Can the Hospital at Home Model Help Rural Hospitals Thrive?

Illinois-based Blessing Health is one of three health systems involved in a pilot to test the innovative platform in a rural setting, where these services could be a lifeline for struggling hospitals.

An Illinois-based health system is taking part in a unique Hospital at Home project aimed at proving the platform's value for rural healthcare providers.

The Blessing Health System is one of three rural health networks (along with Appalachian Regional Healthcare, serving parts of Kentucky and West Virginia; and Wetaskiwin Health Center, part of the Alberta Health Services network in Canada) to test the model, which combines telehealth and digital health tools with in-person services to treat patients, who would otherwise be in a hospital, at their home. Blessing Health is running the program on a technology platform developed by Boston-based Biofourmis.

"This is transforming how we are able to care for patients needing acute care services," says Mary F. Barthel, MD, the health system's chief quality and safety officer. "Instead of providing care under our roof, we're going to provide care under theirs."

The innovative model of care was initially mapped out at Brigham & Women's Hospital in Boston, then molded into a program by the Centers for Medicare & Medicaid Services (CMS). More than 200 hospitals have taken advantage of CMS waivers on telehealth access and coverage during the pandemic to launch Acute Hospital at Home programs.

Blessing Health is following a slightly different path, one that focuses on how this model can help rural health systems, which are struggling to stay afloat. While larger and urban health systems may have the resources in-house to handle patients with acute needs, rural hospitals often lack those resources or have limited access to providers, forcing them to transfer patients to other hospitals when they should be keeping them closer to home.

"It's important for us to be able to keep our capacity," says Barthel, whose tertiary care, safety-net hospital is the largest in more than a 100-mile radius. "We want to be able to care for our patients in our [communities] when we can, and this will help."

A New Strategy for Rural Healthcare

Roughly one year ago, Blessing Health joined the Rural Home Hospital program developed by Ariadne Labs, a joint center for health system innovation overseen by Brigham and Women's and the Harvard T.H. Chan School of Public Health. Using funding from the Spark Grant Program, Ariadne Labs used the Brigham and Women's Hospital at Home model and fine-tuned it for use in rural locations.

"Nearly 80 percent of rural America is deemed medically underserved by the federal government," the organization says on its website, explaining the Rural Home Hospital program. "One in five Americans live in rural areas and depend on their local hospital for care, but rural hospitals are closing and consolidating in record numbers. Residents must drive farther not only for emergencies but for the kinds of diagnostic tests and treatments usually provided in a hospital."

Ariadne Labs partnered with the University of Utah Health system in 2019 to test the model in two remote Utah communities, and is conducting a feasibility study with funding from the Rx Foundation to measure outcomes in rural Utah. More recently, Ariadne Labs has partnered with the Thompson Family Foundation on a three-year project to conduct randomized, controlled pilots of the model at Blessing and the other two rural locations. The organization is also working with the Indian Health Service and First Nations to launch pilot programs for Native American communities.

Under the model of care being tested at Blessing and the other two sites, patients are screened in the Emergency Department and, if they meet qualifications, are sent home with a tablet for telemedicine visits and the appropriate digital health monitoring devices, if needed. A specially trained nurse visits the patient twice a day, and the patient meets with a clinician via the tablet once a day. Vital signs are captured via digital health devices and relayed to the care team, and the patient can connect with that team at any time via the tablet.

Barthel says Blessing Health tried to stand up a remote patient monitoring program to handle patients infected with COVID-19, but "it didn't get off the ground quite as we expected." With the Rural Home Hospital program, she says, Blessing is looking beyond the pandemic. They want to take care of patients dealing with certain infections, pneumonia, congestive heart failure, and COPD, who might otherwise spend three or four days in the hospital.

"These are patients who need [acute care services], but if they could sleep in their own beds, they might do better," she says. Those being treated at home rather than in a hospital tend to sleep better and longer and get more exercise, and they're often in a better frame of mind to follow doctor's orders and manage their medications, she adds.

Those benefits are especially important in rural communities, where residents rely on their healthcare providers and those providers rely on their community to survive. Rural hospitals, clinics, and medical practices don’t want to send their patients away to a larger health system, which might be hundreds of miles away and a stressful journey by ambulance or car.

Barthel says the program has planned carefully to take into account what services can be provided, and to include local healthcare providers who can provide those services. In addition, it may take a little bit of coaxing to convince patients that they'll get the care they need.

"There are patients who come to a hospital who are not doing well, and they want to feel better before they leave," she points out. Others, she says, might not visit a doctor or the hospital at all because they don't want to be hospitalized.

Barthel also hopes to use lessons learned in this model to restart their remote patient monitoring services, saying they could be an important bridge for patients transitioning from inpatient to outpatient care.

A study conducted by Brigham and Women's has shown that the Acute Hospital at Home concept reduced the cost of care by 38% per patient, while also reducing rehospitalizations, laboratory orders, imaging studies, consultations, and improving activity levels. Executives at Blessing Health, Appalachian Regional Healthcare, and Wetaskiwin Health Center will certainly be looking for similar outcomes in their programs, but they'll also be looking for data that shows the model can help rural providers improve outcomes and help resource-thin hospitals improve their bottom line.

Barthel says Blessing Health is taking advantage of the CMS waivers, though those will end with the COVID-19 public health emergency. They're working with the state of Illinois for public health funding and will talk to payers like Blue Cross Blue Shield for support, but long-term sustainability for this program will rely on data that proves its value.

"I think there is a need for this," she says, noting the model would help their large population of seniors, as well as young families and those living with chronic conditions.

"It's tough for people to be in a hospital when they could be at home, in their own beds," she says.