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How At-Home Urgent Care Pays Off for Atrius Health

Analysis  |  By Debra Shute  
   December 15, 2016

Atrius Health's Care in Place program brings urgent medical assistance to patients who can't get to the doctor's office, boosting patient satisfaction and cutting costs.

Medical groups have come a long way toward providing same-day access for patients in need of prompt care.

However, for elderly patients who can't arrange transportation or don't feel well enough to the visit the office, the options—delaying care or calling an ambulance—don't bode well for patients or healthcare organizations.

To solve the problem, Atrius Health deploys care to patients who can't come to the office, says Steven Strongwater, MD, president and CEO of the Newton, MA-based nonprofit health system. Atrius spans 29 clinical locations, 50 specialties, and 750 physicians.

Strongwater described Atrius's new Care in Place program at the HealthLeaders Physician Organizations Exchange, held last week in La Jolla, CA.

Within three months of launch, the Care in Place program's estimated $97,000 up-front development and implementation costs have generated savings of $509,000 in avoided ambulance fees, and emergency department and hospitalization costs, says Eliza Shulman, DO, MPH, a senior chief innovation engineer at Atrius Health.

Atrius based the program's estimated savings on patient and provider feedback. "Half of these patients have said, 'I would have gone to the ER if you hadn't been able to come here today,' " Shulman says.

Decreases in patients' total medical expenses are very good news for Atrius, which receives 75% to 80% of its revenue from global capitated risk and does not own any hospitals.

"Essentially, we behave as though we're at full risk," Strongwater says.

More than Money
Both patients and physicians have lauded the service, showing that cost savings isn't the program's only benefit.

A sample patient testimonial from Strongwater's presentation:

"Everybody did a great job; they are all very good. The X-ray tech… made it as easy as possible to get an X-ray, it worked out very well. I'm glad I didn't have to go anywhere."

Physicians' feedback has also been highly favorable, says Shulman.

"Whatever we develop out of the Innovation Center has to increase joy in practice and not be added work on the clinician. So we've said, 'These patients you're worried about—we're going to see them, create a plan of care, and not interrupt your day to make you coordinate a lot of services.' "

After the home visit, the provider (usually a registered nurse) generates a care plan and gives it to the patient's primary care physician, Shulman explains.

Eventually, the system hopes to expand the program to high-risk populations, such as those with congestive heart failure.

How it Works
Deploying care to patients can be challenging to implement. One major task is educating patients to call the office when they are very ill or injured, Strongwater notes.

Complex Care 'Playbook' Addresses Medical, Social Needs

Under Massachusetts law, if a patient calls 911, he or she must be taken to a hospital ER, he adds, noting that the elderly have a 51% chance of being admitted under such circumstances.

When Atrius Health patients call their physician office instead of 911, triage nurses determine whether the problem is serious enough to send them to the ER, or if a same-day office visit is sufficient.

If a patient over age 65 is eligible for a same-day visit but can't make the trip, an Atrius nurse places a referral for a nurse from the Visiting Nurse Association to visit the home within two hours, with no copay to the patient.

Because of Atrius's close relationship with the VNA, the visiting nurses have access to patients' medical records, Shulman says. The nurses also have phone access to a medical control officer at Atrius to help with decision-making, which cuts down on the cost of personnel deployed to the home.

That access to information is key to Atrius's program, according to Shulman. "Being on the same medical record is so important because you're able to provide a much higher level of care when you know a lot about the patient."

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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