COO Mark Josefovic and CTO Stephen Nusbaum Discuss Technology and Operations that Help Operators Thrive and Succeed
LTC Ally’s Mark Josefovic, COO, and Stephen Nusbaum, CTO, discuss the importance of technology and industry expertise in delivering long-term care operators a suite of back office services that make way for success, growth, stability, and peace of mind in a competitive, complex industry.
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How does LTC Ally helps operators thrive in an industry that’s so competitive?
The nursing home industry has many different components. It involves operating both a nursing care facility and a financial back office. Operators deal with housekeeping, laundry, maintenance, and dietary services while also providing a high level of patient care, nursing, therapy services, and administration. Behind all of these services are very complex functions, including billing, financial and reporting duties, and case management and contracting with insurance companies. LTC Ally plays an important role in enabling operators of facilities to best take care of patients while we handle the very complex, nuanced functions of their back office.
In addition to managing back office functions, we’re enabling operators to be successful. In today’s industry, you have to operate in a specific region and have the ability to scale, maximize revenue, and increase census. In many instances, operators are looking at deals that include 5 to 10 facilities at a time, and there’s a lot of work in the back office that goes into making those transitions in ownership go smoothly.
With the infrastructure we’ve developed, we give our clients the confidence to grow and support them during every stage of that growth. A large component of that support is the custom technology we’ve built in-house that addresses the specific needs of this industry.
What drove the decision to develop technology in-house versus finding an off-the-shelf solution?
While there are some solutions we use that are off-the-shelf software, in terms of workflow, reporting to clients, and anything that requires providing more granular information and careful analysis, we found there weren’t any suitable options available. We felt that if we understood what needed to be built and were willing to pay for it, we could do that on our own. It really started with just a handful of people, and now it’s under Steve’s guidance as our CTO and a really robust team.
To this day, that foundation still drives our in-house development. The fact that we work with so many facilities gives us the ability to understand the workflow better than anyone else. Having our own custom software also gives us the ability to make changes on-the-fly as the industry changes. Claim specialists, for example, and their support team can change rules immediately and don’t have to wait on a software update from an external party.
Since we handle all the data internally, we can deliver incredibly robust reporting and slice the data any way a client wants. This gives them a very competitive edge and lets us operate how we would like to, without the constraints of a system someone else built.
The investment we’ve made in developing all these tools is also a tremendous value-add for our clients. With what we’ve done to successfully run the back office of hundreds of facilities, our clients don’t have to worry about building that out for their facilities.
What recent developments would you like to share?
We recently rolled out an interactive reporting dashboard that enables our clients to access all their data in real-time. We’ve spent a lot of time and resources developing this technology to empower our clients and give them greater transparency into their facilities. Clients now have everything from interactive graphs and charts to key insights and reports at their fingertips. They can analyze everything at the highest level and drill down to the smallest details. In a few clicks, an operator or administrator can review a bill for agency staff, for example, and see the exact invoice behind the amount that was billed.
Our Finance department will be the first to implement this dashboard, but we’re pushing forward with developing it for all our lines of business and accommodating custom requests from our clients. Since we work on a larger scale, we have the ability to assign the proper talent and resources to a project like this. Our clients are very excited about this new capability, and we’ve already received a lot of positive feedback.
What systems have you developed for your revenue cycle management (RCM) services that set operators up for success?
We’ve made tremendous investments in comprehensive tracking and aging software that help track patients for the entire lifecycle of their interaction with a nursing home. This starts before they enter a facility and includes reporting packages that we can customize to the client’s criteria.
Our tracking software ensures that each resident has a payer source for the entirety of their stay at the nursing home. If coverage changes, we’re alerted and can stay ahead of the curve. Without this level of oversight, facilities can have residents without proper payer sources and can end up losing out on their reimbursements.
Our aging software helps our claim specialists and supervisors know exactly what’s outstanding, what has been paid, and which claims to follow up on. We’ve optimized this in such a way that when a person arrives at their desk in the morning, they see exactly what needs to be done in order of priority. We’ve built a lot of automation into this side of things to make it easier for our billing and collection specialists to do their work in the most efficient way possible.
As the industry has evolved, facilities are dealing with more payers—it’s no longer just Medicare and Medicaid. Older, more manual processes that worked for those two payers simply don’t stand up to the demands of today’s industry. We’ve made sure our system is built in a way that can adapt to the needs of multiple payers interacting with a single facility and can accommodate any future changes.
We’ve built these systems to ensure everything is prioritized and we’re capturing every claim for our clients.
