Health-care collaboration gets patients home faster

Any health care facility with "suites" in its name sounds like it's got to be more of a hotel than a clinic.

It's true that Interlude Restorative Suites is a different kind of health care facility, but the most meaningful differences can't be spotted from the parking lot. The innovation here is how the work inside is done, aiming to cut costs by getting the patient home much faster.

The venture is another sign that health care providers may yet get paid for the value they produce and not just the procedures they do.

An Interlude facility is the work of three big health care providers in Minnesota coming together to provide care for people leaving the hospital but not quite well enough to go home. The Interlude facility in Plymouth is next door to Abbott Northwestern — WestHealth of Allina Health, but it was built by Presbyterian Homes & Services, with Allina as a partner.

Benedictine Health System opened another version of the same thing in Fridley, next to Unity Hospital, also with Allina as a partner. All three own a third of the Interlude brand and concept.

The thinking behind Interlude got rolling as all three tried to figure out how to respond to the encouragement in the Affordable Care Act to create what's called an accountable care organization. Becoming an ACO generally means a health care provider takes over a patient's full care and is held financially "accountable" for both cost and quality.

Care for people leaving the hospital who aren't ready to go home is one part of the health care system that is ripe for this kind of accountable care approach. One often-repeated figure is that about one in five Medicare patients has to be readmitted within 30 days of leaving the hospital.

Thousands of patients get discharged every year from Allina hospitals after procedures like hip replacements, and then are sent to a nursing home for rehabilitation. That's a primary business of Presbyterian Homes and Benedictine Health.

They, too, had been thinking about accountable care organizations, and closing the gap.

The players all knew the care needs to be seamless: one care team for one patient who is taken care of until well enough to live at home.

When the thinking reached the point that they wanted to form a company to do that, the partners decided at first to cover five conditions.

The facilities have only been open a few months, and so far, most of the patients have gone there after a major orthopedic procedure. Others include patients recovering from a heart attack or a major episode of chronic obstructive pulmonary disease.

There are a few other simple-sounding improvements, too, like providing rehabilitation seven days a week.

"The key innovation is not the space," said Rocklon Chapin, CEO of Duluth-based Benedictine Health. "But rather it's the relationship we have with the clinicians and the leaders in the other organizations." The Allina physicians will look in on a patient as needed in an Interlude facility, even calling up medical records on the TV in the patient's room.

While still very early, so far the readmission rate at the Presbyterian Homes Interlude in Plymouth has been just 2 percent, according to Sharon Klefsaas, vice president of operations for Presbyterian Homes. As for the length of stay, so far it's been about 9.5 days when the average for these five conditions in the metro area is 16.8 days.

Cutting a week off a stay is a remarkable achievement. And it presents a problem in the business model of Roseville-based Presbyterian Homes and BHS; one of the main ways they get paid is by how many days the patient stays.

Think about this as a resort manager would. Imagine delivering such a great experience that the guests can see and do everything they want in just four days. The resort encourages the guests to just head home, and happily, rather than pay for the whole week. And when they say goodbye, this resort owner is out at least a couple of days of revenue.

By now, Wheeler said, Allina had expected to be much further along in receiving its payments based on outcomes and total cost. She said it's only about 3 percent of her organization's total revenue, with the rest in the traditional fee-for-service model, adding that "even in a progressive community like Minnesota we've been a little bit stuck."

The partners can't say when the customers start paying them for far shorter stays and other good outcomes they think they can keep delivering, but they don't sound worried that the financial model won't ultimately shift to reward it.

They don't plan to lose money this year, said Dan Lindh, CEO of Presbyterian Homes, but "even if we lose money on it, we will learn how to collaborate better and it will strengthen our organizations."