Intermoutnain guy

[Ryan Vass]

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Ryan Vass | MD/MBA Candidate

Penn Med  | Wharton 2014

ryan...@wharton.upenn.edu | 610 716 1602

---------- Forwarded message ----------
From: Erik Heggland <eheg...@gmail.com>
Date: Tue, Apr 23, 2013 at 7:24 PM
Subject: Re: Follow up
To: Ryan Vass <ryan...@gmail.com>

Hi Ryan,

We have at least one skilled nursing / rehab organization (Sunbridge Healthcare is the one that I know of) that collaborates with us by adopting protocols for patient care that we developed in conjunction with them, primarily for heart patients (CHF) thus far.  We are working on something similar for joint replacement and hip fracture patients.  They currently don't share risk, but that would be the idea going forward.

Many post-operative infections start with something that happens in the hospital, but some are potentially due to poor wound hygiene after the patient leaves the hospital.  The most expensive infections tend to be with resistant organisms like MRSA or in complex or revision spine and total joint surgeries.  The extra cost incurred to treat a sensitive organism in a simple case is something in the neighborhood of $50K, and for an MRSA infection it can go as high as $250K.  Where home health and skilled nursing / rehab agencies can really help is in preventing the need for readmission to the hospital in general.  This could be from causes as mundane as constipation to falls with secondary injuries or recurrence of congestive heart failure, etc.

In the long run we are going to either have to provide all the skilled nursing/rehab/home care services ourselves, or have risk sharing arrangements with other companies.  We are starting with voluntary collaboration but as the regulations for the affordable care act are developed we will eventually need to find a way to share risk with these companies.  Any company that provides these types of post-hospital services that approached a hospital system with a proposal for risk sharing before it the hospital approached them would certainly be considered.  The real trick is to know how to collect and analyze data about the patients so you know how to structure the compensation vs risk proposal.  Traditionally insurance companies are very good at this, but hospitals and post-hospital care companies (home or inpatient) have not been.

Erik

On Tue, Apr 23, 2013 at 2:33 PM, Ryan Vass <ryan...@gmail.com> wrote:

Erik,

First of all, I wanted to thank you for the time you took to discuss future models of health care with me. It injected fresh ideas into our group discussions and really propelled us forward.

I had a follow up question: we were hoping to put together slides about current models of risk sharing between hospitals and home health providers. You said "we find that we have to insert ourselves in the home health business model to incentivize better quality care." You provided the example of the $250,000 net loss from infected THRs.  

can you clarify what specifically you guys do in terms of incentives? Can you throw out a couple names of home health organizations with whom you have agreements like this?  We got feedback that specifics would help make the market validation case stronger.

Again, thank you so much for your help.

Ryan

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Ryan Vass | MD/MBA Candidate

Penn Med  | Wharton 2014

ryan...@wharton.upenn.edu | 610 716 1602