Transitional care, a new Medicare billing category as of 2013, is about to see a new form of action thanks to California-based Global Transitional Care, the country’s first Medicare-approved, third-party transitional care provider dedicated exclusively to this service.
GTC began serving patients in southern California in July and has big plans for its future and for its role in shaping this new space in the healthcare industry.
The business oversees vulnerable, post-acute care patients as they transition back to a home setting, with the goals of improving patient care and reducing hospital readmissions, and thereby containing healthcare costs.
“From a Medicare or really any care standpoint, the cost of a readmission versus the cost of transitional care – there’s no comparison,” GTC CEO Rani Khetarpal told Healthcare Dive.
“When you look at the average readmission cost for a hospital, you’re looking in the thousands, whereas the cost for a transitional care period is in the hundreds.”
When you consider that cost differential across the sheer volume of Medicare patients, the savings could be huge, Khetarpal noted. Out of 5 million U.S. hospital readmissions, approximately 76% are considered preventable and potentially worth $26 billion in savings.
Khetarpal added that GTC is going above and beyond what is typically seen in transitional care and that one of their utmost goals is to set the standard for care in this new realm.
“One of the things that we’re really looking to do is to define transitional care,” Khetarpal said. While there are many definitions and models of care, it comes down to providing live, on-site oversight in the patient’s home as of day one, she said, and providing moderate to high complexity medical decision-making—which is what differentiates transitional care from other forms of post-acute home service.
Khetarpal added that it is also about education for the patient, their family members, the provider, and the involved healthcare organizations. “What we’re trying to do at GTC is really to educate as well as provide that service,” she said.
Given the Affordable Care Act’s mandate to reduce preventable hospital readmissions, GTC is likely to be joined by other organizations looking to exclusively operate in this niche service.
“I think this is the first of many programs we will see in California and across the nation,” Dr. Gerald Kominski, director of the UCLA Center for Health Policy Research, told The Orange County Register. “This kind of program is exactly what Medicare needs to be doing.”
GTC’s vision, however, extends beyond Medicare.
Given that non-Medicare patients can have just as many complexities and as much need for this type of service, GTC does offer patients a private pay option and is looking to partner with commercial payers, Khetarpal said.
“In an ideal world, it would be amazing if every patient that’s discharged from a hospital, whether it’s a commercial patient or some other care, or even a cash-paying patient, could be discharged with a transitional care provider that could oversee that post-acute care period and provide care coordination,” she said.
GTC is currently providing services in southern California. It aims to expand into northern California by the end of the year and into different parts of the country for 2016.