Overview

ProHEALTH Care, a New York-based ACO, developed a program for high-need patients that employs home nursing visits, telehealth appointments with palliative care physicians, and other support services to decrease hospital admissions and cost of care at the end of life.

Organization Name

ProHEALTH Care

Organization Type

• Home-based care
• Integrated healthcare system/network

National/Policy Context

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Patient Population Served and Payor Information

• The organization participates in the Medicare Shared Savings Program (Track 1) and is responsible for about 29,000 patients via its ACO.
• The ProHEALTH Care Support program specifically seeks to enroll homebound frail elderly patients, patients with advanced heart failure, patients with COPD on home oxygen, patients with metastatic cancer, and patients with dementia. Enrollment does not include patients living in a skilled nursing facility or who have been diagnosed with behavioral health issues.

Tools or Products Developed

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Training

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Tech Involved

• Electronic medical record
• iPad
• Telephone
• Video conferencing
• Video messaging

Team Members Involved

• Administrative Assistant
• Data Analyst
• Physicians
• RNs
• Social Worker

Workflow Steps

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Budget Details

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Where We Are

• The intervention is currently ongoing.

Outcomes

• Cost per patient in the final year of life: this cost was $10,435 lower for patients enrolled in the home-based palliative care program compared to usual care.  
• Hospitalizations in the final year of life: hospitalizations were decreased for patients enrolled in the program.
• Utilization of hospice services: these services were used more for those enrolled in the program.
• Patient death at home: participation in the program was associated with a high likelihood of patient death at home.
• Compared to standard treatment, the HBPC program allowed more patients to fulfill their wish of dying at home, increased utilization of hospice services, lowered treatment costs for patients in their last year of life, and reduced unnecessary care for patients and unnecessary expenses for the ACO.

Future Outcomes

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Benefits

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Unique Challenges

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Glossary

• Accountable Care Organization: Per Center for Medicare and Medicaid Services (CMS), “ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.”
• Medicare Shared Savings Program: According to CMS, “The Shared Savings Program offers providers and suppliers (e.g., physicians, hospitals, and others involved in patient care) an opportunity to create an Accountable Care Organization (ACO). An ACO agrees to be held accountable for the quality, cost, and experience of care of an assigned Medicare fee-for-service (FFS) beneficiary population.” Organizations can choose which track of the program to participate in.  Each track offers providers different potential rewards and penalties depending on their patient population adjusted cost of care.

Sources

• Lustbader D, Mudra M, Romano C, et al. The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization. J Palliat Med. 2017;20(1):23-28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178024/.
• Driessen J, West T. Variation In End-Of-Life Care Is An Open Invitation For Accountable Care Organization Innovation. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20170825.061646/full/.

Expert Insights

Virtual Care Tips & Tricks March 2020

Based on interview conducted by the CareZooming Team with Dr. Dana Lustbader in March 2020.

What technology do you use to provide virtual care?

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Do you bill for virtual visits?

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What should providers trying virtual care keep in mind?

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