In-home emergency care cuts costs, but needs more payer buy-in

At-home emergency care is gaining momentum — and could cost millions less — but reimbursement challenges create an access barrier for some patients.

Deploying healthcare in patients' homes gained traction during the COVID-19 pandemic as a way to ease overcrowding at hospitals and prevent the virus from spreading. Emergency department care at home lets patients bypass the waiting room through referrals from hospitals or primary care providers if they determine patients do not have life-threatening illnesses or injuries. While many private insurers reimburse for such care, traditional fee-for-service Medicare and Medicaid do not pay for it as a stand-alone service.

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Emergency department-at-home programs deploy paramedics or nurses to check vital signs, draw blood and take x-rays with portable imaging devices. Physicians supervise the visits via telehealth, then refer patients to primary care providers for further treatment or to hospital emergency departments if more complex care is needed.

Healthcare technology company Medically Home and primary care provider Atrius Health, a division of UnitedHealth Group's Optum Health, offer emergency department-care-at-home through a partnership in the Boston area. A study they published last week in the New England Journal of Medicine found more than 83% of 3,668 patients who received emergency care at home over two years did not require a trip to the hospital, saving Atrius approximately $4.5 million.

Medically Home launched its service in 2020 and has served approximately 7,000 patients through contracts with three provider groups, including Atrius. The primary care provider has value-based care contracts with most of its patients and takes on the full risk for their care.

Hospital emergency departments are the default care option for many Americans and are expected to account for about 150 million visits this year, according to the Emergency Department Benchmarking Alliance, a nonprofit that represents more than 2,000 emergency departments. They are also the most expensive places to get healthcare. The average emergency department visit costs about $2,700 versus $185 at an urgent care facility, according to UnitedHealth Group’s website.

Companies including Medically Home and Denver-based DispatchHealth see emergency department-at-home as a huge opportunity to save millions of dollars in unnecessary hospital visits.

“Health systems sometimes get overrun and they want to make sure that patients get the right type of care," said Dr. Phil Mitchell, DispatchHealth's chief medical officer. “In some circumstances, they are actually actively looking to decant what comes into their emergency department.”

DispatchHealth launched its emergency department-at-home program in 2015 and has partnerships with 150 health plans, value-based care providers and health systems. The company has provided care to 1.2 million patients in 50 locations across 23 states, according to Mitchell. It wants to bring the service to another seven locations by the end of this year.

Falls Church, Virginia-based Inova Health Systems contracted with DispatchHealth two years ago to treat some patients in their homes. The service helps the hospital free up beds for sicker patients and helps emergency medical assistance teams turnaround ambulances more quickly, said Toni Arabell, Inova Health System’s chief clinical officer of enterprise operations.

New providers are also jumping into at-home emergency care, including Minnesota-based Lifespark, which operates senior living facilities and provides primary care and home health services to about 20,000 older adults in the Minneapolis area. On Tuesday, the company launched an urgent response service that will provide in-home emergency department care to patients enrolled in certain Medicare Advantage plans who live in its communities or receive primary care services from Lifespark.

CEO Joel Theisen said urgent response aims to close care gaps for about 3,000 chronically ill older adults who frequently use hospital emergency departments and can cost Lifespark thousands of dollars per visit.

“The igniter for setting off the bomb of costs is the acute hospital event,” Theisen said. “If you can keep them out of the emergency room, everyone wins big.”

Still, a large cohort of patients covered by traditional fee-for-service Medicare and Medicaid don’t have access to home-based emergency department care because those government programs don't fully cover for the service.

A spokesperson for DispatchHealth said the company is reimbursed for urgent medical services by Medicare and Medicaid, but the programs may not fully cover the cost of care. The company is optimistic traditional Medicare and Medicaid will eventually pay for the entire service, the spokesperson said.

Medically Home plans to continue expanding the emergency department-care-at-home program despite reimbursement gaps, according to Dr. Greg Snyder, the company’s vice president of clinical strategy and quality improvement. But he said getting buy-in from all payers would be helpful.

“We need to be delivering the service innovations that are going to support the home-based care ecosystem and [emergency department]-at-home is one of those things,” Snyder said.