What Medical Conditions Does Contessa Treat at Home?

Over the past few years, we’ve seen a rapid shift in the prioritization of medical care at home programs. Clearly, COVID-19 was a big driver of this phenomenon. However, care at home has continued to drive the future of healthcare even post-pandemic. Increasingly, patients are demanding it, and studies are showing that it improves outcomes. 

One of many factors behind this push for medical care in the home vs. a facility is the aging US population. By the year 2060, the number of Americans aged 65 and older is projected to comprise 23% of the population. And, of that population of older adults, according to the National Institute on Aging, 85% will have at least one chronic health condition, and 60% will have at least two. 

This begs the question: can all medical conditions, even complex ones, be addressed outside of medical facilities and in the home instead? Finding the answer has been the goal of Contessa’s continuum of care-at-home services. In collaboration with our parent company, Amedisys, we have established ourselves as the leader in both high-acuity and post-acute care services in the home. In doing so, we have been able to develop safe, effective care in the home for a variety of medical conditions, in multiple contexts.  

So, what medical conditions can be treated in the home? 

In 2020, the Centers for Medicare and Medicaid Services (CMS) announced a fee-for-service waiver program called Hospitals Without Walls, which was recently extended by Congress. This waiver program was designed to bring eligible patients home for hospital-level care, a strategy that we were already implementing with our Recovery Care at Home program.  

At the time the waiver was enacted, CMS indicated that they believed “treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD), can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.” 

At Contessa, at the outset of our Recovery Care at Home program we identified five core conditions that could most easily be moved from a hospital setting into the home. They include:  

1. Pneumonia – an infection, commonly caused by bacteria, that inflames air sacs in the lungs. 
2. Congestive heart failure, or CHF – a heart condition in which blood isn’t pumped as efficiently as it should be. 
3. Chronic obstructive pulmonary disease, or COPD – a group of lung diseases, including emphysema and chronic bronchitis, that complicate airflow and one’s ability to breathe. 
4. Cellulitis – a common bacterial skin infection.
5. Urinary tract infections, or UTIs – an infection that occurs in the urinary system, kidneys, bladder or urethra. 

While these are our common core conditions treated, we have also treated a range of other medical conditions. These include COVID-19, influenza, dehydration, acute renal failure, chemotherapy side effects and more. 

Many times, acute illness such as UTI or pneumonia exacerbates other pre-existing chronic diseases. Bringing patients home removes the unfamiliar and noisy hospital environment with its interruptions and restrictions and often results in a better outcome for these chronic conditions as well. For example, patients with dementia do better in their home environment. And we consistently see- in as many as 83% of cases- that patients who are offered the program accept admission.  

Contessa’s Comprehensive Care at Home model offers a continuum of services from hospital-level care to skilled nursing-level care to palliative care. We’ve found several other consistent benefits to care at home vs. a facility: 

• Technology has evolved. Doctors can check in with patients using telemedicine, monitoring their symptoms 24 hours a day. The quality of care stays the same while the patient experience improves. 
• It reduces healthcare fragmentation. When a healthcare provider transitions a patient to another provider, some information can be lost along the way. With Comprehensive Care at Home, there are fewer handoff points and greater care coordination, lessening the risk of a fumble or unnecessary complication. 
• Hospitals are a source of infection. It sounds obvious, but often gets forgotten. Increased masking and improved ventilation have helped in recent years, but the home reduces contact opportunities with infectious diseases. 

What medical conditions can’t be treated in the home? 

Obviously, there are some critical medical conditions that aren’t appropriate for care in the home. Emergency medicine, surgical care, and some other high-acuity cases that need intensive support all call for the additional resources of a healthcare facility.  

Even for these patients, however, healthcare at home can play a role. One way Contessa has done this is exemplified in our work with Mount Sinai Health System in New York, where we developed a program called Completing Hospital Care at Home. This allowed us to transfer stabilized patients home for the final 1-2 days of their hospital stay, further relieving capacity strain for the hospital.   

We also can pick up where a skilled nursing facility (SNF) would otherwise typically become involved, by enrolling patients in Rehabilitation Care at Home. And finally, patients with complex chronic illness benefit from participating in the care management afforded by Palliative Care at Home.  

Continued innovation is needed to advance healthcare at home   

These post-acute programs are only the beginning of the continuum of care-at-home services we are working to develop. In the past, it has been presumed that patients with complicated comorbidities require a hospital stay or SNF admission.   

As we have grown Contessa’s post-acute care, what we have found is that these otherwise fragile-appearing patients can be safely treated at home, and they often recover better. At home they mobilize more, can reach their baseline more quickly, and participate in their own healing trajectory.   

Physicians who practice care in the home are moving the proverbial goalposts for who they are comfortable treating in the home because they see that it works. This is reflected in our reduced readmission rates and low complication rates across our Comprehensive Care at Home model.  

These successes are helping to define the future of healthcare at home, with opportunities to also move programs like primary and urgent care home. Already, together with Amedisys we offer hospice and home health to complement our full suite of at-home services. And payers are beginning to take notice, too—programs like Palliative Care at Home are a perfect fit for helping to reduce the cost of care for complex chronic illness, which makes investing in a reimbursement structure for palliative care a wise move.  

Looking to the future of home healthcare 

The recent extension of the hospital at home waiver by Congress recognizes the value of advancing care in the home, with benefits to patients, providers and payers alike. As we rethink care delivery, Comprehensive Care at Home and the conditions it treats will only continue to expand, adapting to continue to successfully treat many more health concerns right where patients prefer it most- their homes.