Hospice utilization has risen sharply compared to a decade ago, but many patients are still entering hospice care later than ideal. This limits the effectiveness of hospice for both consumers and providers, including those that dually offer home health and hospice services and want to provide the right level of care at the appropriate time.
In 2013, Nashville, Tennessee-based Medalogix began to roll out a predictive analytics product to help its home health provider clients more effectively identify patients nearing their final days of life.
The original purpose of the product, dubbed Medalogix Bridge, was to glean actionable insights from medical records, demographic information and other data sources so providers could reduce home health deaths and maximize the time patients spent receiving hospice care. More than 20 total clients have signed up for the Bridge platform since its initial release five years ago—including some of the largest home health and hospice providers in the nation—and most are seeing very encouraging results, Medalogix CEO Elliott Wood told Home Health Care News.
“We work with a bunch of home health providers,” Wood said. “A lot of times, systems are maybe inefficient and really not set up to identify patients who actually need to shift from curative care to palliative care—that’s the problem we’re trying to solve here.”
More than half of Bridge customers have seen a reduction in home health census deaths since implementing the tech tool in their operations, according to Medalogix statistics.
At the same time, more than a quarter of clients have seen a drop in patients who ultimately experience shorter hospice stays spanning less than one week.
“What we’ve done is taken datasets and identified markers, if you will, or signals in the historical data that help us identify people who are at risk of passing away,” Wood said. “It’s not about finding more patients who need to go into hospice, but rather findings the right patient sooner.”
AccentCare, Elara Caring among Medalogix Bridge users
Major home health players AccentCare and Jordan Health Services are among the list of Medalogix Bridge clients seeing positive results.
Both providers have been using the predictive analytics product since 2015.
Dallas-based AccentCare and its 22,000 employees provide skilled home care, personal care and hospice services to more than 90,000 patients per year. AccentCare and its family of subsidiary companies currently operate in more than 150 locations across 11 states.
Texas-based Jordan Health Services merged with Michigan-based Great Lakes Caring and Connecticut-based National Home Health Care earlier this year. The three-way enterprise is now rebranding as “Elara Caring.” Combined, it serves more than 65,000 patients daily across 16 states, employing about 32,500 caregivers.
The entire Elara Caring enterprise now uses Medalogix Bridge as well.
AccentCare first started using Bridge at a single agency, its chief medical officer, Greg Sheff, told HHCN. As a result of its success, the provider plans on expanding that to a total of 41 agencies by the end of this year.
“It really just comes down to taking care of patients,” Sheff said. “Part of that means making sure they’re in the right level of care. Hospice is a more robust benefit for patients, so if it’s a place that might be better for them, we want to figure that out early and have that conversation.”
In 2017, AccentCare transitioned more than 500 of its home health patients into hospice setting through Bridge, he said. In turn, that has contributed to AccentCare’s home health mortality rate dropping to below 1%, below the national average.
“You don’t want to get on hospice for the last couple days of your life,” Sheff said. “A lot of the benefit for the patient and the family is having that whole period under a time that has appropriate supports, giving the family peace and space they need for that transition. Getting patients to hospice earlier is critical, and we’ve seen significant change in that.”
The average length of stay for hospice patients is about 88 days, according to the Medicare Payment Advisory Commission (MedPAC). The median length of stay, which may be a more representative figure, is about 18 days, however.
In general, the prevalence of short hospice stays has unchanged since the at least the early 2000s.
Prior to using Medalogix Bridge, Jordan Health Services reviewed spreadsheets of patient data and information from the field to determine when a patient was appropriate for the hospice benefit. It was a largely manual processes, Justin Miller, now vice president of continuum development for Elara Caring, told HHCN.
“Our home health offices are trying to get patients better,” Miller said. “As we start to see a decline, we don’t want patients to lose care. With our continuum … we can bridge them over to our hospice agencies to continue to provide care under one umbrella.”
Elara Caring currently is monitoring between 1,000 and 1,200 patients through the Bridge program. The enterprise’s combined hospice census is about 4,500.
A tool like Medalogix Bridge is especially valuable as providers try to become one-stop-shops, capable of offering care throughout the continuum, Miller said.
“If we didn’t have a sister company providing hospice, we would have to work with an outside agency,” he said. “Sometimes, you can’t have that communication back-and-forth, so this helps us provide constant patients care and constant communication from that skilled episode to that hospice hospice and end of life.”
How America thinks about dying
Besides Bridge, Medalogix products include Touch, Nurture and Care, its newest offering.
Touch helps providers identify at-risk patients for hospital readmissions, while Nurture detects individuals likely to decline after a home health episode. Announced in June, Care provides guidance on patient care plans.
Overall, Medalogix works with 11 of the top 15 U.S. home health agencies in terms of size, according to the company. Combined, its products analyze and draw insights from more than 250,000 patient records daily.
“At the beginning of our relationship, we’ll work with [providers] to load their historical data into our platform,” Wood said. “Those datasets are very, very broad with information from OASIS, demographics, medications, patient history and a whole lot more.”
Although Bridge has been proven to help providers improve upon key statistics linked to business performance, many customers on a more human-level have cited its ability to help jumpstart important end-of-life conversations as a main benefit, Wood said. Knowing exactly when to initiative those conversations can often be challenging for providers, patients and family members alike, he said.
“I think America is probably behind in how we think about dying, quite frankly,” Wood said.
That’s a point Congress has also tried to address in recent weeks.
In July, the U.S. House of Representatives passed the Palliative Care and Hospice Education Training Act (PCHETA), a bipartisan piece of legislation written to strengthen end-of-life care by improving outreach efforts.
Written by Robert Holly