Baystate Case Study

DispatchHealth Diverts 2,191 Emergency Visits

Saves Baystate Health An Estimated $1,729 Per Visit Within Risk-Population

Case Study

Details & Data Client

Not-for-profit, integrated healthcare system UMass Medical School Affiliation Baystate’s mission is to improve the health of the people in their communities every day,

Results

3,436 total 1,511 value-based DispatchHealth patient encounters

with quality and compassion. The organization encompasses five acute care hospitals and an employed, academic provider group of more than 750 physicians and 340 advanced practice providers (APPs), all serving more than 850,000 patients each year.

$1,729 per visit Cost savings for value-based program

Location • Western New England

Goals • Deliver effective value-based care • Encourage appropriate utilization of

services

94

96

verall Net O Promoter Score (NPS)

Value-based Net Promoter Score (NPS)

• Decrease readmissions, avoidable

observations, and transports

Solutions • Acute care: On-demand, high acuity

medical intervention in the home that provides an alternative for traditional ER visits and prevents avoidable hospitalization

95%

Clinical notes transferred to patient’s previously established provider for value-based or specialist while safeguarding from readmission

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Service vehicles

• Bridge care: Proactive DispatchHealth visit

24-72 hours post discharge for identified high risk patients to help “bridge” the patient back to their primary care physician or specialist while afeguarding from readmission

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Summary When it comes to population health management innovation, the state of Massachusetts is ahead of the curve. In fact, Massachusetts is the first state to implement statewide, all-payer standards for care delivery.

A not-for-profit integrated health system headquartered in Springfield, Massachusetts, Baystate Health serves Western Massachusetts and the Knowledge Corridor Region of Massachusetts and Connecticut. The

“

organization maintains four hospitals, over 80 medical practices and 25 reference laboratories. Value-based care is a substantial part of Baystate’s operations, with as many as 170,000 risk patients in Medicaid ACO, Medicare ACO and commercial risk contracts.

Working as a clinically integrated network with Baycare Health Partners,

The DispatchHealth team

a physician-hospital organization (PHO), Baystate Health has partnered

had the expertise we needed,

are part of the organization’s value-based healthcare program — with

and I found comfort in the

volume of Emergency Department (ED) visits and hospitalizations.

fact that in-home high-acuity care is their core business.

This means we benefit from

with DispatchHealth to provide high-risk patients — many of which at-home acute care. As a result, Baystate has successfully reduced the

Alternative Care Option Reduces Emergency Department Utilization Baystate Health was struggling to curb excessive ED utilization rates,

the focus and expertise of

which were due in part to an aging, socioeconomically or resource

a trusted partner and can

limited patient population. “A versatile population health management program was needed to treat patients effectively within our local

spend our time and energy

communities,” said Amy Roy, Director of Clinical Integration at Baycare

on other mission-critical

Health Partners. Baycare serves the four Baystate Health hospitals and

initiatives.

about 175 medical practices, with approximately 1,400 physicians in the Pioneer Valley of Western Massachusetts. In addition to managing complex value-based patients through these locations, Baycare

– Andrew W. Artenstein, M.D. Chief Physician Executive, Baystate Health

works with preferred providers to treat high-acuity patients within its extensive network of assisted living and skilled nursing facilities.

Roy leads Baycare’s strategies for ensuring high-quality care delivery with integrated services across the system, with a focus on providing services outside the hospital setting. Her team supports physician leadership at Baystate in developing new care models and payment initiatives that improve clinical performance, which often involves managing contracts to team up with risk partners.

“We've been challenged with high ED utilization in our population for a very long time,” Roy said. “We tried leveraging various approaches through care management, provider practice focus and increasing access, but we still come back to the same issue. We heard about DispatchHealth launching in other markets, and we thought it was a great option that could really enhance our care for patients in this community.”

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“ DispatchHealth has added a whole other level of care to our primary care practice.

Integrating DispatchHealth into the Baystate Model DispatchHealth partners with payers, providers and health systems to deliver on-demand, at-home care to patients with acute medical issues, which helps to reduce unneeded ED visits and hospital admissions. The company employs a Nurse Practitioner or Physician Assistant and an Emergency Medical Technician and equips them with the tools and technology necessary to treat high-acuity medical needs in the field, virtually supported by a Board-certified ER physician. Each vehicle contains a moderate complexity point-of-care lab, IV medications, procedural capability and diagnostics e.g. electrocardiogram.

The ability to have qualified

Partner facilities have direct phone numbers and digital access to

people go in and accurately

on behalf of their patients.

assess patients that really need to be seen, makes a huge difference and it gives an incredible level of

DispatchHealth’s intake and triage center, where they can request care

“ At the time we were considering DispatchHealth, it was a novel, niche idea,” said Andrew W. Artenstein, M.D. and Chief Physician Executive at Baystate Health. “We were drawn in initially because of the severity and acute element, and the prospect of reducing the need for ED observations. The DispatchHealth team had the expertise we needed, and I found comfort in the fact that in-home high-acuity care is their core business. This means

comfort on our part that

we benefit from the focus and expertise of a trusted partner and can

they’re getting treated

spend our time and energy on other mission-critical initiatives.”

appropriately. So many of

To integrate its services into the Baystate model, DispatchHealth

these people were going to the emergency rooms.

implemented marketing outreach that targeted the most medically complex, risk-based patients who would be candidates for ED diversion.

