Meet the First Medicare-Approved Transitional Care Provider

This past year, Newport Beach, Calif.-based Global Transitional Care (GTC) became the first Medicare-approved dedicated transitional care company in the country. As a result, GTC can provide and bill for transitional postacute care management services and transition patients to home upon discharge from hospitals and postacute care facilities.

Most patients seeking transitional care typically have multiple comorbidities and chronic conditions, making it difficult sometimes to manage in the home setting in the first 30 days after discharge. These first 30 days are when these patients are most at risk for being readmitted into the hospital for reasons both preventable and not.

Once a patient is under GTC’s care, they are assigned a transitional care team that consists of a specially trained nurse practitioner and registered nurse. A transitional care plan is developed specifically for that patient. This plan incorporates the patient’s discharge instructions and personal health goals. In addition, the patient has unlimited access to this team for 30 days, including both phone calls and face-to-face visits.

GTC took its first patient in July and has averaged 3–5 patients per week since. And Chief Executive Officer Rani Khetarpal says it has had zero preventable readmissions.

“We know it’s a very small number of patients we are working with, but the acuity of these patients is extremely complex,” she says. “When you look at that and look at the numbers, it’s actually a real good outcome.”

A Clinical Model

GTC was not an overnight success—the seed of this idea began in 2010, and it took several years of careful planning and research to finally enter into this space. The provider developed its transitional care model in collaboration with the University of Pennsylvania’s Transitional Care Nursing Team, which allowed for commercialization. It began the Medicare approval process last year and took nearly 14 months to get the thumbs-up necessary to become the first exclusive provider of transitional care services.

Khetarpal notes that transitional care has become a buzzword in the last few years, and most healthcare providers are attempting some form of it.

“We think that’s great,” she says. “It’s all very beneficial and helpful. There’s nothing bad about doing some sort of transitional care in my opinion; going from zero to anything is going to be helpful.”

But what separates GTC from others is that Khetarpal’s company is focused on a clinical transitional care model. Most providers follow a behavioral-based transitional care model where a health coach, such as a medical assistant, helps patients gain knowledge, skills and tools to become more active participants in their own care. The main difference between the clinical and behavioral models is that the clinical model uses RNPs and RNs who are specifically certified in transitional care nursing.

The benefits of transitional care are twofold, according to Khetarpal. From the perspectives of patients, family members and caregivers, it allows the patient to heal at home, where they are in a familiar environment.

“Countless studies have shown that a patient heals better and feels better when they are in their home environment,” she says. “Transitional care in any aspect, but specifically in the clinical aspect, allows for that patient to remain at home. The benefit is tremendous in that sense alone.”

Khetarpal adds that the clinical model of transitional care allows for better care coordination, since a provider like GTC becomes a patient and caregiver advocate. The goal is to take the burden off the patient and caregiver to ensure the patient stays at home.

“We ensure the patient goes to their primary care or specialist follow-up appointments. Our staff handles the medical reconciliation. We make the calls to the pharmacy or to the doctor’s office,” she says. “We also have the ability to mobilize resources quickly. For example, if the patient goes home without a home health order and upon entering the home we notice one is necessary, we make sure that home health order is put into place.”

The second major benefit to transitional care comes to the institutions and healthcare system in general. The goal is to keep that patient from being readmitted, because that is where the drain on the healthcare system occurs.

“From a hospital or healthcare institution standpoint, your quality metrics go up, your readmission penalizations go down, and your overall outcomes are very positive if that patient remains home,” says Khetarpal. “Through transitional care we have a unique opportunity to make a big impact on the healthcare system right now.”

Overcoming Obstacles

One of the biggest challenges for GTC has been getting others to understand this innovative new model. Khetarpal equates it to when home health first emerged in the 1920s and faced many of the same issues.

Khetarpal acknowledges there are many organizations doing great work in transitional care, including both home health companies and home care companies offering value-added services of transitional care as well as hospitals that have developed their own transitional care programs, some clinical, some nonclinical.

“There has been a tremendous amount of resources put into this,” she says. “Our goal is not to go in, wreck all of that and take over. Our goal is to work with existing programs to make them even better and to give providers who don’t have a program in place an option to utilize us as their transitional care provider. We don’t require a physician’s order or a formal approval; they just have to call us.”

Another obstacle for GTC to overcome is to ease the fear from healthcare providers that they are taking patients away.

“We have to educate physicians and explain that our purpose is to be their eyes and ears in the home and to work in a collaborative relationship,” says Khetarpal. “We don’t make medical decisions for the patients. If our RNP or RN notices something is amiss, they call the primary care or specialty provider immediately to discuss it. We can help implement any follow-up actions after that discussion has taken place.”

Khetarpal has found that once her team meets with physicians, they understand GTC’s model and protocols better and are put at ease. In fact, she says they have not had pushback from any physician they are currently working with.

Looking Ahead to Growth and Expansion

GTC is in discussion now with several health systems that could lead to multistate expansion. By the end of January 2016, it expects to get Medicare approval in all 50 states. That will give it the ability to move across state lines and be more flexible for its current hospital and health system clients that have entities in multiple states.

The company is also in process of adding operations in Northern California while continuing to expand in Southern California.

“There are exciting times coming up in 2016. We are in a rapid expansion and growth mode right now,” says Khetarpal. “We have many interested parties that have contacted us in terms of wanting to know more about what we can offer them. But our focus is on quality, not quantity, so we do not want to expand too rapidly. Instead we’re taking the time to do this the right way. The biggest part of being where we are today is the fact that we went slowly.”

Even though transitional care has been around for a few years now, Khetarpal believes we are just starting to scratch the surface of what this could really mean in a value-based healthcare system.

“Transitional care is not some passing trend. It’s here to stay,” she says. “By moving into this value-based care system, we want to ensure the patient remains at the center of that system, and that’s what is so exciting about this. Ultimately, given what we’re doing and taking aside the cost efficiencies and value for the provider, it’s all about the patient. Having a patient-centered model is only going to enhance what’s coming down the line for healthcare in the future.”

For more information, visit www.globaltransitionalcare.com.

Daniel Casciato is a freelance writer and social media consultant from Pittsburgh, PA. He makes his living writing about health, law, social media and technology. Follow him on Twitter at @danielcasciato.