On May 25, the Health Care Council of Chicago (HC3), in collaboration with Ziegler, hosted an in-person conversation about home health models. A panel discussed the reimbursement dynamics associated with such models and the advancement of digital tools that enable providers to monitor and address the needs of patients in ways that are most convenient and conducive to their condition.
Brian McGough, Managing Director, Ziegler
Denise Keefe, President/Executive Vice President, Continuing Health, Advocate Aurora Health
Sheetal Sobti, System Vice President and Category Leader, Aging Independently at Advocate Aurora Enterprises
Cheryl Hilton, D.O., Chief of Chronic Care Services, Alegis Care
Carla Robinson, CEO, Canary Telehealth
Bill Wynn, Vice President of Strategic Partnerships, Virtue Sense
HEALTH SYSTEMS CONTINUE TO EXTRACT VALUE OUT OF HOME-BASED CARE PARTNERSHIPS | Home Health Care News | May 25, 2022 | Link to Article Here
Event Presentation Slides - 5.25.2022
Video Recording coming soon...
Ziegler Managing Director Brian McGough kicked off the event with an overview of the evolution of “at-home” health care models. For the next phase in the development of health care, providers and health care institutions will need to rethink and revamp their investments in innovation and traditional forms of care. At-home health care models are being developed and implemented to meet the patient where they are. Following his remarks, experts discussed their efforts to meet patients where they are.
Advocate Aurora: Denise Keefe and Sheetal Sobti
Advocate Aurora (AA) began focusing on the evolution of the patient four years ago in their hospice business. Over time, AA has taken on more risk and value-based contracts to help enable people to stay home. The health system continues to broaden the definition and evolution of its “home health” service areas. Through AA’s enterprise efforts, they have been focused on finding innovative services and products to help seniors age, ideally in their homes. They have invested in and explored senior helpers – personal care services, mobile health, personal emergency response solutions, and remote patient monitoring.
Virtue Sense: Bill Wynn
Virtue Sense is focused on utilizing Artificial Intelligence (AI) to augment and provide proactive care. Their chief focus is using remote monitoring technology to address the number and cost of falls. Virtue Sense currently supports 1.2 million patients across the United States and has reduced fall rates among their patient population by 96 percent. According to an independent study, since 2019, they have proactively prevented ~106,000 falls, 23,000 of which would have resulted in an injury.
Virtue Sense conducts high-risk patient monitoring through a sensor mounted on the patient’s wall and maps the entire room in 3D using the same technology as self-driving cars (not full video). AI then determines the risk and intent of the patient getting out of bed and alerts their provider and care team that the patient is getting up 65-70 seconds ahead of time. Their sensors have been proven to be 98 percent accurate, so the care team is not responding to false alarms.
Virtue Sense also offers a wearable device that collects all vitals every minute and an EKG that connects to Wi-Fi or cellular networks. Their wearable device analyzes a patient’s balance and speed within 15-30 seconds and predicts a patient’s risk of falling within the next 6-12 months using AI technology.
Canary Telehealth: Carla Robinson
Canary Telehealth (Canary) was started in 2014 with in-home services. As they expand their services and products, they remain focused on improving access and closing the gaps in quality care. Their remote patient monitoring is dedicated to more high-risk patients. They also have self-managed chronic care management through a smartphone application that offers tracking, education, health tips, feedback, etc. They follow a Centers for Disease Control and Prevention (CDC) evidence-based diabetes prevention program that is also delivered virtually.
Canary’s call center has done outreach campaigns for screenings, such as mammograms and cervical cancer, complemented by their team’s coordination for the appointments of those screenings and services. Some of their in-person services don’t require a provider, but they will send a technician to the home. For example, for a remote eye exam, a technician will be dispatched to the home to take retina pictures to be shared with the optometrist for a remote review. Their overall use case for providers is a customizable workflow based on their needs. Some use Canary’s care teams, and for others, Canary provides the devices/equipment requirements. Overall, Canary’s services can reduce hospitalization costs by 40-60 percent, decrease emergency department visits, and improve patient outcomes. They service a wide range of populations and have expertise in underserved populations, primarily serving Medicaid/Managed care patients for the past eight years.
Alegis Care (a subsidiary of Cigna): Cheryl Hilton, D.O.
Alegis’ core business is in-home primary care services. They customize treatment to patients who cannot access routine care in the office (e.g., homebound, transportation issues, etc.) and offer nurse triage with 24/7 phone support, transitional care, palliative care, and behavioral health services – 60 percent of their patients struggle with behavioral health issues. They are continuing to evolve and move to a full-risk model of care.
Overall, they focus on whole-person care and care in the home, making it easy to identify and address social determinants of health (SDOH) (e.g., looking in their fridge to see if they have healthy or any food). They have social workers in each market, and their social work model can connect patients with resources or even transition patients as needed.
Panel Discussion / Q&A
Q: We are seeing a lot of non-traditional collaborations and ample discussion around SDOH. Do you think that kind of chatter will continue going forward as folks look to collaborate in various ways and probably end up leaning into home health?
