How one medical group uses 'extenders' to improve patient engagement

Genuine Health Group, a Miami-based healthcare company that represents more than 150 primary care providers, has implemented the Genuine Health at Home program to improve medication adherence and better compliance with post-discharge instructions.

The program serves two patient populations: 1) those transitioning home from the hospital and 2) those with chronic conditions, such as congestive heart failure.

“In a nutshell, the program delivers care in the patient’s home by a range of allied professionals and physicians to improve outcomes and decrease hospital admissions or readmissions,” says Joe Caruncho, Genuine Health’s CEO, who developed the program and “deputized” the company’s 150-plus PCPs as ambassadors and advocates and incentivized them to make sure their patients participate in the program.

A recent study in the Journal of General Internal Medicine demonstrated that home-based care can not only be cost-effective, but is dramatically more affordable than inpatient care. Study results showed that costs and utilization were significantly less for the patients who received care at home compared to those who received care in a traditional hospital environment.

“Research has confirmed what doctors already knew: patients who actively participate in their care have better health than those who are not engaged,” Caruncho says. “So in today’s era where quality measures determine everything from reputation to compensation, we have to embrace every tool in our toolbox that improves outcomes. Patient engagement is one of those tools.”

Genuine Health At Home gives PCPs a team of extenders who literally deliver the physician’s messages, their concerns, their compassion, and their caring to the patient in his or her home and then give the primary care provider direct feedback.

“Increased utilization of allied health professionals and physician extenders can increase patient engagement,” Caruncho says. “These caregivers provide additional touchpoints for the patient with their care team, and the more they interact, the more connected and engaged they become.”

He explains that the sickest 5 percent of patients, most of them with chronic conditions such as congestive heart failure, diabetes, and pulmonary disease, account for more than 40 percent of overall Medicare costs. These patients are also the ones that find it hardest to travel to physician appointments to monitor and treat their conditions.

“Without follow-up, the conditions worsen and they end up in the hospital or worse,” Caruncho says. “For these patients, and those recently released from the hospital, Genuine Health At Home becomes an extension of the primary care physician’s practice, by visiting these patients in the comfort of their homes. Our nurses and other extenders develop a trust relationship with the patients and their caretakers, leading to a more robust dialogue, and therefore higher engagement.”

The program seeks to engage patients in multiple dimensions of their care. The result is higher quality care, increased satisfaction with their physician and the health plan, and lower costs.  

Additionally, the company has seen these patients do a better job of taking their meds, following their doctors’ orders, and even showing up for follow-up appointments.

“It’s the ultimate in engagement,” Caruncho says. “In terms of goals, we’re aiming for improved medication reconciliation and adherence; improved understanding of their own conditions; compliance with physician instructions, especially in the days after patients leave the hospital; and improved communication with their primary care doctor-often through more frequent appointments.”

Caruncho notes Genuine Health At Home is a great example of how to positively affect patients’ health without the high cost of complicated technologies or investment in facilities.

“It’s a testament to the power of caregiving as a proven way to make our patients feel better and reduce costs in the process,” he says. “I’m hopeful more organizations will recognize that the tools are right here. We just need to use them. In addition, when patients are engaged, they feel empowered, and therefore happier and more satisfied. It’s a win-win.”