Seeing opportunities to improve quality of care and decrease costs, the home health industry continues to pump resources into specialized care programs for patients with heart failure and related conditions.
Despite mandatory bundled payment programs for cardiac care being put on hold, home health providers of all shapes and sizes are doubling down on specialized, in-home heart care programs. The investment is worth it, they say, because the programs will drive down re-admissions and make providers more attractive referral partners in a value-based care landscape.
That idea holds particularly true for Baton Rouge, Louisiana-based provider Amedisys (Nasdaq: AMED), which says its specialized heart failure program has become a standard of practice.
Since launching its heart failure program in February 2017, Amedisys has reduced its 30-day acute care hospitalization rate for its high-risk patients by about 5%. Likewise, it has slashed its 60-day ACA rate by about 8%.
To achieve that success, though, Amedisys had to first make its specialized program mainstream.
From home health to hospice and personal care, Amedisys provides services to more than 369,000 patients annually. As one of the largest home health providers in the country, it operates across more than 430 care centers in nearly three dozen states.
“We call it a specialized program, and there’s a lot of training that goes into it, but at this point, every single one of our care centers and every single one of our clinicians has been educated,” Susan Sender, chief clinical officer at Amedisys, told Home Health Care News. “It’s no longer a ‘special’ program, so to speak.”
Overall, Amedisys has provided its clinicians and other employees with thousands of hours worth of continuing education training pertaining to heart failure, myocardial infarction (MI) and coronary artery bypass graft (CABG). Along those same lines, Amedisys has also spent thousands of hours advancing what it calls its “empowerment methodology.”
At its core, that empowerment methodology means giving clinicians the knowledge they need to tackle heart conditions and holding patients accountable for their own wellbeing.
“Our empowerment mythology is really about slowing down, doing the education and then holding patients accountable,” Shannon Abbott, Amedisys vice president of specialized clinical programs, told HHCN. “It’s not necessarily going in and instantly taking blood pressure—it’s more going in and asking: ‘What was your blood pressure today?’ ”
Cardiovascular disease remains the leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
The Institute for Healthcare Improvement, an independent nonprofit organized based in Boston, estimates the annual financial burden associated with treating heart failure at about $30 billion.
Even so, a November 2017 study on cardiac rehabilitation training for home care clinicians found that, in general, there is a lack of heart-health education among homebound patients. Clinicians, by and large, also demonstrated a lack of awareness, according to the study.
Specialized programs help address top challenges
Poor diet and exercise habits are common among homebound individuals, which can make them particularly vulnerable to negative outcomes.
Older populations largely confined to the home also have a tendency to bounce around from home to hospitals and emergency rooms, so keeping track of medication can be extremely challenging without the help of an in-home caregiver, Sandra Chlad, a certified nurse practitioner in the Cleveland Clinic’s Heart Care at Home Program, told HHCN.
The Cleveland Clinic, owned and operated by the Cleveland Clinic Foundation, is a multi-speciality academic hospital in Ohio.
In the 2017 top-100 list of home health care agencies by LexisNexis, the Cleveland Clinic ranked No. 67.
“[Medication reconciliation] seems to be the biggest problem that people have,” Chlad said. “With these patients who are getting re-admitted back-and-forth from the hospital multiple times, they’re not going to one doctor—they’re seeing multiple, different doctors, and their medications are changed regularly.”
Similar to Amedisys, the Cleveland Clinic has noticeably reduced patient re-admissions since implementing its in-home heart care program, though Chlad said she did not have updated data readily available.
Also similar to Amedisys, the Cleveland Clinic has built that success on a model that engages with and empowers clinicians and patients. Having a realistic plan and keeping patients informed “absolutely” makes a difference, Chlad said.
“Nobody likes not being able to breathe,” she said. “So, if [patients] are not able to breathe—likely because they’re taking in too much sodium—then I come to them from that standpoint and see if I can get them to make little dietary changes.”
Chlad has worked with the Cleveland Clinic’s Heart Care at Home Program since 2010.
In the past, the Cleveland Clinic used to administer its heart care program through tele-monitoring devices installed in patient homes. It has since abandoned that program, partially due to a decrease in grant funding. However, other organizations—such as Vitalus Health—are just beginning to leverage the latest technology specifically with cardiac patients in mind.
Houston-based Vitalus is currently in the midst of restructuring its entire home health business to focus predominately on heart and pulmonary health.
The company’s home heart program will take a more proactive, technology-based approach to monitoring patients’ cardiovascular health, Karen DeJean, Vitalus’ recently named vice president of health services, told HHCN. Specifically, Vitalus plans on leveraging the data-collecting powers of wearable devices, smart scales and similar technology, then housing that information on a single, condensed platform.
“Our program is designed to reduce the lag time between communications, reduce [emergency department] visits and re-hospitalizations,” DeJean said. “It’s really about using innovative technology, bringing it all together and getting positive results.”
Initially, Vitalus Health started as a small DME company selling wheelchairs, walkers and commodes. The company was purchased in 2012 and shifted to focus on digital and connected health care. In 2017, Vitalus Health expand its services by purchasing a home health organization, which now operates under the name Blessing Hands.
Vitalus plans to start offering basic home health services “with a little extra” within the next 45 days, DeJean said. The full program will “ramp up in stages” and be fully in place within the next 90 to 180 days, she said.
Plans for the restructuring coincide with the health care industry’s shift toward a more quality-of-care approach.
“If you look at the health care environment today, and you look at how things are moving in terms of payment reform and a focus on quality…This is an opportunity to integrate care, to provide a service at a lower cost and have a positive impact to both the population and the patient,” DeJean, whose top goal is to help Vitalus effectively bridge the gap between inpatient and outpatient care, said.
Evaluating return on investment
Providers say that they are, indeed, deriving value from specialized heart failure programs in the form of improved quality metrics, but calculating dollars-and-cents return on investment is tricky.
Although difficult to determine the exact ROI of Amedisys’ heart failure program and those thousands of hours of training, it’s likely “not crazy in either direction,” Sender said.
In an internal survey, more than 80% of Amedisy’s business development department agreed that having a specialized program was important to the company’s overall performance and their ability to positively impact referral sources. About 40% strongly agreed.
“You don’t want to implement a program that’s going to cause you to lose, quite frankly,” Sender said. “We’re still working our way through a real return-on-investment and understanding what the real economic impact of a specialized clinical program is on our company.”
Written by Robert Holly