Since its launch 5 years in the past, a partnership between Contessa, Highmark Well being and Allegheny Well being Community (AHN) has expanded and is starting to show the worth – for sufferers, physicians and payers – of delivering extra acute care at house.

Highmark, AHN and Contessa introduced a partnership in 2020 to launch a home-based acute care mannequin for Highmark well being plan members. The mannequin has since been tailored to supply hospitalized sufferers with an alternative choice to expert nursing and rehabilitation services after discharge. This various is rehabilitation at house.

“We needed to decide not solely what an excellent mannequin would appear to be or what the longer term may convey, but in addition what docs need and the way they like to work, even when they weren’t conscious of their very own preferences,” Dr. Michael Nottidge, senior vice chairman and nationwide medical director at Contessa, informed Residence Well being Care Information. “Bridging the hole between an efficient working mannequin, doctor expertise, affordable construction and what finally advantages sufferers was a key focus in shaping our strategy.”

Inside the mannequin

The unique three way partnership, Residence Restoration Care LLC, offered all important elements of inpatient hospital care at house by means of telemedicine, house care suppliers, and complete care administration oversight. Contessa's patented expertise, designed to coordinate house care throughout hospitals, made this technique attainable.

Primarily based in Nashville, Contessa is a pioneer in house restoration care. It makes use of a risk-based mannequin that mixes important parts of inpatient hospital care with the consolation of the affected person at house. Contessa is a part of house care large Amedisys (Nasdaq: AMED).

Residence Restoration Care was first supplied to sufferers at AHN's Allegheny Normal Hospital and has expanded to incorporate AHN Forbes and AHN Jefferson hospitals. Since its inception, this system has grown from seven sufferers to greater than 40, in line with Dr. Vicenta Gaspar-Yoo, senior vice chairman of care continuum and transitions at AHN.

AHN, a Highmark Well being Firm, is an built-in well being care system that features 13 hospitals, ambulatory surgical procedure facilities, well being and wellness pavilions, an employed doctor group, house and group well being companies, a analysis institute and a gaggle buying group. serving the larger Western Pennsylvania area.

The expanded mannequin, known as Residence Restoration Care Plus (HRCP), permits sufferers recovering from sickness or surgical procedure who require further medical care, bodily remedy or occupational remedy to obtain that care at house quite than in a talented nursing or rehabilitation heart. Just like the flagship program, sufferers use distant monitoring tools and hook up with a restoration care coordinator (RCC) who oversees care supply managed by physicians within the AHN Division of Geriatrics. Sufferers additionally take part in telehealth visits with their suppliers.

Initially, Gaspar-Yoo famous fragmentation amongst healthcare suppliers and an absence of familiarity with the digital world amongst geriatricians working in conventional expert nursing services (SNFs). In distinction, hospital physicians had been typically extra supportive of telehealth visits.

“There was a chance for us to streamline,” Gaspar-Yoo informed HHCN. “We would have liked to determine consistency in the best way our sufferers had been cared for. That is how we designed the prolonged mannequin. Initially, there was some resistance from hospital workers who weren’t used to caring for SNF sufferers at house. That concern disappeared after two days after they realized we may apply the identical framework with out altering their present work processes.”

HRCP extends 30 days past the unique remedy plan. Through the first one to 3 weeks, a registered nurse, bodily therapist, or occupational therapist works with the affected person at house to develop a personalised, physician-directed plan of care with the affected person's well being care group. After this preliminary interval, the affected person's RCC continues to watch the affected person's important indicators, coordinate care, and supply well being training for an extra 60 days.

“Highmark government sponsorship is vital,” mentioned Gasper-Yoo. “Highmark helps this initiative as a result of it’s economically helpful to the payer. We keep away from prices related to room and board and premium labor when a affected person recovers at house. There’s a imaginative and prescient that extra restoration care can be transferred to the house state of affairs within the subsequent 5 years. It’s safer than a conventional hospital, with much less threat of an infection. As well as, rising labor prices for nurses and workers shortages make restoration house a extra wise possibility.”

Advantages and subsequent steps

Contessa's HRCP information signifies improved affected person satisfaction and decrease common size of keep and readmissions.

“Our affected person satisfaction surveys present a excessive stage of satisfaction amongst these recovering at house,” mentioned Gasper-Yoo. “Leaders obtained quite a few constructive messages from sufferers who appreciated recovering at house with their households, reinforcing our resolution to develop this program. We can not develop our inpatient items with out making a whole lot of tens of millions of {dollars}; subsequently, that is essentially the most viable possibility. Moreover, decrease an infection charges and fewer readmissions are key elements driving the expansion of our program.”

One other advantage of this system is elevated workers satisfaction and retention.

“Acute care nurses who make money working from home report vital satisfaction as a result of flexibility that permits them to spend high quality time with their sufferers, which is commonly not attainable in conventional inpatient settings,” Nottidge explains.

He emphasised that nurses in hospitals typically face interruptions and have little time for affected person interplay. In house care, nonetheless, they will construct rapport, educate, and have a significant influence on sufferers, typically offering care that resembles concierge companies.

“Affected person satisfaction in these fashions has been persistently very excessive,” Nottidge mentioned. “Payers agree with this strategy. Sufferers obtain quite a few advantages: they keep at house and are typically extra practical after discharge, making it troublesome to argue in opposition to this mannequin.”

Regardless of all these advantages, transitioning the notion of the mannequin from a pilot program to a long-term enterprise has offered challenges.

“Initially, docs had been informed 'you're going to do that,' which bought blended reactions,” Nottidge mentioned. “Nonetheless, after we created alternatives for voluntary participation and clearly defined the mannequin, many got interested, resulting in larger satisfaction amongst these concerned.”

Trying forward, Nottidge and Gasper-Yoo hope that presenting proof of affected person satisfaction, constructive outcomes and value financial savings will facilitate discussions with healthcare techniques and construct assist for the mannequin. Nonetheless, in line with Nottidge, it’s essential to share success tales deliberately and broadly.

“Success doesn’t mechanically result in extra success,” he warned. “It takes a aware effort. These applications typically wrestle as a result of the story behind them and the required change administration don’t maintain tempo with management transitions that happen each three to 5 years. We’ve to inform our story with goal.”