How Home-Based Care Companies Are Becoming More Involved In Pre-Acute Care

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Home-based care organizations continue to evolve. As they do, they’re becoming more pre-acute and embracing preventative care.

Traditionally, providers step in after an acute event has already occurred. This has slowly begun to shift, as providers realize that if they are already in the home, they can prevent some of these events or outcomes.

Signify Health, a part of CVS Health (NYSE: CVS), exemplifies this shift.


“What we do is pre-acute, we do not specifically target members after acute scenarios,” Denise Graeber, senior vice president of product management at Signify Health, told Home Health Care News. “That doesn’t mean it doesn’t happen, that we actually have a visit after an acute event, but the purpose of our visit is not to address any specific condition. The purpose is to really be holistic and complete in the evaluation, and to help prevent acute incidents.”

Dallas-based Signify is a value-based platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs. The company’s home and community services division conducts millions of in-home evaluations per year.

The company spends anywhere from 45 minutes to an hour in a member’s home doing a full assessment of their health — a medication review, prior history check, a physical examination, coverage of social determinants of health and in-home diagnostics and labs, Graeber noted.


“Last year, a provider came to [a member’s] home and identified something when listening to her heart that sounded like a potential concern,” she said. “We suggested the member follow up with her PCP. She went in and found that she actually did have an issue with her bowels that was extremely concerning, both important and acute. [In-home evaluations] are just another check to help get ahead of acute situations and prevent other health conditions.”

Signify is able to collect data in the home that becomes a bridge to eliminate information gaps for their member’s PCP.

At-home interventions

As a company, MedArrive’s core focus is emergency department (ED) diversion and hospital admission reduction. This means pushing back against the ER as the first primary source of care.

The Dallas-based company works with health plans to enable home-based care and virtual care, utilizing non-traditional workers on the way, such as emergency medical services (EMS) professionals. The company focuses almost exclusively on Medicaid and dual-eligible populations.

More recently, MedArrive moved into the cardiology at-home space, through a partnership with Heartbeat Health, a tech-enabled virtual cardiology company. The collaboration will allow the company to deliver medication titration, symptom assessments and other at-home services.

Even with a focus on preventative care, MedArrive CEO Dan Trigub is quick to clarify that the company isn’t operating in the on-demand care space, and that health care is a lot more than just one acute episode.

“For us to really lower the total cost of care and have a material impact on health outcomes, we want to see these people over an extended window of time,” he told HHCN. “Our case management social work team is really helping to address health literacy, getting better durable medical equipment and helping with transportation.”

Trigub thinks that vulnerable populations will be the ones to benefit most from at-home care companies adapting more features of pre-acute care.

“For more vulnerable populations who don’t have anybody coming to see them and who, unfortunately, use the ER as their primary care source of care, there’s a huge impact from doing pre-acute visits, building relationships and extending care into the home of these populations,” he said.

Whether more at-home care organizations will become more pre-acute in nature will depend on if the company has the size and capacity to potentially pull it off, Alivia Care CEO Susan Ponder-Stansel told HHCN.

“In our case, we have hospice, we have PACE, we have some other lines of service that very much complement one another and are part of a continuum, but if you’re a standalone home health … it might not be something that you really have the resources or interest to do,” she said. “A lot of it depends, too, on the payment source.”

In other words, providers working strictly under the Medicare umbrella may have a tougher time pulling this off.

Alivia Care is primarily a provider of home health, hospice and palliative care services. The company operates across 32 counties in North Florida and Southeast Georgia.

“If you’re working in a value-based environment where you’re either working with a Medicare Advantage plan, or you’re part of a system or medical provider group that has at-risk lives, that’s where I think the opportunity is going to come for preventative, proactive care of the patient rather than, letting things progress to the point where you’re basically cleaning up after an incident that perhaps could have been either avoided or moved fairly far into the future,” Ponder-Stansel said.

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