PegaWorld iNspire 2023: Apria Healthcare Goes Paperless Using Pega Mobile

Apria Healthcare is enabling mission- and health-critical paperless product and service delivery for a user base of 1,700 technicians across the country using Pega Mobile. Watch this replay to discover the challenges that have prevented Apria from going paperless previously and why Pega Mobile was selected. Learn from the organization’s partnership with Pega professional services in defining the most effective mobile user experience and how they were able to deliver the overall mobile solution and incredible ROI.

Transcript:

- My name is Bill Marshall. I'm a industry principal on the Pega Healthcare team. Thanks for for coming today, this is a fun presentation. I've been looking forward to this. Wajmah and Lindsay have put together just a great story, really looking forward to this. Couple of housekeeping items. One, if you could silence your cell phones, that would be much appreciated. And then two, as we wrap up and go to the Q and A in both aisles here, there are mics on the stands, the question and answer period, quite frankly, the presentations are always wonderful. The question and answer is your chance to have a conversation and I love that session. We need you on the microphone so that we can hear the question. All of the presentations are posted online after PegaWorld and that's always disappointing when you hear a fantastic answer to a question that you can't hear. So we would much appreciate if you have a question that you step to the mic. I'll also have a walk around mic over here, so greatly appreciate that. Without further ado though, I want to turn the microphone over to Lindsay and Wajmah and if we could give them a big round of applause.

- Hello everyone. Thank you for joining us today. I'm Wajmah Ashrati, senior director of applications for Apria Healthcare now in Owens and Minor company. I'm responsible for solution design, development, delivery, and support. Today I'm gonna turn it over to Lindsay so she can kick us off and start the session.

- Good afternoon everybody, my name is Lindsay Moon. I am the director of System Support Services with Apria Healthcare. Very similar to Wajmah on the business side, I'm responsible for the product strategy, the vision and manage priority of enhancements for our business stakeholders. Myself and team work closely with the frontline and stakeholders leading business governance committees, system workshops and ideation sessions. And my team also maintains our external system portal maintenance, compliance, and control audits. Wajmah and I are excited to share the story of our journey of digitizing our paper fulfillment process, for our fleet of delivery clinicians and technicians. But first, let me tell you a little bit about Apria healthcare. With over 25 years leading the home healthcare field, serving over 2 million patients across 280 locations in the United States, Apria continues to transform the industry. Similar to pharmacy services like CVS or Walgreens. You get the same medication. What really makes Apria stand out is our dedication to the customer experience. We are passionate about our mission statement and improving the quality of life for our patients at home. Some of the services that Apria Healthcare provides includes home respiratory equipment like oxygen, sleep therapy like CPAP and BiPAP machines, negative pressure wound therapy, as well as general home medical equipment. So how did we start our journey? It was a long and arduous challenge with a compelling problem statement. Healthcare is a paper heavy business. It's built on legacy platforms and legacy understandings. Our focus was to improve the customer experience, improve our technician experience, our clinician experience, reduce cost and time for our setups, and reduce our overall paper cost. We had to look at how we design paper, how it would translate to digital as ensuring we allowed for enrollments, compliance, monitoring and adherence. And of course that we met all of our FDA and DOT regulations. Oh, sorry. So once we had a firm understanding of a challenge before us, we asked set out to define clear and achievable success metrics and scope. One of the benefits to digitizing our paper delivery forms was timeliness to recognizing revenue. On paper, our technicians would carry their route paperwork throughout the day, often bringing it back to the office that night. And the recognition in our system from paper to billing was manual and time consuming. A key advantage of digitizing the delivery and setup paperwork was the ability for the iPad to transmit those details and signature capture to our source system in real time. Not only capturing path to payment faster, but also increasing our inventory accuracy by recognizing what we delivered. We are able to prevent now technicians and clinicians from causing inadvertent product ads or errors. And we also have what we call a touchless system, which is our auto delivery confirmation. We set a lofty goal to be touchless at least 60% of the time when we rolled this out. We also recognized that on paper we couldn't force adherence to a process. With the iPad, we could now apply rules and logic to be intuitive and lead the technicians to check the appropriate boxes and obtain signature where it could be easily overlooked on paper. So after defining and aligning on success metrics, we set out to capture our key features that would help accomplish our goal and provide the return on our investment. This included priority of our consolidation of paper forms. As you could probably imagine with over 25 years of paper process, this required an iterative approach to consolidating and re-imagining our paper forms. Are they still needed? What value do they bring and how we can provide a more streamlined process for all parties involved? Outlining key features must be collaborative with business and development teams to ensure not only business features are outlined, but also technical and maintenance must haves. Wajmah, do you wanna help us better understand the IT focus?

