By JULIE MINDA
Two ministry organizations are among the trailblazing providers exploring how best to offer health care to patients when and where they want to receive it, be it in their home, their office or another location.
DispatchHealth mobile clinicians provide on-demand care to a patient.
Providence St. Joseph Health system of Renton, Wash., is piloting a mobile health care service in two of its markets — Southern California and Seattle; and Centura Health of Centennial, Colo., has partnered with an on-demand mobile health care company to provide Centura patients with the option of being treated in the location of their choosing.
Aaron Martin is executive vice president and chief digital officer for Providence St. Joseph Health and managing general partner of Providence Ventures, the health system's venture fund that makes direct investments in companies working on health care innovation. He said, "Other health systems are really curious about what we will find" through the house calls pilot and other on-demand health care initiatives. He said other industries have been using technology to deliver what consumers want, where they want it, for some time. He said health care is playing catch up in its nascent efforts to harness the potential of technology to ensure people get the care they need, where and when it is convenient for them.
West coast pilots
Martin said Providence St. Joseph Health is creating a suite of on-demand health care services that also includes retail clinics and online health care.
Earlier this summer, Providence St. Joseph Health acquired Medicast, a private, for-profit start-up offering mobile apps through which people could summon a health care provider to their home or other location for low-acuity health care needs. Providence St. Joseph Health is using the Medicast platform to help it launch its house calls pilot in two of its markets — the system will expand into additional markets after the pilot is complete.
Prather
Providence Health & Services is part of Providence St. Joseph Health, and its Southern California region launched the first pilot service — "Express Care at Home" — June 27. The system is dispatching nurse practitioners to the location of the patient's choosing to provide non-acute health care services. The Express Care at Home clinicians, who are employed by Providence, can provide wellness checks and physicals; health management counseling; screenings; treatment of minor injuries, illnesses, skin conditions and pain; and monitoring of some chronic conditions; and they can prescribe or renew select nonnarcotic, noncontrolled medications.
Among the conditions the nurse practitioners can treat are allergies, urinary tract infections, colds, coughs, congestion, the flu, nausea, ear infections, fever, headaches, joint pain, eye infections, sinus infections, upper respiratory infections, burns, cuts, sprains, shingles, eczema, insect bites, asthma, cardiovascular conditions, diabetes, emphysema and osteoporosis. They cannot provide intravenous treatments, treatment for broken bones, X-rays or CT scans, suturing, blood draws or lab work.
Quick access
Express Care at Home is available to anyone in Santa Monica and other Westside communities of Los Angeles, which is the area served by Providence Saint John's Health Center. People can request the mobile visit through an app, the athome.providence.org website or by phone. The service is available between noon and 8 p.m. weekdays. Providence expects to expand these hours in the future.
Morris
Providence charges $199 per visit. According to information from the system, most private insurance companies will cover the cost. Neither Medicaid nor Medicare covers the visits at this time.
The nurse practitioners can visit patients' homes, workplaces, hotels or other sites. Pilot planners expect that busy young adults, young families and travelers without physicians in town will have the most interest in Express Care. The service is meant to complement, not to replace, patients' medical home providers.
As Catholic Health World went to press, Providence St. Joseph Health was preparing to launch the same service in the Seattle area, where the system has a network of facilities.
Mile high care
Centura began its partnership with Denver-based DispatchHealth in April. For now, Centura is dipping a toe into the house calls market; it has not made an equity investment in DispatchHealth.
DispatchHealth is a three-year-old privately funded for-profit with 30 employees, 18 of them clinical providers.
"We're offering the services people want," said Dr. Mark Prather, chief executive of Dispatch-Health.
Dr. Barbara Morris is medical director for senior services for Centura and a geriatrician with a facility that is part of Centura's integrated network. Morris and Prather said that among the many patients they believe will benefit from on-demand mobile care are elderly patients who have trouble traveling to care locations; poor elders who tend to visit the emergency department frequently for conditions that could be treated in a more appropriate venue; people who need care in the evening or on the weekend when their primary care provider's office is closed; and people who do not have the time to go to the doctor's office even when they are sick.
DispatchHealth sends two-person teams of clinicians to the location that patients choose — be it their home, work or other site — to attend to non-life threatening acute illnesses, including urinary tract infections, skin conditions and gastrointestinal issues.
Each DispatchHealth team consists of a nurse practitioner or physician assistant and emergency medical technician. The emergency medical technicians perform some of the basic triage functions. The nurse practitioners handle the bulk of the diagnostic and treatment work, according to Prather. "This model allows us to use everyone at the top of their license and price the care competitively," Prather said. Providing mobile health care under a streamlined staffing model also allows for more efficient care delivery, Prather noted.
The service is available from 8 a.m. to 10 p.m. every day of the year. Currently
DispatchHealth has three care teams working in the Denver metro area every day. Teams work overlapping 10-hour shifts. Some of these mobile clinicians work full-time, some part-time.
On-site triage
DispatchHealth's teams follow care protocols. If a situation deviates from the protocol, the on-site nurse practitioner contacts a board-certified emergency room physician employed by DispatchHealth.
The teams treat fevers, colds, the flu, headaches, dehydration, eye infections, respiratory issues, joint pain, fractures and allergies. They can administer fluids and medications intravenously, provide wound care, test for infectious diseases and insert urinary catheters, among other treatments. They can prescribe nonnarcotic medications.
"It's like house calls on steroids," said Prather.
Convenient for patients
Prather and Morris said that DispatchHealth is an adjunct to Centura primary care providers, not a replacement for them.
During their visit to a patient's home, the DispatchHealth team members can be in constant contact with the patient's primary care office, if that office so wishes. The DispatchHealth team accesses and provides input into the patient's electronic medical record including information about what they saw in the home. Prather said: "Our team is on the scene an average of 56 minutes, and we can look for the social determinants of disease that may be impediments to care." If the patient consents, the mobile team conducts a routine assessment of the home looking for fall risks and other causes of concern.
Preferred partner
DispatchHealth functions almost like a staffing company for Centura, Prather said. According to information from the DispatchHealth website, the company has contracts with Medicaid, Medicare and most major insurance companies, and is an in-network provider with those payers. It charges a flat rate of $195 per visit for all care delivered to uninsured patients.
Prather said providing house-call-type services on-demand at the location of the patient's choosing is one way for Centura's integrated network to distinguish itself from other networks and gain people's loyalty.
Catholic Health Initiatives of Englewood, Colo., co-sponsors Centura with Adventist Health System of Altamonte Springs, Fla.
Copyright © 2016 by the Catholic Health Association of the United States
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