Skip to main content


Seeking Value? Add Nonmedical Workers

By Philip Betbeze  
   January 29, 2016

Investing in community-based services by adding them to payment bundles can reduce readmissions and save significant expense, research suggests.

Hospitals and health systems are under the gun to reduce readmissions. They've been penalized for them since 2012. And that's led many to invest in care management, navigation, and stronger incentives for postacute providers to help keep patients out of hospitals.

It's not enough, says Andrey Ostrovsky, MD.

He says that adding nonmedical personnel into the value equation is critical to bending the cost curve, and he gives two reasons:

  1. Medical personnel don't interact with the patient often enough post-discharge,
  2. Even if they did, their services are far more expensive than what is needed to help keep patients from needing to come back for an acute stay.

Ostrovsky is, of course, talking his book. As CEO and founder of a company called CareAtHand, which uses predictive modeling to forecast when patients are most at risk for a hospital visit, he and his colleagues offer data-driven predictive analytics to suggest mostly non-medical interventions that should reduce the probability of a particular patient needing a return hospital visit.


Andrey Ostrovsky, MD

'It's Not Just about Doctors and Nurses'
He has a pretty impressive set of statistics to back him up, including a peer-reviewed study in the Annals of Long-Term Care: Clinical Care and Aging, which he co-authored. It shows at least a modest effect from using technology and what he calls an "existing underutilized work force" to reduce medical expense while at the same time improving outcomes.

"Some exciting research is confirming that there is bending of the cost curve by investing in home and community services. Currently, the majority of interventions around bundles are medical interventions," he says. "We're trying to ease the blow on health leaders with the fact that it's not just about doctors and nurses all the time, which is what we've been used to with bundling."

He makes a critical distinction between the interventions he's describing and skilled nursing and home health care sites. Many hospitals are seeking to shore up their performance through incentive contracts and preferred provider lists for those care sites that adhere to treatment protocols and interventions the hospital knows will help prevent some readmissions.

How Postacute Care is Evolving

"It's awesome that these are being applied to [skilled nursing] and home health, but they're still performed by skilled clinicians," Ostrovsky says.

"The notion of moving bundles to home and community-based services beyond skilled care gets at what are the real causes of good health. I'm a physician who has been raised with the biases of doctors. We are the end of the line when someone's going downhill. We know the stuff with diseases, but when it comes to meeting the person or consumer where they are, they're mostly not in the hospital."

In fact, he says, research suggests that among the determinants of health, only 15% to 30% comes from medical care.

Philip Betbeze is the senior leadership editor at HealthLeaders.

Get the latest on healthcare leadership in your inbox.