Competing Companies Team Up to Fill Home Care Gaps

Gaps in care for seniors living at home can make them vulnerable to hospital visits, which is why a unique group of providers with both home health care and senior housing services have teamed up to serve Michigan residents.

Tandem365 is a Michigan-based organization that aims to help older adults—55 and older—“navigate” the health system to avoid pitfalls in their health and remain in their homes longer. The concept essentially targets care and services that currently aren’t reimbursed by insurance. Seniors living at home may not have access to essential care services or may need help coordinating care, transportation or even activities of daily living. Qualified adults can join the program on a plan and receive many of these services and more within their home.

Described as “a handful of retirement communities and an ambulance company getting together,” the partnership is an equal joint venture between five Michigan businesses, including four senior housing providers and one wildcard—an ambulatory services company. The providers also have their own home health and home care branches that work within the organization.

The group consists of Sunset Retirement Communities & Services, a senior living and home health provider with four communities; Porter Hills, a multi-services provider with multiple communities and affordable housing offerings; Holland Home, the largest non-profit senior services provider in the Michigan; Clark Retirement, a senior housing provider with two locations; and Life EMS Ambulance, an emergency and non-emergency medical responder.

Each of these organizations was actively working to become preferred partners with regional hospitals when they got together. To be effective and more attractive as partners, they had to build a network.

“We were doing a good job talking with these hospitals independently, but the hospitals said the only way to meet is with everyone at once, together,” Christine Matzke, chief healthcare officer at Sunset, said Wednesday at the Post Acute Link Care Continuum Conference in Chicago. “So, we did.”

From competition to collaboration

The different communities began meeting once a month with regional hospitals to work to become preferred partners and build referral sources. Eventually, the companies decided to start meeting outside of the hospital setting to continue working on partnerships to complement one another’s services.

Instead of competing against one another for referrals, the groups involved formed a new organization harnessing all services of the parties involved. The individual organizations recognized they would be a more powerful and effective partner with other care settings as a network. However, the ultimate aim was not to find more referral sources, but to address care gaps.

“We were competitors,” said Brian Pangle, president & CEO of Clark Retirement. “Now we sit at the table and share more than ever. It wasn’t because we wanted to come together; it was the health system that made us.”

While the concept initially targeted funding from an Innovation Grant with the Centers for Medicare & Medicaid Services (CMS), the grant was rejected, and the group worked with insurance groups to pay for the services they would offer. In action, the insurance company selects patients who qualify based on how they would benefit from Tandem365’s services in the home. The funding works on a per-member/per-month basis for Medicare Advantage patients in the state.

With a patient census of 355 thus far, the organization has already seen dramatic results. Emergency department visits have dropped to just 2.2%, while the 30-day hospitalization rate has plummeted to a 0.2% admission rate for the group.

While the results have started strong in reducing hospital readmissions and achieving better health outcomes, the organization had to overcome barriers to get to this point.

For one, the Life EMS Ambulance needed to receive a special addition license in order for its medical responders to provide care and perform an assessment without bringing a patient into a hospital setting. This service enables a patient to potentially avoid a hospitalization and result in a lower-cost intervention.

Additionally, the emergency response system that is set up for ambulatory discharge is also utilized as a help call center for patients with Tandem365. The responders can help assess a patient’s needs over the phone and access their electronic medical records. Instead of calling an ambulance to someone’s home, an assessment can determine if the patient simply needs a nurse to call them or some other intervention.

At this point, the program is “almost” paying for itself. The partners are also looking into expanding into the private pay market, according to Tandem365 CEO Teresa Toland.

Written by Amy Baxter