How an Enhanced Home Health Program Creates Hospital Capacity

Identifying the target population is a critical element for successful implementation of the Enhanced Home Health program. Starwell convened a group of 10 specialists to determine the types of patients that would best be served by the program. Each clinician then identified the patient subtypes under their respective specialties that could safely be treated in the home.

Patient eligibility

The team uses the following factors to determine patient eligibility.

ED-embedded nurse liaisons identify and enroll patients

Another crucial step is figuring out how to identify and enroll patients into the program. Starwell embeds a care liaison in the ED to work with physicians to identify patients most appropriate for the program.

Currently, Starwell’s program has hired a team of seven full-time liaisons who cover both of their hospitals 24/7 via a central phone number for all Continuing Care Services, including Enhanced Home Health. They have prior experience in case management and are able to help patients navigate care. They work to schedule in-person nurse visits and virtual follow-up care with the physician.

To ensure appropriate ED discharges, the liaisons coordinate expedited oxygen deliveries to allow for appropriate ED discharges. Liaisons also order any DME needed prior to patient discharge. As some patients have expressed concerns with allowing home care staff into their homes, Starwell is utilizing DME proof of delivery waivers to facilitate contactless delivery of ready-to-use equipment.

Following the drastic decline in home health volumes due to cancelled elective surgeries, Starwell reallocated their workforce to support the Enhanced Home Health Program. Starwell recruited LPNs to help with the less acute home health patients to allow the RNs to manage higher acuity patients out of the EDs with a caseload of no more than 10-15 EHH patients on caseload at a time. The RNs perform assessments, administer treatments and medications, and provide education to the patient over 7-10 weekly visits on average.

In-person training ensures patients are managed safely

To ensure that patients receive high-quality care, Starwell also developed a training program to upskill RNs, LPN, and PTs with the relevant knowledge and skills necessary. Since RNs are required to deliver an expanded scope of services under the program, Starwell based the training curriculum off of the most common procedures patient groups eligible for the program typically receive. The training consisted of one week of Covid-19 training, and one day of a non-Covid19 skills refresher.

Over the course of a week, RNs, LPNs, and PTs were trained on Covid-19 infection control measures, including how to don and doff PPE, and when to use appropriate equipment. In case patients required mouth-to-mouth resuscitation, clinicians were issued Ambu bags and isolation kits to decrease the risk of transmission through forced inhalation. The clinicians worked together in simulated scenarios to ensure they were prepared to perform life saving measures if necessary while waiting on EMS to arrive.

Additionally, over the course of one day, RNs refreshed their skills on wound care, peripheral IV infusion, and diuresis protocols. The workshops were handson and conducted by advanced level clinicians.

Finally, to ensure ongoing monitoring of patient care, Starwell Health incorporated advanced level clinician oversight. The program is lead by Master Prepared Nurses and a Continuing Care Medical Director.

RNs directly supervise LPNs and support physicians with developing a plan of care for the patient. They also monitor tests and laboratory results, as well as the patient’s condition. Currently one RN supervises four LPNs in the program.

Home health RNs become the Care Manager for the patients care across the health system while the patient is in the Enhanced Home Health program. Collaborating and coordinating services as well as educating patients and caregivers on disease management and Covid-19 self care and isolation protocols.

Physicians monitor patient progress

Typically, physicians refer patients to home health and approve plans of care, but with Enhanced Home Health, physicians provide ongoing medical management and periodic evaluation and assessments in collaboration with the patient’s primary care provider, Starwell specialists, and Starwell Home Health agencies.

Starwell is taking advantage of CMS’ recent waivers that allow for physicians to bill for virtual visits for home health patients. The physician performs a virtual visit within 36 hours of ED discharge, and again 5-7 days later. Throughout the patient’s care episode, physicians conduct 3-5 virtual visits total. This system ensures a consistent timely follow-up from physicians. Additionally, to ensure that patients can receive a visit within 36 hours of ED discharge, the physicians operate on a rotating schedule.