One of the largest health systems in the country is betting big on its ongoing strategy to provide more care upstream.
In March, Intermountain Healthcare announced it is expanding its home-based offerings in 2019 to include primary care and multiple hospital-level services, along with palliative care for patients with chronic or serious medical conditions.
The expanded services will be part of the Salt Lake City-based health system’s “Intermountain at Home” program, which is largely focused on preventing hospital readmissions and keeping patients in their preferred setting.
“Intermountain has been in the home space for quite a while through our home health and hospice business,” Rajesh Shrestha, chief operating officer of community-based care for Intermountain, told Home Health Care News. “We’ve expanded that over the last couple of months with palliative care, some very early home-based primary care and a little bit of dialysis in the home as well. Essentially, we’re doubling down on moving upstream into patients’ homes.”
The not-for-profit Intermountain is the largest health care provider in the Intermountain West region, with more than 37,000 employees, 22 hospitals and 185 clinics, plus an in-house insurance division that serves about 800,000 members.
The health system’s recently announced plan to expand its Intermountain at Home program comes roughly 10 months after it launched Homespire, a joint venture with Minnesota-based in-home care provider Lifesprk aimed at activities of daily living (ADLs) and social determinants of health.
In general, Homespire is “a big part” of what Intermountain is attempting to do with Intermountain at Home and will function as a key differentiator compared to other home-based primary care programs, Shrestha said.
“With the addition of our Homespire joint venture, we’re able to wrap all of those services around with activities of daily living and social determinants of health work,” he said. “That package together, we feel, is the most comprehensive home-based program in the U.S., once this is all rolled out.”
Creating ‘connection points’
In part, Intermountain is investing so heavily in the home setting because it has already seen impressive results from existing offerings. Home-based nursing services were first introduced at Intermountain in 1982 to help patients transition home following hospital discharge.
“Our traditional home care has some great statistics around that,” Shrestha said.
In 2018, for example, 84.7% of Intermountain knee-replacement patients and 88.4% of its hip-replacement patients were discharged to home health services. With the vast majority of those types of patients receiving care in the home, readmission rates for each group were below 3%.
Additionally, Intermountain’s overall readmission rate for Medicare Advantage (MA) patients is around 8%, thanks chiefly to the health system’s post-acute services and “home-based mentality,” Shrestha said.
“We want to build an entire program around ‘in the home’ that aligns to our community-based care goals,” he said. “Because we have the wrappers of activities of daily living and social determinants of health, we also believe it’s not just us coming to the home. It’s connecting patients to those community resources that can help them as well.”
Home checkups with a primary care physician or advanced practice clinician will be included in the Intermountain at Home mix, as will virtual urgent care visits and appointment-based video visits through the health system’s Connect Care platform.
With so many different home-based services from hospital-level care to telehealth and primary care, creating connection points and avoiding redundancies will be paramount, Shrestha said.
“Obviously, there’s going to be connection points across this continuum,” he said. “If [a patient] is already a home-based primary care patient, we need to ensure that there’s not redundancy in that hospital admission in the home. There’s appropriate handoffs and connection points.”
Intermountain will identify patients for its Intermountain at Home program through internal risk-stratsifcation protocols. Broadly, those patients will be medically complex and likely homebound.
“We expect a significant amount of individuals, particularly our high-risk members, particularly in the MA population, the duals population, the Medicaid complex populations to be utilizing these services,” Shrestha said. “But it also pertains to commercial as well.”
Currently, for context, heart failure patients admitted to an Intermountain hospital have an average stay of 4.6 days and a 30-day rehospitalization rate of 21.7%. With Intermountain at Home, these patients could avoid initial hospitalization and receive face-to-face clinical care from providers and nurses — along with monitoring and medication administration — at home.
Lifesprk making moves
Meanwhile, Intermountain’s Homespire partner — Lifesprk — is also making moves.
Specifically, the home care provider is scaling its own, separate home-based primary care offering in its Minnesota market. The move is, in part, to better position the company for value-based arrangements, CEO Joel Theisen told HHCN.
The home-based primary care line is branded as Lifesprk Health.
“We launched it about a year and a half ago with the intention of building the architecture to now start to deploy it in our fuller, value-based model that we’re super excited about,” he said.
About 120 indviduals are currently receiving services under Lifesprk Health.
The scaling of Lifesprk Health includes naming high-profile senior care leader Bill Thomas as Lifesprk’s medical director. Thomas had been serving on Lifesprk and Homespire’s advisory boards.
“Our health care system has been optimized for maximizing visits, maximizing use of medications — [and] this is really dangerous for older people,” Thomas told HHCN. “That style of practice holds a lot of risk for older people.”
On a national level, the idea of home-based primary care wrapped around ADLs and social determinants of health is in its infancy, according to Thomas. But that is quickly changing, he said.
“The amount of information you get when you walk into someone’s home is orders of magnitude greater than the amount of information you get when somebody walks into your office,” he said.