DispatchHealth identified patients who frequently use the ED — typically high-cost or high-value patients with complex medical conditions or transportation limitations. They also targeted primary care and specialty

– Andrew Weststone, MD Western Mass Medical Group

providers, care managers, home health agencies and assisted living facilities within the Baystate network.

By leveraging DispatchHealth’s services, primary care physicians, skilled nursing and long-term care facilities in Baycare’s network can provide patients with improved access to quality acute care, and Baystate can deliver critical services to local community centers. The partnership helps to strengthen physician liaisons and encourage engagement with DispatchHealth’s services, which ultimately reduces ED visit volume at Baystate’s facilities.

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Over $1,700 Per Visit Saved by Reducing ED Visits, TransportS, and Avoidable Admissions Since they began using DispatchHealth’s services, in just one year, Baystate has been able to divert 2,192 ED visits and 742 emergency transports, while avoiding 86 hospital admissions across all patients.

Within its value-based program, the organization diverted 1,058 ED visits and 330 emergency transports, while avoiding 178 hospital observation admissions and 40 admissions. This lead to an average savings of $1,729 per visit from the acute and bridge care programs. Additionally, the organization achieved an average NPS rating of 96, compared to the industry standard of 9.* “ DispatchHealth has enabled us to provide patients the right level of care, in

“ The DispatchHealth team was able to have a very personal conversation around life goals and the patient's end-of-life plan of care, because they were there in person. They persuaded the

their own environment and at a lower cost, while keeping them out of the emergency room,” said Baycare's Roy. According to Roy, in addition to reducing ED visits and associated cost savings, working with DispatchHealth has been an extremely positive experience. “Of all the vendors we’ve ever partnered with, DispatchHealth is the most seamless and easiest to work with,” she said.

DispatchHealth in Action Use Case: Emergency Room Alternative for Referring Physicians Andrew Weststone, M.D., who owns a Baystate-affiliated practice at Western Mass Medical Group, has leaned into DispatchHealth’s offerings for patients requiring a higher level of care than he can provide, but for

family to agree to hospice

whom the emergency room isn’t an appropriate option.

and made the referral on the

According to Weststone, it’s important that the professionals delivering

spot, ensuring they received

in-home care validate their recommendations with him, because the patients have complex health problems, and a new care provider may

the appropriate level of care,

not understand the nuances of the patient’s condition and health.

while eliminating any hospital

happened to the primary care practice so everyone is informed and care

visit during the pandemic.

Following an in-home visit, DispatchHealth sends a summary of what can continue in a seamless manner.

“DispatchHealth proactively communicates in real-time with my office while

– Amy Roy Director of Clinical Integration at Baycare Health Partners

they’re in the patient’s home, so we’re in sync,” he said.

* Accenture.(2016). Patient Engagement: Think your patients are loyal? Think again.

Retrieved from (https://www.accenture.com/_acnmedia/accenture/conversion-assets/dotcom/ documents/global/pdf/dualpub_25/accenture-think-your-patients-are-loyal.pdf).

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Use Case: Hospice Referral During Covid-19 During the Covid-19 pandemic, telehealth has taken hold as a viable alternative for in-person visits. Although video calls work for some patients, others don’t have the technical savvy or tools to conduct a

“ DispatchHealth has enabled us to provide patients the right level of care, in their own environment and at a lower cost, while keeping them out of the emergency room.

telehealth visit from home. Additionally, some care cannot be delivered over digital channels, as the human interaction and empathy of a handson, in-person visit is lacking as well as the ability to provide needed lab evaluation and procedures. Typically, the highest risk patients have complex medical conditions and often struggle with frailty, decreased mobility, social isolation, and transportation limitations.

For example, one patient was in need of hospice, but the family had extreme anxiety about visiting a facility. In this case, a telehealth visit was insufficient. The care manager recommended DispatchHealth, who was able to complete a Medical Orders for Scope of Treatment (MOST) form in-home, accelerating the process of referring the patient for hospice. " The DispatchHealth team was able to have a very personal conversation around life goals and the patient's end-of-life plan of care, because they were there in person. They persuaded the family to agree to hospice and

– Amy Roy Director of Clinical Integration at Baycare Health Partners

made the referral on the spot, ensuring they received the appropriate level of care, while eliminating any hospital visit during the pandemic."

— Amy Roy, Director of Clinical Integration at Baycare Health Partners

Use Case: In-Home Behavioral Health Assessments Many patients who frequent the Baystate ED have psychiatric needs.

When this happens, Behavioral Health Network (BHN) professionals require medical clearance for an in-patient behavioral stay. Typically, a BHN nurse calls an ambulance which takes the patient to the emergency room, where they wait for an evaluation during a potentially lengthy stay.

