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Dr. Danilo Coité

Episode 31: The Quality of Care System for Improving Patient Care Services, with Dr. Danilo Coité

Danilo Coité, MD, comes to Independence Plus, Inc. (IPI) with over 15 years of experience in clinical medicine, risk management, and managed care insurance plans. He is a visionary leader skilled at turning insight into action with a unique blend of medical and business expertise. He offers strategic, decisive guidance while remaining committed to corporate goals and objectives. Dr. Coité is a resourceful problem-solver with the talent for identifying need and creating effective solutions and is dedicated to building a path of sustainable growth that will improve the quality of care, accessibility, and affordability.

Prior to joining Independence Plus, Dr. Coité served as the President of WhiteGlove Health based out of Austin, Texas. As the President of WhiteGlove Health, Dr. Coité was responsible for all day to day operations of the company. He provided the strategic vision, leadership and organizational guidance that drove the company’s growth and service expansion to five additional states in the Northeast. He built in-home critical care programs, chronic condition management, transitional care, and other clinical programs from the ground up, providing customers with value-based solutions that included a full-service team and mobile care model that delivered on-site health assessments, comprehensive medical reviews with action plans, compliant coding, and follow-up visit outreach.

Prior to WhiteGlove Health, Dr. Coite was the Chief Operations Officer with Alegis Care, where he supervised office functions for their Comprehensive Evaluation product line, Chronic Care product line, and their medical department. In addition, he was personally responsible for starting and maintaining payer relationships in existing and new markets as an integral member of the executive team. Dr. Coité also held a position as Director of Medical Compliance at RSA Medical, a national risk management clinic for major insurance companies. Under his tenure at RSA, they realized five years of tremendous growth.

Dr. Coité graduated from the University of Nevada-Reno and earned his Doctorate of Medicine from the Autonomous University of Guadalajara.

Dr. Coité maintains active involvement in several community service organizations. He is a physician volunteer for Will County Emergency Medical Response Team. He previously served as the president of the Bolingbrook Athletic Council and board member of the Bolingbrook Youth Baseball League. He has coached multiple youth baseball, basketball, and softball teams in his community.

What you’ll learn about in this episode:

  • Turning insight into action
  • What systems best deliver quality of care to patients
  • Why quality begins with individual hiring and continues with a specific training process
  • The different training process Dr. Dan’s employees go through based on their experience
  • The structure of the one-year critical care program the recently graduated new hires go through
  • Why multiple systems are needed for complex patient care
  • Why good systems for quality of care are dependent on a team approach
  • How to customize care for each individual patient and how to create systems to track the care of each individual patient
  • Why systems need to talk to and communicate with each other for patient population management
  • The huge revolution of data in healthcare that is on the way
  • The importance of making sure you’re using the right platform for your company
  • A simple way to figure out if a system is effective for you
  • How integrated systems can help healthcare providers understand a patient from a holistic approach

Ways to contact Dr. Coité:

Transcript:

Welcome to System Execution, the strategy and system behind today’s successful companies. Systems can make or break your company but here, we’ll solve your physical, technological and psychological systems issues by connecting you with experts that have succeeded in overcoming those challenges in their own business, and providing you the guidelines and tools you need to implement those same strategies for immediate results.

Now, here’s your host, Vera Fischer.

Vera Fischer: Today’s episode is sponsored by 97 Degrees West, the brand marketing agency located in Austin, Texas. 97 Degrees West serves regional and national companies in the healthcare, finance, energy and manufacturing industries.

97 Degrees West believes that an integrated approach to marketing that involves traditional and digital strategies that fit your customers’ buying journey, yields the greatest impact on your bottom line. Go to www.97dwest.com to learn more.

Welcome to System Execution, a podcast devoted to using processes and systems to drive to a better outcome for your business. I’m Vera Fischer, your host.

All businesses no matter the size, relies on systems. Some of these are physical systems, such as a factory, some are technological like project management software, while others are psychological systems, such as checklists and organizational charts. Many of these systems will overlap in your business.

I’m really excited to have today the CEO of Independence Plus, and listeners, I’m going to introduce him, I might mess up his name so fair warning, but our guest is Dr. Danilo Coité, and for the remainder of this episode I’ll be referring to him as Dr. Dan. I think that’s much easier.

Danilo Coité: Thank you.

