Since launching five years ago, a partnership among Contessa, Highmark Health and Allegheny Health Network (AHN) has expanded and started to prove out the value–to patients, clinicians and payers–of delivering more acute care in the home.

Highmark, AHN and Contessa in 2020 announced a partnership to launch a home-based acute care model for Highmark health plan members. Since then, the model has adapted to offer hospitalized patients an alternative to skilled nursing and rehabilitation facilities following their discharge. This alternative is rehabilitation conducted at home.

“We had to determine not just what an ideal model looked like or what the future might hold, but also what physicians want and how they prefer to work, even if they were unaware of their own preferences,” Dr. Michael Nottidge, senior vice president and national medical director at Contessa, told Home Health Care News. “Bridging the gap between an effective operational model, the physicians’ experience, a reasonable structure and what ultimately benefits the patients was a significant focus in shaping our approach.”

Inside the model

The initial joint venture, Home Recovery Care LLC, provided all essential components of inpatient hospital care within the home through telemedicine, in-home providers and comprehensive care management oversight. Contessa’s proprietary technology, designed to coordinate home-based hospital care, made this system possible.

Based in Nashville, Contessa is a pioneer in home recovery care. It employs a risk-based model that combines essential elements of inpatient hospital care with the comfort of patients’ homes. Contessa is part of home health giant Amedisys (Nasdaq: AMED).

Home Recovery Care was first offered to patients at AHN’s Allegheny General Hospital and has expanded to include AHN Forbes and AHN Jefferson Hospitals. Since its inception, the program has grown from serving seven patients to more than 40, according to Dr. Vicenta Gaspar-Yoo, senior vice president of care continuum and transitions at AHN.

AHN, a Highmark Health Company, is an integrated health care delivery system that includes 13 hospitals, ambulatory surgery centers, health and wellness pavilions, an employed physician organization, home- and community-based health services, a research institute and a group purchasing organization serving the greater Western Pennsylvania region.

The expanded model, called Home Recovery Care Plus (HRCP), enables patients recovering from an illness or surgery who require additional medical care, physical therapy or occupational therapy to receive that care at home instead of in a skilled nursing or rehabilitation facility. Like the flagship program, patients use remote monitoring devices and connect with a recovery care coordinator (RCC) who oversees the delivery of care managed by physicians in the AHN Division of Geriatrics. Patients also participate in telehealth visits with their health care providers.

Initially, Gaspar-Yoo observed fragmentation among providers and a lack of familiarity with the virtual world among geriatricians working in traditional skilled nursing facilities (SNFs). In contrast, hospitalists were generally more supportive of telehealth visits.

“There was an opportunity for us to streamline,” Gaspar-Yoo told HHCN. “We needed to establish consistency in how our patients were cared for. That’s how we designed the expanded model. There was some initial pushback from hospitalists not accustomed to caring for SNF patients at home. That concern faded after two days when they realized we could apply the same framework without altering their existing work processes.”

HRCP extends 30 days beyond the original treatment plan. During the first one to three weeks, a registered nurse, physical therapist or occupational therapist works with the patient in their home to develop a personalized, physician-directed care plan alongside the patient’s health care team. Following this initial period, the patient’s RCC continues to monitor the patient’s vitals, coordinate care and provide health education for an additional 60 days.

“Executive sponsorship from Highmark is vital,” Gasper-Yoo said. “Highmark supports this initiative because it is economically advantageous for the payer. We avoid costs associated with board, lodging and premium labor if a patient is recovering at home. There is a vision that more recovery care will transition to the home setting in the next five years. It is safer than being in a traditional hospital, with fewer risks of infection. Additionally, rising nursing labor costs and staff shortages make home recovery a more sensible option.”

Benefits and next steps

Contessa’s HRCP data indicates improved patient satisfaction and reduced average length of stay and readmission rates.

“Our patient satisfaction surveys reveal high levels of contentment among those recovering at home,” Gasper-Yoo said. “Leaders received numerous positive messages from patients who appreciated recovering at home with their families, reinforcing our decision to expand this program. We cannot expand our inpatient units without incurring hundreds of millions of dollars; therefore, this is the most viable option. Moreover, reduced infection rates and fewer readmissions are key factors driving our program’s growth.”

Another advantage of the program is increased staff satisfaction and retention.

“Acute care nurses working in home settings report significant satisfaction due to the flexibility of spending quality time with their patients, which is often not possible in traditional inpatient settings,” Nottidge explained.

He highlighted that nurses in hospitals often face interruptions and have limited time for patient interaction. However, in home care, they can bond, educate and make a meaningful impact on patients, often delivering care akin to concierge service.

“Patient satisfaction levels in these models have consistently been very high,” Nottidge said. “Payers are on board with this approach. Patients receive numerous benefits: they remain in their homes, and they tend to be more functional post-discharge, making it hard to argue against this model.”

Despite all these benefits, transitioning the perception of the model from a pilot program to a long-term enterprise has posed challenges.

“Initially, doctors were told ‘you will do this,’ which elicited mixed reactions,” Nottidge said. “However, when we created opportunities for voluntary participation and clearly explained the model, many became interested, leading to higher satisfaction among those involved.”

Looking ahead, Nottidge and Gasper-Yoo hope that showcasing evidence of patient satisfaction, positive outcomes and cost savings will facilitate discussions with health care systems and garner support for the model. However, according to Nottidge, it’s crucial to share success stories intentionally and widely.

“Success does not automatically lead to more success,” he cautioned. “It requires deliberate effort. These programs often struggle because the story behind them and the necessary change management do not keep pace with leadership transitions that occur every three to five years. We need to tell our story purposefully.”