As we reported on Feb. 1, the Louisville-based Humana announced on that date that it was partnering with the Denver-based DispatchHealth, an in-home medical care company, to provide an advanced level of care in members’ homes.
In a press release posted to Humana’s website on Monday, the company announced that “These services will be available in Denver, Colo., and Tacoma, Wash., with expansion to additional markets in Texas, Arizona and Nevada planned for later this year. The agreement will provide members living with multiple chronic conditions – such as cellulitis, kidney and urinary tract infections, chronic obstructive pulmonary disease, heart failure and many others – an opportunity to be treated safely at home and thereby avoid hospital visits. Last November, the U.S. Centers for Medicare & Medicaid Services announced a waiver program to allow qualified health care providers to offer acute, hospital-level care in the home. The Dispatch-Humana agreement is believed to be the country’s first program to provide hospital-level care involving a national payer.” The press release referenced the following statistics: that, according to the Centers for Disease Control and Prevention (CDC), 56 percent of adults aged 65 and above have two or more chronic conditions; and that 63 percent of U.S. adults prefer to receive care at home.
“The agreement enhances Humana’s holistic approach to patient care and empowers clinicians to go beyond traditional clinical treatment,” said Susan Diamond, President of Humana’s Home Business, in a statement contained in the press release. “Humana and DispatchHealth are focused on improving the overall home care experience and health outcomes by allowing individuals to remain at home while also empowering the medical team to identify and address patient needs, including social determinants of health.”
As the press release noted, “The agreement will provide members living with multiple chronic conditions – such as cellulitis, kidney and urinary tract infections, chronic obstructive pulmonary disease, heart failure and many others – an opportunity to be treated safely at home and thereby avoid hospital visits. Last November, the U.S. Centers for Medicare & Medicaid Services announced a waiver program to allow qualified health care providers to offer acute, hospital-level care in the home. The Dispatch-Humana agreement is believed to be the country’s first program to provide hospital-level care involving a national payer.” The program will initially roll out in Denver and in Tacoma, Washington, with further rollouts planned in Texas, Arizona, and Nevada, later this year. And it noted that “DispatchHealth’s unique model and technology empower clinical care and coordination of other critical services, such as pharmacy and meal deliveries, physical and respiratory therapy, Durable Medical Equipment (DME) access and imaging services.”
“Now, more than ever, it is critical that our most vulnerable patients have access to care and avoid unnecessary hospital admissions,” said Mark Prather, CEO of DispatchHealth, in the Feb. 1 press release. “Our Advanced Care services safely provide in-home medical care for acutely ill patients requiring multiple days of treatment. The natural link between our on-demand service offering and Advanced Care delivers on the vision of a hospital-like setting without walls. We look forward to expanding our relationship with our forward-thinking partner, Humana.”
As Joyce Famakinwa wrote in a Feb. 1 news report on the development in Home Health Care News, “The new in-home care initiative is focused on treating medical conditions that require urgent intervention but not necessarily hospitalization. Some of the chronic conditions include chronic obstructive pulmonary disease (COPD), heart failure, cellulitis, urinary tract infections and more.”
What’s more, Famakinwa wrote, “In order to determine who is a good fit for the initiative, Humana plans on using analytics to identify which members frequently or inappropriately use the ER for non-emergent care, Susan Diamond, home care business president at Humana, told Home Health Care News.” And she quoted Diamond as stating that “We will identify those members and do outreach to educate them on the availability of home-based services. “We’ll encourage them to contact Dispatch in an event where they feel like they might need to visit the ER. We’re doing this so we can get more of our members using an appropriate site of care.” In addition, Humana’s physician network can also refer patients to receive care from DispatchHealth, she noted.
