Medically Home developed the world’s first advanced Rapid Response Logistics System on behalf of patients we care for jointly with our customers and ecosystem partners. Providing that care requires equipment and services delivered into patient homes, on-demand, around-the-clock. This is a complex logistical puzzle, involving 18 different services that are required to safely and reliably care for patients with serious or complex illnesses in the home. We call this capability our Advanced Rapid Response Logistics System which Medically Home operates on behalf of our customers in over 30 urban and rural markets across the country. To enable the delivery of safe, high-quality care we source, credential, train, and manage the third-party service providers in our network so that they are prepared to provide high-quality care in the home.
Medically Home’s clinical standards, credentialing program, training, and contractual service level agreements were developed to ensure that the care provided to patients meets our high standards and desired outcomes: high-quality, safe, on-time, reliable, efficient and easy to activate. We have created a standardized, scalable approach for operating the services required for a virtual hospital to deliver optimal outcomes. We set a high standard for third-party service providers so that they have the proper clinical skills and proficiency and can meet our 24/7 on-demand requirements.
Cesia™, Medically Home’s proprietary software, is a key element in solving the challenges of high acuity care in the home presents. Cesia™ interfaces with the patient’s electronic health record (EHR), and in turn drives efficient ordering and scheduling of all services based on orders from the EHR. These services are then provided in the home and Cesia™ allows the patient to remain informed the whole time through Cesia’s™ personal calendar. Everything a patient may need is brought to the home on demand, safely and efficiently, at scale.
Medically Home has spent over 15 years exploring the complexity of the home environment and the services needed to provide high quality, safe high acuity care in the home. Everything a patient requires for their care is brought to the home in a time frame equivalent to that in a traditional hospital. This simple statement belies the reality that although the specific treatment for a medical condition doesn’t change in the virtual hospital, how it is delivered changes dramatically.
When a patient is lying in a hospital bed, they are two dimensional – a care team can only see what is in front of them and the background information is only as good as the questions that are asked. It may be difficult to create an effective plan of care due to incomplete information. Contrast that with what we know about a patient when they are cared for in their home. There is now a much more comprehensive view of the whole person, with nuance and complexity. Adding this additional knowledge to the clinical picture of a person who may have multiple chronic conditions and it’s possible to quickly develop a more robust and effective plan of care that not only treats the patient’s acute illness but also provides needed support for chronic illnesses and social determinants of health.
Once physicians, nurses, and other care team members are trained and proficient in our approach to decentralized care, they can apply those newfound skills to different clinical use cases. In this way, we think of the Medically Home model as a “chassis” that has the advantage of repeating the same core elements (e.g., the command center, rapid response logistics, technology and Cesia™ software) to decentralize care against multiple use cases (e.g., bringing the ED, Obs, and inpatient medical care to the home).
The result of applying our chassis is a powerful capability to provide an overall continuum of care for patients with serious, complex, or high-risk illnesses. Beyond typical general medical cases, the chassis can also be used to provide care for other hospitalized patients: oncology (chemotherapy or stem cell transplant), post-bone marrow transplant, post-surgical or transplant recipient patients.
Medically Home’s chassis is designed around the patient in their home and purpose built for the safe, decentralized care of patients with serious, complex or high-risk illnesses. Our operation model – how we execute the care using the various elements of the chassis – puts the patient at the center of care and emphasizes the connection with the telemedical and in-person care team and ensures the availability of comprehensive, safe and cost-effective care 24/7. Our approach to working with payers, health systems and service providers puts the emphasis on the patient. Redundancy helps solve the challenges presented by decentralizing serious or complex care.
With safety at the forefront, one of our core principles is using proven processes that have been refined across thousands of patients, sometimes with triple redundancy of both technology and in home providers. This redundancy enables all orders and communication from the telemedical Medical Command Center to be routed to the patient in their home. As we serve an ever-increasing number of patients, we continue to learn, improve and medically-harden our operations, with a particular focus on expanding the acuity of patients that can be safely treated.
Our model establishes a single command center (which we refer to as the “Medical Command Center”) staffed by physicians and nurses to provide 24/7 virtual care for patients who may be miles – even states – away from where they are located. With continuous technology to support communication between all clinicians treating the patient and clinical status monitoring, the Medical Command Center can reach patients wherever the clinicians may be located. For example, one of our partner’s Medical Command Centers has virtual nurses and physicians caring for patients in three different time zones across the United States. We can also support participation from other hospital departments such as case management and pharmacy, regardless of physical location, as well as the transition back to the patient’s PCP. The service providers in the home are in close communication with the Medical Command Center during their time in the patient’s home and we emphasize that a close connection is necessary between service providers in the home and the Medical Command Center clinicians.
Medically Home recognizes the challenges around seamless coordination of care and comprehensive care planning across departments (pharmacy, nutrition, specialty consults, etc.). We address this challenge by using our software to connect the Medical Command Center nurse with a team of those service providers that are efficiently coordinated.
Further, through this telemedical Medical Command Center approach, we provide more predictability and visibility for patients into their daily care plan (e.g., timing of services and tests) than they and their family would otherwise have in a traditional hospital. The direct line of contact to the Medical Command Center makes it easy for patients to reach their care team and speak face to face. Fundamentally this empowers patients to be in control of their care. This also empowers the patient’s family or other caregivers in the home to have a better experience supporting their loved one, making visiting and participating in the plan of care easier. It’s more convenient and accessible for the family and can provide the benefit of engaging with the Medical Command Center team on the patient’s progression and medical instructions. The result is an opportunity to better support the patient’s healing and recovery in the long-term.
