After steadily gaining steam over the last decade, in-home primary care models have reached a critical turning point in 2020.
A handful of in-home primary care businesses have received multimillion-dollar investments to expand across the U.S., for example. At the same time, the U.S. Centers for Medicare & Medicaid Services (CMS) is testing out new ways for primary care providers to treat their patients in the home setting.
Part of the Franklin, Tennessee-based GuideWell, PopHealthCare is positioning itself to capitalize on that momentum. To help scale its national network, the in-home primary care and risk-adjustment organization announced the hiring of Dr. Christopher Dodd as its new chief medical officer at the end of September.
PopHealthCare has completed over 100,000 in-home visits since launching. It currently manages the health needs of over 11,000 members with complex conditions.
In addition to PopHealthCare, the nonprofit GuideWell’s portfolio includes Florida Blue, GuideWell Connect, GuideWell Health and Diversified Service Options.
Home Health Care News recently connected with Dodd to learn more about PopHealthCare and its growth plans. Prior to his new role as CMO, Dodd served as chief clinical officer for ConcertoHealth.
Highlights from HHCN’s conversation with Dodd are below, edited for length and clarity.
HHCN: This is my first time connecting with PopHealthCare. Before we jump into things, can you please provide some brief background on your organization?
Dodd: I’ll start with GuideWell.
GuideWell is a mutual holding company that’s focused on building the future of health through innovation and collaboration. It consists of multiple companies focused on improving individual and community health. We have a laser-sharp focus on transforming the U.S. health care system, which has significant opportunities for improvement, we believe.
One of the ways that GuideWell firmly believes the system needs to be transformed has to do with the delivery of high-quality, in-home care for geriatric and vulnerable populations. With that in mind, GuideWell saw the opportunity in 2017 to acquire PopHealthCare, a private company that was leading in the delivery of in-home care for frail and vulnerable populations. On top of that, PopHealthCare also provided prospective- and retrospective-risk adjustment services for health plan partners.
GuideWell felt that PopHealthCare would be a wonderful way to transform the system by delivering better care and outcomes for populations with the most need.
PopHealthCare is under the GuideWell umbrella. But PopHealthCare also has different divisions. CareSight is the in-home primary care business, correct?
You’ve got it. There are three specific products that PopHealthCare offers to its health plan partners. CareSight is the in-home primary care line. There’s also InSight, which is how the company was initially founded. In 2005, the original physician founder saw an opportunity to develop a service that helped better understand the barriers that people were facing in living their healthiest lives possible. InSight is a sort of an in-home assessment program, which continues to this day. The goal is to provide a better lens to see the needs of individual patients.
As we identify patients who have significant care needs, that CareSight program is able to intervene and be the effector arm to help move patients from crisis to stability, in turn improving their health.
Then there’s RiskSight, which brings retrospective risk into full focus to maximize risk-score accuracy.
You were named CMO of PopHealthCare at the end of September. What were you doing before that? And congratulations, by the way!
I appreciate it. So, I’m a trained internist. I also have a background in public health. Overall, my training is really in figuring out, “How do you deliver care to vulnerable populations?” We can be talking about the geriatric population, particularly seniors who have multiple chronic conditions. But we could also be talking about frail and vulnerable non-senior populations. For example, a single mother who is living with diabetes and bipolar disorder, somebody who is at risk of losing her job from repeated hospitalizations.
My training in global health and social medicine has allowed me to closely study health care models for vulnerable populations, both in the United States and around the world. I’ve worked in Mozambique and Nicaragua, for instance, in addition to our underserved communities across the U.S. But regardless of the geographic location, I’ve come to realize the home is really the best place to deliver care.
Why is that the case? At what point did that light bulb go off?
I guess it was in the early 2000s, as I was training in what I refer to as social medicine. I had the opportunity not just to study chronic medical conditions like diabetes, heart failure and emphysema. I had unique training in the sense that I had to understand why people got sick. That was illuminating. Now, everyone’s starting to realize in greater frequency that we need to hone in on social determinants of health. It’s the social barriers and behavioral health conditions that really stand in people’s way of living their healthiest lives possible. If you don’t have the ability to understand a person’s environment, their social selves, then you’ll likely have a very difficult time collaborating with them to develop a treatment plan that addresses, in a comprehensive way, all of the barriers that they’re facing to be healthy.
When PopHealthCare named you as its new CMO, it noted that you’ll be in charge of scaling its existing network. What’s that network look like today?
That’s definitely one of the opportunities that I’m excited about. At present, PopHealthCare operates in 17 states and has relationships with 26 health plans. Those health plan partners range from local, to regional, to national health plans. One of our primary, short-term objectives is to reinforce those relationships and grow them. Why? So we’re able to care for more seniors and more vulnerable populations in our markets. But then we also want to grow that footprint and care for even more individuals moving forward.
HHCN just hosted FUTURE. During that event, Humana’s home segment president explained how she sees in-home primary care as a key part of a “home-centric ecosystem of care delivery assets.” Do other health plans share that view?
