Medically Home Looking to Unlock Hospital-at-Home Model’s Untapped Potential

This article is a part of your HHCN+ Membership

The hospital-at-home model has finally gained momentum in the U.S. One of the beneficiaries – and drivers – of that is Medically Home.

The company had already raised $64 million before two health care titans, Mayo Clinic and Kaiser Permanente, tacked on an extra $100 million to its funding total through a strategic investment in May.

Then, last month, another round of investors joined the party. The latest $110 million investment was led by Baxter International Inc., Global Medical Response and Cardinal Health, with the Mayo Clinic and Kaiser participating as well.

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And although the company has picked up serious steam during COVID-19, as hospitals have looked for ways to free up capacity, Medically Home CEO and co-founder Rami Karjian believes the success of his organization was a long time coming.

Karjian joined Home Health Care News for a conversation detailing the company’s journey and how higher-acuity care will make its way into the home in the near-term future.

HHCN is pleased to share the recording and highlights of our HHCN+ TALKS conversation with Karjian. Read on to learn more about:

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– How Medically Home got to where it is today, having raised nearly $300 million to further its cause

– Why care needs to be “decentralized,” and what the future of hospital at home will look like in the U.S.

– How Medically Home’s investors have helped accelerate the organization and the hospital-at-home initiative overall

The below has been edited for length and clarity.

[00:00:04] Andrew Donlan: Good afternoon, HHCN+ members. Thank you for tuning in to this TALKS conversation. I’m HHCN reporter Andrew Donlan. For this episode, which is No. 7 of TALKS, I’m super excited to be joined by Medically Home CEO Rami Karjian. Rami, thank you so much for joining me today.

[00:00:23] Rami Karjian: Of course. My pleasure.

[00:01:47] Donlan: Can you give a background of Medically Home, in terms of the work you guys do and also the founding story?

[00:01:59] Karjian: The way the company was born has really affected how we think about what we’re trying to do. The initial catalyst came out of a personal event that one of my co-founding partners, Raphael Rakowski, had with his father passing away in a hospital in New England from a medical error. As engineers, that caused him and our team to really step back and say, “How can we deliver this care in a way that’s different – that’s better for the patients and clinicians – and get at some of the root problems that we’ve got with the way we deliver health care in institutional facilities today?”

We did our clinical trial in 2011 and 2012 with Advocate Hospital in Chicago, along with support from Johns Hopkins.

That clinical trial was published in 2015. As you could imagine, the world changed for us then. Because at that point, once the trial came out, it was no longer a question of convincing chief medical officers and chief nursing officers that this was a safe model of care. It was really about how to operationalize it, how to execute it, and frankly, getting CFOs comfortable with the impact it would have on the bottom-line of their health systems.

Our first commercial patient was in 2017, after working for a year with Atrius Health in Boston. And we were slowly building up our expertise and our capabilities to serve more patients.

Then COVID hit, as did the realization that we needed to inject more capacity into our health care system. That really gave Medically Home a lot of tailwinds that propelled us. We’ve been very lucky with the partners that we have to be able to scale now to about 10 states.

A lot of people will believe that COVID really created Medically Home. The reality is our clinical trial was more than a decade ago, and this is something that we’ve believed in far before COVID. The big change with COVID was that so many hospitals and health systems realized the resiliency and the capacity challenges they have. More importantly, the folks at the U.S. Centers for Medicare & Medicaid Services (CMS) provided a reimbursement mechanism that allowed health systems to provide care in the home at the same rates and with the same reimbursement that they were getting for providing care in the hospital.

[00:05:01] Donlan: Your mission hasn’t changed all that much. But externally, how have things changed for the hospital-at-home model over the years?

[00:05:27] Karjian: With COVID in particular, there are two forces. One is the hospitals and the clinicians that are trying to care for patients realizing that the infrastructure of a brick-and-mortar hospital didn’t provide the capacity that they needed to care for the patients in their community. It led them to look for other ways of getting capacity. What better way of getting capacity than to use the infrastructure already in a patient’s home, in an environment where the patient is already used to living? That was one piece of it.

The second piece of it, again, was CMS. It said, “Look, we will pay for you to provide this care at the same rate as we will pay for the care in the hospital.” Those two things coming together, the hospital clinicians needing more capacity and CMS saying we’ll pay for it, really propelled it.

