Successfully Implementing In-home, High-acuity Care
An Exploration of Foundational Clinician Development Strategies
By Dr. Patrick Kneeland, M.D. SFHM, VP Medical Affairs at DispatchHealth
Driven by the distinct gaps in care revealed during the early years of the COVID-19 pandemic and rising patient demand for in-home healthcare options, the conception of an in-home hospital-alternative has undeniable potential. This emerging model continues to drive lower costs and better health outcomes, prompting interest and action from programs eager to capitalize on both. Marked by ongoing innovations, this framework puts provider development front and center, demanding deliberate attention to the unique challenges, strategies, and aptitudes necessary in a novel care model.
The providers leading our Advanced Care program––a first-of-its-kind in-home, hospital-alternative––serve as prime examples of the tremendous value of a strategically created team. Informed by their exceptional outcomes to-date, we’ve determined the following considerations are crucial when selecting and developing clinicians to deliver high-acuity care in the home.
How to Build a Provider Team that Thrives in a Novel Care Environment
The average Advanced Care patient at DispatchHealth has a Charlson Comorbidity Index >5, placing them in the highest risk category for 10-year mortality, and amongst the most frequent utilizers of high-acuity care in the hospital. We’ve identified four key traits that have thus far enabled our providers to successfully address these concerns in the comfort of the patient’s home.
- A strong clinical skillset. First, a successful provider will be well-trained and experienced in providing conventional hospital medicine (hospitalist) care.
- Personal values that align with our mission. Second, the providers that find this work compelling are wired to be patient-centered––and not just as a platitude. The ideal provider is inspired and motivated by meaningful patient relationships, and exceptional service quality resonates as a core value.
- Agility and creativity. In addition, clinicians disposed to agility and creativity will find these care models energizing, embracing the opportunity to solve for the challenges and complexities that can occur with a new approach.
- Open to a flattened hierarchy and energized by team dynamics. High-acuity in-home care demands optimal interdisciplinary communication and a collaborative team environment. Identifying clinicians who are open to this type of environment is critical for team success and patient outcomes.
To Truly Invest in In-home Care Models, Clinicians Need Clarity on Key Issues
Organizations that succeed in aligning with clinicians on crucial points like those below set the stage for individual provider success and that of the program overall. We train to these topics at the DispatchHealth Advanced Care Academy as we bring on new clinicians:
Patient safety: How do we know this type of care is safe? What tools are at my fingertips to facilitate the safe care of my patients?
Progress toward the Quadruple Aim: How does this model support value-based care?
Patient selection. How do we select the appropriate patients for this level of high-acuity care?
Clinical pathways. What conditions will I be treating? What guidance will I have on how to best provide evidence-based care in the home?
Practice scope. What, if anything, does immersion in the world of Advanced Care mean for my traditional practice?
Logistical support. A hospital has the benefits of centralized care and coordinated logistics; how will in-home models reflect these advantages to deploy cohesive healthcare in the home?
Differentiated Provider Aptitudes Necessitated by In-home Care Models
In addition to the core clinical skillsets required by traditional hospital care, providers preparing to deliver high-acuity, in-home care should be given access to deliberate development around two central sets of aptitudes: skills-based and cognitive-based. We train to these skills in the DispatchHealth Advanced Care Academy.
Novel skills-based aptitudes include the ability to:
Integrate technology into care. Providers will have to learn and implement unfamiliar technologies to facilitate remote patient monitoring, provide effective interventions for medically complex patients, and establish coordinated care.
Understand evolving logistics. Much of the tacit knowledge derived from the traditional healthcare environment will have to be re-learned around processes and protocols unique to care in the home.
Implement safety-based protocols. How to safely escalate someone who needs a higher level of care, for example.
Novel cognitive-based aptitudes include:
Being comfortable in the home. Understanding the often-delicate nature of providing care in someone’s private space, and acting accordingly.
Shared decision-making. One of the most powerful elements of our Advanced Care model is the shift in power dynamics relative to a hospital. This allows for unrestrained evaluation of goals of care, and provides a blueprint for care teams, patients, and their loved ones to reach better health.
Clinical reasoning. Clinical reasoning in the home tends to be affected in two significant ways: 1. When following an evidence-based path of treatment, some options (like providing Q6 hour antibiotics for example) may not be practical. Decision-making must both be evidence-supported and practical; 2. Immersion in the patient’s personal and social context introduces the opportunity to more-fundamentally consider how a particular care plan may or may not be effective in that context. Decision-making must also take into consideration the context.
Leading an interdisciplinary team (remotely). Siloed care paradigms around strict and hierarchical roles for physicians vs. APPs vs. RNs are rarely helpful even in traditional settings. This is even more true in a novel paradigm. As such, we have prioritized professional development focused on human-centered leadership and team dynamics to be essential.
Just in Time Professional Development
Certainly, many of the elements described above can and should be built into the onboarding of new clinicians. We’ve tackled continuous education on and iterative reinforcement of key concepts in multiple ways:
By hard-wiring team-based learning into weekly meetings and daily huddles. This takes the shape of recurrent structured peer-to-peer learning around key topics. For example, a weekly meeting may include a discussion around a question like “How are people creating a shared decision-making environment with patients and their people in the home?”
By performing routine interdisciplinary clinical case reviews and disseminating key learnings.
By training to and committing to the collective concept we call “Another set of neurons.” Simply stated, if you are encountering something that is new or complex, get another brain, eyes, ears involved in real-time. No one should feel like they are tackling high acuity in-home care alone.
In-home, high-acuity care continues to showcase its strength regarding relative affordability, convenience, and health outcomes. For organizations eager to future-proof their care models, focusing on clinician development is a near-mandatory aspect of staying competitive in a saturated market.
Patrick Kneeland MD SFHM is Vice President for Medical Affairs and clinical leader of Advanced Care at DispatchHealth. Have ideas or want to learn more?
Reach out: firstname.lastname@example.org or www.DispatchHealth.com/AdvancedCare