MultiCare Case Study

Reimagining the Way Healthcare Is Delivered

Case Study Details & Data Client

MultiCare brings high acuity care to home with DispatchHealth to produce cost savings and exceptional patient satisfaction.

Not-for-profit health care organization MultiCare offers comprehensive, accesible

Summary

care options throughout the Pacific Northwest.

As an innovative health system, MultiCare is located in the highly-

They operate eight hospitals, including one pediatric hospital, outpatient clinics, urgent care, telehealth, home health, hospice care and emergency services.

Serves 887,913 patients per year

competitive Pacific Northwest, where they are pursuing an increased value-based care focus, while also competing with several health systems in the traditional fee-for service business model. Both models require a commitment to lowering the cost of care and improving the patient experience. To differentiate, they have an aggressive plan for serving their communities with the goal of providing the right care, in

Goals

the right setting, at the time care is needed.

• Value-based care

MultiCare has accepted the challenge to reimagine care outside the

• Market differentiation

four-walls of the hospital to bring care to patients, reserving the

• Future of health care—care outside the

walls of a traditional health system

Solutions • On-Demand Acute Care • Bridge Care

hospital setting for care of the sickest of the sick. By extending services to the home, they are achieving higher patient satisfaction, lower complications and infections, and better outcomes. They have also found that they were well-positioned for the changes that resulted from COVID-19.

Situation

Location

MultiCare has been serving patients in Washington state for over a

• Pacific Northwest, based in

century with a long-standing tradition of “partnering for healing and

Tacoma, Washington

a healthy future.”

Client Quote

Disrupting traditional healthcare and innovating care to make it simpler,

"At MultiCare, we do things differently—we're not risk averse and pride ourselves on being first to market. We knew we had to find ways to reduce total cost of care, as we evolve to population management. We want to help craft that new world not sit back and have it happen to us.

easier, and better for consumers is mission critical for Christi McCarren, RN who serves as MultiCare’s Senior Vice President, Retail Health & Community-Based Care. Her responsibilities include all service lines, post-acute care, retail and virtual health. In late 2018, she initiated a partnership with DispatchHealth. “ When we brought on DispatchHealth, we had an existing retail model in

What we saw in DispatchHealth is they truly had

place that included occupational medicine, telehealth, and urgent cares,"

innovative ideas, they were proven, and the had

McCarren explains. "We quickly realized that DispatchHealth provides

the same core values as us."

advantages across a much broader spectrum, and they integrate with

–Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

our full continuum of care. It’s very complementary. DispatchHealth has been a tremendous addition and balance to our urgent cares and ERs and serves very specific needs and patients.”

2

Solution To help align across the continuum of care as they took on more risk, MultiCare leaned on DispatchHealth to extend clinical services into the community and benefit their value based risk populations. “ We recognize that we cannot do everything ourselves. Speed to market is the name of the game. DispatchHealth has a deep understanding of logistics and technology."

“ What works with

The partnership was initially launched in MultiCare’s primary market of Tacoma, WA market in Dec 2018. At the start DispatchHealth deployed 2 vehicles (Dispatch Rovers), and demand steadily grew resulting in the addition of 2 additional rovers by the end of 2019.

Ongoing Coordinated Care Integration

DispatchHealth is the

In order for change to be adopted, communication of the new service

physician communication,

technology that are built to support the integration and adoption of the

including complete notes and follow-up care, if applicable.

Some physicians may initially think this model is going to fragment care, but when it's

was essential. DispatchHealth has a proven methodology, team, and clinical model – tailored to each individual partner and market. “ We’re really focused on retail services and how we’re targeting populations. When we’re talking about retail, we’re always talking about cross-marketing DispatchHealth. We start with our value-based plans and get them information on how well it integrates from a variety of care channels,” states McCarren.

aligned, it works really well.

DispatchHealth worked with the MultiCare team to integrate the services through a variety of on-going channels:

That's what DispatchHealth

• Nurse Consult Line – DispatchHealth is embedded as an option

does so well.

– Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

within protocols used by the nurses to help patients get to the appropriate point of care.

• Care Management – DispatchHealth worked with this team to initially identify the rising risk patients and high-risk discharges. Over time the teams have collaborated on case reviews to continually refine the approach in the community and at discharge in order to optimize the program.

• Physicians – DispatchHealth serves as an adjunct to the physician practices, extending care to the home 365 days a year.

DispatchHealth is also integrated into Epic to provide a closed loop of shared encounter notes within the EMR. • Direct Consumer Outreach – driven by the DispatchHealth team digital campaigns, direct mail, and email can be targeted based on a comprehensive set of data and applied to address specific populations and programs.

