Highmark Health has announced it is expanding its joint venture relationship with Contessa, a company that helps organizations provide hospital-level care in the home through its Home Recovery Care model.
The expansion comes at a time when more health systems and hospitals are looking to redirect acute care into the home setting to maintain capacity and avoid spreading the COVID-19 virus.
Highmark Health is the Pittsburgh, Pennsylvania-based parent company of Highmark Inc., Allegheny Health Network (AHN) and HM Health Solutions. Highmark Health’s businesses include Highmark Health Plan, a hospital and physician network, as well as home- and community-based services.
Founded in 2015, Nashville, Tennessee-based Contessa partners with health systems and health plans through its increasingly popular Home Recovery Care model. Backed by Health Velocity Capital, BlueCross BlueShield Venture Partners and other investors, Contessa has raised more than $10.5 million since launching, according to Crunchbase.
As part of the new JV expansion, two of AHN’s hospitals in Pennsylvania — Forbes Hospital in Monroeville and AHN Jefferson Hospital in Jefferson Hills — will offer Home Recovery Care.
“Healing at home through Home Recovery Care offers patients many benefits,” Dr. Harshit Seth, system medical director of hospitalists services at AHN and the medical director of AHN Home Recovery Care, said in a statement shared with Home Health Care News. “Patients often feel more secure and comfortable in their home environments.”
AHN is using the Home Recovery Care program to allow eligible patients with acute medical needs to receive care in the home for conditions such as cellulitis, congestive heart failure, asthma, urinary tract infections, dehydration, pneumonia and more.
AHN is also using the model to assist with COVID-19 needs, in some cases.
“These are typically low-acuity in-patient admissions,” Christina Weir Ripley, vice president of enterprise clinical transformation at Highmark Health, told HHCN. “[For example], a stable COPD patient that has an acute exacerbation of chronic bronchitis and meets clinical criteria and insurance eligibility would have the option to receive their in-patient care in the home.”
That clinical criteria is decided upon by an emergency department physician and an admitting hospitalist physician.
Prospective patients also pass through a rigorous home safety assessment to make sure their environment is free of fall risks and other potential hazards.
Once patients have been deemed eligible, they can receive home infusion services, in-home nursing visits, telehealth visits and home medical equipment — whatever it takes to keep them healthy and out of an acute setting.
As for Contessa’s role within the partnership, the company mostly provides operational support.
“Contessa’s data demonstrates the Home Recovery care model dramatically improves patient satisfaction and reduces both mean length of stay and readmission rates,” Contessa CEO Travis Messina said in a statement. “We are thrilled to bring this level of care to AHN Forbes and Jefferson and allow patients to recover in an environment that is best suited for their needs, which is often the home.”
Additionally, Contessa is responsible for hiring some members of the clinical team who are embedded in the emergency departments. This includes the recovery care coordinator, who is a registered nurse that’s responsible for organizing the patient’s care, including communication between the emergency department physician and the hospitalist.
Contessa first partnered with Highmark Health last November at AHN’s Allegheny General Hospital in Pittsburgh.
It has a long track record of similar partnerships, too. Prisma Health, Marshfield Clinic Health and Ascension Saint Thomas are just a few of the health care organizations the company has teamed up with over the years.
This made them an attractive partner in Highmark Health’s eyes, according to Ripley.
“They’re one of the leading capability partners in this space,” she said. “As we were looking to adopt this model in the market as a part of our virtual health and home-first strategy, we had assessed a number of different capability partners.”
The Home Recovery Care model uses a value-based reimbursement methodology that was specifically designed and implemented with Highmark, according to Ripley.
“It is a specific reimbursement methodology that the JV has constructed with Highmark,” she said. “Essentially, the Contessa joint venture is in a value-based reimbursement arrangement with Highmark as the insurance plan.”
Despite the model’s ability to lower costs and hospital readmission rates, reimbursement has been one of the biggest barriers to widespread implementation of hospital-at-home programs in the U.S.
Such efforts are much more common abroad, particularly in England, Spain and Italy, for example. That’s rapidly changing, though, with Mount Sinai, Medically Home, Lifesprk and others also leading the charge on the hospital-at-home movement, pioneered in the U.S. by Johns Hopkins decades ago.
HHCN previously connected with experts from both Mount Sinai and Johns Hopkins during the first month of the COVID-19 emergency.
“In times of crisis, things that people wouldn’t normally think about or things they would think about sort of on a slow-burn basis start to get some traction,” Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine, told HHCN in April. “Crises have a way of making things happen.”
Though it’s still in its early days, Home Recovery Care is already resulting in positive outcomes for Highmark Health, according to Ripley.
“The length of stay and readmissions have been very favorable,” she said. “We’ve had a number of patients who have given personal statements about how much they appreciated being able to receive that care in the home. From a clinical quality perspective, we think that one of the most favorable pieces to this model is the care continuity and coordination that occurs after they’re discharged from that acute phase.”
The model has also been an advantage throughout the COVID-19 emergency.
“We viewed home recovery care as a significant option for us as we went through a surge capacity planning,” Ripley said. “Fortunately, in our market, we did not see a surge as we had initially anticipated, but we continue to see Home Recovery Care an advantage that we have to offer.”
Highmark Health has plans to further expand the program to the organization’s Delaware and West Virginia markets in 2021.
“We are currently in discussions to expand the program to additional parts of the Highmark footprint,” Ripley said. “We are in the process of establishing what that will look like.”