Explore how VitalCaring is pioneering AI-driven cognitive care to meet the growing challenges of Alzheimer’s, dementia, and other cognitive impairments. By integrating advanced technology with a patient-centered approach, VitalCaring enhances patient outcomes and empowers clinicians with tools for real-time progress tracking, supporting their role in delivering exceptional care.
Chief Clinical Officer Janice Riggins explains how these solutions not only bolster the patient and caregiver experience but also align with the values-based care standards enabling sustainable, quality care that adapts to the evolving needs of patients. VitalCaring’s initiative prioritizes measurable outcomes through data-backed cognitive therapy and expands resources for patients while upholding excellence in care.
Janice Riggins, MSN, RN, Chief Clinical Officer, VitalCaring
Megan Antonelli, Chief Executive Officer, HealthIMPACT Live
Welcome 0:01 Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS, deep dive on what's really making an impact in healthcare.
Megan Antonelli 0:30 Welcome to Digital Health talks, where we explore how technology is transforming healthcare delivery. I'm Megan Antonelli, and today we're diving into an exciting conversation about AI innovation and home health. Joining us today is Janice Reagans Chief Clinical Officer at Vital caring, leading groundbreaking initiatives in AI powered cognitive care. We'll explore how they're pioneering AI driven cognitive care to meet the growing challenges of Alzheimer's dementia and other cognitive impairments. Hi, Janice, how are you today? I'm great. Megan. How are you good? Thanks so much for joining us. I'm so excited to have this chat. You know, having to kind of just learned about vital caring and all that you guys have been involved with, but share with our audience a little bit about your background and your role. Sure. Thank you.
Janice Riggins 1:15 It's a pleasure being here with you. And I've actually been a registered nurse for 30 plus years now, and most of that time as being a registered nurse, has been practicing in the post acute space in home health and hospice. I will say I fell in love with home health while making rounds with a cardiologist years years ago, believe it or not, they were still doing home visits back in the day, and at that time, we were actually doing rounds under for patients who are undergoing cardiac bypass surgeries, what I discovered when making rounds in the home setting was so much different than caring for patients at the bedside in the hospital, I was able to really learn so much more about the patient and their healthcare journey By stepping into their, you know, their environment, and identifying ways to teach and assess and identify root causes of their illnesses. You know, associated with social determinants of health, but you just didn't see you didn't see that in the hospital. And so for me, it was that moment when I really became hooked on post acute care in home health. I knew that meeting the patients in their home to provide care was my calling, and that's, that's kind of my journey. I started there, and since have moved on into executive roles in, you know, the past 20 years. Absolutely love it.
Megan Antonelli 2:36 That's amazing. I mean, what's so interesting, I think also, as we look at kind of how telehealth and telemedicine has evolved. I mean, I remember back when it was really just beginning, and it really started with the home health nurses. I remember the Home Health Nursing Association of New York and the programs that they had, you know, it makes sense, right? I mean, obviously they were, they were not connected. They needed to communicate. And we've had other folks on the show, you know, around, you know, just that lack of communication and that lack of connection that for those nurses and those caregivers, and that there was so much innovation there because it was needed. And now here we are, and it's interesting as we see this sort of convergence between the two. But tell us a little bit about vital caring and vital caring mission. And you know what you do there?
Janice Riggins 3:23 Sure. So I work at Vital caring now. We are a home health and hospice provider that has fairly new to the industry. However, I would say that our team is not new to the industry. So we have a lot of great pioneering leaders within vital caring, where we really formed multiple home health agencies over the last few years into one umbrella, or under one umbrella of vital caring. And our mission here at Vital caring is simple. Our mission is to transform lives and foster hope through genuine caring. And really, for me, that means not just caring about the patient, but making sure that our employees are also cared for and that they are provided the skill set and the tools to be able to do their very best with every patient, meeting them again in their homes along their journey of home health. And for us, home health is not transactional. It's not just about the visit within a 60 day episode, but it's about making sure that we are really achieving goals to allow patients to age in place, and that is in the best place, which is their home, right?
