Innovations: Bringing hospital-level care home

Home hospitalization programs have been around for about 20 years in the U.S. Pioneered by researchers at Johns Hopkins Medicine in 1994, the programs initially targeted elderly patients. But in the shift toward value-based reimbursement, large hospitals and systems are starting to see home hospitalization as a way to reduce inpatient admissions for a wider array of patients.

Nashville-based Contessa Health seized this opportunity to truly change the way care is delivered and do it in a way that reaches the elusive goal of lowering costs and improving quality of care. Co-founded in 2015 by former venture capitalist Travis Messina, Contessa provides medical and surgical acute-care services to patients in their homes at a bundled rate.

The company recently landed its first partnership with Marshfield (Wis.) Clinic Health System, which runs 50 clinics in the state along with insurance plans.

Members of Marshfield's Security Health Plan, which offers Medicare Advantage as well as other commercial plans, can receive hospital-level care for six acute conditions: congestive heart failure; chronic obstructive pulmonary disease; deep vein thrombosis or pulmonary embolism; urinary tract infection; cellulitis; and pneumonia. For a prospective bundled payment, Contessa caregivers administer intravenous drugs and provide lab testing and other medical services during a 30-day period. The bundled price is still being set.

The pilot program is expected to begin Sept. 1 around Marshfield, Wis. About 350 patients will enroll in the first year, the company reported. The pilot will expand to other health plans if successful.

Chris Meyer, director of virtual health at Marshfield, said the six conditions were selected because they often require fairly routine hospitalizations. For example, congestive heart failure patients sometimes are admitted because they require intravenous diuretics to address water retention. Meyer said that by providing that treatment in the patient's home, the chance for readmission is reduced. While Marshfield's projected cost savings are unknown, according to the company, the shift in care delivery is expected to significantly lower costs.

“A patient doesn't need to be hospitalized for five days to receive the care they need,” Messina said.

After at-home visits, Contessa caregivers will work with Marshfield hospitalists to ensure a care plan is followed.

Messina launched a bundled-payment hospital-at-home program when he was chief investment officer at Martin Ventures, a healthcare venture capital fund based in Nashville. He was inspired by his time as vice president of development at Vanguard Health Systems, a 28-hospital system that was acquired by Tenet Healthcare Corp. in 2013. He said he witnessed Vanguard participate in risk-based initiatives, such as accountable care organizations, with the CMS and private insurers that didn't actually change care practices.

“Home hospitalization was truly focusing on a new care-delivery model and that's what piqued my interest,” he said. The services also work well in bundled-payment models for this reason, he added.

He worked on building the company for a year while still at Martin Ventures. Contessa—named after a group founded in the late 1800s that provided medical and dental care to immigrants in New Orleans—now counts Martin Ventures, Blue Cross and Blue Shield Venture Partners and Sandbox Industries as funders.

Contessa is in talks with several other health plans to use the program in their networks. The company's partnership with Marshfield targets the traditional hospital-at-home care model, which focuses on Medicare patients with acute illnesses. But Contessa also has a surgical program for patients recovering from total joint replacements and spine procedures. That program is available through commercial plans.

While Contessa hopes its program will catch on, hospital-at-home programs are not covered by the CMS. Still, the agency's innovation center gave Mount Sinai Health System in New York City a $9.6 million grant to pilot a program. One of the goals is to develop a bundled-payment program, said Dr. Bruce Leff, a geriatric physician at Johns Hopkins who is a consultant for Mount Sinai. He was a lead researcher for Johns Hopkins' hospital at-home program in the mid-1990s.

Leff said that it only makes sense to identify ways for patients to spend the least amount of time as possible in the hospital. Other countries have robust hospital-at-home programs, and research shows improvements in conditions for patients, he added.

“Really everything should be moved in the community if we're going to actually provide value,” Leff said. “It just makes sense.”