Long-term care centers such as skilled nursing facilities (SNFs) have taken the biggest hit as a result of COVID-19. More than 40% of all virus-related deaths have been tied to nursing homes, a statistic that is scaring away a large number of potential and former residents.
Instead of facility-based care, more seniors are now opting to receive care at home. That, in turn, is accelerating the pace of health care innovation and pushing higher-acuity patients into the home.
But UnityPoint Health was already ahead of the curve. The health system started developing its new SNF-at-home program in the middle of 2019 before the COVID-19 emergency hit.
“Our goal is definitely to provide the right level of care in the right setting,” Mag VanOosten, president and chief clinical officer of UnityPoint at Home, recently told Home Health Care News. “We really believe home is where people are meant to recover.”
West Des Moines, Iowa-based UnityPoint is a health system with hundreds of locations across Illinois, Iowa and Wisconsin. It serves patients across a total of nine geographic regions with its hospitals, clinics and home-based care offerings.
UnityPoint at Home is a comprehensive home care company that offers a range of home-based services.
Its new SNF-at-home program, which is still in development, will fall under Care at Home, which includes all of the work that UnityPoint does for its accountable care organization (ACO) and at-risk contracts.
“[Care at Home includes] things like post-discharge home visits under waivers, and the hospital-to-home program … in addition to what we’re doing on the home health side,” VanOosten said, noting that SNF-at-home program falls under her purview.
UnityPoint at Home and Care at Home are both part of the health system’s population health structure, but Care at Home is an actual clinic. VanOosten oversees both, which together include all home-based programs.
While UnityPoint has well-established home health and hospital-at-home programs, SNF-at-home is different.
“Caregiver support is the difference,” Jenn Ofelt, COO of UnityPoint at Home, told HHCN. She has primary responsibility for traditional clinical service lines, such as home health, hospice and the ancillary supports that go along with those services.
When the SNF-at-home program gets up and running, it will target a very specific population of seniors, Ofelt and VanOosten noted. They bucketed SNF referrals coming from hospitals into three groups to explain.
The first bucket is filled with patients who might not need SNF-level care, but rather, could be well cared for using home health without much additional support. These patients are typically the target of SNF-diversion efforts by home health providers, a tactic some experts expect to skyrocket as a result of COVID-19.
The second consists of residents who have especially intensive needs and appropriately require 24-hour SNF-level care.
Then there’s the third bucket, which is filled with the patients UnityPoint is hoping to help with its SNF-at-home program.
“That’s the group that is eligible [and appropriate] for skilled care, but with some additional help, we really could take them home with services that we’re able to provide either under Care at Home or with home health,” Ofelt said.
In other words, the SNF-at-home model combines home health with home care to fill each individual patient’s caregiver gap.
“Maybe that’s [at] nighttime,” Ofelt said. “Maybe that’s [for the] bathroom or for [activities of daily living]. Maybe it’s 24/7 care, but there’s a caregiver gap.”
Origin story
UnityPoint’s SNF-at-home concept was born out of its successful hospital-at-home program, which has some of the best outcomes for such a model nationwide. For example, UnityPoint’s hospital-at-home program, which is modeled after the program developed by Johns Hopkins University, boasts a 3% hospitalization rate.
Those metrics caught the attention of payers, which suggested the SNF-at-home model several months ago.
“We were approached by some commercial payers who said, ‘Not only would we like you to do hospital-at-home for us, but we would like you to do SNF-at-home for us,’” VanOosten said. “[That] was the first that we had heard of it.”
Following that conversation, UnityPoint got to work developing protocols and figuring out what was necessary to make such a program work. Then the coronavirus hit, pushing program development somewhat to the backburner.
Finally, things are getting back on track.
“Now we’re back working on that and talking with our payers about that model,” VanOosten said. “We’re ready to stand that up and go live as soon as we find a private care partner.”
Because UnityPoint does not currently provide non-medical personal care services itself, it needs such a home care partner to make the program possible. After all, filling patients’ caregiver gaps is a key part of the program.
While UnityPoint has talked to multiple potential partners, it has yet to settle on one. Ultimately, it’s looking for an agency that would be a good cultural fit and would be willing to take on some risk.
“There’s a wide variation in the awareness of … how they could fit in with an ACO-type model,” Ofelt said. “We’re really looking for a partner that can see beyond that billing-the-patient-by-the-hour [model] and really [see] that value-add and proactive provision of service for a value-based arrangement and payment on the on the back end of a shared savings-type agreement.”
UnityPoint hopes to have the SNF-at-home model ready to roll out by Q4 2020.
Much like its hospital-at-home program, the model will serve patients in central Iowa, with an expected monthly census of about 10 to 15 patients, according to VanOosten.
COVID-19 case study
While the SNF-at-home program has yet to officially debut, the COVID-19 emergency allowed UnityPoint to do a small trial run of sorts.
“As a result of the pandemic, … there was a huge change in the workforce, [with] a combination of people working from home, as well as people out of work,” Ofelt said. “We were able to capitalize on that opportunity and use those caregivers that were now available to assist patients to go directly from home.”
Instead of supplementing home health with paid personal care workers, loved ones helped fill the caregiver gap to make the impromptu SNF-at-home program possible.
It became important amid COVID-19 because hospital and ACO discharge planners were having trouble getting patients safely placed into SNFs post-hospital discharge.
“[They were] reaching out to home health to say, ‘Are any of these patients able to go home?’” Ofelt said. “We had SNFs that were just flat out refusing to take new patients. We had SNFs that were putting all patients that had been in the hospital in one wing, whether they were COVID-positive or not.”
As of early July, those five patients were back on their normal trajectory of care, according to Ofelt.
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