Home Care Case Study: Data to the Rescue

Natural disasters and other emergencies are challenging for any health care provider, but home health faces special challenges. Rather than having a single building to evacuate or secure, home health providers have a geographically dispersed client population. During catastrophic events, home care workers have been known to brave extreme conditions to reach remote locations to provide needed care and services.

While intrepid caregivers are irreplaceable in an emergency, organizations also are seeking increasingly effective and efficient ways of responding when disaster strikes. One recent example comes from Washington state. When wildfires broke out there in August, Aging & Long Term Care of Eastern Washington (ALTCEW) relied on the power of data to mobilize and help those in greatest need, providing a case study in the potential of information to improve care and potentially even referrals and bottom line results.

As an Area Agency on Aging, ALTCEW operates in a five-county area, and its services include in-home care needs assessments, a community-based care transition program, and a health homes program featuring case management to help reduce readmissions. It averages around 300 clients served each month, Care Services Director Teresa Michielli tells Home Health Care News.


ALTCEW had been working with Care at Hand, a digital health startup focused on accurately predicting risks to reduce hospital readmissions. At a routine check-in meeting, Michielli mentioned to Care at Hand that the region had gone up in smoke and the agency was desperately trying to reach people in their homes. Care at Hand was able to quickly produce a list of ALTCEW’s patients, organized according to who would be at greatest risk in an area where fire and smoke were prevalent—for instance, people who had conditions such as COPD that affect breathing. Other parameters that the list could be sorted by included ZIP code, to identify who was located farthest out.

Michielli was able to give the list to lead supervisors who broke it down and gave it to coaches who went into the field.

“We were able to stratify based on those criteria where we needed to help first,” Michielli says. “In some of our areas being evacuated, we were able to revamp and then ask specific questions—how is your building, what are your [health] indicators, can family help, do you need a ride to safety? It made us able to think through strategy and identify needs.”


While Care at Hand was able to furnish ALTCEW with relevant data, the company is not focused specifically on emergency response.

“We never thought we’d be an emergency preparedness technology,” Care at Hand co-founder and CEO Andrey Ostrovsky, MD, tells HHCN. “We’re a risk predictor, and it just so happens that natural disasters increase risk.”

The Washington fires were not the first time that Care at Hand technology was involved in disaster response. An organization utilizing the technology in the Boston area saw a significant deterioration in some of its numbers last winter, such as the time between hospital discharge and first home visit. Care at Hand was working with clinical leaders to determine why this was occurring, but it took a worker in the field to point out the obvious: The city had been rocked by blizzards and there were still eight-foot snowbanks hampering travel.

“Whoops, we should’ve thought of that,” Ostrovsky says of the reactions at that time. “It prompted discussion and common sense about what was causing the problem.”

Ultimately, Care at Hand was able to work with the organization on quality improvement projects and furnish data to hospitals that prompted them to change their discharge practices—no small feat, Ostrovsky notes. It suggests another benefit to having easy access to robust data sets for home health—being more persuasive in conversations with hospitals, health systems and managed care organizations, to become contracted providers.

“The home care company says we’re not looking for a 3-year contract to guarantee referrals, but a few months, small scale, if we meet the following milestones, we’ll scale up,” Ostrovsky says of the way that clients are successfully utilizing the Care at Hand data to start working with these organizations. The clients do check-ins every two to three weeks to ensure that they are on track to meet the milestones, such as for readmissions numbers, and can then make pivots if things are getting off track.

Partly due to that experience in Boston, the response to the Washington fires was quicker, Ostrovsky says.

“We haven’t really built out decision support for natural disasters, but there’s cool work going on right now to help with root cause decision support,” he says. The ultimate result should be that providers can react more swiftly to the data they are seeing.

But for Michielli, data already has made big difference.

“You never really appreciate how data can help you until something like this comes up,” she says.

Written by Tim Mullaney

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