Taking time to differentiate your home medical equipment company
from the rest of the pack may seem impossible with the industry's
current focus on survival in the face of competitive bidding and
reduced reimbursements.
Yet Premier HomeCare, a Louisville, Ky.-based provider, has made
a name for itself by empowering patients, thereby improving
clinical outcomes and increasing referrals. And the company is
doing it through disease management.
Keeping Patients Healthy
The 10-year-old company, which has seven locations in Kentucky
and Indiana, offers three disease management programs for patients
with chronic obstructive pulmonary disease (“Breathe
Healthy”), sleep-disordered breathing (“Sleep
Healthy”) and congestive heart failure (“Heart
Healthy”).
“The federal government has recognized through a 13-state
grant that patients do better in their home where they want to
be,” says Wayne Knewasser, vice president of public relations
and government affairs for Premier. “Part of keeping
individuals in their homes is providing caregivers and patients
with tools to meet basic needs on a scheduled basis, including
education on what they need to know to take care of
themselves.”
Disease management is a system of coordinated health care
interventions and communications for populations with conditions in
which patient self-care efforts are significant, according to the
Disease Management Association of America.
Programs should “support the physician or
practitioner/patient relationship and plan of care, emphasize
prevention of exacerbations and complications utilizing
evidence-based practice guidelines and patient empowerment
strategies, and evaluate clinical, humanistic, and economic
outcomes on an ongoing basis with the goal of improving overall
health,” according to the DMAA.
Premier's disease management programs aim to do just that.
Patients are automatically entered in the programs upon
referral, Knewasser says. Each program provides education on the
disease process and the physician's prescribed therapies and
medications. Patients also receive comprehensive instructions and
information on the equipment they have received.
The programs involve home visits by licensed health care
professionals who offer an assessment of the living environment and
provide respiratory assessment with oximetry screening. All
assessment results and patient outcomes are reported to the
referring physician.
“We are trying to empower the patients to make good
decisions about what they can do for themselves. That is the goal
of these programs,” says John Cason, the company's vice
president of marketing.
The disease management programs, which were inaugurated in late
2005 and early 2006, came about through a desire to take a creative
approach to being on the leading edge of patient care and meeting
the needs of referral sources.
“We knew that if we had a good program to offer our
patients, then referral sources would recognize that and would want
to send [us] their patients to make sure they were receiving the
maximized benefits of being on home medical equipment to prevent
re-hospitalization,” says Knewasser.
In addition, Cason says, the company was interested in outcomes
in the acute care arena. Traditionally, he notes, the HME industry
has been challenged because it lacks solid statistics and studies
that demonstrate how it is saving health care dollars.
“We did this because we wanted to be a different type of
[durable medical equipment] company and differentiate ourselves in
the service component,” Cason says.
Tracking Success
The outcomes to date have been impressive. Premier has seen
improved patient compliance, a reduction of hospital readmissions
and emergency room visits, and an increase in patients'
self-management of their disease process, Knewasser and Cason say.
The programs provide an appropriate assessment of patients'
functional levels and exercise needs, both of which can result in a
higher quality of life, they believe. And communication between
Premier HomeCare, its patients and their physicians is also
enhanced.
As well, the programs serve as a source of encouragement for
patients. “We want our programs to be an informational source
for our patients and to reinforce that they can have a strong
quality of life following the diagnosis of a chronic disease. We
want to stop the panic that occurs and help them take care of
themselves by doing the treatments that are prescribed,” says
Cason.
The emphasis on disease management also plays into Premier's
plan for the future. Through talks with various managed care
providers, the company is emphasizing that its disease management
programs will keep its customers healthier and prevent
hospitalization.
“Through these programs, we are trying to be proactive and
diversify our payer sources,” says Cason.
Knewasser adds that physicians' emphasis on “pay for
performance” makes disease management programs even more
attractive. Disease management services provided by an HME company
can actually be an extension of the physician's plan of care while
strengthening the current relationship, he says.
Indeed, physicians have made referrals for the first time due to
the company's disease management programs.
Cason notes that positive results have occurred internally as
well. “Through these programs, we have enhanced the patient
care we offer and our clinicians have embraced the programs,”
he says. “It gives our therapists the ability to provide
one-on-one patient care and education.”
All of this hasn't come cheaply. The initial investment was
between $15,000 and $20,000, Knewasser says, and long-term costs
include printing the program booklets at about $5 each, and a
therapist to educate each patient about his or her program.
Both Cason and Knewasser say careful planning and extensive time
and effort went into creating the patient education materials to
make sure they were user-friendly. And the company has been
deliberate in marketing the programs, making sure that referring
clinicians understand their intent and that the information
exchange between Premier and its referral sources is consistent and
meaningful.
The money and efforts have been well spent, and not only because
business has increased. The disease management programs have paid
off in ancillary benefits as well. The focus on disease management
has created a buzz about Premier within the professional community,
which has been good for the morale of the company's 80
employees.
“Through these programs, our employees have seen that
Premier HomeCare is moving forward. It gives them a source of pride
and has increased their professionalism,” says Knewasser.
“They see that we are a leader rather than a
follower.”
Envisioning the Future
At a time when many HME providers are reducing patient care
services due to reimbursement constraints, Premier's management is
confident it is doing the right thing.
“When we looked at the idea of disease management, we knew
we were not going to get paid for it, but we felt it was the
mechanism we needed to enhance our industry's perception and
provide better patient care,” explains Knewasser. “You
have to be careful where you put your pennies, but if you don't
keep reinventing the future, you are not going to be
around.”
He adds that there is a “certain amount of risk to the
reward. We knew there was a risk and an expense when we started
this.”
It is a good investment, according to Cason. “We feel like
this is a tangible investment in the company,” he says.
“Some of the results are measurable through direct referrals.
However, the intangible results — increasing talk about the
company — are just as important.”
That talk raises the bar for Premier's competitors, and
Knewasser says this is a good thing because it results in increased
patient care across the board.
The company isn't resting on its laurels, however. Premier
continues to look for creative ways to satisfy patients and
increase interest from referral sources, Knewasser says, and
recently added a component to the Sleep Healthy program that offers
a comprehensive approach to achieving successful outcomes for
patients with sleep-disordered breathing.
The company has also partnered with the Louisville YMCA to offer
a program for patients who participate in its Sleep Healthy disease
management program. Each patient receives a free 30-day trial
membership to the “Y” for their family and is able to
use all of the facility's programs and services. In some cases, the
initiation fee may also be waived if the patients decide to
join.
“We do not want to be a company that slaps a CPAP machine
on patients and then tells them they are
‘fixed,’” says Cason. “Instead, we want to
tell them that they now can have the energy to improve their health
through exercise and fitness programs.”
The next step is to partner with other YMCAs so that all of
Premier's locations can offer the program by the end of this year.
Likewise, Cason adds, Premier plans to launch programs at YMCAs
that offer additional patient services such as support groups and
fitness classes specifically for patients with SDB.
In the future, he says, there may be an opportunity to
incorporate a disease management program for asthma patients or to
target the diabetes population, which is becoming a well-recognized
co-morbidity for SDB.
At Premier HomeCare, it's all about finding new ways to improve
patient care.
“It comes down to the patient,” Cason says,
“and what can we do to enhance our company to make sure we
take care of our true customer — the patient.”
