After Achieving 33% Hospitalization Cut and $3.4M in Savings, Skilled Nursing Startup Expands

A care-coordination startup that has generated 33% reductions in avoidable hospitalizations and $3.4 million in net savings for nursing homes is expanding on its success with a cash injection from a non-profit research institute.

Probari — formerly known as Care Revolution — focuses on treating acutely ill residents in place at nursing homes in an attempt to reduce hospitalizations, using both technology and a dedicated registered nurse specialist in charge of care assessments and coordination.

CEO Kathleen Unroe, a geriatrician and researcher at the Regenstrief Institute’s Center for Aging in Indianapolis, spent seven years testing a pilot called OPTIMISTIC — Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms Transforming Institutional Carewhich was backed by a $30.3 million grant the Centers for Medicare & Medicaid Services (CMS).

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The program ran in the field at 19 Indiana nursing homes, reducing all hospital transfers by 20%. Considering that transfers to hospitals are so common and costly — with 25% of nursing home residents moved to hospitals in a given year — Probari’s initiative is a huge potential win for owners and operators in this sector, Unroe said.

Other dramatic cost savings achieved in the pilot include a decrease in total Medicare spending of almost $13.5 million — and a $3.4 million in net savings over two years. Each nursing home saved $1,589 in Medicare spending per resident per year.

Cutting rehospitalizations remains a primary goal of many nursing home operators, both to avoid penalties under such new models as the SNF Value-Based Purchasing initiative and to potentially set themselves up for success under in-house Medicare Advantage options, such as Individual Special Needs Plans (I-SNPs) or Dual-Eligible Special Needs Plans (D-SNPs).

With the backing of Regenstrief as a new part-owner, Probari’s current expansion will focus on efficient data management, better workflow strategies, and training to increase care quality and improve communication by integrating both a mobile app and an experienced RN specialist position to oversee these goals — and input patient data into electronic medical records (EMR).

Probari negotiates pricing with nursing home customers, which includes training the specialist nurse and implementing the app based on the particular need. Subsequent year maintenance costs are also assessed on a per-facility, per-month basis.

Regenstrief — a research organization comprised of academics from Indiana University, Purdue University, and IUPUI — doesn’t typically invest in companies, CEO Peter Embi told SNN. But its leaders made an exception for Probari.

“We want to do the early support for getting the company up and running, because we want to have the greatest impact possible with regard to having our research go out and affect as many lives as possible in a positive way,” Embi said.

Historically, Regenstrief has worked across the health care continuum, collaborating with hospitals and clinics. And with the work of its affiliated Center for Aging Research at Indiana University, “we’ve been focused in all of the environments where people get their care, including nursing homes for quite some time,” Embi said.

Although researching nursing home care has been a long-time focus for the group, migrating its work into the commercial space to have a stronger impact is a newer initiative — as opposed to merely presenting at academic conferences and being printed in journals.

“We realized that in order to have the impact we wanted, to really improve health, we needed to get our innovations out into the marketplace,” Embi added.

The model is centered on an experienced RN embedded in a nursing facility, who works as a connector among staff, residents, and families — while also facilitating advanced care planning. This role will conduct a “root-cause analysis of transfers that occur, support and train staff around recognizing acute changes and conditions, and provide evidence-based medical care for common conditions in place,” Unroe said.

The specialized RN won’t be taking a resident assignment, passing out medications, or performing many of the other important day-to-day functions of nursing home staff, Unroe added. Instead, he or she will focus on “consultation, technical assistance, and implementation support while reducing hospital transfers — potentially because they are part of or looking to become part of an I-SNP or D-SNP in that space.”

Contracts for this role currently last from one to two years long.

Although OPTIMISTIC added a number of tools and protocols related to delivering the specialized role in facilities, they were paper-based. Its next major challenge is creating a business model that’s scalable beyond a small test footprint, which is why software is a key component in applying its principles across multiple settings.

In addition to funding operations with a stake in the startup, Regenstrief is also helping with the development of a companion app to direct more efficient workflow and to support the new RN role — which will provide more in-depth knowledge and clinical assistance.

The new software will allow Probari to standardize findings learned from the CMS pilot. The finished product, an iOS app that works on an iPad, will be be used at a resident’s bedside to assist with clinical decision-making and documentation.

“With the support of Regenstrief Institute, we are working to digitize these protocols and build a software application to build these into create clinical decision support tools, and also be a vehicle to deliver ongoing education for nurses in this role,” Unroe said.

This model differs from other care structures that rely on multiple nurse practitioners, Unroe added, suggesting that the value of this kind of role “can be accomplished by a well-supported and more experienced RN.”

One of the primary goals of the app is to look at changes in a resident’s condition. For instance, when a resident experiences symptoms such as shortness of breath, a cough, or a change in mental status, the model encourages the RN and other staffers to consider a few key questions:

  • What is the focused appropriate nursing assessment that needs to be done?
  • What are the key pieces of information that need to be gathered in order to assess this resident and communicate those needs to the provider, the nurse practitioner, or physician?

In this way, the model helps guide staffers through the assessment and create a clear clinical summary of what’s happening with the specific resident, Unroe explained. Once a change in condition is identified, and staff decides to manage the resident’s issues in-house, a clear plan — including monitoring parameters and all the follow-through for high-quality care in place throughout an episode — is necessary for success, with the specialist nurse leading engagement, Unroe said.

Integrating the software with the clinical staff, which involves streamlining into various EMR platforms will be a challenge — specifically working with the EMR providers to integrate applications “so that we can both pull information from it and push information into it,” Unroe said.

Embi stressed that nursing homes tend to lag behind other settings in terms of tech adoption, a problem that may be due to lack of financial resources. He’s seeing some forward movement with data exchange between hospitals, however.

“At least now, we’re starting to work on the issue of interoperability and data interchange between hospitals. So you can now increasingly go to an emergency room and they can pull your records from somewhere else,” he said. “Certainly here in Indiana, we’ve made a lot of progress in that regard.”

But that isn’t true of information exchanges among nursing homes, hospitals, and primary-care providers.

“It is still very, very nascent, and most places don’t do that very well,” he said. “And if we invest a bit more in initiatives like Probari, we’ll be able to spend our precious resources more wisely on improving health.”

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