The house call provider Bloom Healthcare has leveraged its integrated palliative-primary care model to achieve substantial reductions in hospitalizations and health care costs.

The U.S. Centers for Medicare & Medicaid Services recently recognized Bloom as a top performing High-Needs Accountable Care Organization under the agency’s Realizing Equity, Access and Community Health (ACO REACH) model.

Through its ACO REACH program, Bloom reduced unplanned hospital readmissions by 25% and realized a gross cost savings rate of 24.6%. The company’s patients averaged 326.7 days at home during 2023.

Bloom Healthcare cares for about 10,000 high-needs patients with a comprehensive primary care and care management model that incorporates palliative care. The company currently operates in Colorado and Texas.

Palliative Care News sat down with Bloom CEO Dr. Thomas Lally to discuss the strategies the company used to garner these results and how palliative care factored in.

What were the most important interventions you used to achieve those results in your ACO REACH program?

The first is actually the simplest thing — trust. We build trust in patients homes over a long period of time, and that allows us to really, hopefully, make better shared decisions with that patient, with the decision makers in their family about what end of life looks like, and we’re able to build really a care plan that fits around what matters most to that patient. That is all of the secret to success.

There’s a ton of technology and operations and logistics to make sure that that happens consistently, but ultimately, we’re just building trust in patients’ living rooms, so that they can make better decisions around end of life. That comfort comes from them knowing that we show up when we say we are going to show up. [Patients] see the same person. They get to know them. It reduces a lot of the wasteful spending inside of the health care system, and it sets us up for that kind of better interdisciplinary approach towards the end of life, where we can bring in hospice.

It becomes a tool that really gets them to fulfill their goals, rather than oftentimes feeling that somebody’s giving up on me, and I can no longer see my primary care provider. They’re signing me now to hospice, and I’m going there to die. This is in a reverse order, and we’re saying: what matters most to you is to age in place, to have dignity and respect in your home, and we are going to bring resources in on your terms to be able to make sure that that goal happens.

You mentioned a couple examples, like being there on time, having the same consistent person visit the home. Are there other ways that Bloom works to build that trust?

We’re there seven days a week, day or night. They can call us and get a hold of our provider, and they’re going to see that same provider in a risk-stratified fashion. So if they’re more in the standard category, we might see them 12 to 15 times this year. But if they’re a high-risk patient, we might be seeing them every week for a period of time, and that feeling of just them knowing that there’s a customization, and that they get that sort of priority when they need it adds a ton to the value of this.

Then there’s this other relationship that we also try to make sure is longitudinal. It’s the care manager that they talk to on the phone. Because even if we see somebody very frequently, we might see them once a week, but there’s still six other days in the week, and what happens during that period of time? We often fill that gap with a lot of care management services, and that could be nursing, social work, pharmacy, but they’re generally going to get to know their nurse really, really well. That becomes another trusted care partner and decision maker.

[Patients] know that the nurse and our provider talk all the time, so that becomes a really effective triad of communication where they can always reach out, talk to somebody on that care team, get that message to the provider. If something needs to happen, they can see the patient the same day.

Where does palliative care fit into the model?

It is all throughout. We really describe ourselves as a palliative-primary care [provider] because we really integrate it into every decision we make from the very first time we talk to a patient when we onboard our providers. It is not a typical primary care practice.

We’re really taking care of the primary care needs of a patient over the last three to five years of life, and that is a very palliative time when we have to be thinking about deprescribing, building care plans, about what matters most, taking a lot of geriatric principles into mind.

It becomes something for us that is an ongoing education, and we really find it most effective in that light, because we have that two to three years upstream of hospice to build trust and to start preparing for the time when they may be on hospice, and so we’re able to more appropriately manage their medications, their expectations around admissions, make sure that their care plan is continually refined, and they have the right supports in place.

How are you reimbursed?

We are multi-payer, and so it’s been something that’s been very important to us, to be able to serve the broadest range of patients. We have Medicare-Medicaid dual eligibles, Medicare Advantage, Medicare fee-for-service. We also run our own Accountable Care Organization, and we feel like our model has been proven to really drive value and success in these accountable relationships. So our preference is to always have as much alignment in a contract as possible.

Health equity is a big part of the ACO REACH model. Can you talk about any work you may have done around that?

We are always trying to find more underserved communities and patients who are in need. And that has really been a core part of our growth model, is to look for patients, oftentimes through the Medicare claims data and other means to be able to say there’s a lot of patients who we think really do need house calls in this area.

There are high-needs patients, and then we can actually compare that to some of the other claims data and see how many actually got house calls. And we’ve been able to really hone in on areas where we feel that we can make the most impact. But it’s been guided by that underserved principle, where we know that there are a lot of patients in need that really aren’t getting this type of service today,

There’s a couple more years before the REACH model sunsets, but I’m wondering if there are any kind of lessons learned that you’ve found to date working in the ACO REACH program?

A dedicated, accountable model for high-needs patients is incredibly important and has been a vehicle for success for a lot of practices in this space. It was the first time this has really been pioneered, and it worked.

There were some real policy lessons that we saw around this high-needs model that really made it much more effective, including the concurrent risk score. I think that was something where there was a recognition that these patients in the last three to five years of life have a rapidly evolving medical complexity, and so a concurrent risk methodology really fits and allows practices to invest in these patients at a much more real time pace.