Sentara injects new ideas into infusion market

CHESAPEAKE, Va. - As it observes its 20th anniversary, Sentara Home Care is taking some time to reflect on its first two decades in business. For the most part though, they are focused on what they need to do to be around for the next 20 years. The company, which offers hospice, skilled nursing, private duty nursing, durable medical equipment, pharmacy and infusion services, has a built up a head of steam going into its third decade. Since 1995, the hospital-affiliated enterprise has grown its annual revenues from $14 million to $50 million in 2002. Spurring that growth was the decision to combine the infusion and pharmacy components and split them out as a separate entity. “We felt there was an opportunity there,” said Sheila Schubert, director of home care and pharmacy infusion. “Even though Sentara is best known as a home health agency with an infusion component, we wanted to be recognized as a player in the infusion market. It has turned out to be a strong niche for us.” Initially, Schubert said the intent was to “mimic” what other players were doing in order to gain more respectability in the field. However, that didn't mean Sentara would be content to just mirror other firms' services - it wanted to establish its own identity by charting new territory. As a result, company leaders set their sights on developing new therapies, treatment modalities and operational structure. “We've been attacking areas by looking for patients and payer bases we don't have,” noted Ray Darcey, vice president of home care operations. “We have a good footprint on what it takes to make this business run profitably.” Sentara has made some acquisitions along the line, but Darcey says cultivation of innovative disease state management programs and an assertive sales strategy have propelled the company forward. “We have salespeople out there who weren't here five years ago,” he said. “We've put together some solid service packages.” The newest service Sentara offers is an interventional infusion program for sickle cell anemia patients. The rationale is that the nature of sickle cell anemia causes patients to have episodes that typically require emergency room treatment and hospital admission. But by linking patients directly to an on-call nurse via a pager, the clinical team can dispatch a therapist to the home to provide the necessary treatment - usually hydration and pain management. “All patients have a direct line to the nurse on call - there is no delay going to the answering service,” he said. “And each patient has a standing physician order for hydration, so that saves time.” Modifying staffing models has not only saved time and effort, but it has proven to be cost effective as well, Sentara officials maintain. Using full-time instead of per-diem nurses gives the company flexibility because they can be trained in all facets of the company's services, they say. Cross-training nurses has been an integral part of Sentara's telemedicine program for congestive heart care, pulmonary care, wound care, asthma and high-risk obstetrics patients, Schubert said. “We've had good results in all those areas,” she said. “The key to success is keeping costs down while providing quality care. Technology has helped us be more efficient in our jobs.” To blaze new trails in the infusion market, Sentara had to go up against what has historically been the biggest obstacle to any cutting edge health care idea - securing payer reimbursement. And while insurers typically balk at initiating coverage policies for unproven services, Sentara has worked the proper channels in order to obtain payer sponsorship. Not surprisingly, the effort wasn't easy, Schubert said. “We proposed the [sickle cell anemia] idea five years ago on the premise that it was something patients needed, but it didn't get a warm reception,” she said. “It seemed like a progressive idea, but the insurance companies were skeptical, as were the physicians.” Modifying its sales approach turned the tide. Instead of going to the insurance companies first, the company worked on converting physicians to the idea. “We told them how a sickle cell program could generate major cost savings by reducing emergency room visits and inpatient admissions,” Schubert said. Although there are only seven patients in the program to date and no hard data is yet available, Schubert says there are already preliminary signs that the program is delivering on its promise. “We're seeing a substantial decrease in ER visits and hospitalizations,” she said. “And we're adding more patients to the program every week.” Sentara's success is no small feat in a market characterized by tough competition, tight margins, high overhead and stringent insurance coverage. Still, they typify the determined attitude many regional companies have, said Lorrie Kline Kaplan, executive director of the National Home Infusion Association. “There are a lot of companies out there who have innovative programs, but they tend to be under the radar screen,” she said. “It takes a lot of focus and determination to offer distinctive services to patients. Companies like that are revolutionizing the way people think about health care.”