Vera Fischer: Let me tell you a little bit about Dr. Dan. He’s the CEO of Independence Plus, which delivers the very best home care to ventilator-dependent patients. He’s a visionary leader, skilled at turning insight into action with a unique blend of medical and business expertise.

Before his tenure as the CEO of Independence Plus, he was the president of WhiteGlove Health based out of Austin, Texas, and before that he was the Chief Operations Officer with Alegis Care. There he supervised office functions for their comprehensive evaluation product line. Welcome to System Execution, Dr. Dan.

Danilo Coité: Thank you and thank you, Vera, for having me on your show. By the way, your pronunciation is perfect. Danilo Coité, perfect. You get a point for that.

Vera Fischer: Thank you. Oh, yay. It’s always challenging but you prompted me very well. I appreciate that.

Danilo Coité: I have heard a lot of versions of my name. You know, coyote, coit, coites. I mean you name it. Many, many different variations of my name.

Dr. Dan’s Background

Vera Fischer: Well, I don’t know. Coyote, that seems pretty cool, but we digress. Dr. Dan, I’m so happy to have you here on the show so that you can share your experiences with a specific system or process.

However, before we get started if you’d like to tell us just a little bit about yourself and we’ll get started after that.

Danilo Coité: Absolutely. I’ll be glad to. I’ve been on the admin side of medicine for the most part of the last 15 years because I wanted to bring some of my expertise as a physician to the business side of the medical world.

I’ve been here Independence Plus, as you have mentioned, for the last five months and all that experience related to dealing with product innovations in the home.

As a big step of my way through my journey of my profession, I’ve learned that there are so many patients nowadays that need specific care. They need a specific system to be able to solve their problems that brings a lot of things to be rewarding in what we do in terms of the patient care that we do.

The Quality of Care System for Patient Services

Vera Fischer: That’s really awesome. I’m very excited about that because it is really important and as we had discussed earlier, you don’t really understand the laboriousness of it and the emotional drain that it does take on patients that need that type of continuous care on the family.

I’m really looking forward to talking about the system or process that you’d like to teach us about today. Without further ado, what would you like to talk about today?

Danilo Coité: I think one of the things that you had us … Somebody talk about today was to talk about what’s something that we do really well as a company.

I think in our space, the healthcare space, delivering quality of care, that is more about how we deliver current care and what system do you use to deliver the quality of care in terms of … From the recruiting side of the clinicians … Training the clinicians to be able to deploy the clinicians to the home.

All that expect quality and quality being the word we use here. How can we deliver good quality system? Our quality of the product to be delivered everyday.

Vera Fischer: That’s a great, great system to talk about. This is awesome. Let’s talk about quality of care. I know that … Just to educate our listeners of it, when you are providing a healthcare service in the home of a particular patient, the person that is actually showing up at the front door is got to be recruited.

Let’s start there because that’s where quality begins, I would imagine.

Danilo Coité: Absolutely. The quality start with not only the caliber of the individual we are hiring but more importantly, once we get that individual, what kind of training process we put them in place for them to be able to deliver the quality of care.

From our business, we bring patient mainly from two different places. One, the newly grad that finished school and want to get additional training.

Through that system, we have a residency program, which these nurses spend one entire year going through our critical care program where they learn, they understand how to live in these homes. How to deal with complex care patients in the home and all the things that they have to understand and learn to be able to care for this patient.

The second set of patient that we get or nurses that we get from, we get them … A lot of the nurses there are already seasoned. They have worked for 20 plus years and a lot of time they want to step back and do more of a one-on-one patient care because when you work in an institution, whether it is a hospital or a skilled care facility, you always have the patient’s care in mind and each one of our healthcare workers has that kind of experience. It can be six or seven or maybe even more in some facilities.

Some skilled nursing facilities I’ve heard the nursing home happen to care for 20 to 30 patients. Those are the two avenues where we get a lot of our great nurses. One is from new grad and the other is from seasoned nurses that we train them to do what we do.

Vera Fischer: Dr. Dan, you mentioned that when you have those nurses on board with Independence Plus that they go through a one-year training program. That seems like an awfully long time.

Help me understand that.

Danilo Coité: Yes. What we’re trying to bring is that concept that you’ve seen on other … Especially for physicians where you do your schooling and then you want to get the sub-specialty.

It’s not the sort of training that you would get just to perform a task but rather, understand the complexity of those patients at home. The training is about a one month classroom training that we do here on our headquarters in Oak Brook.

From that point on, they are residents, spending the next 12 months, 11 to 12 months literally caring for different patients to understand different … That not every patient have the same treatment.

