Hospital-at-Home Distribution Program Launched

Cardinal Health’s Velocare™ offers last-mile fulfillment in one to two hours.

Cardinal Health took a deep dive into the hospital-at-home movement this past fall with the launch of Velocare ™ , a supply chain network and last-mile fulfillment service capable of reaching patients in one to two hours with products and services required for hospital-level care at home. Through what it described as a strategic collaboration with Bostonbased Medically Home, Cardinal Health at-Home Solutions was already supporting a Medically Home health system customer with Velocare.

The announcement also signaled Cardinal Health’s deepening ties with Medically Home. In January 2022, Cardinal Health joined Baxter International and Global Medical Response in a $110 million round of funding for Medically Home.

How it will work

Here’s how the Velocare program works:

1. Orders are placed through the Velocare platform for specific goods and/or services to be delivered to patients receiving care in hospitalat-home programs. Common items available through delivery include medical waste containers, medically tailored meals, medical supplies, medical devices, and remote-patientmonitoring (RPM) technology. All contracting, credentialing and integration within the Velocare supplier network will be managed by Cardinal Health.

2. When an order is placed, a care coordinator team reviews and routes it to the nearest local Cardinal Health depot or warehouse for immediate service.

3. The depot team loads items into a Cardinal Health vehicle and delivers them to the home in coordination with the patient and/or care team. Velocare technology is used to ensure care is delivered to patients on time.

4. After a hospital-at-home stay has been completed, Cardinal Health arranges for the collection of remaining medical supplies. RPM technology is cleaned, tested and reconditioned in a facility registered by the Federal Drug Administration, then redeployed. Cardinal Health consolidates billing and invoicing across its network of suppliers to streamline the payment process.

Medically Home works with a number of leading health systems across the country, says Alex Hoopes, director, healthcare innovation, Cardinal Health at-Home. “We have launched our pilot with one of those customers so we can test and learn in a controlled environment before expanding. There are several existing and future Medically Home customers that we believe will benefit from Velocare.”

Lower-cost, safer venue

Cardinal Health for many years has supported patients who are managing chronic conditions in their home through its at-Home Solutions business, says Hoopes. This business includes Edgepark, a provider of medical supplies shipped direct to more than 3 million customers per year. “Now, with the introduction of Velocare, we are supporting patients with more extensive conditions and building capabilities to support patients throughout their entire care journey. We envision a world where the patient receives continuous treatment in their home with the intensity of services throttling up and down as their healthcare needs evolve.

“The home can be a lower cost, safer place for patients to receive care and heal, and payers are one of the primary beneficiaries of those advantages,” he says. “Oftentimes, the reliability of the supply chain can be a rate limiter for higher acuity hospital-at-home programs, so our work addresses that rate limiter. We are also seeing more payers vertically integrate into being care providers, and their provider teams can directly leverage Velocare’s capabilities.”

Among innovations Cardinal Health is developing for the program are small-format depots and short-haul vehicles. The traditional Cardinal Health distribution center can be 200,000 to 300,000 square feet, primarily serviced by 53-foot semi-trucks, says Hoopes. “That model is ideal for large, routine deliveries to healthcare facilities. Velocare uses small-format depots that are a hundredth that size and situated right in the heart of population centers, closer to our patients’ homes. We also use smaller, nimbler delivery vehicles so we can navigate urban areas with ease. We modify our vehicles to act as small, rolling warehouses so we can go directly from one patient to another, which improves our efficiency.”

Medically Home

Medically Home has developed highly differentiated software that takes complexity out of the hospitalat-home supply chain, says Hoopes. “I describe them as a translator –taking a clinical order from a doctor and ‘translating’ it into activities that need to be fulfilled by supply chain and logistics teams like ours. Medically Home’s platform also bundles those activities and consolidates them so fewer actors can do more in fewer trips to the home.”

In a recent company newsletter, Medically Home CEO Rami Karjian said that “the single biggest contributor to the ability to scale HaH [hospital-at-home] is logistics, that is, the ability of a health system to transition from providing tests, treatments, medicine and supplies in the hospital to providing them quickly and reliably in a home, on demand at any time of day or night.