So here’s what’s interesting about all of this: the major commercial health plans have for many years desired to bring down the level of hospitalizations and rehospitalizations of plan members living with chronic illnesses. And they’ve been able to bench some successes, especially in care management programs run by multidisciplinary care teams based in multispecialty medical groups—some independent and some embedded in integrated health systems. But when it comes to acutely ill patients—patients who by and large continue to be admitted as inpatients—health plans have lagged behind hospital-based health systems in creating hospital-at-home programs.
What seems clear now is that the gap involved has been the inability of health plan care and case managers to work directly with clinician teams that could provide the immediate care that so often still involves ambulances ferrying people to hospitals. Now, the physicians and nurses at Dispatch are set up and empowered to work in a multidisciplinary way to handle a range of serious, emergent conditions, including according to their website, “congestive heart failure (CHF) exacerbations,” “COPD exacerbations,” “coronavirus,” “heart palpitations,” “high fevers,” “injuries resulting from falls,” “ pneumonia,” “upper respiratory infections,” “cuts and lacerations that require stitches,” and a range of other serious medical situations (see the list of conditions here), as those conditions become apparent among a defined set of patients whose health histories the Humana care managers already know.
The reality is that many medical conditions would in the past have required hospitalization not because they were ICU-level conditions, but rather because the healthcare delivery system was not organized to respond to them in the home. Now? It appears that, for the first time, a major national health plan has unlocked the code around all of this.
One way to think about this is to see it as an extension of the urgent-care model, applied to more emergent conditions and situations. Indeed, the DispatchHealth people not on their website that “We are in-network with most insurances and typically cost the same as a traditional urgent care visit.”
Now, it’s important to note that DispatchHealth is actively marketing itself as a partner to hospital-based health systems as well. For example, there’s this, on the company’s website: “DispatchHealth provides high acuity medical care that has been proven to drive significant savings in at-risk populations. We deploy our services in coordination with your organization’s unique needs, to serve patients in your risk populations with chronic, high acuity medical needs, as well as to identify and address social needs such as food insecurity. In partnering with DispatchHealth to achieve savings in your value-based arrangements, health systems will: significantly reduce medical costs in risk populations by optimizing the cost of care for the medical needs of at-risk patients; ensure effective communications across the continuum of care; more readily address the social determinants of health (SDOH); provide alternative resources for your staff, patients and community partners; change patterns of behavior in your at-risk populations; mitigate the risk of investing in unproven care models and new facilities.”
Meanwhile, addressing “large payers” on its website, the company states, under the heading “Lower Cost,” that “DispatchHealth helps decrease total cost of care for at-risk populations and frequent utilizers of emergency department for non-emergent conditions. A visit with DispatchHealth costs roughly the same as a walk-in urgent care visit, and nearly one tenth of the medical cost for an ER visit. On average, patients pay between $5-$50 depending on their specific insurance plan. In 2019 alone, we delivered care to more than 71,000 patients, with an average cost savings of $1,200 per patient. We’ve totaled nearly $225 million in cost savings.” And under the heading “Improve Outcomes,” the company notes that, “Since inception, DispatchHealth has prevented over 92,000 ER visits and 2,900 hospitalizations.”
What the folks who’ve developed this initiative clearly understand is that in order to provide an alternative to traditional inpatient hospitalization, one must put into place a number of elements, including an effective care management program; a corps of clinicians appropriate to the levels of care needed to bridge the gap between urgent care and inpatient care; the supply chain and medical equipment matériel needed; and clearly, the electronic health record (EHR) and data analytics tools needed to manage all the processes involved and keep everyone connected.
Now, we’ll have to see how this model works out in practice over time, and how scalable it is. But if this program works out well, it could signal a new phase in the ongoing evolution of care delivery—and not surprisingly, put pressure on hospital-based health systems to improve their efficiencies, in the face of a real potential industry disruptor. Sometimes things start out relatively small in healthcare and suddenly become big. This idea could potentially grow into something significant and lasting; only time will tell. But one would have to think that federal healthcare officials would be watching this development relatively closely. As will the rest of us.
