Photo: Courtesy of Geisigner
Hospital at home for acute care became one of the lifeline programs for health systems during COVID-19, for providers that had the capacity and resources to take advantage of public health emergency waiver.
Hospital at home programs for primary care are rarer and require a combination of factors to be successful for patients and providers.
Geisinger in Pennsylvania has the right combination of a population that needs at-home primary care, an integrated health plan and the resources to make the program successful at scale. Geisinger does not have an acute care at home program, but Geisinger at Home got started in 2018 to bring primary care services to patients who have complex or chronic conditions such as heart failure, emphysema or diabetes.
Currently, an estimated 2,000 of Geisinger Health Plan’s 600,000 members are enrolled. Since 2018, 7,600 patients have taken advantage of the program. Often they’re enrolled up to a year or longer.
“It is typically the most frail or complex patients medically and socio-economically,” said Geisinger CMO Dr. Jonathan Welch. “Three to five percent get involved in this program. We have an integrated care team going into patients’ homes.”
These teams assess for the social determinants of health. The program is not for patients who would otherwise be in the hospital, but it does keep them out of inpatient care and the emergency room, Welch said.
“Because we are getting patients great care, it keeps them out of the hospital,” he said. “We see it as essential for patient populations.”
You can’t see a patient’s refrigerator or medicine cabinet until you go into the home, he said. Clinicians often see discrepancies between what’s in the medicine cabinet and what medication the patient should be taking. They can assess social isolation and fall risks and link patients and family members to community resources for food, transportation and other needs. They can make sure the patient is up to date on vaccines, such as a flu shot.
“If somebody needs an air conditioner, we can address that,” Welch said.
The numbers show the results: A 23% drop in emergency visits and a 35% decrease in inpatient admissions. “We have seen a $400 per member, per month improvement in patient total cost of care,” Welch said, regarding those enrolled in Geisinger at Home
Telehealth plays a role. For instance after an in-person visit, checkups can be done a week later by telehealth.
“We brought specialization to primary care,” Welch said. “We make sure clinical and social supports are there front and center.”
WHY THIS MATTERS
Other hospitals and health systems offer primary care at home, Welch said, but in general, the programs are “few and far between.”
One reason is that a certain combination of factors need to exist for the model to work. First, health systems need a sizable population, over a geographic area that makes sense for clinicians to travel within.
Health systems need to be integrated or have a health plan that allows for value-based and risk-based contracts. The right financing model allows hospitals to reinvest in the program.
“The clinical integration is one essential element,” Welch said, “to have total cost of care responsibility.”
Also, a hospital must develop clinical models that can diagnose for the social barriers to health. “There is a virtuous cycle,” Welch said. “This is the future for engaging patients, having a forward-facing model.”
THE LARGER TREND
Primary care has become competitive as players other than traditional healthcare providers enter the field.
The “retailization” of healthcare is expected to continue and grow as pharmacies and others such as Amazon offer a convenient alternative to traditional primary care.
Email the writer: SMorse@himss.org