A: We intend to continue to grow value-based and risk-based contracts, allowing us to be 100 percent responsible for the patient and their health journey. That is an incentive for care to be more longitudinal rather than point solutions. (Keefe)
A: Care is usually episodic, but we know care is needed in between. Advocate Aurora has been thinking about how we can extend our reach into adjacent health/wellness spaces to support patients not only when they are in our clinical environments but also at home to help them with their ongoing health journey. (Sobti)
Q: You are interfacing with many providers in different settings. The care continuum continues to change, but hospital systems are known for being nimble. As you push out home health solutions, are you finding receptivity? How do they complement previous offerings or support things like addressing SDOH?
A: Yes, one of our focuses last year was reducing utilization and readmission. We instituted a program that supported patients four days post-hospitalization discharge, down from 10. Our objective continues to focus on how we can better support patients as soon as possible, ensuring they partner with the hospital. Hence, the patient receives medications or equipment they need at home to succeed in their treatment. COVID-19 forced us to think outside the box and provide more care virtually. (Hilton)
A: Collaborations have been very ambitious. For example, a patient needed a medication adjustment because they were experiencing hypertension symptoms – dizziness and fatigue. The nurse contacted the patient because her vitals were alarming and brought her in to be seen and get the medication adjustment she required. For a lot of the providers we work with; we are their “eyes and ears in between those visits to the doctor.” (Robinson)
A: In the acute world, there is a lot of receptivity and a need for remote patient monitoring. It is a bit slower moving into hospital systems, but we are in systems that need to reduce fall rates and can utilize technology for telehealth nursing. Early detection and monitoring come into play in addressing SDOH for patients in underserved areas where heart disease, diabetes, and obesity are more common, particularly if they have limited food/grocery access. (Wynn)
A: Some of the challenges that providers are facing are the economics. Unless the payer is willing to pay or the health system can make the economics work, there is the issue of lack of reimbursement for home health. How do we develop a case that there is value in investing in that technology? This work would accelerate a lot faster if that were addressed. (Keefe)
Q: What were some of the significant learnings that came out of the COVID-19 pandemic in the home health space?
A: From a provider perspective, we learned that most of our patients are isolated. We were often the only contact the patient had with the outside world. We didn’t think telephonic or virtual visits would take off when we had to stop in person, but they did because patients still needed the connection and care. Technology helped us to make those connections. (Hilton)
A: During the lockdown phase of COVID-19, in a post-acute environment, many patients did not have access to family, other patients, etc. We saw falls and injuries rise during this time because patients were deteriorating at such a rapid rate from the isolation. Having telecommunication with family or even their care team helped those patients immensely. (Wynn)
Q: We’re hearing a lot about capital planning in hospitals. Dollars allocated towards home health (or anything not happening on campus) are getting more attention. Have you seen this?
A: Hospitals are very hungry for capital. Medicare predicts that 20-25 percent of institutional care will shift to home-based by 2025. We need to pay attention to that and adjust capital allocation. (Keefe)
Q: Older adults are less familiar with some of the newer technologies. How do you address the educational component of this population?
A: We work with patients that have chronic conditions, often seen in older populations, so from the start, it has been baked into the program design. We utilize technologies that are as straightforward and user-friendly as possible. We use large fonts, make it very easy to navigate and try to incorporate simple steps. Even with all that in mind, the critical success factor is the onboarding process – making sure they know how to use the apps and helping them manage any adjacent devices they may require. The simplicity of technology is essential, even for people familiar with the technology. (Robinson)
A: Some of our technologies are just plug-and-play. For the wearables, they are connected to Wi-Fi from the start. We have a team that goes to the home to do the setup. They can talk to the patient immediately. We also have a customer success team that follows up every month (sometimes more frequently in the early stages) to ensure everything is working and they don’t have any questions. We also can use cellular data for patients who may not have access to Wi-Fi, especially in rural areas. (Wynn)
Q: Do home health solutions and remote patient monitoring allow for and help identify, assess, and address SDOH and risk assessment?
A: One of the approaches we use is developing exclusion criteria for systems to roll out to providers, which allows primary care providers to perform the risk assessment themselves. (Robinson)
A: We do risk assessments monthly and SDOH assessments quarterly. (Hilton)
A: Data and predictive capabilities allow us to pool high-risk patients and use an assessment to determine what tools/care would be best for each patient. (Keefe)
Q: Do you sense that the Centers for Medicare & Medicaid Services (CMS) is accelerating or trying to gain insight into technology applications for Medicare?
A: Over the course of the pandemic, some waivers allowed for reimbursement for care in the home; we hope that this will continue beyond public health emergencies. CMS’ goal is to move towards more value-based care, which will probably be included. (Keefe)
Q: How are you preparing for an influx of patients who deferred care as COVID-19 starts to slow down?
A: One of the projects focuses explicitly on patients who deferred care during the pandemic. Over the past couple of years, our concerns were that people were not getting screenings done. So, we did a campaign to get those screenings coordinated for patients. (Robinson)
Thought leadership reports from Ziegler on this topic: