Tech Startup Promises Big Savings to Medicare

A tech startup is making waves in the health care space, recently netting Medicare an estimated $6.5 million by reducing hospitalizations among aging patients in select states, most notably in Massachusetts.

Now, Care at Hand Inc., a San Francisco-based tech company, has set its sights on expanding in Maryland, the only state to have a Medicare payment waiver to set its own rates, which offers health care organizations some huge benefits.

“This is one of the most potential incentives for hospitals to think creatively about how to aggressively drive down the cost of care they provide,” says Andrey Ostrovsky, M.D., Care at Hand CEO.


Helping to drive down that cost is the use of mobile care coordination, as provided by Care at Hand, which expands the reach of nurse care managers through home care workers and health coaches.

Care at Hand created a risk prediction platform that starts with “smart surveys,” which are used by non-clinical workers, such as home care workers, to document and assess the health of clients. The app aims to provide a more proactive solution to fighting health issues in real time by tracking a patient’s health status on a consistent basis, Ostrovsky says.

Its smart surveys ask workers to answer up to 15 questions each day about their client, but the surveys have a library of more than 2,000 questions that adapt to clients’ health at the time of the survey. Additionally, the survey questions change each time they are administered.


After answering these questions, the survey technology determines whether it detects a health issue in the client and whether to send an alert to the patient’s care team when additional follow-up may be needed.

Only about one in five surveys triggers an alert leading to the patient’s care team being notified — but the rewards of using such preventive technology are immense, helping to reduce readmission rates by nearly 40% for one provider.

Putting big data to work

Care at Hand collects patient data in two ways.

“First, the non-clinical worker submits a survey each time they interact with the patient. That survey input drives part of the algorithm,” Ostrovsky says. “Second, the nurse on the care team receives and responds to the alert. Her response drives the final input to the algorithms.”

That data is not only used to lower hospital readmissions, but also provides insight regarding employees’ performance, and quality and cost projections for the care management team.

“If you think about the workforce currently employed in home care — some are stellar, others are subpar, but we can’t wait for an adverse patient event or an employee quitting to find out which are which,” Ostrovsky says, noting how a more accurate reading of employee performance could lead to a boost in pay, lower turnover and better outcomes.

“Until now there’s been no way to quantify individual workers’ value. Not everybody is good at everything, and now we’re using big data to detect performance deficits and provide targeted, brief and active learning experiences in the field rather than generic, daylong, and passive classroom trainings,” he added.

Reducing hospital readmissions

In 2013, Care at Hand helped Elder Services of the Merrimack Valley (ESMV) — a Lawrence, Massachusetts-based Area Agency on Aging that provides care transition services to local hospitals — rework its care transition model. The startup’s app helped ESMV reduce its 30-day readmissions rate for Medicare patients by 39.6% over six months, data show.

Use of the app also created a net savings to Medicare of $567,071 during the six months, ESMV says in a statement. Savings have also been seen in other states, netting Medicare an estimated savings of $6.5 million, Ostrovsky says.

In addition to reducing hospitalizations, Care at Hand has also demonstrated that non-clinical care supports can go a long way — strengthening the case for in-home support.

“Only one if five of the alerts require meeting with a doctor, our data show,” Ostrovsky says.

Roughly 72% of episodes that triggered alerts required a community worker, or non-clinical aide. Less than half of the alerts required a nurse to intervene, and 22% required a doctor. The rest were remedied by the patients, themselves, Ostrovsky says.

Partnership in Maryland

As part of the startup’s expansion into Maryland, Care at Hand’s largest customer in the state began employing its platform to complement its existing care transitions program.

Millersville, Maryland-based The Coordinating Center has partnered with three West Baltimore hospitals and their fee-for-service Medicare beneficiaries — Bon Secours Hospital, University of Maryland Main Campus and University of Maryland Midtown Campus — to reduce the readmission rates of individuals with chronic illnesses.

Between November 2013 and October 2014, 2,828 individuals were enrolled in their program, saving the three West Baltimore hospitals $2,676,259 in avoided re-hospitalizations, according to The Coordinating Center’s website.

Within the next three years, Ostrovsky aims to have Care at Hand in every Maryland-based community-hospital partnership focused on keeping patients in their homes, he says.

“In most cases, hospitals don’t have the penetration into the community that community-based organizations have,” he says. “So outsourcing part or all of their care transitions and ‘pre-admission’ care coordination to the community can be much lower cost and much better aligned at literally meeting patients where they are.”

Written by Cassandra Dowell

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