With DispatchHealth, this is no longer necessary — care professionals can be dispatched to the patient’s home or within the BHN “Living Room” to complete the evaluation and provide medical clearance, eliminating the need for an ED visit.

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A Critical Healthcare Service for High-Risk Patients

“ DispatchHealth has become a useful service in our repertoire to manage and serve the high-risk population.

According to Baystate’s Artenstein, in-home care is a critical part of the future of healthcare. It’s so essential, in fact, that Baystate plans to integrate referral capabilities for DispatchHealth’s service within its EMR/ EHR system in the near future. By doing so, Baystate can better serve risk-level patients within its local communities with rapid and seamless access to in-home care. In certain markets, DispatchHealth provides full hospital-in-home capabilities for general medical conditions that contribute to a significant portion of all hospitalization, leaning on the Acute Care model two-fold - greater patient acceptance of hospital-level care in the home upfront and as a safety net to a 911 call and ambulance ride if something escalates during care. “ About 60% of our primary care revenue is generated from risk,” Artenstein said. “Massachusetts is ahead of the curve in population health, however

– Andrew W. Artenstein, M.D. Chief Physician Executive, Baystate Health

we still have a healthy portion of business from fee-based services, but serving risk patients is a clearly a critical component of what we do as an organization. Along with other critical services such as telehealth, paramedicine, and urgent care, DispatchHealth has become a useful service in our repertoire to manage and serve the high-risk population.” " Our relationship with DispatchHealth is a true partnership — we both bring things to the table to optimize patient care. That’s what makes it a successful program.”

— Andrew W. Artenstein, M.D. and Chief Physician Executive, Baystate Health

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All Patient Encounters / (% of total DispatchHealth patient encounters): The partnership was initially launched in December of 2018.

The data to the left includes performance data and key metrics for the calendar year 2019.

Value-based program encounters / (% of total DispatchHealth patient encounters within Baystate value-based program): 1,511 patient encounters within Baystate value-based program (44% of total patient encounters)

3,436 total patient encounters Appropriate Utilization of Services

• 94

Appropriate utilization of services

2,192 (63.8%) Emergency department diversions

1,058 (70%) Emergency department visits avoided

742 (21.6%) Emergency transport avoided*

330 (21.8%) Emergency transport avoided*

399 (11.6%) Hospital observation admissions avoided

178 (11.8%) Hospital observation admissions avoided

86 (2.5%) Admissions avoided

40 (2.6%) Admissions avoided

NPS**

• $1,729 per visit estimated cost savings •9 6 NPS compared to industry standard of 9

(Source: Accenture analysis)** •9 5% of clinical notes transferred to patient’s established

provider: Integrated care

Social Determinants of Health Insight • 30% lack transportation vs. 9% nationally

for DispatchHealth patients •1 1.2 prescription medications each patient,

vs. 9.7 nationally for DispatchHealth patients

* Based on the severity of the underlying condition, providers facilitate the transfer of the patient to the ED either by private automobile, nonemergent transport or (rarely) EMS. Providers remain on-scene with the patient until the transportation hand-off is made. They also call ahead to the receiving facility and relay pertinent information from their inhome evaluation. ** Patient satisfaction was assessed using the Net Promoter Score (NPS).

NPS is considered an indicator of consumer loyalty and used in health care as a surrogate for patient satisfaction. To determine NPS, organizations subtract the percentage of detractors (consumers who are most likely to speak negatively when asked if they would recommend) from the percentage of promoters (consumers who are most likely to make positive referrals).

•5 % of patients said they could not afford their medications

vs. 1.3% DispatchHealth average

RIGHT SIZED CARE • 11% vs. 9.5% DispatchHeath average:

phone triage escalation • 8.7% vs. 6% DispatchHeath average:

on-scene escalation 8

“ Our relationship with

About DispatchHealth DispatchHealth is redefining health care delivery to offer on-demand care people of all ages with acute medical problems in the comfort of

DispatchHealth is a true

their own home. DispatchHealth’s board-certified medical teams are

partnership — we both bring

injuries and illnesses on scene.

things to the table to optimize patient care. That's what makes it a successful program.

– Andrew W. Artenstein, M.D. Chief Physician Executive, Baystate Health

equipped with all the tools necessary to treat common to complex

DispatchHealth works closely with payers, providers, health systems and others to deliver care in the home to reduce unnecessary emergency room visits and hospital readmissions.

Medical teams are available during the day and also on weekends, evenings and holidays, and can be requested via app, online, over the phone, or through care coordination referral. DispatchHealth is contracted with most major insurance companies, and accepts Medicare and Medicaid.

To learn more about how DispatchHealth can help your health system reduce the total cost of care, improve clinical outcomes, and delight patients by moving high-acuity care into the home visit: dispatchhealth.com/partners or email partners@dispatchhealth.com.

Follow Us for Updates ©️2020 DispatchHealth. All Rights Reserved. DispatchHealth complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Visit www.DispatchHealth.com/non-discrimination-statement to learn more.

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