• Senior Communities and Home Health Agencies – DispatchHealth employs a local team in each market to develop and enhance relationships with these organizations, becoming an extension of the health systems programs to provide care to the community.

3

DispatchHealth protocol is to follow up with physicians and others who may have referred patients to the service after a visit.

In addition, DispatchHealth checks back in with each individual patient or their power of attorney (POA), and views patient’s record at 3, 14 and 30 days to verify if the patient has utilized an ER during that time.

Example of Provider Outreach

“ Health systems are usually surprised by how much care can be safely delivered in the home with the proper model.

– Dr. Mark Prather CEO and Founder DispatchHealth

4

“ Collaborative. Transparent.

Valued. From working

DispatchHealth Clinical Model “ Health systems are usually surprised by how much care can be safely delivered in the home with the proper model,” explains Dr. Mark Prather, DispatchHealth’s CEO and Founder. “For most of my career, I delivered care in an emergency department setting and eventually oversaw care in multiple emergency departments, inpatient wards, and even in the post-acute setting. Our typical facility-based care model can and should be turned on its head. For years, we’ve had ample medical literature to support the conclusion that care in the home is more efficacious in many instances.

side-by-side with our care

However, the inertia has not been there to reengineer our existing approach.

managers and physicians, to

With the emergence of value-based care and healthcare consumerism,

caring for my mother in her final months, DispatchHealth is an outstanding partner.

I cannot imagine caring for our community without them.

– Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

the transition to the home appears to have reached a tipping point.

I want care that is more successful, more satisfying, and less costly for my parents and my family. We spend $4 trillion dollars annually on a healthcare system that produces inferior outcomes compared to other western countries. A third of our spend comes from emergency department visits, hospitalizations and post-acute interventions. Imagine if we could cut that spend in half with a lower cost care model that is preferred and produces better outcomes. The answer is staring us right in the face.”

• DispatchHealth Acute Care - on-demand high acuity medical interventions in the home or other setting. The care team is comprised of a physician assistant or nurse practitioner and a medical technician, virtually supported by a board-certified emergency medicine physician. Each vehicle contains a moderate complexity point-ofcare lab, IV medications, procedural capability and diagnostics e.g. electrocardiogram.

• Bridge Care – patients identified during a hospital stay by provider and/or payer partners as a high-risk patient because of a higher propensity for readmission. DispatchHealth schedules a proactive visit with the patient 24-72 hours post discharge to help "bridge" them back to primary care / specialist.

• Advanced Care – patients identified by our acute care teams or PCP/Specialist partners that meet hospital admission criteria.

Hospitalization in the home with 24/7 care to include hospitalist/IM daily rounding, remote monitoring, bedside nursing, durable medical equipment, social intervention, and care coordination. The care team is led by a board-certified hospitalist, supported by a team comprised of an Advanced Practice Provider and a RN Sherpaa, who helps coordinate care during the episode.

• Extended Care – patients identified during a hospital stay by health system partner. Skilled nursing facility (SNF) care in the home with 24/7 advanced and comprehensive care for medical conditions that otherwise would be treated in a SNF. Care includes that of Advanced Care with added physical and occupational therapy.

• Clinic Without Walls - when a video visit isn’t enough, DispatchHealth enables your physicians to extend their practice into the home and senior community and treat more medically complex issues through hands-on support and tele-presentation.

MultiCare is building on the initial success of the deployment of DispatchHealth’s Acute Care and Bridge Care programs in Tacoma, by continuing to expand the partnership. In late 2019, they expanded the initial services to Olympia, Seattle and Spokane. They are now working on the launch of Advanced Care, Extended Care and Clinic Without Walls projected to launch in the Tacoma market in September 2020. McCarren continues, “Put quite simply, DispatchHealth is part of the team. It’s not separate from MultiCare.”

5

Example Patient Cases Patient

“

Referral Channel Past Medical History

MultiCare care manager • Chronic kidney disease, anemia • Discharged from Good Samaritan Hospital 4 days ago after a 4-day admission for

DispatchHealth is part of

septic pneumonia

the team. It's not separate from MultiCare.

"Betsy" - 83 y/o, Post-Acute Care

Situation

• Reports cough • Fatigued and unable to complete her activities of daily living

– Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

• Getting more agitated with care giver assistance • In-home assessment and evaluation of the etiology of the cough including assessment for effusion, volume overload and worsening pneumonia • Completed medication reconciliation Impact

• Referral provided for social work to assess and provide appropriate referrals • Provided referral for home health to assist with ADL's until placement in a facility • Provided referral for physical therapy • Confirmed with caregiver for follow-up appointment with PCP. Called PCP with recommendations 6

Example Patient Cases

“ We recognize that we cannot do

Patient

medical assessment Referral Channel Past Medical History

everything ourselves. Speed to market is the name of the game.