- Absolutely. Thank you Lindsay. So how did we land on Pega Mobility as our technology of choice? Well, we all know when it comes to technology selection, there are many considerations. For us, the main drivers were, I would say to begin with was to find an off the shelf product that met our core business and technical requirements, that allowed us to enable business agility via low code. That was also easy to integrate with our existing applications. Since we had key business, I would say capabilities hosted on Pega, such as our order intake, patient eligibility qualification, system of billing management, as well as our authorization process, the pieces of the puzzle were starting to fit. The other thing we were looking at is, we didn't want to introduce a brand new technology in our ecosystem because we all know that that's very costly and there are of course use cases for that. But for us that was not the case. We wanted to, I would stay with an existing technology suite that we could simply take our existing app dev resources and do cross training for this new product. And that's exactly what we did, with Pega. We also wanted to work with a reputable, I would say, vendor and technology provider such as Pega since we've had such great success with our other solutions. Client references and positive references was also another key factor for us. Additionally and I would say very important as well is the product cost and the fact that we were able to still meet our business case ROI with the product was an ultimate factor as well. So for us, Pega checked all these boxes and we decided to move forward. But I would say ultimately it came down to Pega Mobile's rich and comprehensive and intuitive, I call it a toolbox that allowed us to build a mobile solution that was modern via low code that had key out of the box features such as, I would say offline capabilities, signature capture, push notifications, case attachments, and the list goes on and on. But those were some key areas that we were focusing on and ensuring that we can deliver to our business values.

- We don't make it easy in healthcare, do we Wajmah?

- Not at all, not at all. So after we settled on Pega Mobility as our product of choice, we now had to plan out our execution. We definitely knew we had a very daunting task ahead of us with all of the complexities and the features needed by the business as Lindsey outlined. And the fact that this would be Apria first mobile solution as well as we would be automating a critical business capability such as delivering products and services to our patients. And this automation would directly touch and impact the patient experience for us. And the fact that we had remote users across the country and this process was fully manual and paper-based. And to top it off, this was a direct ask of our CEO at the time. We gotta go paperless for this business capability. So with all of the known challenges and the end state in mind, those are the two key areas for us. We said, okay, well what do we need to do to get this right? We have no room for error and the fact that we're new to mobile as well. So we decided to partner with Pega Professional Services to help us plan and build the solution. It was a great partnership in that, our existing Pega AP dev team were able to focus on the area of the solution that they're very good at and that they knew and Pega Professional Services brought in the mobility product knowledge to help us build the solution we were looking for. What we wanted to do before we got into any application development was use design thinking approach that we had very successful outcomes with in our previous application and solution development builds. For those of you that are new to design thinking, it's a very collaborative process that allows key stakeholders within the business, the stakeholder within the business, IT app dev team, as well as end user representation to collaborate to deeply understand the problem statement, to understand end user needs, challenges, pain points, and together ideate on solution options. That all would ultimately turn into a prototype, a blueprint to get into application build and solutioning. Not only that, the power of the outcomes of the design thinking really helped align our key business stakeholders, our end user representatives, our IT teams on what is that we're building, gain that ownership and that alignment and really ultimately fast tracked our application development build out. With the outcomes of the design thinking approach and sessions. We had actually clear requirements defined, I would say user story maps defined out of that. We had wire framed and prototyped the solution. I would say within three to four days we had those outcomes and it kick started our technical solution design and build out. So as we had these great outcomes from the design thinking it was time to put the teams together and think about the best way to get this done. The solution required multiple integration points with our existing applications to make it work. And what we did was we took Pega Professional Services app dev team that they brought to the table. We sprinkled a couple of application developers from Apria so that we can make sure that along the way that as the solution was being built. We were learning and gaining knowledge so that we could take over and support the solution after the build out was completed. The Apria app dev team, really focused on all the changes and enhancements with our existing Pega solutions and the integrations there. Additionally, we engaged a UI/UX resource to ensure that we kept the user experience in the forefront, going from paper to an iPad, very difficult for adjustment. We all know what that adjustment would be, those of you that have mobile solution experience. The other difficulty and challenge was, all the legacy behind the paper based product, or I would say paper, that was used to deliver the products and services. It had a ton of legacy behind it and all the rules and logic lived in our legacy system, or I say our core system AS400 system. And we had to take that and translate all of that into the Pega mobile application. And that took a lot of time and effort, but we got it right

- And we did it through a global pandemic, didn't we?

- And we did it through a global pandemic, absolutely. I'm gonna turn it over to Lindsay to help us understand the implementation and roll out of the solution.