Megan Antonelli 4:33 Yeah, we've had a lot of conversations about that too, and I do think it's so important, particularly with cognitive right disability and dementia, you know? I mean, they are, they want to be at home. They are at home and and the caregivers, you know, at home need help as much as you can. Can provide that. So tell us a little bit as we've, you know, we've been talking, as I said, to folks also working in the aging and in place space. But also with the hospital at home, and, you know, the technology initiatives that are behind that tell us a little bit about what, where you see, you know that that impact, and how that's impacted, the changes that you guys are making sure
Janice Riggins 5:13 Well, like you mentioned earlier, you know, going way back in the day when telehealth was really introduced in the home health setting, that hasn't changed, although our reimbursement, unfortunately, is not catching up to the technology, we have definitely found a sweet spot in home health, in the post acute world, where we see that technology is so very important, we are partnering with our hospital partners, for hospital at home and such programs that really allow patients to age in place, to be able to transform care in the home setting at a much higher skill set. And so that's what's so important, is that we are seeing patients coming home sicker. They're coming home quicker. We've heard that, you know, for years now, and it's definitely come to fruition. And what technology has been able to allow us to do is really to be able to take 1000s and 1000s of data points that the human brain just can't really compute and be able to formulate that into individualized care plans and care initiatives for patients, especially those who are suffering from cognitive issues and impairments. When you think about just in our population here at Vital caring, we have well over 10% of our patient population with a primary diagnosis of some type of cognitive impairment, and that's not even including your secondary or comorbidities. So there's a much, much higher prevalence of that, and so we're seeing this more and more, and we need to really partner with our Upstream partners, both hospital and rehabilitation centers, to then use technology to transform the way that we are uniformly providing care across all of our service lines, great, well,
Megan Antonelli 7:02 and then in that, and I think it's really interesting that the way that this has evolved around the cognitive care, you know, area, and tell us a little bit about, you know, the pilot program that you guys have been working on, because that's kind of how I came to this and and what's going on there?
Janice Riggins 7:18 Yeah, absolutely. So at Vital caring, we had a cognitive care program. It was a clinical program where we were involving both therapists and nurses to provide teaching and education to both our patients and our families. And like with any other disease process, you know, you go in for home health, and you have a visit, and you try to get as much done within that visit. But then what happens on the off days? What happens on the days when you don't have a nurse or a therapist in the home? That is where we found that we needed to solve a problem for we needed to figure out, how do we ensure that patients and caregivers can become as engaged as possible while they're receiving the therapy and the treatments while on home health, but also in the interim, in between those visits with with cardiovascular, with stroke, with diabetes, we send nurses, we send therapists. We teach them, and we have Teach Back to teach them that to how to do or perform their their therapeutic exercises, what they do, then we are unable to really monitor or measure because we can only take the word of what that patient says they're actually doing. We wanted to be able to use technology to measure what happens in between those visits, so that we can see the progress and the engagement that was happening with our patients. So we had a pilot program. We started with a small scale so that we can really measure and manage it. We had 52 patients within our pilot program ages between 54 and 92 So on average, our patients were around 77 years old. The program, on average, lasted for 77 days on average for each patient, the pilot itself went on for seven months in duration. And what we found is, not only did we see improvement in cognitive function, you know, 55% of our patients improved at least one cognitive level. 35% of our patients achieved normal cognitive function score by by the time at discharge. But what I also loved about this program was that we saw on average, 557 hours of additional therapy outside of our in home therapy visits. So when you're able to engage patients and family members, and then you're tracking those hours that they're being performed. That is how we were able to then get the results that we saw in such a small pilot that we that we performed. Wow,
Megan Antonelli 9:51 that's amazing, I mean, and that covers another thing that I think is so interesting around as we talk, and there's certainly fear and concern around what. AI can do, and the ability that, you know, to amplify care, to offer more care, and to offer the services that you're not able to offer because there just aren't the resources to do it. So it seems like you guys have really gotten to that. Tell me a little bit. How about how AI is kind of central to this project. So AI
Janice Riggins 10:18 was so important, you know, for us, I think on so many levels, we look at technology on you know, not trying to complicate or create, you know, or replace our nurses, but it's really an adjunct to add to the care and services to be able to elevate their skill set by providing them with information, clinical decision support. So it's allowing them to really individualize their plan of care. So when in front of the patient, being able to go back and look at the hours that the patient has already used within this exercise program, they're able to take that and then tweak the plan of care to progress. So it's not a one size fits all. Every patient is receiving the right amount of care at the right time and the right type of brain exercises that they need to really improve within their cognitive impairments. For me, I felt like that was such an elevation of our clinicians. They were so excited to see the progress that was, that was that was being noted within our cognitive care program. It wasn't a matter of just leaving a handout and saying, Here's your booklet, and let's see if you can remember or recite these things. It really engaged the patients and family members, which is why I say even after discharge, we found that most patients and family members wanted to continue with that program because of the the experience that they had while on services with us. Wow.
