Geisinger at Home offers primary care to the population with chronic or complex illnesses

Geisinger Marketing Director Dr. Jonathan Welch

Photo: courtesy of Geisigner

The Acute Home Hospital has become one of the life-saving programs for health systems during COVID-19 for health care providers who have had the capacity and resources to take advantage of public health emergency waivers.

Inpatient home care programs for primary health care are less common and require a combination of factors to be successful for patients and health professionals.

Geisinger Pennsylvania has the right combination of a population that needs home primary care, a comprehensive health care plan, and resources to make the program successful at scale. Geisinger does not have an emergency home care program, but Geisinger at Home began operations in 2018 to provide primary health care services for patients with complex or chronic conditions such as heart failure, emphysema, or diabetes.

About 2,000 of the 600,000 Geisinger Health Plan members are currently enrolled. Since 2018, 7,600 patients have benefited from the program. Often they are recorded up to a year or longer.

“Typically, these are the weakest or most difficult patients from a medical and socioeconomic standpoint,” said Geisinger marketing director Dr. Jonathan Welch. “Three to five percent participate in this program. We have a comprehensive care team that makes home visits to patients.”

These groups evaluate the social determinants of health. The program isn’t designed for patients who would otherwise end up in the hospital, but it does keep them out of inpatient care and the emergency room, Welch said.

“Because we provide a lot of care to patients, it keeps them from being hospitalized,” he said. “We think it’s necessary for patients.”

You won’t be able to see the refrigerator or the patient’s first aid kit until you enter the house, he says. Clinicians often see a discrepancy between what is in the medicine cabinet and what medications the patient should be taking. They can assess social isolation and fall risk, and connect patients and family members to community resources for food, transportation, and other needs. They can make sure the patient is up to date on vaccines, such as the flu shot.

“If someone needs air conditioning, we can solve that problem,” Welch said.

The numbers show the results: emergency room visits fell by 23% and hospitalizations by 35%. “We are seeing an improvement in the overall cost of patient care by $400 per month per participant,” Welch said of those enrolled in the Geisinger at Home program.

Telemedicine plays a role. For example, after a personal visit, a check-up can be carried out a week later using telemedicine.

“We brought specialization into primary health care,” Welch said. “We make sure that clinical and social support is at the center of attention.”

WHY IS IT IMPORTANT

Other hospitals and health systems offer home-based primary care, Welch said, but programs are “few and far between” overall.

One reason is that the model needs a certain combination of factors to work. First, health care systems require a significant population in the geographic area within which it makes sense for clinicians to travel.

Health systems need to be integrated or have a health care plan that allows for value and risk based contracts. The right funding model allows hospitals to reinvest in the program.

“Clinical integration is one of the most important elements,” Welch said, “to be responsible for the full cost of treatment.”

In addition, the hospital must develop clinical models that can diagnose social barriers to health. “There is a virtuous cycle,” Welch said. “This is the future for engaging patients by having an advanced model.”

BIG TREND

Primary health care has become competitive as players outside the traditional health care providers enter the field.

Healthcare “retail” is expected to continue and grow as pharmacies and other organizations like Amazon offer a convenient alternative to traditional primary care.

Twitter: @SusanJMorse
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