After occupying a niche space in the health sector, the hospital-at-home model gained significant strength.
In November, the United States Centers for Medicare and Medicaid Services (CMS) announced their most wavy program, “Acute hospital care at home.” With the initiative, qualified hospitals can receive new flexibilities regarding the provision of hospital-level care to patients in their homes.
As of March 3, there were 109 hospitals in 29 states with CMS exemption. Although the program was an effort to increase the hospital’s capacity amid the emergence of COVID-19, hospital-at-home participants have been working behind the scenes to drive the model forward for years.
One of the companies at the center of this regulatory and cultural change is Contessa. The Nashville, Tennessee-based company helps healthcare systems provide hospital-level home care through its home recovery care model.
To learn more about Contessa and where it fits into the takeoff from the hospital at home, Home Health Care News recently contacted Mark Montoney, senior medical consultant at Contessa, for our latest episode of “Disrupt”. The highlights of the conversation are below, edited for length and clarity.
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HHCN: To begin with, can you give our listeners some information about Contessa and where is the model currently?
Montoney: Contessa was launched in 2015. Our Home Recovery Care model really brings all the essential elements of hospital care to the patient’s home. Home Recovery Care is a ready-to-use solution that allows a new standard of care for suppliers and progressive payers.
Patients are treated according to the conditions eligible for hospitalization in the comfort of their homes, avoiding what would otherwise be a hospitalization. Our service model has an average patient satisfaction score of over 90%. We were able to reduce the average length of stay by 35% and reduce readmissions by more than 44%.
As I said, we launched six years ago. We have now partnered with seven healthcare systems to create joint ventures that operate Home Recovery Care. There is the Mount Sinai Health System in New York City and the Marshfield Clinic Health System in Wisconsin. More recently, there is the Gundersen Health System, which is also located in Wisconsin. We work with Ascension Saint Thomas in Tennessee, Prisma Health in South Carolina, Allegheny Health Network in Pennsylvania and Dignity Health, which is part of the CommonSpirit Health System in Arizona.
We are scheduled to launch several other markets in 2021, but we value all of these partnerships and were able to advance our Home Recovery Care model in each of these areas.
In terms of the home recovery care model, how does the Contessa model resemble other home hospital concepts? And what can be a differential? What is the clinical approach?
Our clinical approach is, we bring you all the resources you need to support, in terms of operating a home hospital program. We organize clinical resources, using local providers and incorporating them into the model to provide practical clinical care. We bring all the clinical protocols, the sets of orders. We organize the entire auxiliary network necessary to bring acute care services to the patients’ homes, such as infusion services, DME and any other additional services that may be needed.
We also have a system called “Convergence of care”, which is proprietary, which allows us to accompany patients during an episode of care. Essentially, it provides the ability to manage all of the logistics, which is quite significant when you provide acute services at a patient’s home. All of these logistics are tracked using this system.
Finally, we also have a virtual care unit that includes nurses, social workers and other administrative support teams that actually provide virtual support for local clinical resources that provide direct patient care.
You mentioned your health care partners. How do these relationships usually happen?
We have established a joint venture partnership with healthcare systems, whether they have made an appointment for us, or perhaps we are connected to them and are interested in exploring the model. Usually, it starts from the presentations, until the implementation phase, until the establishment of a program in a specific market.
What we have found in recent years is that interest in hospitals at home continues to accelerate. There remains a significant interest among health systems in following this type of model and being able to offer it as a service to patients who care in their community.
In the past year, as you mentioned, interest has increased. How did the CMS acute home care initiative change things for Contessa? How do you think this will change things for hospital programs at home, in general, going forward?
Let me explain a little bit about that.
In March, when we started to see the first peak of COVID, the CMS announced an exemption for “Hospital without walls”. In fact, it offered relatively broad regulatory flexibility for hospitals that provide care outside its four walls.
Then, in November, they went a step further, providing eligible hospitals with regulatory flexibility to treat eligible patients in their homes. At that point, it really started opening up the opportunity for Medicare service fee recipients to qualify for hospital services at home.
In fact, our New York partner, Mount Sinai, had worked closely with CMS to develop some of these regulatory changes. It was one of the first systems in the country to be approved for the model. Since then, our other five additional markets … have also been approved by the CMS to accept Medicare fee-for-service patients into its programs.
In terms of this partnership with Mount Sinai, I know that recently they doubled their partnership with Contessa to launch a more comprehensive palliative care program. Can you explain the purpose behind this?
This is part of our strategy to continuously expand our service lines. This is an area of great need in particular among patient populations.
Obviously, Mount Sinai Health System has been running a nationally recognized palliative care service for several years. The partnership with them in this space allows the opportunity to bring palliative care to the patient’s home. Basically, it is bringing coordinated and specialized care to the homes of these chronic patients, often helping them to avoid unnecessary hospitalizations.
We couldn’t have a better partner to launch this additional program.
Why do you think palliative care has only recently become more popular? It looks like something providers are much more interested in today.
Even if you’re right, it’s been around for a while, I don’t think it’s always been understood as well as it might have been, or should have been. It is sometimes confused with palliative care. Palliative care is, of course, a definite benefit appropriate for patients who are normally in the last six months of life.
Palliative care is bringing support and symptom management services to patients with chronic diseases. They are still receiving all the appropriate treatment for their chronic conditions, that is, there is no reduction in terms of the treatment that patients are receiving. It is really about meeting the needs of patients holistically. I think, culturally, it took a while to become more accepted and popular, but we definitely saw that in the last few years.
Interview conducted by Andrew Donlan