There are various ways to provide transitional care management. Care functions can either be carried out by one transitional care manager per patient or a team of transitional care managers who coordinate care for multiple patients. In a care management team, healthcare professionals with different roles are required to collaborate and plan for effective and timely transition of members to the community through transition activities.

While there is no one-size-fits-all method for running your TCM program, healthcare providers should take the patient’s unique needs and available healthcare resources into consideration.

Common Challenges of TCM

TCM is a proven approach to improving health outcomes and patient satisfaction. However, there are several challenges that healthcare providers should consider in implementing a TCM program.

  • Financial costs: Some healthcare organizations may face financial barriers from the additional costs of hiring medical staff to facilitate transition of care, implementing new telehealth solutions, and providing training to TCM managers and team members.
  • Lack of resource allocation: Staffing shortages, limited community resources from home health agencies and inadequate infrastructure are all factors that need to be considered when allocating resources for TCM.
  • Miscommunication in care coordination: Coordinating between multiple healthcare providers and settings can be difficult. A lack of standardized processes can lead to conflicting recommendations, unclear patient care plans, and inefficient clinical workflows.

Key Benefits of TCM

TCM offers a valuable service to chronic, elderly, and underserved communities by improving health outcomes with high-quality, high-touch care when implemented effectively.

  • Reducing the risk of hospital readmissions for chronic patients: As many as 86% of patients experienced reduced readmissions compared to those who did not engage in TCM services, according to a 2018 study.
  • Increasing access to care for patients in rural areas: By leveraging telehealth, TCM can extend care coordination to chronic patients in rural communities. Telehealth tools enable healthcare providers to consult with patients through virtual visits to increase access in areas where healthcare services are geographically limited.
  • Improving patient satisfaction: With TCM, payors and patients benefit from improved health outcomes and reduced readmission rates. Delivering high-quality healthcare is a competitive advantage that helps with patient retention and referrals.
  • Increasing patient safety: TCM ensures patient safety through collaborative care coordination. With multiple healthcare providers working together to facilitate care transition, the risk of medical errors decreases and provider accountability for patients increases.
  • Reducing the cost of care: As TCM is known to effectively reduce readmissions, providers can utilize the program to avoid value-based penalties that come from hospital readmissions within the 30-day period after discharge.

Billing & CPT Codes for TCM

According to CMS, providers must conduct one face-to-face visit within the timeframe of these two CPT codes used to bill for TCM.

  • CPT code 99495 – TCM with moderate medical complexity requiring a face-to-face visit within 14 days of discharge.
  • CPT code 99496 – TCM with high medical complexity requiring a face-to-face visit within 7 days of discharge.

How Telehealth Supports the Transition

Care transitions are challenging to facilitate in our current healthcare climate due to the rise of chronic conditions and insufficient access to skilled healthcare providers. Telehealth is an invaluable tool in navigating these challenges and ensuring the effective delivery of TCM through improving healthcare access in a convenient and cost-effective way.

Telehealth enables patients who live in rural communities to transition back to their homes easily. Patients have access to healthcare providers at their fingertips without the need to travel long distances. With virtual visits, clinicians can establish strong provider-patient connections while reducing the patient’s burden of traveling. Transitioning patients also receive essential education and support to help them adjust to their new environment with easily accessible online resources.

For patients with chronic conditions, telehealth tools are proven to help patients with chronic care management. In one example, a study examining telehealth’s effects on outcomes for patients with type 1 diabetes recorded an 88% adherence rate for scheduled telehealth appointments, with 100% of patients surveyed expressing their satisfaction with the service.

diabetes glucometer

Ongoing Care Management for Chronic Conditions

After the 30-day transitional period, ongoing care management continues for patients with chronic conditions. In these care management programs, patients are provided services with the goals of improving self-management and reducing healthcare costs. Key components of care management programs include:

One of the most effective ways to manage ongoing care is through virtual care solutions like telehealth. Health Recovery Solutions (HRS) offers a range of telehealth tools that engage patients with care management via tablet offerings, mobile applications, and biometric Bluetooth devices. By actively monitoring patients’ health in a virtual setting, providers can empower them to actively manage their health outside the hospital environment.

Elite Home Health & Hospice is proud to partner with Health Recovery Solutions to bring a comprehensive transitional care approach to your home health services.

4 Tips to Help Your Terminally Ill Loved One Prepare Financially

If you have a loved one who was recently diagnosed with a terminal illness — such as inoperable cancer or Alzheimer’s disease — your life has been turned upside down. Even if your family member struggled with their health prior to the diagnosis, it doesn’t make the situation any easier. In addition to coping with the sadness and anxiety of this difficult time, your loved one will likely need support in preparing for the future financially. This is especially true if the illness came on suddenly or at a younger age.

