Dartmouth Health is launching a suite of home-based care services in partnership with Geisel School of Medicine at Dartmouth College. The program is branded as Dartmouth Health at Home.
Supported by a $20 million philanthropic gift, Dartmouth Health at Home aims to transform rural healthcare by expanding access to care, improving patient outcomes, and facilitating the safe and effective transition of care from hospitals and ambulatory settings to patients’ homes, while supporting patients and their families throughout the process.
The program will include home-based primary care and palliative care.
“One of the things that is revolutionary about Dartmouth Health at Home is bringing a range of coordinated services to patients in their homes rather than patients coming to one of our facilities for services,” said Dr. Nathan Goldstein, chair of the Department of Medicine at Dartmouth Health and co-CEO of Dartmouth Health at Home.
Plans for the Dartmouth Health at Home program include providing primary care and palliative care services in the home. The program will also establish the Family Caregiver Institute at Dartmouth Health to provide family caregivers with services, education, support and access to home care aides.
Additionally, the program will use the expertise at the medical school’s Dartmouth Institute for Health Policy & Clinical Practice to study what works in home-based medical services and how those services can lower costs for health systems, patients, and payers.
To boost access to care, the Dartmouth Health at Home program will be designed to provide medical services in the home for patients who struggle to get to medical appointments, Goldstein said. For example, older frail adults often rely on family members to take them to medical appointments, and providing services in the home will avoid the difficulty that family members face in taking time off from work to take a loved one to a doctor’s office.
The Dartmouth Health at Home program should improve patient outcomes and care quality in several ways, according to Goldstein.
By seeing patients in their home on a timely basis, the program’s clinicians should be able to diagnose and treat medical conditions before illnesses progress to acute stages. When clinicians visit patients in their homes, they can see whether patients are taking their medications, whether they have food in their refrigerator, whether the home is clean and whether there are fall hazards.
Dartmouth Health at Home is expected to reduce cost of care, particularly if clinicians can diagnose and treat medical conditions earlier, which will avoid costly emergency room visits and hospitalizations, Goldstein said. The program should also reduce costs by improving medication management.
Shifting care into the home
In shifting care from the hospital or ambulatory care setting to the home setting effectively and safely, interdisciplinary care teams are crucial, Goldstein indicated.
“With Dartmouth Health at Home, we will have interdisciplinary care teams that include physicians, advanced practice providers, social workers, and home health aides,” Goldstein says. “We will not be having a single provider at a single point in time. We will have an entire team of professionals to serve patients and their families.”
The interdisciplinary care teams will meet at least weekly to review the care of patients in their homes, which should ensure that home-based care services are effective, Goldstein said.
To make sure Dartmouth Health at Home patients are safe, the program will offer home safety assessments for patients as well as 24/7 phone support for patients and their families, Goldstein says.
Financial stability, national expansion
The Dartmouth Institute for Health Policy & Clinical Practice will help to ensure that the Dartmouth Health at Home program is sustainable financially, according to Goldstein.
“The institute will examine how we can create home-based services programs, the costs of home-based services programs, how much revenue will be generated, and the expected financial margin,” Goldstein said.
Reimbursement for palliative care in particular is often sparse. Medicare reimburses for physician and licensed independent practitioner services and does not support the full range of interdisciplinary care.
While the $20 million gift from Dartmouth alumnus Richard “Dick” Levy, is enough to begin the program, it will not sustain the Dartmouth Health at Home program financially over the long term.
“One of the goals is to make sure the home-based services that we offer will be attractive to private and government payers,” Goldstein says.
Dartmouth Health at Home expects that their model will eventually be adopted in rural areas across the country.
“When we look at the intersection of rural health and home care, we think that Dartmouth Health and the Geisel School of Medicine at Dartmouth can be national leaders,” Goldstein says. “We think the programs we are building can be disseminated across the country.”
Advice for CMOs
For CMOs and other senior leaders at health systems considering adoption of programs like Dartmouth Health at Home, the first step is to select patients for participation intentionally, according to Goldstein.
“You should identify the patients who need home-based care services and can benefit from these services, then ensure that you have the right financial model to make home-based care services sustainable,” Goldstein said.
Another starting point is piloting home-based services before scaling them. For Dartmouth Health at Home, one pilot features a physician who is going to be leading the primary care at home service.
“Patients who have difficulty seeing this physician in her office will be enrolled in the primary care at home program,” Goldstein said. “The pilot will test the needs of patients and the operational needs of the program, then the program will be scaled based on what we learn.”
Healthleaders Media CMO Editor Christopher Cheney contributed to this report.
Companies featured in this article:
Dartmouth Health, Dartmouth Health at Home, Geisel School of Medicine at Dartmouth College
