While turmoil in Washington jeopardizes a CMS waiver, health systems are looking at two specific populations to support and sustain the Hospital at Home strategy.
Whether or not it’s reimbursed by Medicare, the Hospital at Home concept is a good idea. The challenge lies in finding the right mix of patients, technology and workflows to create sustainable value for the health system.
Two distinct populations, seniors and rural residents, could prove critical to the success of that strategy.
At Sanford Health, a Hospital at Home program launched less than two months ago is giving the nation’s largest rural health system key insights into how to improve access to care and support providers and rural communities. The program, which adheres to the Centers for Medicare & Medicaid Services (CMS) Medicare-reimbursed model, aims to ease overburdened inpatient services and give rural patients an opportunity to recover at home rather than in a hospital bed.
Susan Jarvis, chief operating officer for Sanford Fargo and Health Network’s north region, says the health system is starting slowly with this program, with a current capacity of four patients at any one time. And while the focus is on patients in Fargo, which has a primary service area of 250,000, the goal is to extend out into rural regions where patients would truly benefit from recovering at home.
“We have a concentrated population in the Fargo/Moorhead area, but once you get out even into the 25-to-30-mile radius, it gets pretty rural out there,” she says.
That, she says, is where small, critical-access hospitals often have to transfer patients rather than manage care for them, and where a transfer can cover hundreds of miles, take hours, and separate patients from their family and community.
“That’s where we need this,” she says.
Like other Hospital at Home programs, Sanford Health’s model is a complex mix of virtual and in-person services, emanating from the hospital. The health system uses a virtual nursing platform and digital health tools to maintain a link with patients at home and coordinates daily visits with its in-house paramedicine program.
Jarvis says Sanford Health is using specific criteria for patient eligibility, focusing now on diagnosis-related conditions like pneumonia and dehydration as well as patients who’ve been in the hospital “and really just need monitoring for a couple of days.” Patients are evaluated through the ED, the prime candidates being those who are admitted and placed in overflow or holding rooms and waiting for a bed upstairs.
In time, as the workflows are defined and data is collected, the health system plans to expand both its patient eligibility criteria and the number of patients who can be treated in the Hospital at Home program, perhaps even creating a hub-and-spoke program that connects other hospitals in the Sanford Health network with small communities.
Jarvis says one surprising challenge has been getting patients interested in the option.
“They’re saying, ‘You’re telling me I need to be in the hospital, but I can go back home?’” she notes, saying some patients feel that because they need hospital-level care they should be staying in the hospital.
“We’re spending a lot of time with patients before they are [admitted],” she says, as well as developing additional marketing materials to address the home effect and caregivers.
Many patients can’t get out of the hospital soon enough, and that’s where the Hospital at Home strategy could gain steam. The argument in favor of the strategy has long been that many patients prefer their own bed to a hospital bed, and that they recover faster and better at home, where they can sleep more comfortably, use their own bathroom, eat their own food, play with their own pets and children and watch their own TV.
The value of this program in rural areas, Jarvis says, will undoubtedly grow. People living in small communities don’t want to travel long distances for healthcare (as an aside, on the day the program was launched, temperatures across South Dakota were 30 to 40 degrees below zero), and healthcare providers in those communities don’t want to send them elsewhere. A Hospital at Home program, she points out, will rely on “boots on the ground” resources, like the local critical care hospital, doctors, home health aides and even social services, to give that patient the necessary care. And those billable services will support the local community.
That’s also what the growing senior population wants to do—and that’s where this type of program could see even more growth.
Sanford Health’s Hospital at Home anticipates addressing the care demands of a growing senior population, which is demanding services and technologies that allow them to age in place, avoiding grueling trips to and from the hospital or doctor’s office.
Addressing the Growing Need for Senior Care at Home
Improving home-based care for seniors was a pervasive topic at CES 2025, particularly in the Digital Health Summit and exhibit hall, which included large sections devoted to the smart home and AARP-supported services.
Some of the conversations there revolved around using remote patient monitoring (RPM) and Hospital at Home to bring care to seniors.
