Why the Hospital at Home Concept Won’t Be Going Away

Executives from three health systems taking part in this week's The Winning Edge webinar say the strategy is reducing hospitalizations and costs, improving outcomes and scoring very high in patient satisfaction.

Hospital at Home programs are here to stay, regardless of the fate of the Medicare waiver, but they may look a lot different a year from now.

That was the biggest takeaway from Tuesday’s The Winning Edge webinar, which featured executives from two of the strategy’s leading proponents, Mass General Brigham and Atrium Health, and Ochsner Health, which launched its program a little over a year ago and is pursuing sustainability beyond the model supported by the Centers for Medicare & Medicaid Services (CMS).

Hospital at Home, which aims to treat selected patients at home with a combination of virtual care, remote patient monitoring and daily in-person visits instead of keeping them in the hospital, took off during the pandemic, with support from a waiver that enabled health systems and hospitals following the CMS model to receive Medicare reimbursement. That waiver is due to expire in September, and while there’s a strong lobbying effort to make it permanent, many hospital executives have said the program has proven its value and will go on regardless.

Robust Outcomes Point to Sustainability

Daniel Davis, MD, senior medical director of primary care for Atrium Health’s greater Charlotte market and senior medical director of continuing health for Atrium’s Southeast region, said the CMS model offers “an important sign of legitimacy” for healthcare leaders, but the more important arguments are reduced pressure on overcrowded hospitals, improved health outcomes and very high patient satisfaction scores.

Davis said Advocate Health, the parent health system of Atrium Health, has 13 hospitals participating in the Hospital at Home program, including one of the first pediatric programs in the nation. Advocate’s Hospital at Home program, which has been in operation for about five years, serves roughly 115-120 patients a day, or about 16,500 patients since the program began.

Davis said the program, which accepts both waivered (eligible for Medicare reimbursement) and non-waivered patients, has resulted in tens of thousands of saved bed days, a key factor for hospitals who are above capacity every day.

Mass General Brigham runs its Hospital at Home program through five acute care hospitals in the greater Boston area, said Stephen Dorner, MD, MPH, MSc, chief of clinical operations and medical affairs for Mass General Brigham’s Healthcare at Home program. The program, which began in 2017, comprises some 70 beds across 72 towns in eastern Massachusetts, serving roughly 400 patients per month.

Dorner said MGB, which pursued Hospital at Home programs separately as Mass General Hospital and Brigham and Women’s Hospital before the two merged in 2019, approached the strategy as a means of improving care for growing populations, including the elderly and those with chronic care needs. Leadership understood that these populations would need more care than the health system’s brick-and-mortar facilities would be able to give them.

Dorner said the program has shown continued positive results in reducing readmissions and complications, while the patient experience is “off the charts.” He said those results will keep the program valuable regardless of the Medicare waiver.

While Ochsner Health is nationally known for its digital health and RPM programs, the New Orleans-based health system is a relative newcomer to the Hospital at Home concept, said Logan Davies, MD, MBA, hospital medical director of access and throughput.

Ochsner’s acute care at home program centers on three hospitals in and around New Orleans and, after going through what Davies called a “series of stops and starts,” launched roughly a year and a half ago to focus on value-based care patients, which number more than 200,000 in New Orleans alone. Davies said the program cares for about 250 patients a month through a contracted care provider and isn’t following the CMS model so that Ochsner can be more creative with how it delivers care in the home.

Davies said Ochsner includes the CFO in planning because the financial and clinical aspects of the Hospital at Home concept should be combined. Just by factoring in the costs of caring for a patient in the hospital against the costs of caring for a patient at home, he said, the Hospital at Home strategy yields an ROI of anywhere between three times and eight times better than the cost of hospital care.

Davies said Ochsner, like every other health system, is waiting to see how Medicare and, especially, Medicaid are affected by the current federal budget negotiations. If the worst-case scenario comes true and drastic cutbacks occur, health systems will need to adjust their Hospital at Home strategies – and that might make the strategy even more important in providing value-based care.

Not a One-Size-Fits-All Model

While all three health systems follow a similar structure, there are many differences that point to the ability of a health system to tailor its program around what leadership wants and needs. For instance, Ochsner Health outsources part of its acute care at home program to a vendor, while Atrium Health uses its own doctors and nurses, as well as paramedics trained through a Mobile Integrated Health program. And while MGB targets populations in defining who would benefit from the Hospital at Home Program, Ochsner looks at the individual patient.

All three agreed, nonetheless, that the concept is a key part of the health system of the future, and it will continue to evolve. They said such programs will improve with the use of more sophisticated RPM technology, enabling providers to track patient biometrics at home and in real time. And they said AI will make a significant impact on care as well, reducing the burden on clinicians and giving them better insights into care management and coordination at home.

Please check back with HealthLeaders on Friday for the You Tube video of this Winning Edge webinar.