We have patients with ALS. We have spinal cord injury patients. We also have a patient population, as I had mentioned to you before, can be adult, can be pediatrics.

Why Independence Plus Takes a Team Approach to Patient Care

Vera Fischer: Once they’ve gone through this training program, and they’ve been caring for patients … That have run the gamut if you will. What’s the next step in this quality of care?

Danilo Coité: Once they do that, it comes now the quality of care system thing is the team. What team approach we have to care for these patients in the home. You start with the nurse that’s on the bedside, dealing with the patient on a day-to-day basis but you also have the clinical managers.

Those are supervising nurses that are doing a lot of critical, great work here in our office, interacting with other healthcare providers and to interact with the hospital discharge personnel.

Our case managers from health plan interacting with PCP. We also have respiratory therapists that we employ and these professionals go to the home also to look, make sure that the patients are well cared when it comes to the ventilator system.

Make sure that everything is going as they’re supposed to. With that system, you have to bring other personnel that have to be part of this bigger system, the big ecosystem to make sure that all the patients are cared appropriately.

Of course, all those different systems to deliver quality of care, it would be very highly dependent on each individual patient. That care is going to be customized. It’s going to be individualized depending on the patient co-morbidities, the age of the patient.

There’s a whole lot of things they go into once we bring it. That’s the reason why the training is so extended because we know there’s so many different avenues that one can take.

I also keep in mind that when you work on a healthcare facility like a hospital, skilled nursing facility, nursing home, there’s always a health available by just walking to someone that’s available. In our ecosystem, we do give all our employees a lot of support but they are not right next to them.

They have to be telephonically. They have to be available through other systems. That way, we have to make sure that these nurses are well prepared to be left alone with patients.

Keeping Track of Patient Care Using Systems

Vera Fischer: Dr. Dan, do you use a specific software or telehealth device or something that keeps that specific patient’s care trackable from the different … The nurse and the supervising nurse et cetera.

It seems like there’s a lot of folks that are just involved with one patient’s care. How do we keep track of all that while we’re delivering that quality of care?

Danilo Coité: It’s like everything else in healthcare, it’s very complex, right?

Vera Fischer: Yes.

Danilo Coité: Very, very complex. I wish there was one software that could do everything. It is so many different pieces to this big puzzle. We have all these different systems that we’ve been thinking on the healthcare right now is systems don’t talk to one another in silo.

To answer your question more specifically, we have equipment in the home that do their measurements. Ventilators that do measures and then we have electronic medical records that have all that information that store all that information, and communicate with the back office support to be able to work with one another.

Then we have scheduling systems to make sure that we know who’s going to be in a main image place on a different day. Who’s calling in. We have phone systems to be able to track who’s calling in and when we were talking to them.

These are just some of the multiple systems that we have in place and not to mention that we also have to talk about patient population management.

We’ve got to talk about doing measures on hospitalization rates, on infection rates, and all those things to be able to … We are managing. It’s a lot of data but that data and the other things that also bring everything together to be able to test that our systems are working together with one another.

In any healthcare company, you see major, massive hospitals that just EMRs, they have two or three different EMRs in one organization. With every organization I’ve been to, the house I’ve been to, tell me all the systems that we have and let’s work on how we can incorporate the system and make them talk to one another, make them kind of, in a multi-level communicate to be able to give us better solutions for our patient care.

How Data Will Affect Healthcare in the Future

Vera Fischer: Dr. Dan, did you take this particular system on when you became the CEO of Independence Plus or did you go in and make some improvements on what was already there?

Danilo Coité: A little bit of both. In every organization that I’ve been to, some systems are very primitive. Through spreadsheets, where you log-in, put in information. When I came to Independence Plus, there were some systems that were starting phase of being implemented.

I have been here for, a little bit over four months and since my arrival, I have deployed systems that were on the beginning phase of being used, being used to it’s entirety and our goal is by the end of the summer, to be fully operational, where all this system communicate with one another.

Vera Fischer: Oh, that’s exciting. That is a huge, huge goal and once you get there, it will be a big accomplishment.

Danilo Coité: Absolutely. Yeah, we will be able to achieve great … We will be able to work smarter, create efficiencies. That’s in a lot of healthcare companies, the biggest cost of care. A lot of cost of care is related to efficiencies.

A lot of people who may be doing the same thing because they are not talking to one another. A lot of our government agencies have paid attention to that. That’s the reason why you have seen so many initiatives in terms about building systems.

