March 1, 2024
Participant:
Alvin Empalmado is the Vice President of a Clinical Quality and Value Based program with over 25 years of leadership and hands-on experience in Medicare, Medicaid, and integrated managed care business lines alive as a world of knowledge.
Video transcript:
Welcome back everybody to Emerest Connect. I hope you’re having a wonderful time at our grand opening. Right now I am seated with Alvin Empalmado who is the vice president of a clinical quality and value based program with over 25 years of leadership and hands-on experience in Medicare, Medicaid, and integrated managed care business lines alive as a world of knowledge. And when it comes to managing care teams and clinical quality we are so happy to have you here, Alvin. Welcome to the show!
Interviewer
Thank you.
Alvin Empalmado
You have a very important role. Royal Care has close to 10,000 clients and caregivers in the state of New York. That is huge!
Interviewer
First, I’m very happy to be here and talk to you about the clinical quality as well as the good things that we are offering to our patients as well as to our caregivers at Royal Care.
Alvin Empalmado
Yeah, and it’s amazing what big an audience you serve.
Interviewer
Yes, it is very important for us because we are at the forefront of taking care of our patients. Our caregivers are always in patient’s homes making sure that they are well. They are the ones who are bringing the quality back and the care that we provide to our shared members with our partners in the Managed Care world. So, they are the caregivers who are preventing the hospitalizations from happening, preventing the patients from going to the emergency room, preventing falls and if they fall, they call us back to make sure that they’re okay and we can do things for them in order to prevent it in the future. So, that’s a great service that Royal Care provides to all of our patients, and the caregivers, that are in the home, are really the heart of that quality that we provide. And one good thing. I’ve been in Royal care now for a while and the caregivers that we speak with and communicate with through our case managers, they really are there to you and can feel the heart from them in giving the very best that they can possibly do for a patient and that is really what quality is all about because quality doesn’t just happen.
Alvin Empalmado
Right.
Interviewer
It is something that is generated to every single caregiver case manager, whoever we are in the organization and that’s our mission.
Alvin Empalmado
Yeah, and I can see that you’re very passionate about it. And what’s interesting, Alvin, is you come from such a varied, but strong sort of medical background. So, that must play into what you do.
Interviewer
Yes, I’ve been in managed long-term care as well as home care for the majority of my career.
Alvin Empalmado
Wow!
Interviewer
And I’ve seen how we have evolved over time in terms of the health care in New York City, how managed care has evolved, how home care has evolved, how providers have evolved. So, being in the Quality Department gives us a good position in Royal Care because in a world that we live in data is important.
Alvin Empalmado
Right, right.
Interviewer
But the data that we collect is only as good as that data. We have to do something about it. So, if we say that we have a lot of false, what do we do about it? That’s where the clinical component of it comes to life because we can create innovative interventions such as having telehealth like Emerest Connect, be involved, and have a nurse that will contact them on a daily basis. If they are really debilitated we can increase the rehabilitation. So, within Royal Care itself, we are a contained Health Care continuum and these are all in the service of providing good quality care to our shared partners with the MLTCs. So, that’s where the managed care component that I have experienced comes in.
Alvin Empalmado
Yeah. Well, and what’s very interesting is, as you said, Alvin, it’s really changed over the years but you have been able to see that and change with it not just stay in one place. So, you must be always evolving and thinking of new ways and help people.
Interviewer
Because the landscape is changing and continues to change. Now we are looking at Social Determinants of Health such as housing, such as tobacco use, such as falls, and ER visits. So, we really are forced to integrate the care and I think Royal Care has done a very excellent job in having all of those components in place, in our position, to really partner with our managed care plan, to deliver the quality care, to deliver the highest possible value for the services and the partnership that we have.
Alvin Empalmado
And it must be challenging though exciting for you when you are able to keep up with the times but you are able to say: “Okay, maybe this should work here, maybe we should bring in here”, but of course at the base is always the importance of giving quality healthcare.
Interviewer
And that is where the innovation comes in. And that’s where it becomes more exciting to see and also to get the feedback from our patients that they’re satisfied with it. It’s very very important because a happy patient is a healthy patient.
Alvin Empalmado
That’s right! And it makes a difference in the fact that they are able to come back to you and give you feedback, and you listen to it and then you implement maybe something that wasn’t that great and maybe something that was great and you continue on that.
Interviewer
Exactly. It’s that personal connection that sets it different from any other service that we offer. It’s a human connection.
Alvin Empalmado
It makes such a difference. I know you’ve started to introduce value-based care in Royal Care for home healthcare aides. What are some of the methods you use to further sort of advance this? I guess that’s something you are looking at too and then evolves over time.
Interviewer
So, each of our patients has a case manager assigned to them as a home health aide. So, what we do is we educate our home health aides that if something happens to the patient if they’re not feeling well, to contact us in the office.
Alvin Empalmado
Right.
Interviewer
Perhaps they can go to urgent care versus sitting in the emergency room. If they have weaknesses and they think that they are at risk for falls, communicate with us. Perhaps we can send a nurse or communicate with our partners in the health plan to change their care plan. So, those are the things that are within the value base that we looked at. We’ve had some success and I should lift my chair, great success in preventing hospitalization.
Alvin Empalmado
And that’s amazing because it has changed. We were talking about this with Jack and Josh. It used to be that you’d go to the hospital nothing with you but the fact that somebody can stay in their home because of the services you offer is really fantastic.
Interviewer
And that’s the value for the patient. They don’t sit in the hospital for X number of days being debilitated sitting in the emergency room. The value to our partners is that they decrease expenditures and costs for hospitalization and it only takes a call. And that’s what value base is about. It only takes a call from the patient to tell us what is going on. So, we can intervene and that’s where we train our caregivers and that’s what I think the clinical quality and value-based program sets us apart in doing that and making an effort. And it’s so supported by our leadership team. So, that’s what makes it different.
