When Amedisys Inc. (Nasdaq: AMED) acquired Contessa Well being in 2021 for $250 million, it modified the panorama of dwelling well being care. Whereas different firms toyed with high-acuity dwelling care, that deal despatched a transparent message: Dwelling care grew to become extra than simply Medicare-certified dwelling care and private care companies.

Since then, Contessa Well being has needed to combat an uphill battle. With any newer service, healthcare techniques and payers have to be satisfied of its worth.

The corporate has now collected sufficient information to show the worth of companies resembling a hospital at dwelling and SNF at dwelling. Contessa has additionally invested in palliative care, which can be changing into an necessary service as value-based cost fashions emerge.

Amedisys leaders have been largely silent over the previous 12 months and a half as a result of impending take care of UnitedHealth Group (NYSE: UNH). However they nonetheless posted quarterly earnings due to their public market standing.

These reviews present that Contessa has seen important development in attendance and income lately, and it seems like this might be top-of-the-line examples of success with regards to various dwelling care fashions.

I lately spoke with Robert Moskowitz, Contessa's chief doctor. We chatted in regards to the monumental potential of those various fashions, the necessity for extra buy-in from a cost perspective, and finally what might make or break the way forward for high-acuity care at dwelling.

For this week's version of the member-exclusive HHCN+ Replace, I dive into the way forward for Contessa and residential care with Moskowitz. The dialog has been edited for size and readability.

Donlan: On the SNF dwelling entrance, that was a mannequin that many had been enthusiastic about in 2020 and 2021, however that pleasure appeared to wane lately. What are your ideas on the way forward for that mannequin?

Moscowwitz: Once you take a look at the normal, bodily nursing wants of the business at massive, the panorama continues to development towards the necessity for extra acute in-home companies, particularly expert nursing companies.

From a affected person's perspective, why is a affected person concerned about in-home expert nursing companies? There are just a few completely different causes. Considered one of them, I believe, is the historic perspective towards SNFs: you're away from dwelling. You’re exterior the consolation of your house. There are burdens on your loved ones; they generally need to journey lengthy distances to see you. And as we see the closure of expert nursing services, they need to journey additional and additional. That is changing into an rising burden, with sufferers – if given the chance – nonetheless desirous to obtain their care at dwelling.

I believe the curiosity in dwelling care is now being extrapolated to dwelling care and different companies. From the affected person's perspective, I need to proceed dwelling at dwelling for so long as doable.

From a hospital perspective it additionally stays a necessity. They’ve a bottleneck with regards to getting sufferers into expert nursing beds. And what hospitals historically search for is a dependable discharge location, and brick-and-mortar SNFs are – throughout the board – not a dependable possibility.

You even have extra hospitals adopting extra risk-based buildings, and as they achieve this, they’re on the lookout for better insights into the affected person's full continuum of care. It was that once they had been discharged from the hospital, it was now not – for lack of a greater phrase – the duty of the hospital.

I truly don't imagine there’s a decline in SNF domestically as a result of there are nonetheless extra of these bodily closures; 87% of SNFs lately reported reasonable to excessive employees shortages. They discover it very troublesome to rent and retain workers.

By their very own admission, they proceed to face challenges purely from a staffing perspective, which is limiting admissions and rising their prices.

There may be all the time a spot for bodily expert nursing, similar to there’s a place for bodily hospitals. However the panorama continues to level within the route of expert nursing at dwelling. There’s a subgroup of sufferers who – similar to in a house hospital – do higher at dwelling, and the forces are all aligned. So I believe that's why we're consistently optimistic.

Do you imagine staffing might be simpler in an SNF-at-home mannequin?

The more durable reply is: it relies upon.

After we create these partnerships with healthcare techniques, and there's a longitudinal view of the affected person journey – hospital at dwelling, expert nursing at dwelling, palliative care at dwelling – there's effectivity, proper? You construct a chassis of companies for the hospital at dwelling. They’re the identical dwelling expert nursing companies.

You want nurses at dwelling – physiotherapy, occupational remedy. You want medical doctors to finish that. You may have already created that infrastructure, or we’ve already created an infrastructure of these companies, with a hospital at dwelling.

So should you say, “Hey, we're going to do a hospital at dwelling and expert nursing at dwelling,” then you’ve got the effectivity of utilizing the identical service chassis for these applications. You get the identical subset of suppliers, distributors, nurses, to serve them each. And that, I believe, is the place you may overcome the staffing challenges, as a result of the normal mindset of a brick-and-mortar SNF is, “I’ve to rent X to be in my constructing and solely serve that inhabitants.”

