How to Provide Value-Based Acute Care in the Home

In the Acute Care at Home program, patients participate in a 15-day episode of care at home, with virtual care provided by a physician, nurse, and care manager staffed by myLaurel, according to Logan Davies, MD, medical director of hospital access and throughput at Ochsner Medical Center—New Orleans. The virtual visits by a physician are accompanied by a paramedic in-person visit.

“Over the 15-day episode of care, myLaurel is managing acute care, the clinical plan, and transitional care services,” Davies says, “where we have virtual nursing and virtual care management doing everything from medication reconciliations, to fall risk assessments, to education for patients and their caregivers.”

Clinicians employed by myLaurel conduct the home care, but they are Ochsner-credentialled providers, Davies explains, which allows them to have full access to the health system’s electronic medical record.

To be enrolled in the Acute Care at Home program, patients must be stable and able to be treated safely in the home, according to Davies.

“A cornerstone of the program is appropriate acuity,” Davies says.

Patients are transferred to the Acute Care at Home program from the emergency department, hospital observation units, and inpatient units.

Acute Care at Home patients are being treated for several medical conditions, Davies explains.

“For the conditions we are managing, the most common are infections, including urinary tract infections,” Davies says. “The second most common condition is congestive heart failure. After CHF, we are treating pulmonary conditions such as chronic obstructive pulmonary disease as well as upper respiratory infections. We also treat patients for electrolyte issues and renal issues.”

Benefits of the Acute Care at Home program

The main benefit of the Acute Care at Home program is that patients get to receive care in the home, which is an appropriate care setting for these patients, according to Raymond.

“People are eligible because they are stable enough to not be hospitalized, but they do need more than just intermittent care that would require travel to and from a clinic or other care setting on multiple visits,” Raymond says. “It’s the right care in the right place. These patients get to be home, where they and their caregivers are more comfortable.”

Secondarily, the Acute Care at Home program is beneficial because it meets an acute need for a patient at a lower cost than hospital inpatient care, Raymond explains.

“This program is currently available to patients that we share in the total cost of care in some way,” Raymond says. “This allows us the freedom to try different models of care while always keeping the patients first. Another benefit is that it frees up beds inside the hospital for those that need that level of care or intervention, and it avoids delaying that care by having better access.”

The Acute Care at Home program exemplifies value-based care, according to Raymond.

The Acute Care at Home program is reducing total cost of care by avoiding hospital admissions and readmissions, Raymond explains.

“Hospitalizations are some of the costliest events in healthcare for not only the payer, but also the patient through deductibles and coinsurance,” Raymond says. “Reducing hospitalizations has a direct and noticeable impact on the total cost of care.”