Driving Healthcare Home: How to Create Capacity by Streamlining Bottlenecks, Improving Throughput, Shortening Length of Stay, and Reducing Readmissions

0:00Hi, everyone. This is Chanel Bunger with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare Podcast series. In today's discussion, we're going to talk about driving healthcare home, how to create capacity by streamlining bottlenecks, improving throughput, shortening length of stay, and reducing readmissions. Joining me for today's discussion is Deidre Rolley, the Senior Director of Clinical Partnerships and Growth at My Laurel. Deidre, thank you so much for joining me today. Thanks for having me. It's a pleasure. Perfect. Well, to get us started out, can you give us a quick overview of your career and healthcare, including your current role in organization? Absolutely. So, I'm an ER nurse by background. Spent many years at the bedside before going into leadership roles at the Academic Medical Center. I was part of a team that stood up a hospital at home program for my organization, post-pandemic, or in the midst of the pandemic, and really got very intimate with the thoughts that patients can actually be taking care of in the comfort of their own home.

1:00I moved into more of a corporate setting, joining an RPM company, as a consultant, as more and more organizations were starting to stand up hospital at home programs. So, I was helping not only the original initiatives, but also working with hospital at home programs that were stagnant in growth and helping them expand. I joined my Laurel just about two months ago as the Senior Director of Clinical Partnerships and Growth, because I really noted that there's a gap between inpatient hospital at home and post-discharge. And my Laurel's model really does a wrap around for their patients, and I love their mission that they're solving for that black hole of what happens to patients after they leave the hospital. Got it, got it. And now that we have a sense of your background, we'll get into the meat of the podcast a bit. Many patients are facing a repetitive cycle of ED usage. This leads to increasing borders,

2:00throughput, etc. And this scenario, how is the patient journey different with care at home? Yeah, so my Laurel is actually offering like a third option for patients. If you think about the difficulty of finding primary care physicians in today's climate, patients are using emergency departments, not only as primary care, but also for chronic disease management. So as we look ahead, my Laurel, like I said, is just another option for clinicians to think about, does this patient need to be admitted to an inpatient unit? Does this patient go home without services? Or is there a line where a patient can go home, be taken care of in a cute way, and have support in the home post discharge? That sounds amazing. And can you talk about my Laurel's approach to this? Sure. So my Laurel is really working with organizations to think about what are their low to

3:00midacuity patients that are being admitted to the hospital? It may be for social reasons. It may be for a couple of days of IV into biotics, but truly, are they needing the resources of a true hospital in patients day? My Laurel has the opportunity to continue the care plan as the patient is discharged. So what we do is we take a discharged patient from either an ED or a traditional inpatient unit, and we are continuing their cute care at home, but then also offering a 14-day episode where we're doing a whole wraparound service, so making sure that they're going into primary care, following up with specialists as needed, so really making sure that they're on a path or a trajectory to actually have success and not represent to an emergency department. And I think that the value of that is that with our ability

4:02to reduce the patient's length of stay, either taking them out two days early from an inpatient bed or from an emergency department's obs unit, you're able to streamline the patients that really need to be in a higher acuity setting, such as an ICU or an inpatient unit, so you're not seeing the border population sitting in areas of the hospital, even pack you or EDs or obs units, so really making it more streamlined, like I said, and thinking more if you go a level deeper is we're actually contributing to ED wait times in the waiting room or left without being seen percentages just by opening beds for the throughput. That's amazing to hear, and now that we know the approach that my Laurel takes, what are the benefits that health systems can realize with the strategy, and do you have any specific case studies or improvement metrics

5:03that you can share? Sure, I think that the majority of health care systems across the nation are really in a bed crunch. It's really, really expensive to build new buildings, to recruit staff, and if you think about how my Laurel is helping organizations solve for that throughput, there's been a lot of benefits. When you're thinking about the strategy, some of our partners are reporting that sending patients home with my Laurel, they're actually seeing that they are able to have a capacity generation of up to 15 beds per day in each facility. Their readmission rates or their highest cohorts has shown a 60% reduction, so those high risk patients that are utilizing that ED as primary care or continue to come back because they're not improving post-discharge. We're also seeing that there's a 9 to 1 ROI that organizations have reported.

6:08Some of our partners are reporting anywhere from 5 to 9% return of investment because they're able to backfill beds with higher acuity patients. So it's threefold. You're not only addressing your capacity issues, you're addressing your staff burnout, and then you're also addressing what's best for the patient, which I think is the most important thing. Absolutely. And now moving forward, traditionally, hospital at home has been a daunting initiative with a rocky path. How is the my Laurel model of care different than that? Like I said, I spent a lot of time in that hospital at home space, and I think that it is definitely for some patients, but there's some resource constraints, and CMS has some very stringent I'll call them rules to follow. My Laurel is an outpatient model, and thinking about your lower acuity patients that may be a soft admit or an observation patient may never even be eligible for hospital at home.

7:11We're able to scale very fast. We're able to take more patients out of the four walls than your traditional hospital at home program, because they have staff constraints, you know, as if you think about they need to be in the home two times a day. The waiver has very specific guidelines, and it's based on a DRG. So you're bringing your patients home. The typical state is three to five days, similar to a traditional inpatient, where my Laurel, we do an episodic visit. We actually are taking these patients out, giving acute care in the home, but then following them for 14 days. So by not only opening up bed capacity, we are ensuring that they're not following into a black hole post discharge. We're tying them back to a primary care physician and checking to make sure that they've done those visits, making sure that they have their resources, their rides. There's a big case management component of the my Laurel solution that I think that is not only beneficial to the patient, but also to the health system.

8:15I love that. And now as you look ahead, what's exciting most in the care at home space? I think that we need to meet the patients where they are, and understand what is going on around them. The care at home space is very different than it was years ago. You can safely deliver acute care in the home while getting a sense of what are the needs of the patient? What is driving them back to the health care system for emergency room visits? And really, what's exciting to me is that patients love it. Our NPS scores are above 97%, which actually then contributes to your hospital HCAP scores, because they think that this is just a smooth transition that this organization is holding my hand and giving me a little bit of a concierge medicine type experience. And I think that that's really great.

9:16That's amazing to hear. Old D.A. Dre, I want to thank you for your time today, but before I let you go, is there anything else that listeners should know? I really love the my Laurel care model. And I think what's amazing is that our company trusts and has confidence in what we have built with organizations. And we actually guarantee our services. So if a patient returns to the hospital within their episodic care, we actually are going at risk because we are so confident that we're doing what's best for the patient. And I don't think that you get that from a lot of other models. So we take risk, and the hospital is not only not only in the risk of that. Well, D.A. Dre, I want to thank you once again for your time and insights today. We also want to thank our podcast sponsor, My Laurel. You can tune in a more podcast from Becker's Healthcare by visiting the podcast page at Becker's Hospital Review.com.