Some health systems have been building their own HaH infrastructure, often relying on home health providers and existing remote patient monitoring tools that were designed for low-acuity, post-acute patients, he said. The result is a misfit between what can be delivered and what an HaH program requires. “Health systems taking a DIY approach have struggled, relying on manual processes that without a supplier network and logistics platform can only support an average daily census of just a few patients.” ʯ Mayo Clinic: In June 2020, Mayo Clinic announced a new care model intended to deliver “innovative, comprehensive, and complex care to patients – all from the comfort of home via a new technology platform.” ʯ UNC Health. In January 2021, Chapel Hill, North Carolinabased UNC Health announced it had reached an agreement with ʯ OSF HealthCare. Peoria, Illinois-based OSF announced its partnership with Medically Home in January 2022 to establish an Acute Care at Home Program. The announcement occurred one year after OSF opened its OnCall Digital Health building. Patients of OSF HealthCare Saint Francis Medical Center in Peoria would be the first to have the OSF OnCall Hospital at Home option starting in the summer of 2022, with plans to extend the program. ʯ Yale New Haven Health. In June 2022, the Connecticut IDN announced its partnership with Medically

More than 7,000 patients have been treated using Medically Home’s platform, as delivered by health systems across the country, according to the company. Some examples.

Mayo selected Medically Home as its implementation partner for the program.

Medically Home to establish an Acute Care at Home Program. The program would offer hospital-level services at home to patients who would otherwise require inpatient hospitalization for serious illnesses. The health system planned to gradually extend the program to patients served by its other 10 hospitals across North Carolina and evaluate opportunities to offer the service in partnership with other North Carolina hospitals.

Hospital-at-home

Home to deliver hospital-level care to Medicare patients meeting certain clinical and social stability criteria who live within 25 miles of Yale New Haven and Bridgeport hospitals. The IDN was expected to expand the program to other YNHHS hospitals in the future.

ʯ Cleveland Clinic. In May 2022, Cleveland Clinic announced that beginning in the fall of 2022, it would collaborate with Medically Home to provide acute and post-acute hospital-level care to patients in their homes, initially in the Florida region.

ʯ Covenant Health. In September 2022, Knoxville, Tennessee-based Covenant Health announced its collaboration with Medically Home as a part of Covenant Health’s newly established Advanced Care at Home program. The program initially would be offered through Covenant Health’s Fort Sanders Regional Medical Center in Knoxville and ultimately to patients receiving care from Covenant Health’s other acute-care hospitals throughout East Tennessee.

The delivery of acute-care services to patients at home (i.e., hospital-at-home programs) is becoming a more important factor in the trend toward home-based care.

Up to $265 billion worth of care services (representing up to 25 percent of the total cost of care) for Medicare Fee-for Service (FFS) and Medical Advantage (MA) beneficiaries could shift from traditional facilities to the home by 2025 without a reduction in quality or access, according to McKinsey & Company. Add hospital-at-home programs, and the firm suggests that 20 to 30 percent of additional Medicare FFS and MA spending for acute care could be delivered at home.

The Centers for Medicare & Medicaid Services has stated that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols. However, higher-acuity and more complicated conditions (for example, severe sepsis, unstable cardiac arrhythmias) cannot yet be treated at home in a highquality and economical way.

The CMS Advanced Hospital Care at Home Program has established a model that has been widely adopted by health systems. More than 114 systems and 256 hospitals in 37 states had applied with CMS for approval by late September 2022.

Participating hospitals must have: ʯ Appropriate screening protocols before care at home begins to assess both medical and non-medical factors. ʯ A physician or advanced practice provider to evaluate each patient daily in-person or remotely. ʯ A registered nurse to evaluate each patient once daily in-person or remotely. ʯ Two in-person visits daily by either registered nurses or mobile integrated health paramedics. ʯ The ability to provide immediate, on-demand remote audio connection with an Acute Hospital Care at Home team member who can immediately connect either a registered nurse or physician with the patient. ʯ The ability to respond to a decompensating patient (i.e., a person at increased risk of disease progression or death) within 30 minutes. ʯ The ability to track several patient safety metrics with weekly or monthly reporting, depending on the hospital’s prior experience level. ʯ A local safety committee to review patient safety data. ʯ Use of an accepted patient leveling process to ensure that only patients requiring an acute level of care are treated.