We’re not where we need to be yet. Earmarked companies, there are hundreds of them and they’re so different from one another. Data analytics, everybody have data analytic tools with different ways of measuring the same thing.

It’s going to be interesting and I think in healthcare, for the next 10, 20 years, you’re going to see a huge revolution on data. The same way we have revolution from data where you see now on sales.

When you go to Amazon. They know what you’re looking for. They know how much you’re spending on each thing.

We want to do the same thing with medicine but on a different way of knowing co-morbidities, symptoms and predicting where that patient is going to and trying to stop them from deteriorating. That’s the goal.

Sometime come in the future. Actually, a lot of that is already here but not in an organized manner. A lot of people are doing different things but I don’t believe everyone is all working with the same thing. It’s trial and error.

Vera Fischer: If you had to choose or rather advise our listeners on any type of system when it comes to quality of care from a failure point, where would you recommend someone pay specific attention to a step in this process that in the past done not right could resolve in unthinkable things?

Danilo Coité: Well, I think that the first … Having worked on different side of medicine from the insurer. When I was at Alegis, which is a Cigna company, I worked in physician care and now I work a lot with the nurse and the respiratory therapist.

What I can tell you is, the most important thing to make sure we prevent failure and fails, is finding the system that better works for your organization. First, you always have that question, build or buy.

Of course, building is very costly. There’s a lot of overhead. If you don’t have the right platform, and you don’t have the right people, they can become a money pit, where you spend years and years and a lot of your resource trying to build something they were never going to get any deliverable for.

There were a few there who buy because there are a lot of other companies out there that are building things to commercialize, to send to other … To be able to commercialize to multiple people so they can leverage the cost of those systems.

Not every system fits into what you’re looking for 100%. Some system are for hospitals but what if the hospital organization have hospital but they also have skilled nursing facilities. That one system may not work well with different platforms.

What you got to do is, is find the system to build to your needs and if it builds your needs not everything is going to always check a box. What can you do to customize to fit your needs.

How easily whatever system you’re using can integrate with other system because most organization, if not all of them, are using five, six, seven different systems and make sure they all talk to one another.

I always look for companies … I’m looking for systems that have been around, that have been tested but also, we’re bringing up solutions for the future. Not systems that are kind of in the Dark Ages and they haven’t always spent a lot of money on innovation. It’s a lot of things and I advise anybody that’s ever asked me that question to do your homework.

Vera Fischer: Interesting. From that perspective, staying in that same vein, how do you flip that and say, “Okay, this system is effective and we prove the efficacy of that system by this outcome.”

How would I figure that out?

Danilo Coité: Well, first of all, within your organization, you do that exercise of what are your needs. What are you trying to accomplish? The stakeholders will be able to write down everything that a system have to be able to produce.

As we go out and do due diligence, and a lot of companies will be a consultant agency to have that discussion, a one-on-one discussion, where they’re going towards to find out from different departments.

From a business standpoint, write the things they need and get it done. From the clinical standpoint, what do you need? From the schedule standpoint … Then checking those boxes and reviewing them, you can come up and be able to find what best fit to your needs. That’s the only way to do it.

Vera Fischer: How interesting. I have not heard it explained so easily. You made that very easy to understand. I absolutely appreciate that.

Anything else you would like to add with this quality of care system?

Danilo Coité: Absolutely. What I’d like to add is, when I was talking about quality, one of the things that I constantly get asked, when I have talks related to patient care and where do you cross the line between savings versus quality, my way I would explain that is, good quality work will yield savings.

With good quality, saving money will follow. I think on the backend, 20, 30 years ago in the ’80s and ’90s with HMOs and availability of increased reimbursements to primary care physicians.

What happened was it was counterintuitive to what we wanted to do because a lot of times physicians will not spend enough time dealing with that patient to really understand the patient care.

From all the organizations that I’ve been to, it has always been the mission, the vision and the values of the company of do good work because medicine, how do you measure medicine? How do you measure success?

The only way you measure success in medicine is about results. Results are saving lives. That’s the part that we do want to leave to your listeners that cutting corners is not always the way to achieve meaningful results.

Vera Fischer: That is such a huge message too. What’s the penny wise and pound foolish. It never … Saving a few dollars today isn’t going to help you necessarily in the long run. I appreciate that and have lived it myself.

Danilo Coité: Absolutely.

Vera Fischer: With the quality of care system that you have provided the insight to, it would be really interesting to know what your next challenge is. You somewhat touched on that about integrating all of those electronic systems by the end of the summer.

Danilo Coité: Yes, because the way, backwards of that quality of care and about meaningful and about results is to understand our patient from a holistic approach from end to end. I think the biggest failure of medicine in the last few centuries have been that we look in individual as pieces.

Many times you go to a specialist and specialist are doing things and then you go back to your PCP because you have no idea what’s going on because there’s no integration. There’s no communication.

What we are trying to accomplish here is, is work with all those different entities. For care coordination, be able to say … To speak with the PCP, to say here’s what’s going on, to do the things we’re doing and then bring the respiratory therapist and say, “Okay, what’s going on?” The respiratory therapist is working in the end with the clinical managers and also with our staff nurses.

We have the ability to … If the patient gets discharged at the hospital … What is the biggest problem right now with re-hospitalization rate is that patient that leaves the hospital, with the infamous brown bag full of medicine, all the information and the language they don’t understand and some of those patients they’re not at age to understand or maybe their culture background means they don’t understand that information.

They take all the pills they got in the hospital beside all the pills they had at home and they’re taking all those pills together and within a week they’re back in the hospital again. On our approach, in the communication system is, we go and meet the patient in the hospital. We bring them from the hospital to the home.

We care for them at home and there are times, we avoid … We have a huge initiative to avoid hospitalization, unnecessary hospitalization, and to decrease the modern infections we have in our patient population.

There are patients, and it comes up quite often. There are patients that we are the first to find out there’s something really wrong with the patient. We take them to the hospital. We instruct … While they are in the emergency room, our nurse is telling the attending physician, “Look, this is what’s going on.”

They are so thankful that they don’t have spend unnecessary resources to try to figure out what’s going on. A lot of times, we pick things up fairly quickly avoiding longer hospitalization and unnecessary tests and all that.

I have tons of example of patients that we have literally made a significant difference because being there, understanding the patient care and being able to communicate that information from all the healthcare providers that is part of this patient ecosystem.

Vera Fischer: That’s really insightful. I really appreciate that guidance. That’s important and I know it’s a time when healthcare is so evolving and it really is a combination of companies like yours and experts like yours that really do understand both the medicine side of it but also the business side of it.

Danilo Coité: Yeah, who use the brain for it.

Vera Fischer: Absolutely. Dr. Dan you’ve shown us that processes are needed to get the work done and you’ve provided us with some great nuances that our listeners need to hear regarding the execution of a great quality of care system.

Before we go, let’s close out today’s discussion with any final advice you’d want to share and then please tell us the best way that our listeners can connect with you?

Danilo Coité: Absolutely. The best advice that I’m giving to our listeners whether you are in our field or whether you are not in the field but you have a family member, even yourself is really understand the type of care you have and understand the type of care you have and understand everyone that is involved with the patient care. It really would make a very important decision in terms of what kind of quality of life you’re going to have on your later years.

Have the ability to help your loved one. If you’re in healthcare, it’s the whole thing related to being able to connect the dots, be able to work fast and find out from other healthcare providers how you can better care for your patient.

We need really as a society, we need to graduate from that archaic system of each entity will deal with their own problems. I think we do have to work more as an ecosystem where everyone has a place within people’s care.

Of course, the person having that care has to be the center of that ecosystem. I’m a big believer that everyone has to come in whether you’re the patient, the family, the healthcare workers. We all have to pitch in. We all have to be able to participate to obtain quality of care and results.

The best way to reach out to me, there’s a couple of ways to reach out to me. You can email me at dcoite@independenceplus.com or you can call me at 630-463-4444 and our web site is www.independenceplus.com and we handle all questions. If you have any questions, feel free to reach out to us.

Vera Fischer: For System Execution fans, no matter how many notes you took or how often you re-listen to the this episode, the key is, every successful business uses systems to drive to a better outcome.

Dr. Dan, I want to thank you so much for sharing your expertise and insight to our listeners today.

Danilo Coité: Well, thank you and enjoy the rest of your day and looking forward to speaking with you in future days but feel free to reach out to us.

We hope you found this episode of System Execution enlightening. For free examples, case studies, eBooks and more, be sure to visit systemexecution.com/resources. Contribute to the conversation by reaching out to Vera directly on email at vera@systemexecution.com. Until our next episode, thank you for the privilege of your time.

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