Elite Home Health & Hospice shares four things that you can do to provide support and assistance to your terminally ill family member.

Handle all tasks and communication with the utmost compassion

Above and beyond anything, show the highest degree of compassion and care in all interactions. As you handle tasks that can be emotional for both you and your family member, be aware of how you are communicating. Avoid showing too little emotion, as this can come off as unfeeling and hurtful. Aim to be a steady source of confidence and love through these challenging end-of-life tasks.

Find ways to help your family member pay for their medical bills

Expenses associated with terminal illnesses are often astronomical. Bills that amount to hundreds of thousands of dollars are often commonplace in these situations. Medications that provide some level of relief from pain and suffering can cost hundreds or even thousands of dollars for every refill. At a time when your loved one is already experiencing such massive distress, the last thing they should have to think about is paying their medical bills.

If your loved one needs extra funds to pay for their prescriptions and medical care, there are options available for most individuals. One popular choice is home refinancing. Refinancing either your home — or your family member’s home — can quickly free up equity for immediate expenses. Research the best refinance rates to ensure that this is the option for you.

Establish end-of-life arrangements

Another incredibly important set of tasks to handle as soon as possible are end-of-life arrangements. This includes everything from creating power of attorney, to planning and funding funeral arrangements. Most people plan to fund funeral arrangements via life insurance, though you may have to change policies after a diagnosis. In such an instance, it’s critical that you fully understand the terms of the new policy and make sure not to cancel the old policy until coverage begins.

When signing so many documents, one option to consider is using an online tool for digital signing. This makes it easier to provide legal signatures for important documents without having to worry about printing and mailing.

It’s also important to plan for or work through selling or closing a business your loved one owns. This can be a relatively simple matter if ownership is in a corporation held in stock. Other business structures can be more complex and may require legal assistance.

Of all of the things you will need to help your family member with, this will almost certainly be the most emotionally challenging. Prepare yourself for these tasks by reaching out to your support network of friends and relatives. Also, if you find yourself struggling most days, consider working with a counselor to cope with your feelings.

Ensure that their will is up-to-date

Revisiting your loved one’s will is a particularly critical task — especially if they have a considerable amount of assets. Without proper designations, some or all of their property could go to the state. Hire an experienced attorney to guarantee that the will is updated in such a way that is legally binding.

Although it can be next to impossible to think about anything other than your terminally ill loved one at this time, addressing the above tasks is an absolute must. Part of honoring your family member is doing everything you can to ensure that their last wishes and requests are granted. As difficult as that is, knowing you helped your loved one when they needed it most can be a great source of comfort in the years ahead.

For trusted home health, palliative care, and hospice servicer, visit Elite Home Health & Hospice today!

Is Telehealth really a good option?

You might wonder if telehealth really is a valid option for seeking healthcare and the opinion of a professional if they are unable to see you in person. Here are some guidelines we use when considering if telehealth makes sense for our patients.

Constitutional: e.g. well-nourished, well-developed, well-appearing, Vitals

Ears, nose, mouth, throat: e.g. normocephalic, atraumatic, external ears normal
by inspection

Eyes: proptosis, extra-ocular eye movement intact, nl sclerae, conjunctivae not
injected

Neck: visible goiter, range of motion of neck

Respiratory: comment on increased respiratory effort

Cardiovascular: patient can palpate PMI

Chest/Breast: e.g. gynecomastia, symmetry

Gastrointestinal: e.g. no caput medusae, no tenderness with self-palpation in
supine position

Genitourinary: visual exam of external genitalia

Musculoskeletal: ROM (active & passive), nails/digits

Lymphatic: Large lymph nodes can be visible

Skin: rashes, ulcers, varicose veins

Psychiatric: anxiety level, affect, memory, tangential conversation

Neurologic: motor deficits, select cranial nerves (e.g. sticking out tongue)

Systems that allow us to gather crucial data, like vitals, facilitate the option for telehealth. Elite Home Health & Hospice pursues telehealth by issuing a system which can support weight tracking, blood pressure recording, pulse oximetry, and heart rate. Telehealth requires patients to participate in their health care assessment, sometimes by being hands on, such as depressing the skin in the shin to show edema.

Using the camera on a phone can facilitate assessment of foot ulcers: Have the patient put the camera on the floor and show you
the bottom of their feet, top of scalp, nape of neck (acanthosis), close-ups of body areas that trouble them, neurologic and musculoskeletal exams: Have the patients move their extremities for passive and active ROM etc, and even GI: self-palpation under supervision may help document rebound, guarding etc, and using a coin/ruler can help create context of the size of a lesion.

Telehealth is a brand new world in healthcare. We are excited to participate in the first steps and bring care to our communities in new ways.