Why Cleveland Clinic ACO Teamed With Virtual Dementia Care Provider Remo Health

Remo Health, a virtual dementia care provider, is involved in a pilot project with Cleveland Clinic Medicare Accountable Care Organization (ACO) to deliver comprehensive support to patients living with dementia and their caregivers. Sabrina Chugani, Remo Health’s chief growth officer, recently spoke with Healthcare Innovation about her company’s business model of partnering with ACOs and health plans to provide a virtual care team that supports both patients and caregivers.

Remo said its partnership with Cleveland Clinic ACO extends their reach, particularly in rural areas, by offering continuous support and education. 

In a statement, Jessica Hohman, M.D., president of Cleveland Clinic ACO, said that as dementia becomes increasingly prevalent, it will place significant pressure on the healthcare system to meet the complex and continuous needs of patients and their caregivers. “We’re excited to embark on this collaboration to deliver wraparound care and support that extends beyond the clinical setting and into the home. It’s important we continue to search for innovative solutions to help guide patients and families through every stage of the 24/7 dementia journey,” she added.

Chugani has extensive experience in value-based care and population health. Prior to joining Remo, she did stints at the Advisory Board, Care Journey, and Cricket Health, which works to slow down the progression of kidney disease.

Healthcare Innovation: Can you talk about the role virtual care can play for families dealing with dementia and the founding of Remo Health?

Chugani: All of the co-founders, including our CEO who is an internal medicine doctor, have lived experience with family members and dementia. We realized that we’ve got to be able to deliver better care for families. The question is how do you take a different business model and apply it to this part of healthcare to drive innovation for vulnerable populations of older adults, and leverage technology in a meaningful way?

It’s been really important to us not to just build a widget to solve a problem, but to look at the problem and have an absolute understanding of why parts of the problem exist, and use technology to actually create this time and space for empathy to occur as it relates to the delivery of care. We want to use technology to take some of the stress out of the day to day for patients and caregivers. So before we built anything, we talked to hundreds and hundreds of family caregivers who said, “My biggest problem is that it's very stressful to bring my loved one out of their routine and take them to the doctor's office, so if you could bring the care to me, I would really appreciate that.” So that is what we are building here. 

HCI: Is the business model to partner with ACOs like Cleveland Clinic’s or payer organizations? Are they interested because it’ll bring efficiencies and improve outcomes for these patients who are under their care?

Chugani: Yes. We built technology and we have what we call a full-stack care team. That team is M.D.-led and includes a social worker, care navigator, pharmacist, and nurse. Our customers are any organizations bearing financial responsibility for Medicare patients. That could be an ACO, that could be a health plan, that could be a risk-bearing entity that's financially responsible for older adults. The value proposition is that our care team and our caregiver support platform wraps around the patient and caregiver to keep that dyad safe at home and out of the hospital. We do that by deploying caregiver support interventions. Our care team deploys safety interventions. We de-prescribe and get people off dangerous medications. We have a whole host of interventions that keep people out of the ED and out of being admitted. 

We’re helping reduce those potentially avoidable hospitalizations, because we're equipping caregivers with the support that they need to care for their loved one. 

We're also diagnosing dementia. The status quo is that dementia is not getting diagnosed early enough. What ends up happening is because people don't have guidance and know what to expect, they don't have a plan in place. They’re ending up in the ER because their loved one is hallucinating or presents challenging behaviors. We diagnose, treat and manage and support the full dyad. We address their medical and social needs, and we leverage our risk stratification models to make sure we know which interventions to deploy at which time. The day-to-day management is really quarterbacked by a care navigator, a social worker. 

HCI: What has the model shown with regard to outcomes so far?

Chugani: To date, we have driven a really significant reduction in hospitalizations and ED visits. About 50% is the reduction I'm talking about. We also have reduced utilization of high-risk medications. So we're seeing that most older adults are on medications they shouldn't be on, and some medications can accelerate cognitive decline. We really focus on getting people off dangerous medications so that we can reduce fall incidents. We reduced utilization of high-risk meds by over 70% and reduced fall incidents by over 80%, so this is working. The predicate evidence we have for this includes randomized control trials that were done at UCSF, UCLA, Ochsner, Emory and Johns Hopkins. We took all of those learnings to define our care model and the interventions that our care team is deploying.

HCI: Is Remo Health participating in CMS’ Guiding an Improved Dementia Experience (GUIDE) Model to support people with dementia and their caregivers?

Chugani: We are a GUIDE participant. We had built out our models of care and our caregiver support platform before the program was announced. We  are very bullish on the GUIDE model in terms of what it means for policy writ large, and where we go. I think CMMI has done an excellent job of looking at what has worked in different populations, and trying to determine how we take that, put it into a set of requirements, and evangelize this type of care and caregiver support.

Although we don’t yet have precision treatments for dementia, there is a lot we can do for people who are diagnosed in the community by neurologists or by geriatricians. But there is a shortage of those types of providers, and the wait times can be very long to get in to see some of those providers,

Primary care struggles to diagnose dementia because it’s time-consuming. So how do you support a primary care doc to make that dementia diagnosis? You’ve got to be able to extend their reach. And that's part of our value proposition for an ACO — we can extend their reach. 
 
HCI: Does GUIDE require Remo to have an ACO or payer partner or can it participate on its own?

Chugani: We can serve dyads on our own. We're not required to have a health system partner. The advantage of having a health system partner is brand trust and credibility in regions. There's a mutual value exchange there. An ACO has a vested interest in keeping their dementia patients safe at home, out of the hospital, and they have an interest in accurately capturing the risk of their patient population.

HCI: Can you talk about the partnership with Cleveland Clinic ACO and how this will help from their perspective?

Chugani: The impetus for the partnership with the Cleveland Clinic ACO was discussions we were having long before the GUIDE model was even announced. The Cleveland Clinic ACO has made a concerted effort to support their patients and enhance what they are providing as an ACO. We're really acting as a virtual extension of their care teams to offer continuous support, bridging the gap between appointments. We are helping them support their more rural, underserved ACO members by delivering this comprehensive dementia care that is complementary to  what they're doing already, but offering education and peer support to  drive the outcomes that they're looking for. 

There's just a tremendous gap in credible and accessible information for family caregivers today, and when caregivers burn out, they are almost 70% more likely to take their loved ones to the ER, so that's a big problem. When we started engaging with the Cleveland Clinic ACO, what really stuck out to them was how thoughtful we are about engaging that family caregiver and how we can help extend their reach and support their primary care practices, and ultimately drive the outcomes that we're all looking for.