Kris Mastrangelo, OTR/L, LNHA, MBA, chief executive officer and president of Harmony Healthcare International (HHI), shares her journey of over 20 years in the long term health care industry.
Provider: You have been quoted in the past saying, “I left what I thought was my dream job to start Harmony, and now this is the dream job." Why did you start Harmony?
Mastrangelo: Initially, I began Harmony in 2001 to lessen my travel for work as I was on the road every week, and I had two young daughters—Savannah 2 ½ and Carissa nine months old. However, within two years of starting the company, the client base grew beyond the New England area, and it became apparent that travel would always be a part of my job.
As the company grew, so did the family, adding two more daughters, Alexandra the Great in 2003 and Mia in 2007. In addition to the travel, I noted that the work I was completing for nursing homes across the country was necessary and relevant as a third-party, unrelated vendor [versus being a department within the organization] to provide the client with unbiased, objective analysis and systems implementation.
Systems require oversight and refinement, and often companies are too close to the situation to see the necessary change or opportunity. Consulting to different organizations was vastly different from being a VP [vice president] in one organization. Consulting brought a deeper understanding and awareness of different ways to solve the same problem or opportunity.
Provider: What did you see that was missing from the industry that Harmony could provide?
Mastrangelo: HHI connects the dots between care and:
- Compliance
- Auditing
- Analysis
- Reimbursement
- Regulatory
- Rehabilitation
- Education
- Efficiency
- Survey
Back in 1998, the Medicare Part A reimbursement system transformed from a retrospective cost-based system to a prospective payment system (PPS). This was the first step in which the health care services rendered to the patient/resident directly impacted the rate of reimbursement.
Before 1998, clinicians virtually had zero fiscal responsibility. As an occupational therapist (OT), licensed nursing home administrator (LNHA), MBA, and, most importantly, the daughter of a mathematician/systems electrical engineer, I could translate the care [service delivery] into the numbers [reimbursement], a powerful combination back then.
Provider: What do you wish you knew as a young entrepreneur that you know today?
Mastrangelo: There is nothing that I wish I knew back then that I know today because every mistake is an educational experience on how not to do it next time. I am all about the journey. While I always have a sense of urgency to get the job done right, I know today that errors can make us better.
However, two concepts that do resonate:
- If it isn't broke, do not fix it. Andy Turner, Sun Health Group, used to say that to us all the time. Yes, it is crucial to refine and improve, but don't blow up a system for a minor change.
- Prioritization is a skill set. Knowing what requires your attention first is how you need to manage every day. Because, as an entrepreneur, there is always something on the to-do list.
Provider: How has your daughter becoming an entrepreneur in the health care industry changed your relationship?
Mastrangelo: Savannah and I have always had a very close relationship and having her begin her career in the health care industry has only strengthened our bond. When Savannah was away for college, we talked every day. And this has not changed. Our conversations are endless, and we jump from subject matter to subject matter with excitement and curiosity. She retains complex, voluminous amounts of information while being able to distill and synthesize the subject matter…. with apparent ease. This affords everyone the benefit of her creations and ideas.
Provider: Tuning in to your motherly intuition, is this the path you knew she would take, or did you imagine her in another field?
Mastrangelo: I always knew that Savannah would be an entrepreneur. I didn't expect her to do it so quickly and so gracefully. She was on the path to be an OT during her freshman year of college. Two things happened.
- She decided, “for fun," to take a computer class the summer of her Tufts University freshman year into her sophomore year, and she loved it.
- The OT profession was discussing the need for doctorate degrees for the trade. Savannah attended a rigorous, academically intense high school and wanted to get into the workforce before graduating college.
Savannah James
Developing a calculator to determine the reimbursement rates for patients in a long term health care facility may not be what a young mind dreams of creating when imagining the future. For Savannah James, daughter of Kris Mastrangelo, reimbursement, patient advocacy, and the complexities of ever-changing regulations have always been standard dinner table talk. The mother-daughter team is rare in the health care industry, let alone the technology field, with two generations mirroring one another's journey through entrepreneurship.
Provider: Please describe Hopforce.
James: Hopforce's mission is to optimize processes (via technology) in the health care industry. Our primary focus is the PDPM [patient-driven payment model] calculator, i.e., pdpm-calc.com, specifically designed for the long term health care industry and specific Medicaid Case-Mix States. In just a couple of clicks, the user can obtain the Medicare Part A or Medicaid Case-Mix reimbursement level by day and for the entire patient stay.
Simplicity in the calculator functionality is paramount; it was important that we make pdpm-calc.com (The PDPM Calculator), user-friendly for those who are less enthusiastic about technology. More importantly, Hopforce provides accurate data, reliable results, that are readily and efficiently displayed despite the dense and often confusing, multifaceted regulations. There are approximately 60,000 potential combination of HIPPS [Health Insurance Prospective Payment System] Codes for every Medicare Part A patient. The opportunity for miscoding or missing an element of care can result in colossal mistakes that impact the facility and patient care.
Provider: What was the inspiration behind Hopforce?
James: I have a background in computer science, software development, and psychology. During my education, I became passionate about optimization and reducing human error. I grew up with a family engrossed in health care, so discussions about what worked and what didn't work in the industry were daily dialogue. The notion of removing the inefficiencies that exist in current processes that are ripe for human error and improving patient care truly spoke to me.
Provider: What has the feedback been like since you launched Hopforce?
James: The reaction has been outstanding! Users provide ongoing feedback and say it has “improved the lives of MDS coordinators, decreasing their stress and enhancing their jobs' efficiency."
Provider: Many startups are concerned about setbacks due to COVID19, quarantining, social distancing, and the restrictive nature of hospitals and long term health care facilities. How has this time helped or hurt Hopforce?
James: There has been a massive surge in usage due to COVID because no one knew how to code for this, let alone code correctly, to receive proper reimbursement and use a new payment model. It was rewarding to offer a level of ease and assistance in helping the long term care facilities generate the information they needed to activate the funds for the most vulnerable population. Using a haphazardly written spreadsheet that does not give accurate data paired with COVID is disastrous for the facility and the patient.
Provider: What are your aspirations for Hopforce as it grows? If you could describe the dream, barring any setbacks, what do you envision?
James: My biggest dream for Hopforce is expanding into other realms of health care that need optimization and improvement. I would like to be able to facilitate them while pioneering how to protect the data. Further down the line, I want to develop software to assist health care disparities toward women and people of color.
Provider: What is it like directly working with your mother? How has it changed your relationship?
James: I have always looked up to my mom. To be in the arena, side by side, it is exciting to run with her and watch her operate. She is a genius and inspiring to watch her problem-solve. I am excited to offer what I do well and be able to play in the same stratosphere, especially in tech, which is so male dominated. I do not think that you see too many mother-daughter duos in the health care and tech field. It's exciting to be pioneering this today in the climate of our country.
Kris Mastrangelo, OTR/L, LNHA, MBA, is chief executive officer and president of Harmony Healthcare International. She can be reached at Kmastrangelo@harmony-healthcare.com. Her daughter, Savannah James, is founder of the PDPM calculator, Hopforce. Savannah James can be reached at savannah.lee@hopforce.com.