[00:06:42] Donlan: Even if the mission is the same, how has Medically Home evolved?

[00:07:00] Karjian: Honestly, it’s hard to talk about how Medically Home has evolved separate from the context of how the hospital-at-home movement has evolved because we’ve been driving this, along with our partners, for so long.

I think the biggest thing that we’ve seen for the movement overall and for Medically Home is that it started off as in-patient substitution. Think of it as your classic heart failure, COPD and pneumonia patients that instead of going upstairs from the emergency department would go home and get treated there.

The evolution that we’ve seen since then is about being able to care for a broader range of disease states, as clinicians have had more experience with these patients, the model and the platform. We’re very pleased that we’ve seen our partners do bone marrow transplants at home. We’ve seen our partners do kidney transplants at home. To be clear, the operation itself is still in a hospital, but the patient is able to go from that to their home and then recover there.

We’ve also seen the parts of institutional facilities, that are better off being decentralized, expand. Again, we started with in-patient substitution, and now our health system customers are using the model to do observation at home, SNF at home, oncology care at home and post-surgical care at home, among other things.

[00:08:55] Donlan: In May of last year, the Mayo Clinic and Kaiser Permanente invested $100 million into Medically Home. What did that mean for you guys?

[00:09:50] Karjian: The investment that they made into Medically Home sent an incredibly loud signal in the U.S. to other health systems, to CMS and to payers that they really believe in this model of decentralizing care. If you really look at it, Mayo is known for serious and complex care, and Kaiser Permanente, of course, is known for longitudinal care and a model that takes all of the patient’s needs into consideration over a longer period of time.

That signal was incredibly powerful, for one. And the funding was used to strengthen our technology platform and to strengthen our ability to get services into the home.

[00:11:45] Donlan: Then there was another $110 million investment that you guys recently announced, with Baxter International, Cardinal Health and Global Medical Response leading the way. Can you explain why this group of investors is different and what it means for your model moving forward?

[00:12:16] Karjian: Baxter and Cardinal coming in as partners and as investors in Medically Home really shows that they’re bringing to bear all of their capabilities in taking goods – and the support that comes with that – into the home. And then we’re very excited about Global Medical Response with what they’re able to do with this partnership. We’re basically able to take 30,000 paramedics that are spread across the country and bring them into the fold – where they are able to actually provide the care and the treatment of the patients in the home.

The way we think about it is that we’re injecting 30,000 new clinicians into providing high-acuity care in the home at a time when our country is desperately short on clinical capacity.

[00:14:13] Donlan: In terms of that CMS “Acute Hospital Care At Home” waiver, how do you think it could be structured better? With the obvious caveat being that all this was new, and it was rushed to some extent because of the nature of the public health emergency?

[00:15:06] Karjian: I believe that CMS saw this as a first step towards how they want to drive more and more decentralization of care. Today, CMS has two reimbursement constructs. One is under the PHE, reimbursing for the DRG and the professional fees at the same rate as the hospital for all in-patient care. The second construct that we’ve seen that CMS has had is bundles around BPCI.

I believe the two are going to get linked post-PHE. That’s where I believe this is going.

CMS took a very bold step in the middle of the crisis to put up reimbursement for decentralizing care with hospital at home. At the same time, they continue to drive more bundles, more value-based care. We believe that it’s only a matter of time before CMS starts to link those two. That’s very consistent with the direction that CMS is trying to go.

[00:20:59] Donlan: There’s a lot of home health and home care providers listening in on this call right now. If this is part of where health care is going in the future, what would you recommend they do in order to try to get involved in bringing more advanced care to the home the future?

[00:21:29] Karjian: As a starting point, we all have to recognize that there’s a big difference in this care from traditional home health. Traditional home health is scheduled in advance.

As we look to decentralize high-acuity, hospital-level care into the home, all of that needs to change pretty dramatically. The care has to be available 24/7. It has to be reliable. It has to be safer than in a hospital.

The starting point is, as an industry, we have to realize we can’t just ask home health to work harder or to add more capacity. It’s a dramatic retooling on every dimension in order to provide safe, high-acuity care in the home. That’s what we’ve gotten really good at doing, along with a big network of partners.

[00:28:31] Donlan: Thank you everyone so much for listening in to today’s TALKS. If you have any questions, you can email me directly at [email protected]. Also, remember there’s going to be a recording of this event, so if you miss some of it, you can go and get that online.

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