Cesia™, named after one of Medically Home's cofounder's mother, Cesia Rakowski, is a reminder to all to provide the same amazing care for patients they would want their family members to receive. Technology plays a critical role in the safe scaling of decentralized care by being the glue that integrates all the elements of our comprehensive chassis – and even more so for serious or complex conditions previously managed only in a traditional hospital. Medically Home has developed a unique and proprietary platform: Cesia™ is designed to be the engine of the new scalable, decentralized healthcare system, delivering safe, world class clinical care for the highest risk illnesses supported by a full range of in-home services.
Software sits behind every aspect of our decentralized care. Every day, Medical Command Center clinicians access a complex network of resources – from labs to pharmacies, paramedics to nursing and from meals to imaging services – in order to deliver care to the patient in the home.
However, just like the 5,000 or more people working in a traditional hospital, all those team members must work together seamlessly to deliver a safe, scalable patient experience. Achieving this effectively and efficiently requires advanced software capabilities that we deliver through Cesia™ and supported by our network of applications and integrated technology partners.
Delivering on a patient episode for serious or complex conditions utilizing our chassis requires software-enabled care and a scalable “back end”. This back end includes Cesia’s™ revenue cycle capabilities that play a critical role providing utilization and cost data to support the billing process in a way that is transparent to the health system, to the patients and to the downstream payors and regulators.
Patients and the clinicians who care for them need to have complete confidence that they will have access to each other when they need it, 24/7 with no exceptions. That confidence must be earned rapidly – a patient entering the virtual hospital has better things to focus on than learning how to use new equipment – and that assumes they are interested in technology at all!
Medically Home’s technology kit was designed from the ground up to support rapid deployment and extreme redundancy, transforming the home into a safe site of care that appeals to the full range of patients. The equipment is deployed in less than twenty minutes by a clinician or technician in the home on the day of admission. Redundancy comes from advanced cellular routers with access to multiple mobile carriers, high performance hardware and access to special equipment for areas with coverage gaps. Since no communications system is perfect, we use three technologies – each capable of running in parallel. If a patient already has a broadband connection that is incorporated as well but it is not required.
Telemedicine capabilities based on the home technology kit – including a “pick up the handset” hot-line phone, an emergency response device, and a tablet for video - are tightly integrated with the Cesia™ platform. This integration includes advanced tools to ensure that patients reach a clinician with context on their care, as quickly as possible. In practice, patients in the virtual hospital room reach their nurse in less than thirty seconds.
In-home technology is a core part of the Medically Home chassis – in addition to the hardware and software, we also deliver 24/7 technical support to clinicians in the home and in the Medical Command Center, and all of the connectivity and networking services required to deliver care in the home.
The in-home technology kit also supports clinical monitoring, with zero-effort interfaces to key medical devices and high-frequency monitoring equipment, as well as advanced tools to support point of care laboratory testing.
Traditional reimbursement approaches incentivize short lengths of stay across ED, Obs, inpatient status combined with care fragmentation that prevents a return to an optimal state of health after a stay in the hospital. Medically Home has redefined the decentralized reimbursement needed to support a new care model that delivers superior outcomes. This reimbursement provides for more care over a longer period of time. Patients, their families and their care teams can systematically address barriers to optimal health, including gaps in social determinants of health. These same gaps often indicate a lack of engagement with care, which leads to suffering and a spiral of poor, ever-worsening clinical outcomes. With our reimbursement model, decentralized high-acuity care can be delivered seamlessly to address these gaps.
The Medically Home payment approach mirrors in form and format the traditional hospital reimbursement model, since this is what health system and payer technology solutions can support. In function, we allow for more care over a longer period of time. For inpatient hospital substitution this can be 15-20 days of care, combining an acute and restorative care phase. Reimbursement for this is at a premium to the DRG payment (since it is more care with better outcomes) that looks like an expanded, DRG-based case rate that delivers savings to the risk-bearing entity (typically a public or commercial payer) through better clinical outcomes. For ED and Obs substitution, the reimbursement model is at market-based rates with savings from improved outcomes shared between the provider, the payer and Medically Home.
Medically Home’s payer team works closely with payers to support the contract and revenue cycle management required. We maintain close relationships with regional and national payors to facilitate model adoption and optimization for each market. In addition, we have experts who previously worked at CMS who now help our health system customers navigate and apply for the CMS hospital-at-home waiver to enable reimbursement for fee-for-service Medicare and Medicaid patients.
One remarkable result of providing care for patients with serious, complex, or high-risk illnesses in their home is how much health care providers love practicing this way. Most physicians and nurses went into medicine to take care of people but too often find themselves burdened by documentation requirements that have very little to do with patient care. Nurses describe their practice on medical floors as "hunting and gathering” while never feeling like they’re providing the best possible care.
By incorporating a full care team of in-home providers with a Medical Command Center medical team, the individual care provider finds that they’re enjoying their practice again in unexpected ways. Not only do patients receive more care, the care practitioners are spending more time caring for them – leading to better satisfaction across the whole continuum.
Patients and their caregivers feel the impact of this increased care, often telling the Medical Command Center team that they always feel like someone is there for them and that anything they need will be provided. Each health system partnered with Medically Home, sees that their virtual hospital is the top performing “hospital” within their network in regard to patient experience. In addition, caregivers are supported with additional staff such as home health aides (when needed) so that they can be a loved one, not a medical provider.