A Premier Plan for Patient Care

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.”