Allegheny Health Network Expands Hospital-at-Home Program as CMS Waiver Total Hits 80

The Acute Hospital Care At Home initiative from the U.S. Centers for Medicare & Medicaid Services (CMS) now has at least 80 participants, Administrator Seema Verma announced Wednesday.

Unveiled in November, the initiative has been growing rapidly, especially of late. On its end, CMS hopes the emerging hospital-at-home models can increase acute care capacity and keep patients where they’re most comfortable.

Allegheny Health Network (AHN) was the eighth organization to have its hospital-at-home program approved by CMS. It was given the go-ahead under an expedited process due to its experience with the model prior to the government initiative.

Pittsburgh, Pennsylvania-based Highmark Health is the parent company of AHN. Its businesses include a hospital and physician network plus home- and community-based services, as well as the Highmark Health Plan.

AHN’s “Home Recovery Care” program is facilitated by a joint venture with Nashville, Tennessee-based Contessa Health, a home-based care startup that has cut its teeth shifting hospital-level care into the home.

Now that its program is certified through CMS, it can be offered to Medicare beneficiaries in the regions that AHN serves.

“We’ve been looking at ways that we could provide high-quality, effective clinical care — in other places beyond the hospital — way ahead of the pandemic,” Christina Weir Ripley, VP of clinical transformation at Highmark Health, told Home Health Care News. “And as we were going through that evaluation process and looking for ways to get there, that’s when we landed on our JV partner, Contessa.”

Contessa was a logical match. It had worked with other hospital-at-home models before, including Mount Sinai Health System’s, which was one of the earliest in the U.S.

AHN began offering its program to Medicare Advantage beneficiaries in January 2020.

For AHN, patients can be admitted into the Home Care Recovery program in multiple ways. They can be admitted after an emergency room visit or in-patient visit, as well as upon observation in the hospital — or without going to the hospital at all.

The organization had already treated dozens of patients in the program before it applied for a waiver from CMS. That led AHN to believe that the transition to the Acute Hospital Care at Home Initiative would be seamless.

AHN also had a natural advantage: It owns and operates its own in-house home care services, which play a key role in the hospital-at-home concept.

“As far as the home health agency piece of it, we certainly had an advantage here as an enterprise, because we own and operate a number of different home care businesses,” Weir Ripley said. “So we were able to utilize a pretty strong and structurally organized home health network to assemble and deliver the care.”

Before the newly launched CMS program, a major barrier to hospital-at-home models was reimbursement. Reimbursement will likely continue to be a challenge moving forward, considering CMS has only made its new waiver available during the public health emergency.

“I think probably our biggest hope is that through the CMS waiver, there’s a demonstration of the value of this type of program,” Weir Ripley said. “We clearly believe in it. We implemented this ahead of the pandemic. We’re hopeful that CMS is going to codify a more permanent reimbursement path so we can continue to offer this once we get past the public health emergency.”

There were just 56 hospitals approved by CMS as of Jan. 4.

Working with patients at home

AHN’s capabilities within the home are extensive, Dr. Harshit Seth, the medical director of the Home Recovery Care model, told HHCN.

When AHN does treat patients within the home, it most often deals with COPD, pneumonia, asthma, acute renal failure and other conditions. Recently, that list also includes COVID-19.

Currently, AHN is working on treating COVID-19 patients with more advanced therapy treatments and expanding its overall offerings.

“With the program, we can decompress our hospitals, which have censuses that are blowing up,” Seth said. “I’m glad that we did this because of the pandemic, and because we can take some of these patients and keep them away from the infection. But the other reason why we started this was because the overall patient satisfaction and overall quality of care has been shown to be better — and the complications happen less.”

U.S. hospital beds were over 70% filled as of Jan. 13, with nearly 18% of them occupied by a COVID-19 patient, according to data from the U.S. Department of Health and Human Services (HHS).

The preliminary results of AHN’s program from a patient-satisfaction perspective have been good, one of the most promising aspects thus far, Seth noted.

“Everybody loves when they can be at home and get the care there, and we also have quality protocols and escalation protocols in case of an unforeseen event,” Seth said. “There’s no visitations in the hospital, which patients don’t like. So there’s a lot of mental health problems happening in patients, especially our older patients.”

Alternatively, at home, loved ones can even help with the recovery process.

In Pennsylvania, over 75% of in-patient beds were filled as of Jan. 13, with over 20% of those filled by COVID-19 patients. Nearly 80% of all ICU beds were also occupied, according to the HHS data.

As hospital-at-home models become more popular and more beneficial to both patients and health care organizations, those that have recognized the perks of home-based care prior to the COVID-19 crisis may have the upper hand.

“This is, for us, the beginning of starting to extend the type of care that we can provide in the home,” Weir Ripley said.

The post Allegheny Health Network Expands Hospital-at-Home Program as CMS Waiver Total Hits 80 appeared first on Home Health Care News.

Startups with tech to improve payer and provider efficiency: Video from MedCity INVEST Digital Health

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Highmark Health, Contessa Expand Joint Venture Delivering Hospital-Level Care in the Home

Highmark Health has announced it is expanding its joint venture relationship with Contessa, a company that helps organizations provide hospital-level care in the home through its Home Recovery Care model.

The expansion comes at a time when more health systems and hospitals are looking to redirect acute care into the home setting to maintain capacity and avoid spreading the COVID-19 virus.

