How an innovative three-way collaboration leads to better patient outcomes and convenience
It’s a unique time in health care. While the challenges that hospitals, physician practices, payers and employers faced before the COVID-19 pandemic are still hovering, the pandemic added new ones. As health care leaders continue to work towards solutions, they’re also adapting to new trends associated with access to care, cost, patient outcomes, and exposure to unnecessary urgent care and emergency department (ED) visits.
- At-home care is one of the fastest growing areas of health care. More and more people are looking for personal, convenient care at home, creating a shift in the health care industry. In-home healthcare is growing year over year at a 7.2% rate thru 2030, one of the fastest healthcare trends.
- Wait times and costs for emergency department treatments continue to increase. People needing less intensive care often end up in the ED because they don’t know what to do or where to go. This impacts patient care and satisfaction and places a financial burden on employers. The CDC estimates that in 2018, there were 130 million visits to the ED. Only 12.4% of those resulted in hospital admission. Wait times vary by state, with the shortest in North Dakota at 104 minutes per visit and the longest in Maryland at 228 minutes per visit.
- Individuals and employers are looking for ways to reduce health care expenses. Health care costs continue to increase for patients, employers and health care providers. Finding efficiencies and alternate care methods can help lower these expenses. Unnecessary ED visits by patients with low health system literacy cost $47 billion annually. Additionally, healthy patients with low health care system literacy were nearly 3x more likely to have visited the ED than those more familiar with the health care system.
- Personalize population health models and efforts to address personal and community needs. Improving early detection, treatments, and dis-ease prevention while addressing social determinants of health (SDOH) improves outcomes. On average, clinical care impacts only 20% of county-level variation in health outcomes, SDOH affects as much as 50% of health outcomes. Successful models personalize programs based on member health needs and preferences.
There is good news about these unique challenges — they often lead to opportunities for unique solutions.
In this white paper, we show how a partnership between Medical Mutual, Conduit Health Partners and DispatchHealth created a revolutionary way of treating acute medical conditions at home. The result is a home care solution that improves patient outcomes, reduces expenses, and exposure risks associated with unnecessary visits to urgent care facilities and EDs.
A business partnership of integrated services
In 2021, a unique partnership formed between a health payer organization, strategic service provider and an in-home care system. Medical Mutual, one of the largest health insurance companies based in Ohio, sought a better solution to help members get the care they need without unnecessary ED or urgent care visits. As part of their population health strategy, Medical Mutual connected Conduit Health Partners, whose nurse-first triage services now give Medical Mutual members 24/7 access to a nurse-first triage line, with at-home care through DispatchHealth. Together, Medical Mutual, Conduit Health Partners and DispatchHealth are getting more patients timely access to needed services while decreasing unnecessary ED utilization.
When members call the Medical Mutual 24/7 Nurse Line, powered by Conduit Health Partners and accredited by Utilization Review Accreditation Commission (URAC), they speak with a registered nurse (RN). The RN uses evidence-based clinical protocols to evaluate the caller’s symptoms and concerns to understand the urgency for care. Conduit’s nurse-first approach is proven to help deliver the right level of care at the right time and expedite care if needed. It also reduces unnecessary and costly ED visits by giving patients immediate access to an RN.
If the RN determines that the caller meets established criteria for a home visit, they consult with DispatchHealth for further evaluation. Once DispatchHealth confirms the need to provide care for the caller, they send a mobile unit to the caller’s home. Every mobile unit includes either a nurse practitioner or physician assistant, along with a medical technician. The teams treat simple to complex illnesses and minor injuries typically treated at an urgent care facility. They also coordinate necessary prescriptions, update the caller’s care team, including their primary care provider (PCP), and work directly with Medical Mutual to process billing. A member with complex follow-up care and ongoing risk, such as multiple chronic conditions, is connected with Medical Mutual’s population health team members. The team helps the member with referrals to programs so they have access to the appropriate support between their PCP visits.
Medical Mutual members can call the 24/7 Nurse Line listed on their ID cards.
CONDUIT HEALTH PARTNERS
Conduit’s URAC-accredited nurse-first line is staffed by RNs who triage a member’s call.
DispatchHealth supports ED diversion by offering in-home or onsite urgent care services.
Medical Mutual helps members connect with health programs.
How an innovative health care collaboration can transform health care
When member/patient-centered organizations focus on innovating to deliver value-based, comprehensive care and come together through nurse triage services and at-home care, it lends itself to many benefits in the health care space.
1. It improves patient outcomes with convenient care.
Through the partnership, nurse triage services are available 24/7. Members can call on evenings and weekends, even when their doctors’ offices are closed. This means members get more timely intervention and appropriate care. With one call, they can access a nurse and care management teams and connect with in-home urgent care if needed.
