Health care in the home is on the rise, and DispatchHealth is leading the boom. DispatchHealth, founded in 2013, partners with insurance companies to deliver in-home care that reduces unnecessary emergency room visits, hospital stays and hospital readmissions. DispatchHealth began working with Regence in 2021 to serve our members in Washington, and the partnership has since grown to Oregon and other markets, including the addition of Salt Lake County in Utah this year.
For this episode of HealthChangers, host Ashley Bach spoke with Dr. Stefen Ammon, medical director of DispatchHealth, and Lara Magnani, director of clinical program management at Regence, about the innovative DispatchHealth model and how the DispatchHealth-Regence partnership has made care more affordable, accessible and effective for Regence members.
Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity.
AB: Dr. Ammon, what is the origin story for DispatchHealth?
SA: Emergency rooms were created to provide immediate and life-saving care to people who are experiencing serious, potentially life-threatening emergency conditions. Over time, however, the emergency department has become something different, oftentimes a safety net for non-emergent issues, really to fill gaps in the health care system.
Our founders, Dr Mark Prather, an emergency physician like me, and Kevin Riddleberger, a physician assistant, saw these problems firsthand and realized that many of these patients could be seen in an alternative setting at a much lower cost. With that in mind, they provided patients, health systems and health plans an alternative to the ER, by developing DispatchHealth, an organization that can deliver high-acuity, on-call medical care directly to patients in their own homes. Today, more than a decade later, DispatchHealth has developed a complex system that can treat most conditions commonly seen in the ER, but in a patient's home instead.
AB: Lara, what have been the results so far of Regence and DispatchHealth working together?
LM: When we look back at 2023, as an example, DispatchHealth helped us save over $3 million by reducing costly ER visits and hospital readmissions. And they really gave our members a new, innovative way to receive care from the comfort of their homes. On average, when we look at an avoided ER visit, we see about $1,700 in savings. And then it's even greater if we look at hospital readmission avoidance. Of course, that savings amount is going to vary widely depending on the circumstances, but on average, across our book of business, we saw about $30,000 in savings for each avoided hospital re-admission.
But what I really take joy in is seeing just how pleased our members are when they use Dispatch’s services. For those Regence members who've used Dispatch as an acute care service, we saw a Net Promoter Score (a customer satisfaction measure ranging from -100 to 100) of 95, which is phenomenal. Dispatch’s Recovery Care at Home model (follow-up care after an ER visit or hospitalization) has shown significant clinical and savings impact as well, including a 49 percent reduction in readmission rates and a 53 percent improvement in 30-day hospital readmissions; the Net Promoter Score for that particular service is even higher at 97.
AB: Dr. Ammon, why is DispatchHealth care more affordable? Why are patients happier, and why are health outcomes better?
SA: The home is a lower cost setting of care. Care in the ER is expensive because it was designed to handle life-threatening emergencies; care in the emergency department requires significant resources, including access to highly trained medical staff equipped with advanced technologies, 24 hours a day, seven days a week, 365 days a year. This contributes to high operational costs that are then passed on to patients.
In terms of our outcomes and why we are successful, it really has to do with a few different facets of our model and those include time, trust, access and clinical capabilities. In terms of time, we provide dedicated one-on-one time during a visit, up to 30 minutes or more, which is really a luxury that we enjoy, that unfortunately many primary care providers or urgent care providers simply cannot replicate.
There's also a certain level of trust and rapport that comes with treating a patient in their own home, where they feel comfortable and at ease. In addition, we have unique access. When we're invited into a patient's home to deliver care, we can add more value by assessing their social determinants of health, which we have come to know are incredibly important in determining patient outcomes. We can take a look in the patient's pantry to ensure they have enough food and the right kinds of foods to keep them healthy. We can assess their environment for fall risks, which is incredibly important with our elderly patients. We can reconcile the patient's medication list with their pill bottles to ensure they're taking their medications as prescribed, and we can help to ensure that they have the appropriate follow-up and access to subsequent care. This is a huge advantage that we enjoy that folks in a clinic or in the hospital may not have access to, and it really allows us to act as the eyes and ears of the patient's primary care provider to ensure the best patient outcomes possible.
I'd love to give you a real-life example of a way in which we've impacted a Regence member.
AB: Yes, please do.
SA: We had a patient who's a Regence member who was in and out of the hospital over a decade because of health challenges. And this is really difficult for patients, right? Every time they leave their social support system, they feel more isolated. It's incredibly difficult on a patient's mental health. Well, since becoming involved in the patient's care, DispatchHealth has helped to avoid 10 subsequent hospitalizations for this patient by helping to care for her in her home; we've treated her heart failure with active diuresis, adjusted her medications and performed medication reconciliation, performed lab analysis, chest X-ray, and even helped to facilitate an echocardiogram in her home. And as a result, she's been able to remain at home with her support system, and has an overall improved quality of life.
AB: The results of the partnership between Regence and Dispatch are pretty undeniable. We’ve also expanded DispatchHealth services this year to members in Salt Lake County in Utah and Vashon Island, outside Seattle. Lara, what does Regence do to raise awareness among its members that they have in-home care available?
LM: We are really pleased with how our members have been able to use DispatchHealth for at-home care, but because it's still relatively new, it's critical to raise awareness. We've deployed extensive marketing and outreach campaigns to promote these services across various channels. This includes direct to our members as well as employer groups, producers and referring providers. And that provider channel can be really effective, and it ensures we're also making connections back to the individual's primary care provider.
We're also exploring how to provide outreach to those individuals when they need it. For example, we've been working with Dispatch to have a Dispatch representative call members who've been recently discharged from an in-patient stay to perform a recovery at-home visit if the member’s having difficulty getting in to see their primary care provider, and if we see that they're at risk for a readmission. We're seeing utilization go up, because once people hear about Dispatch, they want to use it.
AB: The cost of health care continues to go up in the U.S. and we're always looking for new ways to care for people. Dr. Ammon, what kind of long-term impact can in-home care like DispatchHealth have nationally?
SA: I believe that the DispatchHealth model is really the future of health care. And I think that the “silver tsunami” is going to be the driving force to speed up that progress. Of course, the silver tsunami refers to the 72 million Americans who will become 65 or older by 2030; that's roughly 20 percent of all Americans. And data shows that this generation tends to be suffering from more chronic conditions than the generations before it. The reality is, the U.S. health care system simply does not have the capacity to meet this demand, nor can we afford it as a country if we don't find innovative ways to meet this need. I'm an ER fan, and ERs and hospitals have a very important role to play in this scenario, but the DispatchHealths of the health care ecosystem have a crucial role to play in delivering care where patients want to receive it, which is the home. And we can do that by preventing unnecessary ER visits and hospitalizations. Over time, the shift can lead to significant national savings, reducing the health care burden and improving patient outcomes.