And what we're seeing with our partnerships with healthcare techniques… it's not that they need to rent nurses for the house hospital, after which one other workforce for expert nursing at dwelling. It's the identical group of nurses. And for lots of our partnerships, it's the identical group of physicians, which suggests they’ve hospitalists who just about spherical on the hospital sufferers at dwelling, and the identical group who spherical their SNF at dwelling sufferers.

So that they acquire economies of scale, and that's the place I believe [SNF-at-home] can overcome lots of their workforce challenges.

There are lots of dwelling care suppliers who’re concerned about getting concerned in intensive care at dwelling, and a few have already completed so. However do you suppose there's nonetheless a lack of know-how, by way of what's concerned?

I believe they perceive. I don't suppose it's an issue that they don't perceive. I believe they need to make that a part of their longitudinal technique. As a result of there might be issues they need to adapt to. And I believe there are numerous dwelling care organizations which have began doing this, and doing it nicely.

As a result of to some extent they adapt to a better degree of affected person acuity than a standard dwelling care affected person.

I believe the educational curve is that if I'm a house well being firm and I’ve a employees of nurses, a few of whom are comfy with the upper acuity sufferers, you begin to say, “I have already got this employees.” As a result of there might be some employees who simply don't have the medical qualities, they haven't gone for that, or they don't have that have, you must have or create that subset of nurses.

So once more, I don't suppose it's a lack of know-how, however quite the place this suits into their technique. As a result of they need to do it, they need to have a companion. They should have somebody who wants a majority of these sufferers to be cared for – and a very good companion usually.

Are there Amedisys dwelling nurses who give you the results you want on these acute circumstances?

We leverage our Amedisys care facilities and our partnership in order that they’ll have a subset of nurses devoted to high-acuity care, whereas retaining their conventional dwelling care nurses to supply these conventional dwelling care companies. And so they minimize it out and let it develop that manner.

There’s a little bit of overlap. However in all respects, inside our care facilities there’s a subgroup consisting of nurses with a excessive acuity sensitivity.

It additionally seems that CMS is shifting towards these bundled funds, lowering visibility from the hospital. So now looks like a greater time than ever to have these strong partnerships with healthcare techniques.

It’s.

And whether or not it's a well being care system or a payer, there's extra system accountability to the affected person and that longitudinal trajectory – and there's visibility into all of that. That's why there are numerous built-in well being care techniques the place they’ve their PCPs, their ACOs, their dwelling well being entities.

And in the event that they observe a bigger technique, they need to have perception into the outcomes. One of the best ways to not lose observe is to create that ecosystem. That's why you want a trusted companion, as a result of it's sophisticated.

The hospital-at-home and SNF-at-home fashions are nonetheless new to the healthcare lexicon for a lot of. Subsequently, do you imagine that the success you’ve got had up to now in proving these fashions will contribute to better success within the subsequent few years?

For brand new folks coming into the sector, or new companions, it's nonetheless about, “What can I look again on? Are you able to present me what you probably did?

And so success begets absolute success. I believe at the moment the one price limiting element to this more and more exponential cost uncertainty is cost uncertainty. We'll see the way it performs out in Washington, DC. That's one half that retains development from changing into exponential.

After which it issues what you probably did. Individuals need to take a look at what you probably did, how you probably did it and what you realized. Satirically, there’s at the moment much less of a runway for SNF-at-home particularly than for hospital-at-home. It's newer.

And I believe the way in which healthcare techniques analyze that is in two other ways. First, it's half of a bigger technique for prime acuity at dwelling. “Hey, I'm engaged on a hospital dwelling. Let's do expert nursing. Let's do palliative.” Second, they could view it as an remoted element. Is it simply expert nursing at dwelling? That second strategy is an remoted strategy, and I believe it can take without end to maneuver on.

However I'm actually excited that some healthcare techniques are investing in SNF-at-home. As a result of the extra folks do it, the higher you turn out to be at it. That opens up the chance to do it extra typically, and turn out to be higher and stronger at it. Then you’ve got extra issues that the business can look again on and say, “Okay, I see what you're doing now.”

What are you most enthusiastic about at Contessa within the close to future?

My focus, ardour and largest curiosity proper now’s to get higher and overlay these companies to make them seamless. I imply, once more, we return to the idea, it is a longitudinal journey.

We've tailored so as to add these sequentially over time. And whereas we are able to overlap them, there’s additionally a studying curve concerned. So how can we overlap them increasingly? Once more, we would like this to be a seamless journey for the affected person.

I simply got here from visiting certainly one of our markets, and they’re admitting an SNF dwelling affected person who is among the palliative care sufferers in that market, and so they have one other affected person in a house hospital who has palliative wants. and now we introduce them to the palliative care workforce.

That's the place it will get actually thrilling.