“The home is right there waiting for us,” said Gabrielle Goldblatt, partnerships lead for the Digital Medicine Society (DiME), which participated in the Digital Health Summit and had a booth in the AARP pavilion. “We can’t be spending billions of dollars on just another way to go to the hospital.”
And while hospitals are focused on the home front right now, they could pivot with the Hospital at Home strategy to other sites like skilled nursing facilities (SNFs) or assisted living complexes.
Doug Leidig, president and CEO of Asbury Communities, a Maryland-based collection of 11 senior living locations, said the network of close to 2,000 not-for-profit communities around the country should be partnering more extensively with healthcare providers to improve care services. But during a panel at the AARP’s Age Tech Summit, he also noted senior living communities aren’t incentivized to invest in healthcare technology.
“There is so much technology out there now that people become paralyzed” with indecision, he said, pointing out the need for innovating partnerships with healthcare technology companies and providers. “We could be their lab.”
Leidig noted the average senior has five doctors and eight to 12 prescribed medications, making it critical that they have reliable platforms in the home with which to communicate with their care team.
Hon Pak, who heads the digital health team at Samsung Electronics, said healthcare providers are the key to improving the smart home. Tech companies and others can create the best smart home available, layering sensors and digital health tools to capture data and enable virtual care, but unless the consumer has a good relationship with the care team, that technology won’t provide value.
“If you just say, ‘Hey, something’s wrong; go see your doctor,’ that’s an incomplete solution,” he pointed out.
“We need hospitals and provider groups to come in,” added Amelia Hay, VP of startup programming & investments at AARP Innovation Labs.
And that’s what DiME is doing. The organization is partnering with the Consumer Technology Association (CTA), UMass Chan Medical School and UMass Memorial Health on the Connected Health Collaborative Community, an effort to create sustainable and scalable Hospital at Home programs. Participating members include Highmark Health and the Mayo Clinic.
“Right now we need to understand the guardrails and provide education,” she said. “That starts with bringing people into the same room for these conversations.”
And at an uncertain time, with a new administration vowing to shake things up and prospects of a continued CMS waiver for Hospital at Home programs up in the air, these conversations may keep the strategy alive.
At Sanford Health, Jarvis says the waiver may be the key to survival for their program in its current state. She said she’d like to see the proposed five-year extension make it through current Congressional talks.
“I think it's going to be hard without that CMS funding, and [there] won't be nearly as many patients eligible for the program, and you know the payers tend to follow the lead of what happens with CMS,” she says.
“I really think five years will be a great time frame for proof of concept.”
Aspiring CNOs should take these steps to gain perspective as future leaders.
CNOs play an integral role in nursing.
They act as the voice for nurses in the executive space, advocating for investment in new programs that can better the patient care environment.
Nurses who want to become CNOs should consider the following steps, as recommended by Gay Landstrom, senior vice president and chief nursing officer at Trinity Health.
Investment in technology depends on the financial status of your organization, says this CNO.
On this episode of HL Shorts, we hear from Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about making the pitch for technology and innovation in a rural healthcare setting. Tune in to hear her insights.
Intermountain Health’s new high-powered collaboration aims to create a network of connected hospitals, sharing services and providers and reducing transfers. Could this be the model to solve access and care barriers?
The key to rural health access may very well be telemedicine. And a coalition launched by Intermountain Health may be the model for that strategy.
The Salt Lake City-based health system, which has a footprint in several rural states, is joining forces with Microsoft, Epic, Gates Ventures and West Health to develop a hub-and-spoke telemedicine platform aimed at connecting small critical-access and large hospitals in a network that facilitates virtual care and reduces transfers and travel.
Dan Liljenquist, Intermountain’s Chief Strategy Officer, says the partnership, unveiled last December but in planning for a while, aims to address healthcare disparities and access issues across rural America. Roughly 60 million people, or 20% of the nation’s population, are struggling to find the care they need, while 20% of the county’s rural population live in counties without any hospitals.
And those problems are growing. At least 25 hospitals closed in 2024, and more than 700 rural hospitals—about a third of all rural hospitals in the U.S.—are in danger of shutting their doors.
