As one of the largest health systems in the country, Intermountain Healthcare has moved mountains to establish its place in the home-based care space.
With a number of care-at-home programs under its belt — including home health care, primary care, hospital-at-home and more — the health system is attempting to move the needle with an end goal of delivering cost-effective care services.
At the helm of these efforts are Dr. Nathan Starr, who serves as the medical director of home services for Intermountain.
Home Health Care News recently caught up with Starr to learn more about Intermountain’s accomplishments in the home, why value-based care is vital to the organization and the challenges it’s seeing in the space.
HHCN: People may know Intermountain as one of the largest health systems in the U.S., but the organization has been really bullish on at-home care. Can you talk about the different things Intermountain has been doing in the home over the years?
Starr: One of the strengths that we’ve been able to rely on is our Intermountain Homecare, our homegrown home care agency. It’s been really innovative and has driven, I think, a lot of our success as an organization.
That’s kind of been our bedrock. Intermountain is really invested in having those resources available throughout our geography, including a lot of investment in rural areas where we try to be able to help patients, regardless of where they’re at.
Additionally, we started doing more and more primary care in the home especially for patients that are socially and medically complex, who are struggling to get into the clinic and stay out of the emergency department.
We’re looking to expand our remote patient monitoring and other biometric monitoring programs. This really exploded during the pandemic, and not just with our hospital-at-home program. We had a variety of programs where we were monitoring over 10,000 patients.
We’ve been expanding other service lines, such as care management, and recognizing that social determinants of health play such a huge factor in our overall health. Helping with many of these issues, which traditionally haven’t been viewed as part of health care, we actually can keep people healthier and prevent disease and utilization down the road.
In your view, what are some of the more interesting things Intermountain is doing in the home?
They’ve been hugely successful and innovative, and we are piloting some chemotherapy care in the home now, and looking at ways for patients who live more remotely to get the care they need without needing to coming to a center or or even the hospital.
We’ve seen some really great outcomes with our home primary care program in reducing medical expenses and keeping patients out of the hospital. Our hospital-at-home program is taking care of almost 1,000 patients now, and it continues to grow and drive a ton of interest.
We’re doing more and more tele-specialty care, where we can get oncology, neurology, infectious disease care to patients where they’re at, even in their home. That level of outreach and efficiency has just been tremendous.
On the flip side, what have been some of the challenges or roadblocks?
It’s always a bummer how finances come so heavily into medicine, but it’s just the reality, we got to pay for it. Reimbursement is a huge challenge. Everything is so built around hospitals and clinics. How do we fairly reimburse care in the home, while at the same time not increasing utilization?
Take hospital-at-home for an example. It’s easy to say, ‘Yeah, this is great.’ But there is real concern that we over utilize it, meaning somebody that you would just send home, normally, all of a sudden, you’re a little worried about them, so you admit them to hospital-at-home, actually adding to expense. How do we get reimbursed in a way that’s fair? But how do we do that without increasing utilization, in a way that’s fair to the patient and the payer, as well.
Another big problem to overcome is just the rapidly evolving technology and innovation in this space. There are so many companies and organizations trying to move into this arena and it can become a little crowded, and at times hard to sift through what is really working versus what isn’t. We’re currently choosing a new remote patient monitoring vendor and it’s been a challenge to sort through so many vendors. They all kind of offer the moon. How do you really drill down to ones that are not just theoretically providing care, but are providing actual care now.
What are some outcomes related to home-based care at Intermountain at Home that demonstrate what you’ve been able to accomplish?
Our home-based primary care program has been able to show a definitive reduction in ED visits for patients that we help take care of, it’s a 15% reduction in overall ED visits with an over 25% reduction in avoidable ED visits.
We’re super excited about that. It’s a hard number to move in a lot of these patients. We’ve seen a medical expense reduction in patients that have been enrolled in our home-based primary care program.
Our patient satisfaction for our home services, both for our home-based primary care and our hospital-at-home program, has been really strong. Hospital-at-home is at about an 85% likely to refer rate.
How has being an extension of a large health system organization helped you accelerate care in the home?
As part of an integrated system, we work closely with our internal payer, Select Health, and use them to help build out the right structure for reimbursement that is really focused on reducing costs for everyone – patient and payer. Having that partnership has been incredibly valuable, and they’ve been great to work with.
Also, we’ve been able to leverage to get specialists involved with our patients even if they’re at home, because of our close relationships with the hospitals.
If any, what role does value-based care play at Intermountain at Home? What moves are you making around value-based care?
It’s vital. Currently, our home-primary care and our hospital-at-home have really been value-based programs. We’ve been focused on patients with whom we have an at-risk contract. Instead of increasing revenue, our focus has been on, can we provide better or equal or better quality care at a reduced cost?
If we keep patients healthy, we come out ahead, which is just fantastic. We are actively trying to grow our value-based contracts. We view the benefit of being in the home, both in the short-term and long-term, as the ability to reduce avoidable medical expenses.
Looking ahead, what goals do you have in place for at-home care over the next few years?
We met with our [now CEO] last summer, and we talked with them about these care-at-home programs and he said, “I have one goal for you, and that is to grow. Just grow, grow, grow.” That is our number one goal. We feel like our model is sound, so now it’s about taking the steps we need to continue to grow.
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