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The company was originally started by Alline Health as a way to treat COVID patients at home
In early 2020, many hospitals and other healthcare organizations were overrun with COVID 19 positive patients, and many of those patients were sick enough that they required facility level care. The problem was either there wasn't a bed that was available for them in the inpatient units, or maybe the hospital wasn't the safest place for them to be at that point.
Minneapolis-based not-for-profit health care system Allina Health, came up with a solution: it launched Inbound Health, a program that took a subset of those patients and allowed for them to be cared for at home. As the pandemic started to wane, though, the program remained so effective, and so popular, that Allina eventually expanded it to clinical outcomes outside of COVID/
On Tuesday, Inbound Health announced that it is spinning out to be its own company, launching with a $20 million round of capital from Alline and Flare Capital Partners.
"Excuse the pun, but we were getting inbound calls from other health systems and other markets basically having heard what we created here in Minneapolis who said, 'we’re trying to do the same thing, but we don't necessarily have the care model, we don't have the clinical leadership, we don't have the technology.' So, we saw a real market opportunity to take what we had developed within Allina and really productize it and then be able to take that to other health systems," CEO Dave Kerwar explained in an interview.
"It made a lot more sense to be able to do that as a separate organization that could go and raise its own capital and move very quickly as we go to other new health systems. Once we recognized the market opportunity, it was about getting the right amount of capital so that we could scale this to multiple markets around the country."
While Allina initially build Inbound as a temporary program to help with the COVID-19 patients, it has since diversified it to new patient populations, including those with sepsis, heart failure, pneumonia, asthma, COPD, and renal failure.
It also launched a second problem for patients who were already in a brick and mortar hospital and would be due to discharge to a skilled nursing facility; Inbound instead takes those patients, if they have the right medical complexity and functional status, and allowed them to have that same care they'd get in the skilled nursing facility but in their home.
The Inbound team will monitor patient in the emergency room who are due to be admitted as an inpatient, or who are already in hospital and are due to be discharged to a skilled nursing facility, and assess which ones might be good candidates for at-home program.
"We assess them medically, as well as functionally in their home life. If there's a candidate who is a strong candidate for this, we will work with the physician on call at that hospital to basically present the case and say, 'What do do you think? Is this a good safe place for them to be discharged to?' If the physician agrees, then we'll talk to the family members and the patient themselves, and we'll present this program so that they understand," said Kerwar.
The acceptance rate with patients and family members is about 95%, particularly on the skilled-nursing at home side, as there’s a shortage of skilled nursing facility beds, and people don't want to have to wait. In addition, patients are much happier recovering at home.
Once the patient accepts and is discharged from the emergency department, they're met at their home by one of Inbound's community paramedics, and then the company brings in technology for vitals and biometric monitoring, so it can monitor their heart rate, blood pressure, temperature, and pulse oximeter around the clock. It also provides an engagement app where patients will go to get their virtual visits with the hospitals, while also taking digital surveys so that the company can monitor things like pain and mood. Patients also get alerts and notifications, and some content there about their hospital stay.
Inbound also does in-home visits with nurses and therapists who can come as frequently as daily if that's what's required, so the patient is still getting some in-person care.
To date, the company has done 4,200 episodes, and has cared for patients across 185 different diagnoses. The typical patient often has multiple chronic conditions that they're managing but their functional status, meaning their ability to do specific activities of daily living, is going to be high enough that they can be on their own, while also having an appropriate support in the home from loved ones. As a result, the patients tend to be older, sicker, and those with multiple chronic conditions.
In terms of ROI, Inbound Health has proven that the program lowers total cost of care by 30 to 40% on a risk-adjusted basis. While it achieved similar or improved clinical outcomes when compared to traditional facility-based care, Inbound was also able to lower the patient readmission rate, which the company attributez to the fact that it is carefully monitoring the patient during their hospital stay in the home.
"We also have this very, very careful ramp down period; after the home based hospital episode is complete, we continue to monitor them if necessary, and we're very careful to reintroduce them to their primary care team. We're doing medication reconciliation, and monitoring on an ongoing basis. So, we saw similar clinical outcomes in terms of mortality and others, 30, 60, 90 days post hospitalization, but we saw fewer readmissions, which was very encouraging because it leads us to believe that it's a pretty safe program," said Kerwar.
These outcomes have enabled Inbound Health and Allina to develop unique episodic-based payer contracts with multiple Commercial and Medicare Advantage payers in Minnesota, a payment model that the company plans on replicating with partners in other markets; the plan is to be in three or four markets by the end of next year and then to be in 10 to 15 markets over the next five years.
Now that it has this new capital, the company plans to spend more the majority of it developing the product, namely the app that it provides to patients, while also continuing to advance the workflow platform that underpins its technology, as well as furthering its analytics.
"We have AI-driven analytics to help us identify patients that might benefit from this, helps us refine and curate the care plan based on the patient's needs, and then plan, not just their care episode, but also reintroduce them to their traditional care team and prepare them for discharge from the hospital, the acute component of their stay. So, the technology and analytics will be a big component spend," said Kerwar.
It will also go toward building out the team, adding around 100 or so employees by the end of next year; that include local market staff that the company puts on the ground where we're operating so that the health systems it works with know that they can rely on Inbound to help them scale these programs.
Part of what has allowed Inbound to be successful so far, according to Kerwar, is that it was designed from within a health system, which allows it to bring a full stack of capabilities that health systems need to build or buy when they're trying to launch a program like this.
"The most important success would be that we continue to safely provide this care as we expand into those new markets, so that the care model continues to mature and diversify into new different patient sets and we're able to safely provide this care; obviously, safety and quality is our number one, number two, and number three goal here," he said.
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