“What you’re starting to see is a significant disparity in how healthcare is delivered,” he says. “Cancer mortality rates are 2% in urban communities and 15% in rural communities. Why? Because it takes forever to go get care, and people are choosing just not to get care because it’s a three-hour drive and there’s nothing they can do. Or you have a stroke and you’re three hours away. So you have sick people driving by a critical access hospital trying to get to a big city where the specialists are.”
Intermountain’s strategy isn’t entirely new. The health system has long been recognized for its telemedicine and digital health programs and strategies. But Liljequist notes many of those programs have existed in their own silos, serving certain populations or hospitals; whereas this effort aims at an enterprise-wide platform that connects not only hospitals and other sites within Intermountain, but outside the network as well.
“What if we systemize all of this and create what we call a virtual hospital?” he asks.
The effort started, he says, with a plan to lay down a telemedicine infrastructure to stabilize small, rural, critical-access hospitals, giving them on-demand access to clinicians to help them treat more of their patients rather than sending them on costly and risky transfers to larger hospitals. That network now serves roughly 33 hospitals within Intermountain as well as about 40 outside the health system who contract for telemedicine access.
Liljenquist says the cost to those small hospitals is small, but the service helps them to keep an extra 13% to 18% of their patients. This not only reduces transfer costs but allows the hospital to capture charges and improve care management.
“That’s a big, big deal, and it’s a big deal for patients because they don’t have to travel,” he says. “It’s a big deal for the community because we’re able to bring real-time expertise to the bedside. You oftentimes don’t need immediate surgical care. It’s ‘I need somebody with hands on the ground to do this or that [while being] coached by another doctor who’s a specialist.’”
Liljenquist envisions critical-care access hospitals using this platform to access on-demand specialists from Intermountain, enabling on-site staff to care for patients who would otherwise be transferred to a larger facility. This, in turn, improves the hospital’s census, stabilizing finances and keeping patients in their community, closer to home.
“You're paid on a DRG or on a code based on the complexity of the case and the more complex you can handle locally, the better your reimbursement is,” he notes.
This is especially important, he says, in light of the growing senior population, which will demand care closer to home (not to mention the roughly one-quarter of Intermountain’s doctors and nurses that are Baby Boomers themselves).
Collaboration with key technology and healthcare organizations is important, Liljenquist says, because Intermountain can’t do this alone. A telemedicine platform spanning not only hospitals but health systems needs good digital health tools and a strong EHR to coordinate data storage, analysis and exchange, hence the participation of both Epic and Microsoft.
“The biggest challenge is that our doctors sometimes have 15 different logins to 15 different EHRs to try to do that,” he says.
And with this strategy taking aim not only at the growing senior population but access and equity issues affecting rural communities, both the Gates Foundation and West Health are on board.
“It's not just consolidating programs, systematizing what we do, agreeing on all the technology, but really mapping and making sure that that when we go out and offer these services that we're offering them consistently,” he says.
Liljenquist sees this platform as a model that could be embraced by other large health systems, creating hub-and-spoke telemedicine networks across the country.
“What can we share and what we're hoping is, is that there's interest from other folks who say, ‘Oh, we might be able to do something similar,’” he says. “We might be able to learn. We might be able to create really a unique overlay that helps stabilize rural healthcare nationwide. That's what we're interested in figuring out.”
Aspiring CNOs should take these steps to gain perspective as future leaders, says this CNO.
CNOs play an integral role in nursing.
They act as the voice for nurses in the executive space, advocating for investment in new programs that can better the patient care environment. CNOs carry the entire weight of the nursing workforce, and it's not without challenges.
According to Gay Landstrom, senior vice president and chief nursing officer at Trinity Health, CNOs are critical because they can provide insights for the entire nursing team, since they are responsible for all aspects of nursing care.
"It just makes so much sense that the leader that has responsibility for much of the product that we're producing,” Landstrom said. “That care, that experience for patients and all those caregivers; you want them [CNOs] to be at your executive table so that everyone on the executive team has a deep understanding of the patient and those that care for them each day."
CNOs bring what others can't
If CNOs weren't at the table, Landstrom explained, the C suite would lack valuable perspectives and information.
