AccentCare’s advanced community model shows improved readmission rates

Home care nurse giving patient physical therapy
AccentCare CMO Gregory Sheff, M.D., calls integrating home care into a post-acute care model a "win-win"for patients, facilities, and providers. (Image: Getty/Photodisc)

Post-acute care that integrates home care can unlock better outcomes at lower cost, while fostering higher patient satisfaction. 

In a white paper, AccentCare examined the expansion of its healthcare network and community care model to include home care. The program, first launched with Nashville Medical Group, has demonstrated lower 30-day rehospitalizations, as well as lower emergency room utilization rates. Both metrics have received attention in recent research assessing the quality of care provision.

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As providers have increasingly come under pressure to reduce readmission rates, they have had to seek out ways to extend their reach beyond the hospital and into the patient’s home. While telehealth services offer some capabilities in this regard, AccentCare’s model sought a more comprehensive approach that addresses care transitions and supports behavioral health. A clinical liaison coordinates care, simplifying communication and speeding up a process that would otherwise require patients to interact with a range of physicians and other service providers.

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The fact that patients prefer to receive care in their own homes makes a big difference, according to Gregory Sheff, M.D., AccentCare’s chief medical officer. “This care model has been a win-win for health systems, physicians, and most importantly, patients,” he said.

The team-based approach has allowed AccentCare to identify high-risk patients and plot out post-acute care provision, including behavioral health follow-ups, based upon the specific risks presented by various disease types. 

Since patients receive their care at home, the white paper suggests patients become “more active and compliant” in terms of their own care, leading to better adherence and better outcomes. A combination of technological tools, including telemonitoring and a custom medical records platform round out the tools needed to keep track of patients’ progress outside the hospital.