As Julie Sacks, HCCI's CEO, celebrates her 10th anniversary with the company, she reflects on the organization’s progress and impact since both HCCI – and she – began, back in 2015. We sat down to discuss the last ten years and look forward to what the next ten years might look like.
Q: What inspired you to champion home based primary care at HCCI?
For much of my career, I had been working with patients in different capacities, including people living with mental or physical health challenges. When I discovered HCCI, they were looking to add to their leadership team, I was particularly interested for two reasons: 1) because my mom was living with early-onset dementia in a nursing home at the time (a setting in which she had never wanted to have to live) and 2) because when I find a resource people can truly benefit from, I am driven to tell everyone about it!
Q: You started at HCCI in a different role, how did that role change over time into what you're doing now?
I started as VP of Operations and Advancement. I was HCCI’s fifth employee, so I was part of the early team. Dr. Tom Cornwell is HCCI’s founder and was the original CEO. When HCCI’s President, who had been reporting to Dr. Cornwell, left in 2017, I took over as COO. I was named CEO this past March.
Q: How has your vision for HCCI evolved over the years?
HCCI’s original goal was to be a trusted leader in the field of home-based primary care (HBPC), educating medical professionals and practices interested in establishing or growing a quality HBPC program. Through this work, we would increase patient access to this underutilized care model. We started by convening experts in the field and developed the nation’s first, and only, HBPC curriculum.
Our library of online courses and resources continues to provide a valuable foundation to providers and practices. Nuances in healthcare, like the proliferation of value-based care, however, can make this ecosystem more complex and ever-changing. Bearing that dynamic in mind, we realized that people needed “more than a course.” Starting or growing a house call program takes dedication from both our clients and a fair amount of oversight by our subject matter experts.
As such, we started offering consulting and integrated packages that include data analytics. We’ve evolved our offerings over time to meet the needs of the market, and we’ll continue to change and pivot as needed in the years to come.
Q: What leadership lessons have you learned that you think are relevant for physicians and potential customers that are considering offering home-based primary care?
If there’s a practice or health system that's thinking about doing this, we have found it critically important that they identify a clinical champion that understands the value of this care model. Beyond that, they must be able to effectively represent that value to their C-suite. We can help them with that.
It’s also helpful when an entire team is involved in education. We offer clinical as well as operational guidance. Knowing how to run an efficient and effective practice is as important as knowing how to achieve better patient outcomes.
Q: What do you think makes home-based primary care so special? Why do you see it as so essential to the future of healthcare?
Most people want to age and ideally die at home. People don't want to be in a hospital, nor do they want to be in an ICU. With technology evolving as quickly as it has (and will), aging in place is more possible today than it's ever been. It’ll be even more possible in the future. We say at HCCI that “the future of healthcare is in the home.” And I really believe that.
The other shift I've seen over the years—and something that I think about a lot—is not just scaling home-based primary care but integrating it with other home-based care models. This means closing the gaps between home-based primary care, palliative care, hospice care, and home health, etc.
Ultimately, I would love to see a world in which patients with complex care needs are able to get the full continuum of care at home.
Q: Have you noticed any common misconceptions about home-based care, and if so, what are the most common ones, and how have we gone about addressing them?
On the consumer side, the biggest misconception we see is patients not understanding the difference between home-based primary care and home health. It’s our duty to educate patients and caregivers on the different types of services each provides and how each is covered from a payer’s perspective. We have done some public awareness, consumer-facing work to try to dispel that myth.
On the provider side, there is often a lack of understanding (or confidence) that an investment in this care model will be worthwhile and will ultimately save the hospital or practice money.
Q: Are there any moments or stories that you can share that illustrate the impact of home-based primary care on a patient and/or a provider?
We have made it a practice at HCCI that every new employee goes out on a house call, or day of house calls! I did that within my first week and went with then-CEO, Tom Cornwell. To this day, I remember it vividly.
We visited an older gentleman who was very isolated. He looked up at Dr. Cornwell during that visit and said, “you've saved my life.” Dr. Cornwell is one of the most compassionate and loving people and it comes through in every interaction he has. He's exceptional. We see those qualities in many, if not most, home-based primary care providers we work with because they are mission-driven, committed to this work and their patients.
Q: What would you say are the first steps an independent practice should take if they're considering adding home-based primary care as a service line?
Call us and have a “discovery call” with one of the members of our team. In that conversation, we take the time to learn about them and their practice, helping them fully understand the commitment that's involved, and how we can help. If they choose, we can lay out a blueprint and outline the process for starting or growing a practice, step-by-step. The reason I say to call us is that every program is different. Programs have different goals, and the process we recommend can differ based on a practice’s size, service lines, geography, etc.
For example, we've partnered with a Federally Qualified Health Center (FQHC). Their goal in providing house calls was to improve people's A1C levels and then get them back into the clinic. That's a very different goal than reducing hospital readmissions through a house call program. But those are both valid and important, yet different reasons to want to implement an HBPC program.
Q: How can practices navigate reimbursement challenges or regulatory hurdles as they're starting out?
One of our most popular annual events—typically held in late January or early February—is a webinar where we go over all the changes outlined in the new year’s Physician Fee Schedule. Our subject matter experts go through the very detailed information released by CMS and pull out everything that is going to impact home-based primary care. We basically create a cheat sheet that people can use.
We hold this webinar for people to learn and ask questions. Or they can simply get access to helpful resources and find out what is most pertinent for their program.
Q: What trends in healthcare do you think will influence the growth of home-based primary care in the next 5-10 years?
CMS has stated its intention for all (Medicare and Medicaid) beneficiaries to be in an accountable care relationship by 2030. We are seeing the healthcare system move slowly but steadily towards that goal as well as value-based care.
I think we will see more practices joining ACOs, and will see continued emphasis on population health, including how to best manage the high-need, high-cost patient population. That is where HBPC really shines. It allows for better patient outcomes and a lower overall total cost of care.
I foresee continued, positive change, in payment models that make home-based primary care more financially sustainable. And the more financially stable it is, the more patients house call programs will be able to support.
Q: If you could wave a magic wand and change one thing about the healthcare system to better support home-based care, what would you change?
A payment model (or models) that truly supports HBPC, making it financially viable for practices to successfully care for what is so often an underserved population of frail, elderly patients. As I said earlier, each program is different. We need payment alternatives that work for practices of different types and sizes.
Q: What advice would you give to the next generation of healthcare leaders who want to create, innovate, and disrupt in this space?
I wonder whether AI presents a new opportunity to address the interoperability challenge. It’ll make it easier for all of the platforms to talk to each other, regardless of what their native platform is.
Going on a house call is a profoundly moving experience. I am confident many more students would choose to go into this if they could have that experience. HCCI can help. Patients, caregivers and providers can get a sense of what a house call is like by viewing the Rethinking Modern Medicine video on our website and current or future providers can sign up for the HCCI Practicum (our two-day shadowing experience). Most nursing and medical students don't know home-based primary care is an option, and that needs to change in a significant and systematic way. Let’s make it an expected part of how we train the next generation of providers!