As a result of the COVID-19 emergency, there has been an increase in new home-based care models such as SNF at home and, most notably, hospital at home. The latter saw an uptick when the U.S. Centers for Medicare & Medicaid Services (CMS) introduced its “Acute Hospital Care At Home” waiver program in 2020.
“Hospital at home and SNF at home are examples of value-based care, in that they promise to improve a patient’s experience getting care where they really want to receive that care — in the home,” Andy Eilert, president of emerging markets at WellSky, said at the Home Health Care News Home Care Conference. “[These models] improve outcomes and lower costs, ultimately driving value.”
While upside is high, innovative home-based care models do require changes to how health systems, payers and providers have traditionally operated, he noted.
“They require significant coordination between payers, acute care systems and home-based providers,” Eilert said.
Overland Park, Kansas-based WellSky is a post-acute care technology company that utilizes software and analytics to help providers across the continuum achieve better outcomes at lower costs. The company serves more than 20,000 clients.
One health system, UnityPoint Health, has seen success in offering high-acuity care in the home. The health systems’ home-based care subsidiary, UnityPoint at Home, has leaned into hospital-at-home and SNF-at-home models, in particular.
“We recognized that there were a lot more cost savings if we could keep the patients out of the hospitals,” Mag VanOosten, president and chief clinical officer of UnityPoint at Home, said.
West Des Moines, Iowa-based UnityPoint Health is a health system with hundreds of affiliated locations across Illinois, Iowa and Wisconsin.
UnityPoint at Home launched Care at Home in 2018 to create a headquarters or main innovation hub for all of UnityPoint at Home’s non-traditional payment-model programs. In addition to hospital at home and SNF at home, examples include home-based palliative care, home-based primary care and annual wellness visits.
In 2019, UnityPoint at Home recognized that its hospital-at-home program wasn’t really moving the mark, with participating patients seeing an emergency department (ED) utilization rate of roughly 27% and a 30-day rehospitalization rate of about 25%.
“We went back and did a couple of rapid improvement events,” VanOosten said. “We found that the pass-off you have when being discharged in the hospital to home health was the same pass-off we were using from hospital to home to home health. If we could better coordinate that handoff, we felt like we could really make a difference. We wrapped a 30-day bundle around our hospital-at-home episode.”
In turn, UnityPoint at Home saw its ED utilization drop to about 6% in 30 days; similarly, its 30-day rehospitalization rate dropped to about 10%. In 2020, the health system was one of the first six organizations to be accepted under CMS’s waiver program.
Home care providers have also carved out a role when it comes to offering value, according to Kunu Kaushal, founder and CEO of Senior Solutions Home Care.
“If you follow the home and community-based services model, we’ve been a nursing home deferment program for quite some time,” he said. “In Tennessee, where we have the most of our operations, we’ve partnered with those managed care organizations, and we’ve partnered with the state. The thought process is that we can deliver care to individuals at a much lower expense.”
Brentwood, Tennessee-based Senior Solutions Home Care is a company that provides personal care services, transportation solutions and nutrition support. The company has more than 20 offices across the state.
To be successful in new home-based care concepts, Kaushal believes that home care providers need to be able to pinpoint the end goal.
“An interesting element in personal care is that the entire industry has a hard time defining value,” he said. “What is a valuable service? What was valuable about it? I think, ultimately, if you can find a payer or … system that understands the value of essentially having that deferment, having [patients] be at home, the cost savings along the way – that is a form of value that’s very much realized.”
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