Alvin Empalmado
Yeah, and I think it’s important. Also, I know that you are passionate about education.
Interviewer
Yes.
Alvin Empalmado
Education that your caregivers receive. I know here in the building we see classes all the time and it’s really great, and it’s challenging for them too to learn these new things and these skills that are so important. And then, when something comes up, like you said, if somebody doesn’t seem right one of their clients, they can recognize.
Interviewer
It connects us back. I mean having those education sessions with our caregiver connects Royal Care with the caregiver.
Alvin Empalmado
Right.
Interviewer
And having that case manager call them or they know that there’s a case manager, they can call in Royal Care and connect that you’re not alone there, you’re not just working out there by yourself.
Alvin Empalmado
How do you keep up this wonderful quality of your services? I’m sure you have standards because I can tell that you’re so passionate about it that you want it to be the very best it can be, and you want to give some of your healthcare aides the tools to be able to do that. So, your clients feel good. It’s sort of like a snowballing thing.
Interviewer
So, it’s one of the strategies that we employ is what I personally call population management. Within population management you collect data, right?
Alvin Empalmado
Right.
Interviewer
The number of falls, number of hospitalizations, the ER visits. And I’m very happy to say that we have developed a dashboard that we can see in real-time how many hospitalizations, how many ER visits, how many falls have happened. So, we can intervene and that’s where the population management comes in because if you see a high number of falls in the Brooklyn region, let’s do a root cause analysis and see what those issues that making the patient fall or if there’s a high risk of hospitalization. Is it because of infection? Is it because of falls? So, this clinical dashboard that we have, that we build, gives us the information in terms of what’s going on with our population. So we can intervene sooner and create innovative interventions. It’s maybe more calls to the patient, a visit by the nurse or perhaps asking the aid to make an appointment to the doctor in order to change their medication because this is what’s going on, they’ve been in the emergency room several times, what’s going on with a patient?
Alvin Empalmado
Right
Interviewer
And in real time we can intervene and prevent those from happening. And that’s where the quality comes in terms of the delivery of the care that we have and the quality that the patient gets from the service from Royal Care.
Alvin Empalmado
I think that’s so important. Sometimes maybe a patient is reluctant to say something.
Interviewer
Exactly.
Alvin Empalmado
And that caregiver being there can see it in their face in real time.
Interviewer
Exactly.
Alvin Empalmado
And be able to recognize that there is something wrong and let you know about it. Let me ask you, Alvin, how do you think the U@Perks program is helping to achieve these goals? I mean, I have seen it in action right here with your caregivers being offered free services of hair and makeup which are so important, plus the education. How does that play a role?
Interviewer
So, we talk about value base, right? And value base is not only measured by the contracts or the relationship with the health plan. The value base is also with the employees, right? So, you get value out of your employment and that’s what your perks which is very very innovative. I was blown away when I first saw the U@perks services that we provide. They’re getting a hair, they’re getting their nails done, they’re getting their hair done. It’s really not only a service but it’s also a value to our caregivers. It gives them not only a service for their wellness and health but there’s also a space. Because you U@Perks a space for them to just come in and relax. Maybe you’re having a hard day at work, right? Or maybe it was a rough week for you. Caring for our patients it’s a way to prevent caregiver burden to make the caregiver feel good about themselves.
Alvin Empalmado
It’s so important. I mean, it seems like a little thing at first but it makes such a difference in life and like you’re saying, you feel better about yourself. You can go into a situation and feel good and the client can feel like: “Okay, you feel good too”.
Interviewer
It’s like us. If we feel stress, whatever is our means of distress, whether we want to go shopping, we want to go to the supermarket, but some are very important for their well-being, their wellness and health.
Alvin Empalmado
Yes.
Interviewer
It’s important to have a space, a quiet space to feel good about themselves. Their nails are done, their hair, their makeup, and others.
Alvin Empalmado
And they can talk to other caregivers that are there, that maybe they can relate to or talk about what’s going on. It’s just really wonderful!
Interviewer
It’s a wonderful kind of services.
Alvin Empalmado
It really is. And what else? What’s coming up? Is there anything that you want to brag about?
Interviewer
I think I bragged enough.
Alvin Empalmado
that’s okay you’re allowed to
Interviewer
A lot of things are coming up. I think that we’re very excited in the space of the value-based program. There are a lot of things happening on the CMS side in terms of funding the VBP program. Hopefully, that will happen. So, that’s an exciting thing because it will further expand quality. Not only the delivery of quality but highlighting how quality can make a difference in the healthcare space. So, that’s a lot of exciting things happening as well.
Alvin Empalmado
Yeah, you do such a great job! It’s wonderful that you look at it from so many different angles about personal care, education, the importance of seeing what is going on in real-time, and just really pinpointing and addressing those issues.
Interviewer
It’s easy for me because I work with great people in the organization. And I’m just not saying that because I’m on TV but it’s true that you work every day with good people and that takes a long way to make your work easy.
Alvin Empalmado
Yeah. I know that is important to Josh and Jack. They have positive great people that work around to make it work just like you.
Interviewer
Great leadership, great co-workers.
Alvin Empalmado
Yeah, it makes such a difference, thank you so much, Alvin, for taking time out of the party. I know you want to get there and get some food and everything. So, thank you so much for being here and giving us some insights on Royal Care and all the wonderful services that you offer. It’s really interesting and really wonderful. So, I wish you nothing but the best in the coming year.
Interviewer
Thank you so much.
Alvin Empalmado
