The Brentwood, Tennessee-based naviHealth helps patients receive care where they can best be treated.
Over its history as a convener, it has traditionally helped payers and providers with the coordination of care in facility-based settings. Now, it’s shifting with the health care world to help more patients receive care in the home.
Recently acquired by UnitedHealth Group’s (NYSE: UNH) Optum, naviHealth’s goal is to help facilitate care in a way that reduces overall costs and keeps patients healthy and out of institutional settings.
Dr. Jay LaBine, the company’s CMO, has high aspirations for the future of the company and its relationships with home health agencies. Home Health Care News recently caught up with him for an episode of Disrupt to learn more.
Highlights from the conversation are below, edited for length and clarity. Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.
HHCN: Let’s talk about the Optum news first. What does that mean for naviHealth?
LaBine: naviHealth was acquired by Optum in May of 2020.
We believe that our values, vision and mission align very closely with Optum, and we think it’s really an optimal partnership. So we have not seen any disruption whatsoever through that acquisition. We’re excited for what the next phase could bring with us under Optum.
Can you explain in more detail the convener role that naviHealth plays?
When you talk about the convener role, what that refers to is that in the Bundled Payments for Care Improvement (BPCI), CMMI built into this model the ability for an organization like naviHealth to convene a number of different organizations and support them as participants.
Some of these participants that we convened were very experienced, and we were able to basically assist them with BPCI Others were not very experienced. It was us bringing our expertise to help them with the ability to be a participant in this program. That’s, in a nutshell, what our convener role is.
What we do is lead the health systems that are in bundled payments to understand how the bundled payment program works and how to identify the patients that would be appropriate for our services. Also, frankly, to improve the care model for the Medicare patient.
As health care shifts into the home, how will your organization and others help facilitate that?
There’s been an acceleration in the desire for patients — especially seniors — to get care in alternative settings. And because of the pandemic, I think there was a rapid adoption to care in alternative sites. We saw this a lot. There were many seniors who would not want to go into a nursing home because nursing homes were hit so hard with COVID-19.
We were able to say, “Okay, what is the next phase post-COVID around these trends with care in the home?” And we saw a few that we’re investing in.
For one, there are these home-based primary care models where there’s a physician who actually visits a patient in the home and does longitudinal care for that patient; naviHealth really helps this. In fact, we’re working today with a number of companies that are meeting the complex needs for patients who transition out of a nursing home and need more than usual care. These are people who are advanced in age, frail and have multiple chronic conditions. We can identify these patients because we have clinicians in the nursing home.
NaviHealth refers into these programs so that they can get their needs met by these visiting physician programs. Some of the ones that we work closely with are Landmark Health and Prospero Health.
The second one, we call it patient navigation. We have non-clinicians who are community health workers or patient advocates. When a patient or a member is leaving the hospital, and we know that they might have follow-up with clinical people, there are still a whole host of non-clinical factors that lead to them not being able to handle all their medical care in their home. And so we deploy those patient advocates or patient navigators, and what they do is they address all of the social determinant factors that lead to deterioration in your health. We’re seeing great results in reducing the readmission rate back into the hospital.
We’re also now deploying home health management. Because we’ve been involved with post-acute care for so long — we saw that many people could get their needs met, not by inpatient facility care, but by home health care agencies coming to their home. And so we always asked that question, “Well, why not home?”
If we have good partnerships with home health agencies that have visiting nurses, we can be sure that patients are getting their needs met. We’re now expanding our services so that we can help identify the right types of agencies. We can collect data on the agencies that do their start of care well and are timely in getting the nurse into the home.
Was entering into home health something that you guys had planned for a long time?
This was always in our strategic plan.
Somebody might ask why. Well, the problem that we’re trying to solve is that we’ve observed that when somebody transitions from hospital to home, and there’s that handoff, we see that there’s still a large variation in that handoff.
And when I say large variation, what I’m referring to is that sometimes it works well and people don’t have a lot of questions because it’s seamless. But a lot of times it’s not, it’s fragmented, meaning the care that they’re receiving after the hospital isn’t aligning with what was described for them when they were discharging.
We saw that in post-acute care with the skilled nursing facilities. And our solution addressed that problem. We reduced the variation in care for skilled nursing facilities, and now we want to reduce the variation in care and actually help the home health care agencies better understand what’s a more optimal transition into home health.