When we onboard a new client into our RCM suite, we see an average increase in their facilities’ cash flow of approximately 15% because of the efficiency and accuracy with which we can handle their claims from admission to payout. The investment we’ve made in this technology is a great benefit to ourselves and our clients.
How has the importance of reporting shaped the systems LTC Ally has built?
As such a tightly regulated and competitive industry, robust reporting is essential. We’ve made sure each of our systems addresses the needs we’ve heard from operators over the many years we’ve been in the industry, whether that’s for their RCM or financial operations.
On the RCM side, we can send out reporting packages on a monthly or daily basis, depending on what a client wants to see. We’ve made sure our systems can parse data in any way, allowing operators to see how their facilities are doing from a certain perspective, and administrators likewise have access to reports that help them do their job as well. For example, we’ll send out an aging report with census information for different levels within an organization. The C-suite is looking for macro information across their facilities, so we customize summary reporting at a higher level.
For clients using our financial services, we’ve developed a range of systems that use automation as much as possible to eliminate any possibility of error. To us, even an error rate of less than 1% is unacceptable, so we constantly add sophistication and automation to our systems to achieve 100% accuracy. Getting to that 100% involves removing the human element from certain processes and letting the data and technology do the work.
Similar to the RCM department, we can deliver a tremendous amount of customized reporting for our clients on the finance side. We routinely deliver reports for their bank loans, to regulators—whatever is required to keep them operating without a hiccup—and anything they would like to see in more detail to help them make informed business decisions.
In addition to reporting, our critical payments system automates a lot of the business in terms of making sure payments are made on time. We can establish what is considered a critical payment, and the system will ensure that is paid on time.
Within our Managed Care department, we built an online tool that our clients have found really valuable. In addition to standard reporting going to ownership, facility admissions and back office staff are furnished with live data to help determine if they should accept a referral and how to bill for them. These are vital insights that need to be easily accessed by the right facility staff.
Facilities often ask us to set their staff up with this software because they find the platform very user-friendly and is a great way for their team to stay on top of authorizations and contract criteria.
How Does LTC Ally address cybersecurity in light of increasing attacks on nursing homes in recent years?
It’s important to talk about how the industry has been infiltrated and that the attacks are very serious. There are serious repercussions for nursing homes when sensitive information is captured during these attacks. Every nursing home deals with HIPAA information and financial information that’s illegal to disclose without some level of authorization. When these attacks happen and are successful, there’s a lot of information that is very valuable to bad actors, and poorly handling HIPAA information can land nursing homes in trouble as well.
Before these attacks began proliferating in skilled nursing, we set out to make sure our entire infrastructure was extremely secure. What we had seen was that nursing homes didn’t necessarily have the best systems, which is understandable—they have a focus on delivering excellent care, not the business of cybersecurity. So we looked at our role as their partners and committed ourselves to handling their information in the most secure way possible.
Thanks to our incredible team of cybersecurity specialists, we added more locks to every door where information comes into our systems. At any point where information is being accessed during our internal workflows, we ensure that there is only ever authorized access to that information. Ultimately, this brings our clients peace of mind, knowing they don’t have to worry about that piece of the puzzle, hire a specific department of security specialists, or outsource to someone who doesn’t understand the intricacies of our industry.
In general, at LTC Ally, we are never content. We’re constantly looking at ways to improve, which is why we have a dedicated team of cybersecurity specialists, headed by Steve, who are bringing more sophisticated, more secure ways of handling and storing our clients’ data.
What is one of the major pain points LTC is helping operators solve in today’s industry?
In general, almost every industry is having a hard time hiring people. We provide a solution for operators of any size to have their own back office, complete with some of the most talented people in the industry who are solely focused on delivering results so our clients can deliver great care.
When we look at the skilled nursing industry now, there’s more complexity than ever before, more work, and not enough people. When you have to build out a back office, there are multiple technical positions to fill, and that can be quite a headache for an operator of any size. There is a fundamental difference between filling an organizational chart and finding people of the highest caliber.
There is too much complexity involved in running a nursing home to allow for poor billing and collection processes, for example. You’re exposing yourself to a tremendous amount of bad debt.
Our role is to provide our clients with collection rates that are among the highest in the industry, real leverage when negotiating managed care contracts and authorizations, and give them financial sophistication that is extremely difficult for an operator to build on their own. When a client works with LTC Ally, they also benefit from the relationships we have with financial institutions and government agencies. We give our clients peace of mind on two fronts. Firstly, they don’t have to worry about building out their own back office, and secondly, they know we are delivering high-quality work on time and in a manner that suits their business needs.
That peace of mind—knowing their back office is taken care of—allows their core business to run more efficiently, which allows them to take better care of the residents in their homes.
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