Intermountain Healthcare Expands Access, Convenience, and Equity of Care for Patients Through Hospital-Level Care at Home Program

Intermountain Healthcare has expanded the reach and offerings for hospital-level care at home services available to patients and is now treating COVID-19, as well as other acute and chronic clinical conditions, since initial launch of the program in May 2020.

Hospital-level care at home is now available to patients from 12 of Intermountain’s hospitals in Utah, from Logan to St. George (385 miles), with an additional hospital location being added this summer.

These services are offered as an option to Intermountain patients who meet specific clinical and non-clinical criteria who come in through an emergency department visit or have been admitted to the hospital and qualify for early discharge.

Care is provided through a partnership with Intermountain’s population health entity, Castell, which helps improve patient outcomes and keep costs more affordable. The services are provided by in-person caregiver visits by Intermountain Homecare, which has been in operation since 1984, as well as remote monitoring and virtual visits by telehealth providers located at Intermountain’s virtual hospital in Murray, UT.

“Since hospital-level care at home services began, Intermountain has shifted 1,400 patient-bed days from participating hospitals to the home,” said Christine Lipson, RN, MHA, director of home services at Castell.

“Our goal is to be able to offer patients the right level of care in the right place at a lower cost. Our comprehensive in-home services provide the technology to monitor vital signs remotely, plus daily in-home nurse visits, daily tele-health rounding by a medical provider, and access to 24-hour on-call nurses and physicians,” said Nathan Starr, DO, internal medicine physician and medical director of home services for Intermountain at Home and Intermountain’s tele-hospitalist program.

Some conditions successfully managed through Intermountain’s hospital-level care at home services include COVID-19, (including administering Remdesivir), community-acquired pneumonia, congestive heart failure, chronic obstructive pulmonary disease, some kidney-related conditions, some intestinal or vein conditions, infections such as cellulitis, and certain cancer diagnoses.

How are patients benefiting? When Karissa Affleck’s husband, Bill, was in the hospital with a COVID diagnosis, the couple learned he could finish receiving his hospital-level care at home and decided to try it.

“Bill got all the same care at home as he did at the hospital. Doctors were checking in virtually and nurses came to the house. Our questions were answered quickly. He seemed to heal faster and got to sleep in his own bed, and we were able to be home with our kids,” said Karissa.

Bill was on oxygen, and she learned to check his blood pressure and the oximeter, which she said was pretty easy. She was a little surprised she’d also need to help him receive Remdesivir through an IV.

“I thought, I’m not trained, how am I going to do this? The homecare nurse started the IV and showed me how to do it. She was very hands on with me. It takes two hours to administer, and she showed me how to flush it and disconnect it. She also did a tele-call with me and showed me how to give Bill his injections in his abdomen. She followed up with phone calls to see if I had questions and if everything went okay,” said Karissa.

Bill is now back at work. He monitors his energy levels. He finished his treatment at home in June and was able to attend his son’s wedding later in the month.

Intermountain’s virtual hospital is staffed 24/7 by remote monitoring technicians, and tele-nurses, and tele-advance practice providers and tele-hospitalists are available 24/7 to provide digital consultations depending on the patient’s acuity.

Intermountain has been an early innovator in providing hospital-level care at home. About 25-50 programs nationwide offer such services, compared to about 5,000 hospitals in the U.S., according to Fast Company.

The trend will likely increase, as initial national studies estimate hospital level care at home is 19% less expensive than usual hospital care and had equal or better outcomes compared to similar inpatients. Patient mobility also increased.

Home patients spent a smaller proportion of the day sedentary (12% vs. 23%) or lying down (18% vs. 55%) and were readmitted to the hospital less frequently within 30 days (7% vs. 23%).

Providing care in a patient’s home contributes to health equity. When caregivers visit with a patient in their home, patients feel more comfortable and in charge in their own environment. Caregivers find it’s easier to build trust with a patient in their home and can easily meet family members who provide support.

“Heart failure patients often have long hospitalizations that cause stress and prolonged separation from their family and home environment. These new at home services allow us to continue to provide high level of monitoring, including diligent review of lab results and administering the IV medications needed to treat heart failure, but from the comfort of a patient’s home,” said Lana McGill, MD, an internal medicine physician and lead cardiovascular hospitalist at Intermountain Medical Center.

“This has been particularly helpful through the COVID 19 pandemic when visitor restrictions limited the number of family members who could be present during a patient’s hospitalization,” Dr. McGill added.

During home visits, caregivers can recognize aspects of home life that can impact overall health, such as simple ways to reduce the risk of falling, food insecurity, economic stability, emotional support, or other social determinants of health.

Caregivers from Intermountain Homecare, deliver remote patient monitoring equipment and provide hands-on training to the patient and other household members, as well as provide equipment maintenance.

Homecare caregivers make scheduled in-person visits according to the patient’s individually-prescribed care plan. On-demand mobile imaging and mobile lab services are also available. As part of the program, patients and a family member agree to have their phone near them at all times, so tele-nurses and techs can reach out to them to validate any alert.

When patients at home need additional intervention beyond scheduled visits, there are three options that can be used to provide care depending on the urgency of the need. Intermountain Homecare skilled nurses are dispatched for care that can wait for 2-3 hours and 911 can be called for urgent needs.

For patients who live in Utah’s two most populated counties – Salt Lake and Utah counties – whose needs fall somewhere in between those options, a unique partnership with Gold Cross Ambulance emergency medical services (EMS) providers help fill the gap. Intermountain is in discussions with EMS providers in other locations to provide similar services.

“Through this innovative partnership, our EMS Rapid Response Team providers can arrive within 15-20 minutes and do a physical assessment of the patient in their home and consult with Intermountain tele-providers via video-visit to determine if the patient needs intervention and can safely stay at home, or needs to come to the hospital,” said Jamon Smith, director of training/paramedic at Gold Cross Ambulance.

Of the nearly 300 patients who have opted-in to at home hospital-level care, many have expressed several reasons for preferring to receive care at home. Patients and families don’t have to travel back and forth to the hospital or emergency room. Patients report they sleep better, enjoy eating their own food, and feel better in their own home.

To be eligible for hospital level care at home, patients must have SelectHealth insurance, either SelectHealth commercial, Medicare Advantage, Medicaid or be self-pay. Other value-based payers will be added.

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Intermountain Healthcare is a nonprofit system of 25 hospitals, 225 clinics, a Medical Group with 2,600 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Utah, Idaho, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs.

Castell is a comprehensive health platform company that makes the move to value-based care simple for providers, payers, health systems, and accountable care organizations. Castell delivers impactful analytic and service solutions designed to accelerate organizations’ transition from volume to value, improve outcomes, and keep costs more affordable. Castell is an Intermountain Healthcare company.