Megan Antonelli 11:48 I mean, that's impressive. I mean, in terms of just that, that level of impact, and, you know, I think, like, did you say 35% showed improved function? I mean, that that's amazing. What, in terms of, you know, you've seen these programs that, in other places, not have that kind of impact. What do you think contributed to that? Is it the engagement of, do you use tools like, you know, is there gamification, or is it just that in the customization? What? What is the the special sauce, if you will,
Janice Riggins 12:17 Megan, I would say all of the above. So, you know, the program was very intuitive. It adjusts to the level of difficulty based on the patient's performance. So when you think about it, adjusting to the patient's performance with cognitive impairment, a lot of times, patients become frustrated when they're trying, when you're trying to work through certain exercises and brain activities. This allowed the patient to engage more with decreasing the amount of frustration, if you will. So constant therapy has, you know, a proprietary patent program which they call the neuro performance engine. It's the npe, is what they call it, which really analyzes, you know, real world data generated from from the user, interactions with the with the product delivery, evidence based exercises that are customizable to each and every patient. And by using that and allowing our clinicians to then collaborate with both with both patients and family members, we saw that the level engagement increased, and that's where then we saw the level of hours in between visits start to improve, time and over, you know, over that course of the episode of cure, or on average, like I said, 77 days where our patients with cognitive impairments were on services for so it really helps provide examples. Would be, maybe we needed to slow down the instructions within the brain exercises so that the patient could comprehend and feel like they were achieving at a level and pace that allowed them to be successful. So it was able to adjust verbal cues and questions slow down, speed up based on the patient's needs,
Megan Antonelli 14:00 and then around when you mentioned also the the them continuing with the program, right? So what do you think is the driver? There? Is it? The the patient, the individual, the family, again, all of the above,
Janice Riggins 14:13 all of the above, absolutely, I would say that you know when you see when you have a caregiver who a lot of times with cognitive and cognitively impaired patients, there's a level of frustration as well. And so when you start seeing your loved one improving or being able to maintain at the level that you were hopeful that they would be able to maintain, it's like the best medicine that you can give a patient without actually having to go to down the pharmaceutical route. And this is what I love about this program. If you think about every disease process that we teach on, there's two things, two factors or interventions that we always teach on, and that's diet and exercise. And it's no different here with our cognitive. Patients, they need good, strong, healthy nutrition, but they need exercise, and that's brain exercise, functional exercise, and that is really what helps to elevate their level of improvement and ongoing and I would say muscle memory. I think when patients feel like they are being successful and they are feeling a difference, they're going to want to continue to do that. You want to do what makes you feel good, and that's what this program does,
Megan Antonelli 15:25 right? Absolutely, you know. And I think that you know, the the impact on both the caregivers and the patients can't be understated when, when it comes to, okay, so this is the pilot. What's next in terms of, you know, what is full scale implementation look like, and what needs to happen?
Janice Riggins 15:41 Yeah, so after the pilot, we obviously looked at all of the great measures and outcomes. We recognize that this is definitely a program that we want to scale across our platform, and that's what we're currently doing right now, is we're developing some more educational materials. We actually want to get our data peer reviewed and get into a white paper so that we can share that with other resources and other healthcare folks, so that we're all working in tandem to improve our overall outcomes for our patients. So yes, we're looking to also enhance right now, in within our pilot we really focused on speech or speech language pathology and occupational therapist as the driving forces of the pilot program, and now we're looking at ways to expand that into nursing, obviously, with staffing challenges, especially in some of those therapy areas, we know that in order for us to scale at a larger capacity, we need to involve the entire interprofessional team. So that's what we're doing now, right? And then you had
Megan Antonelli 16:47 mentioned your technology partner in the program. Tell us a little bit about that, how that works and how that's going, yeah.
