At-home care providers are looking to the future. This means seriously investing in alternative home-based care models, such as hospital-at-home and Program of All-Inclusive Care for the Elderly (PACE).

DispatchHealth, Contessa Health and Alivia Care are some of the organizations that have jumped headfirst into alternative home-based care models, enabling the creation of more comprehensive care delivery models. While alternative care models come with inherent challenges, including a complex regulatory environment and higher capital investments, these models are set to become an expectation for home-based care providers.

To build out its home-based care capabilities, Contessa Health started with hospital-at-home.

“Our initial thought process on it was this is, for all intents and purposes, the highest acuity care we could imagine in the home,” Dr. Robert Moskowitz, chief medical officer at Contessa Health, said at Home Health Care News’ Capital+Strategy conference in April.

Contessa Health has provided comprehensive in-home care since 2015. The company is based in Nashville, Tennessee, and partners with 11 health systems and multiple health plans, serving patients in nine states.

Once Contessa Health established a strong hospital-at-home program, the company looked to expand its advanced care capabilities in the home.

“It was intentional, once we got that sort of chassis built, so to speak, to then do skilled nursing at home, palliative care at home, so we could have that capability of partnering with health care systems to create that longitudinal journey for the patient,” Moskowitz said.

On its end, DispatchHealth began as an in-home urgent care company. Over the years, the company gradually moved into the hospital-at-home space as well.

One of the key components of the company’s care delivery model is its bridge care program, Jennifer Webster, CEO of DispatchHealth, noted.

“[Bridge care is] after that patient is discharged, in the 30-day window that follows that discharge, helping to make sure that patient doesn’t readmit to the hospital,” she said during the panel discussion. “All the way from that pre-acute, acute, post-acute continuum of high-acuity care is where we’re really focused as an organization.”

DispatchHealth offers a range of health care services to patients in their homes, including hospital-at-home. The company has treated more than 1.2 million people across more than 20 states in the U.S. since its inception. It recently merged with Medically Home.

The merger is another piece of the puzzle that allows the company to deliver greater value to its health system partners.

“If you think about the value proposition to our partners — who are health plans, health systems and value-based providers — whether they want an enablement model [like Medically Home] to be able to do it on their own, or a care delivery organization like DispatchHealth to do it on their behalf, we’re now able to do all of that spectrum of high-acuity care in the home,” Webster said.

For Alivia Care, PACE has served as another avenue to expand the company’s service lines. In 2021, Alivia Care opened Jacksonville, Florida-based The PACE Place.

“It is a model that provides longitudinal care to these patients who meet the criteria, from a functional standpoint, to reside in long-term care, but prefer to stay in the community,” Susan Ponder-Stansel, CEO of Alivia Care, said. “It’s been called the gold standard of care, because it really does manage everything.”

Jacksonville, Florida-based Alivia Care provides home health care, hospice care, personal care, palliative care, advanced care planning and PACE services across Northern Florida and Southern Georgia.

Despite describing PACE as the “gold standard” of care, Ponder-Stansel was also open about the challenges that come with operating a PACE program.

“There’s a capital need that is beyond starting a home health or hospice because you’re basically receiving a capitated payment,” she said. “You are fully at-risk. You are the health plan, and that can be very daunting for organizations to become a health plan, not only because of the financial risk and the capital, but also you have to build an entire care network.”

Ponder-Stansel also pointed out that PACE providers must navigate a complex regulatory environment.

“It’s a three-way contract,” she said. “You have CMS and your state health agency, so they’re both involved, and then you’re the third party to the contract, but it’s very process-driven. If you miss one step in the process, you really have trouble. It is a big thing to bite.”

Contessa Health and DispatchHealth are currently in dialogue with several PACE programs.

“I think PACE programs are a natural progression of where this dialogue is,” Moskowitz said. “It’s just a matter of figuring out the pieces.”

When thinking about the future of PACE, Ponder-Stansel made reference to the PACE Part D Choice Act, which she believes would help the business boom and expand access to this care.

Looking ahead, Webster believes that alternative care models will become the industry standard.

“It’s not going to be an alternative,” she said. “It’s going to be the expectation. It absolutely is going to be where patients want to be treated. It’s going to be established as a lower-cost setting of care. It’s going to be established as an opportunity to release the capacity challenges of our brick and mortar systems.”