Highmark Health is the Pittsburgh, Pennsylvania-based parent company of Highmark Inc., Allegheny Health Network (AHN) and HM Health Solutions. Highmark Health’s businesses include Highmark Health Plan, a hospital and physician network, as well as home- and community-based services.

Founded in 2015, Nashville, Tennessee-based Contessa partners with health systems and health plans through its increasingly popular Home Recovery Care model. Backed by Health Velocity Capital, BlueCross BlueShield Venture Partners and other investors, Contessa has raised more than $10.5 million since launching, according to Crunchbase.

As part of the new JV expansion, two of AHN’s hospitals in Pennsylvania — Forbes Hospital in Monroeville and AHN Jefferson Hospital in Jefferson Hills — will offer Home Recovery Care.

“Healing at home through Home Recovery Care offers patients many benefits,” Dr. Harshit Seth, system medical director of hospitalists services at AHN and the medical director of AHN Home Recovery Care, said in a statement shared with Home Health Care News. “Patients often feel more secure and comfortable in their home environments.”

AHN is using the Home Recovery Care program to allow eligible patients with acute medical needs to receive care in the home for conditions such as cellulitis, congestive heart failure, asthma, urinary tract infections, dehydration, pneumonia and more.

AHN is also using the model to assist with COVID-19 needs, in some cases.

“These are typically low-acuity in-patient admissions,” Christina Weir Ripley, vice president of enterprise clinical transformation at Highmark Health, told HHCN. “[For example], a stable COPD patient that has an acute exacerbation of chronic bronchitis and meets clinical criteria and insurance eligibility would have the option to receive their in-patient care in the home.”

That clinical criteria is decided upon by an emergency department physician and an admitting hospitalist physician.

Prospective patients also pass through a rigorous home safety assessment to make sure their environment is free of fall risks and other potential hazards.

Once patients have been deemed eligible, they can receive home infusion services, in-home nursing visits, telehealth visits and home medical equipment — whatever it takes to keep them healthy and out of an acute setting.

As for Contessa’s role within the partnership, the company mostly provides operational support.

Contessa’s data demonstrates the Home Recovery care model dramatically improves patient satisfaction and reduces both mean length of stay and readmission rates,” Contessa CEO Travis Messina said in a statement. “We are thrilled to bring this level of care to AHN Forbes and Jefferson and allow patients to recover in an environment that is best suited for their needs, which is often the home.”

Additionally, Contessa is responsible for hiring some members of the clinical team who are embedded in the emergency departments. This includes the recovery care coordinator, who is a registered nurse that’s responsible for organizing the patient’s care, including communication between the emergency department physician and the hospitalist.

Contessa first partnered with Highmark Health last November at AHN’s Allegheny General Hospital in Pittsburgh.

It has a long track record of similar partnerships, too. Prisma Health, Marshfield Clinic Health and Ascension Saint Thomas are just a few of the health care organizations the company has teamed up with over the years.

This made them an attractive partner in Highmark Health’s eyes, according to Ripley.

“They’re one of the leading capability partners in this space,” she said. “As we were looking to adopt this model in the market as a part of our virtual health and home-first strategy, we had assessed a number of different capability partners.”

The Home Recovery Care model uses a value-based reimbursement methodology that was specifically designed and implemented with Highmark, according to Ripley.

“It is a specific reimbursement methodology that the JV has constructed with Highmark,” she said. “Essentially, the Contessa joint venture is in a value-based reimbursement arrangement with Highmark as the insurance plan.”

Despite the model’s ability to lower costs and hospital readmission rates, reimbursement has been one of the biggest barriers to widespread implementation of hospital-at-home programs in the U.S.

Such efforts are much more common abroad, particularly in England, Spain and Italy, for example. That’s rapidly changing, though, with Mount Sinai, Medically Home, Lifesprk and others also leading the charge on the hospital-at-home movement, pioneered in the U.S. by Johns Hopkins decades ago.

HHCN previously connected with experts from both Mount Sinai and Johns Hopkins during the first month of the COVID-19 emergency.

“In times of crisis, things that people wouldn’t normally think about or things they would think about sort of on a slow-burn basis start to get some traction,” Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine, told HHCN in April. “Crises have a way of making things happen.”

Though it’s still in its early days, Home Recovery Care is already resulting in positive outcomes for Highmark Health, according to Ripley.

“The length of stay and readmissions have been very favorable,” she said. “We’ve had a number of patients who have given personal statements about how much they appreciated being able to receive that care in the home. From a clinical quality perspective, we think that one of the most favorable pieces to this model is the care continuity and coordination that occurs after they’re discharged from that acute phase.”

The model has also been an advantage throughout the COVID-19 emergency.

“We viewed home recovery care as a significant option for us as we went through a surge capacity planning,” Ripley said. “Fortunately, in our market, we did not see a surge as we had initially anticipated, but we continue to see Home Recovery Care an advantage that we have to offer.”

Highmark Health has plans to further expand the program to the organization’s Delaware and West Virginia markets in 2021.

“We are currently in discussions to expand the program to additional parts of the Highmark footprint,” Ripley said. “We are in the process of establishing what that will look like.”

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digital health smartphone

Executives with Kaiser Permanente, Houston Methodist, Providence St. Joseph Health and Highmark Health shared their thoughts on the future of digital health and how they used technology to care for their patients at the start of the Covid-19 pandemic.