- All right. Well, with a significant change in business process with a large investment in technology, it must be followed by a new way to think about how we execute our processes. Change management is key to a successful implementation. For Apria, this included rethinking how we train our clinician and our frontline technicians. We also wanted to do a phased approach across the United States. As I mentioned, we have 280 locations. We couldn't just let them walk in on a Monday morning and try out this app. So we did a phased approach across the US to get initial insights from technicians to make sure we covered all areas and any process impacts from current state. This is not a one and done approach. We did roll this out in 2021, during a pandemic, we did very well. And while we achieved delivering our minimal lovable product features, enhancements and digitizing additional forms continues today. Wajmah and I call it our rigor, our key to success. And this includes constant collaboration and transparency between our business and IT partners. Healthcare is ever changing, guidelines, contractual requirements. My team focuses on priority of the updates and digitizing the hundreds of forms and processes. We've developed the governance committees and engage our key stakeholders throughout the process. We have an initial show and tell and feedback to ensure the business value is captured and reduce any rework from our IT partners. No transformational change comes without its challenges and we also wanna recognize our successful outcomes. So I'm gonna hand it back to Wajmah to close it out on outlining our lessons learned.

- Great. I think one other thing to point out as well, thank you Lindsay, is that we deliver the solution using an Agile methodology. We're now, at least for the portfolio of technologies that I'm accountable for, we're fully Agile and we're very proud of that. I think another key to success for us, since it was a very complex business problem to solve and the newness to the mobile product, is using Agile to, I'm gonna say, to break out the work in small chunks, to build, demonstrate, get feedback, iterate, and then roll out iteratively, I would say as well as Lindsay described. I think that is extremely important to find out sooner rather than later, if you're not going on the right track. So not only to design thinking, help us align, gain ownership, kickstart our dev process on all those artifacts. We also said, okay, we heard what you said, we heard what you aligned to and I'm gonna show you along the way as in building it. I think that was very important too.

- And from the business side, it was fascinating for me at least, that our frontline drivers actually were our key adopters. It was my licensed nurses and respiratory therapist had the most issues I think adopting the iPad and moving away from paper.

- Absolutely, that was astonishing but they did it and we'll share on what the great outcomes were soon. All right, so obviously a very complex problem statement. Obviously a lot of newness that we described along the way here. We did of course have some lessons learned, we had some challenges along the way, but we overcame them. I think the key challenges I would say for us was we were early adopters of the Pega mobile product, but we had done client reference checks, we understood the product, we understood the roadmap, and we had success with Pega. We trusted Pega that we're gonna get to the solution we needed. And we were gonna have the support we needed along the way. And that's exactly what happened. I think some of the challenges from a product perspective, as the product was growing, we were evolving along with it. So we were adjusting as well. The other aspect would be we just didn't have enough data. We had the data, we just didn't have the informational available to us to really understand the case lifecycle every step of the way with a remote user and they have access to reset the application, uninstall the application, and potentially lose data. Some of those things we had information, we had reporting, but we didn't have the depth that we needed to really know and have a good pulse on what our users are doing with the technology and the solution. That was what I would say was the biggest challenge. The other item was my app dev team still was new to Pega Mobility. And we were learning along the way even after we took ownership of the solution. But I have to say that we were able to and had direct access to the Pega Mobile product engineers of the architects to come and help us understand, answer our questions so that we're successful and that we're able to continue to take advantage of the solution we built and evolve it. But the other challenge, as Lindsay mentioned as well, is communication with the field staff. It was not like a desktop user that we could get ahold of easily, send an email them on team share screen. That was the other challenge. But we got through that as well. I would say through reporting, through data, partner with our MDM team to understand how many users are actually using the latest client that we pushed out. Where are they at with it and through those experiences and I would say just partnerships where we're able to overcome some of the challenges we had. Today, successful outcomes is phenomenal. We have over 1400 technicians and drivers across 250 branches across the country using the mobile solution today to deliver our products, capture signature, make sure they're delivering the right product, make sure the inventory is correct. Patient I would say experience has been great as well. And we're making six to 8,000 deliveries a day using this solution, which is phenomenal and growing because we're not done, as Lindsay said earlier. We realized our success metrics that Lindsay outlined earlier in the presentation. We also have a very strong business case and cases still being developed, but we have another strong business case that we're going to be, that's been approved that we're going to enhance this mobile solution to take payment. I would say take payment, put the credit card on file, take a payment method at the point of delivery with this mobile app. And we're gonna be starting that October this year. So we're very excited. I would say additionally, Lindsay and I are working on digitizing more forms that our clinicians use and our drivers use that we need for various products that we have. And we've gone through, I would say a good chunk of them and the first half of the year we're gonna be doing more and continue to take advantage and provide the value that we need. I think the other item I wanted to point out too, we were able to successfully take ownership of the solution by my team and every, I would say, two weeks with our Agile process, we're able to deliver value features to our business.

- Absolutely.

- Okay. I'm gonna turn it over, Lindsay, to close this out.

- Well that's all we have for today, is there any questions, I know everybody's getting lunch, but do you guys have any questions for us today?

- [Audience 1] What kind of challenges did you find going with supporting offline, either support for connectivity issues or having to do special development of the actual forms? You know, technical challenges.

