MidCoast Health System, Resilient Working to Fix Health Care’s ‘Forever Crisis’

Seniors in rural areas often face more hurdles to gaining access to home-based care, especially in comparison to their urban counterparts.

Resilient Healthcare’s recent Rural Health Initiative aims to address this. The program is the latest development for the rapidly growing in-home care provider, which specializes in treating higher-acuity patients.

“Rural Health Initiative started when we realized that people weren’t able to have the access to the care they’d have in a larger city,” Alysa Newman, director of nursing at Resilient, told Home Health Care News. “The resources weren’t there, the people weren’t there, and the staff wasn’t there.”

Founded toward the end of 2018, Plano, Texas-based Resilient provides hospital-at-home, SNF-at-home and traditional home health care services. The company’s staff includes PTs, OTs, speech therapists, dietary specialists and others.

MidCoast Health System — an El Campo, Texas-based health organization that has four hospitals, with several primary and specialty clinics, plus urgent care and long-term care facilities — became the initiative’s first participant.

As part of the partnership, Resilient will bring its at-home acute care and virtual care capabilities to three of MidCoast Health System’s hospitals: El Campo Memorial Hospital, Llano Memorial Hospital and Palacios Community Medical Center. Other health system partners include Medical City Healthcare, which began working with Resilient under the popular Centers for Medicare & Medicaid Services (CMS) Acute Hospital at Home Program.

Resilient and Medical City were among the first hospital-at-home enablers in the U.S. under the waiver. As of May 5, 96 health systems and 223 hospitals in 34 states had been approved for the program.

The waiver is currently set to expire when the public health emergency ends.

In addition to showcasing Resilient’s momentum, the new initiative also reflects the increasing focus on rural health overall, with an increasing number of home-based care providers and primary care groups targeting such underserved communities. San Francisco-based Homeward, for example, announced a $20 million investment from General Catalyst to support its rural-focused primary and speciality care model in March.

“We started to focus on rural markets, which are not just ‘kind of broken.’ They’re like ‘really broken,’” Homeward CEO Jennifer Schneider told HHCN at the time. “And they’re getting worse.”

An underserved market

Resilient was well-positioned to fulfill a vow it made last year to bring care services to rural communities.

The company had built a technology solution for hospital-at-home and high-acuity care that was aimed at fixing care gaps for patients who had been discharged from the hospital but were too sick for traditional home health agencies, according to Jackleen Samuel, founder and CEO of Resilient.

“We launched that program in suburban areas and urban areas, and then realized that our technology and the solutions we’ve built around it — in virtual and deliverable care — would really expand the reach of rural hospitals and critical care access hospitals to their communities a little bit further out,” she told HHCN.

Samuel noted that oftentimes patients living in rural communities hold off on addressing their health care needs because trying to access services can be inconvenient or even challenging. In turn, rural Medicare beneficiaries are often sicker and more medically complex compared to those in urban areas.

“Rural health has probably been a crisis in America forever,” Samuel said. “There are about 600 hospitals nationally that are teetering, that might shutdown. We built a solution to be able to really expand care from these health systems that are situated in these areas.”

Although the hospital-at-home market is growing, some remain skeptical that higher-acuity care can be delivered in rural areas. Challenges, they say, include rural-connectivity issues, rural supplier networks and transportation barriers.

Mayo Clinic and Medically Home explored that topic as part of a 2021 case study, proving the viability of the hospital-at-home model in Northwest Wisconsin.

“This alternative to brick-and-mortar hospitalization was especially critical during the COVID-19 pandemic when all five hospitals in [Northwest Wisconsin] lacked capacity due to a large surge in COVID-19 cases,” the study explained.

A perfect partner

For Resilient, MidCoast Health System was an ideal first partner for the Rural Health Initiative.

“They are very innovative and their outcomes are much higher than traditional rural hospitals,” Samuel said.

As a health system serving rural communities, the public health emergency took a toll on MidCoast Health System’s hospitals.

“In late 2020, during the pandemic, we had about 25 COVID patients,” Frances Lerma, the chief nursing officer at El Campo Memorial Hospital, told HHCN. “That was all we could have. Many times, we were forced to send patients home that, now, would have been perfect candidates for hospital-at-home.”

Though El Campo Memorial Hospital was able to manage and perform well throughout the public health emergency, being part of Resilient’s initiative has given it additional resources.

Plus, it presented another option for patients who don’t want to be in the hospital, according to Lerma.

“There are a significant [number] of elderly patients that really don’t want to be admitted to the hospital and away from their home,” she said. “If they meet the criteria set up by Resilient, now, we have an alternative for them to get the same quality care. They will be monitored by our own doctors and they will be the ones communicating with a central station. Our charge nurses will also be in touch with a central station, and we’ll have report case conferences daily about that patient.”

Another major factor in this partnership is that Resilient pushed to get Medicare’s approval to reimburse MidCoast Health System for tech-enabled care administered in the patient’s home.

For context, in order to be approved to provide in-patient care in the home setting, providers must go through the waiver application and interview processes, which identify the workflows they’ve set up for the hospital to deliver this kind of care safely and efficiently for patients.

“We worked on those workflows with the hospital,” Samuel said. “We actually went to all three hospitals in person. We identified where there could be a risk or an inefficiency. We worked with Francis and her team in building out solutions for that. We integrated our technology and started identifying what community partners are available in each town. We worked on all of this contracting, and then we all sat down with Medicare and walked through all of our workflows.”

Lerma noted that proving to CMS that this model would work in rural areas wasn’t easy, but that there’s, arguably, a greater need for it in these communities.

Looking ahead, Resilient is in talks with other payers to get this kind of coverage for their plans.

“We’re hoping that some of these payers can follow suit with Medicare, in being innovative with contracting,” Samuel said. “We are essentially taking a leadership role with MidCoast and their contracting arm to talk with payers through what we’re doing in order to increase that kind of access.”

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