Rush University System for Health wants to bring the clinic to some of its patients.
Through a partnership with Colorado-based Dispatch Health, Rush will begin providing in-home medical care for acute healthcare issues that might otherwise send people to emergency departments or urgent care clinics on Oct. 7.
After initial triage to ensure a patient should not be rushed to an emergency department, the typical in-home visit involves a DispatchHealth-employed nurse practitioner or physician's assistant along with a medical assistant driving to a patient's location, treating the condition and connecting the patient with a DispatchHealth medical doctor, usually through telehealth. The DispatchHealth car carries all the tools for most emergency care needs laboratory tests, intravenous medications and medical imaging equipment, DispatchHealth said in a statement.
Years ago, doctors made house calls, even to very sick patients, but technological improvements made the doctor's office and the hospital the preferred site for healthcare. Now technology can bring back the house call, said Rush CEO Dr. Rama Krishnan.
"People don't want to go and sit around in a waiting room," Krishnan said. "They never did, and definitely not with COVID-19 around."
And while teleheatlh grew enormously in both availability and acceptance, people still need to see a healthcare provider sometimes, he said. The program fits into the system's goal of changing the focus of healthcare from the hospital to where the patient wants to access care, he said. In-home, high acuity care is popular with patients, as DispatchHealth touts high customer satisfaction scores, Krishnan said. Employers like the idea that an on-site visit can employees time while insurance companies like the cost savings.
DispatchHealth, which operates in several states, prices its in-home care visits lower than hospital emergency room visits and has saved an average of $1,100-1,700 per acute care visit, said Dr. Mark Prather, co-founder and chief executive officer of DispatchHealth. For that reason, visits are covered by Medicare and by the Medicaid plans and managed care plans in all the states it currently operates, Prather said.
In addition to providing care in a setting where patients are often more comfortable, the in-home visit allows healthcare providers a better understanding of the social determinants of health that are present in the home setting, Prather said. For example, the home visit can reveal fall hazards for elderly patients, food insecurity issues or other barriers to access to healthcare, he said.
From an emergency medicine perspective, the opportunity to avoid an ER visit and still provide quality care and excellent follow-up medicine is key, said Dr. Meeta Shah, an emergency medicine physician at Rush who will act as medical director for the partnership. Shah said the partnership will extend the reach of Rush principals, especially the reputation for quality of care and a focus on equity, to many patients who have barriers to care.
The partnership is also strategic in the Rush system focus on being more consumer-friendly and finding partners who can help diversify where and how Rush serves the Chicago area population, said Tatyana Popkova, chief strategy officer at Rush.
Working with DispatchHealth provides Rush with "speed to market" and lets the system care for patients in the right setting at the right time for the right cost, Popkova said. And while DispatchHealth bills patient's insurance, Medicare or Medicaid for the visits, the Rush-branded in-home service grows the system's reach and builds the customer base for other Rush services, she said.
"We're no longer in a transactional business, we're in a business of relationships," Popkova said.
The program will start off Oct. 7 with two Rush-DispatchHealth teams scheduling in-home appointments and will build from there, Prather said.
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