Blossoming from startup to an established presence within the larger health care continuum is no easy feat. But since launching in 2013, DispatchHealth has solidified its spot in the home-based care space through its mobile high-acuity services and other innovative initiatives.
As the “unicorn” startup has grown, many other organizations have since recognized DispatchHealth’s changemaking efforts and aligned themselves with the company. In recent years, for example, the Denver-based company has formed partnerships with Humana Inc. (NYSE: HUM), as well as health systems such as Baystate Health and MultiCare.
For DispatchHealth, making a name for itself has sometimes meant moving faster than today’s pace of health care, according to co-founder and CEO Dr. Mark Prather.
Home Health Care News caught up with Prather to learn all about his approach to change as part of its 2021 “Changemakers” series. In addition to DispatchHealth’s ongoing evolution, the CEO discussed his views on how change needs to take place within the existing regulatory framework.
Highlights from the conversation are below, edited for length and clarity.
HHCN: You’ve led a lot of change at DispatchHealth over the past few years. Can you please highlight a few of the changes you’re most proud of?
Prather: We’ve had several firsts at DispatchHealth, so I can think of a few.
Back in 2013, when we really started the company, we built the first mobile emergency room embedded in the 911 system. Another big first was when we later added the ability for a moderate-complexity lab to come to the bedside. This allowed our clinicians to safely expand the acuity spectrum of patients we felt comfortable treating in the home. We’ve been expanding that acuity spectrum ever since.
In the last several years, we built what we call our “Advanced Care” model, or our hospital-substitution model, which cares for patients who meet in-patient criteria but in the home. We perfected a concept that is unique in a relatively small industry, which is the ability to assess an unknown patient with an unknown acuity, safely in the home. We perform the entire workup with the necessary evidence-based stratification, then admit them directly to the home. Today, the acceptance rate into that program is 97% for eligible patients.
Finally, I’d say our technology platform is one of a kind. When we started, we knew we had to have a platform, but there was nothing that we could buy off the shelf. Most technology optimizes for scheduled visits, taking into account really just distance and traffic. Our model really is built for the random arrival pattern that you almost always see in an emergency room. It assesses the acuity, then it optimizes the logistics for distance and traffic, but also the acuity of the illness — and it does it safely.
Not all changemaking efforts work. What’s maybe one initiative or goal you’ve tried to fulfill, but failed at?
I’ll talk about one that came to mind because it’s actually come full circle.
In the early days, when I first started thinking about bringing the emergency room into the home, I really wanted the ability to perform a CBC — a white blood cell count, a platelet count, a red blood cell count — in the vehicles. We bought this device we thought we could use to help with temperature control and movement. In short, it turned out to be this very expensive bomb. We were without the ability to perform a CBC for many years because there just wasn’t anything available.
Then just the other day, the team informed me that they now had a machine, and that we’re bringing the CBC back. Now we have this tool that’s even better than before. Sometimes, the care delivery model gets ahead of technology, but the miniaturization of health care is occurring rapidly and will continue to enable innovation outside traditional settings.
All of our ideas were the right ideas, but sometimes we were just really ahead of where the market was.
What are the biggest current changes underway in the home-based care landscape, and what will it take for in-home care providers to adapt and thrive moving forward?
Value-based care will continue to push home-based care providers. I watch it because we’re very close to many of the managed care organizations. Many providers just don’t have access to data or the sophistication to understand the impact of their intervention on a population.
However, moving forward, the siloed, uncoordinated interventions are going to lessen. The providers that can integrate into the value-based care ecosystem and demonstrate returns on their intervention, improved outcomes and lower costs will be the winners.
Do you consider yourself to be somebody who runs toward change or away from it?
I have to caveat this. I run cautiously toward change. I’m an old hospital system operator. I’ve been through JCAHO [Joint Commission on Accreditation of Healthcare Organizations] reviews and have a deep appreciation for the health care regulatory environment. It’s that knowledge but coupled with a profound desire to improve upon our health care delivery model that really moves me forwards.
Change is needed, but I believe it must be accomplished within the existing regulatory framework.
How do you see DispatchHealth continuing to change moving forward? What’s the next step in your organization’s evolution, so to speak?
We have this ambition. We really set out to build the world’s most complete in-home system of care. We will look to continually add services and technologies that improve our care model.