Janice Riggins 16:53 So we couldn't have better partners than constant therapy. I will say one of the things that we really aligned with we were very like minded in our mission, and that was really to foster hope and trends, you know, transform lives and through genuine caring and in reading their history and their background, that is exactly what they were trying to do as well. Is, how do we improve, you know, cognitive impairment. When we know that this is on the rise. We're continuing to see, you know, cognition as some of the driving forces of hospitalizations and paid and patients not being able to to age in place in their homes. And so that was once we aligned with our core values. One of our core values being technology and innovation. We knew that this was a great partner, because they wanted to meet us, to really help solve the problem, to really identify, how do we get to the root cause, and not just, you know, put a band aid on it by, again, providing, you know, pharmaceuticals or, you know, treatment that tends to only be as Good as when the patients and families are actually performing it. So this was a great way for us to see how we can continue, even long after discharge, providing the necessary services and the exercises that these patients needed, and at a at a price that they could also afford. And I think that's the other piece that we worked with constant therapy on, as well as making sure that for patients that would continue on with that therapy, treatments, that they would be able to afford that treatment,
Megan Antonelli 18:30 right? And that's, you know, I think that's so important. And I think especially with cognitive care, you know, programs that you know, they become, you know, hard to hard to access and difficult to afford for folks, and you know, particularly, you know, those who are also have other comorbidities happening that they can't necessarily go outside of the home for that tell us a little bit about in terms of the technology and and what was involved, and where you think that, you know, kind of role we talked about this A little bit already, in terms of, like, patient independence and engagement. Talk a little bit about how the AI, you know, made a difference. I mean, maybe also in the context of like, where this has been to where we are right and why this is possible now, yeah,
Janice Riggins 19:16 so I kind of break it out into a couple of buckets, if you will. So from a clinician perspective, I would say that using this technology, being able to provide objective, evidence based data to apply functional tasks and support medical necessity is a win win. We all know that under Home Health, we're always under regulatory scrutiny and always trying to ensure that we have the ability to document and to prove up Medical Necessities. So that was another thing that we felt like, with our partnership with constant therapy that we were able to do, we were able to provide that medical necessity drive the actual documentation and treatment plan. Within the constant therapy app, and be able to simply copy and paste a lot of that key information into our EMR system. So it helps with efficiencies for our clinicians. It really helped to support and drive home the home bound status as well as the medical necessity, but also the progress that was being made throughout the course of treatment. And then when we think about our patients, you know, it allows them to really receive much higher level of care than what we're simply able to provide during a visit. So they're getting all those hours additional that's going to help, help to over, you know, to provide them with the additional care needs. Like I said, I think 557, additional hours outside of the care and treatment that we were able to provide. So that was a win win as well. Like I said, the limitation that we have with the therapeutic programs that we provide, the patient or caregivers must have either a smartphone or a tablet or a computer. So it's computer or tablet or smartphone agnostic, but you're going to need to have one of those devices in order to really participate in the program as it is today,
Megan Antonelli 21:15 which is, I mean, it's definitely a bar. And of course, we talk about the kind of digital divide that that can create. But, you know, there is, it's not a separate device or a unique, programmed tablet or anything like that. So it's just a web based platform, I would say
Janice Riggins 21:31 web based, which makes it nice, because if you think about, you know, going to your doctor's office, most of, most of your physician appointments or web based. Now there's so much telehealth going on. Your reminders are all you know, generated through some form of technology. I think that you know, when we leave our houses every day, most of us are coming in contact with some form of AI, whether it be through our GPS system getting us from point A to point B, whether it's ordering food and tracking, you know, the distance at which they're going to be arriving. So we're using AI tech technology each and every day, and so being able to apply it, you know, for the greater good of our outcomes, for quality care and being able to age in place much longer, that's a win win for all of us, absolutely.
