“We are a care and care management company that focuses on the 5 percent of the population in this country that drives 50-60 percent of the cost,” stated Mike Tudeen, president and chief executive officer of Brentwood-based INSPIRIS.
Founded in 1998, the company has evolved over time to become a solutions-driven, outcomes-based option focused on improving the quality of life for medically complex cases, the frail and elderly, and those who are chronically ill.
“The chronically ill and medically complex tend to be underserved by the traditional healthcare system,” noted Tudeen. Filling this gap in service has allowed INSPIRIS to enjoy growth and expansion over the past several years. Today, the company provides services in 22 different states. Tudeen said through various programs and corporate offerings, INSPIRIS will assist 40,000-50,000 patients in some capacity this year.
Meeting patients where they live is an essential component of the care plan. Tudeen noted, “We essentially do old-fashioned house calls combined with modern medicine.” Through the care and care management side, which Tudeen called the cornerstone of the business, INSPIRIS providers deliver services in homes, assisted living facilities, skilled nursing facilities and other community settings with a goal of cutting down on inpatient admissions and re-admissions through a proactive program of preventative care and disease management.
INSPIRIS partners with health plans to implement strategies tailored to difficult-to-manage patient populations. Tactics taken with the vast majority of health plan members have been found to be largely ineffective with high-risk members. Through interventions targeted to medical, behavioral, environmental and social conditions, INSPIRIS has been successful in reducing hospital admissions. “Most of these people, before we get involved, are hospitalized two-three times per year. After we get involved, it’s typically one time. We essentially cut their healthcare costs in half. That’s our standard impact,” Tudeen said.
To achieve those results, INSPIRIS providers deliver services or programming to complement a health plan’s medical management strategies. Providers use education to help high-risk members and their caregivers better implement self-management techniques and recognize trigger events. Additionally, INSPIRIS focuses on alignment of treatment goals, improvement of home safety, medication management knowledge, compliance with treatment plans and coordination of care with community providers.
Tudeen said the corporate philosophy is based on three pillars: embracing a preventative model of care, offering an urgent response, and managing end-of-life care. By implementing preventative care measures, Tudeen said INSPIRIS heads a lot of issues off at the pass. “We prevent a whole list of things that someone outside of our care might have seen progress to crisis,” he said.
The second pillar is to adopt an urgent response. Members have the ability to call their provider who is familiar with the complexities of their case at the first sign of trouble. “Our doctors, nurses carry beepers,” Tudeen said. He added that even if it was a weekend or odd hours, a provider would get in the car and bring care and escalated services to the patient. He added the company does use telephone triage, as well, but only in a supporting role to the face-to-face contact. “We don’t believe that’s a strong enough intervention,” he said of using a solely telephonic communication model. Instead, INSPIRIS has adopted a hands-on, provider-driven model.
Because of that, Tudeen explained, “We’ll do a lot of things safely at home that the rest of the world would go to the hospital for. There’s so many things that can be treated effectively and have a better outcome if you catch it early enough and at much less cost to the system.”
The final pillar focuses on appropriate end-of-life care. He stressed that conversations about how care should progress happen “way upstream” as soon as a patient joins one of the company’s programs. Those conversations are updated regularly as circumstances change. “Our philosophy is the only right end-of-life care … in terms of how aggressive care should be … is the decision made by a well-educated patient and family.”
In addition to creating custom solutions driven by customer need, INSPIRIS offers four core programs: CarePlus, Transition Program, Assessment Program and Inspired Living. CarePlus is the program used for high-risk members to avert avoidable hospitalizations. The Transitions Program seeks to avert the readmissions that often accompany poorly coordinated transitions from the acute facility back to a community setting, particularly in the statistically critical first 30 days post-discharge. The Assessment Program is a comprehensive review of a member’s unique physiological, functional, psycho-social and environmental needs to design and manage an optimal care plan. The Inspired Living Program is the company’s end-of-life care planning.
Tudeen said the company’s success is a result of its core mission. “We’re a company that is focused on outcomes rather than process. We don’t get paid based on units of care. We get paid on outcomes — both quality and cost. Health plans see a reduction in costs while seeing a great improvement in quality measures and patient satisfaction so that’s been a win/win all the way around,” he concluded.