‘Not a Threat’ to Operators, UnityPoint Expands Its SNF-at-Home Program

After the success of its hospital-at-home program, UnityPoint Health is looking to expand its skilled nursing at-home offerings and is partnering with care coordination platform WellSky to do so. 

One of six national health systems approved to pilot the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care At Home program in 2018, the success of the program — combined with current patient preferences — led UnityPoint to further expand to SNF-at-home.

Mag VanOosten, president and chief clinical officer of UnityPoint at Home, said UnityPoint’s SNF-at-home program started as a proof of concept in the spring of 2020.

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“What we realized when we came up with the concept was that we needed a caregiver service that was a little bit deeper than what we had,” she explained. “This will allow us to start to build a robust program.”

She said WellSky gives UnityPoint access to a caregiver network that it didn’t have before and will allow them to apply best practices with personal care partners and enable the coordination, coverage and transitions that SNF-at-home requires. 

WellSky’s care coordination platform and network includes more than 4,000 personal care agencies to provide care and help patients with daily life through in-home clinical care, home medical equipment and telehealth.

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With more patients preferring to be cared for at home coming out of COVID, offering at-home care is something that a lot of operators are thinking about right now, but finding a way to staff and pay for such programs can often be the biggest challenges.

VanOosten said starting with a small program offered in one region will help alleviate some of those concerns.

UnityPoint will first be offered to its patients covered by the CMS accountable care organization models but VanOosten said they have been talking with payers about bundling episodes. 

“I certainly see it growing with our commercial payers and our Medicare Advantage plan,” she said. “People just do so much better, our hospital-at-home metrics back it up completely. They do better in their quality metrics and patient satisfaction metrics.”

UnityPoint’s hospital-at-home program has decreased 30-day emergency department (ED) visit escalation from 27% to 6%, averted ​​$904,000 in ED/hospitalization costs and has improved the 30-day hospital admit escalation from 22% to 12.6%.

However, one problem UnityPoint saw when it was first starting its hospital-at-home program was the number of hospitals and health systems that saw it as a threat. Likewise, SNFs aren’t interested in emptying their facilities in favor of at-home care.  

“It’s definitely not a threat,” VanOosten said. “Either there’s already not enough capacity or not enough caregivers in both settings. We’re not taking a large volume of patients, we’re only taking those that we feel like we can do well at home.” 

There’s three buckets of patients that go to SNFs, she explained. The first is high acuity patients that require 24/7 care. The second is patients that could have done alright at home but for some reason ended up in a SNF. 

“We’re looking at the third bucket. The group of individuals that have a higher acuity need but has caregiver support to rehab the patient safely in their home,” she said. “We’re talking about less than 20% of the patients.” 

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