- I would say with offline, the challenge we had, and that's more of a business decision on our end, but it was the fact that we didn't have a strong enough wifi in some of our branches where drivers were coming back and they weren't able to sync up all of the work that they did throughout the day. That was one of the challenges we had. We did have, I would say, some sinking issues in general in the beginning, but that was because the product had, a few bugs that we worked through, but we found it early enough and that we addressed it quickly. And then I'll let Lindsay take the second part of the question.

- Just sort of basic too. I would say just basic things like we bought really strong otter boxes. These are technicians carrying beds and wheelchairs and auction equipment all day. So we gave them like a Fort Knox protector that impact their connectivity. So sinking issues, not only, we worked through some product issues, but as well as just basic stuff, take off that, see if you can sink. And some of our locations are built like Fort Knox, they're bomb shelters. There's no wifi or connectivity, so walk outside and you'll see it sync up. So just some of that basic thing that we had to work through and I feel like we're in a really good place and really successful now.

- [Audience 1] The comment on the Otter boxes, so is that something you found as you had people in different locations actually...

- We did trial and error, like why is this guy in Georgia does Georgia just doesn't have any wifi, we couldn't figure it out. And then he took off his outer box and it connected just fine. So things you learn.

- [Audience 1] Thank you.

- Thank you.

- Yeah, that's a very good question. I think our Agile journey started when we were building out our patient qualification solution. I had some experience myself with Agile and implementing Agile, so I was able to come in and kind of champion that with a lot of help from obviously the team, our partners, our vendors, but just kind of get it kick started. And that's evolved and matured quite a bit now where every solution that we build on Pega and also some of the other modern technologies that I'm also accountable for, we're using Agile. But in turn we also use it as part of our weekly enhancements or biweekly enhancements that we do and maintenance and support. So it's evolved and matured to the fact that we can deliver business value every two weeks with the great methodology that we have in place.

- And I would just say that we were a waterfall shop for many years, and in healthcare it doesn't work. We have immediate problems that require immediate, intermediate, and then a long-term solution. So the power of Pega really enabled us with Watchman's experience to be able to deliver Agile benefit, to be able to have incremental benefits, hundreds of forms. Okay, the VA needs a form, Kaiser needs a form, United healthcare needs a form. How do we streamline that to give the most business value and not make them wait six months? So it's really just changed the way we look at our business.

- And that with low code capability, it's golden. It just goes hand in hand. Modern technology, modern ways of doing app dev and delivery, you've got a great success there.

- [Audience 2] And you're on a two week cycle with your Scrum deliveries?

- We are, we're in a two week cycle. Every two weeks we are rolling out features and proud of that.

- I work every other Sunday Bill.

- [Bill] Folks, any other questions? Yeah.

- [Audience 3] Does the data that's collected on those electronic forms remain in Pega or is that integrated to some other system?

- No. It ends up in our backend system as well as in our systems that it's integrated with, such as our order qualification, order processing in general, which most we have on the desktop applications.

- [Audience 4] The question I have, I know that in so many of the sessions it seems, everything that sounds like gen AI, that's the buzzword. I'm not gonna ask you about that but, having built what you've built right now, looking to the future, do you foresee, the way that your solution is right now, do you see it as acceptable and let's run with this and let's fix stuff that's broken? Or are you now looking at it as, oh, there are other things that Pega offers that we can now incorporate into our solution that would have benefit for the end users?

- That's a really great question. Steph and I were talking about this earlier in our last session. I'm gonna say we built out our Pega solutions very quickly, rapidly to meet the business need. You gotta move fast. We've got a compelling business statement and business case. And after we built out our mobile solution, I took a pause and I said, I wanna make sure we do an assessment of all our Pega solutions, that it's health, get a good bill of health check and make sure that we've done things the right way. We're able to scale up and we're able to take advantage and build more on top of it. So I had Pega Professional Services come in and some architects come in and do the assessment and we got a green bill of health from that. So we were good. And then now it's time to take advantage of what we already have that we're not taking advantage of. There's additional features, capabilities. So I think we're at that point. And then also continuing to add more from a business perspective on the things that we are using. So I think that too. I would say, we're more in a mature place with Pega in general. Now the next step is take advantage of things that we're not using. I would say that the sessions in the last couple of days here has really given me great ideas. Lindsay and I have been talking from the business lens and me from the technical lens and app dev lens on what we could do next. And we have some great ideas. We're looking at process AI, we're looking at WFI and I would say a lot more other that we're looking at. we're looking at smart claims. That's the the other thing that we're interested in. I think that's probably in the shorter term, but we're evolving and and we're loving it.

- [Bill] Other questions? All right, well, Wajmah and Lindsay, thank you so much. Big round of applause please, thanks.

- [Lindsay] Thanks everyone.

- Thank you.

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