This process also helps with continuity of care. The team communicates directly with the patient’s PCP and supporting programs from Medical Mutual’s population health team, so they can better support their patient in the future.
2. It results in high rates of patient and consumer satisfaction.
Over the past two years, members respond positively to the model as seen through reported patient satisfaction rates ranked at 95.8% for “satisfied or very satisfied” when calling the Nurse Line. This, combined with DispatchHealth’s ability to provide 60–70% of traditional ED care in the comfort of a patient’s home, confirms patient satisfaction and ease of obtaining services where and when they need it most.
Because patients value this benefit, employers can promote it to their employees. Even if it’s a benefit an employer already provides, it demonstrates how they value and support their workforce by offering competitive, valuable benefits that other employers may not offer.
3. It prevents unnecessary ED visits, reducing the strain on the health care system.
Considering the calls the partnership directs to home health, 50–60% result in ED or hospitalization diversion.
4. It saves money for patients, hospitals, insurance providers, and employers.
The nurse triage and acute home care partnership reduces medical expenses for the health plan and employer groups, approximately $1K+ per visit, by helping patients avoid unnecessary emergency or hospital visits. Patients experience significant out-of-pocket savings for in-home care versus emergency care, and hospitals experience greater capacity in the ED, freeing up inpatient bed space for higher-margin diagnosis-related groups (DRGs).
5. It fits within the Population Health model of care.
The Medical Mutual, Conduit, and DispatchHealth partnership aligns with these Population Health model focus areas:
- Personalizing programs to support a member’s individual health needs and engagement preferences.
- Helping a patient receive the highest quality of care from the right providers.
- Strengthening a patient’s ability to self-manage their health.
- Supporting individuals with services between their physician appointments.
- Reducing unnecessary medical expenses through providing services and care in lower acute settings and helping individuals reduce long-term risk.
CASE STUDY—KNEE PAIN AND SWELLING
This real-world example shows the partnership in action.
About Member A:
- History of hypertension, Type 2 diabetes, coronary artery disease and gout
- Medical Mutual commercial health insurance
On Sunday, Member A had pain in the left knee after falling at a restaurant two weeks prior
He called the Medical Mutual Nurse Line. After an assessment, the nurse sent a DispatchHealth care team to Member A’s home for further evaluation. The mobile care team completed an exam and provided the following benefits:
- Completed X-rays and gave medication
- Scheduled a follow-up appointment with a primary care provider
- Helped avoid an ED visit
- Responded at 7 p.m. on a Sunday
- Total time on scene: 40 minutes
Are you ready to transform health care with a personalized plan?
Medical Mutual, Conduit and DispatchHealth are at the forefront of transforming health care. Medical Mutual identified a need in its member population and brought together innovative companies in the health care space to help achieve their goals. Working together, these three organizations have positively impacted the Medical Mutual member population.
The right partnership can help your business too. Whether it’s a health system, health plan, employer or other business, a customized health care solution positively impacts:
- Quality of patient care
- Member satisfaction
- Cost savings
ABOUT MEDICAL MUTUAL
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. Medical Mutual provides peace of mind to more than 1.2 million Ohioans through high-quality health, life, disability, dental, vision, and indemnity plans. They offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Medical Mutual’s status as a mutual company means they are owned by members, not stockholders, so they don’t answer to Wall Street analysts or pay dividends to investors. Instead, Medical Mutual focuses on developing products and services that allow them to better serve customers and the communities around them and help members achieve their best possible health and quality of life. For more information, visit the company’s website at MedMutual.com.
ABOUT CONDUIT HEALTH PARTNERS
Conduit Health Partners is an outsource partner that offers customized health care solutions for health systems, health plans, employers, and others to improve care and access for their patients and employees. Led by a team of health care professionals, Conduit offers customized, cost-effective, and time-saving solutions. Since Conduit Health Partners was founded in 2017, the organization has experienced extraordinary growth, expanding its reach from caring for 22,000 people in 2017 to 1.3 million people in 2022 and expanding rapidly.
DispatchHealth brings the power of the hospital to the comfort of the home. DispatchHealth is building the world’s largest in-home care system and offers on-demand acute care and an advanced level of medical care for people of all ages in the comfort of their own homes. DispatchHealth’s emergency medicine and internal medicine trained medical teams are equipped with all the tools necessary to treat common to complex injuries and illnesses. DispatchHealth works closely with payers, providers, health systems, Emergency Medical Services (EMS), employer groups, and others to deliver care in the home to reduce unnecessary emergency room visits, hospital stays, and readmissions. Acute Care medical teams are available seven days a week, evenings and holidays, and can be requested online or by phone. DispatchHealth is partnered with most major insurance companies. For more information, visit DispatchHealth.com.