"There would be so much missing information, so much missing perspective when it comes to setting strategy or determining how to improve operations," Landstrom said. "You would just be missing some of the most vital information about your operation and about the care that you deliver."
CNOs must share their perspectives and insights about nursing, since it's vital to patient care. To Landstrom, however, it's not just about advocating. Listening and seeking understanding opens the door for advocacy.
"For the chief nursing officer to really be a vital and vibrant part of that executive team, they also need to listen," Landstrom said. "They need to hear the perspective of others on the executive team to understand what they're concerned about as well."
Building C suite relationships
Another key aspect of being a part of the C suite is relationship building. CNOs need to become translators, according to Landstrom.
"You absolutely need to build personal relationships with other members of your executive team," Landstrom said, "but it also means that you need to learn enough about strategy to speak strategy language and understand strategy language."
It's critical that CNOs understand all the financial elements of their organizations, including challenges with reimbursement, billing, and revenue cycle. In exchange, CNOs should translate information about clinical matters to non-clinical executives such as CEOs and CFOs.
To communicate better with those executives, Landstrom recommends that CNOs begin with identifying gaps.
"I think it's important to start with what [we're] trying to accomplish," Landstrom said. "Starting with what we agree on needs to be accomplished, and then being really gracious in sharing what you know, and teaching."
Advice for upcoming CNOs
In 2025, many CNOs will be focusing on succession planning and growing the next generation of nurse leaders. According to Landstrom, there are several key things that nurses must learn in preparation to become a CNO.
"An individual does not just arrive in that important role automatically being able to be successful," Landstrom said. "It's important to learn things before you step in that seat and continue learning all throughout your time as a chief nurse."
Landstrom recommends that nurses who want to become CNOs experience other areas of clinical care besides acute care.
"Other services outside of acute care are really growing and I think will continue to grow in the coming years," Landstrom said. "If a CNO's experience is completely in the acute care setting, then they really need to ask for and seek some other learning experiences in other parts of the continuum."
For example, aspiring CNOs should get to know the challenges of home healthcare, palliative care, and senior care, and why those services are important for different populations.
"An aspiring CNO should learn all they can about that, and about payment systems, and what some of the challenges are now and will likely be in the future," Landstrom said. "All of those things are important to learn to gain a really broad perspective and the ability to strategize, [make] improvements, [and innovate] in the care delivery system."
As Gen Z and new technologies arrive simultaneously in the nursing industry, CNOs need to take a hard look at their recruitment strategies.
In the latest edition of HealthLeaders' The Winning Edge webinar series, a panel of nurse leaders discussed best practices for recruiting the best nurses.
The discussion included three key takeaways: how to reboot the nurse recruitment process, the ways Gen Z nurses are changing the face of recruitment, and how CNOs should leverage social media to help new nurses decide where to work.
Supporting your staff in various ways is essential to solving challenges within the workforce, says one health system CEO.
Though healthcare is years removed from the pandemic, the industry's workforce continues to deal with residual effects that place immense pressure on hospital and health system staffs everywhere.
Amy Mansue, president and CEO of Inspira Health, shared with HealthLeaders three critical areas for executives to focus on to strengthen the workforce.
Nuvance Health is partnering with a digital health company to monitor and manage care for patients at home who are dealing with cognitive issues, including dementia. The platform also allows providers to spot early signs of decline.
Many people use brain-stimulating activities, like crossword puzzles or quizzes, to get up to speed in the morning or stay alert during the day. Healthcare providers are now finding that these activities, delivered through a mobile device, can help them monitor and even treat patients at home.
At Nuvance Health, clinicians are integrating Neuroglee Connect into care management for patients at neurology and primary care practices across New York and Connecticut. The digital health interventions are designed for patients with mild cognitive impairment and early-stage dementia.
“I'd like them to take ownership of their healthcare,” says Paul Wright, SVP and system chair of the Neuroscience Institute at Nuvance Health and the John and Joanne Patrick Endowed Chair for Advanced Technology in Neuroscience. “This begins their adoption of [the concept of] ‘This is your body, this is your mind, this is your health, and … being healthy is an active process.’ So I'd like them to be engaged and active.”
