The Hospital of the Future: Intermountain Expands In-Home Care Offering

Utah-based Intermountain Healthcare is delving deeper into the home with its latest offering: hospital-level in-home care. 

Intermountain is a health system with 24 hospitals, a medical group with about 160 clinics and its own health insurance plan, among other services. The not-for-profit announced a concerted effort to move more care into the home last year, when it rolled out Intermountain at Home.

The coronavirus has accelerated the movement of that program.

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Up until now, most of Intermountain at Home’s services were in the primary care and palliative care realms. However, the COVID-19 emergency inspired Intermountain to roll out a new host of home-based, hospital-level capabilities.

Now, the health system is offering a wider swath of services to its higher-acuity patients.

“The hospitals of the future will expand virtually into homes to provide appropriate acute-level care,” Rajesh Shrestha, Intermountain VP and COO for community-based care, said in a press release. “This new service supports patients who are at risk for hospitalization or complications, along with their families.”

To make it happen, the health system is partnering with Castell — an Intermountain company that offers a comprehensive tech platform to help organizations transition to value-based care. Shrestha serves as president and CEO of the Intermountain offshoot.

“This hospital service has been something we’ve looked at and we’ve been working on,” Nick Bassett, vice president of population health services at Castell, told Home Health Care News. “We’ve really accelerated that movement as a result of the COVID pandemic and in the interest of the organization being ready for a potential surge event, where hospitals are full and bursting at the seams.”

Intermountain and Castell have been providing in-home, hospital-level services to patients in the Salt Lake City area for about a month and a half, with most of those referrals coming from the emergency room. Bassett was unable to share the number of patients that have been treated so far.

The program is designed to serve patients with everything from congestive heart failure to cellulitis, pneumonia, certain cancers and more. While not all conditions can be treated in the home, the list of what can be is quickly growing, Bassett said.

In addition to having a qualifying condition, the ideal candidate for home-based hospital care should have a suitable home environment and a caregiver.

Additionally, there are some payer requirements.

“This program right now is intended for payers with whom we have a value-based or risk-based relationship,” Bassett said, noting that includes Medicare Advantage but not Medicare. “We certainly are excited … for the day that traditional Medicare and CMS moves down this path. I know there are active groups pushing this in Washington.”

How it works

Intermountain Homecare and Hospice plays an essential role in helping the health system deliver home-based hospital-level care, Basset said. Caregivers from the provider are the ones delivering the services.

“Most of the interaction for the patient is virtual through a tablet, with remote patient monitoring devices [and] conversing with a nurse and a hospitalist remotely,” Basset said. “But that home care team [makes daily rounds] in the home and provides insights back to the provider.”

On top of that, Intermountain Homecare and Hospice workers are also available to go to patients’ houses on demand 24/7, should the need arise, making them one of the most critical parts of the program.

Ultimately, the goal is to care for patients in the setting where they’re most comfortable while also cutting costs and improving outcomes. Basset predicts the program will equate to a cost savings of 15% to 30% per patient.

“Those savings come from lower readmission rates and fixed costs,” Basset said. “They come from often lower ancillary utilization of labs and imaging and then lower utilization generally.”

While it’s unclear how much the program has saved so far, Intermountain and Castell already have big plans for the future.

“The list is rapidly growing of [conditions we can treat],” Basset said. “We’re excited to dig in and explore how we can kind of bring this package of services … to a broader population.”

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