Risk-Based, At-Home Pilot Program Saves $6 Million Looking After Just 93 Patients

The tech-enabled, home-focused Presidium Health recently reduced hospitalizations within a specific patient population by 53%, saving $6 million on the way.

To do so, it worked with some of the most high-need patients in the U.S. health care system.

Presidium Health performed the pilot program with San Diego’s largest nonprofit health plan — Community Health Group. Following the success of the program, the nonprofit committed to expanding Presidium Health’s services to more of its members.

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Founded in 2015, the San Diego-based Presidium Health has leveraged its digital platform to try to target the top 1% of medically complex patients. The company contracts with health organizations to care for those patients using mobile physicians and nurse practitioners who visit users at their home.

The pilot program results were so successful because of an emphasis on quality over quantity, Presidium co-founder and CEO Pouya Afshar told Home Health Care News.

“When we save $6 million on 93 patients, that’s $65,000 of savings per patient,” Afshar said. “The words ‘quality over quantity’ are very, very important to our ethos, and it shows in our metrics. To show that kind of unprecedented savings at $65,000 per patient per year, that’s what’s going to drive our growth.”

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Enabling 24/7 access and delivering advanced primary care directly to the patient were key drivers of the program, Presidium COO Melody Shedlosky told HHCN.

Taking on risk, she said, is how the company is able to thrive.

“We’ve been pioneers with this kind of care,” Shedlosky said. “Value over volume. No outcome, no income. That’s really been our mantra from Day 1.”

Most of those reduced costs were attributed to getting rid of overutilization of the ER and hospital.

A recent study found the top 1% of the highest-cost patients – 3.3 million people – in the U.S. consume over 20% of the total national health care budget. In California, the top 1% of Medicaid patients consume 36% of the $100 billion Medi-Cal budget.

Presidium’s concierge-level care, Shedlosky said, makes for a cost-effective and efficient process.

For the pilot program with San Diego’s Community Health Group, the 93 participants each had an average health care cost of nearly $200,000 per year. Collectively, the group’s health care costs were about $17.9 million a year.

“And from more of a social justice perspective, we want to help the folks that need it the most,” Shedlosky said. “If we can provide this concierge-level of care to the patients that need it the most, that is the most powerful medicine. Doing that in a special and compassionate manner, we haven’t seen a lot of models out there like that. Not only do we get to fill a gap in health care, but it’s something we’re passionate about and we see there’s a large need for it.”

By providing anything from a cell phone or a ride to refill medications to offering substance abuse assistance in the home, Presidium was able to lower hospitalizations by 53% and reduce the total cost of care to $11.9 million in a year.

Presidium serves Southern California and has plans to expand north within the state in the near future. Afshar believes the company is well-positioned due to the fact California is the largest Medicaid state in the country.

“There are 16 regional nonprofit Medicaid plans in California that collectively represent almost 80% of Medicaid patients in California,” he said.

Those 16 plans have more Medicaid patients than the other 49 states combined, Afshar said.

“They’ve got home field advantage in their markets,” Afshar said. “They’re geographically isolated, and as a result, they control the majority of the market share. We’ve already aligned with one of them here in San Diego and our goal is to penetrate all these 16 regional nonprofit plans. Then from there, the sky’s the limit.”

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