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There is a quiet, maybe not so quiet, revolution happening in healthcare delivery. The transposition of healthcare out of the legacy bricks & mortar sites and into the home.
Payers such as Humana and Optum, as well as retailers such as Amazon, Best Buy Health and Walgreens are spending tens of billions of dollars acquiring companies and capabilities to bring medical care into the home.
There are hundreds of vendors that are already years into creating a home-based care ecosystem. With the increasingly sophisticated remote monitoring, digital diagnostic equipment, predictive analytics, telemedicine & logistics software capabilities, we are seeing these companies provide more personalized and contextualized care that, in many ways, is not only more convenient, but actually superior to care in the hospitals, ED’s & clinics.
We’ll be asking our guest today, Dr. Mark Prather, to share his industry-leading experience and wisdom on all of this.
Dr. Prather has an impressive track record in both the clinical and entrepreneurial domains. He practiced as a board-certified emergency medicine physician for more than two decades. He was a founder and served as President of US Acute Care Solutions, an integrated acute care physician staffing organization serving approximately six million patients annually. He has partnered in multiple medical industry startups, including iTriage, an early digital patient navigation tool. Dr. Prather obtained his undergraduate degree in Molecular Biology at Vanderbilt University. He attended medical school at UCLA, where he graduated with honors, and completed residency training in Emergency Medicine at Denver Health where he also served as Chief Resident. He also obtained a Master of Business Administration from the University of Colorado School of Business.
In this interview, we’ll hear about:
- The profound & documented clinical, interpersonal & economic advantages of home-based care compared to traditional brick & mortar hospital based care.
- How home-based care is much more effective in assessing & addressing social determinants of health.
- The evolution of Dispatch Health from urgent/emergent care at home to a full service home-based healthcare ecosystem, and why Mark decided to start with urgent/emergent care visits.
- How Dispatch Health is evolving their payment into the value-based realm & the incredible cost savings they’ve already demonstrated.
- Some critical comments from Mark regarding how home-based care is actually much safer, far less fragmented, and much more personal than the traditional brick & mortar care being delivered in hospitals, ED’s & doctors’ offices.
- Why Mark firmly believes that home-based care will disintermediate the brick & mortar landscape of healthcare delivery.
There are a few take-aways that I believe are incredibly important for all of us to understand about the home-based care ecosystem.
First – Healthcare in the home is not a hypothetical and not some future state. It is happening and in significant numbers. Dispatch Health has already seen hundreds of thousands of patients, over 700,000 in the home, and is seeing hundreds of thousands of patients annually.
Second – The acuity or severity of patients being cared for in the ‘Hospital at Home’ are not the mildly sick patients. Mark’s data reveals that the patients cared for in the home are in the top 10% of acuity according to the Charleston Comorbidity Index.
Third – the cost savings are real and significant! Dispatch Health is documenting savings of $5000 – $7000 per admission compared to traditional hospital admissions. Mark goes into some detail as to how these cost savings are occurring. What’s remarkable to note is that these savings accrue not because there is less care, but actually because there is more and better care.
Fourth – In addition to the concrete clinical & safety benefits, Dispatch Health has an average Net Promoter Score of 95%, with over 700,000 patient home visits & home hospitalizations. Along the lines of patient experience & satisfaction, it seems almost too obvious to mention but this sort of care delivered in the home is infinitely more convenient and comfortable for patients and their families than hospital-based care or traditional ED or even urgent care.
Fifth – Care delivered in the home is much more personal, customized and contextual than care delivered in hospitals, ED’s, nursing homes, urgent care centers & doctor’s offices. Mark points out that being in the home really shifts the focus of the clinicians from a limited triage & treat function to a treat & recovery function. Clinicians & staff in the home have purview into the patient’s life – into non-clinical determinants of health like social supports, medications, food security and home safety – that have as much, if not more, of an impact on health outcomes.
One great example Mark provides of how home-based is more humanistic is around end-of-life conversations. These sorts of conversations are challenging in the ED & hospital setting. But, in the home care setting, they become much more personalized and comfortable for patients and their families.
Sixth – The clinical benefits are myriad including:(1) far lower risk of hospital acquired infections and other dangerous conditions; (2) lower risk of delirium and falls; (3) lower risk of malnutrition; (4) lower risk of readmission and/or the need for post acute care nursing facilities; and (5) lower risk of mortality – Mark quotes a 20% reduction in mortality.
Seventh – the advantage of the patient being initially evaluated at home. Once a patient enters a brick & mortar Emergency Department, their chance of being referred to ‘hospital at home’ is about 35%. Mark attributes this largely to the pressure ED docs face in getting people out of the ED and into a hospital bed. But, if the patient is initially evaluated in the home, their chance of staying in the home (aka – being referred into the ‘hospital at home’ service) is 97%.
Two final lessons – one of the key reframes I’ve learned from Dr. Prather as well as other leaders in the home-based care space is that the notions of Urgent Care, Emergency Care, Hospital Care, Post Acute Care – are all arbitrary legacy concepts that have little bearing in the home-based care ecosystem. As Mark and other leaders put it, ‘care is care’. If a patient needs medical/clinical care in the home, it’s simply that – whether it’s urgent, emergency, hospital level, post-acute hospital care and so on. The difference is just a matter of how much and how intense that care is. But the point is that it doesn’t make sense to label it based on legacy brick & mortar concepts.
The other related lesson is how much more seamless and safe home-based care is, as compared to traditional brick & mortar hospital-based care. For example – when a patient is discharged from a 5 – 7 day hospital stay, they typically get transitioned to a nursing or rehab facility, or they get transferred back home. What most people don’t understand is that this requires numerous hand-offs which introduce tremendous opportunities for safety errors, and typically leads to a readmission back into the hospital about 20% of the time. If the patient is discharged home, there is also a bit of a leap of faith, because as much as case managers and care managers can inquire about, they don’t have an in-person understanding of what the home environment looks like. What I found fascinating about the Dispatch health ‘hospital at home’ model is that the patient is actually not discharged. The intensity of their care may be reduced after 5 – 7 days, but they are actually followed for up to 30 days. And because there are no artificial hand-offs and because the clinicians and staff are in the home, there is far less risk involved in the transitions of care. I suspect that the vast majority of clinicians and healthcare leaders are unaware of this particularly important point.
Dr. Prather is, as he modestly puts it, “an old hospital systems guy”. But he has spent the past decade intensely studying, innovating and now building an incredibly robust home-based ecosystem of care. Mark is not an academic physician or researcher. He is a seasoned clinician and clinical leader, and a highly experienced and successful healthcare entrepreneur, who had to be convinced that the clinical model and business model for home based care worked better than the traditional hospital and ED based model.
He’s convinced. How about you?
Until Next Time, Be Well
Zeev Neuwirth, MD