A Colorado startup – inspired in part by the philosophy of aging in place – is looking to provide an alternative to emergency room care in more and more cities across the United States.
Denver-based DispatchHealth provides at-home care with mobile equipment and health care workers in small cities like Cleburne, Texas, and Ocala, Florida, as well as in some of the country’s largest metropolitan areas, including Chicago and Houston. And last month, the company began operating in Tucson, Arizona, bringing the number of cities the company serves up to 46.
DispatchHealth co-founder and CEO Mark Prather, MD, is a former emergency physician who also ran a hospital staffing agency. Prather said the popularization of aging in place literature in the 1990s and his personal experiences in emergency rooms and intensive care units made him reconsider whether it was more effective to treat a patient in the hospital or in their home.
“It dawned on me that we had probably gone too far to one end of the spectrum,” Prather said. “[The hospital] is an expensive place to get care. It may be the perfect place to get care if you have had a heart attack or a stroke or a car wreck, but for many other things it’s probably a higher-cost setting of care.”
The company’s first home visits began in Denver in 2015, and soon expanded to Colorado Springs as well as into Arizona and Nevada. Prather said the cost of care is significantly lowered when done through DispatchHealth at home, where a treatment that could cost more than $1,000 in an ER – plus another thousand or so in ambulance costs – could be done for a few hundred in the home.
Prather estimates DispatchHealth has the ability to treat 60-70% of people who would typically show up at an emergency room—using equipment that’s more advanced than what’s typically found in urgent care. Patients who need to be admitted to spend a night in the hospital or those who need treatment on advanced equipment, like CT scans or chest tubes, would not be candidates for the in-home service.
Prather estimates DispatchHealth has the ability to treat 60-70% of people who would typically show up at an emergency room—using equipment that’s more advanced than what’s typically found in urgent care.
“The rest of the population – if you have the diagnostic and treatment capability, frankly – can be treated in another setting,” Prather said. “We have the ability to show up at your home with a moderate-complexity lab. There are different complexities of labs … In an urgent care, you can get a couple of lab tests. You might find, in a hospital, a high-complexity lab, where you can do anything under the sun. But most of the tests you need fall into this bucket of moderate complexity, and that means I can really get any test I’d get in the ER right at your bedside, and we can bring that to your bedside.”
DispatchHealth typically operates 365 days per year from 8 a.m. to 10 p.m., although some service areas have different hours based on local health care partnerships. The company partners with large primary care groups, like medical centers and health systems, in each of its markets and has also acquired two mobile medical imaging companies to provide X-rays and similar services in patients’ homes.
Prather said response time is determined by an assessment of the acuity of the patient’s need, and can range from 30 minutes for something like a respiratory or cardiac need to four hours for an injury like a sprained wrist.
With operations on both coasts and throughout the middle of the country already established, DispatchHealth expanded into Southern California in late 2021, with service in Orange County through a partnership with UCI Health. Prather said he anticipates further expansion into California over the next year and a half.
For seniors specifically, he said care in the home can help prevent deconditioning. He said half of patients over 85 years old who visit the hospital have to change their living arrangement—moving out of their home and into assisted living or a nursing home, for example, when they leave the hospital. Deconditioning also affects seniors under the age of 85, but at a lower rate. Prather said preventing this hospital visit can allow people to remain in the same living situation, and also prevents problems with reacclimation for seniors who have dementia.
…preventing this hospital visit can allow people to remain in the same living situation, and also prevents problems with reacclimation for seniors who have dementia.
For caregivers, he said it can be hard to convince some seniors to go to the hospital for care, and the home alternative can make it easier for caregivers and family members to arrange for health care that patients find acceptable.
“If I’m the son or the daughter, and I’ve got a sick parent and they will not go, that’s really upsetting,” Prather said. “We can show up with many of the same tools and give them peace of mind.”
Additionally, Prather cited a 2012 meta-analysis of data on health care at home, which showed a significant reduction in mortality rate for seniors who received care in their homes.
Prather said DispatchHealth has partnered with more than three-quarters of Medicare Advantage plans, and visits for patients with those plans would cost the same as an urgent care copay, typically about $50. For Medicare, DispatchHealth visits are processed as house calls, which would carry a copay of a few hundred dollars.