As a sales and marketing executive at Las Vegas-based In-House Home Health, Torrie Brizzie has long understood the value of in-home care. But it took her parents falling ill during a visit from the Midwest for her to explore the types of mobile urgent care services offered by a quickly growing startup — one of many new players embracing value-based care by moving treatment into the home.
DispatchHealth provides mobile urgent care to 10 markets across the country, including Las Vegas. Since its founding 2013, the Denver-based startup has served more than 50,000 patients.
That number is expected to nearly triple by the end of 2019 with the help of home health agencies and other community partners, company founder and CEO Dr. Mark Prather told Home Health Care News.
“The ability to flex an ER-like intervention into the home has not really previously been there, so the typical response when someone sounds relatively ill is to send them back to the emergency department,” Prather said. “We offer another response, and as such, end up being a nice partner for the home health agencies.”
That ended up being the case for In-House Home Health, where Brizzie is a community liaison.
After Brizzie heard about the company’s services during a home health networking event, she called DispatchHealth for her parents, who came down with the flu during a visit a little over a year ago. Physicians arrived at the couple’s casino hotel room within a couple hours.
“They gave them both IVs and gave my mom a nebulizer treatment so her breathing improved,” Brizzie told HHCN. “They were able to write prescriptions for medications that they actually sent to the local pharmacy and that were within [my parents’] insurance plan.”
The positive experience went on to spark a professional relationship. DispatchHealth added In-House Home Health — which provides medical at-home care to about 80 to 100 patients weekly in and around Las Vegas — to its roster of partners shortly thereafter.
Although In-House Home Health doesn’t have data related to cost savings associated with the partnership, Brizzie says DispatchHealth helps cut down on re-hospitalizations, an attractive selling point for referral partners.
“When someone is discharging a patient to home health, they want to know this patient is not going to come back to the hospitals because facilities … are now being punished if patients return back to the hospital in a certain time frame,” Brizzie said. “I’ve been able to utilize this added value service and say to my referral sources, ‘Hey, when we bring a patient on, if they’re not doing well, we can always have DispatchHealth come out.’”
Besides In-House Home Health, some DispatchHealth partners include Las Vegas Home Health and DFW Home Health, among others.
How it works
While anyone in participating markets can call DispatchHealth, home health partnerships play an important role in driving business for the mobile urgent care provider. They’re responsible for roughly 20% of DispatchHealth’s referrals, Prather said.
There are a couple of reasons for that. First of all, partnerships help address one of DispatchHealth’s biggest challenges: getting the word out about its services.
“In a lot of ways, it feels like a concierge service, but in most of our markets, it is covered by the majority of payers,” Prather said. “In the partnerships is where we’re really able to drive awareness of the model with patients. So if your doctor recommends the usage of DispatchHealth or your nurse from your home health agency recommends the usage, it’s much easier for us to drive adoption.”
In-House Home Health does that by providing clients with brochures and educating staff about their partnership. If either thinks DispatchHealth could help, they can contact the company by phone, app or online.
“If a nurse is managing a patient with COPD and that patient becomes acutely short of breath, it may be possible for us to safely treat that patient in their home,” Prather said. “There’s an assessment we do. The nurse can call us, we run through that assessment with the patient, we consent them for treatment and then come and treat them in their home.”
DispatchHealth physicians can do everything from IV infusion services to lab and diagnostic tests, in addition to performing procedures such as catheter placement, repair of complex lacerations and more.
Embracing value-based care
DispatchHealth’s urgent mobile care concept is part of a larger trend to move more types of health care into the home.
For example, in December, the University of Utah’s Huntsman Cancer Institute (HCI) launched a program that brings hospital-level cancer care into patients’ homes, allowing them to be discharged sooner and avoid costly ER visits.
Additionally, Holmdel, New Jersey-based Visiting Nurse Association Health Group recently received a $2.5 million dollar grant to continue growing its home-based primary care and palliative medicine offerings.
The crux of the movement is tied to health care’s gradual transition toward value-based care, which focuses on improving patient outcomes and generating long-term savings rather than serving the most patients in the shortest amount of time.
National health expenditures growth is expected to average 5.5% annually from 2018 to 2027, reaching nearly $6.0 trillion by 2027, according to the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. Based on those projections, that would mean health care’s share of GDP would rise from 17.9% in 2017 to 19.4% in 2027.
“If in value-based care settings, we’re concentrated on improved patient outcomes and lower cost of care, the home is an inevitable setting,” Prather said. “If we step back 15 to 20 years and look at care as transaction and the outcomes maybe aren’t quite as important, the cost of care might not be quite as important, then I think there’s push back on use of [care in] the home because it’s not as efficient.”
In addition to saving money, offering home-based primary and acute care can also lead to better outcomes, depending on the patient’s reason for needing treatments.
This is especially true for older, frailer adults who are more likely to be homebound.
A 2012 meta-analysis of Johns Hopkins’ Hospital At Home Program (HaH) — which serves patients with conditions such as community-acquired pneumonia, exacerbations of heart failure or chronic obstructive pulmonary disease, cellulitis and other conditions — found HaH patients showed a 38% lower six-month mortality rate than hospitalized patients.
One reason for that is that is that care can be better customized, Prather believes.
“In the Dispatch model, we’re in the home an average of 45 to 60 minutes,” he said. “I have a much more complete picture of you as a patient, and my care plan is by necessity tailored to you. I’m probably not going to write for a medication you can’t afford. I’m probably not going to tell you to get up and go see a doctor tomorrow if you don’t have transportation. We’re going to make a care plan that takes into account many social determinants.”
After expanding into three new markets in January, DispatchHealth plans to add six more new service areas over the next year, and home health agencies — similar to In-House Home Health — will play a large part in making that happen, Prather said.
“It makes sense for us to align much more closely with some of our home health partners as we scale across the country,” Prather said. “That’s our intent.”
The company’s plans don’t stop there, with ongoing goals to add more service offerings and partners with big names.
“Our intent would be to deliver ER through even more acute care like hospitalization in the home in the future,” Prather said.
Most recently, the company partnered with health technology company Phillips to expand DispatchHealth’s footprint in Arizona and bring more seniors in-home care. The pilot programs will allow select seniors to contact DispatchHealth at the push of a button using their Philips Lifeline medical alert system.
Cost to patients will be one-tenth of the average emergency room visit, according to a release announcing the partnership.