In December, the University of Utah’s Huntsman Cancer Institute (HCI) launched a new program aimed at bringing hospital-level care into patients’ homes. The program allows patients to be discharged sooner and avoid costly emergency department visits.

Dubbed “Huntsman at Home,” this initiative is the latest instance of health care’s shift to the home and the increasingly important role home-based care providers are now playing.

Indeed, HCI’s new program reflects the trend of home-based care providers being part of care programs that target particular conditions, either by rolling them out internally or by partnering with a larger health system. As part of Huntsman at Home, HCI has teamed up with Community Nursing Service, which delivers home health, hospice, palliative care and other services across the Beehive State.

“We wanted to institute a program that really filled the needs of our patients,” Anna Beck, medical director of Huntsman at Home, told Home Health Care News. “There’s a gap that patients and their caregivers experience when they leave the hospital until the next appointment.”

As the only National Cancer Institute (NCI)-Designated Comprehensive Cancer Center in the Mountain West, HCI draws patients from Utah, Nevada, Idaho, Wyoming and Montana. However, participation in the Huntsman at Home program is limited to a roughly 20-mile radius around HCI’s Salt Lake City location during its early stages.

There are currently 186 patients receiving home-based care through the Huntsman at Home, which has an average daily census of about 50, Karen Titchener, the program’s administrative director, told HHCN.

“We’re doing a demonstration to prove that if we give people the level of care that they need, their outcomes are better — and their burden on the health system is better,” she said.

Inside Huntsman at Home

Huntsman at Home services are available seven days a week, bringing hospital-quality care into homes of HCI patients for symptom management, physical therapy and end of life care. To be eligible for the program, HCI patients must receive a referral from their oncologist.

Home-based care begins the same day as the referral.

A patient undergoing chemotherapy and experiencing aggressive symptoms is just one scenario where Huntsman at Home might help reduce health care spending and avoid a trip to the emergency department.

“Rather than them having to come up to the hospital and be admitted for fluids and treatment, they can give us a call and we can respond within two hours of that call, go out and see them,” Titchener, who previously pioneered a version of Huntsman at Home overseas in London, said. “We’re trying to deliver a higher level of care focused around patient need.”

While Huntsman at Home is operated in partnership with Community Nursing Services, care is always given under the direction of the patient’s HCI doctor.

The program — in the first year of a three-year pilot — is supported by the Huntsman Cancer Foundation and NCI. Evaluation of Huntsman at Home is supported by Camba Health Foundation.

“It’s beyond my expectation how good this kind of program is, particularly for cancer patients,” Titchner said. “Unlike other chronic diseases, they can be doing really well when you see them on Wednesday, then Thursday you get a phone call they’re doing really poorly.”

For home-based care providers working in specialized care models, communication, flexibility and education are essential, according to Beck. To streamline processes, Community Nursing Services has access to Huntsman’s electronic medical records.

The two organizations stay in constant contact through HIPPA-compliant communication systems as well.

“I think flexibility is huge,” Beck said. “I think a home health agency needs to realize this is a program that can get out of control very quickly. It’s a very popular program here, and we have to always be very careful about making sure we’re not taking on more patients than we can care for safely.”

Home-based care becoming more specialized

Just a few decades ago, the idea of offering hospital-level cancer care at home through a home health or home care partner would have seemed impractical or even outlandish. Today, though, specialized care in the home setting is becoming a norm for a variety of complex conditions.

Sunrise, Florida-based franchise network Interim HealthCare, which boasts nearly two dozen specialized care lines, is proof. Part of Caring Brands International, Interim has more than 530 franchise locations in seven countries.

Specialized care programs focused on arthritis, congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD) and traumatic brain injury are among its offerings.

While it does not have a cancer-focused program, Interim’s most recent addition is a comprehensive dementia care training program for its caregivers that launched toward the middle of 2018.

“We have these specialized programs so individual offices can choose which ones meet the needs of their particular market,”Interim Chief Clinical Officer Jane Hinton told HHCN. “The most prevalent diseases we see in home care are dementia, heart failure, diabetes and COPD, which is just like most other health care settings.”

From a financial perspective, the benefits of implementing specialized care programs include patient satisfaction and, in some cases, higher margins compared to more standard home-based care services.

Interim has also seen a benefit when it comes to forging relationships with health systems, hospitals and other post-acute care providers, Hinton said.

“Because we can offer the entire continuum of care in many of our markets, from personal care to home health and hospice, we’re easy to work with for health systems,” she said. “As an organization, we think there’s room to grow and more opportunity with health systems, hospitals and other providers, partnering more along the lines of working with home health companies.”

‘It can be a challenge’

For any home-based care provider, launching a specialized care program can be difficult. That’s particularly true for a home care franchise company, Hinton said.

“It can be a challenge. It’s not like you write a program, roll it out and then everybody adopts it,” she said. “Although we have all of these different programs, not all of them fit in a given market, some due to regulatory issues, some due to ownership choice.”

Hinton’s advice for home-based care providers: invest in specialized care programs for patients with chronic conditions — and do it now.

“Home care agencies need to be able to focus on chronic diseases like COPD, coronary artery disease and heart failure, how they’re going to be able to efficiency deliver that care, especially with regulatory and financial changes coming in 2020,” she said. “This year should be used to focus on those chronic diseases and making sure you have a way to reach patients and their families how to manage them.”

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