Digital health tools are gaining momentum with healthcare organizations thanks to the prevalence of mobile health devices in the home. Paired with remote patient monitoring programs, they offer care providers an easy portal to the patient beyond the regularly scheduled six-month checkups in the doctor’s office. Clinicians can draw patient data from these platforms to monitor health outcomes like medication adherence and effectiveness and moods.
With Neuroglee Connect, Wright is looking for a connection to his patients.
“I want to see that there is engagement,” he says. “That's because if you're not, if you're doing this and you're not engaged, then it's not meaningful.”
Through that engagement, which can include games, education, memory compensation, reminiscence and health and wellness activities, Wright says he can monitor patients’ cognitive abilities, even spotting declines or other concerning trends before either the patients or their caregivers notice any differences.
“We have the capabilities now to predict people who are not going to be doing well,” Wright says.
The platform also includes resources and education for caregivers, including support for managing anxiety and stress. Wright says these platforms not only allow the care team to include friends and family—who often see things before doctors or nurses do—but also give them the support they need.
Describing this technology as a platform isn’t unintentional. Digital health tools are part of a much larger care pathway, and the ability to have patients and caregivers access them at the time and place of their choosing (most often the home) gives providers a platform to manage and coordinate care that goes well beyond one app.
Forward-thinking healthcare leaders are using these platforms to develop remote patient monitoring programs that can track a wide variety of patient data in the home, which in turn can impact care management plans. Based on that data, clinicians can adjust, prescribe or discontinue prescribed medications, add educational or wellness resources, even schedule in-person checkups or specialist consults.
Wright says Neuroglee Connect also allows Nuvance to give its primary care providers more opportunities to care for patients they would otherwise send to specialists, like neurologists. Those specialists are in short supply and high demand, he notes, so the more opportunities to have PCPs handle some of the care, the better.
“We're able to, by going through primary care, deliver care to more people normally who would never have accessed it,” he adds.
There's unpredictability around potential changes to programs and their impact, CEO Sam Hazen told investors.
As the Trump administration settles in, health systems are standing by to see how policy shifts could affect strategies for the rest of the year.
HCA Healthcare CEO Sam Hazen relayed some optimism, but also uncertainty, when asked by investors on a recent earnings call what the organization is anticipating for challenges around supply chain and public insurance programs.
The health system giant released its fourth quarter earnings, which reported $18.3 billion in revenue and $1.4 billion in net income. For comparison, HCA yielded $17.3 billion in revenue and $1.6 billion in net income over the same period in 2023.
The possibility of tariffs could put pressure on organizations' supply chain going forward, but HCA CFO Mike Marks stated that the system "has been working on tariff mitigation strategies for many years," including fixed price contracting, supply chain mapping, and risk assessment.
He noted that about 70% of HCA's supply spend for 2025 is contracted with firm pricing and that the system has diversified away from Chinese suppliers over the years.
"Like you, we are closely monitoring the announcements on tariffs from the new administration, including which countries are targeted, the rate of tariffs being implemented, and potential tariff exclusions for healthcare-related items," Marks said.
Hazen, meanwhile, highlighted the growth in exchange enrollment as a positive sign that the Trump administration will keep it around.
"We believe it's a positive outcome for families. It creates greater access to care. It improves outcomes," Hazen said. "So, all of that is a backdrop we think, politically, is a positive and presents an opportunity for the Trump administration, we believe, to sustain and ensure that families have coverage, they have affordability, and they have the opportunity to achieve positive outcomes for themselves and really for their family. So, we don't have any current insights into where this is going."
However, Hazen stated "it's too early for us to call anything" on the direction the administration will take enhanced Medicaid subsidies.
In terms of Medicaid supplemental payment programs for states, which could be nixed under Trump, HCA is still awaiting payments in Tennessee, with a wide range of estimation affecting 2025 guidance.
"When we consider all the various programs, noting the complexity and the variability and the moving parts, we are projecting and estimating that our net effect of supplemental payment programs will range between flat to 2024 to upwards of a $250 million headwind," Marks said.
