The Memorial Hermann Health System is partnering with a digital health company to make sure patients undergoing cancer treatment have a care team around them at all times—especially at home.
Health systems looking to maximize care for patients undergoing cancer treatment are finding value in innovative partnerships that focus on care management and monitoring at home.
"At 3:00 in the morning when a patient is awake and afraid and has pain that they've never felt before, or a nausea that is unceasing, and they've maybe forgotten [to] take that medication, they can pick up the phone," says Sandra Miller, MHSM, RN, NE-BC, VP of the oncology service line at Houston's Memorial Hermann Health System. "They can call, they can talk to someone right away, who can then help them to deescalate and think clearly about what next steps would be."
Those patients aren't necessarily calling the hospital. They're calling a care team employed by Reimagine Care, a Nashville-based company that focuses on cancer care services in the home. That team, which includes oncology nurses and advanced practitioners, enables patients to access care on-demand, while giving Memorial Hermann a platform on which to integrate its clinical team.
"It's a good model for this type of program because we know that cancer patients are terrified," Miller says. "Their levels of anxiety and depression are very high. They need a very strong support team … as an additional component to their family members and their clinical teams that see them regularly."
Partnerships like this are a crucial factor to improving care management and coordination at a time when health systems and hospitals are dealing with workforce shortages and inpatient care stresses and embracing concepts like remote patient monitoring (RPM) and home-based care. Through programs like collaborative or connected care, they can create programs around patients with complex care needs.
And they'll become more important as healthcare innovation leaders develop the Hospital at Home concept and look at improving care coordination for patient groups, such as those with chronic conditions.
Miller points out the partnership enables Memorial Hermann to focus on inpatient and acute care—care for which patients either need to be in a hospital or need to be seen by a clinician—while separating the tasks and services that fill up their workflows but could be handled by other members of the care team.
"It relieves the burden of late nights and overtime and late hours for providers and for nurses," she says.
Reimagine Care is one of dozens (if not more) of companies that have sprung up over the past two decades to tackle care management outside the hospital, offering 24/7 services and the ability to hand off to the hospital when the need is escalated.
The company's CEO, Dan Nardi, says Reimagine Care focuses on cancer care and targets a pervasive pain point for hospitals: Managing care outside the hospital or doctor's office and in between the visits. He cites research conducted in 2023 that found that 82% of patients want to be treated as much as possible at home, and more than 90% want to be able to connect with a member of their care team on demand, whenever they need to make that connection.
Without this type of partnership, a patient might call a doctor's office or hospital and find there's no one to talk to at that moment, and then they might decide to go to the Emergency Department.
The ER "is the last place they want to be," says Miller. She notes that in the year and a half that Memorial Hermann has worked with Reimagine Care, unplanned ER visits have dropped below the national average, while patient satisfaction has improved.
Miller says the platform is proving especially valuable to younger patients and those with families and jobs—patients who are balancing the demands of everyday life with their care routines and having little time to spend on trips to the doctor's office or ED beyond their scheduled visits.
And by creating a care team bolstered by Reimagine Care, Memorial Hermann is able to create room for more patients, especially those facing barriers to accessing care.
"This creates capacity for new patients," Miller says. "There are always patients waiting. There's always a wait time to see a new provider and we don't want patients to wait who have cancer. By being able to triage patients to home care or home support, we're able to see new patients who are waiting, who are sick, who need the attention and time of a medical oncologist. So creating capacity for new patients is paramount in this relationship."
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Faced with workforce shortages and growing pressures on inpatient care, health systems and hospitals are collaborating with innovative companies to improve care management at home and after hours.
These partnerships are especially beneficial for patients undergoing cancer treatment, who often face harrowing care journeys and need on-demand support and access to care.
These programs frequently use remote patient monitoring, telehealth and AI technology to improve care management and coordination, giving clinicians a better look at what patients are going through at home.