Saint Thomas Health is going to start treating more patients in their own homes this fall. The Middle Tennessee hospital system is launching a joint venture with a Nashville-based startup that may be a model for other markets.
Saint Thomas is not reviving the house call and dispatching doctors around the region. But patients who show up at one of its emergency rooms and meet the criteria for a hospital admission will be allowed to opt in to the home-based care program. They'll be set up with at least two visits a day by a nurse, who will take vital signs, start infusions and draw fluids for labs. They also take home a telehealth tablet for daily virtual rounds with their hospital doctor.
The arrangement is only for conditions that don't appear life threatening, like dehydration or pneumonia. Chief clinical officer Greg James says it will give doctors another option when a patient needs a few days of attention.
"I think it's mostly a change in mindset of the providers, to think about which patients are more appropriate for this kind of service," he says. But James says it will also require convincing patients that they might prefer being treated in the comfort of home.
"How do we then go about sort of having the conversation with the patient and their families where they feel comfortable as well?"
The care could save patients money. And while that's a financial loss for the hospitals, Saint Thomas does stand to make some money from patients they send home rather than admit. The joint venture with a fast-growing company named Contessa shares some of the revenue with the hospitals.
This is a pilot program for the Catholic hospital chain Ascension, which James says may expand the home-based care across more markets in coming years.
Contessa can't just partner with a hospital because its model also requires contracting directly with local insurers.
"The biggest hurdle, in our opinion, is that no health insurance company has ever reimbursed providers for the model," says CEO Travis Messina.
Rather than billing for each service rendered in a patient's home, Contessa negotiates a lump sum for each diagnosis eligible for the program. And if the care costs more than that figure, Contessa loses money on that patient. But if the expenses fall below the payment, the company shares those savings with the partner hospital.
Aside from working out a financial arrangement that's agreeable to both hospitals and insurers, Contessa has also had to develop its own software that can update a hospital's electronic medical record system. Most EMRs can't be used by providers outside the four walls of a hospital, Messina says.
Saint Thomas becomes the fifth partner for Contessa, which launched in 2015. Its roster includes all nonprofit health systems, including Mount Sinai in New York City.
"We started contessa with the sole purpose of partnering with health systems," Messina says. "Our goal is to identify and create as many partnerships as we can across the country so we can help the trend of making this the standard of care."