About 15 years ago, Scott Powder — president of Advocate Health Enterprises — was excited about a new idea.

It was 2008 and the project was dubbed “Clinically Home”. The mission was to scale up the hospital-to-home program pioneered by Johns Hopkins University.

Advocate Aurora Health, Amedisys Inc. (Nasdaq: AMED) and Raphael Rakowski — now co-founder and CEO of Medically Home — were leading the charge.

“For a variety of reasons, mostly due to payers not signing up, the company exploded in 2010,” Powder said. “Ironically, before the recession, the medical home had a billion dollar valuation. Amedisys then went out and bought Contessa for $270 million. So I was thinking, ‘Boy wouldn’t it have been great if we’d only been together for those 12 years?’

Perhaps it was an idea ahead of its time, but Clinically Home Powder stands as an example of how investing and innovative risk advocates have proven to be the most at home.

Advocate Health Enterprises is one of America’s largest integrated health systems and is the investment arm of Advocate Health. Powder has said in the past that his team is focused on three areas for development and investment: aging independently, family development and support, and personal wellness.

In December, Advocate Aurora Health and Atrium Health merged, creating one of the five largest hospital systems in the United States, with the two officially dubbed Advocate Health with a network of 67 hospitals, 21,000 physicians and nearly 42,000 nurses.

Advocate Health Enterprises was founded to invest in and acquire companies in the broader healthcare ecosystem. Over the past couple of years, the focus has revolved around aging independently.

“We have a large footprint in value-based care, particularly serving seniors,” Powder said. “We take a lot of full-risk capitation on Medicare Advantage. We’re one of the largest ACOs in the country, and we take a lot of downside financial risk on our ACO members. So, we’ve got financial skin in the game.”

Advocate Health Enterprises recognized the need for a broader ecosystem of services to help seniors stay out of hospitals, emergency rooms, nursing homes and other traditional post-acute care facilities.

For example, Advocate Health now has its own hospital-to-home program, which is expensive to operate, but has been able to succeed despite the reimbursement uncertainty.

“We’re standing — mainly because of COVID — on our own hospital-at-home program,” Powder said. “It’s very expensive and the challenge will always come back to reimbursement. During a public health emergency, it was paid for.” [some]That’s going away. Without relationships with commercial payers, it’s really hard to advance the care model. “

Financially, it still benefits the advocate when less acute patients can be cared for at home.

“Even if we don’t get paid, we return that bed with surgical patients [in the hospital] or a high-intensity patient is better economics for us,” Powder said.

Beyond the scalability of the hospital at home, Powder believes there is real momentum behind the ED at home.

“I don’t know it all in my head, but I think you could have a scenario where people are eventually visiting emergency rooms — in effect — in their homes,” Powder said. “The next step down to that is to stay at their home for observation or even for admission. Today, 30% of people are sitting in our hospital beds and probably 25% of people are in our emergency rooms, maybe more, who probably don’t need to be there. They’re in urgent care. Or should be in a retail clinic. I think a lot of that ends up in the home. If you can figure that out with economics, that would be a huge game changer in the health system.”

Advocate Health Enterprises also acquired non-medical home care provider Senior Associates two years ago.

Powder is excited by care management opportunities that have home-based care capabilities in health systems like the one once advocated.

“If you’re providing services at home, whether it’s private duty, hospice, Medicare-certified home health, you name it, the real innovation opportunity is around care along a huge continuum,” Powder said. “I’ll give my organization a little bit of credit there, because we have about 750,000 lives for which we have full and complete financial risk through value-based contracts. We’ve had to learn how to navigate them to the fastest and most clinically appropriate care setting and make sure they don’t fall through the cracks. .”

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