Megan Antonelli 22:20 And you mentioned around, you know, as we talk about home health and the hospital at home programs, and the reimbursement is a factor here, right? And so my understanding so vital care is part of the Home Health Program, and so that that's how patients would access it, and then once they're done, they would be paying for it, for them, by themselves. What is the in terms of kind of your expansion, growth? Is it more Home Health Partners? Is it insurance? You know, what's the sort of path in terms of the ROI metrics that you need to demonstrate, but also just looking at some of the challenges and implementing this, right? I see those as sort of probably one in the same but, you know, if they're different, then let me know.
Janice Riggins 23:07 Yeah, I think you hit on a very important piece there. You know, it's always a challenge when you have to look at technology and and while they're on the home health services, they're able to, you know, the the the technology is paid for through our through our episode of care, and then once we have to transition them off, we want to make sure that they are still able to to perform their activities and exercises. And so, yes, that that is a small feed that they would then continue on through that course of period. But to your point, I think it is important for us. It's not just about the patient having to pay out of pocket. We want to be able to go to strategic initiatives and through insurance programs and other strategic initiatives, through ACO populations and others. To say, Here, we have a wonderful tool that we can help to reduce costs, improve our outcomes and our quality. And again, it being a win, win situation for all. And so I think we can leverage this type of technology layered on top of our already, you know, wonderful clinical pathways to sell that to our our insurance partners, so that we can improve overall, our relationships and partnerships there as well. Right?
Megan Antonelli 24:20 Can we get, ultimately, part of, you know, a Medicare benefit and that people can access absolutely around. I mean, you talked a little bit about the technology. Are there any other, you know, sort of barriers in terms of having a web base, which, you know, is a barrier, but it's sort of the barrier of all digital tools, right? In terms of other barriers besides reimbursement, do you see, you know, are there challenges that you guys are, you know, seeing that, that you wish would go away,
Janice Riggins 24:52 you know, I think that you know, the reimbursement piece is probably our biggest challenge, right? And. Clearly, we want to make sure, too, that, you know, if patients are unable to afford a piece of technology, how do we, how do we partner with technology, you know, companies to also be able to provide such devices at a lower, discounted rates, or, you know, so really trying to expand our tentacles out into the technology world. And when we, when we get technology and healthcare together, you know, I feel like that we, you know, the opportunities are endless. So it's just a matter of knocking on doors and really identifying ways that we can empower other partners to be part of this, this wonderful outcome and and see the benefits that that we can, we can create together, yeah.
Megan Antonelli 25:44 I mean, I think it's such an important area, and there's so many different initiatives where it would align, right? I mean, there's a large discussion around, sort of the elderly population and loneliness, right? And how are we so I imagine, while this is very specific, that this would have some, you know, certainly relevance and applications there, as well as, you know, the caregiver movement of, you know, the challenges. And I think dementia is probably the, you know, one of the hardest on, on the generations. So
Janice Riggins 26:15 you hit the nail on the head. You know, the the the percentage of, and I don't know the exact percentage of patients with depression, but in the elderly population, but it runs rapid and so that is one of the validated tests that we also perform. Aside from just the cognitive tests and standardized tests that we look at, we also do screenings for PHQ nine and the geriatric screening tool, because within this program, it also addresses those needs for patients that are suffering from depression as well.
