After once occupying a niche space in the health care sector, the hospital-at-home model has gained significant traction.
In November, the U.S. Centers for Medicare & Medicaid Services (CMS) even announced its “Acute Hospital Care At Home” wavier program. Under the initiative, eligible hospitals can receive newfound flexibilities around providing hospital-level care for patients in their homes.
As of March 3, there were 109 hospitals in 29 states with the CMS waiver. While the program was an effort to increase hospital capacity amid the COVID-19 emergency, hospital-at-home players have been working behind the scenes to push the model forward for years.
One of the companies at the center of this regulatory and cultural shift is Contessa. The Nashville, Tennessee-based company helps health systems provide hospital-level care in the home through its Home Recovery Care model.
To learn more about Contessa and where it fits into the hospital-at-home takeoff, Home Health Care News recently connected with Mark Montoney, Contessa’s senior medical advisor, for our latest episode of “Disrupt.” Highlights from the conversation are below, edited for length and clarity.
HHCN: To start, can you give our listeners some background on Contessa and where the model is, currently?
Montoney: Contessa launched in 2015. Our Home Recovery Care model really brings all the essential elements of hospital-level care into the patient’s home. Home Recovery Care is a turn-key solution that enables a new standard of care for progressive provider partners and payers.
Patients are treated for their in-patient eligible conditions in the comfort of their home, bypassing what would otherwise be an in-patient hospital stay. Our care model has an average patient satisfaction score of over 90%. We’ve been able to reduce the average length of stay by 35% and reduce readmissions by upwards of 44%.
As I said, we launched six years ago. We’ve partnered now with seven health systems to create joint ventures that operate Home Recovery Care. There’s Mount Sinai Health System in New York City and the Marshfield Clinic Health System in Wisconsin. More recently, there’s Gundersen Health System, which is also in Wisconsin. We work with Ascension Saint Thomas in Tennessee, Prisma Health in South Carolina, Allegheny Health Network in Pennsylvania and Dignity Health, which is part of the CommonSpirit Health System out in Arizona.
We’re slated to launch several more markets in 2021, but we value all those partnerships and have been able to advance our Home Recovery Care model in each one of those areas.
In terms of the Home Recovery Care model, how is Contessa’s model like other hospital-at-home concepts? And what might be a differentiator? What is the clinical approach?
Our clinical approach is, we bring all of the necessary resources to bear, in terms of operating a hospital-at-home program. We organize the clinical resources, utilizing local providers and incorporating them into the model to provide hands-on clinical care. We bring all of the clinical protocols, the order sets. We organize all of the ancillary network that’s necessary for bringing acute-level care services into the home for patients, such as infusion services, DME and any other additional services that might be necessary.
We also have a system called “Care Convergence,” which is proprietary, that allows us to track patients through an episode of care. It essentially provides the ability to manage all the logistics, which are quite significant when you’re providing acute services in a patient’s home. All those logistics are tracked through that system.
Finally, we also have a virtual care unit that includes nurses, social workers and other administrative support staff who actually provide virtual support for the on-the-ground clinical resources that are providing direct patient care.
You mentioned your health system partners. How do those relationships usually come about?
We establish a joint venture partnership with the health systems, whether they’ve made an inquiry to us, or maybe we’ve been connected to them and there’s an interest in exploring the model. Typically, it starts from introductions, to all the way through an implementation phase, to establishing a program in a particular market.
What we have found over these past several years is the interest in hospital-at-home continues to accelerate. There continues to be a significant interest amongst health systems to pursue this type of model and be able to offer it as a service to the patients they serve in their community.
Over the last year, as you just mentioned, interest has ticked up. How has the CMS Acute Hospital Care At Home initiative changed things for Contessa? How do you think it will change things for hospital-at-home programs, in general, moving forward?
Let me give you a little bit of background on that.
Back in March, when we started seeing the first COVID surge, CMS announced a “Hospital Without Walls” waiver. It actually offered relatively broad regulatory flexibility for hospitals providing care outside of its four walls.
Then in November, they moved it a little further by providing eligible hospitals with regulatory flexibility to treat eligible patients in their homes. At that point, it really started to open up the opportunity for Medicare fee-for-service beneficiaries to be eligible for hospital-at-home services.
In fact, our partner in New York, Mount Sinai, had worked closely with CMS in terms of the development around some of these regulatory changes. They were one of the first systems in the country to be approved for the model. Since then, our other additional five markets … have also been approved by CMS to accept the Medicare fee-for-service patients into their programs.
In terms of that partnership with Mount Sinai, I know recently they have doubled down on their partnership with Contessa to launch a more expansive palliative care program. Can you explain the purpose behind that?
This is a part of our strategy to continually expand our service lines. This is an area in particular of great need across patient populations.
Of course, the Mount Sinai Health System has run a nationally recognized palliative care service for a number of years. Partnering with them in this space allows the opportunity to bring palliative care in the patient’s home. Essentially, it’s bringing coordinated and specialized care into the homes of these chronically ill patients, helping them oftentimes to avoid unnecessary hospitalizations.
We couldn’t have a better partner to launch this additional program with.
Why do you think palliative care has only recently become more popular? It seems like something that providers are much more interested in these days.
Even though you’re right, it’s been around for a while, I don’t think it was always understood as well as it perhaps could be, or should have been. It sometimes gets confused with hospice care. Hospice care is, of course, a defined benefit appropriate for patients that are typically determined to be in the last six months of their life.
Palliative care is bringing supportive services and symptom management to patients who have a chronic disease. They’re still receiving all appropriate management for their chronic conditions meaning, there’s no reduction in terms of treatment that patients are receiving. It’s really meeting the needs of patients holistically. I think culturally it’s taken a while to become more accepted and mainstream, but we definitely have seen that in the past several years.
Interview conducted by Andrew Donlan