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There's something interesting happening right now: while there’s a rising shortage of home health clinicians in the industry, at the same time, there are many clinicians that are working in hospitals, and other facility settings, who only work three to four days a week. Somehow, caregivers are still struggling to find enough work, even though their services are in high demand.
It was this problem that led Victor Gajendran to found Gento, a company that provides staffing and care delivery management to home health agencies and skilled nursing facilities. Essentially, the company acts as a marketplace, providing the clinicians with access to the jobs they need, and healthcare organizations with the ability to fill them.
"Our goal is to solve the staffing problems that home health agencies and skilled nursing facilities have. We’re starting with these two segments, but the solution can be used by anybody who needs a clinician’s time," Gajendran told me in an interview.
Formerly known as Nursing Without Walls, Gento announced a $5 million Series A funding round led by Jeff Anderson at Palisades Growth Capital. This brings the company's total funding raised to over $7 million.
Gento's value proposition
On one side of Gento's marketplace are the clinicians, which can include different types of nurses, such as Registered Nurses, Licensed Vocational Nurses and Certified Nursing Assistants, as well as physical therapists, speech therapists, occupational therapists. There are currently 5,000 clinicians registered on the platform, up from 3,000 only six months ago.
"The value proposition for the clinician is they have one platform that they apply to in order to get credentialed and oriented, so they're available to work as a home health staff or as a skilled nurse. They can take shift work, or infusion type of work, or regular home health type visits," Gajendran explained.
The company also helps the clinicians maintain their credentials online, including keeping them up to date by giving clinicians warnings when it's time for them to be renewed. Gento also optimizes much of the workflow so that clinicians gets to spend more of their time with the patients, rather than with documentation and other administrative work.
One of the most common case studies on the clinician side is that they often use the platform to get extra work so they can pay off their student loans; that case study is so prevalent, in fact, that the company actually promotes it as one of its benefits.
On the organization side, the typical customer for Gento is a small to medium-sized company, as there are few big players in the space, though it does work with some big companies, such as BrightStar Care. Gento now has 550 customers in all, and the main benefit to them is that they get to have a wider area of coverage through the platform than they would have had previously.
Being the invisible bridge
Despite being the connection between the clinicians and healthcare organizations, what Gento really wants to do is "put our technology to work so that we are not in the middle of clinicians and providers. We want to step aside and let the industry operate more efficiently," Gajendran told me.
"We are a bridge, but we want the bridge to be almost invisible in the future so that the clinicians are very connected. The organization can say, ‘I need a nurse to go see this patient Mondays and Tuesdays,’ they don’t need to pass that information to another intermediary company. They can just broadcast it out to the pool, and the matching clinicians will get a direct ping, and they can decide to do the visit or not."
This philosophy also extends to how Gento makes its money; rather than taking a percentage of what the organizations pay their clinicians when they take a job, the company instead takes a flat fee, which varies depending on what kind of nurse or therapist is doing the visit, and what type of visit it is.
This model not only allows the organizations it works with to set their own rates without needing to worry about their margins, it also doesn't mean that the company gets paid more if the clinician gets paid more, therefore not affecting their earnings.
"Our ideal model that we are experimenting with, and have a lot of solutions that we’re going to roll out in the next couple of weeks, is we want agencies and these facilities to publish at the rate they see as fair. They’re all used to paying the clinicians, so they know what is fair. So they can publish it directly, they can decide their rate. All we do is tack on a service fee, which is fixed and transparent, so they know they’re not trying to eat into their margins, which are already squeezed. We just make the pool available for them, the service fee is only to keep the technology up and running," said Gajendran.
"I’s much simpler than charging a percentage, so it’s not like if they offer more to the clinicians then we also want more. We don’t want to make it that way. Please, offer more to the clinician, because they’re taking care of the patient at the end of the day."
So far, Gento has facilitated over home healthcare 75,000 visits.
A star system for home health clinicians
The will use the funds, in part, to expand nationwide; it currently covers most of California, Las Vegas, Chicago, Houston and parts of New Jersey. It next plans to expand to Florida and New York.
"This investment has added to our ability to expand the technology and make it available to a larger population in different geographies. The markets that are appealing to us are where customers have the worst shortage problem. We see shortages in New York and Florida, especially on the shift side," said Gajendran.
"Another thing that happened in the skilled nursing facility side is that they increased a metric called PPD, which is the ratio of clinicians they must have to the number of beds. Because of that, they need to have more staff and, because of the clinician shortage problem, they also have this same kind of issue. So, we make more nurses available for shift work."
The new funding will also toward improving care-delivery through Gento's technology, which means, in part, doing more to help the clinician.
"Staffing is not as simple as, ‘Ok, I found a nurse for you, so you’re good to go.’ The care has to be delivered in the most efficient way, so we have added several technologies that allow the clinicians to clearly understand the patient needs," Gajendran explained.
"We don’t have a lot of direct interactions with the patients; the patients are under the care of our customers, which are the organizations, and the clinicians take care of the patient, so they need the information. However, what we can do is use technology to supercharge the clinician, so that they need to do certain things at a certain time for this patient."
The company has included features that give clinicians personalized care instructions for each patient, such as reminders about when they need lab tests, and the investment will be used to add more features at the point of care.
The other part of the technology advances will go toward creating a clinician rating system, which can be accessed by the patient. This is done by taking data, such as how frequently clinicians make the visits on time, how regular they are in submitting their notes and clinical charting, and how many times their notes are getting reopened for quality assurance reasons. and turning that into a formula that converts those metrics into a clinician rating, which will eventually be turned into a star system.
"In today’s world, when an Uber driver comes at your curbside, you understand the details and the background of the driver. But, when a home health nurse comes, they could inject some lethal medicines or chemicals into your loved one’s body, and you don't know their background, you don’t know their track record. This, to me, was really appalling, coming from a tech background. So, that’s why we started collecting all this data," said Gajendran.
"We measure the improvements in measuring patient outcomes, and any complaints, even the soft aspects. If a clinician did not show up to the visit or misinterpreted something, we capture all of that into the profile, and we change that into the reliable metric."
Despite the fact that there is minimal interaction between Gento and the patient, as the company doesn't even have a patient-facing app, Gajendran sees no reason why the patient should not have access to that information, which can be sent to them in a form as simple as an SMS message.
"I’m a proponent of the patient having access to that information. If it was my mom getting care from a nurse, I would want to know how good that nurse is. I want to have a say if the nurse has a 1 star rating from 300 visits. I don’t want that nurse. Patients don't have that visibility, when the nurse comes they just show their badge and they get onto doing the work. They might have killed five patients in the past, but my mom would not know as the home visit is happening. We have to fix this problem for sure."
The ultimate goal, he said, is to eventually get enough data so the company can analyze the quality of the clinicians in much greater detail, as well as to understand what is working and what is not working in home healthcare.
"We want to help improve the coverage and the operational efficiency in care coordination and all the manual inefficiencies in the system. We want to bring technology to replace all these inefficiencies and put the clinicians back into patient care again."
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