Resilient Healthcare Blazing New Trails for Hospital-at-Home Model

Similar to many other home-based care pioneers, Jaky Samuel founded her company — Resilient Healthcare — after a deeply personal experience.

Samuel, a physical therapist by training, lost her father a little over three years ago. Before he passed away, recurrent strokes forced him in and out of the hospital and skilled nursing facilities (SNFs), with his condition worsening each and every time.

“Every time he came home, he was weaker,” Samuel told Home Health Care News. “I was already a PT by then. I was managing a home health agency as well as working in outpatient space. That experience really highlighted the gaps in health care. Instead of sending people to the hospital whenever something happens, I knew we could recreate some of this care in the home.”

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Driven by that belief, Samuel, launched the Texas-based Resilient toward the end of 2018, with support from PE firm Mezas Capital. She was 26 years old at the time.

“We put together this program to bridge the gap and care for these high-acuity patients, often people with chronic conditions that lead them back to the emergency department multiple times a year,” she said. “The basic idea was, ‘Let’s recreate the hospital as much as we can in the patient’s home and go from there.’”

Growing Resilient had been a grind before last year. Historically, the U.S. Centers for Medicare & Medicaid Services (CMS) hasn’t paid for hospital-level care in the home, despite several promising studies and demonstrations reaffirming the model’s value.

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The lack of a formal payment mechanism under Medicare meant Resilient had to appeal to private insurers instead, Samuel explained.

“The way that health care works, unfortunately, is you do the work, then ask for the money later,” she said.

But then the COVID-19 pandemic turned the health care world on its head, accelerating the nation’s move toward in-home care by years, if not decades. In 2021, Resilient has now become a nimble, up-and-coming hospital-at-home organization with ambitious growth targets on the horizon.

“We’re looking to be in a few more states by the end of the year,” Samuel said. “I can foresee Resilient growing exponentially, both outside of Texas and within Texas.”

Inside the Resilient business model

Currently, Resilient serves upwards of 100 patients in Texas, with a staff of over 40 full-time employees and more than 130 clinicians from a wide range of disciplines. The interdisciplinary team includes PTs, OTs, speech therapists, dietary specialists and more.

Overall, the company has three different service lines, including a traditional home health arm. It has received especially high interest in its hospital-at-home model as of late, though, partly thanks to the CMS “Acute Hospital Care at Home” waiver unveiled in November.

Resilient had been planning for a possible hospital-at-home waiver before that even, with Samuel receiving mentorship support from Dr. Bruce Leff of Johns Hopkins University School of Medicine, a well-known expert in the field.

“We started planning for that back in May, with [our team] fairly confident that CMS would change regulations because they really did not make sense,” Samuel said. “Then in November, CMS announced, ‘Okay, here’s the waiver,’ which allowed us to start having conversations with hospitals in our area.”

As of July 2, there were 66 health systems and 145 hospitals in 32 states participating in the CMS waiver program. Texas alone had at least 16 sites participating in the program, many of which were already working with Resilient.

Resilient treats nearly a dozen different diagnoses under its hospital-at-home model, including COVID-19, Samuel said.

Patients are provided 24-hour continuous monitoring through an FDA-approved patch on their chests. They receive frequent visits from physicians, with nursing visits coming, at minimum, twice a day.

“Hospital-level care has a length of stay of about two to five days,” Samuel added. “These are patients who we’re stabilizing, then we discharge them the same way they would at a hospital.”

Prior to the waiver, her company had also assisted in the state’s efforts to identify and test for the COVID-19 virus. It started in-home testing in March, joining forces with some of the state’s “bigger names” for health system partners.

“We partnered with a few labs in the area. We were getting 24-hour results,” Samuel said. “Then we ventured a little bit into testing preoperative patients. Instead of having the patients go to the hospital to be tested for COVID, we ended up testing them in their home, so that if they were positive, we could intercept prior to them going in for surgery.”

In addition to its hospital-at-home service line and in-house home health agency, the company operates a “SNF-at-home” or “LTACH-at-home” segment designed for complex and chronic individuals.

“Call it what you want, but it is a higher-level interdisciplinary approach for patients who are complex care patients,” Samuel said. “And so we take care of ALS patients, neurology patients, cardiac patients, COPD patients. We manage them for a longer length of stay.”

In total, Resilient touched at least 7,000 unique patients from February 2020 to February 2021.

Investing in technology

So far, the CMS waiver has “meant a lot” to Resilient, Samuel said.

“We’re hoping that that waiver becomes permanent,” she said. “And I think that a lot of hospitals within that program feel it will become permanent.”

The waiver’s impact has not only been felt in more immediate, concrete opportunities with hospitals and health systems, but in its ability to change the perspective of payers, Samuel said. CMS signing off on hospital-at-home care has pushed more insurance companies toward innovative virtual and mobile health systems.

“It gives insurance companies the confidence to say, ‘Oh, well, Medicare gave them a revenue stream for this. It makes sense that we follow suit,’” she said.

Apart from its various in-home care models, Resilient also rolled out a technology company called Artic Health in 2020. Artic’s overarching goal is to develop software to successfully convert homes into clinical spaces and fill gaps in care coordination.

“We all know how difficult care coordination is inside of a hospital,” Jeff McGeath, chief technology officer of Artic, told HHCN. “There’s multiple vendors out there with multiple care coordination solutions. Just imagine then taking that outside the hospital.”

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