"Jose" - 62 y/o, After hours acute

Situation

Direct consumer marketing • Diabetes, hypertension, high colesterol • Has had leg swelling for over a year • Red swollen painful lower leg

DispatchHealth has a deep

• Lab testing performed on scene

understanding of logistics

• DispatchHealth medical director consulted on-scene

and technology.

– Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

• Medication prescribed Impact

• Referred to East Pierce Family Medicine to establish care with PCP • Called East Pierce to facilitate scheduling of appointment and provided patient information • DispatchHealth will plan to come back in 5 days and re-check labs if no PCP appointment secured

7

Results 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.

Social Determinants of Health DispatchHealth is committed to working with health system partner and community organizations to address social determinants of health (SDOH).

DispatchHealth gathers SDOH information in all applicable encounters

The Data

and works to facilitate services to address these issues. Among MultiCare

MultiCare has risk arrangements of various types

information related to social determinants of health was collected:

across commercial, Medicare and Medicaid lives.

• 19.6% Provider indicated that the patient was a fall risk

In 2019, DispatchHealth treat 1,007 patients across all of their value-based arrangements.

The data below indicates the impact of the targeted efforts applied to optimize performance in these contracts.

77.7 average age 93 Net Promoter Score (NPS) 21% 911 diversion 65% ER diversion 10% observation diversion 2% admit diversion $1,520,400 in total medical cost savings $1,509 average savings per patient

affliated patients that DispatchHealth treated in 2019, the following

• 57.1% Fall Risk Unsteady - “Do you feel unsteady when standing or walking?”

• 2% Food Insecurity Worry - “Within the past 12 months we worried that our food would run out before we got money to buy more.”

• 1.9% Food Insecurity - “Has it ever happened within the past 12 months that the food you bought just didn’t last, and you didn’t have money to get more?”

• 7.3% Cost Concerns - “In the past year, have you been unable to get any of the following when it was really needed?” (child care, internet, phone, utilities, clothing, medicine or healthcare) • 23.5% Transportation - “Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?”

• 3.6% Housing Security - “Do you have any concerns about your current housing situation?”

• 8% Lack of Social Interactions - “How often do you have the opportunity to see or talk to people that you care about and feel close to?” (patient indicates < once per week) • 50% Activities of Daily Living - “Do you need help with daily activities

NOTE: Diversion criteria has been developed in cooperation with managed care partners over the years leveraging the data of over 150,000 DispatchHealth patient encounters.

such as bathing, preparing meals, dressing, or cleaning?”

• 10% Requested Resources - “Would you like help connecting to resources?”

• 3.5% Wheelchair or Homebound

8

“ The aging population is who I see benefiting the most from this service.

They have mobility issues which makes it challenging to come in. If they’re even able to go back to senior living, right now they’re immediately quarantined (because of COVID). DispatchHealth works perfectly. I’ve used the service personally four times with my parents, for example when mom’s husband fell. I believe it. My mother had an exacerbation of her heart failure. It was such a relief when her care manager called me, as I

“ There's a bigger play—to push more care into the community, as we roll out Advanced and

felt strongly that I didn’t want her going into the hospital. I didn’t want to put my mother through the ordeal of going to the hospital again and again, as it was such a cycle for her - 5 days inpatient, then into a nursing home for 30,” McCarren continues.

Conclusion By integrating DispatchHealth, MultiCare closed a gap in the care continuum by creating a cohesive, preferred, patient journey and strategically improving cost-savings in their risk populations.

Extended care in the next

With this type of validation, MultiCare continues to embrace the move

year. We see the entire Pacific

consumers in need of care. With the experience they have gained, the

Northwest as our market. We're

future success.

going into markets without a physical hospital location and we're able to do so withou the capital expense by bringing DispatchHealth with us. Care in the future will look totally different than it does today.

to value-based care and expand into new markets to reach more entire organization now fully embraces the partnership as a key to their

“ Besides the clinical model – DispatchHealth is one of our best business partners. I trust what they tell me, they share in my success – we want us both to win. DispatchHealth makes me feel like I'm as invested in them as they are in me,” explains McCarren.

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 their own home. DispatchHealth’s board-certified medical teams are equipped with all the tools necessary to treat common to complex

– Christi McCarren, RN Senior Vice President, Retail Health & Community-Based Care MultiCare Health System

injuries and illnesses on scene.

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.

9