How a Collaborative Approach to Health-at-Home Care Creates Value

Each year, unnecessary emergency department (ED) visits among people with low health literacy contribute to more than $47 billion in avoidable medical spending, according to a recent study by Accenture, a global professional services company.

Those who lack familiarity with their local health system, meanwhile, are three times more likely to have visited the ED, the same study shows.

These are signs of the need for solutions that evaluate individuals before they reach the ED and offer assistance in alternative settings, where possible. Innovative healthcare organizations are exploring partnerships to determine the right setting of care for those most vulnerable and deliver care at home, supported by technology and remote expertise.

The Case for a Collaborative Approach

The health-at-home market is expected to grow 7.2% each year, reaching a total value of just over $153 billion by 2029. Employers and health plans are looking for ways to reduce healthcare costs, shifting care from the ED to the home or another alternative site of care where appropriate offers strong potential for increased value and improved patient experiences.

Consider the case of a 49-year-old man with multiple diagnoses—type 2 diabetes, a history of coronary artery disease and gout—who is suffering from knee pain on a Sunday evening. The man injured his left knee two weeks ago after a fall at a restaurant, but the pain has suddenly become worse.

Ordinarily, the man might have asked a family member to take him to the ED to be checked out. It’s the weekend and there are few other options for care on a Sunday evening. Fortunately, the man’s heath plan offers a 24/7 nurse triage line that he can call to determine whether he needs to be seen and where. The nurse arranges for an acute care medical team to travel to the man’s home for an evaluation.

After taking an X-ray of the man’s knee in a medical services vehicle and conducting an exam in person, the team determines that the patient’s injuries can be treated with anti-inflammatory medication. The team provides the medication needed and schedules a follow-up appointment with the patient’s primary care provider. Total time on site: 40 minutes.

In this scenario, three key stakeholders collaborated to avoid an unnecessary ED visit and the associated expense: the health plan, a nurse-first triage service, and an on-demand, ambulatory acute care and internal medicine team capable of providing 60–70% of traditional ED and urgent care services in the comfort of a patient’s home.

In Ohio, this two-year-old model has helped 50% to 60% of patients seen by an ambulatory team avoid a trip to the ED. It has also delivered patient satisfaction rates higher than 95% while saving money for patients, hospitals, health plans, and employers.

Keys to Designing an ED Diversion Model

What does it take to successfully launch a collaborative model such as this? In our experience, it starts with intentional design. Here are three key considerations.

1. Tie collaborative efforts to a population health model of care. For instance, look for opportunities to personalize programs not just to the population’s health needs, but also the individual member’s preferences, such as communication preferences. This will be critical to engaging members in self-managing their health over time. The right model also will provide services between physician encounters to identify care challenges and proactively address them, further avoiding unnecessary trips to the ED.
2. Ensure patients receive care from the right providers at each point in their encounter. For example, a nurse-first triage model pairs a registered nurse with a patient from the start of their call to the nurse hotline rather than an administrative assistant, speeding the care decision-making process. This, in turn, makes patients more likely to trust in the care provided and rely on the service for help in the future.
   
   Similarly, staffing an ambulatory team with either a nurse practitioner or a physician assistant and a medical technician provides a foundation for treating illnesses that range from simple to complex, as well as minor injuries (i.e., those typically treated at an urgent care facility). Such a team can coordinate necessary prescriptions and relay important details to the patient’s care team, including their primary care provider.
3. Focus on convenience. To make an impact, services should be available on evenings and weekends, when physician offices are closed. This enables members to receive timely intervention and appropriate care outside the ED. It also protects continuity in care.

By customizing collaborative models of at-home care to the health needs of the community and the business needs of key stakeholders, organizations can develop an innovative model that achieves mutual goals while strengthening health outcomes, access, and satisfaction.

Cheryl Dalton-Norman, MBA, BSN, RN, is president and co-founder at Conduit Health Partners.
David J. Muzina, MD, MBA, is interim chief medical officer at Medical Mutual.