University of Tennessee

Healthier at Home?

November 3, 2020

With the COVID-19 pandemic, home-based healthcare and telemedicine’s popularity is surging. Mayank Shah (PEMBA, ’19) isn’t surprised. Shah, a physician and CMO of Alegis Care, a Chicago-based company that offers a slate of home health services geared toward different populations and health conditions, has long advocated for home-based healthcare.

“I’ve always done home-based care in my practice,” he says. “As I’ve moved from practicing physician to CMO, I’ve seen firsthand that we need to dramatically change the way we deliver care.”

But convincing insurance companies – and even fellow physicians – isn’t easy. The common perception that home-based care is more expensive and less efficient remains. Not true, Shah says; it’s simply that few organizations have quantified the long-term benefits.

Shah set out to do just that, while in the Physician Executive MBA program in the University of Tennessee’s Haslam College of Business. He designed his Organizational Action Project (OAP), a sort of work-based research study, to compare the long-term outcomes of home-based care and location-based models using eight years of Alegis Care data.

The Hidden Cost of Office-Based Care

Healthcare practitioners and the health insurance industry frequently focus on short-term results. “We have an office-centric model because you can see 25 patients in a day versus seven in home-based care,” Shah says. “On the surface, that seems more efficient.”

Such efficiency may come at a cost. Shah cites a 70-year-old patient named Shirley who was labeled non-compliant by her primary care physician. She missed regular appointments and was difficult to reach by phone. She visited the emergency room six times in four months and was admitted four times for leg swelling and back pain. Each visit upped her medication count.

A single home visit by Alegis Care uncovered the problems, which were easily solved.

  • Shirley’s leg swelling came from sleeping in a recliner; switching to a hospital bed resolved the situation without medication.
  • Her sleeping position combined with a lack of access to food also had caused a sacral ulcer to develop, which sparked her back pain. Alegis arranged home meal delivery and trained her to keep pressure off her back. The ulcer healed.
  • Shirley’s landline phone service had been cut off, so Alegis got her a $25 mobile phone to contact her doctors. After months of isolation and depression, regular home visits and phone contact gave Shirley a real sense of connection. She didn’t return to the ER.

Millions of patients are homebound in the United States, many with complex or chronic conditions. How many might be treated successfully with home care before an ER visit becomes necessary? Most are not; less than one percent of primary care visits are home-based.

What’s the Value Proposition?

Shah sought a model to accurately assess the long-term benefits of home-based care and allow organizations to mine years of unexamined data to make better decisions.

The challenge was to compare equitably home-based care and office-based healthcare. It would be important, for example, to map a patient’s experience over years with a single physician. What value is created in that relationship? Alegis conducted a study that showed it takes an average of 4.2 office visits before a patient trusts the physician. In a familiar, home-based environment, it takes half that. What are the cost savings associated with that benefit, and how does that play out over time?

Shah created his value-analysis model using factors across Alegis’ suite of home healthcare programs (e.g., medical spend, admissions and emergency visits, readmission rates, provider satisfaction, patient satisfaction). He measured the impact of each program and compared the results to a control group of patients who did not receive home-based care. The outcomes included:

  • Alegis’ Health Risk and Prevention Assessment program, providing periodic wellness visits and preventive screening to patients in good health, showed an 80 percent capture rate for frequently missed chronic conditions and a 6-to-1 ROI.
  • Complex Care Management, which delivers primary care to chronically ill homebound patients, achieved a 39 percent reduction in hospital admissions and a 47 percent reduction in readmissions, delivering a 4-to-1 ROI.
  • Chronic Care Management, which extends primary care into the home via nurse practitioners, achieved similar admissions reduction rates and delivered a 2.3-to-1 ROI.
  • End-of-Life Primary Care saved $2,082 per month in medical spending over the control group.
  • Transitions of Care, a pilot program designed to ease patients from acute care settings back to the home environment, reduced hospital admissions by 70 percent, ER visits by 80 percent and readmissions by 37 percent.

All of these results were consistent over time. Based on his findings, Shah recommends that providers, healthcare systems and third-party payers prioritize a strategy to deliver home-based healthcare to all segments of the population. Additionally, the benefit of a home visit can be extended affordably with televisits, making potential savings even greater.

Shah hopes to share his model in the healthcare community along with the recognition that home-based healthcare has value beyond what can be measured in the short term or in dollars and cents. “It has a significant long-term impact not just on outcomes,” he says, “but on each individual’s experience of the healthcare journey.”