I do think there’s a growing appreciation for in-home primary care. But is home-based primary care right for everyone? Is it the best option for you or me, relatively healthy and young individuals? Not really. Maybe we’d like home-based primary care for convenience, sure. I think we need to get more focused about what the problem statement is in the U.S. health care delivery system. Obviously, it’s complex. But what we know is that 15% to 20% of patients consume 80% of the costs.
What we want to shout out loud here is that for this portion of the population, individuals who are seniors, frail or otherwise vulnerable, they need a different approach to health care delivery. The current approach of clinic-based, facility-based care just doesn’t work. By shifting to a home-based delivery model for primary care — and for what I’d refer to as complex care for frail and vulnerable populations — you’re going to deliver better care and get better outcomes. By doing so, the system wins in terms of lower total costs of care.
A couple of other points that I would add: When you look at all of health care spending, it’s something like 4% or 5% of all dollars go to primary care. For me — and I’m biased, of course, because I’m a primary care doctor — that is fundamentally wrong. There’s not enough resources and focus going into primary care. But with the increasing emphasis and acceleration of value-based care, of getting paid up front and determining how you want to spend the money to get the best health outcomes, primary care has this renewed sense of power that it has lost over the last several decades. That’s the opportunity that PopHealthCare and our health plan partners are seizing. They’re saying, “If we can get the right economic model to support this care delivery model, everybody’s going to win.”
We’ve been talking about in-home primary care generally, but what about at this particular point in time?
First and foremost, in-home primary care is important to keep the senior and at-risk population healthy. We know that the coronavirus is much more likely to create bad outcomes for people over the age of 55, and for people who have complex health and social needs. It’s a terrible thing that’s happening, but it’s been a wonderful opportunity for people like myself and for companies like PopHealthCare. By wonderful, I mean we finally get a chance to have our care model validated. It’s a chance to generate more awareness of how important it is when it comes to keeping people safe and promoting better health outcomes.
Does PopHealthCare currently work with any home health or home care agencies out there?
Everybody clearly understands the immense value that home health agencies bring to the table. At this time, we’ve decided to very much stay in our swim lane of home-based primary and complex care for geriatric and vulnerable populations. But as we’re doing that, we’re spending a lot of time developing relationships and partnerships with home health agencies, durable medical equipment (DME) suppliers, home infusion companies and others. We’re identifying those who do their work the best, making sure we have a “bat phone” to the right people.
Does PopHealthCare plan on working in any of the newer primary care models coming out of the CMS Innovation Center?
There’s a lot of excitement around what I think you’re referring to — CMS’s direct contracting models, with Primary Cares First being one of them. They’re super exciting. There’s a lot of potential there. PopHealthCare is taking a close look at those types of models. At some point soon, I think we’ll make a decision whether we want to to jump right in. But at present, we’re still evaluating.
What’s the most challenging aspect of the in-home primary care model? Is it the payment methodology? Is it the actual delivery of care and getting enough physicians who want to work in the home?
It all starts with who’s on your team. Talent acquisition is critical. While there’s a ton of great health care professionals out there, it’s not easy to find health care professionals who both have the expertise to treat heart failure and keep an eye on the social factors that play into it. You need a social-medicine orientation that allows you to look at the whole person and understand the medical needs along with the behavioral health needs, the mental health needs. You have to understand substance-use disorders and all of those social barriers to health. You have to be able to understand how to put together a treatment plan that takes into account all of these things so you can deliver the right care, at the right place, at the right time, with the right care team. So, talent acquisition is a big challenge.
The economics are critical, too. It’s expensive to deliver this type of care. Operating in a traditional fee-for-service model doesn’t work. You’ve got to get a fee structure up front to be able to fund the business. Then if you do a great job, you can have some sort of gain-share opportunity where — if you keep people healthy, home and out of the hospital, and you reduce the total cost of care — you are able to share in any savings with the health plan.
I think the other thing that’s important in terms of economics is volume. The more volume and the more patients you have in a given geography, the easier it is to deliver care.
What plans does PopHealthCare have for the year ahead? What are your goals as CMO?
Well, let me let me say a couple of things about why I’m so excited to join the team. One of the differentiators for PopHealthCare compared to some of the other companies out there in the market is we have a philosophy that says, “No matter what your age is, you can have complex health and social needs.” So, we’ve developed a care model that is able to provide care for frail elderly patients just as well as it’s able to for people who are in their 30s or 40s, who are living with a mental health condition and a chronic medical condition like kidney disease. I think what’s even more exciting is that we’ve been able to implement our care model across different geographies with different populations and demonstrate really great ROI for our health plan partners — reduced hospitalizations and emergency department visits.
In terms of moving forward, I think that the company is going to keep making the investments that are necessary to continue to be a leader in the delivery of care for complex populations. That means having the right tech and systems in place. That means increasing our telehealth and remote patient monitoring capabilities, so that we’re able to have access to important data points in a more timely fashion.