There’s no place like home: Geisinger reboots the house call

Stanley Ritter is 98 and lives with his wife near Beavertown, a borough of less than 1,000 people in rural central Pennsylvania. Heart failure, along with mitral valve prolapse, aortic valve disease, atrial fibrillation and some respiratory issues, put Stanley in the hospital four times in 2017. Like all of us, rich or poor, young or old, in the city or the countryside, Stanley would much prefer to be home.

As both a Geisinger patient and health plan member, we wanted to see what we could do to take better care of Stanley and other patients in similar situations. He enrolled in Geisinger at Home, an innovative new program that brings a whole care team into the home of patients who have very complicated health conditions. These are patients who have multiple issues such as heart disease, cancer, lung conditions, diabetes and other chronic diseases and who require the most health resources.

Patients in these situations -- the top 5 – 10 percent of the population we treat -- account for about 50 percent of the costs in our system. Plus, whoever is at home taking care of these patients, the husband, wife, daughter or son, is often overwhelmed trying to keep track of prescriptions, doctor appointments, medical supplies, hospital stays and everything else. 

Geisinger at Home sends a team that could include a doctor, nurse, pharmacist, social worker and community health associate into the patient’s home. The goal of the team is to help this patient get needed care in the home and avoid unnecessary trips to the emergency department and hospital stays. 

Often more than one member of the team travel together to the patient’s home, goes through all the medications, gets specialists online for telemedicine visits, lines up services to come help with any medical treatments or social supports needed. A team member returns for follow-up visits as often as needed, which can be daily if the patient’s condition warrants. The family has a phone number to call 24/7 to support the patient and family and if needed get a nurse or other team member out to the home. 

The patient and family are overjoyed. Of course, this is a big investment to support home-based care, especially since so many of our patients live in rural areas. But on the flip side, we’re already seeing this investment lowering health care costs from reduced emergency department visits and hospital admissions. It’s still early, but in our first three months with about 400 patients, the frequency of ER visits for the first Geisinger at Home participants is down almost 60 percent and hospital admissions are down by 30 percent. 

Stanley hasn’t needed to visit the ER since he enrolled in Geisinger at Home. Recently, a high-tech vest that is used by the team to monitor his heart detected that the fluid levels in his lungs were getting higher, something that sends those with heart failure to the hospital frequently for a chest x-ray and IV treatment. With the vest alerting Stanley’s team, they were able to deliver the diuretic medication he needed right to his home. By catching this early, Stanley avoided the discomfort and inconvenience of a bigger crisis with his fluid levels. In fact, he’s feeling so good that he recently had to schedule his home visit around playing 9 holes of golf. 

The improved quality of life for our Geisinger at Home patients is incredible, the level of their day to day activities is improving and the expected cost reductions over the long-term we believe will provide benefits to all of us by making health care more affordable. When care is more affordable, it is more accessible and that promotes better health. 

Programs like Geisinger at Home are possible when care and coverage -- the hospitals, doctors, and health plan – are aligned around what’s truly best for the patient. We can deliver the right care at the right time in the right place – and often, the right place is at home.