To that end, we acquired a mobile radiography business that’s now integrated with our care model, so that our patients and providers are always receiving their imaging study within a timeframe that meets their needs.
Speaking of that, Professional Portable X-Ray (PPX) was DispatchHealth’s first acquisition. How much will acquisitions factor into your growth strategy as a company going forward?
In the past, I’ve been a part of private equity-backed businesses where the strategy was really “growth through acquisition.” I would say that, at DispatchHealth, it’s not a core strategy for our growth. But I can say that we’ll be opportunistic, and we’re constantly evaluating vertical integrations that are strategic to the company.
DispatchHealth has formed a number of strategic partnerships over the years. What sorts of opportunities are you looking for moving forward? And what do you hope these collaborations will help you achieve?
I’ll just step back and say, broadly, we look for value-based partnerships or community partners that align with our worldview, which is the transformation of our care delivery model. Our focus is on the delivery of the most comprehensive and highest-acuity care in the home. We have strategically positioned ourselves as an adjunct to longitudinal care, and we are not focused on the delivery of longitudinal care ourselves.
As such, we’re exploring partnerships with groups that do allow us to create a really high-performing network of providers. You could imagine partnerships with groups that are specialists in oncology, cardiology or nephrology. We’re looking at sort of those disease-specific partnerships today.
If you could snap your fingers and change one thing about how health care is delivered in the U.S, or how we as a nation care for seniors, what would that be?
This is probably going to sound a little self-serving.
I would create a substitutive high-acuity care model in the home. I think it’s exactly what we need for this country. Here’s why: We spend $4 trillion on health care in this country. A third of that is spent on care in the building — ER visits, hospitalizations and post-acute stays. Today, a significant portion of that care can be delivered safely in the home for a fraction of the cost of what is charged in the building — and the outcomes are better.
Specifically for seniors, we’re not debating the aging-in-place literature anymore. It conclusively states that outcomes are improved for seniors when we substitute care in the building and put it in the home.
There are traditional fee-for-service health care operators that say that home care is less efficient. That is true if you view it through the fee-for-service economics of the current system. However, if you view it from the perspective of the total cost of care, it’s highly efficient to intervene in the home. We know those interventions result in decreased overall utilization of health care services, with better satisfaction and improved clinical outcomes. It’s really a no-brainer.
While the past year has been filled with a lot of tragic news, there have been some silver lining, some reasons to hope for a better future. What is one positive lasting change the COVID-19 pandemic has brought on?
I think it’s health care access patterns. There were hundreds of thousands of patients who used telemedicine for the first time — or, in our case, had their first house call. ER utilization hasn’t rebounded to pre-COVID levels. I suspect that those patients got a taste of a more convenient personalized care solution that costs a heck of a lot less.
Dr. Eric Topol said several years ago that the hospital is an edifice we don’t need, except for intensive care units and operating rooms. Everything else can be done more safely, conveniently and economically in the patient’s bedroom. We’re on the precipice, I think, of realizing that statement. COVID was an accelerant toward that.
More than ever before, hospital-at-home has had a breakthrough, solidifying its place in the larger health care continuum. In your view, what else still needs to happen in order for there to be more adoption of the model?
First, we need to stop calling it at hospital-at-home. All we’re really doing is moving what can and should be treated in the in-patient setting to an outpatient setting.
For example, I’m a couple-of-decades-long ER doctor. When I started back in the late 1980s and early 90s, if you had a blood clot in your leg, we would admit you to the hospital for three days on bedrest with IV heparin. It’s very different today. Now, we’d diagnose your clot with an ultrasound in the ER, send you home on a blood thinner, with a shot that you give yourself. That same process is occurring here. To call it “a hospital-at-home admission” is almost a misnomer. We do believe it’s higher-acuity care, and we do support accreditation and competency demonstration for the providers who deliver that care.
Next, we really need to develop the community pathway to Advanced Care — the safe valuation of high-acuity medical conditions in the home that subsequently leads to Advanced Care or hospital substitution in the home.
Finally, acceptance rates into these Advanced Care models out of the ER setting are abysmally low. On the other hand, our acceptance rate from “ER in the home” to “hospital in the home” is running at 97% today.
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