HEALTHCARE AT HOME:
THE  ROWAN TECHNOLOGY REPORT

Serving the home health, home care and hospice industry since 1999.

by Tim Rowan, Editor

Home Health provider Amedisys has been on a growth-through-acquisition plan for years, mostly targeting small Medicare home health agencies. When the Baton Rouge giant acquired Mike Trigilio's personal care company in 2016, he was enthusiastic about being part of their first steps into a new direction. So, Amedisys made him President of their new Personal Care Division.

With Trigilio on board, Amedisys began to scale out and invest more into the personal care space. Medicare Home Health is designed to be temporary, intermittent care but many patients do not do well on their own after discharge. "The nature of disease has changed," Trigilio told us. "There are more people than ever living at home with chronic conditions today. Keeping people who cannot be cured safe and thriving in their homes means you must attend to activities of daily living, you have to pay attention to social determinants of health. These are high-touch clinical areas but you still have to do it on a relatively inexpensive basis."

He added that Managed Care Organizations and government payers are starting to recognize these non-medical factors as drivers of outcomes and cost but have struggled to tightly integrate clinical and personal care services. Amedisys had managed these integrated, home-based care models in selected geographies with great success but now had to figure out how to scale these early models nationally. One way would have been to continue to acquire more non-medical home care agencies.

"Eventually, we decided against that as our primary means of growing personal care," Trigilio continued. "Personal care businesses are too ephemeral, and many are too small to acquire with predictable results. What made them successful when independent and smaller is what also poses challenges as they grow and expand."

Planning discussions turned to partnering with personal care companies like the one he came from rather than acquiring them. Amedisys realized that, with the right coordination and handoffs, it could achieve the same impact on patient outcomes through partnership.  "It sounded great," Trigilio remembers, "but we realized we needed some technology to make sure communications would be efficient and accurate."

ClearCare Steps In

Founder and CEO Geoff Nudd picked up the story to explain his company's role in the partnership. "We talk about interoperability at every conference," he began. "Everyone wants to get it right, everyone says the solutions are elusive. What we are doing is linking our non-medical ClearCare users with Amedisys branches in their market areas.

"Here's how it works. We created a portal that we call 'Claire.' With Claire, Amedisys and personal care agencies using ClearCare can coordinate care plans. Claire also enables timely, accurate sharing of change in condition information from caregivers." Prior to the Amedisys/ClearCare partnership, he explained, these hand-offs and transitions often fell apart during acute situations, at precisely the worst times.

Nudd shared his own family's experience. "My Father-in-law was hospitalized recently and came home to Home Health services. The nurse helped with his meds but he was 91 years old and needed his whole life reorganized. Fortunately, we knew how to facilitate the hand-off to a superb personal care agency, but in the absence of our expertise, he would have been back in hospital or a SNF in no time, costing payers thousands of dollars or more and eliminating his chance to age in place."

After this personal learning experience, Nudd had his developers build in the ability for caregivers to record observations and, upon patient consent and request, and clinical need, share them with Amedisys. Now, when partners make those observations, they can go to Amedisys care coordinators and from there to four post-acute care sectors.

Communication-Facilitated Hand-offs

Taking his turn to describe the partnership, Amedisys CEO Paul Kusserow told us that some of the ideas for making connections and facilitating seamless hand-offs came from his time at Humana. Before coming to Amedisys, Kusserow helped create "Humana at Home" to help seniors age in place and stay out of the hospital.

"With patient consent, and if it is clinically appropriate, the technology allows for a local personal care agency to share information with Amedisys," Kusserow explained. "Instead of asking our local branches to randomly identify and develop a relationship with a good personal care agency, coordinating with ClearCare gives us the ability to exchange data and coordinate care. Patient data can be coordinated bi-directionally, even with hospices and palliative care organizations."

The importance as we move to more and more Managed Care and Medicare Advantage involvement, he explained, is that this level of data sharing opens up the opportunity to offer to share risk with these payers, and the possibility of better payment agreements.

"It's the combination of clinical and non-clinical care that can deliver tremendous improvements to patient outcomes, and keep people out of hospitals and facilities. It's a win for the patient, a win for the family, and a win for health plans and government payers.

From Theory to Practice

There are currently pilots in 15 states where Amedisys is taking on some risk. They are happy with the way it is working so far but looking to do more, confident that adding these personal care agency relationships will enable them to take it even further, perhaps to all 471 branches in 40 states. Amedisys has created a centralized group in Baton Rouge to coordinate interaction with Private Duty partners.

Final Thought

"This is only worth doing if it results in complete care coordination," Mike Trigilio concluded. "As personal care agencies continue to want to partner with us, our care coordination will get better and better while moving patients toward healthier outcomes."


©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com