Megan Antonelli 26:46 And I, you know it, I mean, in some ways, I mean, this is a super non clinical way of looking at it. But in the in the world of of mental health, you know, I mean teenagers and adolescents going through, you know, their challenges. You know, it just happens. We take it as the accepted norm. As elderly get older, we all get to a place where this is, you know, we have cognitive impairments, whether it's Alzheimer's dementia or, you know, just, I can't remember what I went into this room for. Wait. Should
Janice Riggins 27:19 I drive home today. I don't even remember doing that, right, right? You know, I'd like
Megan Antonelli 27:24 to think it's because I'm distracted, but it's mostly because I'm old. So you know, in that this is, well, obviously you guys, you're functioning in an acute place where people need this because they went into a home health episode of care, the opportunities for it to have applications well beyond that, more to similar to, you know, talk space, or, you know, regular, you know, the sort of standard mental health application seems logical to me. Is that sort of the next step? Or, you know, more,
Janice Riggins 28:00 yeah, I think there's just so many opportunities that we have we are just beginning to kind of unravel, if you will. I definitely love thinking through, you know, how do we solve some of these issues, with with with our elderly patients, and suffering from depression, suffering from cognitive suffering from traumatic brain injury, geez. You know, long haul, COVID. You know, all of these things that have played such, you know, major factors within their their health and healing. And when you think about we sometimes tend to Trump a lot of things under the fact that it's just it happens with age, but and the reality is, when you really get to the root cause of things, it really is more about our environment, it's more about our lifestyle, it's our Western diet, you name it. But you put all of that in with technology that is able then to formulate an individualized plan, and be able to help solve for so many of these problems. You know, it's the future. Is just, I'm excited. I'm excited about it, you know, I went back to school back in 2018 to get my Master's in Healthcare Informatics, and it was because I really saw a need to marry our you know, my clinical experience with technology, because it just makes sense. You know, our brains just cannot compute as quickly as all of the AI generated information that we receive in order for us to have those outcomes that we want to have in the time that we want to want to have them. Yeah,
Megan Antonelli 29:40 it's so true, and it is amazing, and the potential has always been there. And, you know, I think the discussion of who's going to pay for it has also always been there. But when you do have tools that really make an impact and really have evidence behind them, it's, you know, the progress happens and it moves forward. So you, I mean, you can't help. I'm hopeful. Yes, yes. Well, as as we always talk about, we like to close with kind of, what's good in healthcare. We have a segment, you know, five good things that we do every month. But I like to always ask folks, what are you most excited about? What are the good things happening? And you just touched on a little bit, but in terms of just that, you know, the bright spots in healthcare, tell me. Tell me what you see.
Janice Riggins 30:21 Well, you know, I think, I think it goes back bright spots that I see is that at the end of the day, regardless of policy, regardless of regulations, you know, everyone is someone's favorite person, and so we have to get back to the fact that we're here to take care and to serve our patients. And that's what that's what gets me up every day. That's what I enjoy seeing and I enjoy doing. And so, you know, regardless of the, you know, the political, political strife or technology challenges that we have from getting reimbursed, it doesn't change the fact that we have an opportunity to change the trajectory of our patients in a positive way. And that's, that's what, that's what keeps me going every day. Yeah,
Megan Antonelli 31:06 no, it is. It's an exciting time, you know. And I think the the AI and technology, and that intersection of what what's possible is becoming, you know, really exciting and positive. So hopefully
Janice Riggins 31:20 we'll, we'll narrow the gap soon, right? You
Megan Antonelli 31:23 know, and there's always nothing's going to be perfect and nothing's going to solve everything but one step at a time. There is, you know, changes, changes that are happening, and this is such an important area. So thank you so much for the work that that you do, and thank you for joining us. Well, my pleasure. Megan, it was great. Thank you. Thank you. A special thanks to Janice Riggins for sharing vital, caring, inspiring journey in AI innovation and their impressive pilot results. Your insights on balancing technology with compassionate care are invaluable for healthcare leaders navigating digital transformation. So thanks so much again for joining us and to our audience for more episodes focused on healthcare innovation, Follow Digital Health talks on your favorite podcast platform. This is Megan Antonelli, signing off.
Thank You 32:09 Thank you for joining us on digital health talks, where we explore the intersection of healthcare and technology with leaders who are transforming patient care. This episode was brought to you by our valued program partners, automation anywhere, revolutionizing healthcare workflows through Intelligent Automation, netera, advancing contactless vital signs, monitoring elite groups, delivering strategic healthcare. IT solutions, sell point, securing healthcare, identity management and access governance, your engagement helps drive the future of healthcare innovation. Subscribe to digital health talks on your preferred podcast platform. Share these insights with your network and follow us on LinkedIn for exclusive content and updates. Ready to connect with healthcare technology leaders in person. Join us at the next HealthIMPACT event. Visit HealthImpactForum.com. For dates and registration. Until next time, this is digital health talks, where changemakers come together to fix healthcare.