After extending into Kalamazoo in 2019 and preparing for a Newaygo County location this spring, Tandem365 wants to grow further.
Montcalm and Ionia counties are eyed in 2020 for Tandem365, an organization that began six years ago in Grand Rapids through a partnership between long-term care providers. The company offers a new model to care for elderly people who are in ill health and want to remain in their own homes.
The rationale behind the push to expand: The aging population creates a steady need for the type of care Tandem 365 provides by using care teams of nurses, paramedics, medical assistants, therapists and social workers. The care enables clients who are in frail health and generally have multiple chronic medical conditions to remain in their homes, rather than move to a nursing home. The model is also meant to avoid costly emergency room visits and hospitalizations.
“We have a pretty aggressive strategy for this year to be in those two additional counties [Ionia and Montcalm],” said Tandem365 President and CEO Teresa Toland. “There’s a bigger population that needs to be taken care of.”
Tandem365 began nearly six years ago in Kent County and soon expanded into neighboring Ottawa County. Allegan County came next in 2015, followed by Kalamazoo last August.
Once Ionia and Montcalm counties are on board this year, Tandem365 aims to extend into Muskegon County, probably in 2021, Toland said.
Tandem365 started when a group of four senior living long-term care providers came together at the urging of Mercy Health Saint Mary’s to rethink the care model for elderly persons with medical conditions that required ongoing management. The founding partners who each own a 20 percent stake of the organization are Sunset Retirement Communities and Services, Clark Retirement Community, Porter Hills and Holland Home.
Out of that process came Tandem365, which enrolled its first client in April 2014.
The organization coordinates medical, behavioral health and social services for older people who generally have multiple chronic conditions such as congestive heart failure, COPD, emphysema, dementia, kidney failure, Parkinson’s and diabetes. Oftentimes the patients are in frail health, lack a social support network and need daily or weekly assistance at home.
“We care for the person as much as they need us, or as little as they need us,” Toland said.
Tandem365 is open to people enrolled in Medicare Advantage health plans with Priority Health or Blue Care Network, the HMO subsidiary of Blue Cross Blue Shield of Michigan that signed on in the last year. The health insurers pay Tandem365 a monthly flat fee for providing services to Medicare Advantage enrollees who meet eligibility criteria for the program.
Tandem365 now serves more than 1,100 clients across its four-county service area. In six years, Tandem365 has avoided hundreds of ER visits and hospital admissions.
Under the care model, Tandem365 clinicians maintain regular contact with clients to monitor their conditions and coordinate their ongoing care.
Social workers conduct a comprehensive assessment on new clients that includes identifying the social determinants of their health and other issues in the home. Staff also provides assistance with adhering to their care regimen and prescribed medications, and can arrange for other assistance for things such as routine household chores and daily tasks.
“They assess the member, they study the pattern of utilization that a member has had in the past and they put a plan in place to address that, 24 hours a day, seven days a week,” said Janet Scovel, director of Medicare care management at Priority Health.
Priority Health was an early supporter of Tandem365, viewing the program as a way to provide better care and quality of life for ailing members in frail health — and at a better cost. Scovel called it a “very innovative and creative model.”
“In all of the factors that are addressed with the program, it exceeds our members’ expectations through the promotion of their satisfaction,” Scovel said. “They have an improvement in their quality of life because with the close monitoring and the quick response of the Tandem team, these folks are able to spend more time in their own home, with comfortable surroundings, enjoying their time, as opposed to bouncing in and out of the hospital environment of the emergency room.”
When a client has an issue and needs assistance, they call Tandem365. An operator triages their situation and turns them over “to the right, appropriate person,” perhaps a clinical care manager or the nurse assigned to their care team, Toland said.
If needed, an operator dispatches its team of paramedics to the home, or an ambulance for an emergency medical issue as a 911 call.
Paramedics that are part of Tandem365’s response team assess the client’s condition and provide the care they need at the moment. If necessary, they will transport members to an ER.
Of the 971 times paramedics were dispatched in 2019 following a call for assistance, clients were transported to the hospital 14 percent of the time. That compares to a transport rate of more than 70 percent when Life EMS responds to a 911 call, according to Tandem365 director of operations Phil Fennema.
“Usually, our patients call us when they really don’t know what to do,” Fennema said. “If we didn’t exist, if we weren’t present, those 900-and-some urgent assessments that we did probably would have been either EMS calls or the patient would have been transported to an emergency department.”
Clinically, emergency room use among Priority Health members served by Tandem365 is 20 percent to 30 percent lower than a patient population “with the same burden of illness” that’s not enrolled in the program, Scovel said. Hospitalization rates as well are 15 percent to 25 percent lower for Tandem365 enrollees, she said.
In six years, more than 2,000 Priority Health Medicare Advantage members have been served by Tandem365. They generally are people with high-risk, medically complex chronic illnesses in advanced stages who are able to keep their condition stabilized with the care coordination and household assistance the program provides, Scovel said. Many enrollees otherwise would live in a nursing home.
“That’s a pretty big satisfier for our members who want to remain at home,” Scovel said.
Seeing the value the program offers, Priority Health welcomes Tandem365’s extension into new markets, although there are limits on how quickly it can expand.
Tandem365 needs to have enough clients in a new area to hire and set up the care teams required, she said.
“The growth needs to be controlled and sustainable, of course,” Scovel said. “But we certainly want to be able to close gaps for our entire membership across the state of Michigan.”
Priority Health is looking at ways to take the lessons learned through Tandem365 to develop other initiatives across its membership.
“We’re kind of noodling on what we’ve learned and looking at perhaps different ways to offer service using what we’ve learned,” Scovel said.
As Tandem365 expands and serves more people, it has had to adapt. What worked five years ago for 200 clients and a staff of eight clinicians doesn’t quite work as well today, as Tandem365 cares for nearly 1,200 people and has a staff of 35.
Rather than the past practice of dividing care teams’ base by providers, with nurses handling all of the case management, staff now looks at whether a nurse or a paramedic is best suited to manage care for clients and “what needs to be in place at which time.”
“We’ve almost had to resize the care model for each stage that we’ve gone through,” Fennema said. “Going from finding the right care, for the right patient, at the right time and with the right providers with 300 people on service looks different than with 1,200.”
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