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

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

Advocate Aurora Health, Amedisys Inc. (Nasdaq: AMED) and Raphael Rakowski – now Medically Home’s co-founder and CEO – were in charge.

“For various reasons, mostly because providers weren’t signing up, the company blew up in 2010,” Powder said. “Ironically, before the economic downturn, medical homes had billion-dollar valuations. Then Amedisys went out and bought Contessa for $270 million. So I was thinking, ‘Boy, wouldn’t it be great if we were together for 12 years?’

Perhaps it was an idea before its time, but clinically home powder stands as an example of how advocates investing in home and innovative risks have proven most.

Advocate Health Enterprises is one of the largest integrated health systems in the United States and is the investing arm of Advocate Health. Powder has said in the past that his team has focused on three areas for growth 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 U.S. The two will officially be called Advocate Health with a network of 67 hospitals, 21,000 physicians and nearly 42,000 nurses.

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

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

Advocate Health Enterprises recognizes the need to have a larger 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-at-home program, which is expensive to operate, but has been able to succeed despite the uncertainty of reimbursement.

“We’ve since come up with — primarily because of COVID — our own hospital-at-home program,” Powder said. “It’s fairly expensive and the challenge is always to go back to reimbursement. During public health emergencies, it was paid for and [some]That’s going away. Without relationships with commercial providers, it’s really hard to move the care model forward.”

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

“Even if we don’t get paid, that bed is filled with surgical patients [in the hospital] Or higher sharpness is better economics for us,” Powder said.

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

“It doesn’t all make sense off the top of my head, but I think you can create a scenario where people end up visiting emergency rooms — virtually — in their homes,” Powder said. “What it comes down to is staying at their home for observation or even admission. There are probably 30% of people sitting in our hospital beds today and maybe 25% of people in our emergency rooms, maybe more, who probably don’t need to be there. They should be in urgent care or a retail clinic. I think a lot of that ends up at home. If you can figure it out with economics, it will be a huge game changer in the health system.”

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

Powder is excited by the opportunity for care management that once advocated for health systems with home-based care capabilities.

“If you provide services at home, whether it’s personal care, hospice, Medicare-certified home health, you name it, the real innovation opportunity is navigating care across a huge continuum,” Powder said. “This is where I will give my organization some credit, because we have about 750,000 lives for whom we have full and complete financial risk through value-based contracting. We need to learn how to navigate them to the most rapid and clinically appropriate care setting and ensure they don’t fall through the cracks.”

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