A model being tested in Arizona aims to reduce ED visits and readmissions while lowering the cost of care.
Seniors participating in a pilot study in Arizona can now receive in-home urgent care at the touch of a button, using the same device many elderly patients already wear for medical alerts and fall detection.
The concept addresses many health system goals, such as reducing emergency department visits, preventing readmissions, lowering the cost of care, and providing health services where patients are located.
Mercy Care, a not-for-profit health plan offering Medicaid and Medicare benefits, has teamed up with Philips, the company behind the Lifeline medical alert system, and DispatchHealth, a Denver-headquartered provider of mobile healthcare services, to test the model over the next month.
During the pilot, organizers expect to provide home services to about 300 patients who already have been approved by Mercy Care for Philips Lifeline monitoring. A total of 1,477 patients are covered within this program. Utilization of healthcare services and the overall cost of care will be compared with enrolled patients who do not have the devices.
How It Works
Once a patient activates the alert button, they are immediately connected to a care specialist trained by Philips. If the situation is non-emergent, the patient is then connected to the DispatchHealth clinical support center, which evaluates risk and sends the appropriate medical team to the senior’s home.
Of the 1,362 emergency calls placed by Mercy Care members in 2018, 73% resulted in a visit by emergency medical services, and 22% resulted in hospital transport, explained Christi Lundeen, chief innovation officer at Mercy Care, during a presentation at HIMSS19 in Orlando.
Many of those patients "could have used a different level of service," including home care, Lundeen said. She believes the pilot will demonstrate the ability to reduce costs by focusing on members or families who have a "tendency to use the emergency room … or use 911 as a way of getting services and care."
A Model that Supports Value-Based Care
As health systems move toward value-based care, this pilot offers a model that could address many challenges encountered in serving elderly populations.
"Healthcare costs are rising 600% faster than inflation, nine million seniors will be homebound by 2030 in the U.S., and 50% of all Medicare payments will be value-based by 2020," says Kevin Riddleberger, chief strategy officer and co-founder of DispatchHealth. "Health systems are moving from fee-for-service to value-based care, which requires them to think about the way they are treating these populations differently."
"In this age of value-based care, it’s critical that we provide seamless access to care—when, where, and how patients want and need it," says Philips General Manager of Aging & Caregiving Rip Martin.
This partnership "is an example of how we can work together to provide an ecosystem of integrated solutions to help health systems provide ongoing, cost-effective interventions to patients as they move through different settings and levels of risk. We hope that this pilot demonstrates the benefits of cross-industry collaboration and provides other health systems with an example of how they can also extend appropriate care services to the home setting."
Preventing Readmissions
According to Martin, 57% of Medicare patients are released from the hospital without any direct monitoring by a healthcare professional, contributing to an annual cost for unnecessary readmissions of $17 billion for Medicare patients alone.
"Because seniors tend to be a high-risk, high-cost patient population, they may need additional support for adhering to their treatment plans once they’re out of the provider’s sight," he says. Martin predicts the model will offer lower acuity options for those who don’t require a hospital visit, minimize patient disruption, and prevent readmissions.
"By facilitating the delivery of proactive and preventive care, we give our health systems the ability to address the complexity of high-acuity patients and deliver better value-based care," says Martin.
Serving Patients Where They Are
The dynamics of healthcare delivery are changing as the provision of care moves outside of hospital walls and into patients' homes. At the same time, the system is focusing on prevention and better management of chronic conditions, versus "sick care."
This home-based model dovetails with those trends.
"Connected technology can help build a foundation of intensive and ongoing care coordination, and help reduce the financial burden of unnecessary hospital visits," says Martin. In addition, home-based visits provide a more extensive intervention than is possible in a primary care setting because care givers can observe things that contribute to social determinant of health, such as the type of food patients consume at home or how they are taking their medications.
"Together, Philips, Mercy Care and DispatchHealth are connecting ecosystems to provide integrated care that makes this shift [to home-based care] possible," says Martin. "Healthcare is moving towards the trend of decentralization, and providers need to equip seniors with solutions that activate them to manage their health within their homes. By transforming the current facility-based care model into a full-service in-home care continuum that provides the appropriate medical services and addressing social needs, we not only increase our touchpoints with patients, but also improve their quality of life."
Mandy Roth is the innovations editor at HealthLeaders.