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Some forward-thinking health systems
believe that house calls for patients seeking urgent care or primary care will
become recognized as an important component of high-value care delivery systems.
Providence St. Joseph Health, an
affiliate of Providence Health & Services, introduced house calls in two
markets—Seattle and the South Bay region of Los Angeles—in 2016 as part of its
Express Care at Home product line. That line also includes walk-in clinics and telehealth
services for urgent care.
All three delivery modes are
designed to increase convenient access to primary care and urgent care for
minor conditions. Without these access points, patients are likely to seek care
at urgent care centers or emergency rooms—or postpone treatment until their
medical condition becomes more complicated and harder to treat, says Sunita
Mishra, MD, MBA, vice president of Express Care at Home and Consumer Innovation
for Providence St. Joseph Health.
Like Vanderbilt University Medical
Center (VUMC), another leading provider of urgent care house calls, Providence
thinks the program’s ROI will be significant across the industry. “Our belief
is that we will be able to lower the total cost of care for payers because we
have these alternative access channels,” Mishra (pictured at right) says.
As part of Providence Express Care
at Home, nurse practitioners travel to a patient’s home, office, or hotel to
diagnose and treat minor illnesses and the manageable symptoms of chronic
conditions. House calls are available from 8 a.m. to 8 p.m., seven days a week,
for patients ages 2 and above.
“For the most part, we see things that
may make patients feel miserable but are not really an emergency, such as pink
eye, cough, cold, earaches, tummy ache,” Mishra says.
Patients or their family caregivers
use a phone app to request a house call, and a provider responds with a phone
call, generally within two minutes. During that conversation, the provider
determines whether a home visit is appropriate or whether the patient should be
referred to a medical clinic or emergency department. “That call is really
important because it helps us ‘right-size’ care,” Mishra says.
If a house call is the right choice,
the nurse practitioner notifies the patient of an estimated time of arrival—usually
within 90 minutes.
In the service’s first year, 66
percent of patients were female, and the average age was about 32. However, the
house call providers recently started seeing Medicare patients, so Mishra
expects the patient mix to change as older patients with more complicated
conditions start seeking at-home care.
About 60 percent of those who used
Express Care at Home in the first year were already Providence patients. The
nurse practitioners access those patients’ electronic health records and add
information about the at-home encounter.
For the 40 percent of patients who
are new to the system, Mishra says, follow-up care is offered if they do not
have a primary care provider.
VUMC, in Nashville, quickly followed
Providence’s lead into the house call business. Three nurse practitioners—two of
whom are devoted full-time to house calls—staff Vanderbilt Health OnCall (VHOC)
to provide 8 a.m.-8 p.m. coverage every day. VHOC treats patients 18 and older.
The nurse practitioners travel with
many common medications so they can administer the first dose, saving patients
an immediate trip to the pharmacy.
In addition to home visits,
Vanderbilt sees significant potential to serve tourists—including members of
the entertainment industry who visit Nashville—at their hotels, says April
Kapu, DNP, APRN-BC, associate nursing officer for VUMC Advanced Practice and
director of the Office of Advanced Practice. Further, she thinks the
convenience of VOHC will be attractive to time-strapped workers.
“There are lots of folks who work here
at Vanderbilt and in surrounding businesses and really can’t break away from
work for an hour or two hours to go to a walk-in clinic,” Kapu (pictured at right) says. “They would
prefer to have someone come and see them in their office.”
Offering a digital platform and
unprecedented convenience, the Express Care at Home service is part of
Providence’s effort to cater to younger healthcare consumers, Mishra says.
“Those are going to be our patients
in the future, so it is important for us to try to reach them in more
convenient ways,” she says.
Sending clinicians to see patients is
expensive, but Providence and Vanderbilt leaders take a broad view of the associated
ROI. For one thing, the service offers a way to increase market share—or to stave
off patient-poaching from national telehealth providers and local concierge
With 90 newcomers moving to
Nashville every day, primary care clinics struggle to meet demand. Meanwhile, the
house call service can expand as needed given that it requires no physical
“Vanderbilt is well-placed within
the community and we have a robust referral base, so if somebody needs another
level of care or wasn’t already established within a healthcare system, we can
make appropriate referrals and help navigate them through the system, if
needed,” says Jennifer Mitchell, MSN, APRN-BC (pictured at right), Vanderbilt’s director of
advanced practice and the executive in charge of the house calls initiative. “That
wouldn’t always be the case for other house call services that are in the
Kapu and Mitchell consider three factors
that make the house call service financially advantageous:
Urgent care and primary care house
calls are still new concepts for insurers. Representatives for Cigna and Anthem
said they do not have company-wide coverage policies for such house calls. But
Providence and Vanderbilt are both finding that many commercial insurers are
willing to support the new delivery model.
For self-pay patients, Providence
charges a flat fee of $199 per visit. Vanderbilt charges $99 for the visit,
with lab tests, first-dose medications, and certain services priced separately.
Both organizations file insurance
claims for home visits just as they would for any other services.
“For patients, it’s very similar to
what they would experience if they went to see a provider in the doctor’s
office,” Mishra says. “They pay the copay, and the remainder of the $199 is
billed to the insurance company.”
Both Providence and Vanderbilt
expect to expand the geography of their house call programs in the years to
come. Providence’s extension of the house call service to Medicare patients could
open up an important market for the model.
Kapu, meanwhile, expects that
Vanderbilt’s house calls team will start providing scheduled visits in the
foreseeable future. “For example, if a patient goes to the emergency room and
the ER contacts our team, we could visit the patient two or three days later to
follow up,” she says.
Both organizations say patients have
been slow to try the service because they either are unaware that the service
is available or are accustomed to “going to the doctor.”
“For patients who use the service,
our net promoter scores are through the roof,” Mishra says, referring to a
measure of how likely a patient is to recommend a service to others. “We are
getting a lot of referrals by word of mouth and by our own primary care
providers, so we are hopeful that this will continue to grow.”
Butcher writes about healthcare business and policy topics for several HFMA
Interviewed for this article: April
Kapu, DNP, APRN-BC, associate nursing officer, Office of Advanced Practice,
Vanderbilt University Medical Center, Nashville; Sunita Mishra, MD, MBA, vice
president of Express Care at Home and Consumer Innovation for Providence St.
Joseph Health, Los Angeles; Jennifer
Mitchell, MSN, APRN-BC, director of advanced practice, Office of Advanced
Practice, Vanderbilt University Medical Center, Nashville.
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This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
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Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
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ICD-10: Managing Performance
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Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
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Streamlining the Patient Billing Process
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7 Steps for Building and Funding Sustainability Projects
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Key Capital Considerations for Mergers and Acquisitions
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Key Capital Considerations for Mergers and Acquisitions
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Yuma Regional Medical Center case study
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Reforming with a New 50-Bed Acute Care Facility
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Providers Focus Too Much On Revenue Cycle Management
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Lucille Packard Children’s Hospital Stanford Case Study
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Automation and Operational Improvement Drive Sustainable Results
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The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
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